Presentation (CTI)

OBJECTIVES: Breast cancer (BC) is the most frequently diagnosed cancer among women and a major source of morbidity, mortality, and societal burden. In France, organized BC screening relies on biennial mammography with double reading for women aged 50-74 years without specific high-risk factors, alongside individual opportunistic screening (DODI). This study estimated productivity-related societal costs associated with alternative BC screening strategies in France.
METHODS: We extended the French-National-Cancer-Institute screening assessment to compare no screening, current DODI, and organized screening strategies for ages 45-70, 45-75, 45-80, 50-70, and 50-80 years. Employment rate, sick leaves (SL), and work absence durations between 6 and 48 months after diagnosis were derived from the French CONSTANCES cohort. Treatment distributions for invasive cancers were informed by the nationwide FRESH cohort while ductal carcinoma in situ and metastatic stages treatment were informed by French guidelines. Part-time SL was incorporated assuming that 71% of BC-related SL occurred part-time, valued at 50% productivity. Monthly productivity was valued at €10,126 based on French national accounts. Mean age at death was set at 74 years, life expectancy at 85.3 years, and mortality losses were valued using a statistical-life-year value (SLYV) of €149,845. Productivity losses were estimated using both the human capital approach (HCA) (including SLYV) and the friction cost method (FCM) with a 3-month friction period and a friction coefficient of 0.8.
RESULTS: Total societal costs difference between no screening and DODI was -€4,972,146,525 under the HCA and €54,590,485 under the FCM. Total societal costs difference between DODI and best cost-minimizing screening age strategy (45-80 years) was -€1,170,550,105 under the HCA and €4,933,834 under the FCM.
CONCLUSIONS: This study provides a broader societal perspective for evaluating BC screening strategies in France and suggests that, although FCM show short-term excess costs, HCA indicates extended screening is more efficient and has greater impact on a lifetime horizon.