Screening for breast cancer: Time, travel, and out-of-pocket expenses

Background: We estimated the personal costs to women found to have a breast problem (either breast cancer or benign breast disease) in terms of time s pent, miles traveled, and cash payments made for detection, diagnosis, init ial treatment, and follow-up. Methods: We analyzed data from personal inter views with 465 women from four communities in Florida. These women were ran domly selected from those with a recent breast biopsy (within 6-8 months) t hat indicated either breast cancer (208 women) or benign breast disease (25 7 women). One community was the site of a multifaceted intervention to prom ote breast screening, and the other three communities were comparison sites for evaluation of that intervention. All P values are two-sided. Results: In comparison with time spent and travel distance for women with benign bre ast disease (13 hours away from home and 56 miles traveled), time spent and travel distance were statistically significantly higher (P<.001) for treat ment and follow-up of women with breast cancer (89 hours and 369 miles), Pe rsonal financial costs for treatment of women with breast cancer were also statistically significantly higher (breast cancer = $604; benign breast dis ease = $76; P<.001) but were statistically significantly lower for detectio n and diagnosis (breast cancer = $170; benign breast disease = $310; P<.001 ), Among women with breast cancer, time spent for treatment was statistical ly significantly lower (P = .013) when their breast cancer was detected by screening (68.9 hours) than when it was detected because of symptoms (84.2 hours), Personal cash payments for detection, diagnosis, and treatment were statistically significantly lower among women whose breast problems were d etected by screening than among women whose breast problems were detected b ecause of symptoms (screening detected = $453; symptom detected = $749; P = .045), Conclusion: There are substantial personal costs for women who are found to have a breast problem, whether the costs are associated with probl ems identified through screening or because of symptoms.