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Legislation

U.S. State and Federal Insurance Legislation, New Ultrasound Study

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State Insurance Bills

Two new state insurance bills for expanded breast imaging coverage have been introduced:

Find It Early Act
As the 2025 Congressional session has begun, re-introduction of the federal Find it Early Act is scheduled. The Senate version has already been formally re-introduced (S1410), and the House bill re-introduction will follow soon.

New Study
Niu et al report on the effectiveness of primary screening with breast ultrasound among women in low-resource settings in rural China. 9100 women ages 35-64 underwent hand-held US (HHUS) and automated breast ultrasound (ABUS). Women over age 45 were also screened by mammography (MG).  All modalities were statistically equivalent but ABUS alone performed very well.

  • The overall CDR was 2.7/1000 women screened and there were no statistical differences in sensitivity and specificity among the 3 screening methods, although the CDR of ABUS was greater than HHUS or MG.¹
  • ABUS detected 2 cancers missed by HHUS and MG, and, in women with dense breasts, ABUS had the highest diagnostic performance of the 3 screening methods.²
  • ABUS overall accuracy in women with non-dense breasts was comparable to HHUS and mammography.³
  • The proportion of women with dense breasts among women aged 45-64 was 67.5%.

¹ There were 25 cancers among 9100 women screened, with CDR of 3.0 for ABUS, 2.3 for HHUS and 2.0 for MG per 1000 women screened.

² Note: BI-RADS 3 was considered “negative” in this analysis, but typically represents a “positive” screening test; 9.9% of ABUS examinations were assessed as BI-RADS 3 in women with dense breasts (as were 12.6% of HHUS and 13.1% of MG examinations). Among women with dense breasts, ABUS sensitivity was 81.8%, specificity (with BI-RADS 3 considered negative) was 98.5%, PPV3 16.7%, NPV 99.9%, and AUC 0.902.  Sensitivity of HHUS was 63.6% and of MG 54.6%, but differences were not significant.

³ Among women with non-dense breasts, sensitivity of all three modalities was 100%. ABUS specificity was 99.5%, PPV3 41.7%, NPV nearly 100% and AUC 0.998.

Legislation Update, New Study U.S. State Insurance Legislation Update

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U.S. State Insurance Legislation Update

  • New Law: Arkansas has amended its existing insurance law to include supplemental screening modalities, CEM, MRI, US and MBI and to eliminate cost sharing on diagnostic examinations.  For more details, please visit the DBI Legislation Map.
  • New Bill: Colorado has introduced a new insurance bill for expanded breast imaging coverage, SB296.

New Study
In a single-center analysis from the United Kingdom, Payne et al reported results on 49,948 digital screening mammograms showing that increasing Volpara-based assessed breast density adversely affects screening mammography performance. They verified that the current quantitative Volpara threshold between category B, scattered fibroglandular density and C, heterogeneously dense, is appropriate, with worse performance in dense breasts.  Overall, 205/614 (33.4%) of cancers were symptomatically detected.

  • Symptomatic interval cancer rates increased with each density category.1
  • Sensitivity decreased with each density category.2
  • Recall rates were higher in dense breasts.3
  • Cancer rates increased with increasing breast density.4

The authors suggest consideration of supplemental screening in women with extremely dense breasts and stress that the 3-year screening interval contributes to delayed diagnosis.  Currently, most women in the UK are not informed of their breast density, and supplemental screening is not widely available.

1 Interval cancer rates at 3 year follow-up were: 1.8/1000 for category A, fatty breasts; 3.2/1000 for category B, scattered fibroglandular density; 5.7/1000 for category C, heterogeneously dense; and 7.9/1000 for extremely dense breasts.

2 Sensitivity was: 75% in category A, fatty breasts; 73.5% in category B, scattered fibroglandular density; 59.8% in category C, heterogeneously dense breasts; and 51.3% in category D, extremely dense breasts (significantly worse in category C or D compared to B).

