Northeast Ohio Hospital Systems Raise Awareness about Expanded Access to Breast Cancer Screenings

This Breast Cancer Awareness Month, Cleveland Clinic, MetroHealth and University Hospitals are collaborating to inform the public about a new Ohio law that expands access to breast cancer screenings. The breast cancer bill, which was signed into law by Gov. Mike DeWine, went into effect Sept. 23, and requires health insurers to cover additional breast cancer screening exams for women in Ohio.

Most insurers must now cover one screening mammogram a year, regardless of age or risk factors. That includes digital breast tomosynthesis, also known as 3-D mammography, which makes it easier for radiologists to identify cancer. At Cleveland Clinic, MetroHealth and University Hospitals, every patient has the option of receiving breast tomosynthesis when appropriate as part of their annual breast cancer screening.

“Standard digital mammography is good for detecting breast cancer. But tomosynthesis has taken us to the next level primarily for two reasons,” said Laura Shepardson, M.D., section head of Breast Imaging at Cleveland Clinic. “First, tomosynthesis makes it easier for doctors to see through dense tissue that could hide a breast cancer. Second, tomosynthesis improves our ability to determine if a finding should be further investigated or not, meaning we are calling back fewer patients for additional imaging.”

The law also requires most insurers to cover supplemental screening exams for those patients with dense breasts or at an increased risk of breast cancer because of personal or family history, ancestry, a genetic predisposition to the disease or other reasons determined by their healthcare provider. The additional screening exam can be an MRI, ultrasound or molecular breast imaging. But the exam must be performed in a hospital or in a facility or mobile unit accredited by the American College of Radiology.

Insurers required to cover the screenings include the Medicaid program, health insurance companies, sickness and accident insurers, and public employee benefit plans.

The expanded coverage might not have happened without a push from cancer survivors, advocates and physicians.

“Our goal with breast screening is to detect small, early-stage cancer and breast disease, giving patients more treatment options and a better chance at a cure,” said Christina Clemow, D.O., MetroHealth’s division chief of Breast Imaging and Intervention, who testified in support of the bill. “Access to annual screening mammograms and supplemental screening exams for qualifying patients will allow us to do that more often.”

The bill also will end barriers that separated those individuals who could pay out-of-pocket for additional screenings and those who could not. “This allows all women to get the care needed to find breast cancer early and have the best outcome,” said Holly Marshall, M.D., division chief of Breast Imaging and Intervention at University Hospitals.

Before the change, insurers did not always cover annual or supplemental screening exams. As a result, many patients would sometimes skip them because they could not pay the out-of-pockets costs.

“Most breast cancers occur in those without known risk factors or significant family history,” said Dr. Clemow. “This is why yearly coverage for screening mammograms is so important. However, if you are found to be high risk for breast cancer you may benefit from an additional screening exam, such as an MRI.”

Forty percent of all women have dense breasts, including 70% of those between the ages of 40 and 50, according to the National Cancer Institute. This simply means breasts are made up of more glandular tissue than fat.

“Dense breasts can make it harder to detect breast cancer, said Dr. Marshall. “Having dense breasts is also a risk factor for developing breast cancer. Supplemental screening has been shown to pick up additional early-stage cancers.”

In the United States, women have a one-in-eight chance of developing breast cancer, which is the second-leading cause of cancer death in women after lung cancer, according to the American Cancer Society. Treatment is most successful when the cancer is detected early. “In fact, finding breast cancer early reduces a patient’s risk of dying from the disease by as much as 25-30%,” said Dr. Shepardson.

“This law is a game changer for all patients and especially those with dense breasts and at high risk for breast cancer,” said Dr. Clemow. “Patients will now have access to additional screening, giving me and other breast imaging radiologists an extra tool to find cancers earlier and more easily.” Dr. Shepardson also encourages all patients to talk with their doctors/providers to better understand their risk factors for breast cancer, and which screening options are best for them.

Dr. Marshall said: “The passage of this bill will move towards ending breast cancer as a fatal illness in Ohio.”