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 CO(2)e. 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.