The total national cost of annual breast cancer screening in a population of younger, commercially insured women is $2.1 billion in the U.S., according to a research letter published online March 23 in JAMA Internal Medicine.
But is this cost worth it? It's unclear, wrote a team led by Natalia Kunst of the University of Oslo in Norway.
"These costs are borne despite the unclear trade-off between clinical benefits and risks of screening women aged 40 through 49 years," the group wrote.
Whether women in their 40s benefit clinically from regular breast cancer screening continues to be debated. But the cost of screening this population hasn't been fully assessed, Kunst and colleagues wrote.
The team conducted a study to address this knowledge gap, using Blue Cross Blue Shield Axis data from over 2.2 million women in the U.S. between the ages of 40 and 49 who were eligible for screening mammography in 2017.
The group tracked subsequent evaluations in the four months after the women underwent initial screening mammography, then calculated the total annual cost of screening based on use and unit costs of the following:
- Initial screening (2D mammography with or without digital breast tomosynthesis [DBT])
- Supplementary screening (ultrasound)
- Recall exams (diagnostic 2D mammography with or without DBT and ultrasound)
- Other diagnostic tests (MRI and biopsy)
Of the total study cohort, 41.2% were screened with mammography that year. Of these, 24.1% were screened with 2D mammography; 17.2% with DBT; 14.8% were recalled; and 2.2% underwent other diagnostic tests.
The team then estimated the mean cost per beneficiary screened. The researchers estimated national screening costs by multiplying the total number of women with private insurance in this age group who are eligible for screening by the proportion of women screened and the mean per-beneficiary-screened cost they calculated.
| Annual breast cancer screening among women 40-49 with commercial insurance | ||
| Exams | Mean cost per beneficiary screened | Total national cost |
| Screening mammography | $249 | $1.5 billion |
| Recall | $56 | $337 million |
| Other diagnostic tests | $45 | $273 million |
| Total screening and evaluation | $353 | $2.1 billion |
Although less than half of the women included in the study received annual breast cancer screening, the estimated national cost was $2.1 billion, the group wrote. It also found regional variations across the U.S. in breast cancer screening costs, ranging from a total annual mean of $151 to $751 per beneficiary.
The researchers hope the data will help policymakers make better choices about healthcare resources.
"Our data add clarity around the costs of breast cancer screening for women in their 40s [and] drivers of these costs," the group concluded. "They can help inform policymakers' decisions and future cost-effectiveness evaluations to optimize resource allocation."
