When money is tight, screening mammography is conditionally cost-effective compared to other proactive options


Screening mammography: what else is there?

Because proactive technology-based health measures, such as screening mammography, are inaccessible in parts of many LMICs, many communities rely on low-tech approaches.

These may include clinical breast exams, risk factor assessments and/or point-of-care ultrasound, the authors note.

Among the key findings of their review: The majority of studies finding mammography screening to be a cost-effective approach compared to other strategies were conducted in upper-middle-income countries (71%).


  • Eighteen of the 21 studies analyzed concluded that screening mammography was a cost-effective strategy, although some of these 18 did not evaluate mammography as a sole screening strategy compared to no screening.
  • Twelve of these 18 studies compared mammography-only screening with no strategy or with another strategy. Two studies compared the combination of mammography, risk-based assessment and ultrasound/clinical breast examination with no strategy or another strategy, while four studies compared mammography screening plus the treatment of stage I-IV breast cancer to an “other” strategy.
  • Three quarters of the included studies specified the screening interval. For most of them, the interval was two years, which generally proved to be profitable. When a comparison was made between biennial screening and annual or triennial screening, a biennial interval was found to be more cost-effective than other screening interval strategies.

The authors also note that in several high-income countries, many women begin breast cancer screening at age 40 or soon after.

The catch is “the obvious uncertainty about the extent of overdiagnosis in young and older women,” the authors point out. In some previous studies, they note, early age “reduces mortality more than at age 50, but it also consumes more resources and results in more false positives.”

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