Breast Cancer Screening
Compare Versions of: "Breast Cancer Screening"
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| Measure Information | 2024 Performance Period | 2025 Performance Period | 2026 Performance Period | 2027 Performance Period |
|---|---|---|---|---|
| Title | Breast Cancer Screening | Breast Cancer Screening | Breast Cancer Screening | Breast Cancer Screening |
| CMS eCQM ID | CMS125v12 | CMS125v13 | CMS125v14 | CMS125v15 |
| CBE ID* | Not Applicable | Not Applicable | Not Applicable | Not Applicable |
| MIPS Quality ID | 112 | 112 | 112 | 112 |
| Measure Steward | National Committee for Quality Assurance | National Committee for Quality Assurance | National Committee for Quality Assurance | National Committee for Quality Assurance |
| Description |
Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer in the 27 months prior to the end of the Measurement Period |
Percentage of women 50-74 years of age who had a mammogram to screen for breast cancer in the 27 months prior to the end of the Measurement Period |
Percentage of women 40-74 years of age who had a mammogram to screen for breast cancer in the 27 months prior to the end of the Measurement Period |
Percentage of women 40-74 years of age who had a mammogram to screen for breast cancer in the 27 months prior to the end of the measurement period |
| Measure Scoring | Proportion | Proportion | Proportion | Proportion |
| Measure Type | Process | Process | Process | Process |
| Stratification |
None |
None |
Report a total rate, and each of the following age strata: Stratum 1: Patients age 42-51 by the end of the measurement period Stratum 2: Patients age 52-74 by the end of the measurement period |
Report a total rate, and each of the following age strata: Stratum 1: Patients age 42-51 by the end of the measurement period Stratum 2: Patients age 52-74 by the end of the measurement period |
| Risk Adjustment |
None |
None |
None |
None |
| Rationale |
Breast cancer is one of the most common types of cancers, accounting for 15 percent of all new cancer diagnoses in the U.S. (Noone et al., 2018). In 2015, over 3 million women were estimated to be living with breast cancer in the U.S. and it is estimated that 12 percent of women will be diagnosed with breast cancer at some point during their lifetime (Noone et al., 2018). While there are other factors that affect a woman's risk of developing breast cancer, advancing age is a primary risk factor. Breast cancer is most frequently diagnosed among women ages 55-64; the median age at diagnosis is 62 years (Noone et al., 2018). The chance of a woman being diagnosed with breast cancer in a given year increases with age. By age 40, the chances are 1 in 68; by age 50 it becomes 1 in 43; by age 60, it is 1 in 29 (American Cancer Society, 2017). |
Breast cancer is one of the most common types of cancers, accounting for 15 percent of all new cancer diagnoses in the U.S. (Noone et al., 2018). In 2015, over 3 million women were estimated to be living with breast cancer in the U.S. and it is estimated that 12 percent of women will be diagnosed with breast cancer at some point during their lifetime (Noone et al., 2018). While there are other factors that affect a woman's risk of developing breast cancer, advancing age is a primary risk factor. Breast cancer is most frequently diagnosed among women ages 55-64; the median age at diagnosis is 62 years (Noone et al., 2018). The chance of a woman being diagnosed with breast cancer in a given year increases with age. By age 40, the chances are 1 in 68; by age 50 it becomes 1 in 43; by age 60, it is 1 in 29 (American Cancer Society, 2017). |
Breast cancer is one of the most common types of cancers, accounting for 15 percent of all new cancer diagnoses in the U.S. (Noone et al., 2018). In 2015, over 3 million women were estimated to be living with breast cancer in the U.S. and it is estimated that 12 percent of women will be diagnosed with breast cancer at some point during their lifetime (Noone et al., 2018). While there are other factors that affect a woman's risk of developing breast cancer, advancing age is a primary risk factor. Breast cancer is most frequently diagnosed among women ages 55-64; the median age at diagnosis is 62 years (Noone et al., 2018). The chance of a woman being diagnosed with breast cancer in a given year increases with age. By age 40, the chances are 1 in 68; by age 50 it becomes 1 in 43; by age 60, it is 1 in 29 (American Cancer Society, 2017). |
Breast cancer is one of the most common types of cancers, accounting for 15 percent of all new cancer diagnoses in the U.S. (Noone et al., 2018). In 2015, over 3 million women were estimated to be living with breast cancer in the U.S., and it is estimated that 12 percent of women will be diagnosed with breast cancer at some point during their lifetime (Noone et al., 2018). While there are other factors that affect a woman's risk of developing breast cancer, advancing age is a primary risk factor. Breast cancer is most frequently diagnosed among women ages 55-64; the median age at diagnosis is 62 years (Noone et al., 2018). The chance of a woman being diagnosed with breast cancer in a given year increases with age. By age 40, the chances are 1 in 68; by age 50 it becomes 1 in 43; by age 60, it is 1 in 29 (American Cancer Society, 2017). |
