How Congress puts women at risk while wasting millions of dollars

CAD? We’ve Been Had!

What would you do with $136 million?

Secure your family’s financial future? Donate to your favorite charity? Buy an airplane? Or maybe an airline?

Here’s what Congress did with $136 million in tax dollars: They set it on fire on the Capital steps.

Poof–gone!

Congress didn’t really do that. But they might as well have. If they had, they would have at least wasted all that money without hurting anyone.

Here’s what they actually did: In 2000, Congress decided that Medicare should pay for the use of computer-aided detection (CAD)–a tool that helps doctors analyze mammograms.

And here’s what they should have done: Someone in Congress ought to have made very sure this “tool” they were unleashing on female Medicare patients was going to do more good than harm.

You can see this one coming a mile away

Several years after Congress gave CAD the green light, there were still no large-scale reviews conducted to determine how well the technology was working. So in 2007, researchers at the University of California, Davis, tracked the outcomes of more than 400,000 mammograms–some used CAD and some didn’t.

UCD results:

In cases where CAD was used, over 30 percent more women were called back for additional tests compared to non-CAD use
Twenty percent more biopsies were conducted based on CAD results
CAD use did not improve early breast cancer detection

In the New England Journal of Medicine the UCD team concluded: “The use of computer-aided detection is associated with reduced accuracy of interpretation of screening mammograms.”

REDUCED accuracy! That’s one mighty impressive technology Congress saddled us with!

The UCD team didn’t end their CAD research with their 2007 study.

Recently, they collected Medicare data and found that CAD was used in 5 percent of mammograms in 2001 (the first year Medicare covered it). But just two years later, more than 25 percent of mammograms were analyzed with CAD. In that year, the extra mammography fees directly linked to CAD use topped $19 million. (2003 was the last year this data was available.)

And that’s how I came up with the $136 million estimate, which I’m sure is low. The actual cost to taxpayers is certainly quite a bit higher.

But it’s the patients, not taxpayers, who are really hurting.

One of the biggest drawbacks of mammography is the high rate of false positives. In addition, many harmless tumors, which would otherwise go undetected, are often treated as life threatening, prompting unnecessary biopsies, surgeries, chemotherapy, and radiation treatments, which can lead to other medical issues and even secondary cancers.

Clearly, CAD just made this situation worse.

However you feel about government’s role in health care, it’s hard to look at this simple blunder and not have misgivings about bureaucrats making decisions that affect our health. Either someone dropped the ball, or someone made a sweet backroom deal.

Either way, many women on Medicare ended up with more harm than good.

To Your Good Health,

Jenny Thompson

Sources:
“Influence of Computer-Aided Detection on Performance of Screening Mammography” New England Journal of Medicine, Vol. 356, No. 14, 4/5/07, content.nejm.org
“Diffusion of Computer-Aided Mammography After Mandated Medicare Coverage” Archives of Internal Medicine, Vol. 170, No. 11, 6/14/10, archinte.ama-assn.org
“Use of Unproven Mammography Tool Soars with Medicare” Ivanhoe Newswire, 6/16/10, ivanhoe.com