Well welcome back!
I hope your day hasn't been quite as busy as mine. It ended with a person having an acute heart attack. This necessitated a trip down to hospital with them in the back of the ambulance. Fortunately the person made it and when I left them they were fine.
Emergency medicine is a lot of fun and very rewarding!
However I think that the most rewarding thing any of us could accomplish would be to see a dream we all share come true
- a reduction in the number of women developing and ultimately succumbing to breast cancer.
So lets summarize what was discussed yesterday.
- That at present the tactic we are taking to try and address the increase in breast cancer rates is to try to "prevent breast cancer deaths". To do this in medicine we try to diagnose breast cancer as early as possible to "prevent women from dying from it". This has lead to slightly muddled thinking that what we are doing is "preventing breast cancer". But actually we are waiting until women have already got it, not preventing it at all.
- Not only that but we seem to not be able to tell WHICH women actually needed our help when they do have it. Some have treatment they would never have needed as the recent Zahl paper confirms previously stated conclusions of the Cochrane review. The Cochrane review saying that 10 women per 2000 screened will under go unnecessary treatment.
Although I promised I would start to share the research pointing towards ways to truly prevent breast cancer, tonight I wanted to extend on the previous posting by sharing with you some information which I have looked into today for you.
Costs - what are the economic costs of the approach we are taking to breast cancer (early detection as the solution) here in New Zealand? If you are from overseas - don't worry, the costs would be in some vague ( fairly amazing as you will see) similar ballpark.
And so here are the results of today's investigation.
It turns out that the New Zealand mammography screening project has an annual budget of $NZ47.8million dollars. There are in the order of 600,000 women aged 45-70 who are eligible for screening here ( actually less but rounding up will decrease the cost per life saved and soften the stats in this case).
If the Cochrane estimates are correct and 1 in 2000 woman will have her life saved by screening over a ten year period the following calculation can be made....
Worst estimate....
600,000 divided by 2000 =300 women saved over 10 years, or 30 women every year.
$47.8million divided by 30 = 1.5million ( if rounded down)
If the Swedish studies are correct and 1 in 472 women will have their lives saved - then the cost per life is
Best estimate....
600,000 divided by 472 = 1271 over 10 years or 127 per year
$47.8million divided by 127 = roughly $370,000 per life saved.
Here in New Zealand we have people dying at times on our waiting lists for heart surgery due to inadequate funds - the sum needed being in the order of $20,000.
However a womans life is very precious. Often we are the king pin that holds a whole family together and so this is not a comment about whether this is a worthwhile sum. And economically it stacks up to fairly equivalent loss of life time earnings if the woman was to not be saved.
It is still a large sum! One that may surprise you. It is so large in fact, Australia is presently going through a major cost review on mammography.
But lets think further. So lets say at best and most generous guess ( in support of mammography) the cost per life saved is in the order of $370,000. BUT this does not include the costs of those women who are treated unnecessarily. Although I don't have the figures for this here in New Zealand, there is some published data on this topic such as that published by the California Breast Cancer Research Program. Click to go to this link Presumably everyone having unnecessary treatment would have low grade cancer and estimates of cost for this were around $16,000 per woman.
So now - if 10 women per 2000 were to have unnecessary breast cancer treatment over a 10 year period in new Zealand lets do the calculations...
600,000 divided by 2000 = 300 x 10 women = 3000 over 10 years or 300 each year.
300 x $16,000 = 4.8 million per year.
Now if we are ( at best estimate ) saving 127 women per year, the economic cost of women unnecessarily needing to be treated to save these women is $4.8million divided by 127 = $37,795.
So the total ( cheapest figure) might look something like $370,000 + $37,795 = lets just say in the $400,000 range.
Now these figures are just playing with numbers. They are not accurate, they take American estimated sums and mix them with New Zealand figures. They make many assumptions.
However.... they give us a rough ball park figure to ask.....
If we were going to actually truly prevent breast cancer what could we achieve with an incredible sum like $47.8 million per year.
What could we do that might actually make a saving
so that the cost per life saved was less than $400,000 per woman?
This site proposes - isn't this the question that we should be asking?
Stay tuned!
live empowered,
and know that you have a right to know
Dr. Elizabeth Harris
MBChB, Dip Obs, Dip MSM, MACNEM, FRNZCGP
New Zealand
