Screening for Breast Cancer: Time, Travel, and Out-of-Pocket Expenses

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We estimated the personal costs to women found to have a breast problem(either breast cancer or benign breast disease) in terms of time spent, miles traveled, and cashpayments made for detection, diagnosis, initial treatment, and follow-up.


Weanalyzed data from personal interviews with 465 women from four communities in Florida.These women were randomly selected from those with a recent breast biopsy (within 6-8 months)that indicated either breast cancer (208 women) or benign breast disease (257 women). Onecommunity was the site of a multifaceted intervention to promote breast screening, and the otherthree communities were comparison sites for evaluation of that intervention. All P values are two-sided.


In comparison with time spent and travel distance for womenwith benign breast disease (13 hours away from home and 56 miles traveled), time spent andtravel distance were statistically significantly higher (P<.001) for treatment andfollow-up of women with breast cancer (89 hours and 369 miles). Personal financial costs fortreatment of women with breast cancer were also statistically significantly higher (breast cancer=$604; benign breast disease=$76; P <.001) but were statisticallysignificantly lower for detection and diagnosis (breast cancer=$170; benign breastdisease=$310; P<.001). Among women with breast cancer, time spent fortreatment was statistically significantly lower (P=.013) when their breast cancerwas detected by screening (68.9 hours) than when it was detected because of symptoms (84.2hours). Personal cash payments for detection, diagnosis, and treatment were statisticallysignificantly lower among women whose breast problems were detected by screening than amongwomen whose breast problems were detected because of symptoms (screening detected=$453; symptom detected=$749; P=.045).


There aresubstantial personal costs for women who are found to have a breast problem, whether the costsare associated with problems identified through screening or because of symptoms.

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