Table 2.

Condensed U.S. Preventive Services Task Force (USPSTF) Policies Relating to Cancer Coverage.

Condition	Relevant policies (Condensed)	Issue areas and groups impacted
Hereditary breast and ovarian cancer (HBOC)	The U.S. Preventive Services Task Force recommends biennial screening mammography for women aged 50–74 years. Women at higher risk may benefit from beginning screening in their 40 s [71]. Screen women who have family members with breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with BRCA1/2 gene mutations with an appropriate brief familial risk assessment tool. Women who are positive should receive genetic counseling and, if indicated, genetic testing [72]. This recommendation applies to women who are asymptomatic for BRCA-related cancer [72].	Women who are currently symptomatic or receiving treatment for HBOC and associated cancers are not covered by the ACA no copay provision. African American women – higher incidence and greater mortality from early-stage breast cancer than other groups – are particularly affected. Men at risk for or symptomatic with breast cancer or who might pass a BRCA1/2 mutation to their children are not covered by the ACA.
Hereditary nonpolyposis colorectal cancer – Lynch syndrome	Screen for colorectal cancer starting at age 50 years and continuing until age 75 years. The risks and benefits of different screening methods vary [73]. This recommendation applies to asymptomatic adults 50 years and older who are at average risk of colorectal cancer and who do not have a family history of known genetic disorders that predispose them to a high lifetime risk of colorectal cancer (such as Lynch syndrome or familial adenomatous polyposis) [73].	Men and women, beginning age 50, are eligible for routine screening. USPSTF recommendations unclear on screening African Americans earlier. Individuals newly diagnosed with colorectal cancer are not covered for Lynch syndrome genetic counseling, screening and mutation testing. At risk low-income, rural populations doubly hit by lack of physician follow-through on family history and lack of ACA coverage.
Prostate cancer	The decision to undergo periodic PSA-based screening for prostate cancer should be an individual one. Men should discuss the potential benefits and harms, and their values and preferences, with their clinician [74]. This recommendation does not include the use of the PSA test for surveillance after diagnosis or treatment of prostate cancer and does not consider PSA-based testing in men with known BRCA gene mutations who may be at increased risk for prostate cancer [75]. Based on the available evidence, the USPSTF is not able to make a separate, specific recommendation on PSA-based screening for prostate cancer in African American men … [or] men with a family history of prostate cancer [74].	Men with germline mutations leading to increased risk for prostate cancer (BRCA2) are not covered by the ACA. African American men - higher incidence and greater mortality from prostate cancer than other groups – are particularly affected.