As young veterans face breast cancer, Congress pushes VA to ensure access to screening
WASHINGTON (SOA) — Earlier this week, Spotlight on America exposed a little-known battle faced by our veterans. Many people are being diagnosed with breast cancer at a very young age. That’s ignited a push to raise awareness among service members about this potential risk, and ensure they have resources for early detection. Congress took major steps to address the issue this year, entering a crucial stage when it comes to putting that plan into action.
When you meet Shane Thomas, he'll tell you why his wife was so special, and give you a million reasons for it.
"I married her because of her heart," he told Spotlight on America, "and just how much she gave of herself."
Shane's wife, Dr. Kate Hendricks Thomas, was Marine Corps veteran, deployed to Fallujah, Iraq in 2005, during one of the deadliest years of the war.
When she came home, she dedicated her life to public service, getting a PhD, becoming a behavioral medicine researcher, author of several books, and a teacher at George Mason University's Department of Global and Community Health. Much of her work focused on preventing veteran suicides and promoting mental health.
Then, on a winter day in 2018, her life changed.
At 38 years old, Kate, a young mom to her son Matthew, was diagnosed with stage four breast cancer, blindsiding her family.
"At her age, nobody was looking for it and she didn't really have any symptoms to speak of," Shane Thomas told us.
As Kate launched the fight of her life, she started to notice a troubling trend: many of the women she had served with were facing a similar diagnosis.
"Once Kate got diagnosed and she started poking the bear a little bit, she started figuring out it was much broader and much deeper than what anybody had ever realized," Shane Thomas told us. "She actually had someone that was deployed with her and had the exact same type of stage-four breast cancer."
As revealed in our first report in this series, studies show that female service members have up to 40% higher risk of developing breast cancer than their civilian counterparts. The VA reports that about 700 military women are diagnosed with breast cancer every year.
With women now the fastest growing population among veterans, it's a number that could rise, according to Joy Ilem, national legislative director with the Disabled American Veterans Organization. Ilem has made it her mission to ensure men and women have equal access to quality care in VA facilities, so the issue of breast cancer is among her top priorities.
"With more and more women serving and more and more women coming to VA, we've really seen this increase in prevalence and a particular attention to breast cancer," Ilem told us.
Ilem believes there has been a strong focus on this issue from the VA, but as the number of female veterans has surged, there is a need for more research to understand the potential risks faced by military women, and ensure they have necessary resources.
"You want VA to really be on the cutting edge of looking out for our nation's veterans and making sure if they do have these unique risk factors, that they're gonna get the screening appropriate screening and care that they need," Ilem told us.
A Spotlight on America investigation found that for decades, women veterans did not have access to in-house mammograms at VA facilities in 15 states. That's nearly a third of the country.
We reached out to the VA for a state-by-state accounting of which facilities have in-house mammography capabilities. The Department could not provide that information, and told us it didn't exist. Instead, they directed us to the American College of Radiology, which provides a listing of accredited facilities Accredited Facility Search.
In response to our investigation, the VA told us all veterans have access to screening, saying there are now 70 in-house mammography programs nationwide, out of nearly 1,300 VA health care facilities. To ensure veterans have access to what could be life-saving screenings, the Department told us veterans may be sent to local community health centers for mammograms.
Coordinating that care can be a challenge, and Joy Ilem worries that with millions of veterans living in rural parts of the country, some could fall through the cracks.
"It's hard to get good access to healthcare in general in a rural community. VA is no different, has struggled with this," Ilem told us. "They need to coordinate that care. They also need to train their providers that may not have a lot of experience with women's health."
The VA long followed universally adopted health guidelines for cancer screening, which generally recommend age 40 as a starting point.
But that would soon change - thanks to Kate Hendricks Thomas.
Kate, even while in treatment for cancer, became a powerful advocate for making sure female veterans have access to mammograms whenever they need them, so no one would fall through the cracks.
Kate was given six to ten years to live. She would only get four.
Even in her final days, she was fighting for others. Shane told us, "The main strength was trying to do what we could to prevent another mom from having to leave her son or her daughter too early."
Kate passed away this past April, but her name lives on in legislation inked by Senator John Boozman (R-AR), who was touched by her story.
"A lady that had everything going for her and a nine-year-old son, and then this happens," Senator Boozman said. "It really focuses your attention."
Inspired by Kate's advocacy, Senator Boozman advanced two key bills that were signed by President Biden this past summer.
First, he sponsored the The Dr. Kate Hendricks Thomas S.E.R.V.I.C.E. Act, allowing for any veteran who served in the Middle East to be eligible for a mammogram, regardless of age. It also requires the VA to study the rates of breast cancer among servicewomen compared with civilians.
"We're going to allow screenings very early, with the very best equipment that can be bought, and make sure that women are going to get the care that they need," said Senator Boozman.
The M.A.M.M.O. Act, or Making Advances in Mammography and Medical Options for Veterans Act, requires the VA to develop a plan to improve breast cancer screening, and provide teleservices to veterans who need it. Senator Boozman was a co-sponsor of the legislation introduced by Senator John Tester (D-MN), who told Spotlight on America:
“Every veteran deserves access to high-quality breast cancer screening and care—no matter where they live,” said Senator Tester, Chairman of the Senate Veterans’ Affairs Committee.
