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Latest State Insurance Bills, MAB News

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U.S. State Insurance Bills
New bills introduced this week to cover expanded breast imaging include the following:

Medical Advisory Board

We welcome Dr. Priscilla J. Slanetz to the DBI MAB! 

Dr. Slanetz is Professor of Radiology, Vice Chair of Academic Affairs & Faculty Development, Breast Imaging Fellowship Director, and the Associate Program Director of Diagnostic Radiology Residency at the Department of Radiology at Boston University Medical Center. She is on the ACR Board of Chancellors and chairs the Commission on Publications and Lifelong Learning (CoPLL) and is also on the AAR Board. In addition, she is part of the editorial committee for Academic Radiology, AJR, and Radiology, and is the recipient of the 2024 Marie Sklodowska-Curie Award, the highest honor from the American Association for Women in Radiology.

State insurance bills, Order of Ontario

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State Insurance Bills
The 2025 legislative session has begun and new insurance bills to cover expanded breast imaging have been introduced in the following states:


Congratulations!
MAB member Dr. Jean Seely has been awarded the Order of Ontario, the province’s highest civilian honor. She was recognized for excellence in breast imaging, and her work has changed clinical practice guidelines for mammography in Canada. Her clinical research has resulted in landmark studies that have led to a better understanding of how mammography screening beginning at age 40 impacts both morbidity and mortality.

DBI Milestone

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The numbers are in! DenseBreast-info.org had over one million website visits in 2024. We are honored to be the “go to” educational resource on the issue of breast density.

We are ready!

Wishing all a peaceful and healthy 2025 ~

MAB News, Happy Holidays!

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Congratulations! Dr. Paula Gordon has been officially invested in the Order of Canada! It is one of the country’s most prestigious honors and recognizes citizens who have made extraordinary contributions to the nation. Dr Gordon has been an effective and relentless advocate for patient notification of breast density as well as appropriate screening beyond mammography.

We wish everyone a Happy Holiday and Happy New Year!

Find it Early Act Update

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Find It Early Act

In November, DBI and our DC lobbying experts held a marathon of Capitol Hill office visits. Our goal is to get the Find It Early Act in the best shape possible for a 2025 re-introduction. Here’s a recap:   

  • Our work continues to build bi-partisan support for the legislation in the House and our visit resulted in new key cosponsors. We have also begun an effort to recruit bi-partisan co-sponsors for the new Senate bill.
  • Both the House and Senate bills will be re-introduced in late winter/early spring of 2025 by the current sponsors, and we are working on recruiting as much GOP support as possible in advance.
  • The DBI organized Statement of Support has brought significant attention to the bill and will be updated in 2025. We anticipate continued support from medical societies and national organizations that have signed on.
  • While our DC meetings are important, the most effective lobbying tool for this bill are personal stories. Constituent direct contact (by phone or in person) with the local district office* of federal representatives is a powerful advocacy tool. Hearing from people in their own districts about personal experiences and examples of breast imaging and insurance coverage issues brings the issue “home” for legislators (for instance, sharing an insurance bill or denial of coverage letter, or explaining how out-of-pocket costs affected your – or a patient’s – breast screening protocol). Tips on how to ask your legislator for support of the bill are HERE.

*  Contact info for your congressperson:  (see zip code search at top right), https://www.house.gov/representatives

Contact info for your senator:  (click on your state), https://www.senate.gov/states/statesmap.htm

 

Updates from RSNA

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SBI Announcements
Congratulations to DBI’s MAB member Dr Paula Gordon for the SBI Gold Medal recognition for her outstanding contributions to breast imaging, and to JoAnn Pushkin for being named 2025 SBI Honorary Fellow!

Abstracts
Prevalence screening results from the randomized UK BRAID trial were presented by Dr. Fiona Gilbert at RSNA 2024.  More than 9000 women with dense breasts and negative 2D mammogram aged 50-70 years were randomized to one of four screening groups (over 2000 women in each group): supplemental screening with abbreviated MRI (Ab-MRI), automated whole breast ultrasound (ABUS), contrast-enhanced mammography (CEM), or standard of care (no supplemental screening).

