More Changes to Mammography Recommendations. Are You Still Covered?
In the last several months there have been changes to the breast cancer screening recommendations of some prominent American health organizations. As these organizations review new research and weigh benefits and risks they periodically update their opinions. In October of 2015 the American Cancer Association released new recommendations. The guidelines advised women with average risk for breast cancer to start screening with mammograms between ages of 40-45, if they wish to. After age 50, they state that women should have the choice to continue yearly mammography or switch to every 2 years. Women assessed to have a higher risk of breast cancer are recommended to receive yearly MRI and mammogram, beginning at age 30 or when the woman and her healthcare provider decide it is appropriate.
January 12, 2016 the U.S. Preventive Services Task Force (USPSTF) released its newest recommendations. The new guidelines advise women age 50-74 to seek mammograms for screening every 2 years. Women between 40 and 49 are advised to make a personal decision, weighing the benefits of biannual mammography against the risk of false-positives and unnecessary biopsies.
The recommendations also state:
In addition to false-positive results and unnecessary biopsies, all women undergoing regular screening mammography are at risk for the diagnosis and treatment of noninvasive and invasive breast cancer that would otherwise not have become a threat to their health, or even apparent, during their lifetime (known as “overdiagnosis”). Beginning mammography screening at a younger age and screening more frequently may increase the risk for overdiagnosis and subsequent overtreatment.
The USPSTF was unable to assess the benefits of mammography to women over the age of 75, due to lack of evidence.
These changes in recommendations cause many women to worry that their healthcare insurance will not continue to cover mammograms. The U.S. Department of Health and Human Services recently released a statement to clarify that these new recommendations will not change coverage.
In part, the statement explains:
The Affordable Care Act improved access to health care, including preventive services, for millions of Americans. Today, most health insurance plans are required to cover many preventive services at no out-of-pocket cost to the consumer, including breast cancer screening. Coverage of preventive services improves access to affordable, quality health care, prevents serious health conditions before they start, and empowers women to obtain better care for their health. Specifically, coverage of preventive services without copays increases the likelihood that low-income and minority women receive these important health care services, such as mammography.
Now, without worry about whether they can afford it, American women can make informed decisions about mammography based on science. The updated USPSTF recommendations emphasize the benefits of mammography screening for all women between the ages of 50–74 years; screening can also be beneficial for women in their 40s, but there may be downsides that they should consider. The USPSTF encourages women ages 40-49 to discuss with their doctors the risks and benefits of mammography screening and then make informed decisions that take into account their own values and situations. As with all USPSTF recommendations, the breast cancer screening recommendations will be reevaluated as more science becomes available to better determine the risks and benefits of screening.
This USPSTF recommendation won’t impact coverage requirements. Here’s why:
In December, the President signed a bill that ensures that women’s coverage for mammography will remain the same through 2017. Women 40 years and older enrolled in most health insurance plans will continue to be covered for screening mammography every 1-2 years without copays, coinsurance, or deductibles – just as they are today. If a woman 40 years and older and her doctor determine that a mammogram is appropriate, she will not have to pay out of pocket.
Screening recommendations will continue to be updated as new evidence is considered. The bottom line is for women to stay engaged in discussions with their healthcare providers, to know their personal risk factors and assess their comfort with the balance between early detection and potential false positives.