Push is on to require insurance coverage for all breast screenings

Oct. 21--For many women, mammograms are not enough to detect breast cancer.

More than 40 percent of women over age 40 have dense breast tissue and benefit from ultrasounds or MRIs to substantially increase the detection of early stage breast cancer, said JoAnn Pushkin, executive director of DenseBreast-info.org.

While the Affordable Care Act made mammograms free, many insurance plans do not cover all the costs for breast ultrasounds or MRIs and that could lead to women spending hundreds of dollars. Since some women can't afford the screenings, they don't get them, Pushkin said.

"I do occasionally hear from women who, because of uncertainty about insurance coverage, elect not to have supplemental screening," she said. "For women with dense breasts, for whom a mammogram is a less effective screening tool, a mammogram alone my be an incomplete screening. Yet, additional screening may involve out-of-pocket expenses."

Pushkin, a Long Island, New York resident, became a patient advocate and helped launch the educational website DenseBreast-info.org in 2015 after her own personal experience with breast cancer.

She said she never missed an annual mammogram and was alarmed when she felt a lump during a self-exam.

She was particularly unnerved because she was told her mammogram was "normal."

A radiological technician told Pushkin since she has dense breast tissue, cancer detection would be a "hard find."

While breast cancer was undetectable on a mammogram, a tumor showed up minutes later on ultrasound in 2005. Based on the size and characteristics, the tumor was estimated to have been growing up to five years, she said.

"Unfortunately, during those five years, the letter I received after my mammogram, every one of those years said normal," Pushkin said.

Pushkin said it came up as normal because the abnormality could not be detected in a mammogram.

After battling breast cancer, she said she had a recurrence almost five years to the day of the original diagnosis and underwent additional surgeries and treatment. There has been no evidence of the disease since 2011, she said.

According to DenseBreast-info.org, a mammogram determines whether or not a woman has more dense breast tissue than fatty tissue.

Cancer is four to six times more likely in women with extremely dense breasts. Though mammograms find some cancers not seen on other screening tests, they will miss more than 50 percent of the cancers present in women with dense breast tissue.

'Diagnostic not preventative'

Breast ultrasounds are not covered by many insurers because they are considered diagnostic not preventative, said Dr. Tina George, Commonwealth Health family physician in Avoca.

While breast ultrasounds have been shown to aid in overall cancer detection, George said they also are much more likely than mammograms to result in false positives and unnecessary biopsies.

If there is more evidence breast ultrasounds reduce mortality rates over time, she said insurers could cover the full costs in the future.

A push for a state law

Two years ago, New York became the first state to pass a law requiring full insurance coverage with no out-of-pocket expenses for all breast screenings, including ultrasounds or MRIs.

"Eliminating these insurance barriers will prevent women from paying out-of-pocket for breast cancer screenings, including imaging for the detection of breast cancer, diagnostic mammograms, breast ultrasounds, or magnetic resonance imaging (MRI)," a news release from Gov. Andrew Cuomo's office stated.

The New York law doesn't mean all women are covered, however, Pushkin said. There are plans like self-funded plans which are exempt from state insurance laws, she said.

Pennsylvania does not have the same law as New York, but state Rep. Tarah Toohil, R-Butler Twp., said she believes it's "something that we need to take a hard look at implementing in Pennsylvania."

"Early detection is half of the battle and greatly increases the success rate for women," Toohil said. "Unfortunately, because of high co-pays, high deductibles, and busy schedules, women are likely to find a million reasons to put off their breast screening or skip the exam altogether."

Toohil said she looks forward to raising the issue with her colleagues to see if they can move legislation forward in Pennsylvania.

Local breast cancer survivor Barb Sciandra, who co-founded Paint Pittston Pink, said she would be in favor of a law that ensures that health insurance covers the full cost of breast ultrasounds.

"It's a relatively safe test. I don't see why insurance wouldn't want to pay for something that has the potential to save someone's life," Sciandra said.

According to Pennsylvania Insurance Department spokeswoman Elizabeth Rementer, two bills were previously proposed in Pennsylvania that would give insurance coverage for breast density.

Senate Bill 869, proposed by Sen. Bob Mensch, a Republican who represents parts of Berks, Bucks and Montgomery counties, says mammogram films of breasts with higher density are harder to read and interpret than those of less dense breasts.

He suggested legislation that would amend the Insurance Company Law of 1921 to extend insurance coverage to ultrasounds and MRIs if mammograms shows dense breast tissue. Younger women are more at risk since about 50 percent of women under 50 years of age have dense breast tissue, he said.

Similar legislation called House Bill 579 also was introduced by State Rep. Isabella Fitzgerald, a Democrat from Philadelphia.

The Pennsylvania Breast Cancer Coalition supports legislation providing insurance coverage for breast density.

"We have met with the Pennsylvania Radiological Society to see how we can jointly move this critical legislation forward," said Natalie Kopp, spokeswomen for the Pennsylvania Breast Cancer Coalition.

Kopp said women need more than "one size fits all" insurance coverage.

According to statistics she provided, more than 140,000 Pennsylvania women are living with breast cancer and 2,000 of those women will die this year.

When detected at its earliest stage, the five-year breast cancer survival rate is 98.6 percent.

"Every Pennsylvania woman deserves the best possible breast cancer screening available," Kopp said. "Sometimes a mammogram, even the 3D mammogram, isn't the only screening needed. We receive calls, emails and letters from women who desperately need these additional screenings like ultrasounds and MRIs for the early detection of breast cancer but can't afford the bills. This legislation will save women's lives."

Pa. first state to cover 3D mammograms

Although Pennsylvania does not yet have a law like New York, the commonwealth has extended its definition of mammography to include 3D mammograms.

In 2015, Pennsylvania Gov. Tom Wolf clarified 3D mammograms must be covered until the existing state mammogram law at no cost to women in the same manner as traditional 2D mammograms.

Pennsylvania Acting Insurance Commissioner Jessica Altman said Pennsylvania is the first state to have this policy.

"Women can't be worried about whether or not they can afford such a potential life-saving test," Altman said.

Self-insured or self-funded health insurance plans offered by employers are not required to provide coverage under the Pennsylvania mandate for 3D mammograms, however. because they are regulated by the federal government and not by the state.

Advantages of 3D mammography are it produces more detailed images of breast tissue and there are fewer false positive mammograms which reduces the number of follow-up tests, Dr. George said.

Pennsylvania also has the Breast Density Notification Act. This means that if a mammogram shows a woman's breast tissue, she must be notified.

While tremendous strides have been made in the detection and treatment of breast cancer, Altman said more work remains.

"Twenty-seven women get the devastating diagnosis that they have breast cancer every day in Pennsylvania," Altman said. "And every day, the families and friends of five Pennsylvania women endure the death of their loved one from this disease."

Contact the writer:

dallabaugh@citizensvoice.com

570-821-2115, @CVAllabaugh

Info box:

--Women who receive a 3D mammogram and receive a bill could file a complaint with the Pennsylvania Insurance Department by calling 1-877-881-6388 or online at www.insurance.pa.gov.

--Pennsylvania's HealthyWoman program provides free early detection services for breast cancer, including mammograms. This Pennsylvania Department of Health program is for uninsured women and funded through a grant from the Centers for Disease Control and Prevention. To check eligibility, and to schedule an appointment, call 800-215-7494.

--Those who have health insurance but have high deductibles or co-payments for these tests may also qualify for help through HealthyWoman. For more information, go to www.pahealthywoman.com.

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