Screening for metastatic disease in newly diagnosed breast cancer patients. What is cost-effective?
BACKGROUND
Significant health care resources are today spent on diagnosing and treatment of early breast cancer.


METHODS
98 consecutive patients referred to our oncological unit between January 1997 and June 1998 underwent an evaluation programme including thoracic X-ray, liver and bone scan and blood test. When findings suspected for metastatic disease were revealed, further examinations (CT-scan, MRI) were performed.


RESULTS
Whereas the screening programme disclosed four cases (4%) of distant metastasis, several patients had to suffer the psychological distress of false positive results. One in three suspicious thoracic X-rays, two in two liver scans and 18 out of 21 suspected bone scans were concluded false positive in terms of metastatic disease. A screening programme including blood test and thoracic X-ray alone, would have mis-classified one out of 98 patients.


CONCLUSIONS
This study indicated thoracic X-ray and blood test as being sufficient and 110 Pounds per patient screened could be saved.
Department of Oncology, University Hospital of Tromsø, Norway. jannorum@fagmed.uit.no
J
J
Norum
T
T
Andreassen
D014408:Biomarkers, Tumor / Q000097:blood*; D001774:Blood Chemical Analysis / Q000191:economics*; D001943:Breast Neoplasms / Q000097:blood / Q000191:economics / Q000473:pathology* / Q000523:psychology; D003362:Cost-Benefit Analysis; D003952:Diagnostic Imaging / Q000191:economics*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics; D008403:Mass Screening / Q000191:economics*; D009362:Neoplasm Metastasis / Q000175:diagnosis*; D009367:Neoplasm Staging; D013902:Radiography, Thoracic / Q000191:economics*; D013315:Stress, Psychological / Q000209:etiology / Q000517:prevention & control; D014057:Tomography, X-Ray Computed / Q000191:economics
D014408:Biomarkers, Tumor