3 Recall rates were: 3% for category A; 4.5% for category B; 5.5% for category C; and 5.3% for category D.

4 Total cancer rates (screen-detected plus interval cancers) were: 7.4/1000 for category A; 12.2/1000 for category B; 14.2/1000 for category C; and 16.1/1000 for category D.

New State Insurance Bill, World Health Organization

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State Insurance Bills
Over 35 state insurance bills have been introduced this legislative session! The latest bill introduced to cover expanded breast imaging is, Georgia HB928.

World Health Organization: Global Breast Cancer Initiative (GBCI), Knowledge Action Portal 
We are proud to announce that DenseBreast-info.org‘s resources are now hosted/linked to on the WHO’s Knowledge Action Portal,  a global community-driven online platform.

New Insurance Laws, Updated Content, SBI Gold Medal Winner

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State Insurance Laws
Two state insurance bills have been signed into law! Both Idaho and Virginia have enacted laws for expanded breast imaging coverage (both effective 1/1/26).

  • Visit DBI’s State Law Insurance Map, HERE
  • Visit DBI’s State Law Insurance Table, HERE

DBI Website New Content and Updates
We’ve been busy! Please see new and/or updated Health Provider content on these pages:

  • NEW! Supplemental screening comparative guideline table, High/Increased-Risk, Dense Breast Screening Guidelines, HERE
  • Health Provider FAQ #52, “What is the recommended breast screening for women with disease-causing genetic variants (mutations)?,” HERE.
  • Heath Provider Risk Model Tutorial, HERE.

SBI Gold Medal Winner
Congratulations to DBI MAB member Dr. Paula Gordon! The Society of Breast Imaging has named Paula Gordon, MD, of the University of British Columbia, winner of the 2025 SBI Gold Medal for her outstanding contributions to the field.

State Insurance Bill, Global Breast Cancer Trends

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State Insurance Bill
There is a new state insurance bill to cover expanded breast imaging in Massachusetts (H1286).

New: Global Patterns and Trends in Breast Cancer Incidence and Mortality
The global burden of breast cancer was recently estimated across 185 countries in the Globocan 2022 and other databases.1

  • Breast cancer was the first or second most commonly diagnosed cancer in 183 of 185 countries, and among the top two causes of cancer-related deaths in 169 countries.
  • In 2022, there were 2.3 million new cases worldwide and 670,000 deaths, numbers that are expected to grow to 3.2 and 1.1 million respectively by 2050 (increases of 38 and 68% respectively).

Importantly, rates vary significantly across regions, with higher mortality rates disproportionately observed in low-income countries due to disparities in early detection and treatment. In particular, incidence and mortality of women younger than 50 years is higher among low income countries.2

 1 Ten-year trends in incidence from 50 countries in the Cancer Incidence in Five Continents plus database were analyzed as were 10-year trends in mortality from 46 countries in the World Health Organization database.
2 Almost half (47%) of new breast cancers in Africa occur in women younger than age 50, compared to only about 20% in North America, Europe, and Oceania. Women younger than age 50 represent 41% of breast cancer deaths in Africa compared to 8% in Europe.

More State Insurance Bills, Canadian Task Force

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U.S. State Insurance Bills
Bill introductions continue to roll in for expanded insurance coverage for breast imaging. New this week:

Canadian Task Force PAUSED
Canada’s Minster of Health announced a temporary pause of the work of the Canadian Task Force on Preventative Health Care. The External Expert Review of the Canadian Task Force on Preventive Health Care is studying the Task Force’s governance, mandate, and processes. This review was prompted, in part, by “important feedback directly from Canadians and key leaders in the area who raise their concerns on the existing guidance and process of the Task Force.” Much credit goes to Dense Breasts Canada who fought a 7-year battle for a revision and to Drs. Paula Gordon, Jean Seely, Anna Wilkinson, and Martin Yaffe for their research and advocacy, and to Dr. Sheila Appavoo for leading a coalition of specialists.

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.

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:

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.

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.

