What does early breast cancer detection cost?

The longer I look at health care issues, the more I am convinced that there is hardly any point in discussing them, because none of us knows what we are talking about. Literally.

Chris and I just returned from a long road trip to El Paso, to spend a weekend celebrating my dad’s 80th birthday. It was two days driving out, two days back. We listened to a fair amount of NPR news programming along the way, and so got an earful of the controversy over the new guidelines for mammograms for women under fifty. In hours of talk I heard only one number that caught my attention, mentioned in passing, stating that for every 1900 women screened one case of cancer will be detected.

I immediately wanted a second number, namely the cost of a mammogram, but never heard it. Just to help with some level-setting, I assumed that it would cost $1000, not uncommon for a medical procedure. That would mean that it would cost $1.9 million to detect that case. It sounds like a lot, but I wasn’t sure how to think about it. And I had my netbook with me, so at the motel room that night I decided to spend a little time doing some research.

The first thing I found was an article somewhere that the one in 1900 number means that one case is discovered if 1900 women are screened annually for ten years, meaning it takes 19,000 scans to find that one case, ten times what I originally thought. So I was alarmed—$19 million dollars to detect a single case of cancer?

The second thing I found was what looks like a fairly useful website, CostHelper, which maintains a database of typical costs for common purchases. On the mammogram page, it says this about the cost:

For an uninsured patient, typical full-price cost of a mammogram ranges from$80 to $120 or more, with an average of about $102, according to Blue Cross Blue Shield of North Carolina. Some providers charge more, and some offer an uninsured discount. For example, at the Kapiolani Medical Center in Aiea, Hawaii, where the full price is about $212, an uninsured patient would pay about $127 to $148.

Ah, mammograms cost roughly $100. Assuming that, it costs $1.9 million to detect a case of cancer. Is that a reasonable cost for society to bear? I don’t know, but it could make sense when spread across the individuals involved—that is, any given woman might be glad to pay $100 each year for the peace of mind a scan would provide, even if there is only a one in 19,000 chance the scan will turn up something.

But then I read further down the page, which contains posts from people giving brief descriptions of what their own mammograms actually cost them, and was dismayed again. First, because the actual costs incurred ranged between about $750 and $2500, making $1000 a reasonable assumption again ($19 million per case detected).

Second, the comments from women involved made it clear that even a few hundred dollars was more than they were willing to pay out of pocket to cover the very small chance that they had cancer. This may sound miserly and unreasonable, but one of the few things I learned from the hours of radio discussion was that the early detection which a mammogram provides may not actually be worth that much—there is a natural assumption that early detection would lead to more effective treatment and a better chance of survival, but this turns out to not be true.

So, where did this all leave me? Mostly confused. Ten thousand dollars over ten years seems a lot for an individual to pay to find out if she is the 1900th woman, and nineteen million dollars seems high for society (or an insurance pool) to pay to find that one woman. One thousand dollars over ten years seems like not so much—at least it seems like a woman could fairly be expected to pay that out of her own pocket to put her mind at ease—but it would take socialized medicine to get the cost down that low, in which case she wouldn’t be paying out of her own pocket, and society would be paying $1.9 million to find her, still a high price.

It seems like an impossible question to discuss, and yet I am reminded that one group of people does discuss it, namely the plain people who eschew insurance and depend on community support to pay for medical expenses which are beyond the individual’s ability to pay. A small Amish or Mennonite community would be instantly bankrupted if they adopted the modern world’s hands-off attitude on how health care should be allocated, and so I assume that these issues are faced honestly and squarely on a regular basis.

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10 thoughts on “What does early breast cancer detection cost?

  1. Just as an aside, I have a story for you.

    Some Amish once asked me to drive them to the hospital’s emergency room. I was curious about the emergency for which we were in such a rush. After several questions, I concluded that she had nothing more than a simple case of mastitis. I asked if it wouldn’t be more practical to try some home treatments and then phone the OB in the morning for an antibiotic to be called into our local pharmacy if the usual remedies didn’t provide relief.

    They declined, saying it was cheaper just to go to the emergency room. Since they’re on medicaid.

