Mammography screening: prospects and opportunity costs.

Health care costs in the United States now consume nearly 15% of the gross domestic product. Continued expansion of health expenditures may have serious economic consequences, including reduction in the standard of living. Health care reform must include cost control without consequent detrimental effects on health status. As a case example, we consider the controversy surrounding mammography screening for premenopausal women. Several literature reviews of published studies suggest that screening of women less than 50 years of age does not statistically significantly reduce mortality from breast cancer. These results are not explained by screening interval, recentness of study, or patient compliance to screening. We conclude that screening is effective in decreasing mortality from breast cancer for women older than 50 years. For women less than 50, mammography screening programs displace resources that could have a greater benefit in women's health status if used for other purposes.