Mammographic screening for breast cancer: An invited review of the benefits and costs

Mammographic screening for breast cancer: An invited review of the benefits and costs
Jon M. Greif
The Breast 2010. 19;4:260-267

Link to Journal

Mammographic screening is a proven method for reducing breast cancer mortality for women 40 years of age and older, but the best method for implementation of mammographic screening, particularly in the age group 40–49, remains controversial. The author, in an invited review, summarizes the data and offers guidance based on the best information available for women at risk for breast cancer, and their care providers, with particular emphasis on costs and benefits

Breast cancer is a global public health problem and the reader can decide for him or her self if the costs and benefits outweigh the risks associated with breast health screening programs. Many governments will continue to debate the costs and the pros and cons; however without population based screening, many women will continue to suffer needlessly throughout the world. Thus, I would like to offer the following conclusions based on one surgeon’s analysis of the literature regarding the benefits and costs of mammographic screening for breast cancer:

1. Women invited to participate in a regular program of mammographic screening, beginning at age 40 and continuing annually for as long as a woman is healthy can be expected to have a 19% reduction in breast cancer mortality compared with women not invited to participate in systematic mammographic breast cancer screening. In fact, 75% of all breast cancer deaths occur in the 20% of women not undergoing periodic screening mammography. Breast cancer screening saves lives, and, when considering the monetary costs to society of treating advanced breast cancer, may actually save money.

2. Screening mammography is less than 100% sensitive or 100% specific for detection of breast cancer, and so there will be false negatives and false positives. Following rigorous quality control guidelines will minimize the incidence of false negatives and false positives. Combining annual screening mammography with annual professional clinical breast exams and encouraging women to become familiar with their breasts through monthly breast self exam are likely also to reduce the impact of the falsely negative mammogram, and should be encouraged.

3. It may be desirable to examine alternatives to current screening strategies, but, hopefully, this does not translate into less effective breast cancer screening strategies that aim to simply reduce costs in the future. Improving efficiency in mammographic screening practices may be a successful cost saving strategy that does not sacrifice benefit.

4. The perfect breast cancer screening tool would be 100% sensitive and 100% specific, inexpensive and not harmful. Mammography is not that perfect tool, but, for now, is a very satisfactory and evidence-based procedure which can save lives, and should be made accessible to all women at risk for developing this dreaded disease.

Risk assessment, screening and prevention of breast cancer: A look at cost-effectiveness

Risk assessment, screening and prevention of breast cancer: A look at cost-effectiveness
Gail S. Lebovic, Alan Hollingsworth, Stephen A. Feig
The Breast 2010. 19;4:260-267
Link to Journal

Following consideration of the above review, it is clear that the cost-effectiveness surrounding the many clinical areas as they relate to breast cancer are difficult, if not impossible to fully assess. However, within the literature we begin to see an important framework for the future. This includes the importance of risk assessment for stratification of women of various ages, preventive measures including lifestyle, chemoprevention and surgery, as well as the continued support for the essential component of mammographic screening according to present guidelines. It is these measures taken together as a whole that ultimately will save lives with the most effective, efficient and most cost-effective approach to breast cancer throughout the world