On May 1, 2023, A new Pennsylvania bill was signed into law requiring insurance coverage for breast and ovarian cancer screenings for high-risk women.The law requires private state regulated insurers to provide people at higher risk of breast cancer to receive genetic counseling, ultrasounds, and MRIs among other treatments with no co-pays. The bill expands on a 2020 law that required state regulated insurers to partially cover MRIs and ultrasounds.

The bill is a great first step but is limited. Only women with extremely dense breast tissue, which is 10% of women, or women with heterogeneously dense breast tissue AND certain risk factor. This is a barrier for the 75-80% of all breast cancer cases that occur in women with no apparent risk factors.

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According to the bill, “all costs associated with one supplemental breast screening every year because the woman is believed to be at an increased risk of breast cancer due to:

1.     Personal history of atypical breast histologies;

2.     Personal history or family history of breast cancer;

3.     Genetic predisposition for breast cancer;

4.     Prior therapeutic thoracic radiation therapy;

5.     Heterogeneously dense breast tissue based on breast composition categories [of the Breast Imaging and Reporting Data System established by the American College of Radiology] with any one of the following risk factors:

i.       lifetime risk of breast cancer of greater than 20%, according to risk assessment tools based on family history;

ii.  personal history of BRCA1 or BRCA2 gene mutations;

iii. first-degree relative with a BRCA1 or BRCA2 gene mutation but not having had genetic testing herself;

iv.  prior therapeutic thoracic radiation therapy between 10 and 30 years of age; or

v.  personal history of Li-Fraumeni syndrome, Cowden syndrome or Bannayan-Riley-Ruvalcaba syndrome or a first-degree relative with one of these syndromes[.]; or

6.     Extremely dense breast tissue based on breast composition [categories of the Breast Imaging and Reporting Data System established by the American College of Radiology. Nothing in this subsection shall be construed to require an insurer to cover the surgical procedure known as mastectomy or to prevent the application of deductible, copayment or coinsurance provisions contained in the policy or plan.”