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The cost of initial cancer screening in the U.S. was estimated to be over $43 billion in 2021, which was less than the reported annual cost of cancer treatment in the first year after diagnosis, according to a modeling study.

Using national healthcare survey and cost resources data, the total healthcare system costs for initial breast, cervical, colorectal, lung, and prostate cancer screening were estimated at $43.2 billion in 2021, reported Michael T. Halpern, MD, PhD, of the National Cancer Institute, and colleagues.

Of note, colorectal cancer screening accounted for 63.6% of the total amount, at $27.5 billion, with screening colonoscopy representing about 55% of the total, they noted in the .

Patients with private insurance accounted for more than 88% of all screening costs, while Medicare beneficiaries accounted for 8.5%, and Medicaid beneficiaries, those with coverage from another government program, and uninsured patients accounted for 3.2%.

"The annual cost of cancer screening represents a notable portion of overall U.S. healthcare system costs related to cancer," Halpern and colleagues wrote. "Identification of these costs and the drivers for cancer screening costs are critical to help inform policy and develop programmatic priorities, particularly for enhancing access to recommended cancer screening services."

While the costs of screening are substantial, the authors noted that "it is important to consider the value resulting from cancer screening."

They pointed out that previous research supports the cost-effectiveness of screening for breast, cervical, colorectal, and lung cancer, and clinical trials have shown that recommended cancer screening can reduce cancer-specific mortality.

However, in an , H. Gilbert Welch, MD, MPH, of Brigham and Women's Hospital in Boston, noted that whether the cost of screening is "$43 billion or $100 billion, questions remain about the value of the expenditure."

He argued that the effect of cancer screening "is so small that randomized trials must enroll tens of thousands of participants to reliably detect a change in cancer-specific mortality -- not all-cause mortality," adding that "exaggeration of benefits and minimization of harms cause real problems."

"Resources devoted to cancer screening would be better directed toward ensuring widespread access to effective cancer treatment," Gilbert wrote. "And addressing the social determinants of cancer risk -- smoking, obesity, poverty, and unhealthy living conditions -- would reduce death from multiple causes, not just cancer."

For this study, Halpern and team estimated the number of people screened for breast, cervical, colorectal, lung, and prostate cancer in the past year using data from the 2021 National Health Interview Survey. To estimate the total cost of cancer screening, they multiplied the number of people screened for those cancers and associated healthcare system costs by typical insurance cost per screen in 2021 dollars.

"For all screening tests, only medical care costs associated with the initial screening were included," they noted. "Due to limitations of available data, costs of follow-up imaging and procedures after initial abnormal or positive screening results were not included, although these are critical components of the screening process."

Halpern and colleagues determined that mammography (32.8 million) and cervical cancer screening (33.0 million) accounted for the largest total number of tests performed in 2021, while an estimated 22.3 million colorectal cancer screening tests were performed, mainly comprising fecal immunochemical testing (9.8 million) and colonoscopy (9.2 million). In addition, there were 8.3 million prostate-specific antigen tests performed, as well as 2.4 million lung screening tests.

Of the estimated cost of $43.2 billion:

• Colonoscopy was the largest component, accounting for an estimated $23.7 billion
• All other colorectal cancer screening tests combined accounted for an additional $3.8 billion
• Breast cancer screening accounted for $8.8 billion, cervical cancer screening for $5.5 billion, and prostate and lung cancer screening each cost an estimated $700 million

The authors also observed that the cost of cancer screening is dependent on facility costs, particularly in the cases of colonoscopy, sigmoidoscopy, CT colonography, and CT lung cancer screening, for which the facility costs are much higher than the physician costs.

"Policies that affect facility costs or sites where screening tests are done (hospital outpatient facilities vs ambulatory surgery centers) may have substantial effects on the cost of cancer screening," Halpern and colleagues wrote. "In addition, changes in rates of receipt of facility- versus home-based colorectal cancer screening tests could have substantial effects on cost estimates."

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