II 

Calendar No. 303 

117TH CONGRESS 

2D 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, Ms. COLLINS, Mr. 

COONS, and Ms. STABENOW) introduced the following bill; which was 

read twice and referred to the Committee on Veterans’ Affairs 

MARCH 10 (legislative day, MARCH 7), 2022 

Reported by Mr. TESTER, with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

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’’. 


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

2 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. 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. 

3 TITLE I—SCREENING AND 

4 EARLY DETECTION 

5 SEC. 101. STRATEGIC PLAN FOR BREAST IMAGING SERV6 ICES FOR VETERANS. 

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

8 date of the enactment of this Act, the Secretary of Vet9 erans Affairs shall submit to the Committee on Veterans’ 

10 Affairs of the Senate and the Committee on Veterans’ Af11 fairs of the House of Representatives a strategic plan for 

12 improving breast imaging services for veterans. 

13 (b) ELEMENTS.—The strategic plan required by sub14 section (a) shall— 

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


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1 (2) address geographic disparities of breast im2 aging furnished at a facility of the Department of 

3 Veterans Affairs and the use of breast imaging 

4 through non-Department providers in the commu5 nity; 

6 (3) address the use of digital breast 

7 tomosynthesis (DBT–3D breast imaging); 

8 (4) address the needs of male veterans who re9 quire breast cancer screening services; and 

10 (5) provide recommendations on— 

11 (A) potential expansion of breast imaging 

12 services furnished at facilities of the Depart13 ment, including infrastructure and staffing 

14 needs; 

15 (B) the use of digital breast tomosynthesis; 

16 (C) the use of mobile mammography; and 

17 (D) other access and equity improvements 

18 for breast imaging. 

19 SEC. 102. TELEMAMMOGRAPHY PILOT PROGRAM OF DE20 PARTMENT OF VETERANS AFFAIRS. 

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

22 year after the date of the enactment of this Act, the Sec23 retary of Veterans Affairs shall carry out a pilot program 

24 to provide telemammography services for veterans who live 

25 in— 


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1 (1) States where the Department of Veterans 

2 Affairs does not offer breast imaging services at a 

3 facility of the Department; or 

4 (2) locations where access to breast imaging 

5 services at a facility of the Department is difficult 

6 or not feasible, as determined by the Secretary. 

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

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

9 beginning on the commencement of the pilot program. 

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

11 under subsection (a), the Secretary may use community12 based outpatient clinics, mobile mammography, Federally 

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

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

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

16 Indian Health Service, and such other sites as the Sec17 retary determines feasible to provide mammograms under 

18 the pilot program. 

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

20 pilot program under subsection (a)— 

21 (1) mammography images generated shall be 

22 sent to the centralized telemammography center of 

23 the Department for interpretation by expert radiolo24 gists; and 


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

2 their primary care provider. 

3 (e) REPORT.— 

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

5 after the conclusion of the pilot program under sub6 section (a), the Secretary shall submit to the Com7 mittee on Veterans’ Affairs of the Senate and the 

8 Committee on Veterans’ Affairs of the House of 

9 Representatives a report evaluating the pilot pro10 gram. 

11 (2) ELEMENTS.—The report required by para12 graph (1) shall include the following: 

13 (A) An assessment of the quality of the 

14 mammography provided under the pilot pro15 gram under subsection (a). 

16 (B) Feedback from veterans and providers 

17 participating in the pilot program. 

18 (C) A recommendation of the Secretary on 

19 the continuation or discontinuation of the pilot 

20 program. 


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

2 DEPARTMENT OF VETERANS AFFAIRS TO 

3 THREE-DIMENSIONAL DIGITAL MAMMOG4 RAPHY. 

5 Not later than two years after the date of the enact6 ment of this Act, the Secretary of Veterans Affairs shall— 

7 (1) upgrade all mammography services at facili8 ties of the Department of Veterans Affairs that pro9 vide such services to use digital breast tomosynthesis 

10 technology, also known as three-dimensional breast 

11 imaging; and 

12 (2) submit to the Committee on Veterans’ Af13 fairs of the Senate and the Committee on Veterans’ 

14 Affairs of the House of Representatives a report— 

15 (A) indicating that the upgrade under 

16 paragraph (1) has been completed; and 

17 (B) listing the facilities or other locations 

18 of the Department at which digital breast 

19 tomosynthesis technology is used. 

