BILL NUMBER:  S1108A

 TITLE OF BILL :

An act to amend the insurance law, in relation to health insurance
coverage for breast ultrasound for cancer screening

 PURPOSE :

To ensure that patients with extremely dense or heterogeneously dense
breast tissue continue to receive coverage for breast ultrasounds
during the course of a mammography screening for breast cancer.

 SUMMARY OF PROVISIONS :

Section 1 of the bill amends section 3216 of the insurance law in
relation to coverage for a breast ultrasound in all instances where a
mammography screening is authorized and the physician determines that
the patient has extremely dense or heterogeneously dense breast
tissue.

Section 2 of the bill amends section 3221 of the insurance law in
relation to coverage for a breast ultrasound in all instances where a
mammography screening is authorized and the physician determines that
the patient has extremely dense or heterogeneously dense breast
tissue.
              

Section 3 of the bill amends section 4303 of the insurance law in
relation to coverage for a breast ultrasound in all instances where a
mammography screening is authorized and the physician determines that
the patient has extremely dense or heterogeneously dense breast
tissue.

Section 4 of the bill is the effective date.

 JUSTIFICATION :

In 2012, New York passed legislation which mandates that women who
undergo a mammogram must be informed by their doctor if the test
indicates that they have dense breast tissue. Dense breast tissue can
make it difficult to detect breast cancer. In many cases, a further
evaluation, using digital mammography or ultrasounds, is necessary to
rule out cancer. Mandating that doctors inform women of these options
will doubtlessly save lives.

For years it has been standard practice for women with dense breast
tissue to receive both mammograms and ultrasounds during screenings as
many issues can be missed if only a mammogram is done. Some women,
however, are discovering that ultrasound procedures for detection of
breast cancer are not covered by their health insurance. While
notification is a good first step in improving the screening for
breast cancer, ensuring that breast ultrasounds are covered by health
insurance is similarly necessary.

Recent statistics from the Susan G. Komen Foundation estimated that in
2016 there would be 246,660 new cases of invasive breast cancer among
U.S. women, and 40,450 deaths due to breast cancer. According to the
American Cancer Society, a false-negative mammogram looks normal even
though breast cancer is present and screening mammograms do not find 1
in 5 breast cancers. Women with dense breasts have an increased number
of false-negative mammogram results. The relation between dense breast
tissue and cancer risk is immense. Women with dense breasts have been
shown to have a 4 to 6 fold increased risk of developing breast
cancer. Extremely dense breasts are not uncommon.  In the U.S., 10% of
women are classified as having extremely dense breasts.

Breasts consist of a mixture of fibrous and glandular tissue and fatty
tissue. Breasts are considered dense if they have a lot of fibrous and
glandular tissue but not much fat. On a mammogram, dense tissue
appears white. Both benign and cancerous lumps also appear white.
Therefore, mammograms are less accurate for women with dense breast
tissue. Breast tissue density is classified by radiologists using a
four level density scale. This scale ranges from almost entirely
fatty, to scattered areas of fibro glandular density, to
heterogeneously dense and to extremely dense. Only ten-percent of
women have almost entirely fatty breast. Therefore, 90% of women are
at risk of an inaccurate mammogram.

Studies have shown that for women with dense breast tissue, ultrasound
and magnetic resonance imaging (MRI) are more accurate tests for
detecting breast cancers than a mammogram. Ultrasound and MRI
technology can find breast cancers that cannot be seen on a mammogram.
An ambiguous mammogram will result in the recommendation of a further
evaluation using ultrasound and magnetic resonance imaging (MRI) by
one's doctor. The issue is that said further evaluation, which is
necessary to detect cancer, is often not covered by one's insurance.

 BILL HISTORY :

New bill.

 FISCAL IMPLICATIONS :

Undetermined.

 EFFECTIVE DATE :
This act shall take effect on the sixtieth day after it shall have
become a law and shall apply to all policies and contracts issued,
renewed, modified, altered or amended on or after such date.