Estimating U.S. Cancer Screening and Detection Costs

Research Objective:

Cancer screening guidelines provide information on specific ages to initiate breast, colorectal and prostate cancer screening in the general population. While the clinical trials that inform guidelines provide important evidence on the efficacy of screening methods, observational studies are necessary to understand the impact of guidelines on population screening, and the costs and benefits of screening.

Study Design:

U.S. guidelines specify an age at which screening should begin, implicitly recommending that screening not occur for asymptomatic individuals below that age. Screening guidelines recommend that mammography begin at age 40, colorectal screening begin at age 50, and that prostate screening (PSA test) be offered at age 50. We first estimate compliance with guideline information from the difference in age-specific screening rates just below and above the ages at which clinical guidelines recommend that screening begin. We then perform instrumental variables regression analyses to estimate the effect of guideline induced screening on breast, colorectal and prostate cancer detection.

Results:

Age-specific screening rates from national BRFSS and NHIS survey data indicate that U.S. breast, colorectal and prostate cancer screening rise by 55%, 88% and 29% precisely at the guideline recommend ages. Results from instrumental variables analyses of SEER data indicate substantial effects of screening at the guideline recommended ages on breast and colorectal cancer detection, but no identifiable effect on prostate cancer detection. The results suggest that a 1% point increase in screening at the guideline recommended ages leads to an additional case of breast and colorectal cancers detected per 100,000 individuals. Accounting for the costs of screening and false positives the breast and colorectal cancer screening results suggest that in the real world it costs approximately $100,000 to detect a breast cancer case at age 40 and $100,000 to detect a colorectal cancer case at age 50. The results also indicate a potential for cost savings from reducing the use of the PSA test because increases in prostate cancer screening at the guideline recommended ages do not result in any prostate cancer detection.

Conclusions:

We used an instrumental variables strategy to identify the impact of cancer screening on cancer detection. Estimates from this study suggest that it costs approximately $100,000 to detect cases of breast and colorectal cancers at the guideline recommended ages. The results from this study also suggest costs savings with no negative health effects from reductions in the use of the prostate specific antigen test.