OBJECTIVES: To describe the burden of recall following traditional screening mammography from the perspective of US self-insured employers.   METHODS: The Truven Health MarketScan Commercial and Health and Productivity Management Databases were used to identify female employees aged 40-65 years undergoing screening mammography (index event) in 2010-2012 with at least 12 months pre- and 6 months post-index continuous enrollment; patients with a breast cancer diagnosis in the pre-index period were excluded.  Recall was defined as receipt of diagnostic mammogram or ultrasound in the six months following the index screen. Employer cost per recall (2013 US$) was the sum of breast-related imagining procedures and associated diagnostic procedure costs in the 6 months post-index, excluding patient payments and breast cancer treatment costs.  Absenteeism costs were calculated using a wage constant ($38/hour).  RESULTS: Of the 339,912 patients who met the study criteria, 47,321 (13.4%) underwent additional diagnostic imaging within 6 months post-index with an average direct medical cost to employers of $1,279 per patient recalled.  Nearly one-fourth (23.4%) of recall costs was attributable to additional imaging (diagnostic mammography or ultrasound), 40.0% was attributable to guided biopsy and 28.0% attributable to open biopsy.  One-fifth (21.9%) of recalled patients had at least two days with recall-related procedures while 4.2% had at least three recall event days.  Absenteeism costs were $948 in the 30 days following recall among patients with absenteeism claims (67.2%), increasing to $4,472 over 6 months post-recall among patients with absenteeism claims (81.9%). Short-term disability claims increased following recall (4.0% vs. 4.4%, p<0.01), with an average cost per claim of $10,849. CONCLUSIONS: Recall following traditional mammography represents a significant cost burden to employers with nearly one-in-six female employees with a new screening mammogram undergoing additional diagnostic imaging and associated procedures.  Strategies to reduce the burden of recall should not ignore indirect employer costs.