Introduction
A new Washington state law will be a lifesaver for Washington residents, say doctors and breast cancer patients.
Starting in 2024, women will be less likely to forgo life-saving tests for breast cancer because they cannot afford them.
The new law encompasses some similar legislation that former state Sen. Sharon Brown, R-Kennewick, pushed for in 2022.
It requires that health insurers that cover certain breast cancer exams, including magnetic resonance imaging, not require patients to share the cost on those tests.
Dr. Rachel Fidino of Kennewick, who worked with Brown, is passionate about using magnetic resonance imaging in addition to mammograms, for checks of women at high risk of breast cancer.
The bill that passed the Senate 48-0 and the House 90-6 this year also addressed exams, including diagnostic mammograms, MRIs and ultrasounds, for anyone if cancer is suspected. Those exams may be used to confirm a cancer diagnosis and come up with a treatment plan.
After Brown decided not to run for another term in the Senate, Fidino approached Sen. Matt Boehnke, R-Kennewick, who signed on as a sponsor for the 2023 bill, with Sen. Lynda Wilson, R-Vancouver, taking the lead.
BREAST CANCER SURVIVOR
Wilson was diagnosed with breast cancer almost five years ago and has used her experience as an opportunity to educate and raise awareness.
She was six months past due for her annual mammogram, thinking she was too busy to get one, when she discovered a lump.
She got a mammogram the next day, followed by an ultrasound and MRI, to determine if the lump was cancer, what kind, where the tumor was and its size — information needed to plan her treatment.
Fortunately, her insurance paid for the extra tests, she said.
“If insurance requires out-of-pocket expenses, many times they are unaffordable and that means unattainable,” she said, at a Senate committee hearing.
“Delaying or avoiding these tests because of costs can be very detrimental to a woman’s health, as it can result in late stage diagnosis which can be very debilitating, very expensive and even shorten your life,” Wilson said. “We all know that early detection saves lives.”
HIGH COST FOR TESTS
Costs for patients, even if they have insurance, can be high, with their share of costs for MRI’s sometimes thousands of dollars, said Kirsten Smith, on the policy staff of the Susan G. Komen breast cancer organization.
Many patients skip the tests until there are physical symptoms, which may not show up until as long as two years after a suspicious mammogram, she said.
“These tests flat out save lives,” she said.
Those most likely to skip additional tests are low and moderate income women, women in rural areas where care may be difficult to access and people of color, she said.
It’s a common issue, said Dr. Peter Eby, a radiologist affiliated with Virginia Mason Medical Center, who specializes in breast imaging.
The greatest barrier to care after a breast lump is discovered is getting a diagnosis due to the out-of-pocket cost, he said at a Senate hearing.
“Access to comprehensive breast cancer screening should be a standard for all Washingtonians,” Boenke said.
That includes those at high risk for breast cancer, for whom Fidino has advocated.
MRIS FOR HIGH RISK PATIENTS
The American Cancer Society says woman at high risk are those with a lifetime risk of developing breast cancer of 20% or higher based on their family history; have a BRCA gene mutation or a close relative with the gene mutation; or have certain other genetic abnormalities or close relatives with them.
“Too many times, I have had patients who had to forego an MRI because of the cost,” Fidino said. “This bill enables women at high risk to have an MRI, which can provide early detection for breast cancer and in return, will save lives.”
Elena Whitemarsh, a Kennewick woman at high risk for breast cancer, said at a Senate committee hearing last year that an MRI screening saved her life.
Her health insurer refused to cover the screening, but she went ahead with it at her doctor’s urging.
“I had the financial means and the willingness to make an independent decision, but others are not in that situation,” she said.
She knows other women at high risk of breast cancer who had never had an MRI screening because it was not covered by insurance, she said.
While the bill that passed this year and was signed into law by Gov. Jay Inslee does not require all insurers to cover MRIs and other tests for high risk women, it does relieve the financial burden of deductibles for women with health insurance that covers supplemental and diagnostic breast examinations.
Just after the legislation died last year, UW Medicine announced the results of a new study publish in “JAMA Oncology,” finding that annual MRI screenings starting at ages 30 to 35 could reduce breast cancer deaths by more than 50% among women with certain genetic changes in three genes.
Variants in ATM, CHEK2 and PALB2 genes are collectively as prevalent as the better known BRCA 1 and 2 gene mutations, according to UW Medicine.
An MRI in addition to a mammogram is recommended by the American Cancer Society for women at high risk of breast cancer, Fidino said last year.
OPPOSITION TO NEW WA LAW
The Association of Washington Healthcare Plans opposed the 2023 legislation, saying that it could raise the cost of health care premiums.
Jennifer Ziegler, speaking for the association, said that the U.S. Preventive Service Task Force determined in 2016 that there was not enough evidence to recommend MRIs as a preventative.
However, the task force has restarted the evaluation, she said, and recommended legislators delay a decision until results are available.
There is no time frame for the task force’s results, said Christopher “Kit” Crancer of Rayus Radiology, testifying in support of the legislation.
More than 7,000 women in Washington state are diagnosed each year with breast cancer, Wilson said.
With the new law “we will save lives, we will keep families together and we’ll ultimately save precious time and costs in treatments that won’t have to be administered because the diagnosis was found early in the game,” she said.
The new requirements approved by the Legislature take effect Jan. 1, 2024.
