Social and Behavioral Sciences Commons^™

The Danger Of Applying Uniform Clincal Policies Across Populations: The Case Of Breast Cancer In American Indians, Paul Nutting, Ned Calonge, Donald Iverson, Larry Green

Don C. Iverson

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 …