WHY IT MATTERS, WHAT TO DO
Forty percent of women age 40 and over have dense breast tissue; this is a normal condition. However, density can obscure tumors on a mammogram since both tissue and tumors appear as white images. Dr. Weinstock has been a long-time proponent of using supplemental screening such as Breast Ultrasound and Molecular Imaging /Breast Specific Gamma Imaging (BSGI) for women with dense breasts, as well as for women at moderate-high risk for breast cancer with other risk factors. These modalities show the breast tissue differently.
WDI now uses Low-Dose 3D Mammography (Digital Breast Tomosynthesis), with added C-View 2D imaging software for all mammography patients. When added to standard mammographic views, Tomosynthesis has been shown to find more cancers on dense breast tissue. Tomosynthesis is an improved mammographic process that reveals the tissue one layer at a time for more thorough analysis. But tissue and tumors are also white on Tomosynthesis so additional imaging such as breast ultrasound may be required even with Tomosynthesis.
Ultrasound is an excellent, non-invasive imaging modality for women with dense breasts or other risk factors. On Ultrasound, abnormalities are seen as gray against the sonographically white tissue. Our Molecular Imaging system, Breast Specific Gamma Imaging (BSGI), is also excellent for finding cancer in dense breasts. BSGI shows the metabolic activity of cells, not the anatomic structure of tissue. We see how cells act, not how they look. Abnormal cells appear as dark spots on the images. Although Women’s Digital Imaging does not conduct MRI exams, Dr. Weinstock refers patients to MRI centers with proven expertise in analyzing results when she thinks that would be the best supplemental imaging for them.
Why we need Breast Density Notification Legislation
When Dr. Weinstock began Women’s Digital Imaging in 2004, she structured her practice so she could give women immediate results from their mammography exams – including their breast density – and perform Ultrasound exams when necessary. That was not standard procedure. Radiologists were required to inform referring physicians about density results on a mammogram but no one was required to inform patients. Screening Ultrasound was not an option in most practices.
In 2009, Connecticut became the first state to require radiologists to inform mammography patients when they had dense breasts, and require insurers to cover supplemental Ultrasound screening. The legislation was largely due to the advocacy of Nancy Cappello, who formed the organization Are You Dense after she was diagnosed with cancer that was missed on her mammogram but later found on Ultrasound. Today, many states have breast density notification laws and a federal law has been introduced.
New Jersey’s Breast Density Notification Law
Dr. Weinstock initiated notification legislation in new jersey so all women in her state, not just her patients, would know that mammograms were less sensitive in dense breasts and that additional imaging might be needed. Although Dr. Weinstock asked that the legislation require mammography providers to include density results to patients, as she does, the New Jersey law, passed in 2014, only requires radiologists to include a paragraph telling women they may have dense breasts. Women are advised to discuss results of their reports with their referring physicians. Dr. Weinstock must include this paragraph in her reports to patients, even though she has been telling her patients their density results since she began practicing in 1995. The law also requires health insurance providers to cover supplemental imaging in network, for women with extremely dense breast tissue.
While this legislation is less specific than in other states, and Dr. Weinstock strongly opposed the vague language, the law has brought the issue into the open and more conversations are taking place between women and their physicians about screening in dense tissue. Dr. Weinstock is proud that she has helped women across New Jersey learn about their breast density and get insurance coverage within network for supplemental imaging.
Are you a New Jersey woman who has been denied coverage for supplemental imaging by your health insurance provider?
The organization Dense-New Jersey suggests taking the following steps:
Step 1: File an appeal with your insurance provider and be prepared to quote the law as follows:
Sections C.17B:26-2.1e and C.17B:27-46 of the NJ law (PL 2013 Chapter 196) state that individual and group health insurance policies are required to cover expenses incurred for an ultrasound evaluation, a magnetic resonance imaging scan, a three-dimensional mammography, or other additional testing of an entire breast or breasts for women with extremely dense breast tissue, if the mammogram is abnormal, or if the patient has additional risk factors for breast cancer including but not limited to family history of breast cancer, positive genetic testing, extremely dense breast tissue...or other indications as determined by the patient's health care provider.
Step 2: Contact the NJ Division of Banking and Insurance to file a complaint by phone or online Call the consumer hotline and request assistance: 1-800-446-7467.
They will answer your questions and guide you through the process. This agency has the power and the resources to investigate whether your insurance provider can legally deny your request for coverage.
Or complete the online complaint form which is available on the State of New Jersey website: http://www.state.nj.us/dobi/consumer.htm
There is a New Jersey advocate who should know about your denial. DenseNJ is compiling statistics in order to continue working with legislators and insurance companies to resolve this issue.
For more information on breast density, visit these websites: