Mammography may miss tumors in women with dense breast tissue. So for these patients, doctors often perform her second scan, such as an ultrasound or her MRI. This increases the chance that cancer will be detected early.
However, some elderly patients encounter unexpected situations. Many women consider additional testing a routine preventive measure, but Medicare won't pay for it, and some patients end up receiving expensive tests.
Joellen Sommer, 66, who lives in Manhattan, went for her annual breast cancer screening in March. However, clinic staff said that while her mammogram would be fully covered by Medicare, so-called follow-up ultrasounds would not.
Sommer has dense breasts and a family history of breast cancer. She has had mammograms and ultrasound imaging all of her adult life, she said. “I don't understand why something that has been recommended as a diagnostic test for years is suddenly no longer covered by Medicare,” she says.
“My mother had breast cancer, my aunt had breast cancer, and I don't think that's enough,” she added. “If this were a test for men, I wonder if we would have the same problems.”
Lenox Hill Radiology in New York City charges up to $450 for a breast ultrasound if you have Medicare insurance, even if your breast tissue is known to be dense and requires an additional scan. The company began warning patients that they could be sued for compensation. It will be performed on the same day as the mammography test.
An information sheet provided to doctors states that Medicare may be used in limited circumstances, such as “to evaluate palpable or nonpalpable breast lumps, equivocal mammograms, and other signs and symptoms suggestive of breast cancer.” The application of breast ultrasound examination is described below.
Guidelines for when and how often to get breast cancer screening have changed over the years, but mammography, which uses low-dose x-rays to detect lesions, has long been the gold standard for early detection.
However, mammography cannot actually “see” tumors within dense breast tissue. Both appear white on X-rays. Also, dense breasts are not uncommon. According to the National Cancer Institute, nearly half of women over the age of 40 who undergo a mammogram are found to have dense breast tissue, although density decreases with age.
Breast tissue is considered dense if it has more fibrous and glandular tissue and less fatty tissue.
Starting in September, all mammography centers in the United States will be required to inform patients undergoing breast cancer screening whether they have dense breasts. Efforts to draw attention to the shortcomings of mammography for these patients were initiated by women whose cancer was discovered at a later stage despite regular mammography screening.
Dense breast tissue itself is a risk factor for breast cancer. Studies have found that women with very dense breasts are twice as likely to have breast cancer as women with so-called “disseminated dense tissue,” or dense tissue scattered throughout the breast. did.
Proponents argue that mammography alone is an “incomplete screening” for women with dense breast tissue, and some scientists agree. Dr. Draya El-Ashley, chief scientific officer at the Breast Cancer Research Foundation, said additional ultrasound examinations are now the standard of care for secondary screening of dense breasts.
“In women with the densest breasts, mammography will miss about half, or half, of the cancers that are present,” said Joanne Pushkin, executive director of the educational group DenseBreast-info.
Pushkin said the most common questions the organization receives are from women trying to overcome additional tests or finding out why they don't have insurance.
“This means that many cancers remain untreated and we miss the opportunity to catch them at the earliest possible stage, when they are most treatable and survivable,” she added. .
The organization supports the Early Detection Act proposed by Rep. Rosa DeLauro, D-Connecticut, and Rep. Brian Fitzpatrick, Republican of Pennsylvania. The measure means all health insurance plans will cover breast imaging and screening, including mammograms, ultrasounds and MRIs, at no cost.
A spokesperson for the federal Centers for Medicare and Medicaid Services said there has been no change to its policy, saying Medicare now covers 100% of annual radiology exams for women age 40 and older as part of preventive care. He said there was.
But the agency distinguishes between mammograms and other screening tests, such as ultrasounds, which are billed like diagnostic tools, a spokesperson said in an email.
Additionally, there is no universal agreement on the value of alternative screening for women with dense breasts. The American College of Radiology says 3D mammography increases the number of cancers that can be detected without additional testing, and ultrasound and MRI scans may help find cancers that mammography cannot see.
However, neither the American College of Obstetricians and Gynecologists nor the U.S. Preventive Services Task Force supports additional breast cancer screening methods for patients with dense breast tissue. The research group says there is insufficient data from clinical trials to do so.
Additional screening methods also have drawbacks, such as the high false-positive rate with ultrasound, which causes unnecessary anxiety and follow-up care, and the high cost associated with MRI scans.
But DeLauro and Rep. Debbie Wasserman Schultz (D-Florida) wrote in a letter to the special committee last year that some of the committee's recommendations put women's lives at risk. He said these include the special committee's failure to recognize “a significant body of evidence.” Supports additional screening for patients with dense breasts.