“That’s why I’m proud to have championed the bipartisan Making Advances in Mammography and Medical Options (MAMMO) for Veterans Act to improve veterans’ access to timely, high-quality screenings and tele-mammography services, especially for those living in rural areas. The fact is, everyone knows someone whose life has been touched by breast cancer, and we need to keep fighting to connect more folks with the critical tools that will lead to earlier detection and help save lives.”
Spotlight on America checked the VA's web site, which still recommends women start being screened at age 45, and has not been updated to reflect that a woman of any age can be screened.
In a sit-down interview with Spotlight on America, Senator Boozman told us he's committed to ensuring the letter of the law is followed.
"The VA system was built for men because predominantly that's who served in the military," Senator Boozman said. "But the VA has not done as good a job as we'd like for women in the past. We're working hard to rectify that situation."
The bills were signed by President Biden on June 7th, with Kate's husband Shane and her son Matthew in attendance.
Now, it's time to start implementing the provisions. We asked Senator Boozman about who will be enforcing and overseeing the changes.
"We're working really hard," he told us. "These are questions that are being asked and following up on. I appreciate the fact that you're doing the same thing. And that's what this is all about all of us working together."
We also asked about the cost of ensuring resources are available to all service members.
"It's going to cost a lot," Senator Boozman said. "We're prepared to increase whatever it costs to implement these things."
It's a commitment to action that was cemented by Senator Boozman as he sat alongside Shane Thomas and his son, Matthew, at an event commending the life-saving legacy left by Kate.
His signature is on the legislation displayed in a shrine to Kate at the Thomas home in Virginia.
Shane Thomas called the passage of the legislation "surreal."
"It was one of those things where you had an extreme amount of gratitude for the fact that your wife was special enough to have made an impact like that," he told us. "But the cost was too high."
For the VA's part, the Administration declined an interview with Spotlight on America. Its web site states that the VA exceeds the private sector in screening rates, and it has mammogram coordinators to help women navigate the process. In addition, they told us in writing a Breast and Gynecologic Cancer System of Excellence team is in place, comprised of doctors to provide the best care, and they've developed an internal dashboard monitoring veterans with breast cancer. It told us it has a team of experts who have developed recommendations for "breast cancer care pathways" to ensure the best outcomes. We're told those pathways are being reviewed and will be implemented next month, something we'll be watching closely. You can read our full Q&A with the Dept. of Veteran's Affairs below.
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To watch our first report, click here, or watch below:
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Spotlight on America asked the VA a list of questions about access to screening for veterans.
You can read the full Q&A below:
We know that the MAMMO Act was recently passed, which requires a study about the availability of breast imaging services at VA centers. I have several questions about the progress of this. Can [you] confirm that the study is happening?
The National Radiology Program is collaborating with the Offices of Spinal Cord Injury/Disorder, Women’s Health and Construction and Facilities Management to conduct a study to assess the accessibility of in-house mammography and community care programs to accommodate the special needs of these Veterans. All Veterans have access to high quality screening for breast cancer at one of the Veterans Health Administration’s (VHA’s) 70 in-house mammography programs or through one of our community care partners. The VHA National Radiology Program developed a breast imaging strategic plan that addresses the evolving needs of Veterans. The strategic plan includes the initiatives outlined in the Making Advances in Mammography and Medicine Options and the Supporting Expanded Review for Veterans In Combat Environments (SERVICE) Act to expand access to clinically appropriate screening mammography.
Where can I find a complete list of which VA centers have mammography services - and those that have 3D breast imaging capabilities?
VA does not have a publicly available database that provides the information requested; however, the American College of Radiology provides an intuitive listing of accredited facilities Accredited Facility Search (acraccreditation.org). Veterans inquiring whether a VA facility offers on-site mammography services may also review their local medical center website. If they are unable to determine if their local facility offers this service, they should reach out to their local Women Veterans Program Manager. Currently, 94% of VHA mammography programs offer 3D digital breast tomosynthesis and the remaining programs are in the process of upgrading required equipment. Veterans may call, text, or chat online with the Women Veterans Call Center (WVCC) at 855-829-6636 to get help and find available resources and services in your area.
According to their web site, “Currently, VA is building the infrastructure necessary to screen for and aggressively treat breast and gynecological cancers affecting women Veterans.” Could you please offer an update as to where that process stands and the anticipated completion timeline of that infrastructure?
VA’s Breast and Gynecologic Cancer System of Excellence (BGSOE) cancer care team is in place and comprises physicians, pharmacists, advanced practice providers, and registered nurses to care for Veterans with breast cancer virtually all over the U.S. in collaboration with the National Tele-Oncology Program. An internal dashboard monitoring Veterans with a breast cancer diagnosis has been created and remains under continuous evaluation to ensure its capability conforms to the care management requirements for the team of VA nurse navigators and eventually social workers that guide Veterans through their breast cancer diagnosis and treatments, whether at a VA medical center or through the network of arranged community care. In addition, a team of multidisciplinary breast cancer experts have developed recommendations for breast cancer care pathways that will help ensure Veterans are receiving the highest quality cancer prevention, treatment, and outcomes. The cancer care pathways are undergoing early stages of review and remain on track to be implemented by December 2022.
