Carlsson H, Fridhammar A, Košir U, Hofmarcher T
Health-economic evaluation of extended age ranges and increased participation in breast cancer screening in four major European countries
Breast cancer is the most commonly diagnosed cancer among women in Europe, and mammography screening is an established method for reducing mortality. Since 2022, the Council of the European Union has recommended organised screening for women aged 45–74, but implementation differs across countries. In France, screening covers women aged 50–74, while Germany has recently raised the upper age limit to 75 and plans to lower the minimum age to 45. In Italy, several regions already offer screening to women aged 45–49 and 70–74, and a nationwide expansion is under way. In Spain, the national programme covers women aged 50–69, although several regions apply broader age limits. At the same time, participation remains below the European target of 75% in all four countries: 47% in France, 52% in Germany, 55% in Italy, and 69% in Spain.
The report analyses the health effects and economic consequences of extending the age range to 45–74 years and increasing participation in national screening programmes in France, Germany, Italy, and Spain. The results show that a combination of extended age ranges and a participation rate of 75% could save more than 3,200 lives per year across the four countries, corresponding to a reduction in breast cancer mortality of more than 9%. In France, Germany, and Italy, increasing participation had the largest effects, while raising the upper age limit had the largest impact in Spain, where participation is already relatively high.
Expanded screening leads to higher costs for the screening programmes themselves, but some of these costs are offset by lower treatment costs and reduced productivity losses. Almost all of the scenarios analysed were assessed as cost-effective. Overall, the findings indicate that both extended age ranges and higher participation can reduce breast cancer mortality, but that in several countries the greatest potential lies in encouraging more women who are already offered screening to participate.
Infographic breast cancer screening
IHE REPORT 2026:8, IHE: Lund, Sweden
Cite: Carlsson H, Fridhammar A, Košir U, Hofmarcher T. Health-economic evaluation of extended age ranges and increased participation in breast cancer screening in four major European countries. IHE REPORT 2026:8, IHE: Lund, Sweden.
