Low cost of cancer detection in the first year of mammographic screening in Poland

Abstract

With great interest we read the Issue 4 (Vol. 19) entitled “Exploring the economics of breast care: A quest for quality” as well as the Supplement 2 (Vol. 20) – “Global breast health care: Optimizing delivery in low- and middle-resource countries, a supplement of consensus statements & special reports to the breast”. Population-based breast cancer screening in Poland was introduced in the year 2007 targeting women aged 50–69. Two-view mammography every two years is used as a standard screening test. The general assessment using early indicators1Perry N. Broeders M. de Wolf C. Tornberg S. Holand R. von Karsa L. European guidelines for quality assurance in breast cancer screening and diagnosis. Fourth edition –summary document.Ann Oncol. 2008; 19: 614-622Crossref PubMed Scopus (460) Google Scholar reveals that diagnostic service in the 3-million region of Lower Silesia conforms the European standards on an acceptable or even desirable level.2Szynglarewicz B. Matkowski R. Kasprzak P. Kotowska J. Forgacz J. Pudełko M. et al.The effectiveness of population-based breast cancer screening programme.Pol Merkur Lekarski. 2009; 26: 117-120PubMed Google Scholar, 3Matkowski R, Szynglarewicz B. First report of introducing population-based breast cancer screening in Poland: experience of the 3-million population region of Lower Silesia. Cancer Epidemiol 2011 Aug 11. [Epub ahead of print]. doi:10.1016/j.canep.2011.01.011.Google Scholar, 4Szynglarewicz B. Matkowski R. Kasprzak P. Strychalska M. Kupczak P. Ziętek M. et al.Quality assessment of mammography and biopsy service for breast cancer screening programme in the Lower Silesian Oncology Centre – Regional Comprehensive Cancer Centre: initial findings from the first year of population-based programme.Eur J Surg Oncol. 2008; 34: s1063Google Scholar In the first year of screening the technical recall rate, further assessment rate and short-term follow-up rate was 0.26%, 6.85% and 0.91%, respectively. Cancer detection rate was 4.59/1000 while cancer detection rate to expected incidence ratio was 3.35.2Szynglarewicz B. Matkowski R. Kasprzak P. Kotowska J. Forgacz J. Pudełko M. et al.The effectiveness of population-based breast cancer screening programme.Pol Merkur Lekarski. 2009; 26: 117-120PubMed Google Scholar, 3Matkowski R, Szynglarewicz B. First report of introducing population-based breast cancer screening in Poland: experience of the 3-million population region of Lower Silesia. Cancer Epidemiol 2011 Aug 11. [Epub ahead of print]. doi:10.1016/j.canep.2011.01.011.Google Scholar, 4Szynglarewicz B. Matkowski R. Kasprzak P. Strychalska M. Kupczak P. Ziętek M. et al.Quality assessment of mammography and biopsy service for breast cancer screening programme in the Lower Silesian Oncology Centre – Regional Comprehensive Cancer Centre: initial findings from the first year of population-based programme.Eur J Surg Oncol. 2008; 34: s1063Google Scholar The potential benefits of screening need to be carefully balanced against the financial burden for the health care system. In our region, the total expense for screening programme in the first year of its operating expressed in 2007 USD was 1,990,500 whereas the number of cancer detected was 543 giving the cost-effectiveness ratio 3665 USD per cancer found. If we assess the start of programme in some Western European countries in the nineties, the reported cost of cancer detection expressed in 2007 USD (using the comparison of purchasing power of money calculated with the Consumer Price Index) varies from 9970 to 11,300.5Spagnolo G. Zappa M. Paci E. Giorgi D. Rosselli del Turco M. Evaluation of the costs of mammographic screening program in the city of Florence.Epidemiol Prev. 1995; 19: 330-337PubMed Google Scholar, 6Plans P. Casademont L. Salleras L. Cost-effectiveness of breast cancer screening in Spain.Int J Technol Assess Health Care. 1996; 12: 146-150Crossref PubMed Scopus (15) Google Scholar Our programme looks favourable but the limitations of that comparison should be kept in mind. This difference might have been influenced by a lot of factors since the number of cancer detected is the product of screening sensitivity, incidence of breast cancer in the eligible population, and percentage of women screened.7De Koning H.J. Breast cancer screening; cost-effective in practice?.Eur J Radiol. 2000; 33: 32-37Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar On the other hand, cumulative cost of programme is related to numerous technical features, e.g. kind of screening mammography (digital vs screen-film, one- vs two-view), evaluation method (single vs double reading), techniques of invasive investigation etc. In addition, the lower reimbursement rates and salary levels in Polish health care system than in Western Europe could play an important role. In conclusion, population-based mammographic screening conforming the European quality standards is cost-effective even for middle-income countries. Breast cancer screening programme should be an important part of the public health policy also in economies of emerging market. None declared.