S. 2533 

One Hundred Seventeenth Congress 

of the 

United States of America 

AT THE SECOND SESSION 

Begun and held at the City of Washington on Monday, 

the third day of January, two thousand and twenty two 

An Act 

To improve mammography services furnished by the Department of Veterans Affairs, 

and for other purposes. 

Be it enacted by the Senate and House of Representatives of 

the United States of America in Congress assembled, 

SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

(a) SHORT TITLE.—This Act may be cited as the ‘‘Making 

Advances in Mammography and Medical Options for Veterans Act’’. 

(b) TABLE OF CONTENTS.—The table of contents for this Act 

is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—SCREENING AND EARLY DETECTION 

Sec. 101. Strategic plan for breast imaging services for veterans. 

Sec. 102. Telescreening mammography pilot program of Department of Veterans 

Affairs. 

Sec. 103. Upgrade of breast imaging at facilities of Department of Veterans Affairs 

to three-dimensional digital mammography. 

Sec. 104. Study on availability of testing for breast cancer gene among veterans 

and expansion of availability of such testing. 

Sec. 105. Mammography accessibility for paralyzed and disabled veterans. 

Sec. 106. Report on access to and quality of mammography screenings furnished by 

Department of Veterans Affairs. 

TITLE II—PARTNERSHIPS FOR RESEARCH AND ACCESS TO CARE 

Sec. 201. Partnerships with National Cancer Institute to expand access of veterans 

to cancer care. 

Sec. 202. Report by Department of Veterans Affairs and Department of Defense on 

interagency collaboration on treating and researching breast cancer. 

TITLE I—SCREENING AND EARLY 

DETECTION 

SEC. 101. STRATEGIC PLAN FOR BREAST IMAGING SERVICES FOR VETERANS. 

(a) IN GENERAL.—Not later than one year after the date of 

the enactment of this Act, the Secretary of Veterans Affairs shall 

submit to the Committee on Veterans’ Affairs of the Senate and 

the Committee on Veterans’ Affairs of the House of Representatives 

a strategic plan for improving breast imaging services for veterans. 

(b) ELEMENTS.—The strategic plan required by subsection (a) 

shall— 

(1) cover the evolving needs of women veterans; 

(2) address geographic disparities of breast imaging furnished at a facility of the Department of Veterans Affairs 
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and the use of breast imaging through non-Department providers in the community; 

(3) address the use of digital breast tomosynthesis (DBT– 

3D breast imaging); 

(4) address the needs of male veterans who require breast 

cancer screening services; and 

(5) provide recommendations on— 

(A) potential expansion of breast imaging services furnished at facilities of the Department, including infrastructure and staffing needs; 

(B) the use of digital breast tomosynthesis; 

(C) the use of mobile mammography; and 

(D) other access and equity improvements for breast 

imaging. 

SEC. 102. TELESCREENING MAMMOGRAPHY PILOT PROGRAM OF 

DEPARTMENT OF VETERANS AFFAIRS. 

(a) IN GENERAL.—Commencing not later than 18 months after 

the date of the enactment of this Act, the Secretary of Veterans 

Affairs shall carry out a pilot program to provide telescreening 

mammography services for veterans who live in— 

(1) States where the Department of Veterans Affairs does 

not offer breast imaging services at a facility of the Department; 

or 

(2) locations where access to breast imaging services at 

a facility of the Department is difficult or not feasible, as 

determined by the Secretary. 

(b) DURATION.—The Secretary shall carry out the pilot program 

under subsection (a) for a three-year period beginning on the 

commencement of the pilot program. 

(c) LOCATIONS.—In carrying out the pilot program under subsection (a), the Secretary may use community-based outpatient 

clinics, mobile mammography, Federally qualified health centers 

(as defined in section 1861(aa)(4) of the Social Security Act (42 

U.S.C. 1395x(aa)(4))), rural health clinics, critical access hospitals, 

clinics of the Indian Health Service, and such other sites as the 

Secretary determines feasible to provide mammograms under the 

pilot program. 

