Lower socioeconomic status African American and Hispanic women suffer from later-stage detection of breast cancer and higher mortality rates than other American women. Low-cost mobile mammography offers one approach to mitigate this problem. This article identifies the economic costs and cost-effectiveness of operating a mobile mammography program targeting indigent populations. Costs are derived from a current mobile mammography service for a range of operating volume conditions and are applied to different detection rates to determine the cost-effectiveness of programs designed to reach different age, racial, and ethnic segments of indigent populations. Results from this work have broad policy implications and form a foundation for future economic and policy analysis in this area.
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References
1.
Aaltomaa, S. , P. Lipponen, M. Eskelinen, V. M. Kosma, S. Marin, E. Alhava, and K. SyrJanen. 1992. Mitotic Indexes as Prognostic Predictors in Female Breast Cancer. Journal of Cancer Research and Clinical Oncology118:75-81.
2.
Andersson, I. , K. Aspegren, L. Janzon, T. Landberg, K. Lindholm, F. Linell, O. Ljungberg, J. Ramstam, and B. Sigfusson. 1988. Mammographic Screening and Mortality from Breast Cancer: The Malmo Mammographic Screening Trial. British Medical Journal297 (October):943-948.
3.
Bassett, M. T. , and N. Krieger. 1986. Social Class and Black-White Differences in Breast Cancer Survival. American Journal of Public Health76 (December):1400-1403.
4.
Bird, R. E.1989. Low-Cost Screening Mammography: Report on Finances and Review of 21,716 Consecutive Cases. Radiology171 (April):87-90.
5.
Brown, M. L. , and L. Fintor. 1993. Cost-Effectiveness of Breast Cancer Screening: Preliminary Results of a Systematic Review of the Literature. Breast Cancer Research and Treatment25:113-118.
6.
Chambliss, L.1995. Battling Breast Cancer. Working Woman, October, 94-95.
7.
Chen, F. , E. J. Trapido, and K. Davis. 1994. Differences in Stage at Presentation of Breast and Gynecologic Cancers among Whites, Blacks and Hispanics. Cancer73 (June):2838-2842.
8.
Chu, K. , C. Smart, and R. Tarone. 1988. Analysis of Breast Cancer Mortality and Stage Distribution by Age for the Health Insurance Plan Clinical Trial. Journal of the National Cancer Institute80:1125-1131.
9.
Costanza, M. E.1992. Breast Cancer Screening in Older Women. Synopsis of a Forum. Cancer69 (Suppl.):1925-1931.
10.
Crowe, J. P. Jr. , N. H. Gordon, R. R. Shenk, R. M. Zollinger Jr., D. J. Brumberg, and J. M. Shuck. 1992. Primary Tumor Size Relevance to Breast Cancer Survival. Archives of Surgery127 (August):910-916.
11.
Cyrlak, D.1988. Induced Costs of Low-Cost Screening Mammography. Radiology168 (September):661-663.
12.
Dodd, G. D.1987. The Major Issues in Screening Mammography: The History and Present Status of Radiographic Screening for Breast Carcinoma. Cancer60 (Suppl.):1671-1674.
13.
Eddy, D. M. , V. Hasselblad, W. McGivney, and W. Hendee. 1988. The Value of Mammography Screening in Women under Age 50 Years. Journal of the American Medical Association259 (March):1512-1519.
14.
Eley, J. W. , H. A. Hill, V. W. Chen, D. F. Austin, M. N. Wesley, H. B. Muss, and R. S. Greenberg. 1994. Racial Differences in Survival from Breast Cancer. Journal of the American Medical Association272 (September):947-954.
15.
Fackelmann, K. A.1993. Refiguring the Odds: What's a Woman's Real Chance of Suffering Breast Cancer?Science News144 (July):76-77.
16.
Farley, T. A. , and J. T. Flannery. 1989. Late-Stage Diagnosis of Breast Cancer in Women of Lower Socioeconomic Status: Public Health Implications. American Journal of Public Health79 (November):1508-1512.
17.
Freeman, H. P. , and T. J. Wasfie. 1989. Cancer of the Breast in Poor Black Women. Cancer63:2562-2569.
18.
