Skip to main content
PMC home page
British Journal of Cancer logoLink to British Journal of Cancer
. 1999 Mar;79(9-10):1428–1436. doi: 10.1038/sj.bjc.6690228

Diagnostic and therapeutic approaches for nonmetastatic breast cancer in Canada, and their associated costs

B P Will 1, C Le Petit 1, J-M Berthelot 1, E M Tomiak 1, S Verma 2, W K Evans 2
PMCID: PMC2362729  PMID: 10188886

Abstract

In an era of fiscal restraint, it is important to evaluate the resources required to diagnose and treat serious illnesses. As breast cancer is the major malignancy affecting Canadian women, Statistics Canada has analysed the resources required to manage this disease in Canada, and the associated costs. Here we report the cost of initial diagnosis and treatment of nonmetastatic breast cancer, including adjuvant therapies. Treatment algorithms for Stages I, II, and III of the disease were derived by age group (< 50 or ≥ 50 years old), principally from Canadian cancer registry data, supplemented, where necessary, by the results of surveys of Canadian oncologists. Data were obtained on breast cancer incidence by age, diagnostic work-up, stage at diagnosis, initial treatment, follow-up practice, duration of hospitalization and direct care costs. The direct health care costs associated with ‘standard’ diagnostic and therapeutic approaches were calculated for a cohort of 17 700 Canadian women diagnosed in 1995. Early stage (Stages I and II) breast cancer represented 87% of all incident cases, with 77% of cases occurring in women ≥ 50 years. Variations were noted in the rate of partial vs total mastectomy, according to stage and age group. Direct costs for diagnosis and initial treatment ranged from $8014 for Stage II women ≥ 50 years old, to $10 897 for Stage III women < 50 years old. Except for Stage III women < 50 years old, the largest expenditure was for hospitalization for surgery, followed by radiotherapy costs. Chemotherapy was the largest cost component for Stage III women < 50 years old. This report describes the cost of diagnosis and initial treatment of nonmetastatic breast cancer in Canada, assuming current practice patterns. A second report will describe the lifetime costs of treating all stages of breast cancer. These data will then be incorporated into Statistics Canada's Population Health Model (POHEM) to perform cost-effectiveness studies of new therapeutic interventions for breast cancer, such as the cost-effectiveness of day surgery, or of radiotherapy to all breast cancer patients undergoing breast surgery. © 1999 Cancer Research Campaign

