The U.S. Preventive Services Task Force (USPSTF) recently issued new guidelines for breast cancer screening, recommending that all women undergo screening every other year starting at age 40. This marks a shift from their previous standards, which endorsed screening starting at age 50. The USPSTF is an influential group whose recommendations directly influence payment policies among both commercial and governmental insurers such as Medicare and Medicaid.

Insurance providers may end up aligning their coverage with these new guidelines, leading to increased screening volumes and earlier detection.  Draft recommendations pertain to women at average risk of breast cancer, including those with a family history or dense breasts, but not to women with a personal history of breast cancer or those at “very high risk” due to genetic markers.

The USPSTF also highlighted the need for additional research on whether women with dense breasts should have additional screening with ultrasound or MRI, as well as the benefits and harms of screening women over the age of 75. The task force is also advocating for additional research to better understand the health inequities faced by African American women, who are 40% more likely to die of breast cancer according to the American Cancer Society.

While the American College of Radiology and Society of Breast Imaging believe that all women at average risk should undergo annual mammograms starting at 40, rather than every other year, they still view the new recommendations as a step in the right direction. These organizations also emphasize the need for continued screening past age 74, and for all women to undergo risk assessments for breast cancer by age 25.

The new USPSTF guidelines are open for comment until early June and Advocate will continue to monitor how payers align their coverage with the updated screening recommendations.

As always, ADVOCATE will keep you up to date on this and other issues impacting our industry as they become available.


Kayley Jaquet,

Manager of Regulatory Affairs