Hurley, S. F. , P. M. Livingston, N. Thane, and L. Quang. 1994. Mammographic Screening: Measurement of the Cost in a Population Based Programme in Victoria, Australia. Journal of Epidemiology and Community Health48 (August):391-399.
19.
Joensuu, H. , and S. Toikkanen. 1991. Prognosis of Breast Cancer with Small Primary Tumor (pTl). Acta Oncology30:793-796.
20.
Kiefe, C. I. , S. V. McKay, A. Halevy, and B. A. Brody. 1994. Is Cost a Barrier to Screening Mammography for Low-Income Women Receiving Medicare Benefits? A Randomized Trial. Archives of Internal Medicine154June):1217-1224.
21.
McCoy, C. B. , E. L. Khoury, L. S. Hermanns, and L. Bankston. 1992. Mobile Mammography: A Model Program for Medically Underserved Women. Women's Health Issues2 (winter):196-205.
22.
McCoy, C. B. , L. R. Metsch, E. Komaroff, H. V. McCoy, R. Anwyl, and J. Zavertnik. 1996. Determining the Onset of Mammography Screening: Age, Race/Ethnicity and Family History of Breast Cancer. Working paper, University of Miami.
23.
Miller, A.1991. Is Routine Mammography Screening Appropriate for Women 40-49 Years of Age?American Journal of Preventive Medicine7:55-60.
24.
Miller, A. B. , C. J. Baines, T. To, and C. Wall. 1992. Canadian National Breast Study 1: Breast Cancer Detection and Death Rates among Women Aged 40-49. Canadian Medical Association Journal147:1459-1476.
25.
Nystrom, L. , L. E. Rutqvist, S. Wall, A. Lindgren, M. Lindqvist, S. Ryden, I. Andersson, N. Bjurstam, G. Fagerberg, J. Frisell, L. Tabar, and L. -G. Larsson. 1993. Breast Cancer Screening with Mammography: Overview of Swedish Randomized Trials. Lancet341 (April):974-978.
26.
Rosenquist, J. , and K. Lindfors. 1994. Screening Mammography in Women Aged 40-49 Years: Analysis of Cost-Effectiveness. Radiology191:647-650.
27.
Sickles, E. A. , W. N. Weber, H. B. Galvin, S. H. Ominsky, and R. A. Sollitto. 1986. Mammographic Screening: How to Operate Successfully at Low Cost. Radiology160 (July):95-97.
28.
Swanson, G.1994. May We Agree to Disagree, or How Do We Develop Guidelines for Breast Cancer Screening in Women?Journal of the National Cancer Institute86:903-905.
29.
Tabar, L. , G. Faberberg, N. E. Day, and L. Holmberg. 1987. What Is the Optimum Interval Between Mammographic Screening Examinations? An Analysis Based on the Latest Results of the Swedish Two-County Breast Cancer Screening Trial. British Journal of Cancer55:547-551.
30.
U.S. Bureau of the Census . 1993. Current Population Reports, Series P60-184: Money Income of Households, Families, and Persons in the United States: 1992. Washington, D.C.: Government Printing Office.
31.
U.S. Census Bureau . 1997. U.S. Census Bureau Current Population Survey: Poverty Thresholds in 1993 by Size of Family and Number of Related Children under 18 Years [On-line]. Available from: www.census.gov/hhes/poverty/threshld/thres93.html.
32.
van Der Maas, P. J. , H. J. de Koning, B. M. van Ineveld, G. J. van Oortmarssen, J.D.F. Habbema, T.N.L. Koss, A. T. Geerts, H.J.A. Collette, A.L.M. Verbeek, J.H.C.L. Hendriks, and J. J. Rombach. 1989. The Cost-Effectiveness of Breast Cancer Screening. International Journal of Cancer43:1055-1060.
33.
White, E. , N. Urban, and V. Taylor. 1993. Mammography Utilization, Public Health Impact, and Cost-Effectiveness in the United States. Annual Review of Public Health14:605-633.
34.
Zavertnik, J. J. , C. B. McCoy, D. S. Robinson, and N. Love. 1992. Cost-Effective Management of Breast Cancer. Cancer69 (Suppl.):1979-1984.
