A Note on the Cost-Benefit Problem in Screening for Breast Cancer

Abstract

The strategy of early recognition and treatment of breast cancer by mass screening, practised and discussed for a number of years, is a diagnostic method whose evaluation still encounters considerable difficulties. These derive mainly from problems in the interpretation of success statistics, survival rates for a number of women, identified as »cases« who had volunteered for, or refused breast screening, or were kept as controls. With a series of biometrical arguments and very crude cost estimates, the author gets the impression that survival results would justify the increased costs that might result from mass screening.

Economic approaches to alternative patterns of health care.

“…Indeed, sometimes the final definition of the objective may be dependent on the costeffectiveness study itself. For example, different screening techniques may result in different rates of false positives and some assessment of the 48 importance of these varying rates may be required (Kodlin, 1972).…”

“…The economist would tend to be suspicious about objective (i), to achieve the lowest screening cost per woman screened, because of the omission of certain costs which would arise as a result of screening and because of the lack of homogeneity of the 'output' as stated (Dickinson et al, 1972;Kodlin, 1972).…”

Economic evaluation of health care: a survey.

“…In a review of the literature, Pole (1972) considers a number of screening processes, including a search for bacteruria where he finds a rough balance between the costs of treating and screening, and breast cancer where costs of treatment seem likely to be small in comparison with the cost of finding the cases. Kodlin (1972) provides an elegant framework in which to consider screening for breast cancer, in which he divides the cases into the number of true/false positives and true/false negatives and adds up costs in each cell after weighting them with the probable frequencies.…”