Although professional society guidelines vary, most private insurance companies in the US will reimburse for the costs of mammography for women age 40 through 49 years.1 While the clinical benefits and harms of screening women in their 40s have been widely discussed,2,3 there is limited evidence regarding the cost implications of contemporary breast cancer–screening practices among this population. We estimated annual breast cancer screening–associated costs among US women in their 40s who have private insurance. We also assessed regional variation in these costs.
We conducted a retrospective study of women aged 40 through 49 years who had private insurance using data from the Blue Cross Blue Shield Axis, a large commercial claims database accessed via a secure portal. We selected women between ages 40 and 49 years who were eligible to receive a screening mammography in 2017 and identified screening mammography in 2017 using a validated algorithm and relevant Current Procedural Terminology codes.4 For each beneficiary screened, we identified subsequent evaluation tests in the 4 months after the initial screening mammography and calculated the total annual cost of screening based on use and unit costs of initial screening (2-dimensional mammography with or without digital breast tomosynthesis [DBT]), supplementary screening (screening ultrasonography), recall (diagnostic 2-dimensional mammography with or without DBT and ultrasonography), and other diagnostic tests (magnetic resonance imaging and biopsy). We then estimated the mean cost per beneficiary screened.