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The Dilemma of Digital Mammography
Trudy Lieberman | February 7, 2011
The rapid changeover from traditional mammography'pictures taken with film'to the new digital imaging technology poses a thorny dilemma for women, especially those over 65.' The scientific evidence suggests that digital mammography does not improve the detection of breast cancer in older women.' ' The results of a five-year clinical trial sponsored by the National Cancer Institute and released a few years ago found that the new machines detect no more cancers in older women than film mammograms.
The marketplace reality, though, is that older women who want the old-fashioned technology can hardly find radiologists who still use it.' ' Eight years ago, 96 percent of all mammograms were done with garden-variety film; three years ago 47 percent were.' That number continues to drop.' 'Over time, film mammography will cease to exist,' said Anna Tosteson, the lead researcher on the NCI study, told the Center for Public Integrity, which published a fine story about the marketing of digital mammography that should be required reading for women.' 'One thing that's certain'there is no evidence that one should pay a premium for digital mammography,' Tosteson said.
The Center's investigation showed how clever marketing, public relations, and campaign contributions by imaging machine makers have so far triumphed over science, and succeeded in raising the price of mammography.' That, of course, boosts the national health care tab.' Medicare pays the bills for women 65 and older, reimbursing doctors $78 for film mammograms and $129 for digital ones.' ' So it's not hard to see why film mammograms are buggy whips of the 21st century.' It doesn't matter that Medicare beneficiaries don't benefit much from digital technology.' There's big money to be made from using it.
So what's a consumer to do?' I recently faced that dilemma when I phoned the radiology practice I like to use for my yearly mammograms.' It provides patient-centered care for a procedure that ties me in a pretzel for days before the test.' Over the years I have valued their consistent kindness and access to trusted and quick results.' So even though this practice doesn't take my insurance, I pay out of pocket.' ' That's my choice.'
Recently, I phoned for my annual appointment and learned that a mammogram would now cost $400, a 60-percent increase over what I last paid.' ' 'We've gone digital,' the receptionist said. That put me in a quandary.' I knew what the evidence suggested.' Digital mammography was not cost effective and probably wasn't worth the higher price tag.' I could call all over New York City trying to 'shop' for a practice that not only uses old-school film but also accepts my insurance' If I found one, I might not like how its doctors treated their patients.' That would stress me even more.' In the end, I stayed with what I knew, liked, and trusted.' The heck with the money.
So how can you be an informed consumer and affect the health care marketplace?' You can't, despite what those advocating a market approach to medical care promote.' The rapid diffusion of digital mammography into common medical practice shows just how powerless patients are likely to be at slowing escalating costs and determining the delivery of care in America. ' My little tale is another example of why health care is not like cell phones.
More Blog Posts by Trudy Lieberman
Trudy Lieberman, a journalist for more than 40 years, is an adjunct associate professor of public health at Hunter College in New York City. She had a long career at Consumer Reports specializing in insurance, health care, health care financing and long-term care. She is a longtime contributor to the Columbia Journalism Review and blogs for its website, CJR.org, about media coverage of health care, Social Security and retirement. As a William Ziff Fellow at the Center for Advancing Health, she contributes regularly to the Prepared Patient Blog. Follow her on twitter @Trudy_Lieberman.
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February 7, 2011 at 11:39 PM
Medicare uses reimbursement to encourage the use of certain procedures. If Medicare is paying more for digital mammography, the government, despite clinical trials showing equivalence in this age group, favors this procedure. In addition, there is probably benefit to having digital mammograms both for the sake of compatibility with the trend for all radiologic imaging to be created, stored, and transmitted digitally, and to avoid the obsolescence of plain film storage that will inevitably occur. In addition, if you are not a Medicare patient, then you could be considered a younger woman for whom digital mammography is beneficial. Anecdotally, in some instances, there will be some Medicare age women who benefit from digital mammography, even though statistically this is not born out for the entire cohort.
Further, as always occurs, the cost of new technologies will over time decrease making the procedure more and more affordable. In addition, digitalization may allow for the automation of reading of mammograms by computers, leading to decreased cost, hopefully with the same or perhaps better sensitivity and reliability.
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