20 SEC. 104. STUDY ON AVAILABILITY OF TESTING FOR 

21 BREAST CANCER GENE AMONG VETERANS 

22 AND EXPANSION OF AVAILABILITY OF SUCH 

23 TESTING. 

24 (a) STUDY.— 

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

26 Affairs shall conduct a study on the availability of 


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1 access to testing for the breast cancer gene for vet2 erans diagnosed with breast cancer, as recommended 

3 by the guidelines set forth by the National Com4 prehensive Cancer Network. 

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

6 paragraph (1), the Secretary shall examine— 

7 (A) the feasibility of expanding the Joint 

8 Medicine Service of the Department of Veterans 

9 Affairs to provide genetic testing and coun10 seling for veterans with breast cancer across the 

11 country; and 

12 (B) access to such testing and counseling 

13 for veterans living in rural or highly rural 

14 areas, and any gaps that may exist with respect 

15 to such access. 

16 (b) EXPANSION OF AVAILABILITY OF TESTING.— 

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

18 guidelines or institute new guidelines to increase the 

19 use of testing for the breast cancer gene and genetic 

20 counseling for veterans diagnosed with breast can21 cer. 

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

23 instituting guidelines under paragraph (1), the Sec24 retary may develop clinical decision support tools to 


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1 facilitate delivery of breast cancer care that is in line 

2 with national cancer guidelines. 

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

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

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

6 the Committee on Veterans’ Affairs of the House of Rep7 resentatives a report on— 

8 (1) the results of the study under subsection 

9 (a); 

10 (2) any updates to guidelines or new guidelines 

11 instituted under subsection (b); and 

12 (3) any progress of the Department in improv13 ing access to and usage of testing for the breast can14 cer gene among veterans diagnosed with breast can15 cer, including for veterans living in rural or highly 

16 rural areas. 

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

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

19 in the Rural-Urban Commuting Areas coding system of 

20 the Department of Agriculture. 

21 SEC. 105. MAMMOGRAPHY ACCESSIBILITY FOR PARALYZED 

22 AND DISABLED VETERANS. 

23 (a) STUDY.— 

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

25 Affairs shall conduct a study on the accessibility of 


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1 breast imaging services at facilities of the Depart2 ment of Veterans Affairs for veterans with paralysis, 

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

4 disability. 

5 (2) ACCESSIBILITY.—The study required by 

6 paragraph (1) shall include an assessment of the ac7 cessibility of the physical infrastructure at breast 

8 imaging facilities of the Department, including the 

9 imaging equipment, transfer assistance, and the 

10 room in which services will be provided as well as 

11 adherence to best practices for screening and treat12 ing veterans with a spinal cord injury or disorder. 

13 (3) SCREENING RATES.— 

14 (A) MEASUREMENT.—The study required 

15 by paragraph (1) shall include a measurement 

16 of breast cancer screening rates for veterans 

17 with a spinal cord injury or disorder during the 

18 two-year period preceding the commencement of 

19 the study, including a breakout of the screening 

20 rates for such veterans living in rural or highly 

21 rural areas. 

22 (B) DEVELOPMENT OF METHOD.—If the 

23 Secretary is unable to provide the measurement 

24 required under subparagraph (A), the Secretary 

25 shall develop a method to track breast cancer 


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1 screening rates for veterans with a spinal cord 

2 injury or disorder. 

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

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

5 shall submit to the Committee on Veterans’ Affairs 

6 of the Senate and the Committee on Veterans’ Af7 fairs of the House of Representatives a report on the 

8 findings of the study required by paragraph (1), in9 cluding— 

10 (A) the rates of screening among veterans 

11 with a spinal cord injury or disorder, including 

12 veterans living in rural or highly rural areas, as 

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

14 (B) if such rates are not available, a de15 scription of the method developed to measure 

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

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

18 The Secretary shall update the policies and directives of 

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

20 a spinal cord injury or disorder for care from a non-De21 partment provider, the Secretary shall— 

22 (1) confirm with the provider the accessibility 

23 of the breast imaging site, including the imaging 

24 equipment, transfer assistance, and the room in 

25 which services will be provided; and 


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1 (2) provide additional information to the pro2 vider on best practices for screening and treating 

3 veterans with a spinal cord injury or disorder. 

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

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

6 in the Rural-Urban Commuting Areas coding system of 

7 the Department of Agriculture. 

