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Why Early Screening for Breast Cancer Is a Health Care Conundrum

The 2010 Affordable Care Act lifted a significant burden for women facing breast cancer by classing breast cancer screening mammograms as a preventive service within the Essential Health Benefits. That meant screening mammograms — the kind most women get first — were now available at no charge to the patient.

But what happens after a screening mammogram is as important as the initial screening itself. And that’s where things get tricky… and maddening.

After the mammogram​​​​​​​

Roughly 10 percent of the women who get that fully covered annual screening mammogram will require further tests, because the first mammogram showed something suspicious. It could be nothing. Or it could be breast cancer. Making this determination usually requires a more detailed diagnostic mammogram, breast MRI or breast ultrasound.

This additional testing frequently requires out-of-pocket costs ranging from a couple hundred dollars to over $1,000. These additional costs are especially troublesome for people who have had breast cancer or are considered high-risk for the disease — as diagnostic mammograms are often done annually in such cases.

One patient’s plight

Take, for example, Kirsten of Tampa, Florida. Kirsten’s employer-provided health insurance fully covers annual screening mammograms. Fortunately, Kirsten has never been diagnosed with breast cancer, but because she has a strong family history of the disease and has had abnormal findings on her screening mammograms, doctors recommended she receive annual diagnostic mammograms moving forward. This test is not covered.

“I am being forced to pay out of pocket for a preventive screening service that I know I need and is covered for everyone else who has a lower risk of developing breast cancer than I do,” Kirsten says.

For many women, the extra costs mean they won’t get the screening they require, defeating the whole purpose of early detection of breast cancer. The stakes are even higher when we consider that late-stage breast cancer treatment is as much as five times more costly than treatment for early stage breast cancer and delaying screening can lead to late-stage diagnosis.

Komen believes, and advocates to ensure, that patients have access to the breast cancer screening, diagnosis and treatment services they require when they need them. Cost should never be a barrier to care.

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