Newer breast imaging technologies more accurate, but perhaps more costly

According to the American Society of Clinical Oncology, the number of women who have died of breast cancer has decreased by 43% since 2020, thanks to earlier detection, treatment advancements and greater awareness of breast cancer.

Earlier detection has been a game-changer for many women. Annual screening mammograms for women over 40 are provided with no out-of-pocket costs or deductibles by most commercial health insurance plans, insurance purchased through Healthcare.gov, original Medicare and Medicare Advantage Plans.

In Illinois, uninsured women over 40 can receive free mammograms under the Illinois Breast and Cervical Cancer Program, or IBCCP. You can learn more by contacting your county health department or calling the Women's Health Line at (888) 522-1282.

Advancements in imaging technology have helped the roughly 50% of women with dense breast tissue, which puts them at greater risk for cancer.

Dense breasts contain less fat and more fibrous and glandular tissue, making cancers harder to detect with a standard X-ray mammogram. A law went into effect in Illinois in 2019 requiring mammogram providers to notify women if their test results show dense breast tissue. The U.S. Food and Drug Administration is making this rule nationwide this year.

You should be aware, though, that some of the more advanced tests are subject to deductibles and coinsurance under commercial insurance plans and Medicare, usually requiring patients to pay around 20% of the cost. One reason is the difference between screening tests and diagnostic tests.

A screening test is looking for signs of disease when there are no symptoms. Mammograms typically fall into this category.

A diagnostic test is conducted when there's already a suspicion that something is wrong. Under original Medicare, a patient has to have met their Part B deductible before Medicare will cover the test, and they will still have to pay coinsurance. This is different under various Medicare Advantage and insurance plans, so be sure to check with your provider.

So what does that mean for breast imaging to detect cancer early? Let's look at a few of the newer imaging technologies.

• 3D mammograms: Also called “digital breast Tomosynthesis,” 3D mammograms allow the radiologist to see breast tissue details more clearly and may uncover cancers that would otherwise be camouflaged by overlying breast tissue. It releases about the same amount of low-dose radiation as a 2D mammogram.

It has been Medicare-approved since 2015 and has been shown to result in fewer false positives and retests.

• Automated breast ultrasound (ABUS): If a mammogram looks suspicious, your doctor may recommend a breast ultrasound. It uses sound waves rather than X-rays to detect cysts, masses and breast implants.

Studies have found that 3D mammography used with ABUS improves the accuracy of breast imaging, but it also increases the incidence of false positives. And it's not covered 100% like mammography because it's ordered based on symptoms or the presence of dense tissue.

• Breast MRI: MRI uses strong magnets instead of radiation to make very detailed, cross-sectional pictures of the body. Though not used as a screening test by itself, it may be recommended if someone has symptoms that might be the result of breast cancer or because of exam findings.

Breast MRI can be expensive and may require preapproval by an insurer. Medicare coverage is case-by-case based on some pretty rigid criteria, such as cancer being detected in a lymph node.

• Thermography: As cancer cells multiply, they need more oxygen-rich blood for growth. The blood flow leads to an increase in temperature around the tumor. So thermography measures this heat difference to detect cancer. Dr. Ethan Cohen of MD Anderson Cancer Center explains: “There's no way to follow up abnormalities with thermography. If someone has an abnormal thermogram, they have to start over and come back to us and get a mammogram.” Thermography is excluded from Medicare coverage.

In May of this year, a bill called the Find It Early Act (H.R. 3086) was introduced in the U.S. House to provide coverage for supplemental screenings for those with greater risk factors for breast cancer, including dense breasts, genetic mutations and family history. The legislation would require all health insurance plans to cover screening and diagnostic mammograms, breast ultrasounds and MRIs with no cost-sharing.

Katie Couric, who was diagnosed with breast cancer in 2022, is working with a bipartisan group to move the legislation forward. “I feel incredibly fortunate that I was diagnosed early, but so many women find out too late,” she said in an interview.

A woman has a 1 in 8 chance of developing breast cancer in her lifetime. We are fortunate there are so many new methods of detection and treatment, and I am encouraged that insurance coverage might be expanded. It will save lives.

• Teri Dreher is a board-certified patient advocate. A critical care nurse for 30+ years, she is founder of NShore Patient Advocates (www.NorthShoreRN.com). Her new book, “How to Be a Healthcare Advocate for Yourself & Your Loved Ones,” is now available on Amazon. She is offering a free phone consultation to Daily Herald readers; call her at (847) 612-6684.