Delivering Quality Care: Cervical and Breast Cancer Screenings

January 13, 2022

Regular screenings for cervical cancer and breast cancer play an important role in women’s health. The new year is an opportunity to remind our members to schedule their screenings, which can detect problems early when they’re easier to treat.

Recommended Screenings

The U.S. Preventive Services Task Force recommends:

  • Screening all women for cervical cancer starting at age 21
  • Screening women ages 50 to 74 for breast cancer every two years. You may want to discuss with members the risks and benefits of starting screening mammograms before age 50.

See our preventive care guidelines for more information.

Closing Gaps in Care

Cervical Cancer Screening and Breast Cancer Screening are Healthcare Effectiveness Data Information Set (HEDIS®) measures developed by the National Committee for Quality Assurance (NCQA). We track data from HEDIS measures to help assess and improve the quality of our members’ care.

For Cervical Cancer Screening, NCQA measures the following:

  • Women ages 21 to 64 who had cervical cytology performed within the last 3 years
  • Women ages 30 to 64 who had either:
    • cervical high-risk human papillomavirus (hrHPV) testing within the last 5 years or
    • cervical cytology/high-risk human papillomavirus (hrHPV) cotesting within the last 5 years

Breast Cancer Screening assesses the percentage of women ages 50 to 74 who had at least one mammogram in the past two years.

Tips to Consider

  • Talk with our members about risk reduction and prevention. We’ve created resources on cervical cancer and breast cancer screenings that may help.
  • Document screenings in the medical record. Indicate the specific date and result.
  • Document medical and surgical history in the medical record, including dates.
  • Use correct diagnosis and procedure codes. Submit claims and encounter data in a timely manner.

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.

HEDIS is a registered trademark of NCQA. Use of this resource is subject to NCQA’s copyright, found here. The NCQA HEDIS measure specification has been adjusted pursuant to NCQA’s Rules for Allowable Adjustments of HEDIS. The adjusted measure specification may be used only for quality improvement purposes.