Nurse with young women having a mammography. Getty Images.
The following article was originally published on News5Cleveland.com and is published in the Ohio Capital Journal under a content-sharing agreement. Unlike other OCJ articles, it is not available for free republication by other news outlets as it is owned by WEWS in Cleveland.
Ohio is set to make breast cancer care much more accessible than ever before, potentially saving thousands of lives in the state. Once House Bill 371 gets to Gov. Mike DeWine’s desk, he plans on signing it, according to a spokesperson for the governor.
The legislation, referred to as the “Breast Cancer Bill,” would allow everyone, regardless of age, to receive coverage for an annual screening, including advanced screenings for those with dense breasts. It was introduced by state Reps. Sedrick Denson, a Democrat from Cincinnati, and Jean Schmidt, a Republican from Loveland.
The bill passed the House almost unanimously, minus state Rep. Sarah Fowler Arthur, a Republican from Ashtabula. The Senate was the same with everyone but state Sen. George Lang, a Republican from West Chester, voting yes.
Doctors and survivors agree that the best way to stop breast cancer is to find it early. About one in eight women will develop breast cancer, according to the Ohio Dept. of Health.
“In the early screening, the early detection saves your lives,” Karriejoi Coit, a breast cancer survivor, said. “It keeps you here for your children, it keeps you here for your families.”
At 25 years old, Coit was diagnosed with ovarian uterine cancer. After her hysterectomy, she thought she was in the clear.
During another visit at 30, she found a lump in her.
“Cancer doesn’t discriminate,” she said. “It doesn’t care about the socioeconomic status or your culture or your race — and so expanding those things to people who have any type of indicator is extremely important now.”
The bill will also allow patients to receive digital breast tomosynthesis, which is a newer, high-tech way of getting a mammogram. It creates 2D and 3D-like pictures of the breast for a closer look. Chest MRIs and ultrasounds would also be more accessible for supplemental screening.
“We used to have to fight for that 30-year-old patient to get a mammogram, even with a mass,” Dr. Tara Scott said. “We couldn’t just send them if they didn’t meet the criteria.”
Scott is an Akron OB/GYN for her health group Revitalize and is the integrative medicine medical director for Summa Health. Lives could be saved if there was more accessibility for early and supplemental screenings, she said.
“We were taught if your mother or your relative has breast cancer, you need to get screening ten years before, so let’s just say your mother was 49 — that means you start at 39,” the doctor said. “But some, like the United States Task Force said start at 50.”
The majority of insurance plans are required to cover mammograms every one to two years for people beginning at age 40 with no out-of-pocket cost, according to the CDC.
Medicaid and insurance companies are looking for the most cost-effective way of screening, she added. She and many other doctors feel frustrated by the pushback they receive when trying to get medical coverage for screenings, the doctor said.
“I can think of a patient in particular who was 32-years-old and she was breastfeeding her 6-month-old and found a lump and by the time they got her scheduled in, they were going to have her wait two months,” Scott said.
The woman, who ended up getting into another hospital system for testing, died in her thirties.
“Why should she have to fight to get that that that imaging done?” the doctor said.
There is also an informational aspect of the bill, which gives additional and more thorough notification of dense breast tissue risk factors to patients. Having dense breasts means the cancer is more difficult to detect, according to Chief Medical Officer for Redirect Health Dr. Janice Johnston.
“They turn up a little bit whiter on the images,” Johnston said. “So, typically will encourage patients to have what we call supplemental screening in addition, whether that be through ultrasound or through a 3-D type imaging or maybe even a breast MRI.”
About 90% of women have at least some form of dense tissue, according to the CDC, but there are ranges of density values. Of those 40-years-old or older, about half have dense breasts.
“We do find because they’re harder to read — things can be obscured because of the density, that cancers and the early abnormalities may be missed,” she said.
Patients with dense breasts have a higher chance of getting breast cancer, Johnston said.
The bill requires Medicaid and insurance companies to cover these supplemental screenings. The eligibility includes most likely everyone who needs one.
To be eligible, someone must have dense breast tissue; or they are at increased risk of breast cancer due to family history, prior personal history of breast cancer, ancestry, genetic predisposition, or other reasons as determined by the health care provider.
Scott said she is excited about the law, but there is more access to fight for.
“There’s still, even the working poor, though, the people that don’t qualify for Medicare or can’t take time off work to go to get imaging,” Scott added. “It is a step in the right direction, but I still think there’s obviously always going to be access problems.”
Coit agreed about making sure accessibility is equitable, because outcomes aren’t. Black women have more than a 40% higher rate of dying from breast cancer than white women, according to the American Cancer Society.
“I’m hoping that with this, the new law, access to care is also going to be addressed by a lot of the providers and the people who are working, the nonprofits that are working hard to get people to the doctor’s office,” Coit added.
Educating young people so they can start learning some of the risk factors is what should happen now, she said.
“We see all those memes all the time, ‘let’s normalize this, let’s normalize that,’ well, some things are just not normal,” Coit said, laughing. “I tell people all the time, if you feel a certain way or certain things are going on, you need to go and see your provider — you don’t need to wait.”
It is recommended to do at least one self-exam a month, according to the Cleveland Clinic. Here is their guide to exams.
The Breast and Cervical Cancer Project offers no-cost breast and cervical cancer screenings and diagnostic testing to qualified people. The number is 1-844-430-BCCP (2227).
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