A group of lawmakers on both sides of the political aisle have pushed forward legislation for congressional review that would cover digital breast tomosynthesis (DBT) under TRICARE coverage for members of the U.S. military.

Leading the effort is Senator Martha McSally (R-Az.), who along with Senator Jeanne Shaheen (D-NH.), Congresswoman Chrissy Houlahan (D-PA.) and Congresswoman Elise Stefanik (R.-NY), introduced the Better and Robust Screening Today Act this month in Congress.

"Service members and their families sacrifice so much and deserve the best health care and technology available,” said McSally, who is a U.S. Air Force combat veteran, in a statement. “There is simply no good reason to deny DBT screening, the latest breast cancer imaging technology, to TRICARE patients. As a female veteran myself, I am proud to lead this bicameral, bipartisan bill to expand TRICARE coverage for our heroes and their families."
About half of women who undergo standard mammograms have dense breast tissue, a condition which raises the chance for missed diagnoses due to the dense tissue masking tumors and hindering the ability of mammography systems to detect their presence. Having dense breast tissue raises a woman’s risk of developing breast cancer in her lifetime, and also creates a twofold increased risk of developing secondary cancer in the contralateral breast.

DBT, in contrast, carries a higher chance of identifying lesions within dense tissue. For years, however, many practitioners were wary of notifying patients of their breast density status and the risks associated with dense breast tissue in mammography. Congress addressed the issue this year when it passed a law mandating that providers notify patients of their breast tissue status so they can consult physicians about further screening. Prior to this, a number of states enacted similar laws for their respective residents.

While it covers DBT for diagnostic follow-up screenings, TRICARE does not do so for initial scans, and is the only national payor not to. Access to DBT can enable abnormalities — that may be missed by traditional mammograms in patients with dense tissue — to be detected earlier, potentially making secondary scans unnecessary.

“MITA applauds the introduction of the Better and Robust Screening Today Act, which will ensure our nation’s servicewomen have the coverage necessary to receive the right breast cancer diagnostic technology for them,” said Patrick Hope, executive director of the Medical Imaging & Technology Alliance (MITA), in a statement. “We will continue to support these ongoing efforts and commend lawmakers for fighting to ensure that former and current members of the U.S. military whose mammograms show they have dense breast tissue have access to the same advanced screening options as those with private insurance, Medicare, and Medicaid.”

Houlahan previously encouraged the Military Health System earlier this year to include DBT in TRICARE coverage in a separate effort.

Dr. Stamatia Destounis, a clinical professor and managing partner at the Elizabeth Wende Breast Care center, says further expanding access to DBT for all patients depends on providers raising awareness about the benefits it brings to patients.

"It is important for users of DBT to continue to collect their medical outcomes and publish their findings, to continue to establish the benefits of utilizing DBT for screening and the diagnostic population," she said. "These findings can be communicated to the medical community in their areas via peer review journal publications and patient publications to demonstrate the importance of DBT use and availability in their region. Providers can continue to submit claims for DBT even if not a covered service to establish the demand for use of the technology for screening in clinical practice."

CT Homepage