Closing the Quality Gap: Breast Cancer Screening

Closing the Quality Gap: Breast Cancer Screening

Mammograms save lives. In the United States, 1 in 8 women will be diagnosed with breast cancer in her lifetime. Screening mammography is the only method proven to reduce breast cancer deaths by detecting the cancer early before signs or symptoms. Early detection can lead to early treatment, more treatment options, and a better chance of survival. The United States Preventive Services Task Force (USPSTF) recommends that women who are 50 to 74 years old and are at average risk for breast cancer get a mammogram every two years.

Breast Cancer Screening as a Quality Measure

There are 10 individual measures included in the 2022 CMS Web Interface targeting high-cost chronic conditions, preventive care, and patient safety. Due to its prevalence and increased risk as individuals age, CMS has included “Breast Cancer Screening” as a quality measure, defined as:

“Percentage of women 50 – 74 years of age who had a mammogram to screen for breast cancer in the 27 months prior to the end of the measurement period.”

This quality measure is included in various Medicare Advantage (MA) and Commercial quality programs. Patients excluded from quality reporting for this measure include those:

  • using hospice or receiving palliative care
  • with advanced illness and frailty diagnoses
  • enrolled in an Institutional Special needs Plan (I-SNP) or living long-term in an institutional setting
  • with a bilateral mastectomy

All types and methods of mammograms are acceptable in meeting quality reporting requirements. This includes screening, diagnostic, film, digital, and digital tomosynthesis. Not counted toward this measure are MRI, ultrasound, and biopsy.

Breast Cancer Screening Tips and Best Practices

  • Consider ordering a mammogram every two years for patients beginning at 50 years old – or sooner when risk factors, such as family history, exist
  • Educate patients about the importance of early detection and encourage testing
  • Engage patients to discuss fears about mammograms and let women know the test is less uncomfortable and uses less radiation than it did in the past
  • Provide female patients with a list of facilities that provide mammograms and schedule for them (if possible)
  • Document date of service (at minimum, the month and year) and result of most recent mammogram in the medical record
  • Document mastectomy and date of service (at a minimum, the year performed) in the medical record

Reference: 2022 Humana Quality Reference Guide, 2022 United Healthcare Quality Reference Guide, 2022 CMS Web Interface Measure Specifications

Tresa Shaw, MSN, RN

Tresa Shaw, MSN, RN

Director of Quality at CHESS