{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:01:55Z","timestamp":1787166115406,"version":"build-2736575974"},"reference-count":53,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2018,12,8]],"date-time":"2018-12-08T00:00:00Z","timestamp":1544227200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["71273016"],"award-info":[{"award-number":["71273016"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["71673004"],"award-info":[{"award-number":["71673004"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl Journal of Cancer"],"published-print":{"date-parts":[[2019,5,15]]},"abstract":"<jats:p>In low and middle\u2010income countries mammographic breast cancer screening is prohibitively expensive and a cheaper alternative option is to use ultrasound as the primary screening test. In 2009, China launched a breast cancer screening programme for rural women aged 35\u201364 years with clinical breast examination coupled with ultrasound as the primary tool. Our study aimed to analyse the cost\u2010effectiveness of breast screening compared to no screening among Chinese rural women. We developed a Markov model to estimate the lifetime costs and effects for rural women aged 35 years from a societal perspective. Asymptomatic women in the intervention arm were screened every 3 years before age 64 years. Breast cancer in the non\u2010screening arm can only be diagnosed on presentation of symptoms. Parameter uncertainty was explored using one\u2010way and probabilistic sensitivity analyses. Compared to no screening, breast cancer screening cost $186.7 more and led to a loss of 0.20 quality\u2010adjusted life years (QALYs). Breast screening was more expensive and did harm to health among rural women with an incremental cost\u2010effectiveness ratio (ICER) of $\u2010916\/QALY. The sensitivity analysis identified utility loss from false positives as the factor that most influenced the results, but this did not affect the conclusions. In a rural setting with such low breast cancer incidence, screening for asymptomatic disease is not cost\u2010effective with current screening tools. Priority should be given to ensure that symptomatic women have proper access to diagnosis and treatment at an early stage as this will lead to mortality reductions without the usual screening harms.<\/jats:p>","DOI":"10.1002\/ijc.31956","type":"journal-article","created":{"date-parts":[[2018,10,27]],"date-time":"2018-10-27T03:39:23Z","timestamp":1540611563000},"page":"2596-2604","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Cost\u2010effectiveness of breast cancer screening programme for women in rural China"],"prefix":"10.1002","volume":"144","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5569-7296","authenticated-orcid":false,"given":"Li","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine  London UK"},{"name":"School of Public Health Peking University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zia","family":"Sadique","sequence":"additional","affiliation":[{"name":"Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"dos\u2010Santos\u2010Silva","sequence":"additional","affiliation":[{"name":"Department of Non\u2010communicable Disease Epidemiology London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0640-2003","authenticated-orcid":false,"given":"Li","family":"Yang","sequence":"additional","affiliation":[{"name":"School of Public Health Peking University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Legood","sequence":"additional","affiliation":[{"name":"Department of Health Services Research and Policy London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,12,8]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.29210"},{"key":"e_1_2_7_3_1","unstructured":"SEER Program. 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