| Clinical Recommendation Statement |
The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women aged 50-74 years (B recommendation) (USPSTF, 2016). The decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years (C recommendation) (USPSTF, 2016). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women aged 75 years or older (I statement) (USPSTF, 2016). The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of digital breast tomosynthesis (DBT) as a primary screening method for breast cancer (I statement) (USPSTF, 2016). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, magnetic resonance imaging, DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram (I statement) (USPSTF, 2016). The National Comprehensive Cancer Network (NCCN) and the American College of Radiology (ACR) recommend using conventional mammography or DBT for screening women at low, intermediate or high risk for breast cancer (NCCN, 2021) (ACR, 2017). |
The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women aged 50-74 years (B recommendation) (USPSTF, 2016). The decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years (C recommendation) (USPSTF, 2016). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women aged 75 years or older (I statement) (USPSTF, 2016). The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of digital breast tomosynthesis (DBT) as a primary screening method for breast cancer (I statement) (USPSTF, 2016). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, magnetic resonance imaging, DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram (I statement) (USPSTF, 2016). The National Comprehensive Cancer Network (NCCN) and the American College of Radiology (ACR) recommend using conventional mammography or DBT for screening women at low, intermediate or high risk for breast cancer (NCCN, 2021) (ACR, 2017). |
The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women aged 40-74 years (B recommendation) (USPSTF, 2024). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women aged 75 years or older (I statement) (USPSTF, 2024). The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of digital breast tomosynthesis (DBT) as a primary screening method for breast cancer (I statement) (USPSTF, 2024). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography and magnetic resonance imaging in women identified to have dense breasts on an otherwise negative screening mammogram (I statement) (USPSTF, 2024). The National Comprehensive Cancer Network (NCCN) and the American College of Radiology (ACR) recommend using conventional mammography or DBT for screening women at low, intermediate or high risk for breast cancer (NCCN, 2021) (ACR, 2017). |
The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women aged 40-74 years (B recommendation) (USPSTF, 2024). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women aged 75 years or older (I statement) (USPSTF, 2024). The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of digital breast tomosynthesis (DBT) as a primary screening method for breast cancer (I statement) (USPSTF, 2024). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography and magnetic resonance imaging in women identified to have dense breasts on an otherwise negative screening mammogram (I statement) (USPSTF, 2024). The National Comprehensive Cancer Network (NCCN) and the American College of Radiology (ACR) recommend using conventional mammography or DBT for screening women at low, intermediate or high risk for breast cancer (NCCN, 2021; ACR, 2017). |
| Improvement Notation |
Higher score equals better quality |
Higher score equals better quality |
Higher score equals better quality |
Higher score equals better quality |
| Definition |
None |
None |
None |
None |
| Guidance |
This measure evaluates primary screening. Do not count biopsies, breast ultrasounds, or MRIs because they are not appropriate methods for primary breast cancer screening. Please note the measure may include screenings performed outside the age range of patients referenced in the initial population. Screenings that occur prior to the measurement period are valid to meet measure criteria. This eCQM is a patient-based measure.
This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
This measure evaluates primary screening. Do not count biopsies, breast ultrasounds, or MRIs because they are not appropriate methods for primary breast cancer screening. Please note the measure may include screenings performed outside the age range of patients referenced in the initial population. Screenings that occur prior to the measurement period are valid to meet measure criteria. This eCQM is a patient-based measure.
This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
This measure evaluates primary screening. Do not count biopsies, breast ultrasounds, or MRIs because they are not appropriate methods for primary breast cancer screening. Please note the measure may include screenings performed outside the age range of patients referenced in the initial population. Screenings that occur prior to the measurement period are valid to meet measure criteria. This eCQM is a patient-based measure.
