Dr. Madhavi Raghu, a radiation oncologist in western Connecticut, emphasized the importance of ultrasounds in detecting cancers that may not be visible on mammograms. She explained that if tomosynthesis and ultrasound results are normal, the likelihood of underlying cancer is low. The Food and Drug Administration notes that women with dense breast tissue, affecting about half of women over 40, are at a higher risk for breast cancer. Due to the difficulty in spotting cancer on mammograms in such cases, the FDA now requires notification to women with dense breast tissue for further evaluation and screenings.
However, the cost of these screenings is a concern for many women. While private health insurance plans typically cover one mammogram per year, additional screenings are often not fully reimbursed. Furthermore, Medicare has stopped reimbursing for breast cancer ultrasound screenings that were covered in 2023, leaving both Medicare and privately insured women in a challenging situation.
The lack of coverage has left women like Molly Smith, who has private insurance, feeling anxious about both their health and the potential financial burden. Medicare clarified that ultrasounds are only covered as diagnostic tests, not as screening tests, which has caused confusion among physicians. The denial of reimbursements for these screenings by Medicare has led to higher out-of-pocket costs for women, especially those with high-deductible insurance plans.
Physicians and researchers warn that the increasing unreimbursed expenses may deter women from getting necessary screenings, ultimately impacting their health outcomes. There is a growing concern about the limitations of mammograms as a standalone screening method, and the need to raise awareness about alternative screening options.
Pearfish, South Dakota. Inflammatory breast cancer does not usually appear in mammograms, so Caldwell undergoes annual MRIs. This year, she anticipates having to pay $1,200 out of pocket. Doris Caldwell, accompanied by her husband, Joel, and a granddaughter, expressed frustration at the need to struggle to obtain the necessary additional screenings for early cancer detection. Caldwell emphasized the importance of early cancer detection in reducing treatment costs and stressed that it should be easily accessible. Recent data from the American Cancer Society revealed a faster increase in breast cancer diagnoses among women under 50 compared to those over 50.
Lisa Lacasse, president of the American Cancer Society Cancer Action Network, stated that out-of-pocket costs pose a significant barrier for individuals requiring multiple early detection services. She emphasized the importance of eliminating cost sharing for each screening intervention to enhance cancer treatment effectiveness. Iowa recently passed legislation mandating private health insurers to cover the full cost of additional breast cancer screenings. Similarly, Massachusetts introduced a law requiring insurers to cover ultrasounds and other screenings without increasing patients’ out-of-pocket expenses.
Several states, including Connecticut, Florida, Indiana, Hawaii, South Carolina, and Virginia, have proposed bills mandating coverage for additional screenings. The American College of Radiology reported these developments, with hopes of enacting similar legislation in states like Nebraska, Pennsylvania, Rhode Island, and Wisconsin. Despite unsuccessful attempts in South Dakota and Montana, other states continue their efforts. Shelley Emslie, a schoolteacher and breast cancer survivor in Bigfork, Montana, expressed dismay over the failed legislation. Emslie emphasized the financial burden of regular MRIs, costing approximately $3,500 annually, which her high-deductible insurance plan does not cover.
Emslie highlighted the plight of women who cannot afford necessary screenings due to costs, underscoring the potential consequences of missed early detections. She emphasized the importance of accessible and affordable screenings to ensure optimal care for all individuals.