(d) SHARING OF IMAGES AND RESULTS.—Under the pilot program 

under subsection (a)— 

(1) mammography images generated shall be sent to a 

telescreening mammography center of the Department for 

interpretation by qualified radiologists; and 

(2) results shall be shared with the veteran and their 

primary care provider in accordance with policies established 

by the Secretary. 

(e) REPORT.— 

(1) IN GENERAL.—Not later than one year after the conclusion of the pilot program under subsection (a), the Secretary 

shall submit to the Committee on Veterans’ Affairs of the 

Senate and the Committee on Veterans’ Affairs of the House 

of Representatives a report evaluating the pilot program. 

(2) ELEMENTS.—The report required by paragraph (1) shall 

include the following: 

(A) An assessment of the quality of the mammography 

provided under the pilot program under subsection (a). 
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(B) Feedback from veterans and providers participating 

in the pilot program. 

(C) A recommendation of the Secretary on the continuation or discontinuation of the pilot program. 

SEC. 103. UPGRADE OF BREAST IMAGING AT FACILITIES OF DEPARTMENT OF VETERANS AFFAIRS TO THREE-DIMENSIONAL 

DIGITAL MAMMOGRAPHY. 

Not later than two years after the date of the enactment 

of this Act, the Secretary of Veterans Affairs shall— 

(1) upgrade all mammography services at facilities of the 

Department of Veterans Affairs that provide such services to 

use digital breast tomosynthesis technology, also known as 

three-dimensional breast imaging; and 

(2) submit to the Committee on Veterans’ Affairs of the 

Senate and the Committee on Veterans’ Affairs of the House 

of Representatives a report— 

(A) indicating that the upgrade under paragraph (1) 

has been completed; and 

(B) listing the facilities or other locations of the Department at which digital breast tomosynthesis technology is 

used. 

SEC. 104. STUDY ON AVAILABILITY OF TESTING FOR BREAST CANCER 

GENE AMONG VETERANS AND EXPANSION OF AVAILABILITY OF SUCH TESTING. 

(a) STUDY.— 

(1) IN GENERAL.—The Secretary of Veterans Affairs shall 

conduct a study on the availability of access to testing for 

the breast cancer gene for veterans diagnosed with breast 

cancer, as recommended by the guidelines set forth by the 

National Comprehensive Cancer Network. 

(2) ELEMENTS.—In conducting the study under paragraph 

(1), the Secretary shall examine— 

(A) the feasibility of expanding the Joint Medicine 

Service of the Department of Veterans Affairs to provide 

genetic testing and counseling for veterans with breast 

cancer across the country; and 

(B) access to such testing and counseling for veterans 

living in rural or highly rural areas, and any gaps that 

may exist with respect to such access. 

(b) EXPANSION OF AVAILABILITY OF TESTING.— (1) IN GENERAL.—The Secretary shall update guidelines 

or institute new guidelines to increase the use of molecular 

testing and genetic counseling for veterans diagnosed with 

breast cancer, including veterans living in rural or highly rural 

areas. 

(2) DECISION SUPPORT TOOLS.—In updating or instituting 

guidelines under paragraph (1), the Secretary may develop 

clinical decision support tools, such as clinical pathways, to 

facilitate delivery of breast cancer care that is in line with 

national cancer guidelines. 

(c) REPORT.—Not later than two years after the date of the 

enactment of this Act, the Secretary shall submit to the Committee 

on Veterans’ Affairs of the Senate and the Committee on Veterans’ 

Affairs of the House of Representatives a report on— 

(1) the results of the study under subsection (a); 
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(2) any updates to guidelines or new guidelines instituted 

under subsection (b); 

(3) breast cancer clinical pathways implemented by the 

Department of Veterans Affairs and the utilization of those 

pathways across the Department; and 

(4) any progress of the Department in improving access 

to and usage of molecular and genetic testing among veterans 

diagnosed with breast cancer, including for veterans living in 

rural or highly rural areas. 

(d) DEFINITIONS.—In this section, the terms ‘‘rural’’ and ‘‘highly 

rural’’ have the meanings given those terms in the Rural-Urban 

Commuting Areas coding system of the Department of Agriculture. 

