The value of mammography in different ethnic groups in Israel--analysis of mortality reduction and costs using CAN*TROL.
Routine follow-up using screening mammography is currently considered the best method available for the early detection of breast cancer. The potential impact of such an activity is highly dependent on the size of the population suitable for and attending the screening program, and on the basic disease rates in this population. A computer-based model for designing cancer control strategies (CAN*TROL) was used. The screening scenario involved annual mammography of females 50 to 70 years of age in the two major Jewish ethnic groups in Israel. Two outcome parameters were studied: change in mortality rate and costs. Using the same scenario, a greater reduction in mortality rates was achieved in the whole screening period among European-American born females (-20%) than among Asian-African born females (-14.7%). Cost showed different trends over time in the two groups, but totaled about $130,000,000 in each of the screening groups. The total cost of saving one case of death from breast cancer was much less for European-Americans ($316,000) than for Asian-Africans ($1,944,000). These results reflect the higher risk for breast cancer among European-American females as well as the difference in age structure of these two groups. The planning of every screening program should include an effort to estimate the real impact on mortality and the cost-effectiveness in the specific population involved.
Rennert
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Department of Community Medicine, Kupat Holim Klalit, Carmel Hospital, Haifa, Israel.
D000349:Africa / Q000208:ethnology; D000368:Aged; D000569:Americas / Q000208:ethnology; D001208:Asia / Q000208:ethnology; D001943:Breast Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control; D003362:Cost-Benefit Analysis; D003936:Diagnosis, Computer-Assisted; D004812:Epidemiologic Methods; D005006:Ethnicity; D005060:Europe / Q000208:ethnology; D005260:Female; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008327:Mammography / Q000191:economics; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D013997:Time Factors