Benefits, Harms, and Costs of Screening with Digital Mammography

Stout et al in their article published by the JNCI, report on the economic impact digital mammography had as it has replaced film in the United States.

Their research compared digital screening strategies starting at age 40 or 50 years applied annually, biennially, or based on density with biennial film screening from ages 50 to 74 years and with no screening. Common data elements included cancer incidence and test performance, both modified by breast density. Lifetime outcomes included mortality, quality-adjusted life-years, and screening and treatment costs.

For every 1000 women screened biennially from age 50 to 74 years, switching to digital from film yielded a median improvement of 2 life-years, 0.27 additional deaths averted, 220 additional false-positive results, and $0.35 million more in costs. For an individual woman, this translates to a health gain of 0.73 days. Extending biennial digital screening to women ages 40 to 49 years was cost-effective, although results were sensitive to quality-of-life decrements related to screening and false positives. Targeting annual screening by density yielded similar outcomes to targeting by age. Annual screening approaches could increase costs to $5.26 million per 1000 women, in part because of higher numbers of screens and false positives, and were not efficient or cost-effective.

They concluded that transition to digital breast screening in the United States increased total costs for a small added health benefit.  While the value of digital mammography screening for breast cancer among women aged 40 to 49 years was cost effective the women should be cognizant of the high rate of false positives.