8 SEC. 106. REPORT ON ACCESS TO AND QUALITY OF MAM9 MOGRAPHY SCREENINGS FURNISHED BY DE10 PARTMENT OF VETERANS AFFAIRS. 

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

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

13 of the Department of Veterans Affairs shall submit to the 

14 Secretary of Veterans Affairs, the Committee on Veterans’ 

15 Affairs of the Senate, and the Committee on Veterans’ Af16 fairs of the House of Representatives a report on mam17 mography services furnished by the Department of Vet18 erans Affairs. 

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

20 (a) shall include an assessment of— 

21 (1) the access of veterans to mammography 

22 screenings, whether at a facility of the Department 

23 or through a non-Department provider, including 

24 any staffing concerns of the Department in pro25 viding such screenings; 


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1 (2) the quality of such screenings and reading 

2 of the images from such screenings, including wheth3 er such screenings use three-dimensional mammog4 raphy; 

5 (3) the communication of the results of such 

6 screenings, including whether results are shared in a 

7 timely manner, whether results are shared via the 

8 Joint Health Information Exchange or another elec9 tronic mechanism, and whether results are incor10 porated into the electronic health record of the vet11 eran; 

12 (4) the performance of the Women’s Breast On13 cology System of Excellence of the Department; and 

14 (5) the access of veterans diagnosed with breast 

15 cancer to a comprehensive breast cancer care team 

16 of the Department. 

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

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

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

20 Senate and the Committee on Veterans’ Affairs of the 

21 House of Representatives a plan to address the defi22 ciencies identified in the report under subsection (a), if 

23 any. 


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1 TITLE II—PARTNERSHIPS FOR 

2 RESEARCH AND ACCESS TO 

3 CARE 

4 SEC. 201. PARTNERSHIPS WITH NATIONAL CANCER INSTI5 TUTE TO EXPAND ACCESS OF VETERANS TO 

6 CANCER CARE. 

7 (a) ACCESS TO CARE IN EACH VISN.— 

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

9 Affairs shall enter into a partnership with not fewer 

10 than one cancer center of the National Cancer Insti11 tute of the National Institutes of Health in each 

12 Veterans Integrated Service Network of the Depart13 ment of Veterans Affairs to expand access to high14 quality cancer care for women veterans. 

15 (2) TREATMENT OF RURAL VETERANS.—The 

16 Secretary, in carrying out partnerships entered into 

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

18 breast cancer who reside in rural areas or States 

19 without a cancer center that has entered into such 

20 a partnership with the Secretary are able to receive 

21 care through such a partnership via telehealth. 

22 (b) REPORT ON PARTNERSHIP TO INCREASE ACCESS

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

24 date of the enactment of this Act, the Secretary shall sub25 mit to the Committee on Veterans’ Affairs of the Senate 


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

2 Representatives a report on— 

3 (1) how the Secretary will ensure that the ad4 vancements made through the existing partnership 

5 between the Department of Veterans Affairs and the 

6 National Cancer Institute to provide veterans with 

7 access to clinical cancer research trials (commonly 

8 referred to as ‘‘NAVIGATE’’) are permanently im9 plemented; and 

10 (2) the determination of the Secretary of 

11 whether expansion of such partnership to more than 

12 the original 12 facilities of the Department that 

13 were selected under such partnership is feasible. 

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

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

16 three years thereafter, the Secretary shall submit to the 

17 Committee on Veterans’ Affairs of the Senate and the 

18 Committee on Veterans’ Affairs of the House of Rep19 resentatives a report— 

20 (1) assessing how the partnerships entered into 

21 under subsection (a)(1) have impacted access by vet22 erans to cancer centers of the National Cancer Insti23 tute, including an assessment of the telehealth op24 tions made available and used pursuant to such 

25 partnerships; and 


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1 (2) describing the advancements made with re2 spect to access by veterans to clinical cancer re3 search trials through the partnership described in 

4 subsection (b)(1), including how many of those vet5 erans were women veterans, minority veterans (in6 cluding racial and ethnic minorities), and rural vet7 erans, and identifying opportunities for further inno8 vation. 

9 SEC. 202. REPORT BY DEPARTMENT OF VETERANS AFFAIRS 

10 AND DEPARTMENT OF DEFENSE ON INTER11 AGENCY COLLABORATION ON TREATING AND 

12 RESEARCHING BREAST CANCER. 

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

14 date of the enactment of this Act, the Secretary of Vet15 erans Affairs, in collaboration with the Secretary of De16 fense, shall submit to Congress a report on all current re17 search and health care collaborations between the Depart18 ment of Veterans Affairs and the Department of Defense 

19 on treating veterans and members of the Armed Forces 

20 with breast cancer. 

