Changes in Missouri state law that expanded coverage of screening mammography exams in 2019 led to significantly enhanced utilization of mammography for women on Medicaid and those who had commercial health insurance.
In a retrospective study, recently published in the Journal of the American College of Radiology, researchers examined the impact of Missouri state law changes on screening mammography coverage (expanding coverage to annual exams and lowering the age threshold from 50 to 40 years of age) upon screening mammography utilization among women with Medicaid, commercial insurance and Medicare Advantage (MA) plans that are federally regulated. The cohort involved 1,008,881 women, according to the study.
In comparison to women on MA plans, the study authors found that women with commercial health insurance in Missouri were five percent more likely to have screening mammography exams due to the expanded breast cancer screening coverage in Missouri. Women in Missouri with Medicaid were 45 percent more likely to have screening mammography exams in contrast to women with MA plans, according to the researchers.
Among Missouri women, the researchers also noted significant increases in the likelihood of utilizing digital breast tomosynthesis (DBT) in contrast to women from bordering states. There was a 64 percent higher likelihood of having DBT for Missouri women with Medicaid and a 24 percent higher likelihood for women with commercial health care insurance in comparison to similar populations in bordering states that did not have the expanded breast cancer screening coverage, according to the study authors.
“ … The results show that the expansion of mammography screening coverage in Missouri law was strongly associated with increased screening rates for Medicaid patients, and for those with screening, a greater use of DBT for both Medicaid and commercial patients,” noted lead study author Amy K. Patel, M.D., the medical director of the Liberty Hospital Breast Care Center in Kansas City, and colleagues.
Three Key Takeaways
- Expanded state coverage increased screening. Changes to Missouri’s state law in 2019, which included expanding coverage for annual mammograms and lowering the age threshold from 50 to 40, led to significantly higher screening mammography rates, especially among women with Medicaid (45 percent increase) and commercial insurance (5 percent increase) compared to those with Medicare Advantage (MA) plans.
- Digital breast tomosynthesis (DBT) utilization rose sharply. The law was also associated with greater use of DBT, with Medicaid-insured women in Missouri 64 percent more likely and commercially insured women 24 percent more likely to undergo DBT compared to similar populations in neighboring states without such expanded coverage.
- Policy implications may extend beyond Missouri. The findings suggest that similar legislative changes in other states — or at the federal level —could significantly boost breast cancer screening and advanced imaging utilization, especially among underserved populations.
Given the increased likelihoods of screening mammography and DBT utilization related to the expanded breast cancer screening coverage in Missouri, the study authors called for future research examining this impact in 25 other states that have enacted similar expanded coverage.
“Accordingly, we expect that the passage of similar legislation in other states or via federal legislation would have similar impact to those we observed for Missouri,” posited Patel and colleagues.
(Editor’s note: For related content, see “Mammography Study Reveals Over Sixfold Higher Risk of Advanced Cancer Presentation with Symptom-Detected Cancers,” “Emerging AI Mammography Model May Enhance Clarity for Initial BI-RADS 3 and 4 Classifications” and “Can Radiomic Parenchymal Phenotypes Derived from Mammography Enhance Risk Stratification for Breast Cancer?”)
In regard to study limitations, the authors acknowledged that supply constraints can affect the use of screening mammography and DBT. Missing race and ethnicity data in 53.9 percent of the cohort thwarted analyses specific to race and ethnicity, according to the researchers.
