Logo of brjcancerBJC HomepageBJC Advance online publicationBJC Current IssueSubmitting an article to BJCWeb feeds
Br J Cancer. Jun 1992; 65(6): 950–955.
PMCID: PMC1977784

Advanced breast cancer and its prevention by screening.

Abstract

In discussions on breast cancer screening, much attention has been focussed on the possible morbidity generated by screening. Favourable effects like the prevention of advanced disease seem underestimated, probably because quantification is that difficult. To analyse the amount of care and treatment given to women with advanced breast cancer, we report on patients followed from first recurrence until death using patient files and national sources. A random sample of 60 female cases from computerised registries of two cancer centres and a sample of 20 cases from a non-computerised hospital registry was taken. A total of 68 patient files were sufficiently documented. A woman with advanced breast cancer is estimated to have a 39% loss in utility compared to a healthy woman (range 27-45%). Hormonal treatment is the main modality during 14 and chemotherapy during 4 months. Total medical cost from diagnosis of advanced disease until death amounts to 17,100 US dollars, or 21,000 when including extramural cost. The effect of breast cancer screening by preventing the occurrence of advanced disease is quantified. The resulting gain in quality of life contributes 70% of the total gain in quality of life. In the long run, almost half of the annual cost of screening will be offset by savings in the cost for advanced disease. Only the changes in palliative surgery and/or radiotherapy will be small in contrast to primary treatment changes. Besides the mortality reduction, screening is justified by the improvements in quality of life and cost savings for women prevented from reaching advanced disease.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.2M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Andersson I, Aspegren K, Janzon L, Landberg T, Lindholm K, Linell F, Ljungberg O, Ranstam J, Sigfússon B. Mammographic screening and mortality from breast cancer: the Malmö mammographic screening trial. BMJ. 1988 Oct 15;297(6654):943–948. [PMC free article] [PubMed]
  • Baker MS, Kessler LG, Urban N, Smucker RC. Estimating the treatment costs of breast and lung cancer. Med Care. 1991 Jan;29(1):40–49. [PubMed]
  • Cassileth BR, Lusk EJ, Strouse TB, Miller DS, Brown LL, Cross PA, Tenaglia AN. Psychosocial status in chronic illness. A comparative analysis of six diagnostic groups. N Engl J Med. 1984 Aug 23;311(8):506–511. [PubMed]
  • de Haes JC, van Knippenberg FC, Neijt JP. Measuring psychological and physical distress in cancer patients: structure and application of the Rotterdam Symptom Checklist. Br J Cancer. 1990 Dec;62(6):1034–1038. [PMC free article] [PubMed]
  • de Haes JC, de Koning HJ, van Oortmarssen GJ, van Agt HM, de Bruyn AE, van Der Maas PJ. The impact of a breast cancer screening programme on quality-adjusted life-years. Int J Cancer. 1991 Oct 21;49(4):538–544. [PubMed]
  • de Koning HJ, van Oortmarssen GJ, van Ineveld BM, van der Maas PJ. Breast cancer screening: its impact on clinical medicine. Br J Cancer. 1990 Feb;61(2):292–297. [PMC free article] [PubMed]
  • de Koning HJ, van Ineveld BM, van Oortmarssen GJ, de Haes JC, Collette HJ, Hendriks JH, van der Maas PJ. Breast cancer screening and cost-effectiveness; policy alternatives, quality of life considerations and the possible impact of uncertain factors. Int J Cancer. 1991 Oct 21;49(4):531–537. [PubMed]
  • Dixon AR, Ellis IO, Elston CW, Blamey RW. A comparison of the clinical metastatic patterns of invasive lobular and ductal carcinomas of the breast. Br J Cancer. 1991 Apr;63(4):634–635. [PMC free article] [PubMed]
  • Dixon JM, John TG. Morbidity after breast biopsy for benign disease in a screened population. Lancet. 1992 Jan 11;339(8785):128–128. [PubMed]
  • Ellman R, Angeli N, Christians A, Moss S, Chamberlain J, Maguire P. Psychiatric morbidity associated with screening for breast cancer. Br J Cancer. 1989 Nov;60(5):781–784. [PMC free article] [PubMed]
  • Holli K, Hakama M. Treatment of the terminal stages of breast cancer. BMJ. 1989 Jan 7;298(6665):13–14. [PMC free article] [PubMed]
  • Hopwood P, Howell A, Maguire P. Psychiatric morbidity in patients with advanced cancer of the breast: prevalence measured by two self-rating questionnaires. Br J Cancer. 1991 Aug;64(2):349–352. [PMC free article] [PubMed]
  • Nerenz DR, Love RR, Leventhal H, Easterling DV. Psychosocial consequences of cancer chemotherapy for elderly patients. Health Serv Res. 1986 Feb;20(6 Pt 2):961–976. [PMC free article] [PubMed]
  • Patel JK, Nemoto T, Vezeridis M, Petrelli N, Suh O, Dao TL. Does more intense palliative treatment improve overall survival in metastatic breast cancer patients? Cancer. 1986 Feb 1;57(3):567–570. [PubMed]
  • Perez JE, Machiavelli M, Leone BA, Romero A, Rabinovich MG, Vallejo CT, Bianco A, Rodriguez R, Cuevas MA, Alvarez LA. Bone-only versus visceral-only metastatic pattern in breast cancer: analysis of 150 patients. A GOCS study. Grupo Oncológico Cooperativo del Sur. Am J Clin Oncol. 1990 Aug;13(4):294–298. [PubMed]
  • Powles TJ, Coombes RC, Smith IE, Jones JM, Ford HT, Gazet JC. Failure of chemotherapy to prolong survival in a group of patients with metastatic breast cancer. Lancet. 1980 Mar 15;1(8168 Pt 1):580–582. [PubMed]
  • Roberts MM. Breast screening: time for a rethink? BMJ. 1989 Nov 4;299(6708):1153–1155. [PMC free article] [PubMed]
  • Roberts MM, Alexander FE, Anderson TJ, Chetty U, Donnan PT, Forrest P, Hepburn W, Huggins A, Kirkpatrick AE, Lamb J, et al. Edinburgh trial of screening for breast cancer: mortality at seven years. Lancet. 1990 Feb 3;335(8684):241–246. [PubMed]
  • Tabar L, Fagerberg G, Duffy SW, Day NE. The Swedish two county trial of mammographic screening for breast cancer: recent results and calculation of benefit. J Epidemiol Community Health. 1989 Jun;43(2):107–114. [PMC free article] [PubMed]
  • Tomin R, Donegan WL. Screening for recurrent breast cancer--its effectiveness and prognostic value. J Clin Oncol. 1987 Jan;5(1):62–67. [PubMed]
  • van Oortmarssen GJ, Habbema JD, van der Maas PJ, de Koning HJ, Collette HJ, Verbeek AL, Geerts AT, Lubbe KT. A model for breast cancer screening. Cancer. 1990 Oct 1;66(7):1601–1612. [PubMed]
  • Wald N, Frost C, Cuckle H. Breast cancer screening: the current position. BMJ. 1991 Apr 6;302(6780):845–846. [PMC free article] [PubMed]

Articles from British Journal of Cancer are provided here courtesy of Cancer Research UK

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...