Abstract P3-02-12: The Cost of Mammography Screening in the United States by Screening Policy
Authors: Thorsen CM , Eklund M , Ozanne EM , Esserman LJ 
Published: August 2014

Abstract
Background: Multiple mammography screening strategies exist; however, the resources associated with screening strategies are not well known and are rarely discussed. Many organizations recommend annual mammography for women over the age of 40, while the United States Preventative Services Task Force (USPSTF) and most countries outside the US recommend biennial screening, focusing screening efforts on women over 50 years. Additionally, some suggest risk-based approaches to improve screening. This analysis seeks to estimate the aggregate cost of mammography screening in the US in 2010 and to then further compare the costs of these proposed strategies, specifically comparing annual versus biennial screening.
Methods: We simulated the annual cost of mammography in the US under the following screening strategies: 1) estimate of screening that occurred in 2010 under current policy, 2) annual screening of women older than 40 years, 3) biennial screening of women 50 to 75 years, and 4) biennial screening of women 50 to 75 years and high risk women 40–50 years following USPSTF guidelines. The simulated 2010 screening policy was based on current screening rates ranging from 51% of forty-year-old women to 66% of sixty-five-year-old women. Screening strategies 2–4 simulated screening 85% of women overall, and for the USPSTF policy 20% of women 40–50 years were estimated to be high risk. The simulation was carried out using R statistical software.
Results: Aggregate costs of the four screening strategies were estimated. The total cost of mammography screening in the US in 2010 was estimated to be $7.95 billion. The projected cost under an annual screening policy beginning at 40 years was $10.71 billion. The projected cost of biennial screening from 50–75 years was $5.25 billion compared to $5.33 billion following the USPSTF guidelines. The biennial USPSTF policy cost $5.38 billion less than annual screening. The largest drivers of cost were the percent of women screened, the cost of a mammogram, and the percent of women recalled after mammography.
Conclusions: The costs of mammography vary greatly by strategy and are relevant to screening policy. The basic biennial strategy was the least expensive; however for a slight increase in cost, the USPSTF 2009 guideline strategy screened more age appropriate women for $2.62 billion less than current policy. For less cost, the modeled USPSTF guidelines screened 85% of women compared to current policies that screen less than 65% of women. Biennial screening provides screening to more women, lowers overall false-positive rates, and improves capacity for access to high-quality equipment and well-trained mammographers. As data to support evidenced based strategies increase, resources can be better allocated toward screening a broader, larger population of women that are most likely to benefit from screening. With no evidence for adverse outcomes, a biennial screening policy enables the population of US women to benefit from mammography for less cost.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-02-12.