  • Cancer detection rates and recall rates were higher for CEM and Ab-MRI than ABUS, but all modalities significantly increased cancer detection1
  • Among those women invited to supplemental screening, participation rates were highest among women invited to have ABUS2
  • All cancers detected were small, but cancers seen with contrast methods were smaller3
  • All cancers detected by ABUS were invasive, as were 82% and 86% detected by CEM and Ab-MRI, respectively

 Supplemental screening in women with dense breasts results in earlier detection, with Ab-MRI and CEM finding more cancers than ABUS with higher recall rates.

 1 Cancer detection rates and recall rates for Ab-MRI, ABUS, and CEM were 17.4/1000, 4.2/1000, and 19.2/1000, respectively and 9.7%, 4.0%, and 9.7%, respectively.

2 Approximately 95.5% of invited women completed ABUS vs. 91.8% Ab-MRI and 91.1% CEM.

3 Median invasive cancer size for Ab-MRI, ABUS, and CEM respectively was 10 mm (IQR: 8-15 mm), 22 mm (IQR: 14 – 35 mm) and 11 mm (7 – 15 mm).

 Results of another study presented at RSNA 2024 by Annie Ng, Ph.D., from Kheiron Medical Technologies (now Deep Health), London, UK, found that a 2D-mammographic AI system identified more cancers than a human reader in dense breasts. The retrospective study compared sensitivity of the commercially available Mia AI system to the first human reader in double reading among 306,839 cases from over 236,739 women between 2017-2021. 

  • Sensitivity of AI was significantly greater than the human reader in women with dense breasts, whereas there was no statistical difference among women with non-dense breasts1
  • These results were maintained when analyzed by age in women aged 49-55 years or 56-71 years, respectively

 AI as a second reader has the potential to increase cancer detection in women with dense breasts compared to human readers alone.

State Insurance Law, RANZCR Statement, New Study

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State Insurance Law
A new Massachusetts insurance law requiring no-cost coverage for screening and diagnostic imaging (exemptions apply) will go into effect on 1/1/2026. For more details, see DBI’s State Law Insurance Map and Table.

RANZCR Position Statement
The Royal Australian and New Zealand College of Radiologists have issued an updated Breast Density Position Statement – Why Reporting Matters.  According to the statement, “RANZCR supports the inclusion of breast density reporting in all mammographic assessments. This move aligns with the growing global recognition of the importance of breast density in breast cancer screening. In countries like the USA, it is already mandatory to report breast density in mammograms, and similar practices are being considered in Europe.”

New Study
A study by Gjesvik and colleagues examined whether a commercially available AI algorithm for breast cancer detection could also estimate risk for future breast cancer development. This retrospective cohort study included 116,495 women aged 50-69 years who underwent at least 3 consecutive biennial mammography screening rounds in Norway. The study found that the AI algorithm for cancer detection was able to estimate future breast cancer risk 4-6 years before diagnosis. Specifically, compared to women who did not develop breast cancer,1 the study found:

  • The mean absolute difference in AI scores between breasts of women who developed screen-detected cancer or interval cancer was greater at each round and increased over the three rounds.2,3

These results suggest that AI scores for cancer detection may be used to identify women at high risk of developing cancer who may benefit from supplemental screening.

1A cancer detection score of 0-100 was given to each breast. The mean (SD) absolute differences in AI scores between breasts of women who did not develop breast cancer were  9.9 (17.5),  9.6 (17.4), and 9.3 (17.3) at the first, second, and third screening rounds, respectively.

2Scores were higher in breasts that developed cancer, and this was compared to the noncancerous breast. The mean (SD) absolute differences in AI scores between breasts of women who developed screen-detected cancer in one breast and not the other were 21.3 (28.1), 30.7 (32.5), and 79 (28.9) at the first, second, and third screening rounds, respectively.

3The mean (SD) absolute differences in AI scores between breasts of women who developed interval cancer in one breast and not the other were 19.7 (27.0), 21.0 (27.7), and 34.0 (33.6) at the first, second, and third screening rounds, respectively.

Patient Fact Sheet, New Study

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Our popular and printable dense breast Patient Fact Sheet, already translated into 25+ languages, is now available in Albanian. We extend our thanks to DBI/Europe Education Supporter Dr. Iris Allajbeu for the translation assistance!

