Insurance and Real Estate Committee

JOINT FAVORABLE REPORT

SPONSORS OF BILL:

Insurance and Real Estate Committee

REASONS FOR BILL:

This bill would request coverage for tomosynthesis in addition to a mammogram and allow women the option to choose either process for breast cancer screening in consultation with their treating physician.

Substitute Language:

The language would change in lines 10, 12,35,37, after “tomosynthesis” insert “at the option of the woman covered under the policy”.

RESPONSE FROM ADMINISTRATION/AGENCY:

Rep. Themis Klarides, House Republican Leader, 114^th District testified in support of this bill. It will enhance the opportunity for the early detection of breast cancer by adding tomosynthesis to the available breast cancer screening methods that must be covered by insurance. This bill does not require medical providers use tomosynthesis to screen for breast cancer, but it affords providers with the option to use tomosynthesis screening with the knowledge that such screening will be covered by a patient's insurance. Tomosynthesis is an FDA approved method of mammography that produces three dimensional images of the breast. These images can provide clearer and more accurate views of the breast allowing doctors to more effectively pinpoint the location, size and shape of any abnormalities. Tomosynthesis is a powerful tool in the fight against breast cancer.

State of Connecticut, Department of Insurance cautions the committee that any new mandated benefits enacted in 2016 can have a fiscal impact to the State of Connecticut. Per guidance from center for Consumer Information and Insurance Oversight (CCIIO), the primary federal office within Health and Human Services overseeing implementation of the Affordable Care Act, a mandate for which the state would need to defray the cost is any legislation that requires specific care, treatment or services beyond those require prior to December 31, 2011.

Permanent Commission on the State of Women supports this legislation. Currently about 1 in 8 women in the United states will develop invasive breast cancer over her lifetime. Regular screenings for breast cancer increases the likelihood of early detection, when treatment is easier. A report in 2014 compared the utilization of tomosynthesis in combination with traditional mammography versus solely traditional mammography showed a decrease in false positives and an increase in the detection of early cancers when both screenings were used together. PCSW urges the support of this legislation, which will make this potentially life-saving cancer screening more accessible to women in Connecticut.

Connecticut State Medical Society stated that tomosynthesis differs rom a mammogram in that it creats a 3-demensional picture of the breast whereas a mammogram usually takes two x-rays of each breast: from top to bottom and side to side. MAmmograms are limited by their lack of dimension. Tomosynthesis takes multiple pictures from multiple angles to create a high resolution picture of the entire breast with often less obstruction. The quality of picture provided by tomosynthesis significantly lowers the recall rate for further studies. This prevents the need for additional expensive services, but eliminates prolonged worrying over potential outcome.

Nancy Cappello, Founder and Director of Are you Dense, Inc and Are you Dense Advocacy, Inc. spoke stating like a 2D mammogram, tomosynthesis is an xray. Breast cancers appear as whiter areas on xrays and can be difficult to detect against the white dense breast tissue because of the lack of contrast. Tomosynthesis has shown a direct benefit to improving overall invasive cancer detection rates and diminishing call-backs. Many facilities in CT are using 3D to replace 2D as the first time of defense against breast cancer. However, for women with dense breast tissue, the adjunct screening may still be necessary.

Michael Crain, MD, Chairman, Radiology Department, Middlesex Hospital testimony stated at Middlesex, they have watched the development of Breast Tomosynthesis for years, and we only began our tomosynthesis service in 2015, when the medical literature showed a dramatic, clinically significant improvement over traditional mammography. The first major large scale study was published in the Journal of the American Medical Association in June 2014. In 2015, we began replacing our current mammography unit with tomosynthesis units at a cost of $400,000 for each unit. Many studies have been published, clearly showing that tomosynthesis mammography finds 40$ more invasive cancers. The call-back rate has decreased by 40$, since we can see the tissues inside the breast, not just a summation of the tissues through the breast.

Linda Kowalski, Executive Director, Radiological Society of CT stated that Medicare covers breast tomosynthesis. Connecticut's Department of Social Services decided to do likewise late last year in the Medicaid program. Tomosynthesis is no longer investigational. The test has been shown to improve key screening parameters compared to digital

mammography.

Liane Philpott, MD, Professor of Radiology and Biomedical Imaging & Chief of Breast Imaging, Yale-New Haven Hospital spoke to provide her unconditional support for this bill.

While mammography has long been the gold standard for screening, it is not without limitations. 2D digital mammography has been the most advance screening technology available, yet there are inherent limitations primarily due to superimposition of breast tissue, which may result in missing cancer and/or mimicking cancer that result in a false positive result.

Breast Tomosynthesis deserves to be covered and paid for mammography service for all women in Connecticut. The clinical benefits are clear and we now have longitudinal data supporting the benefits are sustained over time.

NATURE AND SOURCES OF OPPOSITION:

Jennifer Herz, Assistance Counsel, CBIA is concerned about the cost of new mandates. However, without the specific data it is not possible to analyze the cost/benefit impact of any given mandate. The impact on smaller employers and individuals who are paying for health insurance must be emphasized.

Connecticut Association of Health Plans feels until science can speak to the clinical benefit of such procedures; the legislature should refrain from taking further action. This bill will result in a cost to the state employee and retiree health plan, municipalities, and the state, for providing coverage for tomosynthesis in the event a mammogram shows dense breast tissue, or the woman is believed to be at increased risk for breast cancer. The volume of mandates and the other insurance provisions under consideration by the Committee add appreciable volatility to the overall process that is not conducive to an efficient, stable and predictable insurance market.

Connecticut Conference of Municipalities (CCM) has concerns with the bill. The proposal would, among other things, create new or mandated expansions of health insurance policies in order to provide coverage for various treatment, services, procedures, supplies and/or equipment. They urge the committee to hold this proposal until further analysts is conducted.