Breast cancer remains the most commonly diagnosed cancer for women in the United States. Approximately 1 in 8 women (13%) will be diagnosed with invasive breast cancer at some point in their life, and 1 in 43 (2.3%) will die from the disease.
While many women are aware of the risks elevated by their family history or the presence of mutated BRCA genes, what many don’t know is that 70% to 75% of breast cancer cases are sporadic — that is, they occur in patients with no family history of the disease, further underscoring the importance of regular breast exams and mammograms.
With early detection and treatment, the five-year breast cancer survival rate is almost 100%. In fact, progress in cancer research has improved survival rates for people of all ages and with all stages of breast cancer, resulting in 4.3 million breast cancer survivors in the U.S. as of January 2025.
Unfortunately, despite the clear role that preventive care plays in these survival rates, not all women at risk can readily access these important screenings. Even among those who can, a lack of comprehensive, transparent coverage and pricing information means many are still paying significant out-of-pocket costs, especially if further diagnostic testing is required.
As this year’s Breast Cancer Awareness Month comes to a close, we’re exploring what those expenses look like, their real impact on both plan members and payers, and how they can be minimized with care navigation services offered by Vālenz Health® — helping members access high-value, low-cost healthcare that supports strong, vigorous, and healthy cancer-free lives.
As part of the Affordable Care Act legislation passed in 2010, private insurers are required to cover certain preventive services, including mammograms for eligible women, without charging any deductible, co-pay, or coinsurance.
In theory, this legislation should make preventive mammograms available for free to women in the United States — but, unfortunately, this isn’t always the reality.
Between 2019 and 2022, the total breast cancer screening cost for the healthcare industry was $11 billion, with approximately 37% of eligible women screened each year. As this cost rises, insurers are frequently passing more of those expenses onto members, especially when it comes to follow-up diagnostic testing.
A study conducted in 2016 reveals that many women can (and do) still face significant out-of-pocket charges for services associated with breast cancer screening. Out of 230,000 commercially insured women, participants paid a mean of $75.24 in out-of-pocket costs for subsequent imaging after their initial screening mammogram.
Another study by the American Cancer Society backs up the finding, revealing that the typical patient in 2023 paid $169 for follow-up diagnostic testing. Furthermore, the number of patients facing out-of-pocket cost-sharing for follow-up tests and imaging rose by 8% between 2018 and 2023.
For those who are uninsured, the costs are even greater. Across top U.S. hospitals in 2025, the average chargemaster rate for a screening mammogram was $855 — with an average cash price for the same service being $305.
The same study revealed “wide variation” across hospitals and facilities for chargemaster rates, payer-negotiated rates, and discounted cash rates for mammograms, highlighting an ongoing issue of price discrepancy based on insurance status, facility location, and administering physician.
Bottom line: Despite the promises of the ACA, many women continue to face significant cost barriers to preventive breast cancer screenings.
According to the American Cancer Society, only 67% of women aged 40 years or older had a breast cancer screening in the last two years. Potential out-of-pocket costs are only one reason; today, Americans are frequently delaying much-needed care due to difficulty finding a doctor or facility that accepts their insurance, scheduling challenges, limited appointment availability, and the travel distance required to obtain care.
For those who do receive screening mammograms, the cost of additional diagnostics — both financial and logistical — can deter them from receiving the follow-up care they need.
Studies reveal that patients with higher out-of-pocket costs undergo significantly fewer subsequent diagnostic breast procedures than patients enrolled in plans with lower out-of-pocket costs. In addition, for every $100 increase in the out-of-pocket expenses for baseline mammograms, the likelihood of a patient receiving necessary subsequent screening within 12 to 24 months decreases by 1.9 percentage points.
That’s not even mentioning the time and effort required to schedule additional appointments, especially when many women cite childcare barriers as the primary reason for deferring necessary healthcare.
