An actuarial analysis of breast cancer screening and follow-on diagnostics in a commercially insured population

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By Ellynne Dec, Jonah Broulette, Kathryn V. Fitch, Tyler Engel | 24 February 2014

The Affordable Care Act (ACA) has defined breast cancer screening as an essential health benefit and has eliminated patient cost sharing for breast cancer screening. The ACA’s elimination of cost sharing is expected to lead to higher patient adherence to breast cancer screening. Increased adherence to breast cancer screening will result in increased follow-on diagnostics, which are the topic of this study. Follow-on diagnostics are performed after screening mammograms that have suspicious findings. The vast majority of follow-on diagnostics rule cancer out.

Our findings of higher follow-on diagnostic rates, variation in patterns of follow-on diagnostics, higher breast biopsy rates, and higher false positive biopsy rates compared to Breast Cancer Surveillance Consortium (BCSC) rates, highlights the need for payers/employers to evaluate the quality and value of breast cancer screening follow-on diagnostic patterns.