New Study
A recent study by DBI Medical Advisory Board member Jean Seely, MD and colleagues assessed differences in breast cancer incidence, mortality, stage, and molecular subtypes by race/ethnicity among women aged 20 and older in Canada. The analysis of linked Canadian Cancer Registry (CCR) and census data found that compared to white women, women from other race/ethnicity groups:

  • Had earlier peak age at diagnosis
  • Were more likely to have a more advanced stage at diagnosis
  • Were more likely to have molecular subtypes with poorer outcomes

In addition, compared to white women, black and indigenous women had higher breast cancer mortality. These data suggest race/ethnicity-based health care inequities that should be considered in Canadian Breast cancer screening and health care policies.

Mammo Screening Guideline Comparison Table, Silver Medal of Honor, New Studies

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Comparison In Average Risk Women
This popular DBI table just updated to include the new ACOG recommendation that mammograms begin at age 40. Visit the table for comparative mammography recommendations by organization on recommended age to start, stop, and frequency.

Congratulations!
On October 24, 2024, Dr. Wendie Berg, Chief Scientific Advisor to DenseBreast-info.org, received the prestigious Silver Medal of Honor from the Austrian Medical Society to recognize her contributions to the design of the Austrian Breast Cancer Screening Program (which includes screening ultrasound for women with dense breasts).

New Studies:

-Breast Density and Sensitivity of Digital Mammography
Consistent with many prior analyses, Payne et al reported in a single-center UK study that digital mammography sensitivity decreases with increasing breast density as assessed by Volpara software, at 75% for grade a, 74% for grade b, 60% for grade c, and 51% for grade d.  Symptomatic interval cancer rates at three years increased from 1.8 per 1000 for grade a to 3.2, 5.7, and 7.9 per 1000 for density grades b, c, and d, respectively.

-CEM for Breast Screening
A retrospective, single-institution study by Sorin et al. from Tel-Aviv University evaluated performance of CEM for breast cancer screening over a 10-year period in 5,424 women at intermediate or high risk for breast cancer (15-20% lifetime risk and >20% lifetime risk, respectively), with the following results:

  • Most women (85%) included had dense breasts
  • Contrast enhancement increased cancer detection compared to the low-energy images (which are similar to a standard 2D mammogram)1,2
  • Specificity for CEM increased from the first to the third screening round, likely due to familiarity with the modality and availability of prior exams for comparison3

This study supports the viability of CEM as an effective screening modality for women with dense breasts and/or at intermediate breast cancer risk, and for high-risk women for whom MRI is not possible.

1Sensitivity for contrast-enhanced CEM images was 96% (71/74) compared to 58% (43/74) for low-energy images alone.  

2The added cancer detection rate for CEM compared to the low energy images was 5.2 per 1000 screens (13.1/1000 for CEM vs. 7.9/1000 for the low energy images).

3Specificity overall was 81.8% (4378/5350); patient-level analysis showed improvement from 79.2% (2717/3431) in the first round to 89.2% (412/462) in subsequent rounds.

Inform and Insurance Law Maps

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NEW! Now that the FDA dense breast reporting standard is in effect, DBI has retired its “State Inform Law Map” (however, the map is still available upon request).

 As the next focus is insurance coverage for supplemental screening, DBI has launched a new interactive State Law Insurance Map. The map tracks breast imaging insurance coverage by state, and a corresponding State Law Insurance Table is also available.

Visit the ”Insurance/Inform Laws” tab for individual links to:

Risk Model Tutorial / New Study

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Risk Model Tutorial
A resource reminder! DBI’s Risk Model Tutorial content for health care providers includes:

  • How the models are used
  • Risk model explanations
  • Diagnostic considerations
  • Risk models table (with live links)

 

New Study
At Rush University affiliated centers in Chicago, a retrospective review of automated breast ultrasound (ABUS) use in women with dense breasts showed the following:

  • Use of ABUS was greater in white women than in other racial or ethnic groups.1
  • Adding ABUS for women with dense breasts (both screening and diagnostic populations) increased early-stage breast cancer detection.2
  • Added false positives were not detailed.

