To the Editor.
—Drs Lindfors and Rosenquist1 present the results of an interesting intellectual exercise in their article on the cost-effectiveness of mammographic screening. We concede that such an exercise may have value in informing policy decisions given current imperfect knowledge. However, the usefulness of their model is severely restricted by the lack of consideration given to the undoubted disutility of screening.This is particularly relevant when annual screens and screening in younger women are being advocated because screening this population increases the number of false positives. This issue cannot be avoided by suggesting that this model is designed to evaluate cost-effectiveness and not cost utility, for in an example such as breast cancer cost-effectiveness, analysis takes into account all of the potential advantages of screening without any of the disadvantages—principally the anxiety, fear, and discomfort associated with the screening process itself and the consequent diagnostic doubts and delay.
Donnelly PD, Lo SV. Cost-effectiveness of Mammography Screening. JAMA. 1996;275(2):111. doi:10.1001/jama.1996.03530260025020