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

22 (a)— 

23 (1) shall include a description of potential op24 portunities for future interagency collaboration be25 tween the Department of Veterans Affairs and the 


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1 Department of Defense with respect to treating and 

2 researching breast cancer; and 

3 (2) may include a focus on— 

4 (A) with respect to women members of the 

5 Armed Forces with a diagnosis of or who are 

6 undergoing screening for breast cancer, transi7 tion of such members from receiving care from 

8 the Department of Defense to receiving care 

9 from the Department of Veterans Affairs; 

10 (B) collaborative breast cancer research 

11 opportunities between the Department of Vet12 erans Affairs and the Department of Defense; 

13 (C) access to clinical trials; and 

14 (D) such other matters as the Secretary of 

15 Veterans Affairs and the Secretary of Defense 

16 consider appropriate. 

17 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

19 ‘‘Making Advances in Mammography and Medical Options 

20 for Veterans Act’’. 

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

22 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. 


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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 EARLY 

2 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 Veterans 

7 Affairs shall submit to the Committee on Veterans’ Affairs 

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

9 the House of Representatives a strategic plan for improving 

10 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 

17 through non-Department providers in the community; 


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1 (3) address the use of digital breast 

2 tomosynthesis (DBT–3D breast imaging); 

3 (4) address the needs of male veterans who re4 quire breast cancer screening services; and 

5 (5) provide recommendations on— 

6 (A) potential expansion of breast imaging 

7 services furnished at facilities of the Department, 

8 including infrastructure and staffing needs; 

9 (B) the use of digital breast tomosynthesis; 

10 (C) the use of mobile mammography; and 

11 (D) other access and equity improvements 

12 for breast imaging. 

13 SEC. 102. TELESCREENING MAMMOGRAPHY PILOT PRO14 GRAM OF DEPARTMENT OF VETERANS AF15 FAIRS. 

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

17 months after the date of the enactment of this Act, the Sec18 retary of Veterans Affairs shall carry out a pilot program 

19 to provide telescreening mammography services for veterans 

20 who live in— 

21 (1) States where the Department of Veterans Af22 fairs does not offer breast imaging services at a facil23 ity of the Department; or 


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1 (2) locations where access to breast imaging serv2 ices at a facility of the Department is difficult or not 

3 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))), rural 

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

13 Health Service, and such other sites as the Secretary deter14 mines feasible to provide mammograms under the pilot pro15 gram. 

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

17 pilot program under subsection (a)— 

18 (1) mammography images generated shall be sent 

19 to a telescreening mammography center of the Depart20 ment for interpretation by qualified radiologists; and 

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

22 their primary care provider in accordance with poli23 cies established by the Secretary. 

24 (e) REPORT.— 


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

2 the conclusion of the pilot program under subsection 

3 (a), the Secretary shall submit to the Committee on 

4 Veterans’ Affairs of the Senate and the Committee on 

5 Veterans’ Affairs of the House of Representatives a re6 port evaluating the pilot program. 

7 (2) ELEMENTS.—The report required by para8 graph (1) shall include the following: 

9 (A) An assessment of the quality of the 

10 mammography provided under the pilot program 

11 under subsection (a). 

12 (B) Feedback from veterans and providers 

13 participating in the pilot program. 

14 (C) A recommendation of the Secretary on 

15 the continuation or discontinuation of the pilot 

16 program. 

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

18 DEPARTMENT OF VETERANS AFFAIRS TO 

19 THREE-DIMENSIONAL DIGITAL MAMMOG20 RAPHY. 

21 Not later than two years after the date of the enact22 ment of this Act, the Secretary of Veterans Affairs shall— 

23 (1) upgrade all mammography services at facili24 ties of the Department of Veterans Affairs that pro25 vide such services to use digital breast tomosynthesis 


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1 technology, also known as three-dimensional breast 

2 imaging; and 

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

4 of the Senate and the Committee on Veterans’ Affairs 

5 of the House of Representatives a report— 

6 (A) indicating that the upgrade under 

7 paragraph (1) has been completed; and 

8 (B) listing the facilities or other locations of 

9 the Department at which digital breast 

10 tomosynthesis technology is used. 

