What to know about prevention and coverage
By KFF News
October is Breast Cancer Awareness Month — a good time to take stock of what you know about your breast health and the and preventive services available to you.
The hopeful news: When breast cancer is caught in its earliest, localized stages, the five-year relative survival rate is more than 99 percent.
From routine mammograms to genetic testing for women at higher risk, knowing when to screen — and what your insurance may cover — can make early detection and preventive care more accessible.
Among women in the United States, breast cancer is the most diagnosed cancer and the second leading cause of cancer death. In 2021, an estimated 4 million women in the U.S. were living with breast cancer.
Breast cancer makes up about 16% of all new cancer diagnoses in the U.S., and approximately 1 in 8 women will be diagnosed with breast cancer during their lifetime.
In 2025, there will be an estimated 316,950 new cases of female breast cancer and 42,170 deaths attributable to breast cancer in the U.S.
Breast cancer is most often diagnosed among middle-aged and older women, with 71% of new cases diagnosed among women 55 and older.
Most breast cancers are diagnosed at an early stage. Sixty-six percent of breast cancers diagnosed are localized, meaning they are found only in the organ in which they started; 25% are regional, meaning the cancer has spread to surrounding organs; and 6% have metastasized, meaning the cancer has spread to other regions of the body.
Risk factors for breast cancer include, but are not limited to, a personal or family history of breast cancer, genetic predispositions, breast density, obesity, drinking alcohol, early menstruation and delayed menopause.
In the U.S., while white women have the highest incidence of breast cancer, black women have higher breast cancer mortality rates. These disparities are likely attributable to a combination of factors, such as differences in stage at diagnoses, as well as disparities in access to , follow-up care and treatment.
Although very rare (less than 1%), men can develop breast cancer. In 2025, there will be approximately 2,800 cases of male breast cancer diagnosed and 510 deaths.
Costs Covered
While several health organizations issue guidelines for breast cancer and prevention, private insurance coverage of clinical preventive services under the ACA is governed by recommendations from the United States Preventive Services Task Force (USPSTF) and the Health Resources and Services Administration (HRSA).
Under these guidelines, private group and individual insurance plans and state Medicaid expansion programs must cover the following breast cancer and prevention services at no cost:
- mammography at least every 2 years and as frequently as once a year for women ages 40 to 74 with average-risk for breast cancer
- Genetic counseling and testing for mutation of the BRCA1 and BRCA2 genes in some women with a personal or family history of breast, ovarian, fallopian tube, or peritoneal cancer.
- Preventive medication for some women with elevated risk of breast cancer and at low risk for adverse medication effects.
Screening Basics
Screening mammography is a low-dose x-ray that provides images of the internal structures of the breast and is the most common test for breast cancer.
Across the U.S., 76.5% of women ages 50-74 reported having had a mammogram in the past two years.
Mammograms are the most used imaging method for breast cancer , but dense breasts can be difficult to interpret with this technique. Fibroglandular tissue and masses in the breast appear similarly in mammogram images, meaning cancerous masses may go undetected in someone with dense breasts. Additional imaging such as ultrasound, MRI, or digital breast tomosynthesis (DBT) may be needed to complete a breast cancer .
Genetic Testing and for BRCA 1/ BRCA 2 Mutations
Mutations to the tumor suppressor genes BRCA1 and BRCA2, increase the risk of female breast and ovarian cancers, as well as fallopian tube, peritoneum, pancreatic and skin cancers.
While almost 13% of women in the general population will develop breast cancer at some point in their lives, over 60% of women who have inherited a mutation in either BRCA1 or BRCA2 will develop breast cancer in their lifetime. Factors associated with an increased likelihood of having a harmful BRCA1 or BRCA2 mutation include a personal or family history of breast cancer diagnoses before age 50, cancer in both breasts, both breast and ovarian cancers in the same individual, reoccurring cases of breast cancer, family history of BRCA mutations, cases of male breast cancer, and being of Ashkenazi Jewish descent.
Primary care providers use a familial risk assessment tool to screen women who have a personal or family history of breast, ovarian, tubal, or peritoneal cancers or have an ancestry associated with BRCA 1/2 gene mutations. This is required to be covered by insurance plans without cost sharing as a preventive service.
When it comes to breast cancer, knowing your risk and staying on top of can make a difference.