Does the VA currently have a program to allow tele-screening for veterans who don't live near a center that is equipped with mammography technology?
VHA is developing a Tele-screening Mammography pilot program which will allow for establishment of screening mammography services at selected locations in accordance with the MAMMO Act. Several VA medical centers currently offer tele-screening mammography services to their patients at affiliated outpatient clinics.
If a veteran lives far from a VA facility with mammography, what programs are in place in your state to ensure there is coverage for travel expenses associated with receiving a mammogram?
VA travel pay reimbursement pays eligible Veterans and caregivers back for mileage and other travel expenses to and from approved health care appointments. More information on VA travel pay can be found here: VA Travel Pay Reimbursement | Veterans Affairs.
Your web site states that there are "mammogram coordinators" who ensure women are receiving their key screenings. How many mammogram coordinators are currently employed by the VA- and where are they located?
There are more than 115+++ mammography coordinators at VA Health Care Systems (HCS) located in the below:
- White River Junction, VT HCS
- Bedford, MA HCS
- Boston, MA HCS
- Manchester, NH HCS
- Central Western Massachusetts HCS
- Providence, RI HCS
- Connecticut HCS
- Bronx, NY HCS
- Western New York HCS
- Finger Lakes, NY HCS
- Syracuse, NY HCS
- Albany, NY HCS
- Hudson Valley, NY HCS
- New York Harbor HCS
- Northport, NY HCS
- Wilmington, DE HCS
- Altoona, PA HCS
- Butler, PA HCS
- Erie, PA HCS
- Pittsburgh, PA HCS
- Wilkes-Barre, PA HCS
- Baltimore, MD HCS
- Beckley, WV HCS
- Huntington, WV HCS
- Martinsburg, WV HCS
- Washington, DC HCS
- Fayetteville, NC HCS
- Hampton, VA HCS
- Asheville, NC HCS
- Richmond, VA HCS
- Salem, VA HCS
- Salisbury, NC HCS
- Atlanta, GA HCS
- Birmingham, AL HCS
- Columbia, SC HCS
- Dublin, GA HCS
- Tuscaloosa, AL HCS
- Bay Pines, FL HCS
- Miami, FL HCS
- West Palm Beach, FL HCS
- Gainesville, FL HCS
- Tampa, FL HCS
- Orlando, FL HCS
- Lexington, KY HCS
- Louisville, KY HCS
- Memphis, TN HCS
- Mountain Home, TN HCS
- Middle Tennessee HCS
- Ann Arbor, MI HCS
- Battle Creek, MI HCS
- Chillicothe, OH HCS
- Cincinnati, OH HCS
- Cleveland, OH HCS
- Dayton, OH HCS
- Indianapolis, IN HCS
- Northern Indiana HCS
- Saginaw, MI HCS
- Columbus, OH HCS
- Chicago, IL HCS
- Danville, IL HCS
- North Chicago, IL HCS
- Hines, IL HCS
- Madison, WI HCS
- Milwaukee, WI HCS
- Kansas City, MO HCS
- Columbia, MO HCS
- Eastern Kansas HCS
- Wichita, KS HCS
- Poplar Bluff, MO HCS
- Marion, IL HCS
- Fargo, ND HCS
- Sioux Falls, SD HCS
- Black Hills, SD HCS
- Minneapolis, MN HCS
- Nebraska-W Iowa HCS
- Central Iowa HCS
- Iowa City, IA HCS
- St. Cloud, MN HCS
- Alexandria, LA HCS
- Gulf Coast, MS HCS
- Fayetteville, AR HCS
- Houston, TX HCS
- Jackson, MS HCS
- New Orleans, LA HCS
- Shreveport, LA HCS
- Amarillo, TX HCS
- Big Spring, TX HCS
- Dallas, TX HCS
- Temple, TX HCS
- Texas Valley Coastal Bend HCS
- El Paso, TX HCS
- Montana HCS
- Cheyenne, WY HCS
- Grand Junction, CO HCS
- Muskogee, OK HCS
- Oklahoma City, OK HCS
- Salt Lake City, UT HCS
- Sheridan, WY HCS
- Anchorage, AK HCS
- Boise, ID HCS
- Portland, OR HCS
- Roseburg, OR HCS
- Puget Sound, WA HCS
- Spokane, WA HCS
- Walla Walla, WA HCS
- White City, OR HCS
- Honolulu, HI HCS
- Fresno, CA HCS
- Las Vegas, NV HCS
- N. California HCS
- San Francisco, CA HCS
- New Mexico HCS
- Loma Linda, CA HCS
- Phoenix, AZ HCS
- Northern Arizona HCS
- Southern Arizona HCS
