ACR and SBI Support Mammography Insurance Coverage Required by New HRSA Breast Cancer Screening Guidelines

Under the Affordable Care Act (ACA), new Health Resources & Services Administration (HRSA) adopted breast cancer screening guidelines requiring private insurers to cover regular mammography screening for women ages 40 and older with no copay. The American College of Radiology (ACR), which took part in the guideline process, and the Society of Breast Imaging (SBI) support such coverage.

The ACA requires private insurers (with certain exceptions) to cover (with no cost-sharing) preventive care and screening exams recommended by HRSA or that receive a grade of “A” or “B” by the U.S. Preventive Services Task force (USPSTF). USPSTF’s failure in 2009 and 2016 to give an “A” or “B” grade to routine mammography screening for women ages 40-49 required Congress to pass legislation to ensure coverage for these women.

HRSA’s adoption of Women’s Preventive Services Initiative (WPSI) guidelines, which include screening women as early as age 40, ensures the USPSTF’s 2016 breast cancer screening recommendations are not used to deny mammography coverage to women 40 and older.

The HRSA adopted guidelines specifically recommend that average-risk women:

• Initiate mammography screening no earlier than age 40 and no later than age 50
• Be screened at least biennially and as frequently as annually
• Continue screening through at least age 74 — and that age alone should not be the basis to stop screening

“All major stakeholders agree that annual mammography screening beginning at age 40 saves the most lives. These HRSA recommendations protect women’s access to screening at the time and frequency of their choosing and that has the best chance of saving their lives,” said Debra Monticciolo, MD, FACR, chair of the American College of Radiology Breast Imaging Commission.

“Women should be able to choose for themselves when to be tested and to have that decision respected in terms of covered access. These recommendations help ensure that women continue to have that screening choice,” said Elizabeth Morris, MD, FACR, FSBI, president of the Society of Breast Imaging.

The American Congress of Obstetricians and Gynecologists (ACOG), National Comprehensive Cancer Network and the American College of Radiology (ACR) and Society of Breast Imaging (SBI) recommend that women start getting annual mammograms at age 40.

For more information regarding mammography and breast cancer screening visit MammographySavesLives.org, RadiologyInfo.org and sbi-online.org/endtheconfusion.