Politics, mammography screening coverage and the Affordable Care Act

The Affordable Care Act (ACA) made great strides forward reducing financial barriers to women’s access to important health care services through the Women’s Health Amendment (WHA).  As a result of the WHA, beginning in 2012, all new plans must cover contraception, STI screening, breast pumps and other preventive services with no additional fees.  However, the Women’s Health Amendment also mandated that all new plans cover mammography screening beginning at age 40, despite the fact that the 2009 update of US Preventive Services Task Force recommendations advised against beginning population-wide routine screening before age 50.  By explicitly prohibiting plans from basing their coverage on the most recent edition of the guidelines, Congress disregarded the weight of current evidence and singled out mammography screening to be treated differently than all other women’s health services.  Why did politics play such an out-sized role ACA coverage of mammography screening?  The author will trace the history of Congressional involvement in mammography screening, including the establishment of mammography as the first screening test covered by Medicare, the creation of the federally funded Breast and Cervical Cancer Detection Act, and its use of Congressional oversight authority.  The role of the breast cancer movement will also be explored by examining the differing perspectives of various advocacy organizations.