1. Breast density notification laws substantially increase costs yet save few lives
Laws requiring women to be notified of their breast density so that they may discuss supplemental screening options, including ultrasound, with their health care providers would substantially increase costs and save relatively few lives, according to an article published in Annals of Internal Medicine . More than 40 percent of women between the ages of 40 and 74 have dense breast tissue, which puts them at increased risk for breast cancer and affects how well a mammogram can detect abnormalities. As such, at least 19 states have enacted breast density notification laws so that women can make informed decisions about supplemental screening. With similar legislation being considered at a national level, researchers sought to determine the benefits, harms, and cost-effectiveness of supplemental ultrasound screening for women with dense breasts. Three validated simulation models predicted that supplemental ultrasound screening after a negative mammogram for women with dense breasts would result in limited health gains and substantially increased expenses. According to model estimates, supplemental screening for women with dense breasts and a negative mammogram would save 0.36 additional breast cancer deaths, gain 1.7 quality adjusted life years (QALYs), and result in 354 false-positive ultrasound biopsy recommendations per 1,000 women with dense breasts compared to biennial screening by mammography alone. The cost-effectiveness ratio was $325,000 per QALY gained, but costs could be improved by restricting supplemental ultrasound screening to women with extremely dense breasts.
Note: The URL for this story will be live when embargo lifts. For a PDF, please contact Megan Hanks. To interview the lead author, please contact Sarah Keblin at sarah.keblin@med.uvm.edu or 802-656-3099.
2. Institute of Medicine 'Dying in America' report sparks discussion and debate
Four commentaries published in Annals of Internal Medicine discuss the recent report from the Institute of Medicine (IOM) titled "Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life." Each commentary offers a different perspective on the topic of end-of-life care.
Annals of Internal Medicine