Breast Cancer Screening (BCS-E)

This measure assesses the percentage of members 50–74 years of age recommended for routine breast cancer screening who had a biennial mammogram to screen for breast cancer.

Why It Matters

Breast cancer is the second most common type of cancer among American women. In 2013, over 3 million women were estimated to be living with breast cancer. Advancing age is the primary risk factor for breast cancer, which is most commonly diagnosed between 55 and 64.¹

Mammograms are the best method to detect early breast cancer, before it is big enough to feel or cause symptoms and is easier to treat.² Detecting early breast cancer via mammography can provide people with a greater range of treatment options, such as less aggressive surgery (e.g., lumpectomy vs. mastectomy), less toxic chemotherapy or the option to forego chemotherapy. Mammography can also reduce the risk of dying from breast cancer by 20%.³

Conversely, mammography can lead people to be diagnosed and treated for noninvasive or invasive breast cancer that would otherwise not have become a health threat during their lifetime. It could produce false-positive results, which may lead to invasive follow-up examinations like biopsies and cause women to experience anxiety, or false-negative results in which cancer is missed. Mammography exposes people to radiation, though the risk of radiation-induced breast cancer has been found to be minimal.⁴

Given the benefits and risks of mammography, major clinical organizations have developed guidelines on the attributes of screening programs that produce the highest net benefit for women. The U.S. Preventive Services Task Force (USPSTF) and the American College of Physicians recommend that women ages 50–74 should have biennial screening. These organizations note that, for women 40–49, the decision to start screening should be an individual one.⁵ The American Cancer Society recommends that women 40–44 should have a choice about whether to have annual mammograms, and recommends annual mammograms start by age 45.⁶ The American College of Obstetricians and Gynecologists, the National Comprehensive Cancer Network (NCCN) and the American College of Radiology (ACR) recommend annual mammograms for women ages 40 and older.^7,8,9

Additional guidelines from the University of California San Francisco Center of Excellence for Transgender Health,¹⁰ World Professional Association for Transgender Health¹¹and The Fenway Institute12 recommend breast cancer screening for transgender and gender-diverse patients assigned female at birth or with breasts from natal puberty, as well as transgender and gender-diverse patients assigned male at birth with at least 5–10 years of exposure to gender-affirming estrogen therapy, excluding those with bilateral mastectomy or chest reconstruction.

Digital breast tomosynthesis (DBT), a newer mammography technology, uses three-dimensional (3D) images. The USPSTF states that the current evidence is insufficient to assess the balance of benefits and harms of using DBT as a primary screening method for women at average risk of breast cancer. Screening for women at higher risk for breast cancer was not within the scope of USPSTF recommendations.⁴ The NCCN and the ACR recommend using conventional mammography or DBT for screening women at low, intermediate or high risk for breast cancer.^7,8

Studies have found that DBT may reduce false positives and detect slightly more invasive cancers than conventional mammography alone, but there are potential risks. It is not clear whether the extra cases detected by DBT are clinically significant or that DBT reduces morbidity or mortality,⁴ and there could be increased costs for patients, based their benefits plan. The earliest-approved DBT method that involves a 3D imaging procedure and a conventional mammography procedure has about twice the radiation dose than conventional mammography alone. A newer DBT method uses one imaging procedure and software to reconstruct images; it delivers radiation dose levels similar to conventional digital mammography. Given these concerns, experts in the field emphasize the need for engaging patients in shared decision making when considering mammography screening.⁷

Historical Results – National Averages

§ Not available due to CMS suspension of data reporting during COVID-19 pandemic.

This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.

Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via my.ncqa.org for analysis that accounts for trend breaks.