Policy Brief: Addressing Inequitable Access to Diagnostic Services and Screenings for Breast Cancer in California
Written by: Ysabella Faune
Further examinations after initial screening mammograms are not easily accessible, especially for those with a higher risk due to higher breast tissue density; this reduces the chance for early detection. Policies do address and cover select costs, like initial screening, but supplemental imaging, like breast MRI's, lack better coverage and details. Research in this area is not sufficient to provide proper guidelines. Both issues make it increasingly harder for women to seek follow-up care. One way to combat this is the proposal of the Supplemental Imaging & Research in Breast Cancer Coverage Act, as it addresses the coverage, what constitutes as supplemental imaging, and research. This bill is expected to decrease mortality rates from higher early detection rates, promote utilities of further examination, and reduce financial burdens.
Background & Current Landscape: Breast cancer is one of the most common cancers women face in California and screenings were generalized despite studies displaying different individual risks. Categories determining the level of risk include age, genetics, lifestyle, health history, and breast density, allowing for recommendations for screening mammograms based on level of risk. There have been efforts made in California to increase access and limit barriers, like financial burdens or cultural disparities.
Statistics:
The rate of new cases for Black women are lower than White women, yet the mortality rate is higher for Black women by 38%, studies indicate a delay in diagnostics and overall lack of access to follow-up care. (BCRF).
66% of breast cancer cases are diagnosed at a localized stage. (BreastCancer.org)
In 2023, of women aged 50-74 years, 79.8% had a mammogram in the past 2 years. (National Cancer Institute ).
Due to widespread mammography, between 1990 and 2025 the death rate for breast cancer has fallen by 43% in the U.S. (American College of Radiology)
Problems/gaps to address: Despite policies covering initial screening mammograms, there is a lack of both further coverage for follow-up care or uniform clinical guidelines for those with higher density in breast tissue that requires advanced examinations.
These gaps affect individuals with dense breasts who are typically younger women, those with lower BMI's, or Asian and African women. This is due to the lower mammogram accuracy, as both dense tissue and tumors appear white, and a correlation between dense breasts and an increased risk of breast cancer developing in glandular tissue. Without accessible diagnostic services for dense breasts early detection is increasingly more difficult; this results in the cancer being harder to treat.
Evidence:
"Unfortunately, there is not yet enough evidence for the Task Force to recommend for or against additional screening with breast ultrasound or MRI" (U.S Preventive Services Task Force).
"In the U.S.A, under the Affordable Care Act (Obamacare), insurance carriers are required to cover the full cost of a screening mammogram. A screening mammogram is for women with no symptoms. If the screening is performed by 3D/tomosynthesis mammography, the full cost might not be covered by some insurance companies" (DenseBreast-info.org).
"Millions of American women are at high risk for breast cancer but many insurances don't cover the costs of follow-up screenings needed to detect the diseased. Typically, the companies cover one annual mammogram for women over 40, but these screenings can miss cancers, especially when a woman has dense breast tissue" (NBC News).
Policy Proposal: Bill - Supplemental Imaging & Research in Breast Cancer Coverage Act
Bill conditions:
Mandate coverage for supplementary examinations to be paid in full just as screening mammography is, while covering screening mammograms with inconclusive results due to breast density; prohibiting cost-sharing.
Defines supplemental imaging for breast cancer to include, but is not limited to, contrast-enhanced mammography (CEM), breast MRI, and breast ultrasound; promoting further examinations, improving detection.
Promote and cover research to create guidelines on further care and additional screening for dense breasts.
Rationale:
Having access to advanced care for those with dense breast tissue can increase detection rates, for mammograms may not be effective.
Further care is sought with the elimination of out-of-pocket costs, preventing individuals with higher breast tissue density from abandoning follow-up care after inconclusive results.
Addresses high-risk factors, as dense breast tissue both masks mammograms and is associated with a higher likelihood of cancer development.
Expected Outcomes:
A reduction in financial burdens for patients seeking follow-up care
Improvements in long-term clinical outcomes due to earlier detection; requiring less invasive treatments and causing an increase in survival rates.
Higher use of supplemental screening (CEM, breast MRI, breast ultrasound).
High breast tissue density can significantly impact screenings and lead to inconclusive results, while also increasing the risk of developing breast cancer. Policies lack further information on the additional treatment for dense breasts and coverage on these costs, preventing individuals from being diagnosed earlier. With these recommendations, finances won't hinder further care and there will be proper research regarding the treatments.
Groups in the U.S:
UCSF- UCS Study Finds a Better Way to Screen for Breast Cancer
U.S Preventive Services Task Force- Final Recommendation Statement, Breast Cancer:
ScreeningFacing Heredity Cancer Empowered- Public Policy & Advocacy, State Laws
Works Cited
American College of Radiology- Screening Mammography and the Impact of Breast Imaging in Lowering Mortality Rates
Breast Cancer Research Foundation- Black Women and Breast Cancer: Why Disparities Persist and How to End Them
Breast Cancer Research Foundation- Dense Breast Tissue: What It MEans and What to Know
Cover Image: Hirschfield Oncology
