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