Abstract
STUDY OBJECTIVE--To compare the costs and effects of routine mammography screening by a single mediolateral-oblique view and two views (mediolateral-oblique plus craniocaudal) of each breast. DESIGN--A cost effectiveness analysis of a prospective non-randomised trial comparing one and two view mammography screening was carried out at St Margaret's Hospital, Epping. All women in the study had two view mammography. The mediolateral-oblique view was always the first image read by the radiologist. After reading the films for a clinic session, the same radiologist then went back and read both the mediolateral-oblique and craniocaudal views together. Each set of films was read by two radiologists. The main outcome measures were recall rates, number of cancers detected, screening and assessment costs, and cost effectiveness ratios. SUBJECTS--A total of 26,430 women who attended for breast screening using both one and two view mammography participated. A sample of 132 women attending for assessment provided data on the private costs incurred in attending for assessment. RESULTS--There was a reduction in the recall rate from 9.1% (2404 of 26,430) after one view screening to 6.7% (1760 of 26,430) after two view screening. The results also suggest that for every 10,000 women screened an additional five cancers would be detected earlier with two view screening. The additional health service screening cost associated with two view screening was estimated to be 3.63 pounds: the costs associated with one and two view screening policies were estimated to be 41.49 pounds and 32.99 pounds respectively. Private costs incurred were estimated to be 0.35 pounds per woman screened and 32.75 pounds per woman assessed. Two cost effectiveness ratios were calculated: an incremental health service cost per additional cancer detected of 4129 pounds and an incremental health service plus private cost per additional cancer detected of 2742 pounds. The sensitivity analysis suggested that the results were sensitive to relatively large changes in a number of parameters. These included screening costs, assessment costs, equipment life, and recall rates. CONCLUSIONS--Use of two view screening increased early cancer detection and also costs. The reduction in the recall rate with two views was not sufficiently large to make the cost of two view screening neutral. While these results are not completely generalisable, a framework is provided to allow other centres to estimate the cost effectiveness of two view screening in their locality.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bull A. R., Campbell M. J. Assessment of the psychological impact of a breast screening programme. Br J Radiol. 1991 Jun;64(762):510–515. doi: 10.1259/0007-1285-64-762-510. [DOI] [PubMed] [Google Scholar]
- Chamberlain J., Moss S. M., Kirkpatrick A. E., Michell M., Johns L. National Health Service breast screening programme results for 1991-2. BMJ. 1993 Aug 7;307(6900):353–356. doi: 10.1136/bmj.307.6900.353. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cockburn J., Staples M., Hurley S. F., De Luise T. Psychological consequences of screening mammography. J Med Screen. 1994 Jan;1(1):7–12. doi: 10.1177/096914139400100104. [DOI] [PubMed] [Google Scholar]
- Ellman R., Angeli N., Christians A., Moss S., Chamberlain J., Maguire P. Psychiatric morbidity associated with screening for breast cancer. Br J Cancer. 1989 Nov;60(5):781–784. doi: 10.1038/bjc.1989.359. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gram I. T., Lund E., Slenker S. E. Quality of life following a false positive mammogram. Br J Cancer. 1990 Dec;62(6):1018–1022. doi: 10.1038/bjc.1990.430. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lerman C., Trock B., Rimer B. K., Boyce A., Jepson C., Engstrom P. F. Psychological and behavioral implications of abnormal mammograms. Ann Intern Med. 1991 Apr 15;114(8):657–661. doi: 10.7326/0003-4819-114-8-657. [DOI] [PubMed] [Google Scholar]
- Valentin J., Leitz W. Mass screening for breast cancer: benefits, risks, costs. Med Oncol Tumor Pharmacother. 1988;5(2):77–83. doi: 10.1007/BF02985442. [DOI] [PubMed] [Google Scholar]
- Whynes D. K., Walker A. R., Hardcastle J. D. Cost-effective screening strategies for colorectal cancer. J Public Health Med. 1992 Mar;14(1):43–49. [PubMed] [Google Scholar]
- van Dijck J. A., Verbeek A. L., Hendriks J. H., Holland R. One-view versus two-view mammography in baseline screening for breast cancer: a review. Br J Radiol. 1992 Nov;65(779):971–976. doi: 10.1259/0007-1285-65-779-971. [DOI] [PubMed] [Google Scholar]