Breast cancer testing expenses can cause costly delays

DAR staff will work during the month of September to put together an annual magazine featuring women who are undergoing or have undergone treatment for breast cancer. I’ve written many of these stories over the years and had an opportunity to meet some amazing women and their families. One of the most heartbreaking stories was of a woman who talked about how early detection could have prevented her cancer from reaching the most serious stage. She had tried several treatment options and had one last hope at the time we talked. Sadly, that treatment was not enough to save her life. She left behind a daughter and many friends and family. Someone I love recently had a mammogram. It was paid for by her health insurance as preventative care for women, something guaranteed under the Affordable Care Act. Doctors found an area they were concerned about, and she scheduled a biopsy to follow up. The biopsy was clear, thankfully. And, then came the phone call from the billing department. The follow-up biopsy would cost about $2,000, an expense she wasn’t expecting. The median household income in Butler County is $37,878. Allowing for taxes and withholdings, that biopsy is probably equal to about a month’s salary for the median household in our area. For many, it’s probably closer to two months’ salary. The Susan G. Komen Foundation reports the cost of follow-up, diagnostic exams can be a barrier for many women and cause delays in determining if lifesaving treatment is needed. “Women across the country are delaying, or even foregoing, needed diagnostic exams due to the high and varying out-of-pocket costs,” said Paula Schneider, Susan G. Komen’s CEO, in 2019. “It does women little good to know they have something suspicious if they can’t afford the test(s) that will explain the finding or confirm the need for a biopsy.” “Solving this barrier to care is key to saving lives,” added celebrity home life expert Sandra Lee, a breast cancer survivor, speaking with Schneider. “No woman should be put in the position of knowing something is wrong, but unable to do anything about it because of the cost. We can, and must, do better for the women of this country.” They spoke after the bipartisan “Access to Breast Cancer Diagnosis Act” was introduced in 2019 by Rep. Debbie Dingell (D-MI). It would have increased access to medically-necessary diagnostic breast imaging by reducing out-of-pocket costs for patients. It was introduced also in January 2020 by Sen. Roy Blunt (R-MO). It was referred to the Committee on Health, Education, Labor and Pensions the same day and action appears to have stalled there. From an early-detection perspective, a screening mammogram would not be considered successful if the follow-up diagnostic imaging was not performed to rule out breast cancer or confirm the need for a biopsy, the Susan G. Komen Foundation said in 2019, when advocating for the bill. The systematic use of breast cancer screening and follow-up diagnostics has led to significant increases in the early detection of breast cancer in the past 20 years, they reported. A 2018 study by three doctors with Truven Health Analytics found between 2011 and 2015, more than 12 million patients required follow-up, diagnostic procedures in the U.S. after a mammogram, at a total cost of $7.91 billion. That included more than 8 million diagnostic mammograms; 6 million breast ultrasounds; and 1 million biopsies. About half of women screened had a second procedure, 20% followed with a third procedure and 10% a fourth. On average, diagnostic mammograms cost $349; ultrasounds $132; and biopsies, $1,938. The doctors believed their findings underscored the need for better diagnostic ability, to lower health care expenses and shorten the patient’s journey to a diagnosis. The doctors noted in their study that controversy remains in balancing breast cancer screening costs with rates of detection, rates of false-positives or over diagnosis and reduction in mortality. One of the tragedies of our world is that at a time when we have the power to save lives, the biggest barrier for some women is quite simply the cost. Not even the most frugal of budgeters can find a month’s worth of salary to devote to one diagnostic test, particularly when it may need to be repeated in future years. I don’t know what the answer is, but I’m afraid it isn’t likely to be found as long as the only people it impacts are the women struggling to find a way to pay for these tests and the children they leave behind. Farley is the editor of the Daily American Republic and can be reached at dfarley.dar@gmail.com .