This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
This measure evaluates primary screening. Do not count biopsies, breast ultrasounds, or MRIs because they are not appropriate methods for primary breast cancer screening. Please note the measure may include screenings performed outside the age range of patients referenced in the initial population. Screenings that occur prior to the measurement period are valid to meet measure criteria. This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
| Initial Population |
Women 52-74 years of age by the end of the measurement period with a visit during the measurement period |
Women 52-74 years of age by the end of the measurement period with a visit during the measurement period |
Women 42-74 years of age by the end of the measurement period with a visit during the measurement period |
Women 42-74 years of age by the end of the measurement period with a visit during the measurement period |
| Denominator |
Equals Initial Population |
Equals Initial Population |
Equals Initial Population |
Equals Initial Population |
| Denominator Exclusions |
Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy on or before the end of the measurement period. Exclude patients who are in hospice care for any part of the measurement period. Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period. Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness with two outpatient encounters during the measurement period or the year prior - OR advanced illness with one inpatient encounter during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior Exclude patients receiving palliative care for any part of the measurement period. |
Exclude patients who are in hospice care for any part of the measurement period. Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy on or before the end of the measurement period. Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness diagnosis during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period. Exclude patients receiving palliative care for any part of the measurement period. |
Exclude patients who are in hospice care for any part of the measurement period. Women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy on or before the end of the measurement period. Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria: - Advanced illness diagnosis during the measurement period or the year prior - OR taking dementia medications during the measurement period or the year prior Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period. Exclude patients receiving palliative care for any part of the measurement period. |
Exclude patients who are in hospice care for any part of the measurement period. Exclude patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period. Exclude patients 66 and older by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria:
Exclude patients receiving palliative care for any part of the measurement period. Exclude women who had a bilateral mastectomy or who have a history of a bilateral mastectomy or for whom there is evidence of a right and a left unilateral mastectomy on or before the end of the measurement period. |
| Numerator |
Women with one or more mammograms any time on or between October 1 two years prior to the measurement period and the end of the measurement period |
Women with one or more mammograms any time on or between October 1 two years prior to the measurement period and the end of the measurement period |
Women with one or more mammograms any time on or between October 1 two years prior to the measurement period and the end of the measurement period |
Women with one or more mammograms any time on or between October 1 two years prior to the measurement period and the end of the measurement period |
| Numerator Exclusions |
Not Applicable |
Not Applicable |
None |
None |
| Denominator Exceptions |
None |
None |
None |
None |
| Telehealth Eligible | Yes | Yes | Yes | Yes |
| Reporting Options | MVP | APP Plus, MVP | APP Plus, MVP | |
| MVP ID | M1366 | M1366 | M1366 | |
| Next Version | No Version Available | |||
| Previous Version | No Version Available |
Additional Resources for CMS125v15
Header
| TRN | Measure Section | Source of Change |
|---|---|---|
Updated the eCQM version number. | eCQM Version Number | Annual Update |
Updated the measurement period from 'January 1, 2026 through December 31, 2026' to 'January 1, 2027 through December 31, 2027.' | Measurement Period | Annual Update |
Updated copyright. | Copyright | Annual Update |
Updated grammar, wording, and/or formatting to improve readability and consistency. | Multiple Sections | Annual Update |
Updated all in-text citations from APA6 style to APA7 style. | Multiple Sections | Standards/Technical Update |
Updated all References from APA6 style to APA7 style. | Reference | Standards/Technical Update |
Updated references to reflect current evidence and new or updated literature. | Reference | Measure Lead |
Updated Denominator Exclusions description to list cross-cutting exclusions first, followed by measure-specific ones for consistency across eCQMs. | Denominator Exclusions | Measure Lead |
Logic
| TRN | Measure Section | Source of Change |
|---|---|---|
Updated the version number of the AdvancedIllnessandFrailtyQDM library to 11.0.000. | Definitions | Annual Update |
Updated the version number of the PalliativeCareQDM library to 6.0.000. | Definitions | Annual Update |
Updated Advanced Illness diagnosis timing from 'starts during' to 'overlaps' to better reflect how chronic conditions are documented in EHRs, ensuring more accurate identification of advanced illness. | Definitions | Annual Update |
Updated the 'Is Age 66 Or Older Living Long Term In A Nursing Home' definition to improve readability. | Definitions | Annual Update |
Updated all logic and shared library definitions to be written in initial case for alignment with the CQL Style Guide. | Definitions | Standards/Technical Update |
Updated the timing comparison precision in the definitions by adding 'day of' operator to align with the measure intent and address time zone differences. | Definitions | Standards/Technical Update |
Updated measure logic to list cross-cutting exclusions first, followed by measure-specific ones for consistency across eCQMs. | Definitions | Measure Lead |
Updated the version number of the AdvancedIllnessandFrailtyQDM library to 11.0.000. | Functions | Annual Update |
Updated the version number of the PalliativeCareQDM library to 6.0.000. | Functions | Annual Update |
Replaced Direct Reference Code 'F' with SNOMEDCT Direct Reference code 'Female (finding)' (248152002) to represent 'Female' sex. | Terminology | Standards/Technical Update |
Replaced qualifier value Direct Reference Codes (SNOMEDCT 7771000 and SNOMEDCT 24028007) with body structure codes (SNOMEDCT 361716006 and SNOMEDCT 361715005). | Terminology | Annual Update |
Value Set
The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.
