Variation in Legislative Mandates for Follow-Up Imaging After Lung and Breast Cancer Screening

Purpose: Lung and breast cancer are the leading causes of cancer incidence and mortality in the United States. Screening enables early detection, reduces mortality, and is supported by U.S. Preventive Services Task Force (USPSTF) recommendations. Although insurance plans are required to cover these screenings without cost sharing, diagnostic follow-up coverage is not federally mandated and is instead determined by state-level legislation, which may affect timely access to clinically relevant imaging. This study assesses variation in state-level insurance mandates for diagnostic follow-up coverage following lung versus breast cancer screening.

Methods/Materials: State legislative websites and statutes were systematically reviewed to identify insurance mandates for coverage of diagnostic follow-up imaging after USPSTF recommended screening. States were characterized based on enacted laws and proposed or pending legislation.

Results: As of January 1, 2026, only 4 states (representing 9.5% of the population) mandate insurance coverage of diagnostic follow-up imaging after lung cancer screenings, with no states having pending or proposed legislation. In contrast, 31 states and DC (representing 63.4% of the population) currently mandate coverage of diagnostic follow-up imaging after breast cancer screenings with 17 states having proposed or pending legislation for this coverage.

At the federal level, the Find It Early Act has been introduced in the U.S. House of Representatives to require insurance coverage of follow-up breast cancer imaging, while no comparable legislation exists for follow-up lung cancer imaging.

Conclusions: State-level legislative mandates for diagnostic follow-up imaging are more widespread for breast than lung cancer, despite lung cancer being the leading cause of cancer-related mortality in the United States. In the absence of comprehensive federal mandates, state legislation has largely shaped coverage, with fewer protections for lung cancer screening follow-up. These findings underscore the need for additional state-level policy initiatives to mandate follow-up lung cancer imaging, as timely access to diagnostic evaluation may have important implications for morbidity and mortality.