A new report by the American Cancer Society Cancer Action Network (ACS CAN) found that over 70% of commercially-insured patients encountered out-of-pocket expenses for follow-up breast cancer diagnostic tests in 2023. These follow-up tests, such as a diagnostic mammogram, MRI, ultrasound or biopsy, are medically recommended next steps to determine if an individual may or may not have cancer; however, barriers like cost can keep people from getting them.
While screening mammograms are free to most insured women starting at age 40, follow-up testing after a suspected or actual abnormal screening often results in out-of-pocket cost sharing for patients. The report showed the out-of-pocket costs across procedures varied across states with Pennsylvania having an average out-of-pocket cost share of nearly 32%.
Pennsylvania state lawmakers are looking to address the financial barriers to residents’ access to potentially lifesaving screening. This legislative session, leaders will have the opportunity to support a bipartisan proposal, what was formerly House Bill 1944, that seeks to remove costs associated with diagnostic and supplemental imaging. This will ensure that out-of-pocket obligations do not discourage Pennsylvanians from completing the breast cancer screening process.
“In the fight against cancer, knowledge is power, especially around a patient’s diagnosis. Cancer screenings equip patients with lifesaving knowledge and, where we can, we must empower Pennsylvanians to seek out this information through early detection tools, like diagnostic breast imaging,” said Donna Greco, Pennsylvania Government Relations Director for ACS CAN. “State lawmakers will have the chance to eliminate a real barrier that Pennsylvanians face in their pursuit of information about what’s going on in their bodies. Out-of-pocket costs should not be the reason that Pennsylvania’s mothers and daughters miss out on getting screened and the opportunity to confirm or rule out a cancer diagnosis as early as possible.”
Due to these costs, many patients choose to delay receiving follow-up diagnostic tests which can result in later-stage cancer diagnoses and higher healthcare costs. Black and African American women die from breast cancer at alarmingly higher rates than their White counterparts. In 2024, more than 1 million women aged 40 to 75 were estimated to experience a delay in follow-up testing and imaging due to associated costs. The report also determined that out-of-pocket costs are having an impact on the completion of future screening mammograms. Approximately 378,000 more women were likely to skip future mammograms (in 2024) due to fear of subsequent out-of-pocket cost sharing from follow-up diagnostic tests
The report also showed that the elimination of out-of-pocket cost sharing for follow-up tests could prevent more than 7,500 later-stage diagnoses and ultimately save the U.S. an estimated $2.2 billion in lifetime breast cancer treatment costs.
“Out-of-pocket cost sharing is a significant barrier for those individuals who need access to multiple early detection services in order to find cancer at an earlier stage when treatment is more effective,” said Lisa Lacasse, president of ACS CAN. “These additional expenses can lead to delayed or even skipped medically necessary procedures resulting in potentially life-threatening consequences. Removing cost sharing for each intervention in the screening process is a critical step toward ending cancer as we know it, for everyone.”
Despite some states adopting legislation eliminating out-of-pocket costs for post-mammogram diagnostic testing, these protections are not available to every woman. Patients living in other states or those enrolled in non-state-regulated health plans still face significant costs.
###
About ACS CAN
The American Cancer Society Cancer Action Network (ACS CAN) advocates for evidence-based public policies to reduce the cancer burden for everyone. We engage our volunteers across the country to make their voices heard by policymakers at every level of government. We believe everyone should have a fair and just opportunity to prevent, detect, treat, and survive cancer. Since 2001, as the American Cancer Society’s nonprofit, nonpartisan advocacy affiliate, ACS CAN has successfully advocated for billions of dollars in cancer research funding, expanded access to quality affordable health care, and advanced proven tobacco control measures. We stand with our volunteers, working to make cancer a top priority for policymakers in cities, states and our nation’s capital. Join the fight by visiting www.fightcancer.org.