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Health Reform Law Includes Changes to Breast Cancer Coverage, Education

Health Reform Law Includes Changes to Breast Cancer Coverage, Education

September 28, 2010 — The federal health reform law (PL 111-148) includes a "little-noticed" provision that allocates $9 million annually for four years, starting in 2010, for programs to increase awareness about the risk of breast cancer in women ages 15 through 44, the Washington Post reports.

According to the American Cancer Society, although only about 10% of the roughly 250,000 breast cancer diagnoses each year occur in women younger than age 45, they are typically more aggressive cases. The five-year-survival rate for women diagnosed before age 40 is 83%, compared with 90% for other women. A woman's risk of being diagnosed with breast cancer at a young age can increase based on family history, ethnicity and genetics. Women's health experts say it is difficult to detect breast cancer in women younger than age 40, whose breast tissue is often too dense to be screened by a mammogram. Moreover, widespread screening with mammograms would not be cost-effective because of the low incidence of breast cancer in younger women.

Under the health reform provision, the Centers for Disease Control and Prevention is charged with creating education campaigns focusing on breast cancer in younger women and encouraging healthy habits that promote prevention and early detection. Groups that support young women with breast cancer are eligible for grants under the provision. The law also directs NIH to develop new screening and early-detection tests and prevention methods for younger populations (Andrews, Washington Post, 9/28).

Advocates, Doctors Lobby for Medicare Coverage for Breast Prostheses

In related news, breast cancer advocates and doctors are lobbying lawmakers to provide Medicare coverage of custom breast prostheses for mastectomy patients, arguing that the devices are the only custom prosthetic replacements not covered by the program, Politico reports.

Advocates say the devices provide women with a low-maintenance and less risky alternative to silicone implants, which require reconstructive surgery and possible replacement down the road. Richard Fine, chair of the American Society of Breast Surgeons' coding and reimbursement advisory group, said prostheses are "a medically appropriate alternative to surgical breast reconstruction." He added, "A custom breast prosthetic is medically necessary for some women, as they are not adequately served by off-the-shelf non-customized prosthetic products currently covered by Medicare."

CMS in 2009 declined a request to reconsider its policy on the devices. CMS spokesperson Don McLeod said the agency denied the request "because the level of evidence ... submitted was not scientifically adequate to justify reconsideration."

According to Politico, some advocates are pushing to include breast prostheses in a provision in the health reform law requiring health insurers to cover a package of "essential benefits." The law provides a broad outline of what the package should include, and regulators have not indicated what kinds of medical devices, if any, will be included.

Other advocates are lobbying lawmakers to pass the Custom Fabricated Breast Prosthesis Act of 2010 (S 3255), which would provide "coverage for custom fabricated breast prostheses following a mastectomy." The bill was introduced over the summer by Sens. Blanche Lincoln (D-Ark.) and Olympia Snowe (R-Maine), who wrote in a letter to other senators that the bill targets a "significant inequity currently faced by women post-mastectomy ... while providing a lower-cost alternative to reconstructive surgery." The bill awaits scoring by the Congressional Budget Office. It is unlikely that the measure will be taken up in the Senate before the election recess, Politico reports (Kliff, Politico, 9/28).

Multimedia Examines Bishops' Anti-Contraception Efforts

NPR's "Tell Me More" on Monday included a discussion with U.S. Conference of Catholic Bishops general counsel Anthony Picarello about the Catholic Church's objections to including coverage of contraception in a provision of health reform law that requires health plans to cover preventive care without cost sharing by patients (Martin, "Tell Me More," NPR, 9/27).