SEC. 105. MAMMOGRAPHY ACCESSIBILITY FOR PARALYZED AND DISABLED VETERANS. 

(a) STUDY.— 

(1) IN GENERAL.—The Secretary of Veterans Affairs shall 

conduct a study on the accessibility of breast imaging services 

at facilities of the Department of Veterans Affairs for veterans 

with paralysis, spinal cord injury or disorder (SCI/D), or another 

disability. 

(2) ACCESSIBILITY.—The study required by paragraph (1) 

shall include an assessment of the accessibility of the physical 

infrastructure at breast imaging facilities of the Department, 

including the imaging equipment, transfer assistance, and the 

room in which services will be provided as well as adherence 

to best practices for screening and treating veterans with a 

spinal cord injury or disorder. 

(3) SCREENING RATES.— (A) MEASUREMENT.—The study required by paragraph 

(1) shall include a measurement of breast cancer screening 

rates for veterans with a spinal cord injury or disorder 

during the two-year period preceding the commencement 

of the study, including a breakout of the screening rates 

for such veterans living in rural or highly rural areas. 

(B) DEVELOPMENT OF METHOD.—If the Secretary is 

unable to provide the measurement required under 

subparagraph (A), the Secretary shall develop a method 

to track breast cancer screening rates for veterans with 

a spinal cord injury or disorder. 

(4) REPORT.—Not later than two years after the date of 

the enactment of this Act, the Secretary shall submit to the 

Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives 

a report on the findings of the study required by paragraph 

(1), including— 

(A) the rates of screening among veterans with a spinal 

cord injury or disorder, including veterans living in rural 

or highly rural areas, as required under paragraph (3)(A); 

or 

(B) if such rates are not available, a description of 

the method developed to measure such rates as required 

under paragraph (3)(B). 

(b) CARE FROM NON-DEPARTMENT PROVIDERS.—The Secretary 

shall update the policies and directives of the Department to ensure 

that, in referring a veteran with a spinal cord injury or disorder 

for care from a non-Department provider, the Secretary shall— 
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(1) confirm with the provider the accessibility of the breast 

imaging site, including the imaging equipment, transfer assistance, and the room in which services will be provided; and 

(2) provide additional information to the provider on best 

practices for screening and treating veterans with a spinal 

cord injury or disorder. 

(c) DEFINITIONS.—In this section, the terms ‘‘rural’’ and ‘‘highly 

rural’’ have the meanings given those terms in the Rural-Urban 

Commuting Areas coding system of the Department of Agriculture. 

SEC. 106. REPORT ON ACCESS TO AND QUALITY OF MAMMOGRAPHY 

SCREENINGS FURNISHED BY DEPARTMENT OF VETERANS 

AFFAIRS. 

(a) IN GENERAL.—Not later than two years after the date of 

the enactment of this Act, the Inspector General of the Department 

of Veterans Affairs shall submit to the Secretary of Veterans Affairs, 

the Committee on Veterans’ Affairs of the Senate, and the Committee on Veterans’ Affairs of the House of Representatives a report 

on mammography services furnished by the Department of Veterans 

Affairs. 

(b) ELEMENTS.—The report required by subsection (a) shall 

include an assessment of— 

(1) the access of veterans to mammography screenings, 

whether at a facility of the Department or through a nonDepartment provider, including any staffing concerns of the 

Department in providing such screenings; 

(2) the quality of such screenings and reading of the images 

from such screenings, including whether such screenings use 

three-dimensional mammography; 

(3) the communication of the results of such screenings, 

including whether results are shared in a timely manner, 

whether results are shared via the Joint Health Information 

Exchange or another electronic mechanism, and whether results 

are incorporated into the electronic health record of the veteran; 

(4) the performance of the Women’s Breast Oncology 

System of Excellence of the Department; and 

(5) the access of veterans diagnosed with breast cancer 

to a comprehensive breast cancer care team of the Department. 

