Access to Breast Cancer Diagnosis Act (H.R.2428)

Millions of women across the country now have access to free screening mammography, thanks to its inclusion as a required essential benefit under the Affordable Care Act (ACA). However, if the results of that screening mammogram suggest the need for a follow-up exam to determine if the woman has breast cancer, she may be faced with hundreds to thousands of dollars in out-of-pocket costs — all before she ever gets to treatment.

DIAGNOSTIC BREAST IMAGING

  • Diagnostic breast imaging (i.e. diagnostic mammography, breast ultrasound and magnetic resonance imaging (MRI)) is typically non-invasive and often used as a follow-up test after an abnormal finding on a mammogram or clinical breast exam.
  • Required follow-up diagnostic services due to an abnormal mammogram are pivotal in the process of detecting breast cancers early. An estimated 10 percent of screening mammograms required a follow-up diagnostic mammogram.
  • From an early detection perspective, a screening mammogram would not be considered successful if the follow-up diagnostic imaging were not preformed to rule out breast cancer or confirm the need for a biopsy. The systematic use of breast cancer screening and follow-up diagnostics has led to significant increases in the early detection of breast cancer in the past 20 years.
  • Due to the elimination of cost-sharing, patient adherence and use of screening mammography is expected to increase. The increase in breast cancer screening will result in an increased need of follow-up diagnostic imaging.

FAIR AND EQUAL COVERAGE

  • A recent Susan G. Komen-commissioned study found the out-of-pocket costs for patients to be high, with frequent variation for diagnostic breast imaging. For example, average patient cost for a mammogram is $234, and for a breast MRI, $1,021.
  • The same study found that the inconsistency in cost and coverage is a recognized issue among both patients and health care professionals.
  • Out-of-pocket cost is particularly burdensome on those who have previously been diagnosed with breast cancer, as diagnostic tests are recommended rather than traditional screening.
  • If women are unable to afford the costs associated with diagnostic imaging, many might delay or forego additional tests to rule out or confirm a breast cancer diagnosis. This delay can mean that woman won’t seek care until the cancer has spread beyond the breast making it much deadlier and much more costly to treat.

Komen encourages Members of Congress to cosponsor the Access to Breast Cancer Diagnosis (ABCD) Act, H.R.2428, which Increases access to medically-necessary diagnostic breast imaging by reducing out-of-pockets costs for patients.