11 SEC. 104. STUDY ON AVAILABILITY OF TESTING FOR 

12 BREAST CANCER GENE AMONG VETERANS 

13 AND EXPANSION OF AVAILABILITY OF SUCH 

14 TESTING. 

15 (a) STUDY.— 

16 (1) IN GENERAL.—The Secretary of Veterans Af17 fairs shall conduct a study on the availability of ac18 cess to testing for the breast cancer gene for veterans 

19 diagnosed with breast cancer, as recommended by the 

20 guidelines set forth by the National Comprehensive 

21 Cancer Network. 

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

23 paragraph (1), the Secretary shall examine— 

24 (A) the feasibility of expanding the Joint 

25 Medicine Service of the Department of Veterans 


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1 Affairs to provide genetic testing and counseling 

2 for veterans with breast cancer across the coun3 try; and 

4 (B) access to such testing and counseling for 

5 veterans living in rural or highly rural areas, 

6 and any gaps that may exist with respect to 

7 such access. 

8 (b) EXPANSION OF AVAILABILITY OF TESTING.— 

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

10 guidelines or institute new guidelines to increase the 

11 use of molecular testing and genetic counseling for 

12 veterans diagnosed with breast cancer, including vet13 erans living in rural or highly rural areas. 

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

15 instituting guidelines under paragraph (1), the Sec16 retary may develop clinical decision support tools, 

17 such as clinical pathways, to facilitate delivery of 

18 breast cancer care that is in line with national cancer 

19 guidelines. 

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

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

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

23 Committee on Veterans’ Affairs of the House of Representa24 tives a report on— 

25 (1) the results of the study under subsection (a); 


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1 (2) any updates to guidelines or new guidelines 

2 instituted under subsection (b); 

3 (3) breast cancer clinical pathways implemented 

4 by the Department of Veterans Affairs and the utili5 zation of those pathways across the Department; and 

6 (4) any progress of the Department in improving 

7 access to and usage of molecular and genetic testing 

8 among veterans diagnosed with breast cancer, includ9 ing for veterans living in rural or highly 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 the 

13 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 Af18 fairs shall conduct a study on the accessibility of 

19 breast imaging services at facilities of the Department 

20 of Veterans Affairs for veterans with paralysis, spinal 

21 cord injury or disorder (SCI/D), or another dis22 ability. 

23 (2) ACCESSIBILITY.—The study required by 

24 paragraph (1) shall include an assessment of the ac25 cessibility of the physical infrastructure at breast imVerDate Sep 11 2014 06:16 Mar 11, 2022 Jkt 029200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6203 E:\BILLS\S2533.RS S2533

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1 aging facilities of the Department, including the im2 aging equipment, transfer assistance, and the room in 

3 which services will be provided as well as adherence 

4 to best practices for screening and treating veterans 

5 with a spinal cord injury or disorder. 

6 (3) SCREENING RATES.— 

7 (A) MEASUREMENT.—The study required by 

8 paragraph (1) shall include a measurement of 

9 breast cancer screening rates for veterans with a 

10 spinal cord injury or disorder during the two11 year period preceding the commencement of the 

12 study, including a breakout of the screening rates 

13 for such veterans living in rural or highly rural 

14 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 the 

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

23 submit to the Committee on Veterans’ Affairs of the 

24 Senate and the Committee on Veterans’ Affairs of the 


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1 House of Representatives a report on the findings of 

2 the study required by paragraph (1), including— 

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.—The 

11 Secretary shall update the policies and directives of the De12 partment to ensure that, in referring a veteran with a spi13 nal cord injury or disorder for care from a non-Department 

14 provider, the Secretary shall— 

15 (1) confirm with the provider the accessibility of 

16 the breast imaging site, including the imaging equip17 ment, transfer assistance, and the room in which serv18 ices will be provided; and 

19 (2) provide additional information to the pro20 vider on best practices for screening and treating vet21 erans 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 the 

25 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 of 

6 the Department of Veterans Affairs shall submit to the Sec7 retary of Veterans Affairs, the Committee on Veterans’ Af8 fairs of the Senate, and the Committee on Veterans’ Affairs 

9 of the House of Representatives a report on mammography 

10 services furnished by the Department of Veterans Affairs. 

