title: Diagnostic and therapeutic path of breast cancer: effectiveness, appropriateness, and costs--results from the DOCMa study.
abstract: OBJECTIVE
  An increase in breast cancer incidence has been documented in Italy and in other countries, and some women decide by themselves to undergo diagnostic examinations outside the official screening campaigns. The aim of this paper was to analyze - in terms of effectiveness, appropriate access, and related costs - the path spontaneously followed by a sample of Italian women for the early diagnosis of breast cancer.
  
  
  METHODS
  A total of 143 women who consecutively referred themselves to the breast cancer outpatient facilities at the Sant'Andrea University Hospital in Rome from May to June 2007 were enrolled in the study, gave their consent, and were screened according to their individual risk factors for breast cancer. The entire diagnostic and therapeutic path followed in the previous 2 years by each of them, either at Sant'Andrea or in other medical facilities, was reviewed and evaluated in terms of its operative efficiency and fair economic value.
  
  
  RESULTS
  The subjects' mean age was 47.5 years (standard deviation 13.6 years); 55% of the women were <50 years old (28% <40 years), and were thus not included in the official screening campaigns; 97 women (70%) were requesting a routine control; and 49% of them had already undergone four to seven examinations before the enrollment, although no major risk factor was present in 73.5%. After enrollment in the study, nine of the patients had surgical interventions performed on them at Sant'Andrea's, identifying five invasive carcinomas and two ductal in situ carcinomas and two benign lesions. Operative efficiency and fair economic value were found to be optimal only in diagnostic/therapeutic paths followed at Sant'Andrea.
  
  
  CONCLUSIONS
  The diagnostic path at Sant'Andrea's specialized center for breast cancer diagnosis and therapy is characterized by higher operative efficiency and more sustainable costs than at general hospitals, outpatient facilities run by local health authorities, or private medical centers. This result seems to confirm the present tendency to refer high-risk patients for breast cancer directly to breast units like the one at Sant'Andrea.
authors.affiliation: Department of Clinical and Molecular Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy.
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Giovagnoli
authors.affiliation: Department of Medical-Surgical Sciences and Translational Medicine, Sapienza University of Rome, Sant'Andrea University Hospital, Rome, Italy.
authors.forename: Adriana
authors.initials: A
authors.lastname: Bonifacino
authors.affiliation: Euro Mediterranean Scientific Biomedical Institute (ISBEM), Brindisi, Italy.
authors.forename: Cosimo
authors.initials: C
authors.lastname: Neglia
authors.affiliation: Euro Mediterranean Scientific Biomedical Institute (ISBEM), Brindisi, Italy ; Department of Economics, Scuola Superiore Sant'Anna, Pisa, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Benvenuto
authors.affiliation: Euro Mediterranean Scientific Biomedical Institute (ISBEM), Brindisi, Italy.
authors.forename: Francesco Vincenzo
authors.initials: FV
authors.lastname: Sambati
authors.affiliation: eCampus University, Novedrate, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Giolli
authors.affiliation: Department of Statistical Sciences, University of Bologna, Bologna, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Giovagnoli
authors.affiliation: Coleman Ltd, Southern Italy Hospital Institute, Naples, Italy ; IOS, Southern Italy Hospital Institute, Naples, Italy.
authors.forename: Prisco
authors.initials: P
authors.lastname: Piscitelli
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics* / Q000473:pathology / Q000628:therapy; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: breast cancer; breast unit; cost analysis; early diagnosis; prevention; screening