Effectiveness and Outcomes in Health Care Proceedings of an Invitational Conference (1990) / Chapter Skim
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Pages 49-60
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From page 49... ...
PART III The IOM Clinica Workshops Condition
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From page 51... ...
However, existing Medicare data are primarily hospital-based, and HCFA does not yet have good ambulatory data. Evaluating mammography for its effectiveness in breast cancer screening and diagnostic uses, to take another example, will require long-term follow-up data, not simply data on acute care encounters between the patient and a provider.
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Murray, an orthopedic surgeon, examines these and other effectiveness issues related to treating hip fracture. One of the major issues confronted in the clinical workshops was how to make the best use of administrative data bases for effectiveness and outcomes research.
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Currently, the American Cancer Society estimates that 1 in 10 American women will be affected by this devastating and highly emotional disease during her lifetime. Several studies have shown that screening mammography can detect breast cancer at a more favorable stage, resulting in improved prognosis for screened women found to have breast cancer (1-10~.
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, which was found to be a small invasive ductal carcinoma at surgery. She has had no evidence of spread to the axillary lymph nodes or elsewhere in her body in one year of follow-up, and her prognosis is excellent.
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IOM CLINICAL CONDITION WORKSHOPS 55 FIGURE 2 Oblique left mammogram of a 60-year-old woman with bloody nipple discharge and a large, hard, palpable mass behind the nipple. The mammogram demonstrates a 6 centimeter mass, found to be invasive ductal carcinoma with posi tive axillary lymph nodes at surgery.
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From page 56... ...
Exposure to radiation was a serious consideration in previous years (12~; however, mammography equipment and film systems have improved markedly, and the radiation dose from properly performed mammography is so small that radiation exposure is no longer a problem (131. It has been estimated that, for women over age 50, the risk of having yearly mammograms is one-tenth the risk of early death caused by failure to diagnose breast cancer by screening mammography (14~.
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These are major issues in determining the effectiveness of breast cancer screening in this country. Current investigations are studying the reasons women do not go for mammograms and the reasons their physicians do not order them.
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If Medicare pays for screening mammography, it will be a golden opportunity to study utilization and effectiveness of breast cancer screening; however, we must accurately determine and record the reason for the mammography (that is, screening vs. diagnostic examination)
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Selection, Follow-up, and Analysis in the Health Insurance Plan Study: A Randomized Trial with Breast Cancer Screening. NCI Monograph 67:65-74, 1985.
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From page 60... ...
Breast Cancer Screening: All's Well That Ends Well, or Much Ado About Nothing? American Journal of Roentgenology 151: 659-665, 1988.
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