Medicare to Continue Paying for Annual Mammograms
for All Women Over Age 40
HHS Secretary Kathleen Sebelius says controversial
breast screening recommendation by U.S. task force is not government
policy
Nov. 19, 2009 HHS Secretary Kathleen Sebelius
made it clear yesterday that Medicare will not be changing its policy of
paying for annual mammograms for women beginning at age 40 and
continuing for life, despite recommendations by a government task force
that women in their 40s and those age 75 and older should not get the
breast cancer test that often unless recommended by their doctor.
Recommendation for breast exams from age 50
- 74, not enough known to make firm decision on women 75 up;
American Cancer Society sticks with test as long as you are healthy
There is no question that the U.S. Preventive
Services Task Force Recommendations have caused a great deal of
confusion and worry among women and their families across this country.
I want to address that confusion head on, said Sec. Sebelius.
The U.S. Preventive Task Force is an outside
independent panel of doctors and scientists who make recommendations.
They do not set federal policy and they dont determine what services
are covered by the federal government.
The USPTF recommended against routine screening
mammography in women aged 40 to 49 years.
The task force also said there is not enough
evidence to make a solid recommendation for women age 75 or older,
basically leaving the question up to these older women and their
doctors.
Neither of these recommendations was in sync with
the positions of the American Cancer Society or the practices encouraged
by Medicare. The ACS recommends women begin annual mammograms at age 40
and continue as long as there are in good health.
Risk of Being Diagnosed with Cancer: 2004-2006
All U.S. Females 10-Year Risk by Age
Age
10-Yr.
Percent (%)
0
0.00
10
0.00
20
0.06
30
0.44
40
1.44
50
2.39
60
3.40
70
3.73
80
3.04
National Cancer Institute
The Medicare policy says, Medicare covers an
annual screening mammogram for all women with Medicare ages 40 and
older. A doctor's prescription or referral is not necessary for Medicare
payment.
Most people covered my Medicare are age 65 or
older, but the program does cover younger people when they are disabled.
The USPSTF report does suggest more testing should
be done to get a better understanding of the potential value in
screening women 75 and older.
There has been debate in this country for years
about the age at which routine screening mammograms should begin, and
how often they should be given, noted the Sebelius.
The Task Force has presented some new evidence for
consideration but our policies remain unchanged. Indeed, I would be very
surprised if any private insurance company changed its mammography
coverage decisions as a result of this action.
What is clear is that there is a great need for
more evidence, more research and more scientific innovation to help
women prevent, detect, and fight breast cancer, the second leading cause
of cancer deaths among women.
My message to women is simple. Mammograms have
always been an important life-saving tool in the fight against breast
cancer and they still are today. Keep doing what you have been doing for
years -- talk to your doctor about your individual history, ask
questions, and make the decision that is right for you.
Median Age of Breast Cancer Diagnosis
From
2002-2006, the median age at diagnosis
for cancer of the breast was 61 years of age
Approximately
►
0.0% were diagnosed under age 20;
►
1.9% between 20 and 34;
►
10.5% between 35 and 44;
►
22.5% between 45 and 54;
►
23.7% between 55 and 64;
►
19.6% between 65 and 74;
►
16.2% between 75 and 84; and
►
5.5% 85+ years of age.
Women in there 70s and even their 80s are much more
likely to develop breast cancer than are women in their 40s and 50s.
And, too, it is surprising to many that the debate over the task force
recommendations has focused on their lack of support for testing those
age 40 through 49, rather than their lack of support for testing women
over age 74, who are much more likely to develop breast cancer.
More than 20 percent of breast cancers are
discovered in U.S. women age 75 or older. That is about one out of every
five.
Medicare Mammography
Overview
The Mammography section provides information and
resources related to the coverage, billing, delivery, and promotion of
screening mammography. Medicare covers an annual screening mammogram
for all women with Medicare ages 40 and older. A doctor's prescription
or referral is not necessary for Medicare payment.
This page provides general facts about mammography
and links to other resources.
General Facts
Introduction:
● Breast cancer is the second leading cause of
cancer deaths after lung cancer.
● Every woman is at risk, and the risk of breast
cancer increases with age. Approximately 94% of breast cancers are
diagnosed in women over age 40 (CDC).
● Mammography is the best available way to
detect breast cancer early, when it is most curable. Timely screening
can reduce breast cancer mortality in women 40 and older by 17% to 30%
(CDC).
● A mammogram is a low-dose x-ray of the breast
which can find lumps that are too small to be felt during a clinical
breast examination.
What Medicare Covers:
● All women with Medicare ages 40 and older are
eligible to receive a screening mammogram every 12 months. Medicare also
covers digital technologies for screening mammograms.
● Medicare pays for one baseline mammogram for
women with Medicare between ages 35 and 39.
● A doctor's prescription or referral is not
necessary for Medicare payment of screening mammograms.
● There is no Part B deductible, but a 20%
coinsurance or co-payment applies.
Other Helpful Information:
● Despite Medicare coverage, mammography rates
are suboptimal. In 2000, approximately 68% of women ages 65 and older
reported having a mammogram within the past two years (Federal
Interagency Forum on Aging-Related Statistics).
● CMS is conducting the national Medicare
Mammography Campaign to improve beneficiaries' knowledge of breast
cancer screening and awareness of Medicare's annual screening
mammography benefit. The campaign also targets health care providers to
encourage them to promote screening mammography to their patients.
Nov. 19, 2009 HHS Secretary Kathleen Sebelius
made it clear yesterday that Medicare will not be changing its policy of
paying for annual mammograms for women beginning at age 40 and
continuing for life, despite recommendations by a government task force
that women in their 40s and those age 75 and older should not get the
breast cancer test that often unless recommended by their doctor.