Mammographic screening: how to operate successfully at low cost.

To offer mammographic screening to asymptomatic women at low cost requires a different approach than is appropriate for solving the more complex problems presented by symptomatic patients. Since the goal of screening is to detect unsuspected abnormalities, not to characterize them fully, operational procedures can be streamlined to maximize patient throughput and achieve substantial cost savings. Such procedures will be successful only if applied to large numbers of patients, thereby permitting cost reduction by economies of large-scale operation. Computerization of record-keeping and of image interpretation is ideally suited for screening examinations and permits further cost savings. Experience with a prototype low-cost screening program has shown that with only 15 patients per day, operation is feasible at a charge of 50 per patient. The income lost from asymptomatic patients, who will pay lower fees compared with the traditional mammography fees they now pay, is more than offset by the income generated by additional problem-solving mammograms needed to fully characterize screening-detected abnormalities and by the increased use of needle localization procedures to guide biopsy.