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Recommendations From the Women's Preventive Services Initiative on Breast Cancer Screening for Women at Average Risk
Catherine T Witkop1, Carla Picardo, Alexis Vosooney
1Departments of Preventive Medicine and Gynecologic Surgery & Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, and the American College of Physicians, Philadelphia, Pennsylvania; the Alina Health Group-West St. Paul Clinic, West St. Paul, Minnesota; the Department of Health Systems Science, Kaiser Permanente School of Medicine, Pasadena, the University of Southern California Keck School of Medicine and the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, and KFF (formerly the Kaiser Family Foundation), San Francisco, California; the Departments of Medicine, Family Medicine, and Obstetrics & and Gynecology, Oregon Health & Science University School of Medicine, Portland, Oregon; the American College of Obstetricians and Gynecologists, the National Women's Law Center, the National Partnership for Women & Families, and the National Association of Nurse Practitioners in Women's Health, Washington, DC; the College of Nursing and Health, Loyola University New Orleans, New Orleans, Louisiana; the Department of Obstetrics, Gynecology & Women's Health, Saint Louis University School of Medicine, St. Louis, Missouri; the Division of Geriatrics, University of Utah, Salt Lake City, Utah; the Department of Obstetrics & Gynecology, Columbia University Irving Medical Center, New York, New York; the Department of Community and Family Medicine, Duke University Medical Center, Durham, and the Division of General Internal Medicine and Epidemiology, Department of Medicine, UNC School of Medicine, Chapel Hill, North Carolina; the Office of the President, University of Arizona, Tucson, Arizona; and the American Academy of Family Physicians, Leawood, Kansas.
Abstract:
The Women's Preventive Services Initiative (WPSI) expanded its previous breast cancer screening recommendation-initiate annual or biennial mammography screening for women at average risk of breast cancer between the ages of 40 and 50 years-by including additional imaging and pathology evaluation as part of the screening process if needed. Consistent with the previous recommendation, screening should continue through at least age 74 years, and age alone should not be the basis for discontinuing screening. To increase utilization of screening recommendations, the WPSI also issued a new recommendation to provide patient navigation services for breast and cervical cancer screening. To update its 2016 breast cancer screening recommendation, the WPSI found no new evidence of benefits and harms of screening. However, additional studies reported that gaps in insurance coverage contributed to incomplete follow-up after an initial abnormal mammogram for many women. For its new patient navigation recommendation, the WPSI evaluated 42 randomized controlled trials of patient navigation services for breast and cervical cancer screening and follow-up that showed increased rates compared with usual care. Patient navigation services involve person-to-person contact and are individualized to the patient's specific needs. Services include but are not limited to person-centered assessment and planning, health care access and health system navigation, referrals to support services, and patient education. The new recommendations are intended to expand breast cancer screening follow-up and to improve access and equity for cancer screening. Beginning in 2026, under the Affordable Care Act, these services will be covered without copay or deductible charges for most eligible women.
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