THE DANGER OF APPLYING UNIFORM CLINICAL POLICIES ACROSS POPULATIONS -THE CASE OF BREAST-CANCER IN AMERICAN-INDIANS

Objectives. This study examined the implications of annual screening m ammography for cost and mortality in American Indian populations with differing baseline breast cancer rates. Methods. A decision tree compa red annual screening mammography and screening clinical breast examina tion with referral for diagnostic mammography when appropriate. The de cision tree was constructed to examine the effect of different base-li ne cancer rates, stage at diagnosis, and stage-specific survival. Outc omes included 5-year relative survival, deaths prevented at 5 years, c ost per death prevented, and total costs. Results. The findings sugges t that the total cost of breast cancer is 3.6 times higher with the sc reening mammography program hut results in a 27.9% reduction in breast cancer deaths over the first 5 years of the program. Both costs and d eaths prevented are sensitive to the incidence of breast cancer in the population and are less favorable in the range of incidence seen in A merican Indians. Conclusions. The cost and impact of a given strategy for cancer screening vary among communities with different disease inc idence, stage at diagnosis, and stage-specific survival, as seen in Am erican Indian populations.