Clinical Breast Exams in India Offer Cost-Effective Benefits

Option compares favorably to mammography in developed nations

THURSDAY, Sept. 11 (HealthDay News) -- The potential cost-effectiveness of clinical breast examination screening for cancer in India appears at least comparable to the cost-effectiveness of mammography in developed countries, but still may be challenging to implement, researchers report in the Sept. 17 issue of the Journal of the National Cancer Institute.

Quirine Lamberts Okonkwo, M.D., of the University Medical Center Rotterdam in the Netherlands, and colleagues used a microsimulation screening analysis model, incorporating the lower cumulative incidence and delayed diagnosis seen in India, to estimate costs of screening and its effects on mortality.

Screening programs aimed at women between the ages of 40 and 60 offered the highest estimated mortality reduction, the investigators found. Annual clinical breast examination between these ages could be almost as efficacious as biennial mammography for reducing mortality from the disease, with half the cost, the authors note.

"Screening for breast cancer by any modality will result in false positives that will require further investigation with possible surgery to confirm the diagnosis; these incur not only financial costs [but] also increased anxiety. The latter has been shown to be mostly short-lived in a Western setting, but that may differ in different cultures. There is also a potential for overdiagnosis of disease that would not otherwise present within a woman's lifetime. Although overdiagnosis may be less likely with clinical breast examination than mammography, lower life expectancy will increase the possibility that it will occur," writes Sue Moss, Ph.D., of the Institute of Cancer Research in Surrey, U.K., in an accompanying editorial.

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