I remember the phone call that transformed my life forever. It was in the early spring of 2015 and my father said to me, “I have cancer.” Families all across our country have felt the sting of those three words and the devastation that cancer can cause to our loved ones. I lost my father to this dreaded disease a few months after that call, and it spurred me to become a stronger advocate for using innovation and advances in medical technology to help us detect cancer sooner.
In that spirit, I have worked closely with leading medical professionals in our state to provide greater access to clinically proven methods of detecting invasive cancers much more quickly. In that regard, I have been particularly focused in the area of breast cancer. One of the leading causes of death in women is this form of cancer, and oftentimes doctors are able to increase the chances of survival by early detection and intervention. Two years ago, I proudly authored the law to expand insurance coverage for enhanced breast screening for patients with dense breasts. As an extension of that work I recently introduced a proposal, A4320, would require health insurers and health maintenance organizations to provide coverage for expenses incurred in conducting digital tomosynthesis mammograms to detect or screen for breast cancer in women 40 years of age and over; and for diagnostic purposes in women of any age.
A tomosynthesis mammogram is a special kind of mammogram that produces a 3-dimensional image of the breast by using several low dose x-rays obtained at different angles. It is the only mammogram clinically proven to detect cancer 15 months sooner than traditional 2D screenings. Recently the National Comprehensive Cancer Network (NCCN), a not-for-profit alliance of 27 of the world's leading cancer centers devoted to patient care, research, and education, recommended for the first time ever that clinicians "consider" tomosynthesis as part of annual breast cancer screening. This is a very significant designation as it is widely known that the NCCN and its guidelines influence insurers' coverage decisions.
One national insurance carrier, Cigna, used this information to change its coverage requirements. In August of this year, they became the first national insurer to provide coverage for digital breast tomosynthesis exams as an option for patients' annual breast cancer screening for all women aged 40 and over. Cigna’s rationale was simple and captured in their public statement when they announced the move, “We have a responsibility to our customers and clients to ensure that the medical treatments, tests and procedures they’re paying for have proven clinical value and will help improve their health and well-being. That’s a responsibility that we don’t take lightly.”
Now the debate on this tool is far from settled. The US Preventive Services Task Force (USPSTF), another major organization that also influences insurance coverage, recently did not endorse the technology. The USPSTF concluded that the current evidence was insufficient to assess the benefits and harms of digital breast tomosynthesis as a primary screening method for breast cancer. They stated in their conclusion that screening with tomosynthesis has not been proven at this point to reduce patient mortality. However, let’s examine this objection in fuller detail.
In order to clinically demonstrate a reduction in mortality, it would require at least one randomized controlled trial. This is an extremely expensive and lengthy process that has not been used during the past decade for any breast imaging technology. Additionally, the verification of technology-specific mortality reduction has not been required to justify insurance coverage for either Full Field Digital Mammography (FFDM) or any other breast imaging technology. However, what is clear is that the research shows tomosynthesis "consistently" show an increase in the breast cancer detection rate.
According to a 2014 study published in the Journal of American Medical Association (JAMA), digital breast tomosynthesis was shown to locate significantly more (41%) invasive cancers than can conventional digital mammography, a 15% decrease in the recall rate from screening mammography, and a 29% increase in the detection of all breast cancers. This particular study sampled nearly half a million patients and is the largest study on digital breast tomoysnthesis known to date. My goal, and that of others in this fight, is to create a reality where there will be fewer memorials and more birthdays for cancer patients. By embracing advances in medical technology and providing greater access to them, we can hopefully achieve this goal. That’s my take. What’s yours?