Cost Shouldn’t Be a Barrier to Finding Breast Cancer Early

Rona Ahdout5 min readThis piece is part of a series of stories on the breakthroughs reshaping breast cancer screening and prevention to personalize care, detect cancer earlier, and save lives. Read the rest of the stories here. Breast Cancer Awareness Month is an important reminder that early detection matters, but early detection often requires more than simply getting a yearly mammogram. It means understanding how your personal risk factors determine when your screening should begin. It means knowing what type of screening is appropriate based on those risk factors. And it means making sure you can afford to get the screening you need. But too often, women face financial barriers to screening tests beyond standard mammograms. Cost should not be a barrier that stands between a woman and additional breast testing her health care provider determines she needs to find cancer at the earliest stage possible.This issue is especially important for women with dense breasts. Dense breast tissue refers to the tissue composition of a woman’s breast, as determined by a mammogram. Since September 2024, a federal regulation has required mammography facilities nationwide to inform women about their breast density, which is classified into one of four categories. The last two categories, “heterogeneously” and “extremely” dense, are considered “dense breasts.” Dense breasts are normal and common, and about half of women in their 40s have them. But they also create a potentially life-threatening double whammy: Women with dense breasts are both at greater risk of developing breast cancer, and of having that cancer go undetected on a mammogram.In women with the densest breasts, about half of cancers may go undetected by a mammogram alone, whether the mammogram is 2D or 3D. Half. When cancers remain undetected, they have the chance to grow, spread, and become harder to treat. But when found early, before a cancer starts to spread beyond the breast, the five-year survival rate is 99 percent. That is why, depending on a woman’s breast density and/or other risk factors, additional tests like ultrasounds or MRIs may be recommended.DenseBreast-info, Inc.A cancer growing in non-dense tissue can be relatively easy to see on a mammogram, while that same cancer growing in dense tissue may remain hidden on a mammogram. The images above show mammograms from two different patients for comparative purposes.Knowing that additional breast testing is needed and being able to afford it are two very different things. When a woman is told she has dense breasts and/or is at increased risk and is advised to have additional testing, what happens when insurance does not fully cover that test? While costs vary, without insurance coverage a breast ultrasound may cost several hundred dollars, while a breast MRI may cost well over $1,000. For many women, it can mean putting the test on a credit card, spreading payments over months, delaying the test, or, worse, deciding not to have the test at all.The good news is that 38 states and Washington, D.C. have passed expanded insurance coverage laws to help address this problem. But these laws vary from state to state. Some still require out-of-pocket costs from the patient, and many types of plans are not subject to state insurance laws, such as self-funded employer plans and federal plans like Medicare, VHA, and TRICARE.DenseBreast-info, Inc.You can learn more about your state’s insurance laws here.There is also progress at the federal level. Beginning in 2026, updated federal guidelines require most eligible private health plans to cover, without patient cost-sharing, additional tests needed to complete the screening process or evaluate findings from the initial mammogram. This coverage applies to women at average risk and includes women with dense breasts. However, the guidelines do not address additional testing for women at increased risk. They also do not extend this requirement to federal programs such as Medicare, VHA, and TRICARE.If finding cancer early matters, it matters regardless of the type of insurance a woman has. This is the gap the bipartisan Find It Early Act would address. The federal legislation, co-sponsored in the House by Representatives Rosa DeLauro and Brian Fitzpatrick and in the Senate by Senators Amy Klobuchar and Roger Marshall, would ensure that all health insurance plans cover screening and diagnostic breast imaging with no out-of-pocket costs for women with dense breasts or at higher risk for breast cancer. This includes mammograms.While screening mammograms are already generally covered for women age 40 and older, the bill would provide coverage for women who need screening before age 40 based on risk factors such as race or ethnicity, and personal or family medical history. (You can learn your lifetime risk of developing breast cancer by taking a risk-assessment test here.) Importantly, this comprehensive legislation closes a critical coverage gap by including both private insurance plans and federal health programs, including Medicare, VHA, and TRICARE.Insurance Tip: Your health care provider will need to order any recommended additional breast testing. Before the test, ask the imaging center or your insurer to confirm coverage and any out-of-pocket costs. If coverage is denied or less than expected, you can file an appeal with your insurer. If your appeal is unsuccessful, you can contact the state agency that oversees health insurance in your state for additional help.Breast screening is not one-size-fits-all. While a mammogram is the first step for most women, for many women it should not be the last. We at DenseBreast-info.org have spent years working to make sure that women are informed about their breast density and what it means, and that they know to discuss additional breast testing with their health care provider. Women should get comfortable asking the question, “Is My Mammogram Enough?” and starting a personal risk conversation with their doctor. That conversation can help a health care provider plan the best screening approach based on a woman’s breast density and individual risk factors.The hurdle is whether that patient can afford to follow the recommendation. The goal of the Find It Early Act is simple: to make sure women have the opportunity to find breast cancer early, no matter their type of insurance or their ability to pay unexpected medical costs. The bill has Democratic and Republican support, but more members of Congress are needed to sign on in support. Federal legislators need to hear directly from you, their constituents, about why no-cost coverage for recommended breast testing matters to patients and their families.This Breast Cancer Awareness Month, let's make sure that when a woman is told her mammogram is not enough, she can follow her provider’s recommendations for additional testing. The path to an early stage diagnosis should not be blocked by financial barriers. Until there is a cure, the goal is to Find It Early.Visit FindItEarlyAct.org for information about the bill, how to contact your members of Congress, and helpful guidance for requesting a phone call or meeting. Learn more about dense breasts and additional testing here.DenseBreast-info, Inc. is a 501(c)(3) nonprofit and the world’s leading medically sourced resource on dense breasts, breast cancer risk, and screening. Its Medical Advisory Board includes internationally recognized experts in breast imaging and obstetrics and gynecology.Photographs: Rona AhdoutVisual Director: Fabienne Le RouxArt Director: Christine Giordano