New Missouri law requires insurance coverage of 3D mammograms

Jan. 26--Insurance providers in Missouri are required, as of this month, to cover the cost of 3D mammography, and health care providers say that mandate could help save lives if the technology is able to catch invasive cancers earlier.

"This law is a big win for women," said Kim Sanders, a mammography technician at the Mercy Breast Center in Joplin.

In a 3D mammogram, images are taken at a series of angles -- as opposed to one angle with a conventional 2D mammogram -- and reconstructed by a computer, allowing technicians to view the breast in layers, Sanders said. The technology, also called tomosynthesis, is particularly useful for the approximately half of all women who have denser breast tissue, which contains more glandular tissues as opposed to fatty tissues, she said.

"It really helps with detection," she said. "We can detect breast cancer at an earlier stage, and early treatment is key to surviving the disease."

'Great opportunity'

With the new law, which went fully into effect on Jan. 1, Missouri joins nearly a dozen other states that require 3D mammography coverage. The legislation easily passed through the Missouri General Assembly last spring and was signed by the governor in June.

The bill's sponsor, Rep. Dean Plocher, R-St. Louis, told the Kansas City Star last summer that it seemed like a "no-brainer" given the prevalence of breast cancer.

"I think the doctor should have a greater input, along with the patient, as to the course and scope of medical care and not just the insurance company that's trying to make a bottom line," he told the newspaper in July.

The Hope4You Breast Cancer Foundation in Joplin said through its president, Sharon Clark, that the law provides a "great opportunity for women to take advantage of the newer technology."

Speaking from a personal standpoint as a breast cancer survivor, Clark said she believes the law will be a "phenomenal" help to women who need that level of mammography.

"I've seen too many deaths that maybe, had there been a 3D mammogram available, I have to wonder if it would have saved their life," she said.

Most insurance companies in Missouri already covered the technology prior to the law's implementation, although a few didn't, Sanders said. In the latter cases, women who wanted a 3D mammogram through Mercy were covered by their insurance for the screening and had to pay an additional charge for the 3D portion out of pocket, she said.

Testing the technology

Many health care centers have embraced tomosynthesis, but others have decided to wait a bit until the technology matures.

Long-term research on 3D mammography and its benefits is limited. A National Cancer Institute-funded clinical trial underway until at least 2025 aims to compare 2D and 3D mammography, and determine whether the newer technology can reduce a woman's risk of developing cancer compared with conventional mammograms.

"We need to determine if 3D mammography is better than 2D at finding the sort of breast cancers that are most likely to spread and kill women," said study chair Etta D. Pisano in a 2017 statement at the start of enrollment for the trial. "If a newer screening technology does not reduce the numbers of advanced, life-threatening cancers, then are we really improving screening for breast cancer?"

Freeman Health System in Joplin so far doesn't offer 3D mammography, but it does provide a broad range of services to diagnose and treat patients at all stages of cancer, said John Williams, medical director for the Freeman Women's Pavilion.

The health system has invested in digital mammography, ultrasounds, MRI exams and CT scans for patients, and each technology serves a different subset of people, Williams said. For example, Freeman has diagnosed more than 320 cases of breast cancer in the past four years just through individuals undergoing CT scans for other reasons, he said.

In the coming year, Freeman administrators and physicians will explore additional supplemental technologies, including tomosynthesis, to add to their lineup, Williams said.

"When I look at the evolution of breast care, I don't want to focus too much on tomosynthesis," he said. "It's valuable, and it's above the level of the basic full-field digital mammography. However, it's not really needed for all patients. ...The idea is if we have a broad coverage of equipment, then we can provide a high-quality high standard (of care) for our community."

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