• Michael T Halpern, Benmei Liu, Douglas R Lowy, Samir Gupta, Jennifer M Croswell, and V Paul Doria-Rose.
• Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland (M.T.H., B.L., J.M.C., V.P.D.).
• Ann. Intern. Med. 2024 Sep 1; 177 (9): 117011781170-1178.

BackgroundCancer has substantial health, quality-of-life, and economic impacts. Screening may decrease cancer mortality and treatment costs, but the cost of screening in the United States is unknown.ObjectiveTo estimate the annual cost of initial cancer screening (that is, screening without follow-up costs) in the United States in 2021.DesignModel using national health care survey and cost resources data.SettingU.S. health care systems and institutions.ParticipantsPeople eligible for breast, cervical, colorectal, lung, and prostate cancer screening with available data.MeasurementsThe number of people screened and associated health care system costs by insurance status in 2021 dollars.ResultsTotal health care system costs for initial cancer screenings in the United States in 2021 were estimated at $43 billion. Approximately 88.3% of costs were attributable to private insurance; 8.5% to Medicare; and 3.2% to Medicaid, other government programs, and uninsured persons. Screening for colorectal cancer represented approximately 64% of the total cost; screening colonoscopy represented about 55% of the total. Facility costs (amounts paid to facilities where testing occurred) were major drivers of the total estimated costs of screening.LimitationsAll data on receipt of cancer screening are based on self-report from national health care surveys. Estimates do not include costs of follow-up for positive or abnormal screening results. Variations in costs based on geography and provider or health care organization are not fully captured.ConclusionThe $43 billion estimated annual cost for initial cancer screening in the United States in 2021 is less than the reported annual cost of cancer treatment in the United States in the first 12 months after diagnosis. Identification of cancer screening costs and their drivers is critical to help inform policy and develop programmatic priorities, particularly for enhancing access to recommended cancer screening services.Primary Funding SourceNone.

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