OBJECTIVES: The objective of this literature review was to explore the existing evidences regarding cost-effectiveness of breast cancer screening (BCS) tests in average-risk women and in high-risk women.  METHODS: A literature review was performed using the PICO method: Population consisted of women at average risk and at high risk for breast cancer; Intervention and Comparators were BCS tests, and Outcomes were incremental cost-effectiveness ratios (ICERs). The literature search was performed with the NHS EED filters using the electronic databases (MEDLINE, EMBASE and PubMed) from January 2005 until May 2015. RESULTS: The literature review allowed retrieving 1,699 studies of which 39 fulfilled the eligibility criteria. Fourteen studies were cost-effectiveness analyses, twenty-one were cost-utility analyses and four were both. Eighteen studies used a Markov model while seven studies used a decision tree. Time horizon varied from 5 years to lifetime. Main interventions compared were no screening, biennial mammography, annual mammography and annual mammography combined to MRI. For average-risk women, ICERs for biennial mammography varied between (2015US)$4,715-$21,747/LYG and between (2015US)$7,548-$107,590/QALY compared to no screening, while ICERs for annual mammography ranged from (2015US)$24,124-$40,266/LYG and (2015US)$69,217/QALY. For high-risk women, ICERs for annual mammography ranged from (2015US)$7,221-$39,251/QALY compared to no screening. Also for high-risk women, combined MRI and mammography were associated with ICERs from (2015US)$19,288/QALY to dominant compared to mammography alone. These results include women of any age and mammography of any type.  CONCLUSIONS: Results suggest that annual mammography is mostly cost-effective when compared to no screening. According to a $100,000/QALY threshold, most of analyzed studies suggest that combined screening is cost-effective in high-risk women compared to mammography alone, despite a wide cost-effectiveness ratios range. Notwithstanding the high level of heterogeneity among selected studies, this review provides a comprehensive overview of the cost-effectiveness of BCS and could serve in the realization of future economic evaluations.