Cover Breast Ultrasound Screening

Section 2 of the bill amends section 3221 of the insurance law in relation to coverage for a breast ultrasound in all instances where a mammography screening is authorized and the physician determines that the patient has extremely dense or heterogeneously dense breast tissue.

Section 3 of the bill amends section 4303 of the insurance law in relation to coverage for a breast ultrasound in all instances where a mammography screening is authorized and the physician determines that the patient has extremely dense or heterogeneously dense breast tissue.

Section 4 of the bill is the effective date.

Justification

In 2012, New York passed legislation which mandates that women who undergo a mammogram must be informed by their doctor if the test indicates that they have dense breast tissue. Dense breast tissue can make it difficult to detect breast cancer. In many cases, a further evaluation, using digital mammography or ultrasounds, is necessary to rule out cancer. Mandating that doctors inform women of these options will doubtlessly save lives.

For years it has been standard practice for women with dense breast tissue to receive both mammograms and ultrasounds during screenings as many issues can be missed if only a mammogram is done. Some women, however, are discovering that ultrasound procedures for detection of breast cancer are not covered by their health insurance. While notification is a good first step in improving the screening for breast cancer, ensuring that breast ultrasounds are covered by health insurance is similarly necessary.

Recent statistics from the Susan G. Komen Foundation estimated that in 2016 there would be 246,660 new cases of invasive breast cancer among U.S. women, and 40,450 deaths due to breast cancer. According to the American Cancer Society, a false-negative mammogram looks normal even though breast cancer is present and screening mammograms do not find 1 in 5 breast cancers. Women with dense breasts have an increased number of false-negative mammogram results. The relation between dense breast tissue and cancer risk is immense. Women with dense breasts have been shown to have a 4 to 6 fold increased risk of developing breast cancer. Extremely dense breasts are not uncommon. In the U.S., 10% of women are classified as having extremely dense breasts.

Breasts consist of a mixture of fibrous and glandular tissue and fatty tissue. Breasts are considered dense if they have a lot of fibrous and glandular tissue but not much fat. On a mammogram, dense tissue appears white. Both benign and cancerous lumps also appear white. Therefore, mammograms are less accurate for women with dense breast tissue. Breast tissue density is classified by radiologists using a four level density scale. This scale ranges from almost entirely fatty, to scattered areas of fibro glandular density, to heterogeneously dense and to extremely dense. Only ten-percent of women have almost entirely fatty breast. Therefore, 90% of women are at risk of an inaccurate mammogram.

Studies have shown that for women with dense breast tissue, ultrasound and magnetic resonance imaging (MRI) are more accurate tests for detecting breast cancers than a mammogram. Ultrasound and MRI technology can find breast cancers that cannot be seen on a mammogram. An ambiguous mammogram will result in the recommendation of a further evaluation using ultrasound and magnetic resonance imaging (MRI) by one's doctor. The issue is that said further evaluation, which is necessary to detect cancer, is often not covered by one's insurance.

Bill history

New bill.

Fiscal implications

Undetermined.

Effective date

This act shall take effect on the sixtieth day after it shall have become a law and shall apply to all policies and contracts issued, renewed, modified, altered or amended on or after such date.