Spending more does not always mean screening better — and for older women on Medicare, a decade of data reveals a troubling drift toward costlier imaging technologies that may deliver little additional clinical benefit. For health-conscious adults navigating screening decisions after 65, understanding where healthcare dollars actually go matters as much as the screening itself.
Analyzing SEER-Medicare data from 2009 to 2019, this serial cross-sectional study tracked breast cancer screening patterns among roughly 229,000 Medicare fee-for-service women aged 67 and older each year. The most striking finding: digital breast tomosynthesis (DBT), a 3D mammography upgrade, rose from zero use to 70.3% of screened women over the decade — a near-total technology replacement with significant cost implications. Meanwhile, biennial mammography among women 65–79 remained nearly flat (11.2% to 11.9%), and annual mammography held relatively steady around 30–32%. Screening among women 80 and older fell meaningfully, from 19% to 12.9%, a directional change the researchers classified as a reduction in cost-ineffective care. Using published economic analyses rather than guidelines, the authors defined cost-effective screening as biennial mammography under age 80, while annual mammography, DBT additions, screening ultrasound, and any screening at 80-plus were tagged as cost-ineffective.
The central tension this study reveals is one the broader radiology and oncology communities have debated for years: newer imaging technology diffuses rapidly into clinical practice well ahead of robust cost-effectiveness data. DBT offers modestly improved cancer detection and lower recall rates compared to standard 2D mammography, but whether those gains justify the cost premium — particularly in Medicare populations — remains contested. The classification of DBT as cost-ineffective here is not universally accepted and reflects economic thresholds that some clinicians would dispute. This study is observational and cannot assess downstream outcomes like stage at diagnosis or mortality. Nevertheless, the scale — a full decade, nationally representative Medicare data — gives this analysis real weight. The finding that cost-ineffective modalities now dominate screening volumes should prompt both policymakers and clinicians to revisit how new imaging technologies earn routine coverage status.