Shaheen, McSally Lead Bipartisan Push to Expand Breast Cancer Screenings for U.S. Service Members, Veterans

(Washington, DC) – U.S. Senator Jeanne Shaheen (D-NH) and Martha McSally (R-AZ) led a bipartisan letter yesterday urging the Department of Defense (DoD) to expand and improve breast cancer screening coverage options for female service members and veterans. Senators Kyrsten Sinema (D-AZ), Marsha Blackburn (R-TN), Shelley Moore Capito (R-WV), Susan M. Collins (R-ME), Kirsten Gillibrand (D-NY), Kamala D. Harris (D-CA), Cindy Hyde-Smith (R-MS), Amy Klobuchar (D-MN) and Elizabeth Warren (D-MA) co-signed the letter. 

In a letter to Assistant Secretary of Defense for Health Affairs Thomas McCaffery, the Senators requested that the DoD expand TRICARE’s coverage to include Digital Breast Tomosynthesis, also known as DBT or 3D mammography. This additional coverage would ensure that women who have served or currently serve in the armed forces have access to the newest medical and technological advancements that have the best possible chance of detecting breast cancer early.

“Digital Breast Tomosynthesis (also known as DBT or 3D mammography), which is now the standard of care in all 50 states, was developed to address the limitations of two-dimensional imaging by allowing the breast to be examined layer by layer,” the Senators wrote.  “Currently, TRICARE is the only national payer that does not cover preventative screening with DBT, creating a lower standard of care for the women who serve in our Armed Forces. It is only upon discovering a lump in which TRICARE covers 3D mammograms. We ask that the MHS address this disservice to those who protect our country, and we urge TRICARE to promptly implement positive coverage for DBT screening.”

In June, Shaheen introduced bipartisan legislation with Senators Marsha Blackburn (D-TN) and Diane Feinstein (D-CA) to improve access to lifesaving breast cancer screenings. The Protecting Access to Lifesaving Screenings (PALS) Act of 2019 would postpone recommendations from the U.S. Preventive Services Task Force (USPSTF) that would limit access to breast cancer screenings for women in their 40s. It would continue the moratorium on the USPSTF recommendations, which Congress has extended several times.

You can find a copy of the letter HERE and below.

Dear Mr. McCaffery:

On behalf of our nation’s servicemembers, military family members, and veterans, we write to express our concern with TRICARE’s current breast cancer screening coverage options, and urge the Military Health System (MHS) to take action. Breast cancer is the second leading cause of cancer deaths among women, exceeded only by lung cancer. However, when detected in an early and localized stage, overall chance of survival increases dramatically, which is why accurate and efficient screening is essential. 

While digital mammography screening is covered by TRICARE, the technology only provides a two-dimensional image of the breast and therefore has inherent limitations in detecting cancer. Digital Breast Tomosynthesis (also known as DBT or 3D mammography), which is now the standard of care in all 50 states, was developed to address the limitations of two-dimensional imaging by allowing the breast to be examined layer by layer. Hundreds of recent studies have shown that DBT is superior in breast cancer detection, as well as in the reduction of unnecessary recalls from screening. Currently, TRICARE is the only national payer that does not cover preventative screening with DBT, creating a lower standard of care for the women who serve in our armed forces. It is only upon discovering a lump in which TRICARE covers 3D mammograms. We ask that the MHS address this disservice to those who protect our country, and we urge TRICARE to promptly implement positive coverage for DBT screening. 

In the United States, 93 percent of women aged 40-74 have insurance coverage and reimbursement for DBT through Medicare, Medicaid, or private insurance (including United, Aetna, Anthem, Cigna, and Humana). In 2015, Medicare established coverage and reimbursement for all Medicare beneficiaries, both in screening and diagnostic testing. Additionally, the Department of Veterans Affairs has established DBT as an approved breast cancer screening procedure under the medical benefits package. Without coverage from TRICARE, many servicewomen are unable to receive the optimal care to which other women have access, or are forced to pay out-of-pocket for the exam. The 2019 Medicare national average for a DBT screening exam is $55.86, a cost that is minimal in comparison to the cost of additional testing and treatment that may be required if cancer is not detected in its early stages. DBT has now been on the market for seven years, and we strongly urge coverage to be added for TRICARE beneficiaries. 

Providing superior care to our servicemembers should be a top priority for the MHS. The lack of coverage for DBT denies women who served or currently serve in the armed forces the most effective imaging option, particularly for women with dense breast tissue Over 250 peer reviewed clinical studies have demonstrated that DBT provides earlier breast cancer detection, including detection of 20 to 65 percent of more invasive breast cancer. It also reduces the chance of callbacks or additional screening by nearly 40 percent, which means greater cost effectiveness overall. The 3D imaging capability, which more than 50 percent of mammography machines in the United States possess, allows for superior breast cancer detection in women with dense breast tissue. The federal government is now requiring mammography providers to inform all patients of their breast density, a known risk factor for breast cancer. This implies that some of our servicemembers on TRICARE will receive a notice that they may be at risk, but will be denied coverage for screening with DBT. 

TRICARE remains the only national payer that does not provide coverage for DBT, and their beneficiaries continue to be put at a disadvantage. We urge you to implement coverage for DBT so that our servicemembers are provided with the efficient screening and care they deserve.

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