II 

117TH CONGRESS 

1ST SESSION S. 2533 

To improve mammography services furnished by the Department of Veterans 

Affairs, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JULY 29, 2021 

Mr. TESTER (for himself, Mr. BOOZMAN, Ms. HIRONO, and Ms. COLLINS) introduced the following bill; which was read twice and referred to the Committee on Veterans’ Affairs 

A BILL 

To improve mammography services furnished by the 

Department of Veterans Affairs, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Making Advances in Mammography and Medical Options 

6 for Veterans Act’’. 

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

8 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—SCREENING AND EARLY DETECTION 


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

Sec. 102. Telemammography 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. 

1 TITLE I—SCREENING AND 

2 EARLY DETECTION 

3 SEC. 101. STRATEGIC PLAN FOR BREAST IMAGING SERV4 ICES FOR VETERANS. 

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

6 date of the enactment of this Act, the Secretary of Vet7 erans Affairs shall submit to the Committee on Veterans’ 

8 Affairs of the Senate and the Committee on Veterans’ Af9 fairs of the House of Representatives a strategic plan for 

10 improving breast imaging services for veterans. 

11 (b) ELEMENTS.—The strategic plan required by sub12 section (a) shall— 

13 (1) cover the evolving needs of women veterans; 

14 (2) address geographic disparities of breast im15 aging furnished at a facility of the Department of 

16 Veterans Affairs and the use of breast imaging 


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1 through non-Department providers in the commu2 nity; 

3 (3) address the use of digital breast 

4 tomosynthesis (DBT–3D breast imaging); 

5 (4) address the needs of male veterans who re6 quire breast cancer screening services; and 

7 (5) provide recommendations on— 

8 (A) potential expansion of breast imaging 

9 services furnished at facilities of the Depart10 ment, including infrastructure and staffing 

11 needs; 

12 (B) the use of digital breast tomosynthesis; 

13 (C) the use of mobile mammography; and 

14 (D) other access and equity improvements 

15 for breast imaging. 

16 SEC. 102. TELEMAMMOGRAPHY PILOT PROGRAM OF DE17 PARTMENT OF VETERANS AFFAIRS. 

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

19 year after the date of the enactment of this Act, the Sec20 retary of Veterans Affairs shall carry out a pilot program 

21 to provide telemammography services for veterans who live 

22 in— 

23 (1) States where the Department of Veterans 

24 Affairs does not offer breast imaging services at a 

25 facility of the Department; or 


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1 (2) locations where access to breast imaging 

2 services at a facility of the Department is difficult 

3 or not feasible, as determined by the Secretary. 

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

5 pilot program under subsection (a) for a three-year period 

6 beginning on the commencement of the pilot program. 

7 (c) LOCATIONS.—In carrying out the pilot program 

8 under subsection (a), the Secretary may use community9 based outpatient clinics, mobile mammography, Federally 

10 qualified health centers (as defined in section 1861(aa)(4) 

11 of the Social Security Act (42 U.S.C. 1395x(aa)(4))), 

12 rural health clinics, critical access hospitals, clinics of the 

13 Indian Health Service, and such other sites as the Sec14 retary determines feasible to provide mammograms under 

15 the pilot program. 

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

17 pilot program under subsection (a)— 

18 (1) mammography images generated shall be 

19 sent to the centralized telemammography center of 

20 the Department for interpretation by expert radiolo21 gists; and 

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

23 their primary care provider. 

24 (e) REPORT.— 


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1 (1) IN GENERAL.—Not later than one year 

2 after the conclusion of the pilot program under sub3 section (a), the Secretary shall submit to the Com4 mittee on Veterans’ Affairs of the Senate and the 

5 Committee on Veterans’ Affairs of the House of 

6 Representatives a report evaluating the pilot pro7 gram. 

8 (2) ELEMENTS.—The report required by para9 graph (1) shall include the following: 

10 (A) An assessment of the quality of the 

11 mammography provided under the pilot pro12 gram under subsection (a). 

