Insight

ACS CAN Report: High Costs Block Critical Follow-Up Tests for Breast Cancer

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Jan 16, 2025, 16:28

ACS CAN Report: High Costs Block Critical Follow-Up Tests for Breast Cancer

A new report by the American Cancer Society Cancer Action Network (ACS CAN) reveals troubling cost barriers for patients needing follow-up diagnostic tests for breast cancer.

ACS CAN

The report found that in 2023, over 70% of commercially-insured patients encountered out-of-pocket expenses for tests such as diagnostic mammograms, MRIs, ultrasounds, and biopsies—critical next steps for determining whether an individual may have cancer.

While screening mammograms are typically covered for most insured women starting at age 40, follow-up diagnostic tests often result in additional costs that can deter patients from seeking necessary care.

The financial burden of these follow-up tests varies significantly across states. North Dakota had the highest out-of-pocket costs (51.8%), followed by South Dakota at 48.6%.

In contrast, states like Delaware (9.0%) and New York (12.9%) reported lower out-of-pocket expenses.

“Out-of-pocket cost sharing is a significant barrier for those individuals who need access to multiple early detection services in order to find cancer at an earlier stage when treatment is more effective.”– Lisa Lacasse, President of ACS CAN

She further emphasized that these additional expenses can lead to delayed or skipped procedures, resulting in potentially life-threatening consequences.

The financial strain is causing many patients to delay or forgo essential diagnostic tests, which could lead to diagnoses at later, more advanced stages of cancer, ultimately increasing both healthcare costs and patient suffering.

In 2024, an estimated 1 million women aged 40 to 75 will likely experience delays in follow-up testing due to the associated costs.

The report also found that out-of-pocket expenses are affecting future screening as well, with approximately 378,000 women expected to skip future mammograms due to concerns about additional costs for follow-up procedures.

In a positive finding, the report suggests that eliminating out-of-pocket costs for follow-up tests could prevent more than 7,500 later-stage breast cancer diagnoses and save the U.S. an estimated $2.2 billion in lifetime treatment costs.

However, while some states have enacted legislation to eliminate out-of-pocket costs for post-mammogram diagnostic tests, these protections are not yet universal.

Many women, particularly those in states without such legislation or those enrolled in non-state-regulated health plans, continue to face significant financial barriers to essential care.