Bethesda, Md., Apr 3: A new editorial from a faculty member at the Uniformed Services University (USU) is drawing attention to critical gaps in breast cancer screening that may disproportionately affect active duty women and have broader implications for military readiness.
Published online on March 30, 2026, in the Journal of the American Medical Association (JAMA), the editorial titled “Breast Density Masking and the Need for Precision Screening” is authored by Danielle Holt, MD, an associate professor of surgery at USU.
The article examines the impact of dense breast tissue—present in nearly half of women eligible for breast cancer screening—which not only increases cancer risk but also makes detection more difficult using standard mammography. For women serving in the military, these challenges carry heightened urgency.
Research conducted at Walter Reed National Military Medical Center by Craig Shriver, director of the USU Murtha Cancer Center Research Program, indicates that active duty women aged 40 to 59 experience significantly higher rates of breast cancer compared to the general population. Dense breast tissue can obscure tumors, leading to delayed diagnoses and potentially impacting both treatment outcomes and operational readiness.
“Breast cancers in women with dense breasts often present later because they are harder to detect with standard screening,” said Holt. “For active duty women, delayed diagnosis can have serious consequences not only for individual health but also for readiness across the force.”
The editorial also references the SERVICE Act of 2022, which recognizes the need for enhanced risk assessment among women who have served in the military under National Comprehensive Cancer Network (NCCN) guidelines. However, while many states mandate supplemental screening for women with dense breast tissue, these requirements do not extend to federal healthcare systems such as TRICARE and the Veterans Health Administration.
Holt underscores the limitations of current insurance coverage policies and calls for expanded access to supplemental imaging when recommended by physicians. Studies cited in the editorial show that breast MRI offers significantly higher sensitivity than standard mammography, particularly for women with extremely dense breast tissue. Despite this, coverage for MRI screening remains restricted to a limited group of patients.
At the same time, the editorial acknowledges that universal MRI screening may not be practical due to risks such as false positives and unnecessary procedures. Instead, Holt advocates for a precision screening approach—leveraging advanced risk assessment tools and emerging technologies—to determine which patients would benefit most from additional imaging.
Artificial intelligence-driven diagnostic tools and risk prediction models are highlighted as promising solutions to help clinicians tailor screening strategies based on individual patient profiles.
“Precision screening—guided by clinical judgment and modern risk stratification tools—offers a more effective approach than rigid coverage policies,” Holt wrote. “Insurers should support physician-directed supplemental imaging rather than relying on arbitrary criteria.”
For the Military Health System, improving early detection and screening accuracy could significantly enhance health outcomes while reducing the impact of advanced-stage cancer diagnoses on force readiness.
The editorial calls for better alignment between evolving clinical evidence and screening coverage policies, enabling healthcare providers to deliver more effective, personalized care for patients with dense breast tissue.
