Charging for breast-cancer screening reduces attendance N.B. Please note that if you are outside North America the embargo for Lancet press material is 0001 hours UK time Friday 26th October 2001.
Researchers from Finland report, in this week's Lancet, a fall in uptake of breast cancer screening with the introduction of charges.
In many countries where there is a policy of screening women by mammography (taking an X-ray of the breasts), the procedure is free of charge. The public expense of screening for breast cancer is thought to be justifiable as a public-health policy to reduce deaths from the disease. If a charge is made for screening, will fewer women attend?
Dr Pirjo Immonen-Raiha and colleagues from Turku, Finland, ask this question in this week's Lancet. In Turku, breast-cancer screening was free until 1997 when charges for some women were introduced to reduce the health-care budget. Screening continued to be free for women aged 50-59, but women aged 40-49 and 60-69 were charged a sum equivalent to 17 Euros.
The researchers compared the proportion of women eligible for screening in the 40-49 and 60-69 age groups who attended for the test before and after the introduction of charges. Before the introduction of charges, 75% of women in the 40-49 age group and 99% of women in the 60-69 age group attended. After the introduction of charges, the attendance rates were 66% and 88%, respectively. Socioeconomic status, income, and type of employment did not affect these differences.
The authors conclude, "The introduction of a customer fee in Turku sent a message to the female population, stating that the health-care system was questioning regular screening by mammography. For breast-cancer screening to reduce mortality the attendance rates need to be high, which means screening should be free of charge."
Contact: Dr Pirjo Immonen-Raiha, Raiso Region Hospital, PO Box 43, 20201, Raiso, Finland. T) + 35 82 4388311, F) +35 82 4388573; E) firstname.lastname@example.org.