title: Screening for breast cancer: time, travel, and out-of-pocket expenses.
abstract: BACKGROUND
  We estimated the personal costs to women found to have a breast problem (either breast cancer or benign breast disease) in terms of time spent, miles traveled, and cash payments made for detection, diagnosis, initial treatment, and follow-up.
  
  
  METHODS
  We analyzed data from personal interviews with 465 women from four communities in Florida. These women were randomly selected from those with a recent breast biopsy (within 6-8 months) that indicated either breast cancer (208 women) or benign breast disease (257 women). One community was the site of a multifaceted intervention to promote breast screening, and the other three communities were comparison sites for evaluation of that intervention. All P values are two-sided.
  
  
  RESULTS
  In comparison with time spent and travel distance for women with benign breast disease (13 hours away from home and 56 miles traveled), time spent and travel distance were statistically significantly higher (P<.001) for treatment and follow-up of women with breast cancer (89 hours and 369 miles). Personal financial costs for treatment of women with breast cancer were also statistically significantly higher (breast cancer = $604; benign breast disease = $76; P < .001) but were statistically significantly lower for detection and diagnosis (breast cancer = $170; benign breast disease = $310; P < .001). Among women with breast cancer, time spent for treatment was statistically significantly lower (P = .013) when their breast cancer was detected by screening (68.9 hours) than when it was detected because of symptoms (84.2 hours). Personal cash payments for detection, diagnosis, and treatment were statistically significantly lower among women whose breast problems were detected by screening than among women whose breast problems were detected because of symptoms (screening detected = $453; symptom detected = $749; P = .045).
  
  
  CONCLUSIONS
  There are substantial personal costs for women who are found to have a breast problem, whether the costs are associated with problems identified through screening or because of symptoms.
authors.affiliation: Office of Health Promotion Research, University of Vermont, Burlington, USA. rseckerw@zoo.uvm.edu
authors.forename: R H
authors.initials: RH
authors.lastname: Secker-Walker
authors.forename: P M
authors.initials: PM
authors.lastname: Vacek
authors.forename: G J
authors.initials: GJ
authors.lastname: Hooper
authors.forename: D A
authors.initials: DA
authors.lastname: Plante
authors.forename: A S
authors.initials: AS
authors.lastname: Detsky
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001941:Breast Diseases / Q000191:economics; D001943:Breast Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000628:therapy; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D004180:Direct Service Costs / Q000706:statistics & numerical data*; D005260:Female; D005431:Florida; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D012959:Socioeconomic Factors; D013995:Time; D014195:Travel