117TH CONGRESS 

2D SESSION S. 2533 

AN ACT 

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, 
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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

3 ‘‘Making Advances in Mammography and Medical Options 

4 for Veterans Act’’. 

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

6 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. 

7 TITLE I—SCREENING AND 

8 EARLY DETECTION 

9 SEC. 101. STRATEGIC PLAN FOR BREAST IMAGING SERV10 ICES FOR VETERANS. 

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

12 date of the enactment of this Act, the Secretary of Vet13 erans Affairs shall submit to the Committee on Veterans’ 

14 Affairs of the Senate and the Committee on Veterans’ Af15 fairs of the House of Representatives a strategic plan for 

16 improving breast imaging services for veterans. 
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1 (b) ELEMENTS.—The strategic plan required by sub2 section (a) shall— 

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

4 (2) address geographic disparities of breast im5 aging furnished at a facility of the Department of 

6 Veterans Affairs and the use of breast imaging 

7 through non-Department providers in the commu8 nity; 

9 (3) address the use of digital breast 

10 tomosynthesis (DBT–3D breast imaging); 

11 (4) address the needs of male veterans who re12 quire breast cancer screening services; and 

13 (5) provide recommendations on— 

14 (A) potential expansion of breast imaging 

15 services furnished at facilities of the Depart16 ment, including infrastructure and staffing 

17 needs; 

18 (B) the use of digital breast tomosynthesis; 

19 (C) the use of mobile mammography; and 

20 (D) other access and equity improvements 

21 for breast imaging. 
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1 SEC. 102. TELESCREENING MAMMOGRAPHY PILOT PRO2 GRAM OF DEPARTMENT OF VETERANS AF3 FAIRS. 

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

5 months after the date of the enactment of this Act, the 

6 Secretary of Veterans Affairs shall carry out a pilot pro7 gram to provide telescreening mammography services for 

8 veterans who live in— 

9 (1) States where the Department of Veterans 

10 Affairs does not offer breast imaging services at a 

11 facility of the Department; or 

12 (2) locations where access to breast imaging 

13 services at a facility of the Department is difficult 

14 or not feasible, as determined by the Secretary. 

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

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

17 beginning on the commencement of the pilot program. 

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

19 under subsection (a), the Secretary may use community20 based outpatient clinics, mobile mammography, Federally 

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

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

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

24 Indian Health Service, and such other sites as the Sec25 retary determines feasible to provide mammograms under 

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

2 pilot program under subsection (a)— 

3 (1) mammography images generated shall be 

4 sent to a telescreening mammography center of the 

5 Department for interpretation by qualified radiolo6 gists; and 

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

8 their primary care provider in accordance with poli9 cies established by the Secretary. 

10 (e) REPORT.— 

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

12 after the conclusion of the pilot program under sub13 section (a), the Secretary shall submit to the Com14 mittee on Veterans’ Affairs of the Senate and the 

15 Committee on Veterans’ Affairs of the House of 

16 Representatives a report evaluating the pilot pro17 gram. 

18 (2) ELEMENTS.—The report required by para19 graph (1) shall include the following: 

20 (A) An assessment of the quality of the 

21 mammography provided under the pilot pro22 gram under subsection (a). 

23 (B) Feedback from veterans and providers 

24 participating in the pilot program. 
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1 (C) A recommendation of the Secretary on 

2 the continuation or discontinuation of the pilot 

3 program. 

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

5 DEPARTMENT OF VETERANS AFFAIRS TO 

6 THREE-DIMENSIONAL DIGITAL MAMMOG7 RAPHY. 

8 Not later than two years after the date of the enact9 ment of this Act, the Secretary of Veterans Affairs shall— 

10 (1) upgrade all mammography services at facili11 ties of the Department of Veterans Affairs that pro12 vide such services to use digital breast tomosynthesis 

13 technology, also known as three-dimensional breast 

14 imaging; and 

15 (2) submit to the Committee on Veterans’ Af16 fairs of the Senate and the Committee on Veterans’ 

17 Affairs of the House of Representatives a report— 

18 (A) indicating that the upgrade under 

19 paragraph (1) has been completed; and 

20 (B) listing the facilities or other locations 

21 of the Department at which digital breast 

22 tomosynthesis technology is used. 
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1 SEC. 104. STUDY ON AVAILABILITY OF TESTING FOR 

2 BREAST CANCER GENE AMONG VETERANS 

3 AND EXPANSION OF AVAILABILITY OF SUCH 

4 TESTING. 

5 (a) STUDY.— 

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

7 Affairs shall conduct a study on the availability of 

8 access to testing for the breast cancer gene for vet9 erans diagnosed with breast cancer, as recommended 

10 by the guidelines set forth by the National Com11 prehensive Cancer Network. 

