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The aim was to assess the effect of population-based mammography screening on treatment costs for fatal breast cancer in Turku, Finland.The study included 556 women with invasive breast cancer, diagnosed at the age of 40-74 years in 1987-1993: 427 in the screened group (screen-detected or interval cancer) and 129 in the unscreened group (not yet invited or refused screening). Both groups were followed up for 8 years from diagnosis.In the unscreened group, 32 (25%) patients died of breast cancer versus 49 (12%) in the screened group (p < 0.001). The non-discounted mean treatment costs were 2.8-fold for those dying of breast cancer compared to survivors: €26,222 versus €9,434; the difference between means was €16,788 (95% CI 14,915-18,660) (p < 0.001). The mean costs for fatal cases were high, irrespective of the way cancer was detected: €23,800 in the unscreened group versus €27,803 in the screened group; the difference between means was €−4,003 (−10,810 to 2802) (p = 0.245). In the unscreened group, patients with fatal breast cancer accounted for 41% (€0.76/1.87 million) of the total treatment costs versus 29% (€1.36/4.76 million) in the screened group. It was estimated that about one third of costs for fatal breast cancer were avoided through mammography screening, accounting for 72-81% of the estimated total treatment cost savings achieved by screening. About 31-35% of the screening costs for 1987 to 1993 were offset by savings in treatment costs.Treatment costs for fatal breast cancer are high. Mammography screening results in substantial treatment cost savings, in which reduction of fatal disease is the key element.