Who gets a mammogram amongst European women aged 50-69 years?

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On the basis of the Survey of Health, Ageing, and Retirement (SHARE), we analyse the determinants of who engages in mammography screening focusing on European women aged 50-69 years. A special emphasis is put on the measurement error of subjective life expectancy and on the measurement and impact of physician quality. Our main findings are that physician quality, better education, having a partner, younger age and better health are associated with higher rates of receipt. The impact of subjective life expectancy on screening decision substantially increases after taking measurement error into account. JEL Classification C 36, I 11, I 18

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Publié le 01 janvier 2012
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Langue English
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wuebker Health Economics Review 2012, 2 :6 http://www.healtheconomicsreview.com/content/2/1/6
R E S E A R C H Open Access Who gets a mammogram amongst European women aged 50-69 years? Ansgar wuebker
Abstract On the basis of the Survey of Health, Ageing, and Retirement (SHARE), we analyse the determinants of who engages in mammography screening focusing on European women aged 50-69 years. A special emphasis is put on the measurement error of subjective life expectancy and on the measurement and impact of physician quality. Our main findings are that physician quality, better education, having a partner, younger age and better health are associated with higher rates of receipt. The impact of subjective life expectancy on screening decision substantially increases after taking measurement error into account. JEL Classification: C 36, I 11, I 18 Keywords: Mammogram, Physician quality, Life expectancy, Instrumental variables
Introduction A mammogram screening is the best tool available for Breast cancer is the most common cause of cancer detecting breast cancer in the early stage, i.e. before deaths among women in the member states of the symptoms appear. Mammography can detect a breast European Union [1]. According to estimates of inci- lump before it can be palpated; it can save live by detect-dence and mortality by the International Agency for ing breast cancer in the earliest stage. For women aged Research on Cancer (IARC), there were 331,000 new 50- 69 years, mammography has been shown to lower cases and 90,000 deaths due to breast cancer in the EU the risk of dying from breast cancer by 35% [4]. In addi-in 2006 [1]. Breast cancer accounts for almost one out tion it has shown to be highly cost-effective for women of three new cancer cases and one out of six (17%) can- in this age group [5]. In light of the evidence available, cer deaths. One in nine women gets breast cancer at the International Agency for Research on Cancer expert some point in her life and one in thirty perishes as a working group (IARC Working Group, [6]) advises that consequence of the disease [2]. Due to demographic mammography screening should be offered as a public trends, significantly more women per capita will be con- health policy directed to women aged 50-69 every two fronted with this disease in the future [3]. A Moreover years in order to reduce the risk of death from breast breast cancer is associated with high costs for national cancer. EU guidelines [7] promote a target screening rate health care accounting to about 0.5-0.6% of the total of at least 75% of eligible women in European countries. health care expenditure of developed countries [2]. Even though mammography i s officially recommended Breast cancer takes years to develop. At the onset of both on the national and European level, screening rates the disease, most breast cancers cause no symptoms. As in most European countries remain far from 100%. B For long as cancer has not metastasized, i.e. that has not example, in the Slovak Republic only around 20% of moved to the lymph system or to other organs of the women aged 50-69 years are screened annually [2]. body, patients have a five-year survival rate of 96%. If Correspondingly, increasing mammography for women the cancer has spread to the nearby lymph nodes, the aged 50-69 years is an important public health goal in rate drops down to 81%. Women whose breast cancer Europe [1]. has metastasized to other organs of the body have a There exists a considerable amount of empirical and five-year survival rate of 26% [4]. theoretical research in health economics on the predictors of screening and preventive behaviour. Theoretical eco-nomic models include those of Grossman [8], Cropper [9], Correspondence: ansgar.wuebker@uni-wh.de © 2012 Wubker; licensee Springer. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.