(c) FOLLOW-UP.—Not later than 180 days after the submittal 

of the report under subsection (a), the Secretary shall submit to 

the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs of the House of Representatives a plan 

to address the deficiencies identified in the report under subsection 

(a), if any. 

TITLE II—PARTNERSHIPS FOR 

RESEARCH AND ACCESS TO CARE 

SEC. 201. PARTNERSHIPS WITH NATIONAL CANCER INSTITUTE TO 

EXPAND ACCESS OF VETERANS TO CANCER CARE. 

(a) ACCESS TO CARE IN EACH VISN.— 

(1) IN GENERAL.—The Secretary of Veterans Affairs shall 

enter into a partnership with not fewer than one cancer center 

of the National Cancer Institute of the National Institutes 

of Health in each Veterans Integrated Service Network of the 
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Department of Veterans Affairs to expand access to high-quality 

cancer care for women veterans. 

(2) TREATMENT OF RURAL VETERANS.—The Secretary, in 

carrying out partnerships entered into under paragraph (1), 

shall ensure that veterans with breast cancer who reside in 

rural areas or States without a cancer center that has entered 

into such a partnership with the Secretary are able to receive 

care through such a partnership via telehealth. 

(b) REPORT ON PARTNERSHIP TO INCREASE ACCESS TO CLINICAL

TRIALS.—Not later than 180 days after the date of the enactment 

of this Act, the Secretary shall submit to the Committee on Veterans’ Affairs of the Senate and the Committee on Veterans’ Affairs 

of the House of Representatives a report on— 

(1) how the Secretary will ensure that the advancements 

made through the existing partnership between the Department 

of Veterans Affairs and the National Cancer Institute to provide 

veterans with access to clinical cancer research trials (commonly referred to as ‘‘NAVIGATE’’) are permanently implemented; and 

(2) the determination of the Secretary of whether expansion 

of such partnership to more than the original 12 facilities 

of the Department that were selected under such partnership 

is feasible. 

(c) PERIODIC REPORTS.—Not later than three years after the 

date of the enactment of this Act, and every three years thereafter, 

the Secretary shall submit to the Committee on Veterans’ Affairs 

of the Senate and the Committee on Veterans’ Affairs of the House 

of Representatives a report— 

(1) assessing how the partnerships entered into under subsection (a)(1) have impacted access by veterans to cancer centers 

of the National Cancer Institute, including an assessment of 

the telehealth options made available and used pursuant to 

such partnerships; and 

(2) describing the advancements made with respect to 

access by veterans to clinical cancer research trials through 

the partnership described in subsection (b)(1), including how 

many of those veterans were women veterans, minority veterans (including racial and ethnic minorities), and rural veterans, and identifying opportunities for further innovation. 

SEC. 202. REPORT BY DEPARTMENT OF VETERANS AFFAIRS AND 

DEPARTMENT OF DEFENSE ON INTERAGENCY 

COLLABORATION ON TREATING AND RESEARCHING 

BREAST CANCER. 

(a) IN GENERAL.—Not later than 180 days after the date of 

the enactment of this Act, the Secretary of Veterans Affairs, in 

collaboration with the Secretary of Defense, shall submit to Congress a report on all current research and health care collaborations 

between the Department of Veterans Affairs and the Department 

of Defense on treating veterans and members of the Armed Forces 

with breast cancer. 

(b) ELEMENTS.—The report required by subsection (a)— 

(1) shall include a description of potential opportunities 

for future interagency collaboration between the Department 

of Veterans Affairs and the Department of Defense with respect 

to treating and researching breast cancer; and 

(2) may include a focus on— 
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(A) with respect to women members of the Armed 

Forces with a diagnosis of or who are undergoing screening 

for breast cancer, transition of such members from 

receiving care from the Department of Defense to receiving 

care from the Department of Veterans Affairs; 

(B) collaborative breast cancer research opportunities 

between the Department of Veterans Affairs and the 

Department of Defense; 

(C) access to clinical trials; and 

(D) such other matters as the Secretary of Veterans 

Affairs and the Secretary of Defense consider appropriate. 

Speaker of the House of Representatives. 

Vice President of the United States and

President of the Senate.