Comparisons of strategies to prevent breast cancer mortality

A health system should meet the health needs of the population. Given limited resources, choices are made about problems--typically, diseases--to attack. Then, choices must be made as to how to identify, treat, and ultimately, prevent their occurrences. This process is the subject of this article; it uses the case of breast cancer to examine allocation of resources to disease prevention and treatment. The paper reviews current allocation patterns among three strategies for prevention: primary, secondary, and tertiary. Each varies with respect to where the disease process is halted and in the amount of technological support required. Currently, the U.S. health care system allocates most resources to tertiary prevention, with scant support of primary and limited support of secondary prevention. Possible explanations for the current allocation patterns are discussed. Areas where social sciences have made contributions are highlighted. Finally, cost-effectiveness analyses are presented to illustrate a relatively balanced method for making decisions about future allocations.