Is Mammography for Breast Cancer Screening Cost-Effective in Both Western and Asian Countries?: Results of a Systematic Review

Background: Mammography is considered the gold standard of breast cancer mass screening and manycountries have implemented this as an established breast cancer screening strategy. However, although theincidence of breast cancer and racial characteristics are different between Western and Asian countries, manyAsian countries adopted mammography for mass screening. Therefore, the objective of this research was todetermine whether mammography mass screening is cost-effective for both Western and Asian countries.Materials and
Methods: A systematic review was performed of 17 national mammography cost-effectivenessdata sets. Per capita gross domestic product (GDP), breast cancer incidence rate, and the most optimal costeffectivenessresults [cost per life year saved (LYS)] of a mammography screening strategy for each data setwere extracted. The CE/per capita GDP ratio is used to compare the cost-effectiveness of mammography bycountries. Non-parametric regression was used to find a cut-off point which indicated the breast cancer incidencerate boundary line determining whether mammography screening is cost-effective or not.
Results: We foundthat the cost-effective cut-off point of breast cancer incidence rate was 45.04; it exactly divided countries intoWestern and Asian countries (p<0.0014).
Conclusions: Mammography screening is cost-effective in most ofWestern countries, but not in Asian countries. The reason for this result may be the issues of incidence rate orracial characteristics, such as dense breast tissue. The results indicate that mammography screening should beadopted prudently in Asian countries and other countries with low incidence rates.