Association Between False-Positive Results and Return to Screening Mammography in the Breast Cancer Surveillance Consortium Cohort
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Association Between False-Positive Results and Return to Screening Mammography in the Breast Cancer Surveillance Consortium Cohort. Ann Intern Med.2024;177:1297-1307. [Epub 3 September 2024]. doi:10.7326/M24-0123
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Payor mix
One possible factor the authors do not address is the possible copay for diagnostic imaging and procedures. ( e.g. most US health insurances do not entirely cover diagnostic mammograms) The Netherlands in general has a very low copay or none at all for diagnostic imaging and procedures, which would suggest that the reasons for lower rates of screening mammograms for women with false positive results, are not financially driven. For a lot of women the copays involved in the work up, especially after 2 false positive results after screening, start to add up in addition to time needed for scheduling, missed work and income.
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Author Response to Hoekstra
We agree that out-of-pocket costs are a potential contributor to decreased probability of screening re-attendance following a false-positive result. We include the following in the discussion section: "Another potential contributor to discontinued screening may be financial concerns. Screening services are fully covered by most health plans under the Affordable Care Act;42 however, diagnostic imaging and biopsies typically incur out-pocket costs, which could dissuade future screening. (43-45) To address this issue, Washington State enacted legislation, effective January 1, 2024, mandating that health insurance plans cover diagnostic breast imaging examinations without any cost sharing by patients. (46)" We also mention financial and opportunity costs in the introduction: "However, screening mammography is also associated with potential harms including false-positive results that lead to additional imaging and biopsies, associated financial and opportunity costs, and patient anxiety.(1-6)"