13 (B) Feedback from veterans and providers 

14 participating in the pilot program. 

15 (C) A recommendation of the Secretary on 

16 the continuation or discontinuation of the pilot 

17 program. 

18 SEC. 103. UPGRADE OF BREAST IMAGING AT FACILITIES OF 

19 DEPARTMENT OF VETERANS AFFAIRS TO 

20 THREE-DIMENSIONAL DIGITAL MAMMOG21 RAPHY. 

22 Not later than two years after the date of the enact23 ment of this Act, the Secretary of Veterans Affairs shall— 

24 (1) upgrade all mammography services at facili25 ties of the Department of Veterans Affairs that proVerDate Sep 11 2014 18:28 Aug 04, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S2533.IS S2533

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1 vide such services to use digital breast tomosynthesis 

2 technology, also known as three-dimensional breast 

3 imaging; and 

4 (2) submit to the Committee on Veterans’ Af5 fairs of the Senate and the Committee on Veterans’ 

6 Affairs of the House of Representatives a report— 

7 (A) indicating that the upgrade under 

8 paragraph (1) has been completed; and 

9 (B) listing the facilities or other locations 

10 of the Department at which digital breast 

11 tomosynthesis technology is used. 

12 SEC. 104. STUDY ON AVAILABILITY OF TESTING FOR 

13 BREAST CANCER GENE AMONG VETERANS 

14 AND EXPANSION OF AVAILABILITY OF SUCH 

15 TESTING. 

16 (a) STUDY.— 

17 (1) IN GENERAL.—The Secretary of Veterans 

18 Affairs shall conduct a study on the availability of 

19 access to testing for the breast cancer gene for vet20 erans diagnosed with breast cancer, as recommended 

21 by the guidelines set forth by the National Com22 prehensive Cancer Network. 

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

24 paragraph (1), the Secretary shall examine— 


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1 (A) the feasibility of expanding the Joint 

2 Medicine Service of the Department of Veterans 

3 Affairs to provide genetic testing and coun4 seling for veterans with breast cancer across the 

5 country; and 

6 (B) access to such testing and counseling 

7 for veterans living in rural or highly rural 

8 areas, and any gaps that may exist with respect 

9 to such access. 

10 (b) EXPANSION OF AVAILABILITY OF TESTING.— 

11 (1) IN GENERAL.—The Secretary shall update 

12 guidelines or institute new guidelines to increase the 

13 use of testing for the breast cancer gene and genetic 

14 counseling for veterans diagnosed with breast can15 cer. 

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

17 instituting guidelines under paragraph (1), the Sec18 retary may develop clinical decision support tools to 

19 facilitate delivery of breast cancer care that is in line 

20 with national cancer guidelines. 

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

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

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

24 the Committee on Veterans’ Affairs of the House of Rep25 resentatives a report on— 


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1 (1) the results of the study under subsection 

2 (a); 

3 (2) any updates to guidelines or new guidelines 

4 instituted under subsection (b); and 

5 (3) any progress of the Department in improv6 ing access to and usage of testing for the breast can7 cer gene among veterans diagnosed with breast can8 cer, including for veterans living in rural or highly 

9 rural areas. 

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

11 and ‘‘highly rural’’ have the meanings given those terms 

12 in the Rural-Urban Commuting Areas coding system of 

13 the Department of Agriculture. 

14 SEC. 105. MAMMOGRAPHY ACCESSIBILITY FOR PARALYZED 

15 AND DISABLED VETERANS. 

16 (a) STUDY.— 

17 (1) IN GENERAL.—The Secretary of Veterans 

18 Affairs shall conduct a study on the accessibility of 

19 breast imaging services at facilities of the Depart20 ment of Veterans Affairs for veterans with paralysis, 

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

22 disability. 

23 (2) ACCESSIBILITY.—The study required by 

24 paragraph (1) shall include an assessment of the ac25 cessibility of the physical infrastructure at breast 


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1 imaging facilities of the Department, including the 

2 imaging equipment, transfer assistance, and the 

3 room in which services will be provided as well as 

4 adherence to best practices for screening and treat5 ing veterans with a spinal cord injury or disorder. 

