Policy Archive

Protect Access to Free Annual Screening Mammograms for Women Ages 40-49

This year, it is estimated that 281,550 new cases of invasive breast cancer will be diagnosed, and more than 43,600 Americans will die from the disease. Death rates have been steady in women under 50 since 2007, but have continued to drop in older women. Early-onset, aggressive breast cancers are more common in the hereditary cancer community. The PALS Act ensures that access to annual mammograms for women starting at age 40 will remain covered by insurance without cost-sharing requirements.

Originally enacted in 2015, the Protecting Access to Lifesaving Screening (PALS) Act places a moratorium on the U.S. Preventive Services Task Force (USPSTF) recommendation that breast screening for women ages 40-49 should only be performed selectively, while women ages 50-74 should have mammograms bi-annually. Because many insurance companies use these guidelines as the basis for coverage of preventive screenings, over 20 million women between the ages of 40 and 49 may lose coverage for lifesaving mammograms. Since 2015, four appropriations bills have included moratorium extensions, currently set to expire on January 1, 2023. The PALS Act reauthorization seeks to make the following changes and clarifications to the current statute. It will:

• Extend the PALS Act moratorium through January 1, 2028
• Clarify that women in the armed forces should benefit from this same screening mammography protection starting at age 40
• Make clear that the statutory language, which states “all modalities,” is intended to include breast tomosynthesis/3D mammography

It is important to note that the above breast screening guidelines are for women considered "average risk" for breast cancer. Women at increased risk of breast cancer due to an inherited genetic mutation or family history of the disease often need earlier, more intensive screening. See the Risk Management Guidelines for more information as recommendations vary for different hereditary mutations.