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Show :lmFR0M ONE WCELL By Murie L. ficxl fr-j UiiKuli Unit l'r'itleiu Anirririin (lunrer Soc-ii'l Screening costs Mass screening programs are designed to 1) learn something about the people who get particular forms of cancer and 2) to offer low cost tests in an effort to detect cancers earlier and thus prevent cancer deaths. These programs are generally funded by state or federal health agencies or by organizations such as the American Cancer Society. Last week, I discussed the problems of reaching the proper audience. This week I'd like to concentrate on the cost effectiveness of such programs. MOST COMMON TESTS The programs most commonly offered of-fered to the public are those where cancer is easy to detect, primarily cervical, breast, colon-rectum and oral cancer. Lung cancer can be detected on x-rays, but by this time the cure rate is very low. So mass screening with x-rays x-rays is not worthwhile. In 1974, 56 million women had Pap tests, primarily from private physicians. At an average lab fee of $7, these tests cost about $392 million. In that same year, 61,000 cases of cervical cancer were detected. Thus, the average cost of detection was about $6,420. In Canada and England, where most of the cost is covered by the government, govern-ment, annual Pap smears are not recommended for low risk women, In the U.S. the push for annual tests still exists. Of the 56 million women listed above, 87 percent had waited 2 years or less since their previous test. Although I don't have the data to prove it, I suspect that the great majority of the cervical cancer cases were found among the other 13 percent of the women tested. ' At such costs, mass screening for cervical cancer is probably not justified. The available facts about this cancer should be used to limit the participants and possibly increase the effectiveness of these programs. BKK.VST PROGRAMS The costs of the Breast Cancer Detection Demonstration Projects in terms of "needless mastectomies" received much public attention, but costs in dollars have rarely been mentioned. Such programs were used to screen asymptomatic women and included taking medical histories, physical examination and mammography mam-mography at a minimum cost of $25 per participant. Among the 300.000 women who participated 2,500 early breast cancers were discovered. This would mean a minimum cost of about $3000 per cancer detected. One screening program in New York estimated that it cost $50,000 per life saved. Decisions to continue, or expand, such programs will be based only partially on the costs involved, but realistically, it is difficult to place a value on human life THE FUTURE Decisions to fund national programs of mass screening are made by the national board of the ACS. Only recently are these people beginning to consider the cost effectiveness of such programs. Although mass screening programs give a good public image, they might be too costly in the overall battle against cancer. Accurate determinations of the costs and values of such programs are essential. |