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When choosing which disease management programmes to fund, health maintenance organisations must consider both the needs of its membership and the realities of economic survival - what is good for patients is not necessarily good for the bottom-line. In the case of breast cancer, a programme encouraging the use of the hormonal drug tamoxifen would provide clear benefits for women since the agent has been shown to reduce the risk of breast cancer by 49%. But what about the cost of such a programme? Researchers at the 4th Annual Disease Management Congress [ Boston, Massachusetts, US; October 1999 ] presented data examining the cost of breast cancer in two managed-care populations and the impact of a breast cancer risk management programme.