1From September 2017 to December 2022, across 51,086 screening or diagnostic mammogram exams, 24,637 (48%) women had dense breasts and were recommended for ABUS, and 9865/24,637 (40%) had at least one ABUS examination.  Of 10,667 white women, 4943 (46%) had at least one ABUS exam, versus 2604/6843 (38%) Black, 1466/4278 (34%) Hispanic women, and 521/1590 (33%) Asian women.

2Among 9865 women who had at least one ABUS exam, 37 were found to have breast cancer, with 33/37 (89%) of those stage 0 or stage I and all node negative. The added cancer detection for ABUS was estimated at 2.4/1000 ABUS exams (the number of ABUS exams was not given).

Flowchart Update; CEM Study

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Who Needs More Screening? Flowchart
This popular screening decision support tool for health providers has just been updated, view it HERE.

CEM Study
A retrospective, single-institution study at Memorial Sloan Kettering Cancer Center reported results of several rounds of screening contrast-enhanced mammography (CEM) in 609 women with extremely dense breasts, most of whom also had other risks for breast cancer. Compared to low-energy images (similar to a standard 2D full-field digital mammogram), contrast enhancement:

  • Increased cancer detection1
  • Decreased specificity, which improved at follow up exams when prior images were available for comparison2

As summarized in an accompanying editorial by Marc Lobbes, MD, PhD, these results support the use of CEM as a safe and effective screening tool for women with dense breasts.

1The cancer detection rate after contrast enhancement vs. low-energy images was 12.7 per 1000 (16/1264) vs. 4.0 per 1000 (5/1264) for an incremental cancer detection rate of 8.7 per 1000 screens (11/1264). The sensitivity after contrast enhancement vs. the low energy images was 88.9% (95% CI: 65.3, 98.6) vs. 27.8% (95% CI: 9.7, 53.5) (P = .003).

2The specificity after contrast enhancement vs. low-energy images was 88.9% vs. 96.2%, P < .001. Specificity at follow-up improved to 90.7% (95% CI: 88.5, 92.7; P = .01).

World Dense Breast Day SUCCESS, NY insurance law

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2024 Success Story

  1. We had participation from people in 104 (!) countries
  2. Over 16.8 million people saw/read the posts
  3. Over 51,200 people interacted with the posts by liking, or sharing


New York State Insurance Law
New York has amended its breast imaging insurance law to require certain insurance policies to allow patients additional screenings for breast cancer when the provider deems such screening is necessary under nationally recognized clinical practice guidelines. Please see DBI’s Insurance/Inform Laws tab for more details.

#WDBD, Find It Early Act, EUSOBI

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#WorldDenseBreastDay Analytics
While still waiting for final analytics to come in for #WorldDenseBreastDay, but 2024 participation will break previous records! And, it was indeed a world event – we had participants from 70+ countries. Thank you to all that participated!

Find It Early Act
The U.S. bipartisan bill for expanded no-cost insurance coverage after a mammogram introduced in the House (HR3086) now has a Senate companion bill (S5141). Many thanks to co-sponsors Reps. Rosa DeLauro (D), Brian Fitzpatrick (R), and Sens. Amy Klobuchar (D), Roger Marshall (R). See Find It Early Act for updates and lobbying tools.

EUSOBI 2024, Oct 3-5
The European Society of Breast Imaging Annual Scientific Meeting takes place 3 – 5 October in Lisbon. The DenseBreast-info.org/Europe exhibition stand will be located at R4.  Please Visit! Cheryl Cruwys, DBI’s European Education Coordinator, will be there, and Executive Director JoAnn Pushkin will be at the booth on Friday the 4th.

FDA “dense breast” reporting rule

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This week’s news of the FDA effective date for density reporting resulted in much media interest and a very busy week for us. Below is a sample of some of the major stories (and more scheduled):

Alaska insurance law, National density inform

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State Insurance Law
Alaska is the latest state to enact a law that requires insurers to cover expanded breast imaging. Visit the DBI Insurance/Inform Laws tab for updated maps and new insurance table.

National Density Inform Standard (finally)
On Tuesday, September 10, the FDA’s requirement to provide patients with one of two standardized letters (“dense” or “not dense”) after their mammograms goes into effect. More information, including how to contact the FDA with questions, is available HERE.

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