Insurance coverage is critical for breast cancer screening

Having dense breast tissue is normal, and the density tends to reduce with age. But if you have dense breasts, you have an increased risk of developing breast cancer.

We have an incomplete understanding of the reasons why breast density is associated with increased breast cancer risk. According to researchers, one reason may be that having more glandular tissue means there are more potential places for cancer to develop. What we know for sure is that dense breast tissue appears white on mammograms—and so does cancer, making it more likely for mammograms to miss cancer in dense breasts.

The National Comprehensive Cancer Network Guidelines for Breast Cancer Screening and Diagnosis recommend that doctors talk to women with dense breasts about whether supplemental screening, such as ultrasound or MRI, might be helpful for monitoring risk. But in most of the U.S., insurance companies are not required to pay for dense breast supplemental screenings.

Having dense breasts is just one of many breast cancer risk factors. Others include having a personal or family history of breast cancer, testing positive for an inherited high-risk mutation, and having past radiation therapy to the chest. No-cost supplemental screenings for all these high-risk situations means a greater chance that breast cancer can be detected early, when it’s most treatable. However, just like supplemental screenings for dense breasts, extra screenings in these situations are not often covered by insurance. Without insurance, such screenings can be very expensive and create access issues for those who cannot afford to pay out-of-pocket. Access to no-cost screening is critical, and many people living with increased risk experience delayed diagnosis and follow-up—and lower survival—without it.

Legislators in several states have responded to these challenges. Connecticut, Louisiana, Ohio, Pennsylvania, and Texas have all passed legislation requiring insurance companies to pay some or all out-of-pocket costs for high-risk supplemental screenings. Other states—including Maryland, Nebraska, and Oregon—have introduced supplemental screening coverage bills for consideration. It’s important to know that each piece of state legislation is unique, and while some state laws and bills do require 100% coverage of out-of-pocket costs for certain screenings, many do not.

On a federal level, the Find It Early Act, introduced in December 2022, would require health insurance plans nationwide to cover all out-of-pocket costs of high-risk screening, including 2D or 3D mammograms, breast ultrasounds, and breast MRIs.

Lack of access to high-risk screening can bring a devastating physical, emotional, and financial impact to individuals and families. Everyone deserves access to breast cancer screening, early detection, and prompt treatment if cancer is found. And there’s a lot we can do to help eliminate financial barriers to high-risk screening. Living Beyond Breast Cancer supports legislation to combat these financial barriers.

There are also actions you can take to help get high-risk screening coverage legislation passed in your state.

• Learn more about current high-risk screening coverage laws and bills in development:
  • Visit Densebreast-info.org for information on legislation status in your state.
  • Read Susan G. Komen coverage of state legislation.
• Enter your zip code in this tool to get the names and contact information for your senators and representatives.
• If you have an increased risk of breast cancer but your state does not require your insurance company to pay for supplemental screenings, contact your congresspeople to share your personal story. Let them know why these screenings are critical for you, and the kinds of insurance issues you’ve experienced.
• If your state has not passed high-risk screening access legislation and does not have a bill in development, urge your congresspeople to introduce legislation.

On a federal level, here are ways you can help get the Find It Early Act passed into law.

• Learn more about the bill:
  • Read the Find It Early Act press release.
  • Read information about the Find It Early Act on Densebreast-info.org.
• Learn how to get congress member support for this bill.

We also encourage you to share your story with LBBC. Let us know if you’ve been affected by lack of coverage for breast cancer screenings. If you have, we want to know what it’s been like for you.