Delayed breast cancer detection increases government, individual costs
Australian women are encouraged to continue getting regular check-ups for breast cancer to avoid potentially thousands of dollars in increased treatment costs.
The more advanced the cancer, the higher the cost to the government and individual, a new Monash University study shows.
Some women may have no choice but to delay breast cancer screening appointments due to the COVID-19 pandemic. But, a new study by Monash Business School shows women with a delayed diagnosis are likely to incur additional out-of-pocket expenses.
The study investigated the costs absorbed by governments and individuals associated with screen-detected and community-detected cancers. Community-detected cancers are those diagnosed outside of Australia’s organised screening program, BreastScreen. Participation in BreastScreen is free as the Federal Government funds it.
Under the BreastScreen program, women can get regular screening checks and be diagnosed and treated prior to becoming symptomatic. However, many women don’t screen regularly and only seek professional advice once they notice cancerous symptoms.
Although government expenditure for a diagnosis was similar inside and outside of BreastScreen ($777 vs $837), women diagnosed outside of screening incurred an additional $254 in out-of-pocket costs, on average.
The out-of-pocket costs to get a diagnosis were mainly attributable to co-payments required for diagnostic services that are accessible free-of-charge through BreastScreen, such as mammographies and biopsies. After diagnosis, these out-of-pocket costs add up even more if their cancer is more advanced.
In extreme cases, government expenditure could exceed $30,000 and $2,000 for individuals in the three years following diagnosis according to the study, published in The Australian and New Zealand Journal of Public Health.
Lead author and PhD candidate, Karinna Saxby, along with Associate Professor Dennis Petrie from Monash Business School’s Centre for Health Economics, found that following diagnosis, costs for out-of-hospital medical services and prescription medicines were significantly associated with how the cancer was detected and its characteristics at diagnosis.
“We found that compared to screen-detected cancers, community-detected cancers were more likely to incur additional costs relating to extra diagnostic procedures, professional attendances and medicines for breast cancer treatment,” Ms Saxby said.
“This was in part due to community-detected cancers having more advanced cancer characteristics at diagnosis.
“However, unobservable characteristics and pathological differences may also be driving treatment decisions and, in turn, community costs. These costs should be included in future evaluations of the BreastScreen program, in particular when considering screening strategies that might affect cancer characteristics at diagnosis.”
The study looked at 553 women from the Lifepool cohort who were diagnosed with breast cancer. Lifepool comprises more than 50,000 women who were recruited predominately through BreastScreen.
The data analysis examined 396 women with screen-detected breast cancer (BreastScreen) and 157 women with community-detected cancers (detected outside of BreastScreen).
Community-detected breast cancers included diagnoses in women who never participated in screening, last participated in screening more than two years ago, or were in-between screening rounds.
Invasive cancer prognostic factors (large tumours, grade 3 tumours, HER2 positive tumours and positive lymph node involvement) were associated with significantly higher expenditure.
“Our findings are consistent with these characteristics being associated with more intense and costly treatment, such as chemotherapy,” Ms Saxby said.
“Policymakers need to fully understand the costs associated with breast screening, diagnosis and treatment. The costs presented in our study capture the additional community costs associated with breast cancer, which means that these costs are incurred on top of women’s existing medical expenses.
“Given women can lose their job, or have reduced work hours as a result of cancer, these numbers are only scratching the surface of the full cost burden experienced by breast cancer patients.”
Download a full copy of the research from https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.12976.
Read more about this research on Monash Impact.
The research team comprises Karinna Saxby and Associate Professor Dennis Petrie (Monash Business School); Dr Carolyn Nickson, Dr Louisa Velentzis and Dr Pietro Procopio (Cancer Council NSW, University of Melbourne and The University of Sydney); Professor Bruce Mann (Royal Melbourne and Royal Women's Hospital and University of Melbourne); Hannah Bromley (University of Birmingham and University of Melbourne); and Professor Karen Canfell (Cancer Council NSW and The University of Sydney).
8 June 2020.