Dorte Gyrd-Hansen and Jes Søgaard
There is currently much focus on screening programmes such as screening for cervical cancer, breast cancer and colorectal cancer. Such programmes either have been introduced or are considered in many countries. Several cost-effectiveness studies have been published in the last decade (van der Maas et al., 1989; Eddy, 1990; Koopmanschapf et al., 1990a, b; de Koning et al., 1991; Mushlin and Fintor, 1992; Gyrd-Hansen et al., 1995, 1998; Wagner et al., 1996). These studies have only to a small extent incorporated intangible benefits and costs, or perceived utility and disutility associated with cancer screening. How is the risk of a false positive screen test over lifetime traded off against the prospect of reduced disease specific mortality risk over lifetime - due to better survival prognosis at early diagnosis? The cost of increasing frequency of screening tests in terms of time costs and discomfort with the test and/or anxiety while waiting for the results of the screening test (Cohen and Henderson, 1988)? Do extra-attributive participation benefits exist (beyond mortality risk reduction) in terms of obtaining information (Berwick and Weinstein, 1985) and/or eliminating regret (Loomes and Sugden, 1982; Mooney and Lange, 1993)? Importance of such costs and benefits are widely recognized (Cairns and Shackley, 1993) and undoubtedly they influence health policy makers’ decisions to introduce screening or not as well as individual decisions to participate if they are or become available.
The purpose of this chapter is to assess some intangible costs and benefits associated with participation in screening for colorectal cancer using the fecal occult blood test (H-II) or in mammography screening. The former is self-administered, whereas breast cancer screening involves a visit to a local mammography unit. If the screening test is positive, participants will be referred to diagnostic tests. In the case of colorectal cancer, a positive screening test is followed up by a colorectal examination, also called a colonoscopy. If a patient is suspected of having breast cancer, the introductory diagnostic test will entail a clinical mammography i.e. further x-rays, palpation and possibly a needle biopsy.
We interviewed a random sample of the Danish population at the age of 50 years to elicit their stated utility and disutility associated with participation, with cancer-specific mortality risk reduction, with risk of false positive test outcomes,