Sustainable breast cancer screening: evaluating the climate impact of mammography in Austria

Abstract Background Healthcare contributes 4.4% of global greenhouse gas emissions, with radiology, including medical imaging production and use, accounting for about 1%. The climate impact of breast cancer screening remains unquantified. As mammography use grows, especially with risk-adjusted protocols based on breast density, reducing low-value care and quantifying environmental burden is critical. This study provides the first life cycle assessment (LCA) of contrast-enhanced mammography (CEM) to inform sustainable screening practices. Methods Within Vienna's VABABS project, we conducted a cradle-to-grave process-based LCA at University Hospital Vienna using ISO 14040/44 standards and an attributional approach. The analysis covered pre-clinical (equipment and consumables), clinical (energy use, travel), and post-clinical (waste) phases of a single patient examination. We used openLCA with ecoinvent version 3.11 database and applied the Environmental Footprint 3.1 method to quantify greenhouse gas emissions in CO2 equivalents (CO2e). Results Preliminary results show that a single CEM exam emits approx. 13.7 kg CO2e. The largest contributor is patient travel (63%, 8.6 kg), followed by consumables and waste (30%, 4.1 kg), energy use (4%, 0.6 kg), staff travel (1%, 0.14 kg), equipment production (0.8%, 0.10 kg), and linens production and laundering (0.5%, 0.07 kg). Conclusions Targeting patient mobility and reducing single-use materials could substantially lower the climate impact of breast cancer screening. We propose three actions: (1) prioritize low-emission patient pathways, (2) reduce single-use items and packaging, and (3) integrate environmental criteria into screening guidelines and health technology assessments. Sustainability must become a cornerstone of radiology and public health policy. Key messages • Our study is the first to measure the full environmental impact of mammography for breast cancer screening, providing data to guide sustainable screening while maintaining health benefits. • Our findings support waste reduction and travel mitigation as effective strategies to cut emissions while preserving diagnostic quality in screening programs.