  2. Amy,

    I’ve read several other stories like yours. I’d like to think it demonstrates that our modern attitude towards health is so corrosive that it can undermine even an adamantly premodern community. But it may instead be that the plain people in practice don’t come close to my idealized image of them.

    Still, there are those other stories. Like Raymond Martin in South Fork, for whom the community stages charity auctions to help pay for his dialysis. And the Amish family who caused an ethical crisis among a group of doctors, some of whom wanted to forcibly detain them when they said their community would need to decide if surgery for their child was worth the cost.

    I don’t know if the plain attitude (as I imagine it) towards health care is a better one. But it constantly reminds me that the conventional attitude I’ve held in the past was nothing but unexamined assumptions, not an understanding that I achieved on my own.

  3. My attitude has always been that getting squashed and radiated can’t possibly be good for them, and might even be bad, so I’ve never had one and never will.

    A lot of our health care decisions are made like that, long before we even get to calculating the cost in dollars.

  4. Kelly, ME TOO! We have a dear friend who is a doctor of osteopathic nuclear radiology (say that three times fast!). He is currently having angst over the cost/benefit of what he is asked to do. Lots of times, he is trying to diagnose folks who are already VERY sick, but he is seeing more and more of this “preventative” mentality, and he tends to think that radiation is very hurtful unless you are attempting to head off death itself. When my husband was in the hospital, he was constantly helping me wade through which tests were necessary and which were not–he was very concerned with how much radiation my husband was being exposed to in the ICU.

    With that said…no mammograms for me, either!

  5. Having been in the military and experienced total government-managed medicine, I am very much against socialized medicine, not to mention the Constitutional problems with it. That said, it is a sad twist that we women are being manipulated or frightened into protesting this monster by the fear of less mammograms. A woman’s chance of breast cancer goes UP 2% for every mammogram she receives. It is not a detection issue. The radiating and trauma to the breast are now known to cause more problems than they detect. Further, there IS a harmless screening that truly DOES detect very early breast cancer that has been largely unavailable to women in the US: thermography, which does not radiate the breast at all.

  6. I’m with you. Health care is a mess.

    It’s troubling that the price of a mammogram is so hard to pin down. Even more troubling is that the most expensive mammograms are for women who are paying for them out of their own pocket.

    I’m starting to think that we won’t begin to get health care costs under control unless a) we pay for more of our own care out of our own pocket, and b) we provide explicit, government-funded medical care for everyone in cases of major illness (I’m not talking about our current system of universal health care: wait until you’re really really sick and then go to the ER.)

    Neither of these things are likely to happen soon. Btw, have you read Goldhill’s health care proposals in the Atlantic?

    http://www.theatlantic.com/doc/200909/health-care

    This passes the common-sense test for me, but the chances of getting any of it done are slim.

  7. Have you read Goldhill’s health care proposals in the Atlantic?

    Carey,

    I read the article when it was first published, but remember more about the horror story he told than about his proposals. I will go back and read it again. Thanks.

  8. Reading that post of yours about your NPR listening was almost as boring as being forced to listen to NPR. Yes, I listen to them some when my mind doesn’t have a good enough cue of ideas of my own. Sometimes they have some good information or something thought provoking, or something to get me all riled up and ready to argue with some atheist/tyrant in person!

    But when I do turn it on, I’m always ready to turn it off when it gets boring or too awful wicked. Just remember, it is our duty to wage war with the thoughts that set themselves up against God’s word. And that doesn’t usually mean we have to know the world’s positions ahead of time, but only that we know, meditate on, study, and formulate God’s word with wisdom against the wicked and discuss these things with other Christians to sharpen each other.

    Government subsidized health care is wrong because God has given that responsibility to families first, then churches as ministry, and never given that authority to civil government.

  9. Government subsidized health care is wrong because God has given that responsibility to families first, then churches as ministry, and never given that authority to civil government.

    Really? Got a chapter and verse for that?

    I think I could make a prudential argument from Catholic Social Teaching and the principle of subsidiarity that this is the correct ordering… but that’s a pretty dogmatic statement, and I can’t think where in the Bible the correct locus of responsibility for health care is given as a commandment.

    peace,
    Zach

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