COMPARISONS OF STRATEGIES TO PREVENT BREAST-CANCER MORTALITY

A health system should meet the health needs of the population. Given limited resources, choices are made about problems-typically, diseases -to attack. Then, choices must be made as to how to identify, treat, a nd ultimately, prevent their occurrences. This process is the subject of this article; it uses the case of breast cancer to examine allocati on of resources to disease prevention and treatment. The paper reviews current allocation patterns among three strategies for prevention: pr imary, secondary, and tertiary. Each varies with respect to where the disease process is halted and in the amount of technological support r equired. Currently, the U.S. health care system allocates most resourc es to tertiary prevention, with scant support of primary and limited s upport of secondary prevention. Possible explanations for the current allocation patterns are discussed. Areas where social sciences have ma de contributions are highlighted. Finally, cost-effectiveness analyses are presented to illustrate a relatively balanced method for making d ecisions about future allocations.