Overutilization of Breast Cancer Screening in the US: Awareness of a Growing Problem

Excerpt

Recently, a 72-year-old female patient of mine with stage IV metastatic thyroid cancer came in for a routine visit, accompanied by her daughter. As we began to talk, the patient mentioned that the medical assistant (MA) who roomed her said that she needed a mammogram since she had not been screened in 2 years. Based on my patient’s thyroid cancer and other medical problems, I estimated her life expectancy to be <10 years. I told her that I did not think that she needed a mammogram due to the low likelihood of benefit and because there are risks to being screened. The patient was comfortable not having a mammogram, but her daughter still wanted her to have it done, though she has not yet scheduled the test. Ironically, the MA who recommended the mammogram was doing so in the name of “quality.” Receipt of biennial screening mammograms among women aged 50–74 years is a national quality metric, and my practice receives a financial incentive if nearly all (90%) women aged 50–74 are screened.1 To help achieve this goal, numerous systems are in place in our practice to ensure that as many women as possible are screened, including availability of same-day mammograms and training of MAs to identify and notify patients in need of screening. While these efforts result in more women being screened, they also lead to more screening in women who are unlikely to benefit, or low-value care.2 …