Hawaii’s legislators are currently considering a bill that requires health insurers to cover digital breast tomosynthesis (also known as 3-D mammography). The medical literature strongly supports such a mandate, and numerous states across the nation have already passed such mandates into law.
State Sen. Lorraine Inouye, who introduced Senate Bill 1034, and the Women’s Legislative Caucus, should be lauded for their support of this important measure.
A woman in the United States has a one in eight risk, over the course of her lifetime, of being diagnosed with breast cancer. Mammography is decades-old technology that uses x-rays to detect breast cancer at an early and more treatable stage, and has unquestionably improved the lives of American women since its advent. Numerous studies show that women who undergo screening mammography are more than 40 percent less likely to die from breast cancer than those who do not.
Tomosynthesis is not new technology, having been approved by the U.S. Food and Drug Administration in 2011 for all the same indications as conventional digital mammography, and covered by Medicare and Medicaid since 2015. The reasons for the approval are clear: Studies show that tomosynthesis detects 30 percent more breast cancers than conventional mammography, and 40 percent more invasive cancers (those more likely to seriously harm a patient).
Because tomosynthesis provides a three-dimensional view of the breast compared to the two-dimensional view of conventional mammography, artifacts are reduced, and about 15 percent fewer women need to come back for additional imaging. In short, tomosynthesis is more effective and efficient at detecting cancers, which equates to saving more lives.
“There is no question that digital breast tomosynthesis is superior for finding small cancers early,” said Dr. Scott Harada, a Honolulu radiologist with special training in breast imaging. “This is particularly true in women with dense breast tissue.”
Tomosynthesis may be especially beneficially to Hawaii’s patient ohana, where there is a large Asian population. 57 percent of Hawaii’s women are of Asian descent, and these women typically have dense tissue, which makes conventional mammograms more difficult to interpret, and may result in cancers being missed. Tomosynthesis is particularly beneficial for women with dense breast tissue because of its ability to evaluate the breast in three dimensions.
Despite the advantages of increased cancer detection and cost savings, tomosynthesis is not universally covered by private insurers. There are now 16 states that require health insurers to pay for tomosynthesis, and five states are considering mandates similar to that proposed in Hawaii. Across the nation, 93 percent of women ages 40-74 have insurance coverage for tomosynthesis, compared to only 22 percent in Hawaii.
Citizens and lawmakers alike should know that digital breast tomosynthesis is not investigational technology, but mainstream technology that is widely available throughout the United States. Hawaii’s women deserve the same benefits available to so many other Americans.
Dr. Elizabeth Ann Ignacio is president of the Hawaii Radiological Society. Dr. Dana Smetherman is chairwoman of the Breast Commission of the American College of Radiology.
