Spokane Journal of Business

Breast exam volume to increase due to new law

Eliminating out-of-pocket expenses said to reduce some financial barriers to early cancer detection

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-Inland Imaging LLC
Inland Imaging LLC’s Nicole Stroupe, right, shows how to make images with a 3D Tomographic Scanner, which is used both for screening and diagnostic mammograms.

An increase in demand for breast imaging examinations is expected in the new year due to a new Washington state law that will eliminate out-of-pocket expenses for patients who require medically necessary exams.

Breast screening and imaging is a consistent and effective way to detect cancer in a patient, says Dr. Mariam Shehata, a diagnostic radiologist and breast imaging specialist at the Seattle office of Spokane-based Inland Imaging LLC.

“This bill that was passed is huge for breast imaging and for patients. It’s a major win for increasing access,” Shehata says.

Effective Jan. 1, the law eliminates deductibles, coinsurance, and copayments for breast imaging exams.

The World Health Organization’s Guide to Cancer Early Diagnosis states that less than half of breast cancers are screen-diagnosed, and a large proportion of low- and middle-income women with breast cancer were diagnosed at advanced stages of the disease.

Early detection increases the chance of survival for patients because if the disease progresses, the size of the cancer grows and can spread, Shehata says.

“We have to cast a wide net to make sure we’re detecting things early, before they get bigger,” says Shehata.

Breast imaging exam costs currently vary depending on the type of test performed and can cost patients between $230 for diagnostic mammograms and over $1,000 for an MRI, according to a study commissioned by Dallas-based breast cancer organization, Susan G. Komen.

In Washington state, insurance companies will be required to cover the costs of follow-up breast imaging required after an abnormal screening exam; imaging for examination of a detected breast lump, pain, or other symptoms; and ultrasound and MRI exams for individuals at high risk for breast cancer.

Screening mammograms are already free under the Affordable Care Act as a preventive exam, says Dr. Amy Henkel, a breast imaging specialist at Inland Imaging in Spokane, in a press release from the company.

“The new law makes it easier for patients to get follow-up coverage, and ultimately we believe it will save more lives,” Henkel says.

Shehata says high exam costs have been a longtime barrier for some patients to access needed follow-up care.

“This has been a huge burden to a lot of patients getting their diagnostic mammograms,” Shehata says. “It can be very costly to get this additional imaging after a screening mammogram.”

Of those who receive annual screenings nationwide, an estimated 16% require further diagnostic imaging—a figure that aligns with callback exams at Inland Imaging, says Shehata.

Additional tests often are required after a patient’s first breast exam due to a common condition known as breast density, where dense breast tissue can hinder detection because both the tissue and the cancer appear as white spaces on image results, Shehata explains.

“Most of our callbacks turn out to be benign,” she adds.

High-risk patients are expected to especially benefit from the elimination of out-of-pocket expenses, Shehata says.

“We think there’s benefit of additional screening on top of screening mammograms every year … for women who are at higher risk of breast cancer,” says Shehata.

The risk of a breast cancer diagnosis increases for people 40 and older and for those who are overweight, according to Komen’s website. Additionally, alcohol consumption, menopausal hormone therapy, and smoking are linked to an increased risk.

Shehata adds that women who carry a genetic mutation known as BRCA1 also are at high risk of breast cancer.

“This mutation predisposes you to have more breast cancer, so we recommend screening by MRI in these patients, or if they have family history in a first-degree relative,” she says.

The new legislation is expected to improve access to health care for some people within marginalized groups, she says.

The Komen-commissioned study states that Black and Hispanic breast cancer patients tend to get diagnosed later than other demographic groups, and the new law in Washington state is expected to increase early detection of breast cancer for these groups.

Statistics from the American Cancer Society show that Black women have the highest death rate from breast cancer. Overall, it’s the second leading type of cancer in women across all demographics and kills about 1 in 39 women, or 2.5%.

Senate Bill 5393 was introduced by Sen. Lynda Wilson and Rep. Amy Walen to remove the financial barriers to imaging for breast cancer diagnosis.

Demand for breast imaging exams has mostly recovered to pre-pandemic levels at Inland Imaging, Shehata says. The imaging company experienced a drop in the number of breast exams during 2020 that gave way to an uptick of breast cancer diagnosis, but Shehata says she’s hopeful that by eliminating imaging exam fees, access to care will greatly improve early breast cancer detection.

“I love the ability to educate patients about breast cancer, about risk of breast cancer, about things that they can do to make sure that they’re doing their self-exams and reduce that risk or detect cancer early,” Shehata says. “That’s one of the main things that drew me to the field of radiology.”

Inland Imaging is preparing for the expected influx of exams in 2024 by ramping up hiring efforts. The company has already begun seeking new radiologists and technologists in anticipation of increased demand.

Inland Imaging operates seven Spokane-area locations, as well as at two clinics in Seattle, and one in the Tri-Cities, Washington, area. The Spokane-based company has 813 full-time employees in Spokane County, up from 535 employees here in November 2022.

Shehata says she’s hopeful that more women will now have a talk with their primary care doctor about their risk factors and if they are high-risk, they will schedule a screening.

She notes that one in eight women will be diagnosed with breast cancer.

“So it touches almost every life,” she says. “Everybody knows somebody who has been diagnosed with breast cancer.”

Erica Bullock
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Reporter Erica Bullock has worked at the Journal since 2019 and covers real estate and construction. She is a craft beer enthusiast, who loves to garden and go camping with friends.

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