As we kick off Breast Cancer Awareness Month, there is no better time to discuss how advocacy can lead to change and save lives.
Driven by our own life experiences, expanding access to diagnostic and supplementary breast screening holds personal significance for both of us.
Breast cancer is the most commonly diagnosed cancer among American women, with about one in eight women facing a diagnosis in their lifetime. We know that regular mammograms are essential to early detection and saving lives, and since its passage, the Affordable Care Act (ACA) has enabled millions of women to access cost-free screening mammograms.
Another lesser-known benefit of mammograms is that they can also help women determine if they have dense breast tissue. Breasts are made of fatty and glandular tissue held together by fibrous tissue. When the breast has a higher proportion of fibroglandular (fibrous and glandular) tissue than fatty tissue, the “denser” the breast tissue appears on a mammogram.
Dense breast tissue is common but can put women at a four to six times higher risk for developing breast cancer as well as make the detection of cancer more challenging. While mammography is considered the most reliable breast imaging technique, dense breast tissue makes the need for supplemental screening more critical in order to help spot breast cancer in its earliest stages.
After years of advocacy, the U.S. Food and Drug Administration announced a new nationwide reporting standard earlier this year requiring the reporting of the patient’s level of breast density. This update is a significant and long overdue win for women and the health care community in the fight against breast cancer.
The updated regulations, in addition to the national reporting standard, require that patients be informed about their breast density risks; their potential need for further screening; and the accuracy of their mammogram. Providing women with this kind of information increases the likelihood of early diagnosis and helps facilitate important conversations between women and their doctors around supplemental imaging options available — such as traditional or automated breast ultrasound (ABUS), magnetic resonance imaging (MRI), and contrast-enhanced mammography (CEM).
This year, we have also seen progress in access to preventative care with the update of the United States Preventative Services Task Force (USPSTF) breast cancer screening guidelines released in May. These guidelines now officially recommend women start receiving mammograms at age 40, which has been the consensus in the medical community for over a decade.
The national dense breast notification and updated USPSTF guidelines are a step in the right direction, but there is still work to be done — particularly with respect to women with dense breasts.
When the new nationwide reporting standard takes effect on Sept. 10, 2024, it’s important to ensure all women have access to supplemental screening options with no cost-sharing.
The Find it Early Act recently introduced in the House would require all health coverage, including private insurance, Medicare and Medicaid, to cover screening and diagnostic breast imaging — such as screening and diagnostic mammograms, ultrasounds and MRIs — with no patient cost-sharing. This bill is critical and will help save lives by giving women access to early detection and the personalized care they deserve.
In addition to this legislation, continued advocacy is needed in areas where Task Force recommendations fall short for women with dense breasts.
The USPSTF recommendations continue to find evidence for additional screening for women with dense breasts “insufficient.” So when follow-up is needed, many will continue to be forced to pay high out-of-pocket expenses for supplemental screening — like traditional or automated breast ultrasound (ABUS), magnetic resonance imaging (MRI), and contrast-enhanced mammography (CEM). If insurance will not cover them, there is no doubt that women then face a difficult decision and may choose to forgo further screenings — but at what cost when we know the importance of early detection.
While USPSTF’s recommendation for screening to begin at age 40 addresses a necessary change, the Task Force also continues to recommend biennial — instead of annual — mammograms for average risk women. This conflicts with the experience and recommendations of most oncologists, cancer experts, and patient advocacy groups who advocate for annual mammograms.
These kinds of discrepancies and barriers contribute to inequities in accessing life-saving screening, and instead, result in later-stage detection where cancer can be harder to treat.
Ensuring coverage for diagnostic and supplemental screenings is an important driver of continued advocacy, as well as legislative efforts, to help women access the personalized care they deserve.
The observance of Breast Cancer Awareness month provides an opportunity to shine a spotlight on the influence of legislation, like the Find it Early Act, on critical health care issues for women nationwide – including female veterans and servicewomen.
We are proud to have the opportunity to work together and stand with the many advocates using their voice to raise awareness in the ongoing effort to shape the future of health care and improve outcomes for those at risk of or diagnosed with breast cancer.
Rosa DeLauro serves as ranking member of the House Appropriations Committee and is the ranking member of the Labor, Health and Human Services, and Education Appropriations Subcommittee. Jyoti Gupta, PhD, is president and CEO of Women’s Health & X-Ray for GE HealthCare.