Wisconsin bill would remove out-of-pocket costs for supplemental breast cancer screenings

Patients at a higher risk of breast cancer could see the cost of preventative screenings eliminated under a new bill introduced to the Wisconsin Legislature.

The bill, introduced last Tuesday, would require health insurance companies to cover additional breast cancer screenings and diagnostic exams like ultrasounds and MRIs.

Current state law requires health insurance agencies to provide one mammogram per year to women over 50, and two mammograms per year for those ages 45 to 49 who meet certain risk factors. Tests currently provided are free of cost.

But the bill aims to close a loophole for some 40 percent of women with dense breast tissue — something that makes mammograms less effective.

Bill co-author state Sen. Rachael Cabral-Guevara, R-Appleton, said patients can rack up hundreds or thousands of dollars in medical bills for additional, lifesaving testing — or they avoid the extra tests all together.

“We’re hoping that this legislation today will make screening for women with dense breasts more affordable,” Cabral-Guevara said at a press conference broadcast by WisconsinEye.

Gail Zeamer was diagnosed with Stage 3 breast cancer in 2016, one week after a normal mammogram. She discovered a lump in her breast and was told it was likely a cyst. It never showed up on her annual mammogram screenings.

She later learned she had dense breast tissue, which could make a tumor difficult to see on a mammogram. When doctors discovered an enlarged lymph node under her left arm, they ordered an ultrasound. It revealed a mass that had gone undetected for years.

After extensive treatment including a double-mastectomy, chemotherapy and radiation, her cancer entered remission. But in 2021, it returned, having spread to her uterus, bones and brain.

Zeamer said she hopes this bill will give other people a better chance at early detection. She said for her and so many others, it’s a “matter of life and death.”

“We need a cure for breast cancer. But in the meantime, we need to find it early so that women have a better chance at treating the disease and of long-term survival,” Zeamer said at the press conference. “Passage of this bill would allow women all across Wisconsin to have this life-saving access to care.”

In 2023 alone, an estimated 5,400 people will be diagnosed with breast cancer in Wisconsin, according to breast cancer organization Susan G. Komen.