Unfortunately, by attempting to avoid the costs associated with preventive care maintenance, the costs incurred for those who are ultimately diagnosed with breast cancer later down the line often grow exponentially.
In 2020, treatment costs for breast cancer in the U.S. hit $29.8 billion — the highest of any type of cancer. As one could expect, the cost of treating each individual case depends on how early the disease is caught.
According to one study of Medicare beneficiaries, the 10-year total claims cost of treating breast cancer was directly related to stage at diagnosis, ranging from $103,573 for stage 0 cancers to $376,573 for stage 4 cancers.
In other words, by delaying necessary screenings, breast cancer is more likely to be diagnosed at a later stage — meaning diagnosis and treatment costs are higher for the plan, the payer, and the member with the diagnosis.
Of course, the financial costs of a cancer diagnosis and subsequent treatment are only one factor to consider.
Many cancer patients (and survivors) live with persistent symptoms that affect their quality of life (fatigue, pain, neuropathy, and more), including their daily functioning, relationships, and work. Even years after treatment, 20% of patients in one study reported “deteriorating” or “poor” quality of life.
In addition, studies show that health outcomes and work outcomes are closely linked, with cancer diagnoses leading to negative impacts on work productivity. The silver lining: Employers can play a “pivotal role” in empowering employees living with cancer diagnoses — highlighting the importance of supportive work environments, flexible work arrangements, and, above all, comprehensive healthcare benefits packages.
To reduce the financial and emotional burdens of breast cancer (and improve the care outcomes for a disease growing ever more common), today’s patients should be made aware of and empowered in their options for high-value, low-cost breast screenings and mammograms — before they ever step foot into a medical facility.
Unfortunately, many health plan members are unaware of just how much costs can vary for services like this. According to one study by AKASA, 64% of Americans have never sought out pricing for healthcare services, although 58% of them would be willing to do so if pricing information was disclosed prior to services being rendered.
And that's where Valenz Bluebook comes in.
Valenz Bluebook is a comprehensive cost and quality solution that empowers smarter, more cost-effective healthcare decisions by members. With data for more than 4,000 facilities and 500,000 providers, Valenz Bluebook helps members navigate to the highest-quality provider for their needs, including services like regular mammograms and follow-up diagnostic testing.
Using the Valenz Bluebook Provider Directory, health plan members can review facilities and providers within their network — filtered by coverage, location, and price — to select the best choice for their needs, resulting in an average savings of $1,500 per procedure.
Members can also take advantage of personalized, intuitive care navigation offered through Valenz Clinical Engagement. Whenever they need to, patients can connect with experienced, dedicated Nurse Case Managers, who can coordinate care on their behalf and provide personalized guidance throughout treatment. This includes:
For those members who are less likely to seek out necessary preventive care, the Valenz Bluebook Engagement Rewards program proactively educates and reminds members to get their breast cancer screenings. Through email campaigns and gamification rewards systems, members are encouraged to use the Valenz Bluebook tool to shop for a high-value, “green”-labeled (Fair Price™) facility or provider — and, depending on employer programs, are given monetary rewards for doing so.
With the incidence of breast cancer diagnoses rising significantly over the past few years (along with the associated financial and emotional costs of treating this disease), health plan members simply can’t afford not to receive regular, preventive screenings and diagnostic testing. Unfortunately, the challenges of the modern healthcare system often make doing that easier said than done.
The Valenz integrated healthcare platform exists to fill that gap, guiding members to the high-value, low-cost care they need to live strong, vigorous, and healthy lives.
With solutions like Valenz Bluebook and Clinical Engagement, our team actively supports health plan members through their preventive health journeys, including necessary mammograms and other breast cancer screenings. As a result, we not only reduce member out-of-pocket costs and improve care outcomes but also deliver an average of 3:1 ROI for plan payers who invest in our care navigation solutions.
To learn more about how Valenz can help plan members optimize the utilization of high-value healthcare for breast cancer and other serious medical conditions, contact one of our team members below.