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

13 paragraph (1), the Secretary shall examine— 

14 (A) the feasibility of expanding the Joint 

15 Medicine Service of the Department of Veterans 

16 Affairs to provide genetic testing and coun17 seling for veterans with breast cancer across the 

18 country; and 

19 (B) access to such testing and counseling 

20 for veterans living in rural or highly rural 

21 areas, and any gaps that may exist with respect 

22 to such access. 

23 (b) EXPANSION OF AVAILABILITY OF TESTING.— 

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

25 guidelines or institute new guidelines to increase the 

26 use of molecular testing and genetic counseling for 
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1 veterans diagnosed with breast cancer, including vet2 erans living in rural or highly rural areas. 

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

4 instituting guidelines under paragraph (1), the Sec5 retary may develop clinical decision support tools, 

6 such as clinical pathways, to facilitate delivery of 

7 breast cancer care that is in line with national can8 cer guidelines. 

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

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

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

12 the Committee on Veterans’ Affairs of the House of Rep13 resentatives a report on— 

14 (1) the results of the study under subsection 

15 (a); 

16 (2) any updates to guidelines or new guidelines 

17 instituted under subsection (b); 

18 (3) breast cancer clinical pathways implemented 

19 by the Department of Veterans Affairs and the utili20 zation of those pathways across the Department; 

21 and 

22 (4) any progress of the Department in improv23 ing access to and usage of molecular and genetic 

24 testing among veterans diagnosed with breast can-
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1 cer, including for veterans living in rural or highly 

2 rural areas. 

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

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

5 in the Rural-Urban Commuting Areas coding system of 

6 the Department of Agriculture. 

7 SEC. 105. MAMMOGRAPHY ACCESSIBILITY FOR PARALYZED 

8 AND DISABLED VETERANS. 

9 (a) STUDY.— 

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

11 Affairs shall conduct a study on the accessibility of 

12 breast imaging services at facilities of the Depart13 ment of Veterans Affairs for veterans with paralysis, 

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

15 disability. 

16 (2) ACCESSIBILITY.—The study required by 

17 paragraph (1) shall include an assessment of the ac18 cessibility of the physical infrastructure at breast 

19 imaging facilities of the Department, including the 

20 imaging equipment, transfer assistance, and the 

21 room in which services will be provided as well as 

22 adherence to best practices for screening and treat23 ing veterans with a spinal cord injury or disorder. 

24 (3) SCREENING RATES.— 
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1 (A) MEASUREMENT.—The study required 

2 by paragraph (1) shall include a measurement 

3 of breast cancer screening rates for veterans 

4 with a spinal cord injury or disorder during the 

5 two-year period preceding the commencement of 

6 the study, including a breakout of the screening 

7 rates for such veterans living in rural or highly 

8 rural areas. 

9 (B) DEVELOPMENT OF METHOD.—If the 

10 Secretary is unable to provide the measurement 

11 required under subparagraph (A), the Secretary 

12 shall develop a method to track breast cancer 

13 screening rates for veterans with a spinal cord 

14 injury or disorder. 

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

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

17 shall submit to the Committee on Veterans’ Affairs 

18 of the Senate and the Committee on Veterans’ Af19 fairs of the House of Representatives a report on the 

20 findings of the study required by paragraph (1), in21 cluding— 

22 (A) the rates of screening among veterans 

23 with a spinal cord injury or disorder, including 

24 veterans living in rural or highly rural areas, as 

25 required under paragraph (3)(A); or 
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1 (B) if such rates are not available, a de2 scription of the method developed to measure 

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

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

5 The Secretary shall update the policies and directives of 

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

7 a spinal cord injury or disorder for care from a non-De8 partment provider, the Secretary shall— 

9 (1) confirm with the provider the accessibility 

10 of the breast imaging site, including the imaging 

11 equipment, transfer assistance, and the room in 

12 which services will be provided; and 

13 (2) provide additional information to the pro14 vider on best practices for screening and treating 

15 veterans with a spinal cord injury or disorder. 

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

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

18 in the Rural-Urban Commuting Areas coding system of 

19 the Department of Agriculture. 

