American Cancer Society Breast Cancer Screening Guidelines
Who: Women of all ages, but particularly women above age 45, whether insured or not.
When: On October 20, 2015 the American Cancer Society (ACS) published new guidelines for breast cancer screenings in the Journal of American Medical Association.
What: The American Cancer Society updated its screening guidelines based upon new studies and recommends breast cancer screenings for most female adults.
Executive Summary: The ACS guidelines for women at “average risk” for breast cancer are:
Women at “increased risk” may need a different testing schedule. Increased risk includes women who:
1. Have a lifetime risk of breast cancer of 15-20% based on family history.
2. Have a personal history of breast cancer, ductal carcinoma in stiu, lobular carcinoma in situ, atypical ductal hyperplasia, or atypical lobular hyperplasia.
Women at “high risk” should get an MRI with MRI-guided breast biopsy and a mammogram every year. High risk includes women who:
1. Have a lifetime risk of breast cancer about 20-25% based on family history.
2. Have known BRCA1 or BRCA2 gene mutation
3. Have 1st degree relative with the gene mutation and have not had genetic testing themselves.
4. Had radiation therapy to the chest between ages 10-30.
5. Have Li-Fraumeni syndrome, Cowden syndrome, mor Bannayan-Riley-Ruvalcaba syndrome, or have 1st degree relatives with one of these syndromes.
The ACS guidelines should NOT be confused with the 100% preventive care cancer screening requirements mandated by the ACA. USPSTF recommendations are: “A” (strongly recommend), “B” (recommend), “C” (No recommendation), “D” (recommend against) and “I” (insufficient evidence). Grades “A” and “B” are ACA mandates requiring 100% coverage (no patient cost sharing).
Actions: Women may want to follow their preferred screening schedule with the recognition that some may not be covered by insurance. Plan sponsors should consult with their agent, broker, plan consultant, legal counsel, and/or Human Resources Department to determine if plan benefits for breast cancer screenings should follow ACS guidelines or the ACA preventive care mandates. In addition, state laws may require a different set of breast cancer screenings. Plans should also assure that their employee notifications properly inform plan participants of any the benefits and any changes.
The information presented and contained within this article was submitted by Ronald E. Bachman, President & CEO of Healthcare Visions and Chairman of the IHC Editorial Advisory Board. This information is general information only, and does not, and is not intended to constitute legal advice. You should consult legal advisors to determine the laws and regulations applicable to your company. Any opinions expressed within this document are solely the opinion of the individual author.