Report: U.S. Cancer Screening Is Pricey, But With No Better Outcomes Than Public System

Is more screening worth the money?

A new report comparing cancer screening programs in the U.S. and the Netherlands comes up with this not-so-surprising conclusion: we screen more here — three to four times more in this case — but mortality rates are the same in both countries.

The analysis of cervical cancer screening programs, published in the Milbank Quarterly, makes the health system in the Netherlands look pretty darn rational. Not only does the publicly-run system focus on prevention, but it appears to implement its prevention plan in a way that saves money without undermining care, notably it limits cervical cancer screening to the group at highest risk, women between the ages of 30 and 60.

Here’s are some of the study details from the news release:

The team [led by by Dr. Martin L. Brown from the National Cancer Institute in the United States, alongside colleagues from the Erasmus MC University Medical Center in Rotterdam] focused on cervical cancer screening, which accounts for a small fraction of overall health care spending, but represents broader preventive health services. For comparison the authors carried out a cross-national study of cervical cancer screening intensity and mortality trends in the United States and the Netherlands.

The team used national cancer incidence and mortality data from both the United States and the Netherlands to estimate the number of Pap smears and the cervical cancer mortality rate since 1950. Their results revealed that even though three to four times more Pap smears per woman were conducted in the United States than in the Netherlands over a period of three decades, the two countries’ mortality trends were similar.

Five-year coverage rates for women aged thirty to sixty-four were comparable between the countries at 80 to 90 percent. However, because screening in the Netherlands was limited to ages thirty to sixty, screening rates for women under thirty and over sixty were much higher in the United States.

“The components of the screening service, such as evidence review, monitoring of screening practices and reimbursement policies, were more systematically linked and implemented nationwide in the Netherlands than in the United States, making the service more cost-effective,” said Brown. “To a large extent this was due to the Dutch model of having a public health service, rather than the U.S. medical services model.”

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