20 SEC. 106. REPORT ON ACCESS TO AND QUALITY OF MAM21 MOGRAPHY SCREENINGS FURNISHED BY DE22 PARTMENT OF VETERANS AFFAIRS. 

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

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

25 of the Department of Veterans Affairs shall submit to the 
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1 Secretary of Veterans Affairs, the Committee on Veterans’ 

2 Affairs of the Senate, and the Committee on Veterans’ Af3 fairs of the House of Representatives a report on mam4 mography services furnished by the Department of Vet5 erans Affairs. 

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

7 (a) shall include an assessment of— 

8 (1) the access of veterans to mammography 

9 screenings, whether at a facility of the Department 

10 or through a non-Department provider, including 

11 any staffing concerns of the Department in pro12 viding such screenings; 

13 (2) the quality of such screenings and reading 

14 of the images from such screenings, including wheth15 er such screenings use three-dimensional mammog16 raphy; 

17 (3) the communication of the results of such 

18 screenings, including whether results are shared in a 

19 timely manner, whether results are shared via the 

20 Joint Health Information Exchange or another elec21 tronic mechanism, and whether results are incor22 porated into the electronic health record of the vet23 eran; 

24 (4) the performance of the Women’s Breast On25 cology System of Excellence of the Department; and 
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1 (5) the access of veterans diagnosed with breast 

2 cancer to a comprehensive breast cancer care team 

3 of the Department. 

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

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

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

7 Senate and the Committee on Veterans’ Affairs of the 

8 House of Representatives a plan to address the defi9 ciencies identified in the report under subsection (a), if 

10 any. 

11 TITLE II—PARTNERSHIPS FOR 

12 RESEARCH AND ACCESS TO 

13 CARE 

14 SEC. 201. PARTNERSHIPS WITH NATIONAL CANCER INSTI15 TUTE TO EXPAND ACCESS OF VETERANS TO 

16 CANCER CARE. 

17 (a) ACCESS TO CARE IN EACH VISN.— 

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

19 Affairs shall enter into a partnership with not fewer 

20 than one cancer center of the National Cancer Insti21 tute of the National Institutes of Health in each 

22 Veterans Integrated Service Network of the Depart23 ment of Veterans Affairs to expand access to high24 quality cancer care for women veterans. 
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1 (2) TREATMENT OF RURAL VETERANS.—The 

2 Secretary, in carrying out partnerships entered into 

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

4 breast cancer who reside in rural areas or States 

5 without a cancer center that has entered into such 

6 a partnership with the Secretary are able to receive 

7 care through such a partnership via telehealth. 

8 (b) REPORT ON PARTNERSHIP TO INCREASE ACCESS

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

10 date of the enactment of this Act, the Secretary shall sub11 mit to the Committee on Veterans’ Affairs of the Senate 

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

13 Representatives a report on— 

14 (1) how the Secretary will ensure that the ad15 vancements made through the existing partnership 

16 between the Department of Veterans Affairs and the 

17 National Cancer Institute to provide veterans with 

18 access to clinical cancer research trials (commonly 

19 referred to as ‘‘NAVIGATE’’) are permanently im20 plemented; and 

21 (2) the determination of the Secretary of 

22 whether expansion of such partnership to more than 

23 the original 12 facilities of the Department that 

24 were selected under such partnership is feasible. 
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1 (c) PERIODIC REPORTS.—Not later than three years 

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

3 three years thereafter, the Secretary shall submit to the 

4 Committee on Veterans’ Affairs of the Senate and the 

5 Committee on Veterans’ Affairs of the House of Rep6 resentatives a report— 

7 (1) assessing how the partnerships entered into 

8 under subsection (a)(1) have impacted access by vet9 erans to cancer centers of the National Cancer Insti10 tute, including an assessment of the telehealth op11 tions made available and used pursuant to such 

12 partnerships; and 

13 (2) describing the advancements made with re14 spect to access by veterans to clinical cancer re15 search trials through the partnership described in 

16 subsection (b)(1), including how many of those vet17 erans were women veterans, minority veterans (in18 cluding racial and ethnic minorities), and rural vet19 erans, and identifying opportunities for further inno20 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. 

Passed the Senate March 23, 2022. 

Attest: 

Secretary. 
117TH CONGRESS 

2D SESSION S. 2533 

AN ACT 

To improve mammography services furnished by 

other purposes. the Department of Veterans Affairs, and for