USU Surgeon Highlights Breast Cancer Screening Challenges for Women with Dense Breast Tissue

A new editorial by a Uniformed Services University (USU) faculty member calls attention to challenges in breast cancer screening that may disproportionately affect active duty women and have implications for military readiness.

A medium shot inside a clinical examination room. A female patient, wearing a hospital gown over dark pants, is seated on the edge of an exam table. She is looking to the left, towards a female clinician whose back is mostly to the camera, wearing pink scrubs patterned with breast cancer awareness ribbons. To the right of the patient, another female clinician in a white lab coat over blue scrubs is seated on a stool, looking up and engaging in conversation with the patient. In the background, standard medical equipment, including a vitals monitor and a red sharps container, is visible.

A clinical team discusses preventative health options with a patient in an examination room. Timely access to
advanced breast cancer screening and diagnostic tools is a critical component of maintaining operational
readiness for active duty women, particularly for the nearly 50 percent of the population with dense breast
tissue. (Photo credit: U.S. Navy photo by Jason Bortz)

March 31, 2026 by Sharon Holland

An editorial published online March 30, 2026, in the Journal of the American Medical Association (JAMA), titled “Breast Density Masking and the Need for Precision Screening,” authored by Army Col. (Dr.) Danielle Holt, an associate professor of surgery at USU, examines how dense breast tissue—present in nearly half of women eligible for breast cancer screening—both increases the risk of breast cancer and makes the disease more difficult to detect through standard mammography. For women in the military, the issue carries particular urgency.

A clinical team discusses preventative health options with a patient in an examination room. Timely access to advanced breast cancer screening and diagnostic tools is a critical component of maintaining operational readiness for active duty women, particularly for the nearly 50 percent of the population with dense breast tissue. (Photo credit: U.S. Navy photo by Jason Bortz)

Research conducted at Walter Reed National Military Medical Center by Dr. Craig Shriver, director of the USU Murtha Cancer Center Research Program, indicates that active duty women ages 40 to 59 experience significantly higher rates of breast cancer compared to women in the general population. Because dense breast tissue can obscure tumors on mammograms, cancers in these patients are more likely to be detected at later stages, potentially affecting treatment outcomes and readiness.

“Breast cancers in women with dense breasts often present later because they are harder to detect with standard screening,” Holt explained. “For active duty women, delayed diagnosis can have serious consequences not only for individual health but also for readiness across the force.”

Congress recognized the need for improved screening through the SERVICE Act of 2022, which acknowledges that women who have served in the military may qualify for additional breast cancer risk assessment under National Comprehensive Cancer Network (NCCN) guidelines. However, while 39 states have enacted laws requiring supplemental screening for women with dense breast tissue, these mandates do not apply to federal health systems such as TRICARE and the Veterans Health Administration, which operate under separate federal authorities.

Holt’s editorial highlights the limitations of current screening coverage policies and urges insurers to expand access to supplemental imaging when physicians recommend it. Studies cited in the article show that breast MRI is significantly more sensitive than mammography and detects cancers at higher rates, particularly in women with extremely dense breast tissue.

Despite these advantages, insurance coverage for MRI screening remains limited to a small subset of patients.

According to Holt, physicians can face difficult decisions when recommended screening options are not fully covered, sometimes requiring additional insurance review or out-of-pocket costs for patients.

At the same time, she acknowledges that universal MRI screening is impractical because of potential drawbacks, including false positives and unnecessary biopsies. Instead, she advocates for a precision screening approach that uses advanced risk assessment and emerging technologies to identify which patients would benefit most from supplemental imaging.

Artificial intelligence–enabled diagnostic tools and risk prediction models could help clinicians tailor screening strategies based on an individual patient’s risk profile, she notes.

“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, the issue extends beyond individual patient care. Earlier detection and more accurate screening strategies could improve health outcomes for service members while reducing the readiness impacts associated with advanced-stage cancer diagnoses.

Holt’s editorial highlights opportunities to better align screening coverage decisions with evolving clinical evidence and enable physicians to provide the most appropriate screening for patients with dense breast tissue.