Abstract PS3-01-23: National cost of the WISDOM risk-based breast cancer screening algorithm with comparison to advocated guidelines

Abstract Background: The WISDOM (Women Informed to Screen Depending on Measures of risk) Study is testing the safety and effectiveness of risk-based breast cancer screening. We aimed to estimate the total, national, yearly cost of screening in the USA if WISDOM’s screening algorithm were used, with comparison to current screening guidelines. Methods: We used Optum Labs Data Warehouse (OLDW) to estimate 2D and 3D- mammograms, and MRI screening and recall costs and rates for commercial and Medicare Advantage insurance. OLDW contains longitudinal de-identified administrative, medical, and pharmacy claims for over 200 million commercial and Medicare Advantage enrollees and patients. Screening and recall costs were normalized to calendar year 2020. We used real-world participation rates by age of 54-78%. The risk-based strategy included a cost of USD$270 for genetic testing and risk assessment. We modeled three guidelines: 2021/2023 American College of Radiology (ACR), 2023 American Cancer Society (ACS), and 2024 United States Preventative Services Task Force (USPSTF). The percentage of high-risk/average-risk women per guideline were estimated using the literature. Total cost of screening was calculated as the sum of screening and recall costs. The average lifetime cost of screening per woman until 74 years was also calculated. One-way deterministic sensitivity analysis was used to determine the impact of inputs on the aggregate cost. Results: Median mammogram costs ranged from $139-$360, MRI costs ranged from $545-$2,439, while recall rates ranged from 9.2%-20.9%. The projected national cost of screening was $30B for ACR, $18B for ACS, $8B for USPSTF, and $7B for WISDOM. The average lifetime cost through age 74 years to screen a high-risk/average-risk woman was: $89,725/$13,416 for ACR, $89,725/$7,946 for ACS, $6,931/$6,931 for USPSTF, and $66,451/$6,618 for WISDOM. For USPSTF, the cost of screening high-risk/average-risk women were the same because these women were screened the same. Participation rates, proportion of women with a lifetime risk >20%, and commercial MRI and 3D costs had the largest impact on total costs. Conclusion: WISDOM’s risk-based screening algorithm can reduce national cost substantially, even with the added cost of genetic testing, while maintaining intensive screening for the highest-risk women. The resources saved can be used to improve screening for women at high risk for fast-growing cancers, which are often identified between screens, and to encourage improved adherence. Citation Format: K. Badal, J. Staib, J. A. Tice, M. Kim, M. Eklund, L. Wilson, S. Dacosta Byfield, K. Catlett, L. Maffey, R. Soonavala, A. Stover Fiscalini, L. Esserman. National cost of the WISDOM risk-based breast cancer screening algorithm with comparison to advocated guidelines [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-01-23.