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April 27, 2023

People at high risk of breast cancer will have all screening costs, genetic testing covered by insurance in Pennsylvania

Under new legislation expected to be signed by Gov. Josh Shapiro, even out-of-pocket expenses, like copays, will be waived

Pennsylvania residents at high risk for developing breast cancer soon will be able to get vital screenings and genetic testing covered entirely by their health insurers.

All costs associated with breast cancer MRIs, ultrasounds and BRCA-related genetic testing for people considered at high risk for breast cancer will be covered by insurance under a bipartisan bill that passed unanimously by the General Assembly on Wednesday. Gov. Josh Shapiro is expected to sign it into law.

Under a 2020 law, health insurers are required to cover the costs of breast cancer MRIs and supplemental breast imaging for high-risk patients. But the new bill eliminates copays, deductibles, co-insurance and other out-of-pocket costs for breast cancer imaging, making it the first of its kind in the United States. 

Under the bill, patients are considered high risk if they have a family history of breast cancer, have had the disease or have dense breast tissue. Last month, the U.S. Food and Drug Administration issued guidelines requiring health care providers to notify patients about breast density. Pennsylvania was one of 38 states that already required that disclosure.  

Having dense breasts increases the likelihood of developing breast cancer and makes it more difficult to detect the disease with an annual mammogram. Many women are unaware that dense breasts are associated with a higher risk of cancer than having a family history of breast cancer.

The legislation also eliminates out-of-pocket costs associated with testing for the BRCA-1 and BRCA-2 genetic mutations, which significantly increase the risk of breast and ovarian cancers. For high risk patients, the American Cancer Society recommends breast MRIs in addition to an annual mammogram beginning at age 30.

During a news conference Wednesday, House Speaker Joanna McClinton, a Democrat from Philadelphia, recalled a conversation she had with a constituent who is a cancer survivor. Though the woman's mammogram had come bak clear, she sensed that something wrong, requested a breast MRI and learned that her cancer had returned. 

"When you look at the numbers of new cases, and when you look at the mortality rates, especially for women of color, it's absolutely staggering," McClinton said. "Breast cancer is one of those diseases that many times for women of color, women that look like me, it is a death sentence. There are treatments done, but for a variety of reasons and most of them being late detection, they are not able to survive and we fall and succumb to this disease too often." 

The breast cancer death rate dropped 43% between 1989 and 2020, according to an American Cancer Society report. But racial disparities abound. Though Black women have a 4% lower incidence rate than white women, they have a 40% higher breast cancer death rate. 

Breast cancer is the leading cause of cancer-related death among Black and Hispanic women, and is the second leading cause of cancer-related death among all women, after lung cancer. The report also found that Black women have the lowest survival rate for all subtypes of breast cancer, and have the lowest 5-year survival rate of any racial group. 

Advocates of the bill say it will lead to earlier cancer detection, which will in turn save lives and health care costs. When caught early, breast cancer has a 99% relative survival rate

Understanding the risks and symptoms of breast cancer can help people increase the likelihood of early detection. 

Self-exams, breast cancer screenings and annual physical examinations by a gynecologist or primary care doctor increase the likelihood of early detection.Annual mammograms are recommended for women after age 45, but they are available to all women at age 40. 

The legislation was spearheaded by the Pennsylvania Breast Cancer Coalition, an organization that advocates for laws that fight breast cancer and support survivors. During Wednesday's press conference, Senate Pro Tempore Kim Ward, a Republican from Westmoreland County who survived breast cancer, quipped that the organization's founder, Pat Halpin-Murphy, called her office so often that staffers blocked her phone number. 

"14,000 women in Pennsylvania are newly diagnosed with breast cancer each year," Ward said. "So these bills are not only helping with the diagnosis, they're preventative. When we prevent the disease, we save money. This has been a long haul, and as I went through this breast cancer journey, I did see things that needed to be addressed. It is important to families, it is important to women and it is important to every single one of us." 

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