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) pirjo.immonen-raiha@tyks.fi .
The Lancet