Abstract
We prospectively assessed trends in utilization and costs of diagnostic services of screen-positive women in a biennial breast cancer screening program for women aged 50–75 years. All 2,062 women with suspicious findings at screening mammography in the southern region of the Netherlands between 1 January 2000 and 1 July 2005 (158,997 screens) were included. Data were collected on any diagnostic examinations, interventional procedures, and surgical consultations with two-year follow-up. We used national reimbursement rates to estimate imaging costs and percutaneous biopsy costs. Cost prices, charged by hospitals, were used to estimate open surgical biopsy costs and surgical consultation costs. The largest increase in utilization of diagnostic procedures per 100 referrals was observed for axillary ultrasound (from 3.9 in 2000 to 33.5 in 2005) and for stereotactic core biopsy (from 2.1 in 2000 to 26.8 in 2005). Per 100 referrals, the open surgical biopsy rate decreased from 34.7 (2000) to 4.6 (2005) and the number of outpatient surgical consultations fluctuated between 269.8 (2000) and 309.7 (2004). Mean costs for the diagnosis of one cancer were €1,501 and ranged from €1,223 (2002) to €1,647 (2003). Surgical biopsies comprised 54.1% of total diagnostic costs for women screened in 2000, but decreased to 9.9% for women screened in 2005. Imaging costs increased from 23.7 to 43.8%, percutaneous biopsy costs from 9.9 to 27.2%, and consultation costs from 12.3 to 19.1%. We conclude that diagnostic costs per screen-detected cancer remained fairly stable through the years, although huge changes in the use of different diagnostic procedures were observed.
Similar content being viewed by others
References
Fletcher SW, Elmore JG (2003) Mammographic screening for breast cancer. N Engl J Med 348:1672–1680
Miles A, Cockburn J, Smith RA, Wardle J (2004) A perspective from countries using organized screening programs. Cancer 101:1201–1213
Broeders MJM, Scharpantgen A, Ascunce N, Gairard B, Olsen AH, Mantellini P, Mota TC, Van Limbergen E, Seradour B, Ponti A, Trejo LS, Nystrom L (2005) Comparison of early performance indicators for screening projects within the European Breast Cancer Network: 1989–2000. European Breast Cancer Network Eur J Cancer Prev 14:107–116
Otto SJ, Fracheboud J, Looman CWN, Broeders MJM, Boer R, Hendriks JHCL, Verbeek ALM, de Koning HJ (2003) Initiation of population-based mammography screening in Dutch municipalities and effect on breast-cancer mortality: a systematic review. Lancet 361:1411–1417
Tabar L, Yen MF, Vitak B, Chen HHT, Smith RA, Duffy SW (2003) Mammography service screening and mortality in breast cancer patients: 20-year follow-up before and after introduction of screening. Lancet 361:1405–1410
Berry DA, Cronin KA, Plevritis SK, Fryback DG, Clarke L, Zelen M, Mandelblatt JS, Yakovlev AY, Habbema JDF, Feuer EJ (2005) Effect of screening and adjuvant therapy on mortality from breast cancer. The Cancer Intervention and Surveillance Modeling Network (CISNET) collaborators. N Engl J Med 353:1784–1792
Kauhava L, Immonen-Räihä P, Parvinen I, Helenius H, Kaljonen A, Räsänen O, Pylkkänen L, Klemi PJ (2004) Lower costs of hospital treatment of breast cancer through a population-based mammography screening programme. Eur J Public Health 14:128–133
Kauhava L, Immonen-Räihä P, Parvinen I, Holli K, Kronqvist P, Pylkkänen L, Helenius H, Kaljonen A, Räsänen O, Klemi PJ (2006) Population-based mammography screening results in substantial savings in treatment costs for fatal breast cancer. Breast Cancer Res Treat 98:143–150
Fracheboud J, de Koning HJ, Boer R, Groenewoud JH, Verbeek ALM, Broeders MJM, Van Ineveld M, Hendriks JHCL, De Bruyn AE, Holland R, Van der Maas PJ (2001) National Evaluation Team for Breast cancer screening in the Netherlands (NETB). Nationwide breast cancer screening programme fully implemented in the Netherlands. Breast 10:6–11
Duijm LEM, Groenewoud JH, Hendriks JHCL, de Koning HJ (2004) Independent double reading of screening mammograms in the Netherlands: effect of arbitration following reader disagreements. Radiology 231:564–570
Duijm LEM, Groenewoud JH, Fracheboud J, de Koning HJ (2007) Additional double reading of screening mammograms by radiologic technologists: impact on screening performance parameters. J Natl Cancer Inst 99:1162–1170
