New state legislation passed earlier this year has eliminated out-of-pocket costs for diagnostic mammograms in an effort to improve access and allow more timely diagnosis and treatment of breast cancer. 

House Bill 170 went into effect Sept. 1. The Susan G. Komen Foundation authored the bill, which State Rep. Diego Bernal (D-San Antonio) introduced in the last three legislative sessions until it finally got enough support to pass and be signed into law on June 15. 

Once a screening mammogram has found signs or symptoms of breast disease, a diagnostic mammogram is recommended to help determine if the symptoms – including a lump, a thickening of skin, or breast pain – indicate cancer. While traditional screening mammography is typically covered at no out-of-pocket cost to patients, diagnostic mammography had not been.

“Diagnostic imaging can cost anywhere from $300 to $800, and for some women that can mean choosing between feeding their families and getting the life-saving information they need to begin treatment for breast cancer,” said Elyse Bernal, executive director of Susan G. Komen San Antonio. “Some survivors and patients have said they have to take out payday loans to get it covered, and others just sit and wait to see if symptoms get worse because they can’t afford the cost.”

Bernal called the bill’s passage a “win for a lot of women in our community, including women of color, those with a history of cancer in their families, and cancer survivors.”

“We need to continue to work on opening access to health care for vulnerable populations,” he said. “It not only has the potential to improve and save lives, but early detection for breast cancer is far less expensive than treating stage 3 or 4 cancer.”

A recent Susan G. Komen-commissioned study found that out-of-pocket costs for diagnostic mammograms for women could be more than $1,000 for women without insurance and up to $836 for women with insurance. 

The study included interviews with women who stated they avoided recommended diagnostic mammograms because they were waiting to qualify for Medicare, were saving up money, or simply felt they would not be able to afford the mammogram along with the costs of everyday living. The study also documented that the lack of coverage for diagnostic mammograms added additional stress to women’s lives.

For Elaine Ochoa, finding out her insurance wouldn’t cover a diagnostic mammogram when one was recommended in 2015 was “one of the scariest moments” of her life. 

“I didn’t know what I was going to do, because I knew I couldn’t afford it,” she said. “They were telling me that it would be around $600, but even that I didn’t trust. I knew it would probably be more and I couldn’t afford that.”

Ochoa ended up skipping the diagnostic mammogram and did not develop breast cancer. 

“I was lucky,” she said. “But I didn’t have the money. So I just prayed and waited. And when nothing got worse I just told myself I could wait” until my next regular screening, Ochoa said.

Bernal said that eliminating the out-of-pocket cost for diagnostic mammograms will help ease the emotional and financial burden placed on women, and also free up funding that Komen San Antonio used to help women cover those costs. 

“We are now able to allocate more funding toward treatment, which will have a huge impact on the breast cancer community,” Bernal said. “Now we have to do the work to get the word out to women that these diagnostic screenings are available to them through their insurance at no [out-of-pocket] cost.”

Of the estimated 1,144 Bexar County women diagnosed with breast cancer in 2018, as many as 213 will die from the disease, according to the Department of State Health Services. 

On Saturday, Komen San Antonio will celebrate the passage of HB 170 at the Tower of the Americas, which will be illuminated with bright pink lights at 7 p.m. The fundraising event also kicks off Breast Cancer Awareness Month, during which Komen San Antonio ramps up local educational efforts to get the word out about its efforts to help women afford breast cancer treatment. 

“Our goal is to reduce the number of breast cancer deaths by 50 percent in the next [six years],” Bernal said. “Funding freed up thanks to the passage of HB 170 will help us do that.”

Proceeds from the More Than Pink Tower Lighting funds Komen San Antonio’s outreach initiatives and grants. For more information about tickets and pricing, click here.

Roseanna Garza

Roseanna Garza

Roseanna Garza reports on health and bioscience for the San Antonio Report.