6 (3) SCREENING RATES.— 

7 (A) MEASUREMENT.—The study required 

8 by paragraph (1) shall include a measurement 

9 of breast cancer screening rates for veterans 

10 with a spinal cord injury or disorder during the 

11 two-year period preceding the commencement of 

12 the study, including a breakout of the screening 

13 rates for such veterans living in rural or highly 

14 rural areas. 

15 (B) DEVELOPMENT OF METHOD.—If the 

16 Secretary is unable to provide the measurement 

17 required under subparagraph (A), the Secretary 

18 shall develop a method to track breast cancer 

19 screening rates for veterans with a spinal cord 

20 injury or disorder. 

21 (4) REPORT.—Not later than two years after 

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

23 shall submit to the Committee on Veterans’ Affairs 

24 of the Senate and the Committee on Veterans’ Af25 fairs of the House of Representatives a report on the 


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1 findings of the study required by paragraph (1), in2 cluding— 

3 (A) the rates of screening among veterans 

4 with a spinal cord injury or disorder, including 

5 veterans living in rural or highly rural areas, as 

6 required under paragraph (3)(A); or 

7 (B) if such rates are not available, a de8 scription of the method developed to measure 

9 such rates as required under paragraph (3)(B). 

10 (b) CARE FROM NON-DEPARTMENT PROVIDERS.— 

11 The Secretary shall update the policies and directives of 

12 the Department to ensure that, in referring a veteran with 

13 a spinal cord injury or disorder for care from a non-De14 partment provider, the Secretary shall— 

15 (1) confirm with the provider the accessibility 

16 of the breast imaging site, including the imaging 

17 equipment, transfer assistance, and the room in 

18 which services will be provided; and 

19 (2) provide additional information to the pro20 vider on best practices for screening and treating 

21 veterans with a spinal cord injury or disorder. 

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

23 and ‘‘highly rural’’ have the meanings given those terms 

24 in the Rural-Urban Commuting Areas coding system of 

25 the Department of Agriculture. 


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1 SEC. 106. REPORT ON ACCESS TO AND QUALITY OF MAM2 MOGRAPHY SCREENINGS FURNISHED BY DE3 PARTMENT OF VETERANS AFFAIRS. 

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

5 date of the enactment of this Act, the Inspector General 

6 of the Department of Veterans Affairs shall submit to the 

7 Secretary of Veterans Affairs, the Committee on Veterans’ 

8 Affairs of the Senate, and the Committee on Veterans’ Af9 fairs of the House of Representatives a report on mam10 mography services furnished by the Department of Vet11 erans Affairs. 

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

13 (a) shall include an assessment of— 

14 (1) the access of veterans to mammography 

15 screenings, whether at a facility of the Department 

16 or through a non-Department provider, including 

17 any staffing concerns of the Department in pro18 viding such screenings; 

19 (2) the quality of such screenings and reading 

20 of the images from such screenings, including wheth21 er such screenings use three-dimensional mammog22 raphy; 

23 (3) the communication of the results of such 

24 screenings, including whether results are shared in a 

25 timely manner, whether results are shared via the 

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1 tronic mechanism, and whether results are incor2 porated into the electronic health record of the vet3 eran; 

4 (4) the performance of the Women’s Breast On5 cology System of Excellence of the Department; and 

6 (5) the access of veterans diagnosed with breast 

7 cancer to a comprehensive breast cancer care team 

8 of the Department. 

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

10 submittal of the report under subsection (a), the Secretary 

11 shall submit to the Committee on Veterans’ Affairs of the 

12 Senate and the Committee on Veterans’ Affairs of the 

13 House of Representatives a plan to address the defi14 ciencies identified in the report under subsection (a), if 

15 any. 

