In 2007, the VHA prioritized expansion of screening mammography services. In this context, Kvasnovsky and coauthors performed a retrospective evaluation of breast cancer cases treated at the Baltimore Veterans Affairs (VA) Medical Center from 2000 to 2012, comparing process-of-care metrics before and after the expansion. Mammography and breast cancer volumes increased significantly (1200% and 61%, respectively). Most patients required non-VA referral for specialized services not available on-site. The time from diagnosis to definitive treatment also increased significantly (from 33 days to 51 days; P = .03), suggesting that the VHA might benefit from acquiring fully on-site breast cancer services.