Advocacy to Access: Missouri’s Breast Screening Success

Amy K. Patel, MD, Chair of the ACR Radiology Advocacy Network and RADPAC, and Medical Director of the Liberty Hospital Breast Care Center in Kansas City, contributed this piece.

A new study published in the Journal of the American College of Radiology (JACR®) demonstrates the powerful role of radiology advocacy in improving access to and quality of patient care.

Effective 2019, Missouri law changed to require coverage for (1) annual screening mammography beginning at age 40 (previously biennial starting at age 50) and (2) Digital Breast Tomosynthesis (DBT), also known as 3D mammography, in addition to 2D mammography in accordance to ACR recommendations on screening mammography. Prior to this, the law had not been amended since introduced in 1992

Working with researchers from the Harvey L. Neiman Health Policy Institute, we evaluated the impact of Missouri legislation that expanded insurance coverage for screening mammography and discovered the following improvements:

• Women with Medicaid in Missouri were 45% more likely to undergo screening mammography than those with Medicare Advantage plans
• Medicaid patients in Missouri were 64% more likely to utilize DBT than similar populations in neighboring states without expanded screening coverage.
• Overall, Medicaid patients in Missouri were 9% more likely to get screened than their counterparts in neighboring states.
• Commercially insured women in Missouri saw a 24% increase in 3D mammography use following the legislation and were 5% more likely to be screened compared with Medicare Advantage patients.

This case study demonstrates that expanding access to breast cancer screening, particularly for underserved populations, leads to higher utilization of lifesaving imaging services. The expanded access to DBT supports the growing body of evidence showing its superior cancer detection capabilities and reduced recall rates compared to traditional 2D mammography.

Our findings also underscore the power of strategic, state-level advocacy in shaping legislation that closes care gaps and improves public health. Radiologists working in collaboration with key state elected officials as well as other state specific medical societies can ensure that critical legislation can be passed and enacted. Whether its collaborating with state elected officials to craft and edit legislation, testifying on behalf of the legislation, and or responding to state-specific calls-to-action, we can all play an integral role to ensure access to crucial care for our patients.

This is advocacy in action – where radiologists and policymakers come together to ensure patients can access high-quality imaging care. I hope that more states follow suit as our patients’ lives depend on it.