R.I. to keep 40+ mammogram policy

Despite a high-profile, but very controversial new federal recommendation to start mammograms at age 50 and screen women only every other year, Rhode Island will continue to require insurers to pay for annual mammograms starting at age 40.
Health Insurance Commissioner Christopher F. Koller’s office announced the decision on Thursday, as a national firestorm over the U.S. Preventive Services Task Force report continued to brew. Many doctors and advocates have objected to changing the guidelines, many insurers and government agencies have said they don’t plan to change their policies.
The task force’s reasoning is that the benefits of mammograms are too modest – they reduce the breast-cancer death rate by about 15 percent – to outweigh the risk from radiation exposure and especially from follow-ups, such as biopsies, when a small lump is found.
The risk-benefit ratio is particularly low for women in their 40s, the report found, with one death prevented for every 1,904 women age 40 to 49 who are screened for 10 years,versus one for every 1,339 women age 50 to 59, and one for every 377 women age 60 to 69.
Still, the American Cancer Society, using the same data as well as other materials, has concluded that annual mammograms starting at age 40 are appropriate. That is the advice that Koller’s office cited in announcing that local coverage requirements wouldn’t change.
Rhode Island health insurers are required to pay for one mammogram per year for women 40 and older, and two per year when recommended by a physician for women who have been treated for breast cancer or who are at high risk of developing breast cancer.
The USPSTF specifically excluded the latter group from its recommendation to reduce the use of mammography, since those women are not only at greater risk for cancer, but also specifically for fast-growing cancers.
In a news release, John A. Cogan, Koller’s executive assistant for program and policy review, noted that while the American Cancer Society “acknowledged that mammography has limitations (e.g., some women who are screened will have false alarms, some cancers will be missed, some women will undergo unnecessary treatment),” the group “concluded that the limitations do not change the fact that breast cancer screening using mammography starting at age 40 saves lives.”
Rhode Island’s coverage requirement for annual screening mammograms applies only to fully insured group health plans and individual health insurance policies. Employers who offer group health insurance benefits on a self-funded basis are exempt from Rhode Island coverage requirements by federal law.
Koller’s office encouraged employees and dependents who have questions about how the USPSTF recommendations would affect their coverage to contact their company’s personnel office or human resources department.
The UPSTF recommendations can be read online.