Biennial and Risk-Based Breast Cancer Screening Associated With Significant Cost Savings

The current recommendations for preventive breast cancer (BC) screening are that all women aged 40 or older at average risk for BC should be screened biennially (every other year), according to the US Preventive Task Force (USPSFT). However, the American College of Radiology (ACR) recommends yearly screening for the same women, and the American Cancer Society recommends annual screening for women beginning at age 45.

To better inform policy, a group of researchers led by Kimberly Badal, PhD, of the University of California, San Francisco, CA, collected data on women who underwent BC screening between 2019 and 2021 and analyzed the cost (screening and recall) for each of the 4 different screening strategies: annual, biennial, hybrid, and the WISDOM (Women Informed to Screen Depending on Measures of risk) clinical trial’s risk-based strategy.

The team used data from the FDA Mammography Quality Standards Act and Program to estimate the number of screens during the study period, and the Optum Labs Data Warehouse (OLDW) to determine the costs of screening, recalls, and relative use of 2D versus 3D mammography. For publicly funded screens, the team used Medicare Advantage claims to approximate cost. Risk-based genetic testing was estimated at $270.

Based on the aggregate data from the FDA and OLDW, the team determined that the median cost of mammography ranged from $139-360 and the median cost of MRI was $545-2439. “The estimated yearly aggregate cost of screening 100% of eligible women was: $26.71B ($24.61-32.82B) for annual; $18.09B ($16.03-21.16B) for hybrid; $7.57B ($6.97-9.29B) for biennial; and $9.60B ($8.88-11.70B) for risk-based strategies,” the researchers reported.

Presented on a per-person scale, the cost of the various strategies for women screened from age 40-74 on a 100% strategic compliance basis was $22,315 for women screened annually, $16, 552 for women who followed a hybrid screening model, $6,878 for women who adhere to the WISDOM trial’s screening strategy, and $4,133 for women screened biennially.

“Biennial and risk-based screening can reduce cost substantially,” the team concluded. “Risk-based screening reduced cost even with the cost of population genetic testing included while maintaining intensive screening for the highest-risk women.”

Reference

Badal K, Staib J, Tice J, et al. Cost of breast cancer screening in the USA: Comparison of current practice, advocated guidelines, and a personalized risk-based approach. Abstract #e18917. Presented at the 2023 ASCO Annual Meeting, Chicago, IL, June 2-6, 2023.