Keywords: breast cancer, cost, microsimulation model

Full Text

The Full Text of this article is available as a PDF (120.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Baker M. S., Kessler L. G., Urban N., Smucker R. C. Estimating the treatment costs of breast and lung cancer. Med Care. 1991 Jan;29(1):40–49. doi: 10.1097/00005650-199101000-00004. [DOI] [PubMed] [Google Scholar]
  2. Cady B. Cost-effective preoperative evaluation, operative treatment, and postoperative follow-up in the breast cancer patient. Surg Clin North Am. 1996 Feb;76(1):25–34. doi: 10.1016/s0039-6109(05)70419-9. [DOI] [PubMed] [Google Scholar]
  3. Cady B., Stone M. D. Selection of breast-preservation therapy for primary invasive breast carcinoma. Surg Clin North Am. 1990 Oct;70(5):1047–1059. doi: 10.1016/s0039-6109(16)45229-1. [DOI] [PubMed] [Google Scholar]
  4. Capri S., Majno E., Mauri M. The cost of hospital stay for operable breast cancer. Tumori. 1992 Dec 31;78(6):359–362. doi: 10.1177/030089169207800601. [DOI] [PubMed] [Google Scholar]
  5. Delouche G., Bachelot F., Premont M., Kurtz J. M. Conservation treatment of early breast cancer: long term results and complications. Int J Radiat Oncol Biol Phys. 1987 Jan;13(1):29–34. doi: 10.1016/0360-3016(87)90256-2. [DOI] [PubMed] [Google Scholar]
  6. Evans W. K. An estimate of the cost effectiveness of gemcitabine in stage IV non-small cell lung cancer. Semin Oncol. 1996 Oct;23(5 Suppl 10):82–89. [PubMed] [Google Scholar]
  7. Evans W. K., Le Chevalier T. The cost-effectiveness of navelbine alone or in combination with cisplatin in comparison to other chemotherapy regimens and best supportive care in stage IV non-small cell lung cancer. Eur J Cancer. 1996 Dec;32A(13):2249–2255. doi: 10.1016/s0959-8049(96)00298-5. [DOI] [PubMed] [Google Scholar]
  8. Evans W. K., Will B. P., Berthelot J. M., Wolfson M. C. Diagnostic and therapeutic approaches to lung cancer in Canada and their costs. Br J Cancer. 1995 Nov;72(5):1270–1277. doi: 10.1038/bjc.1995.499. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Evans W. K., Will B. P., Berthelot J. M., Wolfson M. C. Estimating the cost of lung cancer diagnosis and treatment in Canada: the POHEM model. Can J Oncol. 1995 Dec;5(4):408–419. [PubMed] [Google Scholar]
  10. Evans W. K., Will B. P., Berthelot J. M., Wolfson M. C. The economics of lung cancer management in Canada. Lung Cancer. 1996 Feb;14(1):19–29. doi: 10.1016/0169-5002(95)00510-2. [DOI] [PubMed] [Google Scholar]
  11. Farrow D. C., Hunt W. C., Samet J. M. Geographic variation in the treatment of localized breast cancer. N Engl J Med. 1992 Apr 23;326(17):1097–1101. doi: 10.1056/NEJM199204233261701. [DOI] [PubMed] [Google Scholar]
  12. Ferguson C. M., Feinstein A. C., Pendergrast W. J. Determinants of primary therapy of early stage breast cancer. J Med Assoc Ga. 1990 Jun;79(6):351–354. [PubMed] [Google Scholar]
  13. Ganz P. A. Treatment options for breast cancer--beyond survival. N Engl J Med. 1992 Apr 23;326(17):1147–1149. doi: 10.1056/NEJM199204233261708. [DOI] [PubMed] [Google Scholar]
  14. Hillner B. E. Economic and cost-effectiveness issues in breast cancer treatment. Semin Oncol. 1996 Feb;23(1 Suppl 2):98–104. [PubMed] [Google Scholar]
  15. Hillner B. E. Financial costs, benefits, and patient risk preferences in node-negative breast cancer: insights from a decision analysis model. Recent Results Cancer Res. 1993;127:277–284. doi: 10.1007/978-3-642-84745-5_36. [DOI] [PubMed] [Google Scholar]
  16. Howe HL, Johnson TP, Lehnherr M, Warnecke RB, Katterhagen JG, Ford L. Patterns of Breast Cancer Treatment: A Comparison of a Rural Population With an Urban Population and a Community Clinical Oncology Program Sample. Cancer Control. 1995 Mar;2(2):113–120. [PubMed] [Google Scholar]
  17. Iscoe N. A., Goel V., Wu K., Fehringer G., Holowaty E. J., Naylor C. D. Variation in breast cancer surgery in Ontario. CMAJ. 1994 Feb 1;150(3):345–352. [PMC free article] [PubMed] [Google Scholar]
  18. Jaakkimainen L., Goodwin P. J., Pater J., Warde P., Murray N., Rapp E. Counting the costs of chemotherapy in a National Cancer Institute of Canada randomized trial in nonsmall-cell lung cancer. J Clin Oncol. 1990 Aug;8(8):1301–1309. doi: 10.1200/JCO.1990.8.8.1301. [DOI] [PubMed] [Google Scholar]
