single case of what might be termed cancerophobia which did not exist, either in its current form or in some other type of phobia, prior to the beginning of the program. In those cases which have come to our attention, the receipt of a negative report seemed to decrease the sense, of fear. We strongly suspect, how¬ ever, that such persons promptly transferred their anxiety to some other field. In the light of our experi¬ ence, therefore, we cannot subscribe to the point of view that detection centers create cancerophobia.Relation of Detection Centers to Private Practice.-To some it might appear that the offering of free exami¬ nations to apparently well persons is an invasion of the prerogatives of the private practitioner. Such a pro¬ gram may appear even more menacing when it is recalled that the patient is admitted to the center volun¬ tarily and without the formality of being referred by a physician. As the program has developed, however, the following points have become increasingly clear:(a) The centers serve as demonstrations providing careful and comprehensive examinations for a few persons, and create in that community a demand for periodic physical examinations.(b) The centers have demonstrated that in a large propor¬ tion of presumably well persons there exist a significant number of lesions of early cancer and a high proportion of other impor¬ tant conditions, many of which require prompt medical attention.(c) Treatment is not provided in these centers, and every patient with significant abnormality is referred to a private physician for further study.(d) Instead of diminishing the medical care needs of the community, the program creates demand for medical service which did not previously exist.Cost of the Program.-The cost of discovering a single cancer is frequently advanced as criterion for evaluating a new service of this type. During the fiscal year Sept. 1, 19471, to Aug. 31, 1948 were examined in detection centers at a cost to the cancer society of $29,475.90, or $8.10 per person. The cost to the health department is difficult to determine, because many of the services rendered are incidental to other functions of that agency, but the total is believed to be at least equal to that of the cancer society. This brings the estimated cost to about $16.20 per person. No charge was made to the person examined. During this same period 17 cancers were found in the centers at a cost to the society and the department of approxi¬ mately $3,468 per case. From the point of view of these 17 persons in whom early cancer with a favorable prognosis was detected, the cost undoubtedly would not be considered too high. Whether this expenditure per discovered case is high or low, however, cannot be determined in the absence of figures for comparable programs.If the cost per discovered case were the only criterion of the value of the cancer detection center, the expense involved might be considered excessive or even pro¬ hibitive. It is important to note, however, that there are other tangible benefits, including t...
