I read with interest the article on the Screening Mammography Program of British Columbia (SMPBC) by Ivo A. Olivotto and colleagues. [1] On the basis of my experience as a screening radiologist since 1988 and as a centre administrator since 1991, I wish to comment on 3 areas.
First, the average cost per screening examination quoted in the article excludes significant direct screening costs including capital costs, hospital costs, hospital occupancy costs and some administrative costs that are incurred by publicly administered facilities in hospitals and are paid for by public funds outside of the SMPBC. Only the costs for the privately administered centres are close to being all-inclusive.
Second, the authors state that "the radiologists read the films in batches of 50 to 100 examinations per hour." The average reading rate in the SMPBC is likely below 50 per hour because most of the patients have previous films and it is often necessary to compare the new films with multiple previous examinations or with outside films.
Third, the authors excluded unilateral mammograms from their analysis of cost savings despite the fact that many unilateral mammograms done in diagnostic facilities are work-ups of abnormal SMPBC mammograms. When additional views are required as a result of screening in a diagnostic facility, they are not billed separately because they are included in the medical services plan fee for diagnostic mammography (see the BC Medical Association's Guide to Fees). Thus, exclusion of screening-generated unilateral mammograms exaggerates the cost savings of the shift from diagnostic facilities to the SMPBC.
BC has the lowest screening mammogram reading fee and the lowest average screening examination cost in Canada. The program's administration and the radiologists and employees providing services within the program deserve credit for achieving these cost efficiencies. In addition, the program has always been a cooperative effort among hospitals, the diagnostic imaging community, the Ministry of Health and the BC Cancer Agency, and it also benefits from their monetary, and other, contributions.
Lynette Thurber, MD
Chief Radiologist; Burnaby Screening Centre; Burnaby, BC
References
- 1.↵