Mammographic screening of women aged 40-49 years. Benefit, risk, and cost considerations

A recently published meta-analysis of seven randomized trials showed a statistically significant 24% reduction in mortality rate with the use of mammographic screening for women age 40-49 years. The benefit would have been even greater if screening had been performed at shorter annual intervals with the most up-to-date mammographic equipment. Additionally, these trials underestimated benefit due to inclusion of breast cancer deaths among study group women who refused to undergo screening. In contrast to these documented benefits, no woman has ever been shown to have developed breast cancer as a result of mammography, even with multiple examinations at doses many times higher than the current 0.25 cGy from a two-view-per-breast examination. The possibility of low dose risk has been theorized based on excess rates of cancer among populations that have received doses of 100 to more than 1000 cGy, such as atomic-bomb survivors. If there is a risk, it is negligible or nonexistent compared with the screening benefit. The total cost of screening is a summation of the following costs: (1) screening mammogram plus down-stream costs of supplementary mammographic views and/or ultrasound for further evaluation of some screenees; (2) mammographic follow-up; and (3) core or excisional biopsy for those women in whom a suspicious abnormality persists after workup. Based on a range of procedural costs, a 30% reduction in breast cancer deaths due to incidence screening of women age 40-49 will cost $6,930.00-$13,413.00 per year of life expectancy gained.