Susan G. Komen® Commends Introduction of Legislation to Remove Financial Barriers to Diagnostic Imaging

Newswise — Susan G. Komen^®, the world’s leading breast cancer organization, commends the introduction of the Access to Breast Cancer Diagnosis (ABCD) Act of 2023 in the U.S. House of Representatives and the U.S. Senate. The legislation would remove a significant financial barrier to people receiving medically necessary diagnostic and supplemental breast imaging, such as an MRI, ultrasound or diagnostic mammogram, which is an important step in diagnosing breast cancer.

“It is too hard and too expensive for people to get the breast imaging they require, a contributing factor to the nearly 44,000 breast cancer deaths expected this year alone,” said Molly Guthrie, Vice President of Policy and Advocacy at Susan G. Komen. “We need this legislation passed as soon as possible so that people don’t face barriers to a timely diagnosis or face the impact of high out-of-pocket expenses for necessary imaging due to their personal circumstances. Thank you to Senators Jeanne Shaheen and Katie Britt and Representatives Debbie Dingell and Brian Fitzpatrick for their leadership on this vital legislation.”

Under current law, insurance providers are only required to cover the full cost of annual screening mammograms. However, an estimated 16% of people who receive annual screening mammograms nationwide get called back for diagnostic imaging. This imaging allows medical providers to take a deeper look at a patient’s breast to evaluate signs or symptoms of breast cancer to determine if a biopsy to test for cancer is needed. Supplemental imaging is also often used for people who are at a higher risk of breast cancer, including those with a personal or family history of the disease.

“We know that early diagnosis saves lives, so no one should be unable to access critical testing because they can’t afford it,” said Rep. Dingell. “One in eight women will develop breast cancer in her lifetime, and this bipartisan legislation would eliminate financial barriers that prevent women from getting vitally important diagnostic imaging tests.”

Added Rep. Fitzpatrick, “Key in the fight against breast cancer is timely diagnostic testing, which greatly increases a patient’s chance of beating this devastating disease. I am proud to join my bipartisan colleagues in introducing this legislation so that we can eliminate undue financial obstacles associated with diagnostic exams and increase access to the medical care that patients need.”

A Komen study found the costs to patients range from $234 for a diagnostic mammogram to more than $1,021 for a breast MRI which can lead to patients delaying care solely due to cost. This delay may mean the cancer has time to advance before treatments begin, making it much deadlier and much more costly to treat.

“Screening for breast cancer is an essential service that no one should forgo due to high costs,” said Sen. Shaheen. “I’m proud to lead this bipartisan legislation to make breast cancer diagnostic tests more accessible and affordable by eliminating the expenses that block so many Americans from this lifesaving health care service.” 

Added Sen. Britt, “The ability for women to receive an initial mammogram as part of their health insurance plan is a crucial, potentially lifesaving tool to detect breast cancer. This commonsense legislation would ensure that a warranted follow-up diagnostic examination is also covered by health insurers at no out-of-pocket cost to the patient. No woman across America should be faced with the impossible choice between affording basic necessities such as food or being able to confirm whether she has a life-threatening illness. I’m proud to help lead this effort to provide greater access to mammography so women can be diagnosed as soon as possible, giving them the widest variety of treatment options and the best chance to defeat this disease.”

Across the U.S., 19 states have already enacted legislation to eliminate the out-of-pocket costs for state regulated plans. States with legislation already signed into law include Arkansas, Colorado, Connecticut, Delaware, Georgia, Illinois, Louisiana, Maine, Maryland, Minnesota, Missouri, Montana, New Mexico, New York, Nevada, Oklahoma, Tennessee, Texas and Washington. Passage of the ABCD Act would require federally regulated health plans across the country to cover the full cost of medically necessary diagnostic and supplemental imaging.

More diagnostic and supplemental breast imaging is likely going to be needed due to “missed” breast cancers during the COVID-19 pandemic. Experts warn that missed mammograms could lead to more later-stage breast cancer diagnoses, once detected, so it is critically important that we increase access to affordable tests for those who medically require it.