Breast cancer screening programs are regularly used in developed countries where the cases of the disease are highest, and an extensive health care system is in place.
However, the value and practicality of such screening programs in the developing world is less clear.
Although the developing world has a lower breast cancer incidence rate, women tend to have more advanced disease at diagnosis and a greater risk of dying from their disease.
In order to estimate the ability of screening in a developing country to reduce the number of deaths and the stage of disease at diagnosis, Harry J. de Koning, M.D., Ph.D., of Erasmus Medical Center in Rotterdam, The Netherlands, and colleagues conducted a study.
They used a Microsimulation Screening Analysis model to estimate the impact of screening with clinical breast exams or mammography in India.
The researchers estimated the cost-effectiveness, which is the cost of screening per life year gained, for each screening approach in international dollars (Int dollars), which are used by the World Health Organization and has the same purchasing power in India as a U.S. dollar does in the United States.
The researchers found that a single clinical breast exam for women at age 50 was estimated to reduce breast cancer mortality by 2 percent at a cost-effectiveness of Int dollars 793 per life-year gained.
And if women had clinical breast exams every five years between the ages of 40 and 60, mortality reduction would increase to 8.2 percent and the cost-effectiveness would grow to Int dollarsl,l35 per life-year gained.
The researchers estimated that annual screening with clinical breast exams would lead to nearly the same mortality reduction as biennial mammography screening but at half the net cost.
"Our results indicate that every-5-year, biennial, and annual [clinical breast exams] for women aged 40-60 all lead to considerable reductions in mortality and high numbers of life years gained," the authors said.
The study is published in the September 9 online issue of the Journal of the National Cancer Institute.