OBJECTIVES : Between 3% and 35% of cancer deaths can be avoided by proper screening. However, using preventive protocols in large segment of population is associated with significant cost. We have investigated colon and breast cancer prevention and related cost and outcome comparing US and several countries in Europe (UK, Germany, Netherlands). Our initial assumption was that in countries with universal health coverage, cancer prevention would be widespread, and outcome would positively reflect the preventive measures.

METHODS : Cancer screening guidelines and outcomes were identified for each country based on a retrospective review of the pertinent literature.

RESULTS : The five-year survival rate for colon cancer in the US is higher than that of the UK, Germany and the Netherlands (64.4%, 58.7%, 63%, 62%, respectively). The five-year age-survival rate for breast cancer in the US is better than in the UK, Germany and the Netherlands (89%, 77%, 78% and 83% respectively).

The United States Preventive Services Task Force recommends Colonoscopy (Col) every 2 years (age 45-75) with selective screening in older patients (estimated $700-1000 pro/capita cost). However, in the U.K., a fecal occult blood test (FIT) is recommended every 2 years (age 60- 74) (estimated $20-50 pro/capita cost). Germany recommends either Col or FIT (age 50-75) and the Netherlands FIT (age 55-75).

The US also provides the most extensive coverage for breast cancer prevention: for women age 40-74 with average-risk for breast cancer (age 30+ for high risk), mammography as frequently as once a year is recommended (estimated $ 400/person) In the UK, coverage is restricted to only women age 50-71 with a three-year frequency. Germany and the Netherland have similar restrictions (estimated $225/person)

CONCLUSIONS : Our study shows that even in the absence of mandated universal health coverage, the US has broader screening coverage and better outcomes as compared to developed countries in Europe.