Adoptees Lacking Medical History May Get Coverage for Early Mammograms

Andrew Kitchenman | October 6, 2014 | Health Care
Opponents of bill worry about state taking stand on when preventive benefits of screenings outweigh radiation risk

Adoptees who don’t know their biological family’s medical history have always had to live with the fear of the unknown – even if they have been able to undergo DNA testing, they often feel they must be vigilant about early detection of hereditary illnesses.

Now, following last year’s enactment of a law that gave adoptees greater access to their biological medical histories, the state Legislature is considering a bill that would mandate insurance coverage for mammograms for women younger than 40 who were adopted.

Currently, insurers in the state approve mammograms for women younger than 40 if their doctors recommend them, so it appears unlikely that the bill would have an immediate effect.

However, insurance industry representatives are raising concerns about the broader message the bill would send to young women and doctors, saying that if the Legislature enacts a mandate, it could lead to mammograms that would expose women to unnecessary risks, procedures and worry over inaccurate screening results.

The debate is occurring in the context of broader discussions about the appropriate timing of mammograms. While the American College of Obstetricians and Gynecologists recommends mammograms each year starting at age 40, the U.S. Preventive Services Task Force recommends mammograms every other year starting at age 50. New Jersey state law already mandates coverage for annual mammograms at age 40.

Assemblywoman Pamela R. Lampitt (D-Burlington and Camden) noted that the cost of mammograms has gone down over time, while there could be a benefit for women of establishing a “baseline” reading through a mammogram at an age younger than 40.

Mammograms are used by women between the ages of 25 and 40 if they have a family history of breast cancer, or if other tests have determined that they are at a higher risk for the disease.

Wardell Sanders, president of the New Jersey Association of Health Plans, said that the insurance industry isn’t concerned about the costs that could result from the bill. But insurers are concerned about the message the bill could send, he said.

Unless doctors or women have specific concerns based on symptoms or tests, clinical guidelines don’t currently recommend mammograms for younger women.

Industry concern is “really about a statement from the Legislature that this is a good idea, and the clinical guidelines aren’t really there,” Sanders said.

His concerns are similar to those addressed in a report by a state commission that is responsible for reviewing proposed changes to mandated health benefits.

In a 2012 report in response to an earlier version of the bill, the Mandated Health Benefits Advisory Commission noted that the risk for breast cancer increases as women get older. While certain genetic mutations, including BRCA1 and BRCA2, greatly increase the risk of breast cancer for some young women, they are rare — affecting between 1 in 300 to 1 in 800 women. If these genes are found through genetic tests, then annual mammograms are recommended starting at age 25 or at the earliest age of onset for breast cancer in their families.

But the advantages of early testing must be weighed against potential problems. The negative aspects of mammograms for women younger than 40 include “cost, radiation exposure, the anxiety and cost of false positive results, and ineffectiveness or failure to detect tumors due to breast tissue density or to detect tumors in a timely manner due to rapid growth in the interval between screenings,” according to the report.

Young women have denser breasts, which makes mammograms less accurate for them. The report also notes that the radiation from mammograms can cause breast cancer..

In addition, the commission noted that a lack of knowledge about family health histories isn’t limited to adoptees,, Many people – including the children of adoptees, some people whose parents are divorced, and people whose parents or grandparents died without passing on family health histories—may also have limited knowledge of their family’s medical history.

Sanders said he’s concerned that the Legislature, by mandating coverage for something that would normally be determined by clinical guidelines written by doctors, will end up having to revise the law as the medical guidelines evolve.

“My concern is that it puts the state’s imprimatur on a recommendation around a screening,” Sanders said. “It’s not saying you have to get it, but it suggests that it’s a good idea.”

Assemblywoman BettyLou DeCroce (R-Essex, Morris and Passaic) said she would prefer that the mandate be in place and so women can decide, in consultation with their doctors, whether the risks from radiation outweigh the benefits of a mammogram.

“Let the individual make the decision,” she said.

The Assembly Financial Institutions and Insurance Committee released the bill with a unanimous vote on Oct. 2. A Senate version hasn’t been introduced this session.