UCSF doc explains what can
be done to fix this

Low-risk patients subject to costly, unnecessary breast imaging, says study

July 23, 2018
by Lauren Dubinsky, Senior Reporter
New research published in JNCCN revealed that many low-risk patients are receiving high-cost breast imaging procedures that are not recommended.

“While the utilization of imaging has plateaued or even declined in recent years for other diagnoses, imaging utilization continues to increase in cancer care,” Dr. Benjamin Franc of UC San Francisco told HCB News. “We wanted to investigate whether this utilization is rational or whether there are areas where we could improve the value patients receive.”

It’s well known that some patients forgo annual mammograms but on the opposite end of the spectrum, some are undergoing unnecessary full-body scans. These scans can cost anywhere from $2,000 to $8,000, which puts a huge burden on patients with high-deductible insurance policies.

The American Society of Clinical Oncology and the National Comprehensive Cancer Network published guidelines that recommend women with non-metastatic breast cancer should receive annual physical exams and mammograms, but not full-body CT, MR, PET or bone scans.

Franc and his team obtained data on 36,045 women between the ages of 18 and 64 who had surgery for cancer in one breast between 2010 and 2012. This data came from the Truven Health MarketScan Commercial Database.

They evaluated the patients over an 18-month period and found that 70.8 percent of women received at least one dedicated breast imaging exam (either a mammogram or MR), which are recommended for this patient population. However, 31.7 percent underwent at least one high-cost imaging procedure and 12.5 percent had at least one PET scan.

The team found no concrete evidence, but they suspect this is due to the differences in common practices among hospitals and physician groups.

Franc explained that there is no single solution for this — the guidelines from medical associations are helpful, but they cannot fit every possible scenario.

“We are currently working directly with physicians and patients to better understand the drivers of under- and over- utilization,” he added. “I suspect that any solution to these issues will include tools or frameworks that improve coordination of care between physician providers, improve access to data across different health systems, and facilitate communication between patients and their doctors.”