Where Guidelines and Practice Don’t Align
At The Full Scoop, our Policy and Systems continuum addresses the structural factors that shape access to risk assessment, screening, and preventive care. We work to ensure that women with elevated risk—due to dense breasts, family history, prior cancer, lifestyle, occupational factors, race/ethnicity, or high-risk scores—can access the screenings and preventive services they need.
While mammograms remain a vital tool for early detection, they are not equally effective for all women. For many, supplemental screening such as MRI or ultrasound can detect cancers that mammograms may miss. Yet systemic barriers—coverage gaps, misaligned guidelines, and inconsistent provider guidance—often prevent timely access.
The Disconnect
Misalignment Between Federal Recommendations and Medical Guidelines
The U.S. Preventive Services Task Force (USPSTF) recently updated its guidelines to recommend recommends biennial mammograms for average-risk women starting at age 40, but does not recommend supplemental screening for women with elevated risk or dense breasts.
Leading medical organizations, including the American College of Radiology (ACR) and American Cancer Society (ACS) advocate for more personalized, risk-based screening:
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Annual mammograms starting at age 40, with earlier screening for elevated-risk women
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Annual MRI for women with ≥20% lifetime risk
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Individualized discussions for women with 15–20% lifetime risk and additional risk factors
This misalignment creates coverage gaps and confusion for patients, providers, and policymakers, resulting in inconsistent care recommendations and unequal access to potentially life-saving screening tools.
Insurance coverage gaps, where recommended care may not be reimbursed, especially under Medicare, Medicaid, and federally guided plans.
Patient confusion, with conflicting guidance, makes it harder for women to navigate their screening options, who may receive different guidance from providers and payers.
Provider and policy confusion, where clinicians must balance evolving evidence with coverage limitations and inconsistent recommendations.
Our Focus: Evidence-Informed Policy and Advocacy
We translate real-world evidence and community insights into actionable policy initiatives to improve equity and access:
Promoting equitable access:
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Ensure all women, regardless of socioeconomic or geographic factors, can access risk-aligned screening options.
Aligning coverage with evidence:
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Advocate for insurance policies that reflect current medical guidance, enabling coverage for supplemental screening when clinically indicated.
Reducing systemic barriers:
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Address structural factors—health system workflows, provider guidance, and community resources—that affect access to preventive care.
Supporting informed decision-making:
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Provide resources for women and providers to navigate complex guidelines, coverage policies, and risk assessment tools.
