Breast Cancer Screening Is a Conversation for Every Specialty
October is Breast Cancer Awareness Month, and the guidance behind that conversation has moved in the last two years. Patients now arrive with questions about density notices, earlier screening, and what their insurance will cover. They bring those questions to every kind of appointment, not only primary care and OB/GYN. Here is what has changed and what it means for your practice.
Screening now starts at 40
The U.S. Preventive Services Task Force recommends mammography every other year for women ages 40 to 74. It also names the benefits and harms of screening after 75 as an open question. The American College of Radiology goes further and calls for risk assessment by age 25, particularly for Black and Ashkenazi Jewish women, to identify who needs to start before 40. Maryland is already doing relatively well. 79.1% of women ages 40 to 74 reported a mammogram in the past two years, sixth among the states.
What you can do: A quick family history and screening-status check at a routine visit takes a minute in any specialty. Patients whose history suggests earlier screening can be referred for a formal risk assessment.
Dense breast notices are now national
Since September 2024, an FDA rule requires mammography reports to include a density category and standard patient language. About 40 percent of women have dense tissue. The notice tells patients that other imaging may help find cancers and to talk with their healthcare provider. That provider is often you. The Task Force is urgently calling for more research on whether and how supplemental screening helps these women, so there is no single right answer yet.
What you can do: Be ready for the question. A patient who has just read a density letter mostly wants to know whether to do anything differently, and an honest "it depends on your overall risk, let’s look at it together" is a good place to start.
Maryland covers supplemental imaging without cost sharing, with one catch
For plans issued or renewed on or after January 1, 2024, Maryland law bars copays, coinsurance, and deductibles for diagnostic and supplemental breast exams, including MRI and ultrasound. A supplemental exam is defined as one for a patient with a personal or family history or other factors that may increase breast cancer risk. High-deductible health plans may still apply the deductible.
What you can do: Record the risk factors behind an imaging order, since they are what bring an exam within the statute’s definition. Patients on high-deductible plans may want to check their cost before scheduling.
Screening access is not the whole story
Maryland screens well. In 2022, 83.2% of women ages 50 to 74 reported a mammogram in the past two years, and Black women met both the national and state screening targets. The state’s overall breast cancer death rate that year, 19.4 per 100,000, was statistically similar to the national rate of 18.7, so the gap that matters sits inside Maryland. From 2018 to 2022, the death rate among Black women was 25.8 per 100,000, compared with 18.5 for White women. Montgomery County’s overall rate of 16.9 sits below the state’s 20.0, but the gap holds here too: 21.3 for Black women and 18.1 for White women. Black and Hispanic women also had the largest shares of cases diagnosed at the regional or distant stage.
Incidence is moving the wrong way. Maryland’s rate rose 2.2% a year from 2018 to 2022, against 1.0% nationally, and 3.6% a year among Black women. Montgomery County’s 2022 incidence rate of 151.7 per 100,000 ran above the state’s 144.3.
What you can do: Close the loop on abnormal results, and keep local navigation and financial assistance information on hand at the point of care so patients can be connected quickly.
MCMS will keep following changes in screening guidance and Maryland coverage rules and will share updates with members as they come.