FDA Rule, European Supporter, New Study

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FDA Reporting Standard
We are 10 days away from the FDA’s effective date for mandatory density reporting to both patients and referring providers. Please visit DBI’s FDA page which now includes a link to an FDA Compliance Guide (with helpful Q+As). DBI public comments on the September 10th effective date are available HERE.

New European Education Supporter, Albania
We welcome, Iris Allajbeu, MD, PhD, FRCR to the DBI/Europe team! Dr. Allajbeu is Associate Professor of Radiology, Western Balkans University, Tirana, as well as honorary consultant radiologist for the American Hospital in Tirana, International Advisory Board for the Western Balkans University, honorary clinical lecturer and co-lead of Clinical Research, President of ALSOBI and Vice President of the AAR. She is also Senior Clinical Research Associate, Honorary Consultant, Department of Radiology, University of Cambridge Addenbrooke’s Hospital, Cambridge, UK.

Study: Geographic Accessibility
Christensen et al. considered access to MRI and mammography by examining zip codes and a mapping tool that displays the relative socioeconomic conditions of neighborhoods. The study found the average distance to access breast MRI was 23 miles, 22 miles for breast ultrasound, and only 8 miles for mammography.

  • Distances were greater in lower socioeconomic areas and rural zip codes.
  • Contrast-enhanced mammography can be implemented on most existing digital mammography equipment and could improve access to supplemental screening.

State Insurance Law; AbMRI research

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State Insurance Law Amendment
Illinois has amended its insurance law for expanded breast imaging.  MBI will now be included (effective 1/1/26), please see DBI’s legislation MAP for details.

Research Analysis
An analysis of “real-world” experience with supplemental abbreviated MRI (AB-MRI) screening in women with dense breasts and average breast cancer risk was conducted by senior author and DBI Advisory Board Member Emily Conant, MD and colleagues. The cancer detection rate for baseline AB-MRI exams was higher than for subsequent exams, however the difference was not significant. [1]

  • As expected, for exams with one-year follow-up, the false-positive rate decreased with subsequent exams compared to baseline exams. [2]
  • All cancers detected with baseline or subsequent AB-MRI exams were stage 0 or 1, and there were no symptomatic interval cancers.
  • The results support the effectiveness AB-MRI for supplemental screening in women with dense breasts at otherwise average breast cancer risk and suggest that adding screening MRI every two years may be sufficient, though further study is warranted.

1. The cancer detection rate for baseline vs. subsequent AB-MRI exams was 18.9 per 1000 (38/2007) vs. 12.1per 1000 (7/278) respectively (P=.37).
2. The false positive rate decreased from 7.7% (116/1497) for baseline exams to 2.8% (10/359) for subsequent exams (P<.001).

New State Insurance Laws

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State Insurance Laws
NEWS on insurance laws for expanded breast imaging in Louisiana, Mississippi, New Hampshire, and Nevada. Currently, 32 states + DC have insurance laws for expanded coverage for either screening or diagnostic imaging. Alaska may be next – that bill is on the governor’s desk – stay tuned!

  • Full details by state HERE
  • Insurance map visual HERE

Amended “Inform” Law, New Study

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Rhode Island Density Inform Law Amended
In preparation for the FDA’s new dense breast reporting standard going into effect Sept 10, 2024, Rhode Island has amended its existing “inform” law. The Rhode Island inform law will now defer to the FDA’s national reporting standard. Please see DBI’s State Law Map or Table for details.  As previously mentioned, existing state density inform laws may remain in effect in addition to the FDA requirement unless that state law specifically defaults to the new FDA standard, expires, or is repealed.

Just Published
A retrospective study just out in Radiology,  Comparison of Mammography and Mammography with Supplemental Whole-Breast US Tomography for Cancer Detection in Patients with Dense Breasts, evaluated the performance of US tomography (UST)  combined with full-field digital mammography (FFDM) in a reader study in women with dense breasts. The addition of UST improved cancer detection over FFDM alone and the detection rate was comparable to other ultrasound screening methods.

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