JAMA Int Med：昂贵的乳腺癌筛查技术或并不能使女性个体从中获益

近日，刊登在国际杂志JAMA Internal Medicine上的一篇研究报告中，来自耶鲁大学医学院的研究者表示，尽管医疗保险每年在乳腺癌筛查中花费了将近10亿美金，比如进行乳房x线摄影术等，但是并没有证据显示，高额的花费会给乳腺癌患者带来福利或者对患者受益。

这项研究中研究者旨在帮助大众理解乳腺癌扫描筛查、相关疗法以及乳腺癌的花费开支等情况，研究者对2006年之前没有患上乳腺癌的137，274名女性进行乳腺癌筛查和相应疗法的开销进行了评估计算，并且对这些参与者进行两年时间的跟踪调查，来掌握其乳腺癌筛查、乳腺癌发病率及其相关的开支情况。

研究小组发现，因地理区域的不同，乳腺癌筛查所花费的钱在每位40美元到110美元不等，差别主要取决于筛查技术的差异。研究者Gross说，尽管乳腺癌筛查因不同地理区域变化在两倍以上，但是并没有证据揭示高额的花费对于高花费地区妇女的生活质量或者生存质量有明显改善。

目前并没有充足的证据揭示，对于75岁以上妇女来说，乳腺癌筛查是否有效，而且研究者也发现在这个年龄段的妇女中，每年进行筛查所花费的金钱为4亿美元。

研究者需要进行深入分析研究来揭示妇女是否可以从筛查中获益，并且确定乳腺癌筛查是否的确有效，在某些案例中，乳腺癌筛查技术可以挽救个人的生命，但是并没有人会愿意接受一种不能使其获益，反而对机体产生有害影响的技术，相关研究由国立癌症中心等机构提供资助。

doi:10.1001/jamainternmed.2013.1397
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The Cost of Breast Cancer Screening in the Medicare Population

Cary P. Gross, MD; Jessica B. Long, MPH; Joseph S. Ross, MD, MHS; Maysa M. Abu-Khalaf, MD; Rong Wang, PhD; Brigid K. Killelea, MD, MPH; Heather T. Gold, PhD; Anees B. Chagpar, MD, MA, MPH, MSc; Xiaomei Ma, PhD

Background Little is known about the cost to Medicare of breast cancer screening or whether regional-level screening expenditures are associated with cancer stage at diagnosis or treatment costs, particularly because newer breast cancer screening technologies, like digital mammography and computer-aided detection (CAD), have diffused into the care of older women. Methods Using the linked Surveillance, Epidemiology, and End Results–Medicare database, we identified 137 274 women ages 66 to 100 years who had not had breast cancer and assessed the cost to fee-for-service Medicare of breast cancer screening and workup during 2006 to 2007. For women who developed cancer, we calculated initial treatment cost. We then assessed screening-related cost at the Hospital Referral Region (HRR) level and evaluated the association between regional expenditures and workup test utilization, cancer incidence, and treatment costs. Results In the United States, the annual costs to fee-for-service Medicare for breast cancer screening-related procedures (comprising screening plus workup) and treatment expenditures were $1.08 billion and $1.36 billion, respectively. For women 75 years or older, annual screening-related expenditures exceeded $410 million. Age-standardized screening-related cost per beneficiary varied more than 2-fold across regions (from $42 to $107 per beneficiary); digital screening mammography and CAD accounted for 65% of the difference in screening-related cost between HRRs in the highest and lowest quartiles of cost. Women residing in HRRs with high screening costs were more likely to be diagnosed as having early-stage cancer (incidence rate ratio, 1.78 [95% CI, 1.40-2.26]). There was no significant difference in the cost of initial cancer treatment per beneficiary between the highest and lowest screening cost HRRs ($151 vs $115; P = .20). Conclusions The cost to Medicare of breast cancer screening exceeds $1 billion annually in the fee-for-service program. Regional variation is substantial and driven by the use of newer and more expensive technologies; it is unclear whether higher screening expenditures are achieving better breast cancer outcomes.