Mammograms can miss tumors in ladies with dense breast tissue. So for these sufferers, docs usually embrace a second scan — ultrasound, for instance, or an M.R.I. — which usually tend to flip up cancers at early levels.
But some older sufferers are operating into an sudden twist. Though many ladies see the additional scan as a routine type of prevention, Medicare received’t pay for it, and a few sufferers are left to choose up a hefty tab.
Joellen Sommer, 66, who lives in Manhattan, went for her annual breast most cancers screening in March. But the clinic’s employees mentioned that whereas her mammogram can be totally lined by Medicare, a so-called supplemental ultrasound was not.
Ms. Sommer has dense breasts, and a household historical past of breast most cancers. She mentioned she has acquired mammograms and ultrasound imaging all through her grownup life. “I just don’t understand how something that has been the recommended diagnostic test for years is suddenly not covered by Medicare,” she mentioned.
“My mother had breast cancer, my aunt had breast cancer — I guess that’s not enough,” she added. “I wonder if it was a test for men, if the same issue would arise.”
Lenox Hill Radiology in New York City has began warning sufferers that if they’re insured by Medicare, they could be on the hook for as much as $450 in the event that they obtain a breast ultrasound, even when breast tissue is understood to be dense and the additional scan is carried out on the identical day as a screening mammogram.
An info sheet offered to physicians famous that Medicare does cowl breast ultrasound beneath restricted circumstances, akin to “to assess palpable or nonpalpable breast masses, ambiguous mammograms and other signs or symptoms suggestive of breast cancer.”
Guidance about when and the way usually to endure breast most cancers screening has modified over time, however mammograms, which use low dose X-rays to detect lesions, have lengthy been the gold customary for early detection.
But mammograms can’t really “see” tumors in dense breast tissue; each seem white in an X-ray. And dense breasts usually are not unusual: While density declines with age, almost half of girls aged 40 and older who get mammograms are discovered to have dense breast tissue, in response to the National Cancer Institute.
Breast tissue is taken into account dense when it has extra fibrous and glandular tissue, and fewer fatty tissue.
Starting in September, all mammography facilities within the United States shall be required to tell sufferers who’re screened for breast most cancers if they’ve dense breasts. The effort to attract consideration to the shortcomings of mammograms for these sufferers was began by ladies whose personal cancers had been detected at a late stage, regardless of common mammography screenings.
Dense breast tissue is itself a danger issue for breast most cancers. Women with extraordinarily dense breasts have twice the chance in contrast with those that have what is known as “scattered dense tissue,” or dense tissue right here and there within the breast, research have discovered.
Advocates say that for girls with dense breast tissue, mammograms alone are “incomplete screening,” and a few scientists agree. Dr. Dorraya El-Ashry, chief scientific officer of the Breast Cancer Research Foundation, mentioned {that a} supplementary ultrasound is the present customary of take care of a secondary screening for dense breasts.
“In women with the densest breasts, mammograms will miss about half of cancers present — half,” JoAnn Pushkin, government director of DenseBreast-info, an academic group, mentioned.
The commonest questions the group receives are from ladies attempting to navigate supplemental screenings, or discover out why they weren’t lined by insurance coverage, Ms. Pushkin mentioned.
“That’s a lot of cancers being left on the table, and an opportunity missed to find them at the earliest stage possible, when they’re most treatable and survivable,” she added.
The group is supporting the Find It Early Act, laws proposed by Representative Rosa DeLauro, Democrat of Connecticut, and Representative Brian Fitzpatrick, Republican of Pennsylvania. The measure would be sure that all medical insurance plans cowl screening and diagnostic breast imaging, together with mammograms, ultrasounds and M.R.I.s, with no price sharing.
A spokeswoman for the federal Centers for Medicare & Medicaid Services mentioned its insurance policies haven’t modified: Medicare covers annual radiologic screening for girls ages 40 and older at 100%, as a part of preventive care.
But the company makes a distinction between mammograms and different screening checks, like ultrasounds, and they’re billed like diagnostic instruments, the spokeswoman mentioned in an e-mail.
And there’s not common settlement on the worth of other screening for girls with dense breasts. The American College of Radiology says that 3-D mammography will increase the variety of cancers that may be seen with out further testing, and that ultrasound and M.R.I. scans may help discover cancers that may’t be seen on a mammogram.
But neither the American College of Obstetricians and Gynecologists nor the U.S. Preventive Services Task Force has endorsed further breast most cancers screening strategies for sufferers with dense breast tissue. There is inadequate information from scientific trials to take action, the teams say.
There are additionally disadvantages related to supplementary screening strategies, akin to a excessive charge of false positives with ultrasounds, which trigger pointless anxiousness and follow-up care, and the excessive prices related to M.R.I. scans.
But in a letter final yr to the duty power, Ms. DeLauro and Representative Debbie Wasserman Schultz, Democrat of Florida, mentioned a number of of the panel’s suggestions have put ladies’s lives in danger, together with the duty power’s failure to “recognize the significant body of evidence supporting additional screenings” for sufferers with dense breasts.
