Costs and benefits of diagnosing familial breast cancer.

Costs and benefits are ill-defined terms; this review discusses some interpretations and some ways of assessing costs and benefits. Cost-benefit calculation is a misconception in health care, in that costs should be considered together with what the patients gain in terms of prolonged life and life quality. In the emerging commercialization of Western health care, however, money benefit is to be calculated in order to ask for funding. As professionals we are dealing with inherited breast cancer. We come to know the families and the individual women within these families. We care, we cure, we prevent and we are gaining knowledge. We are doing good, not harm. We are profoundly involved, and we are so deeply and personally involved that we may not even try to be objective in a debate on choosing between our patients and patients cared for by others. As we present our arguments, society has to decide. There is no argument to provide service for other inherited disorders based on ethical standards alone, and to deprive women at risk for breast cancer the life-saving health service they need because of money costs. The money needed is based on a number of rapidly fluctuating factors: the most stable costs are genetic counseling and physical examinations to demonstrate disease, while laboratory costs are rapidly decreasing. The overall conclusion is that economical cost-benefit analysis as an argument for our activity is outside our professional ethics, and should never become a reason for our continued endeavors. Copyright 2004 European Society for Medical Oncology