16 TITLE II—PARTNERSHIPS FOR 

17 RESEARCH AND ACCESS TO 

18 CARE 

19 SEC. 201. PARTNERSHIPS WITH NATIONAL CANCER INSTI20 TUTE TO EXPAND ACCESS OF VETERANS TO 

21 CANCER CARE. 

22 (a) ACCESS TO CARE IN EACH VISN.— 

23 (1) IN GENERAL.—The Secretary of Veterans 

24 Affairs shall enter into a partnership with not fewer 

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1 tute of the National Institutes of Health in each 

2 Veterans Integrated Service Network of the Depart3 ment of Veterans Affairs to expand access to high4 quality cancer care for women veterans. 

5 (2) TREATMENT OF RURAL VETERANS.—The 

6 Secretary, in carrying out partnerships entered into 

7 under paragraph (1), shall ensure that veterans with 

8 breast cancer who reside in rural areas or States 

9 without a cancer center that has entered into such 

10 a partnership with the Secretary are able to receive 

11 care through such a partnership via telehealth. 

12 (b) REPORT ON PARTNERSHIP TO INCREASE ACCESS

13 TO CLINICAL TRIALS.—Not later than 180 days after the 

14 date of the enactment of this Act, the Secretary shall sub15 mit to the Committee on Veterans’ Affairs of the Senate 

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

17 Representatives a report on— 

18 (1) how the Secretary will ensure that the ad19 vancements made through the existing partnership 

20 between the Department of Veterans Affairs and the 

21 National Cancer Institute to provide veterans with 

22 access to clinical cancer research trials (commonly 

23 referred to as ‘‘NAVIGATE’’) are permanently im24 plemented; and 


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1 (2) the determination of the Secretary of 

2 whether expansion of such partnership to more than 

3 the original 12 facilities of the Department that 

4 were selected under such partnership is feasible. 

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

6 after the date of the enactment of this Act, and every 

7 three years thereafter, the Secretary shall submit to the 

8 Committee on Veterans’ Affairs of the Senate and the 

9 Committee on Veterans’ Affairs of the House of Rep10 resentatives a report— 

11 (1) assessing how the partnerships entered into 

12 under subsection (a)(1) have impacted access by vet13 erans to cancer centers of the National Cancer Insti14 tute, including an assessment of the telehealth op15 tions made available and used pursuant to such 

16 partnerships; and 

17 (2) describing the advancements made with re18 spect to access by veterans to clinical cancer re19 search trials through the partnership described in 

20 subsection (b)(1), including how many of those vet21 erans were women veterans, minority veterans (in22 cluding racial and ethnic minorities), and rural vet23 erans, and identifying opportunities for further inno24 vation. 


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1 SEC. 202. REPORT BY DEPARTMENT OF VETERANS AFFAIRS 

2 AND DEPARTMENT OF DEFENSE ON INTER3 AGENCY COLLABORATION ON TREATING AND 

4 RESEARCHING BREAST CANCER. 

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

6 date of the enactment of this Act, the Secretary of Vet7 erans Affairs, in collaboration with the Secretary of De8 fense, shall submit to Congress a report on all current re9 search and health care collaborations between the Depart10 ment of Veterans Affairs and the Department of Defense 

11 on treating veterans and members of the Armed Forces 

12 with breast cancer. 

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

14 (a)— 

15 (1) shall include a description of potential op16 portunities for future interagency collaboration be17 tween the Department of Veterans Affairs and the 

18 Department of Defense with respect to treating and 

19 researching breast cancer; and 

20 (2) may include a focus on— 

21 (A) with respect to women members of the 

22 Armed Forces with a diagnosis of or who are 

23 undergoing screening for breast cancer, transi24 tion of such members from receiving care from 

25 the Department of Defense to receiving care 

26 from the Department of Veterans Affairs; 


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1 (B) collaborative breast cancer research 

2 opportunities between the Department of Vet3 erans Affairs and the Department of Defense; 

4 (C) access to clinical trials; and 

5 (D) such other matters as the Secretary of 

6 Veterans Affairs and the Secretary of Defense 

7 consider appropriate. 

Æ 


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