A new Ohio law is expanding access to extra breast cancer screenings for people with an increased risk for breast cancer or who have dense breast tissue, which can make it more difficult for doctors to catch cancer with a regular mammogram.
House Bill 371, which took effect in September, requires health insurers to cover additional breast cancer screening exams, which can be a 3D mammogram or a MRI, ultrasound or molecular breast imaging, according to a joint media release from the Cleveland Clinic, MetroHealth and University Hospitals.
Most insurers must now cover one screening mammogram per year, regardless of age or risk factors and supplemental screening exams for patients with dense breast tissue or an increased risk.
Previously, some insurers didn't cover the additional screenings that are sometimes needed to check whether a blip on a mammogram is benign — or something more troubling.
Those second looks are sometimes necessary because it can be more difficult to read regular mammograms, especially in women who have higher breast density, the hospital systems said. The Centers for Disease Control and Prevention (CDC) say about 40% of women in the U.S. have dense breast tissue, which increases both the risk of developing breast cancer and the likelihood that cancer could be missed on a mammogram.
“Dense breast tissue is the amount of glandular tissue that makes up the breast relative to fat,” said Dr. Christina Clemow, MetroHealth’s division chief of Breast Imaging and Intervention. “So, if your breasts have more than 50% of dense breast tissue or glandular tissue, you're considered to be dense breasted.”
It’s common — 70% of women in their 40s have it, the release said.
Both dense tissue and cancer appear white in a mammogram, sometimes obscuring cancer, said Dr. Laura Shepardson, a radiologist at Cleveland Clinic.
A 3D mammogram, which is available at the Clinic, Mercy Health, MetroHealth and UH, is a good diagnostic tool for women with dense tissue, Shepardson said, because it takes multiple images of the breast from different angles. That can reduce callbacks and biopsies, she said.
"If you have something at the top of your breast and then something overlaps on the bottom, we don't have to call you back and do all those extra views to prove that it's nothing," said Shepardson. "It's just normal tissue. We don't need to call her back."
Determining when to start getting mammograms and whether you need additional screenings is best done as part of a conversation with your doctor, said Shepardson.
There’s disagreement about when women should get screened because different medical associations make different recommendations, according to the CDC.
Shepardson said women should talk to their doctors and then decide because dense breast tissue or a family history isn't the only circumstance that increases breast cancer risk.
Obesity, diet, cigarette smoking, hormone exposure like hormone replacement therapy or radiation exposure earlier in life can also increase risk, said Dr. Natalie Joseph, an oncologist at MetroHealth. Most women, about three-quarters, don't have actual genetic risk.
Joseph also said that MetroHealth doctors recommend that African American women get screened early.
"Although their incidence of breast cancer is less in that population, they have a higher rate of mortality from breast cancers," she said. "And they also have a higher rate of breast cancer in early age."
It can be complicated to decide on the best course, said Shepardson.
"If they do a full risk assessment and they determine, holy smokes, you have five sisters, three of them have breast cancer, your mom had it, a grandmother had it — then that takes your risk that much higher, and you should be screening with MRIs," she said.
Still some will opt for no additional screening.
"Some patients, believe it or not, are going to say, 'No, I don't want that extra screening. I don't want that extra challenge in my life'" she said.
For most women, the first step is to get a mammogram.
”We just want to stress the importance of screening, particularly for women who are 40 and over and for women who are Black or African-American because of their increased mortality,” said Joseph with MetroHealth.
The screening won't prevent cancer, but it does allow doctors to detect it early, when there are more choices for treatment and survival is more likely.