  19. Kiebert G. M., de Haes J. C., van de Velde C. J. The impact of breast-conserving treatment and mastectomy on the quality of life of early-stage breast cancer patients: a review. J Clin Oncol. 1991 Jun;9(6):1059–1070. doi: 10.1200/JCO.1991.9.6.1059. [DOI] [PubMed] [Google Scholar]
  20. Long D. S. How breast cancer patients choose a treatment method. Radiol Technol. 1993 Sep-Oct;65(1):30–33. [PubMed] [Google Scholar]
  21. Margolese R. G. 1994 Roussel Lecture: a biologic basis for changes in breast cancer management. Can J Surg. 1995 Oct;38(5):402–408. [PubMed] [Google Scholar]
  22. McManus S. A., Topp D. A., Hopkins C. Advantages of outpatient breast surgery. Am Surg. 1994 Dec;60(12):967–970. [PubMed] [Google Scholar]
  23. McPhee S. J., Richard R. J., Solkowitz S. N. Performance of cancer screening in a university general internal medicine practice: comparison with the 1980 American Cancer Society Guidelines. J Gen Intern Med. 1986 Sep-Oct;1(5):275–281. doi: 10.1007/BF02596202. [DOI] [PubMed] [Google Scholar]
  24. Riley G. F., Potosky A. L., Lubitz J. D., Kessler L. G. Medicare payments from diagnosis to death for elderly cancer patients by stage at diagnosis. Med Care. 1995 Aug;33(8):828–841. doi: 10.1097/00005650-199508000-00007. [DOI] [PubMed] [Google Scholar]
  25. Satariano E. R., Swanson G. M., Moll P. P. Nonclinical factors associated with surgery received for treatment of early-stage breast cancer. Am J Public Health. 1992 Feb;82(2):195–198. doi: 10.2105/ajph.82.2.195. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Satariano W. A. Comorbidity and functional status in older women with breast cancer: implications for screening, treatment, and prognosis. J Gerontol. 1992 Nov;47(Spec No):24–31. [PubMed] [Google Scholar]
  27. Sawka C. A., O'Connor A. M., Llewellyn-Thomas H. A., To T., Pinfold S. P., Harrison-Woermke D. Appropriateness of adjuvant systemic therapy for axillary node-negative breast cancer: a physician opinion survey. J Clin Oncol. 1995 Jun;13(6):1459–1469. doi: 10.1200/JCO.1995.13.6.1459. [DOI] [PubMed] [Google Scholar]
  28. Silliman R. A., Guadagnoli E., Weitberg A. B., Mor V. Age as a predictor of diagnostic and initial treatment intensity in newly diagnosed breast cancer patients. J Gerontol. 1989 Mar;44(2):M46–M50. doi: 10.1093/geronj/44.2.m46. [DOI] [PubMed] [Google Scholar]
  29. Stommel M., Given C. W., Given B. A. The cost of cancer home care to families. Cancer. 1993 Mar 1;71(5):1867–1874. doi: 10.1002/1097-0142(19930301)71:5<1867::aid-cncr2820710525>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
  30. Tabár L., Fagerberg G., Day N. E., Duffy S. W., Kitchin R. M. Breast cancer treatment and natural history: new insights from results of screening. Lancet. 1992 Feb 15;339(8790):412–414. doi: 10.1016/0140-6736(92)90090-p. [DOI] [PubMed] [Google Scholar]
  31. Taplin S. H., Barlow W., Urban N., Mandelson M. T., Timlin D. J., Ichikawa L., Nefcy P. Stage, age, comorbidity, and direct costs of colon, prostate, and breast cancer care. J Natl Cancer Inst. 1995 Mar 15;87(6):417–426. doi: 10.1093/jnci/87.6.417. [DOI] [PubMed] [Google Scholar]
  32. Tomiak E. M., Diverty B., Verma S., Evans W. K., Le Petit C., Will P., Berthelot J. M. Follow-up practices for patients with early stage breast cancer: a survey of Canadian oncologists. Cancer Prev Control. 1998 Apr;2(2):63–71. [PubMed] [Google Scholar]
  33. Will B. P., Berthelot J. M., Houle C., Verma S., Tomiak E., Evans W. K. A model for estimating the costs and burdens of breast cancer diagnosis and treatment in Canada. Health Rep. 1993;5(4):399–408. [PubMed] [Google Scholar]
  34. Wodinsky H. B., Jenkin R. D. The cost of radiation treatment at an Ontario regional cancer centre. CMAJ. 1987 Nov 15;137(10):906–909. [PMC free article] [PubMed] [Google Scholar]
  35. Wolfson M. C. POHEM--a framework for understanding and modelling the health of human populations. World Health Stat Q. 1994;47(3-4):157–176. [PubMed] [Google Scholar]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK

RESOURCES