AdvaMed Calls on Medicare to Cover Supplemental Imaging as Part of Breast Cancer Screening

In letter to CMS: Gap in Coverage is an "Unacceptable Barrier" to Millions of Women with "Dense Breast Tissue"

Washington, D.C. - AdvaMed, the Medtech Association, called on Medicare in a letter sent Friday to cover supplemental imaging for women with heterogeneously and extremely dense breast tissue, noting the life-saving value of the additional screening and the pressing health equity needs Medicare coverage of these critical services would address.  

"While supplemental imaging increases the effectiveness of detecting breast cancer in women with dense breast tissue, cost, availability, and insurance coverage limit its use," Scott Whitaker, AdvaMed President and CEO, wrote to leaders at the Centers for Medicare & Medicaid Services. "As a result, beneficiaries may either forgo supplemental imaging or are surprised by bills, especially when those exams were recommended and ordered by their healthcare provider."  

"Only 23% of Medicare beneficiaries are enrolled in a Medigap plan, leaving most without coverage for these cost-sharing gaps. This is an unacceptable barrier, especially given recently enacted FDA requirements that women be notified about their breast density and the inherent risk of dense breast tissue. AdvaMed urges CMS to cover imaging, in addition to a mammogram, for women with heterogeneously or extremely dense breast tissue," the letter continues. 

Effective in September, the FDA requires mammographers to notify women when they have dense breast tissue. While traditional mammography is an important screening tool, it is less sensitive in women with dense breasts and more likely to miss cancer, especially at the critical early stages, than other imaging technologies such as ultrasounds, magnetic resonance imaging (MRI), or contrast-enhanced mammography. 

Breast cancer is the most diagnosed cancer among U.S. women. Seven out of ten cases of breast cancer are diagnosed in women aged 55 years and older. Additionally, nearly half of all women 40 and older who get mammograms are found to have dense breast tissue. 

Black women are often diagnosed with breast cancer at more advanced stages when treatment options are more limited, costly, and result in death rates 40 percent higher than white women. Black women may face worse disease progression in part because of their increased likelihood of having dense breast tissue.   

Recognizing these needs, a number of state legislatures have enacted legislation requiring insurers to cover supplemental breast cancer screening for women who need it. An additional number of states are considering such legislation. In Congress, a number of pending bills would require such coverage. Patient advocates have led this advocacy work, with strong support from AdvaMed and its member companies that innovate breast cancer screening technologies. AdvaMed thanked Senators Amy Klobuchar and Dr. Roger Marshall for their continued efforts to expand access to breast cancer screening by introducing the bipartisan Find it Early Act. 

Medicare coverage of supplemental imaging would close coverage gaps for women and save lives in states without laws covering additional imaging. Medicare coverage also would set an important precedent for state Medicaid programs and private health insurance plans, which often follow Medicare, as the nation's largest insurance provider, in coverage decisions. 

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