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

12 shall include an assessment of— 

13 (1) the access of veterans to mammography 

14 screenings, whether at a facility of the Department or 

15 through a non-Department provider, including any 

16 staffing concerns of the Department in providing such 

17 screenings; 

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

19 the images from such screenings, including whether 

20 such screenings use three-dimensional mammography; 

21 (3) the communication of the results of such 

22 screenings, including whether results are shared in a 

23 timely manner, whether results are shared via the 

24 Joint Health Information Exchange or another elec25 tronic mechanism, and whether results are incorVerDate Sep 11 2014 06:16 Mar 11, 2022 Jkt 029200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6203 E:\BILLS\S2533.RS S2533

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1 porated into the electronic health record of the vet2 eran; 

3 (4) the performance of the Women’s Breast On4 cology System of Excellence of the Department; and 

5 (5) the access of veterans diagnosed with breast 

6 cancer to a comprehensive breast cancer care team of 

7 the Department. 

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

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

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

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

12 of Representatives a plan to address the deficiencies identi13 fied in the report under subsection (a), if any. 

14 TITLE II—PARTNERSHIPS FOR 

15 RESEARCH AND ACCESS TO 

16 CARE 

17 SEC. 201. PARTNERSHIPS WITH NATIONAL CANCER INSTI18 TUTE TO EXPAND ACCESS OF VETERANS TO 

19 CANCER CARE. 

20 (a) ACCESS TO CARE IN EACH VISN.— 

21 (1) IN GENERAL.—The Secretary of Veterans Af22 fairs shall enter into a partnership with not fewer 

23 than one cancer center of the National Cancer Insti24 tute of the National Institutes of Health in each Vet25 erans Integrated Service Network of the Department 


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1 of Veterans Affairs to expand access to high-quality 

2 cancer care for women veterans. 

3 (2) TREATMENT OF RURAL VETERANS.—The Sec4 retary, in carrying out partnerships entered into 

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

6 breast cancer who reside in rural areas or States 

7 without a cancer center that has entered into such a 

8 partnership with the Secretary are able to receive care 

9 through such a partnership via telehealth. 

10 (b) REPORT ON PARTNERSHIP TO INCREASE ACCESS

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

12 date of the enactment of this Act, the Secretary shall submit 

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

14 the Committee on Veterans’ Affairs of the House of Rep15 resentatives a report on— 

16 (1) how the Secretary will ensure that the ad17 vancements made through the existing partnership be18 tween the Department of Veterans Affairs and the Na19 tional Cancer Institute to provide veterans with ac20 cess to clinical cancer research trials (commonly re21 ferred to as ‘‘NAVIGATE’’) are permanently imple22 mented; and 

23 (2) the determination of the Secretary of whether 

24 expansion of such partnership to more than the origiVerDate Sep 11 2014 06:16 Mar 11, 2022 Jkt 029200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6203 E:\BILLS\S2533.RS S2533

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1 nal 12 facilities of the Department that were selected 

2 under such partnership is feasible. 

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

4 after the date of the enactment of this Act, and every three 

5 years thereafter, the Secretary shall submit to the Com6 mittee on Veterans’ Affairs of the Senate and the Committee 

7 on Veterans’ Affairs of the House of Representatives a re8 port— 

9 (1) assessing how the partnerships entered into 

10 under subsection (a)(1) have impacted access by vet11 erans to cancer centers of the National Cancer Insti12 tute, including an assessment of the telehealth options 

13 made available and used pursuant to such partner14 ships; and 

15 (2) describing the advancements made with re16 spect to access by veterans to clinical cancer research 

17 trials through the partnership described in subsection 

18 (b)(1), including how many of those veterans were 

19 women veterans, minority veterans (including racial 

20 and ethnic minorities), and rural veterans, and iden21 tifying opportunities for further innovation. 


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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 Veterans 

7 Affairs, in collaboration with the Secretary of Defense, shall 

8 submit to Congress a report on all current research and 

9 health care collaborations between the Department of Vet10 erans Affairs and the Department of Defense on treating 

11 veterans and members of the Armed Forces with breast can12 cer. 

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 De18 partment of Defense with respect to treating and re19 searching 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 un23 dergoing screening for breast cancer, transition 

24 of such members from receiving care from the 

25 Department of Defense to receiving care from the 

26 Department of Veterans Affairs; 


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1 (B) collaborative breast cancer research op2 portunities between the Department of Veterans 

3 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. 


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Calendar No. 303 

117TH CONGRESS 

2D SESSION S. 2533 

A BILL 

To improve mammography services furnished by 

other purposes. the Department of Veterans Affairs, and for 

MARCH 10 (legislative day, MARCH 7), 2022 

Reported with an amendment 


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