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The danger of applying uniform clinical policies across populations: The case of breast cancer in American Indians

https://arctichealth.org/en/permalink/ahliterature4097
Source
American Journal of Public Health. 1994 Oct;84(10):1631-1636
Publication Type
Article
Date
Oct-1994
  1 website  
Author
Nutting, PA
Calonge, BN
Iverson, DC
Green, LA
Author Affiliation
Department of Family Medicine, University of Colorado Health Sciences Center, Denver 80220.
Source
American Journal of Public Health. 1994 Oct;84(10):1631-1636
Date
Oct-1994
Language
English
Geographic Location
U.S.
Publication Type
Article
Keywords
Adult
Aged
Alaska - epidemiology
Breast Neoplasms - diagnosis - epidemiology - mortality
Comparative Study
Cost-Benefit Analysis
Decision Support Techniques
Female
Humans
Incidence
Indians, North American
Mammography - economics - standards
Mass Screening - economics - standards
Middle Aged
Organizational Policy
Southwestern United States - epidemiology
United States
United States Indian Health Service - organization & administration - standards
Value of Life
Abstract
OBJECTIVES. This study examined the implications of annual screening mammography for cost and mortality in American Indian populations with differing baseline breast cancer rates. METHODS. A decision tree compared annual screening mammography and screening clinical breast examination with referral for diagnostic mammography when appropriate. The decision tree was constructed to examine the effect of different base-line cancer rates, stage at diagnosis, and stage-specific survival. Outcomes included 5-year relative survival, deaths prevented at 5 years, cost per death prevented, and total costs. RESULTS. The findings suggest that the total cost of breast cancer is 3.6 times higher with the screening mammography program but results in a 27.9% reduction in breast cancer deaths over the first 5 years of the program. Both costs and deaths prevented are sensitive to the incidence of breast cancer in the population and are less favorable in the range of incidence seen in American Indians. CONCLUSIONS. The cost and impact of a given strategy for cancer screening vary among communities with different disease incidence, stage at diagnosis, and stage-specific survival, as seen in American Indian populations.
PubMed ID
7943483 View in PubMed
Online Resources
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