Preprints.org · Oct 30, 2026

Cost-Effectiveness of Breast Screening by Five-Year Age Group in a Population-Based Program

By Krueger H, Godfreyson A, Yonghing C et al.

Background: Controversy remains about the optimal age at which screening mammography should be started. Methods: Cost-effectiveness analysis was based on a British Columbia birth cohort of 40,000 individuals, including 19,661 women alive at age 40. Ten screening scenarios were modeled: no screening versus best-in-the-world screening rates for ages 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 50-74, 40-74. The main outcomes included breast cancers treated by stage at diagnosis, deaths attributable to breast cancer averted, and quality-adjusted life years (QALY) gained or lost associated with ruling out false-positive results, receiving treatment, the metastatic phase, and living in remission. Results: Screening in women aged 50-74 would result in 92.9 deaths avoided and 889 QALYs gained, at a cost of $ 38,242 per QALY. Screening in women aged 40-74 would result in 99.6 deaths avoided and 744 QALYs gained, at a cost of $ 71,155 per QALY gained. Excluding patient time costs reduced the cost per QALY to $ 2,086 and $ 13,622, respectively. The only scenario in which benefits outweighed harms in women aged 40–49 was when harms attributable to false-positive results were excluded in the model, resulting in a cost per QALY of $ 138,594 and $ 83,210 in women aged 40-44 and 45-49, respectively. Conclusion(s): Our model results are highly sensitive to assumptions regarding utility losses associated with false-positive screening results and inclusion/exclusion of patient time costs, especially in younger women. Subsequent modeling investigations and policymakers who may utilize these investigations should be aware of the impact of these assumptions on model results.

doi.org/10.20944/preprints202610.3093.v1Open accessInterventions