Imaging societies, advocates continue railing against Braidwood ruling


Imaging societies and cancer screening advocates continue to criticize a recent federal ruling that challenges no-cost preventive health services.

It comes in response to a June 21 ruling by the Fifth Circuit Court of Appeals on Braidwood Management Inc. et al. v. Xavier Becerra et al. The court agreed with a 2023 ruling made by the District Court of the Northern District of Texas, saying that recommendations made by the U.S. Preventive Services Task Force (USPSTF) are unconstitutional since they violate the Appointments Clause. However, the Fifth Circuit did not agree with the district court's decision to apply the outcome nationwide, stating that the ruling should only apply to the parties in the case.

"We feel the Fifth Circuit's ruling really misses the mark here and sets a dangerous precedent," Valerie Nelson, manager of federal policy and advocacy at Susan G. Komen, said. "It really opens the door to widespread invalidation of the recommendations of the USPSTF, and that opens up, unfortunately, a lot of negative possibilities here."

While the ruling only impacts parties in Braidwood v. Becerra, imaging society experts said it could open the door for future legal challenges to such services. Breast and lung cancer screening advocates say that adhering to screening guidelines, including receiving routine imaging services such as mammography or low-dose CT, is easier when cost is not a concern.

"The introduction of cost burdens for screening mammograms will discourage some individuals from undergoing screening mammograms, resulting in decreased screening adherence, increased advanced-stage breast cancers, and increased breast cancer deaths," Vilert Loving, MD, from the Society of Breast Imaging (SBI), said.

"These sobering outcomes will be especially true for people in lower socioeconomic groups and people of color, where access barriers to screening contribute to the disparities in breast cancer deaths that afflict these populations," Loving added.

The SBI "strongly" supports the continued no-cost insurance coverage of preventive services.

Nelson meanwhile said that the ruling and potential future legal challenges could undo the progress made in cancer screening, vaccination, and tobacco cessation efforts by reducing access to such services.

"For some people, this could look like needing to make a decision between paying for your kid's tuition or for your risk-reducing medication this month. For others, it could look like delaying or saving up for your mammogram due to cost, only to find a cancer that has progressed much later down the road," she said.

In 2023, Komen, for the first time in the organization's history, filed an amicus curiae (friend of the court) brief to address the potential impact of nationwide challenges to providing these services at no cost.  

The American College of Radiology (ACR) is closely monitoring the ongoing case as it heads back to district court. The ACR's stance is that Americans deserve fully covered access to preventive care, including lifesaving cancer screenings, according to the ACR's statement to

"Imaging screening exams for breast, lung, and colon cancer are shown to significantly reduce deaths from these terrible diseases," the ACR stated. "Full coverage for this care with no co-pay can reduce downstream costs of treating advanced disease and injury and improve and maintain the health of Americans. This fully covered access must be preserved."

Breast radiologist Stamatia Destounis, MD, from Elizabeth Wende Breast Care, in her own personal opinion, agreed that the "complicated" ruling causes concern for the potential reversal or removal of the requirement for insurers and employers to cover preventive services without cost sharing.

"The preventive services requirement is a popular provision of the law that has been in effect since 2010 and extends coverage of evidence-based preventive services without cost-sharing to more than 150 million people each year," she said. "That guaranteed benefit could go away if the courts agree with the plaintiffs, and it becomes adopted nationwide."

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