CHICAGO ― One in five women will skip further imaging after an abnormal mammogram if they have to pay out of pocket before their deductible is met, new data indicate.

“The ACA [Affordable Care Act] removed out-of-pocket costs for screening mammograms under most health plans to encourage women to partake in this important preventative healthcare measure,” Michael Ngo, MD, a radiology resident at Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine, said in a statement.

However, the screening mammogram is only the first step. If it’s abnormal, additional tests and a biopsy help determine whether the patient has cancer. The ACA does not mandate coverage for those, Ngo noted.

Ngo was lead author of the study presented at the Radiological Society of North America (RSNA) 2022 Annual Meeting.

Researchers collected 932 surveys. Asked whether they would skip follow-up imaging if they knew that they would have to pay a deductible, 151 of 714 (21.2%) said that they would skip the imaging; 424 (59.4%) said that they would not skip further imaging; and 139 (19.5%) were undecided. Responses differed by race, education level, household income, and insurance payer.

Groups Most Likely to Forgo Further Tests

The groups with the highest percentage of persons who would skip additional imaging were Hispanic persons (33%); persons whose level of education was high school or less (31.0%); persons with a household income of less than $35,000 (27%); and those covered by Medicaid or who were uninsured (31.5%).

Dr Wendie Berg

Wendie Berg, MD, PhD, professor of radiology at the University of Pittsburgh School of Medicine, who was not part of the study, said that because insurance companies had to cover initial mammograms fully under the ACA, “they generally increased deductibles. That resulted in more charges to patients when they came in for additional testing.

“It caught a lot of women by surprise,” she told Medscape Medical News.

The out-of-pocket charges can escalate with each step — more images, a biopsy, then more if they do have cancer, she said. This puts patients on the hook for hundreds, if not thousands, of dollars in medical bills.

However, Berg said, “The vast majority of women ― 95% ― who are called back for additional testing don’t have cancer. It is a problem that a lot of women will experience the cost and don’t have any benefit.”

Reducing False Positive Recalls

The study highlights several things, she said. One is that “it’s incumbent on all of us to reduce false positive recalls, which is one of the benefits of 3D mammogram.”

Physicians who order additional tests must also consider the financial burden for patients, she said.

Some states have tackled the issue, she said. “Seven states do require insurance to cover diagnostic testing.” But those states differ in the extent of the coverage. DenseBreast-info.org, a website she helps with on a volunteer basis, explains the benefits by state.

Further compounding the problem is that not every insurer is subject to state law, she said.

Many states have programs that cover the cost for those who meet income requirements, although, she noted, some women make too much to qualify.

“It would be great to have a federal law that is inclusive,” she said.

Education Efforts May Help

Brian N. Dontchos, MD, with the University of Washington in Seattle, who was not part of the study, views the data another way. He told Medscape Medical News, “It is encouraging from the study that the majority of women would pursue additional imaging after an abnormal screening mammogram despite incurring more cost.”

Dr Brian Dontchos

He said that since direct patient education “has been shown to be effective in improving patient participation in screening programs, it is possible that with more education of patients and providers, that advocacy could influence payers to support downstream imaging and biopsies that result from screening programs.”

Ngo, Berg, and Dontchos report no relevant financial relationships.

Radiological Society of North America (RSNA) 2022 Annual Meeting.

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News, and Nurse.com, and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.

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