In low and middle-income countries mammographic breast cancer screening is prohibitively expensive and a cheaper alternative option is to use ultrasound as the primary screening test. In 2009, China launched a breast cancer screening programme for rural women with ultrasound and clinical breast examination as the primary screening tool. This study aimed to analyse the cost-effectiveness of breast cancer screening compared to no screening among Chinese rural women. We developed a Markov model to estimate the lifetime costs and effects for rural women aged 35 years from a societal perspective. Asymptomatic women in the intervention arm were screened every three years before age 64 years. Breast cancer in the non-screening arm can only be diagnosed on presentation of symptoms. Parameter uncertainty was explored using one-way and probabilistic sensitivity analyses. Compared to no screening, breast cancer screening cost $186·72 more and led to a loss of 0·20 quality-adjusted life years (QALYs). Breast cancer screening was more expensive and did harm to health among Chinese rural women with an incremental cost-effectiveness ratio (ICER) of $-916/QALY. The sensitivity analysis identified disutility from false positives as the factor that most influenced the results, but this did not affect the conclusions. In a rural setting with such low incidence, screening for asymptomatic disease is not cost-effective with current screening tools. Instead, priority should be given to ensure that symptomatic women have proper access to diagnosis and treatment at an early stage as this will lead to reductions in mortality from the disease without the usual harms associated with screening.