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Evaluating & Reducing Breast Cancer Risk

According to the American Cancer Society (ACS), breast cancer is the second most common form of cancer among women and the second leading cause of death among women. An estimated 182,460 new cases of invasive breast cancer are expected to occur among women in the U.S. during 2008. An estimated 40,930 breast cancer deaths are expected in 2008 (40,480 in women and 450 in men). No one knows why some women develop breast cancer and others do not. Researchers have found that certain risk factors, such as a woman’s age when she had her first menstrual period or when she had her first baby, can influence her chance of getting the disease. The risk of breast cancer increases as women get older, with the majority of breast cancer cases occurring in women older than age 50.

The Breast Cancer Risk Assessment Tool is a computer program developed by the National Cancer Institute. Health care providers can use this tool to estimate a woman’s chance of developing breast cancer based on several recognized risk factors. This tool estimates a woman’s risk of developing breast cancer over the next five years, as well as over her entire lifetime.

Go to the Breast Cancer Risk Assessment Tool program.

Breast Cancer Risk Evaluation & Risk Reduction

Over the past several years, considerable developments have occurred in the area of evaluating and reducing breast cancer risk. Although there have been recent contradictions in medical literature regarding the value of screening mammography and breast self-examination, AmeriHealth continues to support the United States Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS) recommendations for screening mammography in women age 40 and older.

Download Evaluating & Reducing Breast Cancer Risk.

The monograph summarizes how to assess an individual woman’s breast cancer risk and how to determine appropriate cancer risk reduction strategies. Please remind your patients to refer to their benefit description material for the complete details of the terms, limitations, and exclusions of their coverage.

As a result of the feedback received from our members, we have made the following changes to our mammography reminder program and our mammography benefit policies:

Improvements in AmeriHealth Mammography Program
Improvement Description
Added more than 200,000 women to our reminder program Since October 2001, women between 40 and 49 years of age have been added to our mammography reminder program (previously sent to women 50 years and older).
Eliminated need for mammogram referral forms Since February 2001, a PCP referral for screening and diagnostic mammograms is no longer required for HMO members.
Please note: There are radiology sites that require a prescription before they will perform a mammogram. Diagnosis codes may be required.
Introduced calendar reminder stickers Our Preventive Health Services Department conducted a survey among members asking how AmeriHealth could improve its reminder program. The most common response was, “My mammography screening schedule does not coincide with my birthday.” As a result, calendar stickers have been created to assist women to schedule and receive their mammogram based on their personal schedule.
Eliminated age limitations Coverage restrictions for mammograms based on the age of the member have been eliminated.
Eliminated distinction between “screening” and “diagnostic” mammograms. Appropriate codes may be required The screening mammogram benefit will cover mammograms coded as either “screening” or “diagnostic.”
Eliminated frequency distinctions There is no coverage limit to the number of medically required mammograms members may obtain within a given time period.
Eliminated copayments, deductibles, and coinsurance for in-network services Since April 2002, mammograms performed at a network radiology site are not subject to deductibles and coinsurance.
Mammograms can be obtained at any participating network facility Since October 2000, HMO members do not have to go to capitated radiology sites for mammograms.

Important information about links to other sites