Nederlandse zorgautoriteit (2007) ctg.bit-ic.nl/Nzatarieven/top.do. Accessed 21 Nov 2007
UICC (International Union against Cancer) (1987) TNM classification of malignant tumours, 4th edn. Springer-Verlag, Berlin
Brewer NT, Salz T, Lillie SE (2007) Systematic review: the long-term effects of false-positive mammograms. Ann Intern Med 146:502–510
Breast Imaging Reporting and Data System (BI-RADS) (2003) American College of Radiology, 4th edn. American College of Radiology, Reston, VA
Vizcaino I, Gadea L, Andreo L, Salas D, Ruiz-Perales F, Cuevas D, Herranz C, Bueno F, and the Screening Program Working Group (2001) Short-term follow-up results in 795 nonpalpable probably benign lesions detected at screening mammography. Radiology 219:475–483
Yasmeen S, Romano PS, Pettinger M, Chlebowski RT, Robbins JA, Lane DS, Hendrix SL (2003) Frequency and predictive value of a mammographic recommendation for short-interval follow-up. J Natl Cancer Inst 95:429–436
BOBZ annual report 2005 (in Dutch). Hub. Tonnaer bv, Kelpen-Oler
Poplack SP, Carney PA, Weiss JE, Titus-Ernstoff L, Goodrich ME, Tosteson AN (2005) Screening mammography: costs and use of screening-related services. Radiology 234:79–85
Otten JD, Karssemeijer N, Hendriks JHCL, Groenewoud JH, Fracheboud J, Verbeek ALM, de Koning HJ, Holland R (2005) Effect of recall rate on earlier screen detection of breast cancers based on the Dutch performance indicators. J Natl Cancer Inst 97:748–754
Kwaliteitsinstituut voor de Gezondheidszorg CBO, Vereniging van Integrale Kankercentra (2005) Richtlijn Behandeling van het mammacarcinoom. Van Zuiden Communications, Alphen aan den Rijn
Skaane P, Balleyguier C, Diekmann F, Diekmann S, Piguet JC, Young K, Niklason LT (2005) Breast lesion detection and classification: comparison of screen-film mammography and full-field digital mammography with soft-copy reading–observer performance study. Radiology 237:37–44
Pisano EA, Gatsonis C, Hendrick E, Yaffe M, Baum JK, Acharyya S, Conant EF, Fajardo LL, Bassett L, D’Orsi C, Jong R, Rebner M, for the Digital Mammographic Imaging Screening Trial (DMIST) Investigators Group (2005) Diagnostic performance of digital versus film mammography for breast-cancer screening. New Engl J Med 353:1773–1783
Fenton JJ, Taplin SH, Carney PA, Abraham L, Sickles EA, D’Orsi C, Berns EA, Cutter G, Hendrick E, Barlow WE, Elmore JG (2007) Influence of computer-aided detection performance of screening mammography. New Engl J Med 356:1399–1409
Skaane P, Hofvind S, Skjennald A (2007) Randomized trial of screen-film versus full-field digital mammography with soft-copy reading in population-based screening program: follow-up and final results of Oslo II study. Radiology 244:708–717
Duijm LEM, Groenewoud JH, Roumen RMH, de Koning HJ, Plaisier ML, Fracheboud J (2007) A decade of breast cancer screening in The Netherlands: trends in the preoperative diagnosis of breast cancer. Breast Cancer Res Treat 106:113–119
Damera A, Evans AJ, Cornford EJ, Wilson ARM, Burrell HC, James JJ, Pinder SE, Ellis IO, Lee AHS, Macmillan RD (2003) Diagnosis of axillary nodal metastases by ultrasound-guided core biopsy in primary operable breast cancer. Br J Cancer 89:1310–1313
Ciatto S, Brancato B, Risso G, Ambrogetti D, Bulgaresi P, Maddau C, Turco P, Houssami N (2007) Accuracy of fine needle aspiration cytology (FNAC) of axillary lymph nodes as a triage test in breast cancer staging. Breast Cancer Res Treat 103:85–91
Lehman CD, Gatsonis C, Kuhl CK, Hendrick E, Pisano ED, Hanna L, Peacock S, Smazal SF, Maki DD, Julian TB, DePeri ER, Bluemke DA, Schnall MD, for the ACRIN Trial 6667 Investigators Group (2007) MRI evaluation of the contralateral breast in women with recently diagnosed breast cancer. New Engl J Med 356:1295–1303
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Duijm, L.E.M., Groenewoud, J.H., Fracheboud, J. et al. Utilization and cost of diagnostic imaging and biopsies following positive screening mammography in the southern breast cancer screening region of the Netherlands, 2000–2005. Eur Radiol 18, 2390–2397 (2008). https://doi.org/10.1007/s00330-008-1043-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-008-1043-5