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Use of unproven mammography tool soars with Medicare coverage
Date:6/14/2010

(SACRAMENTO, Calif.) In a study illustrating the potentially powerful influence of political pressure on medical practice, a UC Davis physician-researcher has found that use of a largely unproven mammography screening device has surged since Medicare began covering its cost.

Joshua Fenton, assistant professor in the UC Davis Department of Family and Community Medicine, with colleagues from the University of Washington and University of Minnesota, examined use of computer-aided detection (CAD), a medical device designed to help radiologists interpret mammograms, since Congress mandated that Medicare pay for it 10 years ago.

He found that the prevalence of CAD jumped from 5 percent in 2001 when Medicare began covering it, to 27 percent in 2003, the most recent year for which data was available. Extra mammography fees for CAD use cost Medicare an estimated $19.5 million in 2003 alone. But actual costs are probably greater because the device has been associated with higher recall rates and greater use of diagnostic tests such as breast biopsy.

The increase in computer-aided detection use occurred even though "systemic reviews point to uncertainty regarding whether CAD has a clinically important impact on key breast cancer outcomes," Fenton writes in today's issue of the Archives of Internal Medicine.

The authors explain that Medicare coverage of the device was key to marketing the device to hospitals and health-care facilities, which resulted in intense lobbying of Congress for approval of CAD as a covered benefit.

"This illustrates how industry and government interact to determine the course of health-care practice, and it's not really guided by science," Fenton said. "This is a case in which expensive technology gets widely adopted in clinical practice before it is proven effective."

Computer-aided detection software analyzes the mammogram image and marks suspicious areas for radiologists to review. In a prev
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Contact: Dorsey Griffith
dorsey.griffith@ucdmc.ucdavis.edu
916-734-9118
University of California - Davis - Health System
Source:Eurekalert

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