Law helps ensure access to 3D mammography

All Missouri women who would benefit from 3D mammography, also called tomosynthesis, can now receive those benefits, regardless of their insurance, thanks to a state law that went into effect Jan. 1, requiring all insurance providers to cover the cost of the procedure. Experts across BJC say the law is a win for women.

Dr. Sadaf Summer Chaudhry

Dr. Sadaf Summer Chaudhry

“The new law mandates insurance companies in Missouri to cover yearly 3D screening mammography for women age 40 and older,” says Sadaf Summer Chaudhry, MD, medical director of the Breast HealthCare Center at Missouri Baptist Medical Center. “This is a welcome development for our patients, since 3D mammography allows physicians to detect cancers at early stages and decreases unnecessary additional imaging, especially in women who may have dense breasts.”

Dr. Steven Poplack

Dr. Steven Poplack

Siteman Cancer Center radiologist Steven Poplack, MD, adds that the law will save lives. “Based on data from scientific trials and international screening programs, we know mammography helps reduce death from breast cancer by about 40 percent because it finds breast cancer at a small size,” Dr. Poplack says. “Tomosynthesis detects breast cancer better than traditional mammography. An additional one to three cancers per 1,000 women are detected by tomosynthesis above the usual cancer detection rate. So, this absolutely will help save lives.”

With the law in effect, Missouri joins about a dozen other states, including Illinois, that require insurance providers to cover 3D mammography. Many insurance companies already covered the technology prior to passage of the law, but women whose insurance covered only traditional mammography were required to pay an additional out-of-pocket cost for 3D mammography.

Since the law went into effect in Missouri, Dr. Poplack says Siteman Cancer Center has seen about a 20 percent increase in screening tomosynthesis. “And that’s the minimum impact,” he says. “It probably reaches out to more women than that.” He adds that increases in tomosynthesis also were seen after the Illinois law took effect in July 2016.

The Missouri law also lowers the patient age at which insurers must cover annual mammograms from 50 to 40, the age at which the American College of Radiology and the American Society of Breast Surgeons recommend beginning annual mammograms.

What is tomosynthesis — or 3D mammography?

Tomosynthesis, a form of mammography that uses X-rays to create a 3-D image of the breast, was approved by the U.S. Food and Drug Administration in 2011. During the procedure, a camera takes a series of mini X-ray exposures in an arc within a few seconds. The data from these exposures is reconstructed into thin cross-sections, allowing radiologists to examine breast tissue layer-by-layer.

This can be especially helpful, Dr. Chaudhry says, when viewing dense breast tissue. “Whereas overlapping tissue can make it difficult to see signs of early cancer with traditional 2D mammograms, this technology allows doctors to examine dense breast tissue one layer at a time. As a result, breast cancers, especially smaller cancers, are easier to detect.

“That means screening mammograms using 3D technology can help doctors find smaller cancers sooner, at more treatable or curable stages,” Dr. Chaudhry says.

And, while breast tomosynthesis provides enhanced images, the experience for a patient is no different than traditional mammography.

Dr. Poplack, who is also a professor of radiology at Washington University School of Medicine and the Ronald and Hanna Evens Endowed Chair in Women’s Health at Barnes-Jewish Hospital, was involved in pioneering research in the development of breast tomosynthesis, helping lead a multisite clinical trial of tomosynthesis that resulted in the FDA approving the technique.

He says there’s virtually no downside to tomosynthesis. “It is one of the few new technologies that have double benefit. A lot of new technologies find more cancers, as tomosynthesis does — but tomosynthesis also decreases the number of false alarms for routine mammography.

“About 10 percent of women are recalled for a possible abnormality. Of those, only 20 percent truly have an abnormality we would need to take action on, such as a biopsy. So, 80 percent of callbacks from screening are false alarms. Tomosynthesis reduces the rate of callbacks by about 15-20 percent. So, not only do you get benefit from increased cancer detection, but you also get a benefit from decreased false alarms.”

And fewer false alarms means less worry for patients, who must deal with the anxiety of “not knowing” when they’re asked to return for additional testing.

Every patient can benefit

Both Dr. Chaudhry and Dr. Poplack say patients should learn whether tomosynthesis is offered at the facility where they get their mammogram.

When Diane Widmann got her annual mammogram recently at Missouri Baptist Medical Center, she asked about 3D mammography, because she was told it was more effective than traditional mammography for dense breasts like hers.

Widmann was pleased to learn about the Missouri law requiring insurance companies to cover the cost of 
the 3D screening. “Anything that helps us to find something sooner — before it becomes a problem — is a good thing,” she says.

Dr. Poplack agrees. “I’m grateful to the legislators in Missouri and Illinois for passing the legislation that makes coverage of this technology possible. In the past, if you didn’t have the resources, you didn’t get the test. Having mitigated that issue is important.

“Every patient, regardless of financial resources, can benefit from the technology,” he says. “It’s a great service to women.”

More about breast cancer

Of the most common cancers in American women, breast cancer is second only to skin cancers. Currently, the average risk of a U.S. woman developing breast cancer sometime in her life is about 12 percent. This means there’s a 1-in-8 chance a woman will develop breast cancer.

The American Cancer Society estimates that, in the U.S. in 2019, about 268,600 new cases of invasive breast cancer will be diagnosed in women, about 62,930 new cases of carcinoma in situ (CIS) will be diagnosed (CIS is non-invasive and is the earliest form of breast cancer) and about 41,760 women will die from breast cancer.

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