Costs of screening for breast cancer.

A cost-benefit analysis clearly shows that the costs for screening a large population of asymptomatic women are well within the cost-benefit range that is accepted for other areas within the medical care system. If profit and loss were the only considerations, one would opt for screening with combined examination for all women age 40 and older. If medical and philosophical considerations were to be included in the equation, clinical examination alone at any age cannot be justified. However, one might be able to justify mammography screening. Bierman has stated, "ultimately, when the scent is of flesh rather than figures, even the economist concedes that it will be important to insulate the individual practitioner (from cost-benefit/cost-effectiveness analysis) on a day-to-day basis because of potential conflict with the commitment to do what is best for each patient. Here is the crux. The economist's reference to the 'nation's health' is at best ambiguous and more likely meaningless. The physician's commitment to the patient's health is neither of these: it is clear, undeniable, and profoundly meaningful." Reduction in cancer deaths is not easy to come by. When a method is available that can achieve this result, every effort should be made to make it available until it can be replaced satisfactorily by a less expensive, equally effective modality.