In a widely reported update this week, the U.S. Preventive Services Task Force (USPSTF) announced a major revision to its breast cancer screening recommendations. The task force now recommends biennial screening mammography for women, beginning at the age of 40 until they reach 74 years. Previously, the USPSTF's recommendation called for screening women age 50 or more. In 2009, the USPSTF recommended biennial screening mammography for women aged 50 to 74 years and concluded that the decision to start screening mammography in women prior to age 50 years should be an individual one. This remained the USPSTF recommendation until now.

Both the American Cancer Society and the American College of Radiology have long recommended annual mammography screening for women in their 40s. The USPSTF's new recommendations are welcome news to advocates for breast cancer prevention, even though the task force recommends screening only every other year.  

But the recent legal decision by a Federal District Court judge in Texas raises questions about the potential impact of the new USPSTF recommendations on when mammography screening should begin.

Those questions result from the recent Federal court ruling in the case of Braidwood Management, Inc., et al. v. Xavier Becerra, et al. in the U.S. District Court for the Northern District of Texas, in which the Patient Protection and Affordable Care Act's (ACA's) preventive service insurance mandate for services recommended by the USPSTF was vacated nationally. The ACA mandates that group health plans and health insurers cover a long list of preventive health services like cancer screenings, immunizations and contraceptives without out-of-pocket, co-insurance and deductible costs to patients. The Braidwood Management ruling applies to services recommended by the task force made after 2010 when the ACA was enacted. 

Despite the ruling, certain aspects of mammography screening services are believed to remain covered without out-of-pocket costs because they were recommended by the USPSTF prior to the ACA's enactment 2010. As noted above, biennial mammography screening was included as a USPSTF recommended service in 2010, but it was limited to adults ages 50 to 75. 

With the newly expanded USPSTF recommendation for mammography screening for women ages 40 to 74, will women in their 40s continue to face cost barriers to mammography screening? 

So, while it is certainly welcome news to see the expanded breast cancer screening recommendations published, we will likely have to await the outcome of the appeal that has been filed by the US Department of Jusice in the Braidwood Management case before we will know whether the new USPSTF recommendation will be mandated for coverage without patient co-pay and deductible obligation. Stay tuned.