The price of cancer screening

Abstract

Effectiveness of a screening test is an essential but not adequate criterion for its application to patient care. The potential benefit has to be balanced against the possible harm and cost of screening. This paper presents a framework on how the price can be balanced against the benefit of cancer screening. The principles are illustrated by modelling cervical cancer and breast cancer screening programmes in the setting of Hong Kong. The estimated price for every cervical cancer death prevented by regular smear screening is 1158 women suffering from psychological harm and HK$2,277,900. The estimated price for every breast cancer death prevented by regular mammography screening is 372 women suffering from psychological harm and HK$6,249,600. Breast cancer screening is about three times more costly than cervical cancer screening but it is associated with fewer women suffering from unnecessary psychological stress. The family doctor has a duty to counsel patients on not only the potential benefit but also the cost and possible harm of a cancer screening programme, so that patients can make truly informed choices.