| TRN | Measure Section | Source of Change |
|---|---|---|
Value Set 'Advanced Illness' (2.16.840.1.113883.3.464.1003.110.12.1082): Added 8 ICD10CM codes (G35.A, G35.B0, G35.B1, G35.B2, G35.C0, G35.C1, G35.C2, G35.D) based on SME/Expert recommendations. Added 20 SNOMEDCT codes (702429008, 1260328002, 1343507003, 1343682000, 1344640009, 1348304006, 1359858006, 1363184005, 1363185006, 135811000119107, 235601000112100, 941871000124103, 16067571000119106, 16067651000119101, 140633841000119106, 386085001000119102, 417437921000119101, 543826841000119109, 711570201000119105, 932947661000119102) based on SME/Expert recommendations. Deleted 33 SNOMEDCT codes (1236965009, 1237491009, 1240357005, 1254729000, 1254730005, 1254731009, 1263997005, 1263998000, 1264257008, 1264496004, 1264498003, 1264521002, 1264523004, 1264524005, 1268355005, 233765002, 705176003, 733185001, 781076008, 94176003, 94177007, 94182000, 94244003, 94276008, 94277004, 94297009, 94385006, 94387003, 94401004, 94443006, 94444000, 94653000, 94655007) based on SME/Expert recommendations. | Terminology | Annual Update |
Value Set 'Bilateral Mastectomy' (2.16.840.1.113883.3.464.1003.198.12.1005): Deleted 1 SNOMEDCT code (1279986002) based on SME/Expert recommendations. | Terminology | Annual Update |
Value Set 'Encounter Inpatient' (2.16.840.1.113883.3.666.5.307): Added 4 SNOMEDCT codes (112689000, 15584006, 442281000124108, 81672003) based on SME/Expert recommendations. | Terminology | Annual Update |
Value Set 'Frailty Device' (2.16.840.1.113883.3.464.1003.118.12.1300): Deleted 13 SNOMEDCT codes (266731002, 336608004, 466382000, 466986006, 467068002, 1142151007, 1255320005, 1256013004, 1256014005, 1256015006, 1256019000, 1256020006, 1256022003) based on SME/Expert recommendations. | Terminology | Annual Update |
Value Set 'Office Visit' (2.16.840.1.113883.3.464.1003.101.12.1001): Added 8 CPT codes (98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007) based on SME/Expert recommendations. Added 2 SNOMEDCT codes (30346009, 37894004) based on SME/Expert recommendations. | Terminology | Annual Update |
Value Set 'Payer Type' (2.16.840.1.114222.4.11.3591): Deleted 42 SOPT codes (111, 1112, 3111, 3112, 3114, 3115, 3116, 3119, 3121, 3122, 3211, 3212, 32121, 32122, 32123, 32124, 32125, 32126, 32127, 32128, 3222, 3223, 3229, 3711, 3712, 3713, 3811, 3812, 3813, 3819, 6, 61, 611, 612, 613, 614, 619, 62, 621, 622, 623, 629) based on new or changed coding guidance. | Terminology | Annual Update |
Value Set 'Telephone Visits' (2.16.840.1.113883.3.464.1003.101.12.1080): Added 6 CPT codes (98979, 98980, 98981, 99457, 99458, 99470) based on SME/Expert recommendations. | Terminology | Annual Update |
Replaced Value Set 'Unilateral Mastectomy, Unspecified Laterality' (2.16.840.1.113883.3.464.1003.198.12.1071) with new Value Set 'Unilateral Mastectomy' (2.16.840.1.113883.3.464.1003.1285) to align with parent HEDIS measure based on SME/Expert recommendations. | Terminology | Annual Update |
Value Set 'Virtual Encounter' (2.16.840.1.113883.3.464.1003.101.12.1089): Added 1 CPT code (98016) based on SME/Expert recommendations. Deleted 4 CPT codes (98980, 98981, 99457, 99458) based on SME/Expert recommendations. | Terminology | Annual Update |