Arizona's Breast Cancer Screening Statute: A Testament to Physician Advocacy
By Christina Ferraro, MD, Radiologist at Valleywise Health
Digital - August 2023
Breast cancer impacts one in eight women, and of those who receive this devastating news, one in six will be under the age of 50.
Numbers can be cold, but these statistics are very real and human to me. As a breast imaging specialist, I interact with the people behind these numbers every day.
When it comes to breast cancer, the best offense is defense: preventative care.
Mammography, especially the latest advancements, has brought us a long way in the fight against breast cancer; since the widespread implementation of this technology, breast cancer mortality rates have fallen by nearly 40% in the United States.
However, as our technology propelled forward, state laws and statutes stagnated.
My patients’ access to breast cancer screening was being threatened by outdated laws and statutes that had not tracked with the latest screening technology and recommendations. These stale laws were, in turn, enabling insurance companies to deny screening coverage to women who needed it.
This, of course, perpetuates a cycle we are all too familiar with: poor access leading to late diagnoses, strains on our systems, clinician burnout, and, most importantly, poor health outcomes.
Updating state statutes to avoid these outcomes seemed not only relatively straightforward but like something everyone should get behind. So, I spoke up.
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Speak Up and Success Will Follow
Governor Katie Hobbs signed Senate Bill 1601 into law on May 9, 2023. Sponsored by Senator Janae Shamp and championed by the Arizona Medical Association, SB1601 brings breast cancer screening leagues ahead in Arizona.
To be precise, SB1601 adds tomosynthesis to the definition of mammography, thereby ensuring this innovative, widely adopted technology will be covered by insurance for all Arizonans. The accuracy and clarity of tomosynthesis’s 3-D imaging enable us to detect cancer early and decisively, thereby reducing callbacks. For our patients, this makes a world of difference as they are spared from weeks of anxious waiting to find out if the mammogram in question is a life completely altered.
The bill not only ushers in the new; it also replaces the old. State statute reflected outdated guidance on how often and when patients should start getting screened for breast cancer, recommendations that have long been updated by evidence-based findings. Under SB1601, however, insurers will be required to cover screening for both average-risk and high-risk women at ages and intervals suggested by the National Comprehensive Cancer Network’s latest recommendations, which are informed by experts from more than two dozen leading cancer centers in the United States.
Unanimity is Hard to Come By
Thanks to dedicated lobbying by physician advocacy groups, SB1601 received broad support from both sides of the aisle. Senator Shamp and the Arizona State Legislature saw the indisputable need to update the state’s breast cancer screening regulations, and I am thankful for their support.
It was not all smooth sailing, however. While the bill was backed by the healthcare community, collaboration was needed amongst insurance industry lobbyists to address some of their concerns about the bill’s proposed language.
Concerns were also raised about balancing the benefits of regular screening with the exposure to harm from overdiagnosis and false positives. These concerns are valid, which is why SB1601 does not tie a physician or patient to a specific time frame. It only holds insurance companies accountable to cover the costs of these screenings should the patient seek them because inconsistent screening coverage is as unjust as it is inefficient.
A Testament to Something Larger
The moral of my story? Physicians are often the only ones in tune with incongruences between state law and the best practices in medicine. We have the authority and, therefore, responsibility to instigate legislative change that betters patient care in our state.
I urge you to investigate the state laws and statutes that regulate and affect the work you do in your specialty. For many of us, I suspect there are misalignments, some of which may be relatively painless to adjust but infinitely impactful.
We all know how powerful physician advocacy is, but there are not nearly enough of us taking charge. I hope you will feel inspired to join the collective voice.
We are louder and stronger with you.
For Physicians across Arizona:
Do you know state laws or statutes that need to be addressed? Contact ArMA’s advocacy team by emailing Amanda Sheinson, Director of Government Relations, at asheinson@AZmed.org.
*Staff from the Arizona Medical Association contributed to this article.
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About the Author:
Christa Ferraro, MD, is a practicing breast radiologist at Valleywise Health in Phoenix, Arizona. She is also an assistant professor at the Creighton University School of Medicine and the University of Arizona College of Medicine-Phoenix. After graduating from Creighton University School of Medicine in Omaha, Nebraska, Dr. Ferraro completed her radiology residency at St. Joseph's Hospital in Phoenix. She then went on to complete a breast imaging fellowship at Mayo Clinic in Phoenix. Dr. Ferraro is passionate about serving the underserved and teaching radiology residents and medical students.