Returning Bill Would See Cost of Preventive Screenings for Breast Cancer Eliminated

Friday, May 2nd, 2025 -- 9:01 AM

(Corrinne Hess, Wisconsin Public Radio) Patients at a higher risk of breast cancer could see the cost of preventative screenings eliminated under a bill being introduced for a third time by Wisconsin legislators.

According to Corrinne Hess with Wisconsin Public Radio, Gail’s Law would require insurers to cover supplemental breast screening exams for individuals at increased risk.

Current Wisconsin law requires insurance coverage for an initial mammogram, but it does not require coverage for follow-up screenings, including those needed due to dense breast tissue or abnormal results.

About 50 percent of women have dense breast tissue, making them four to six times more likely to develop breast cancer, since tumors are often more difficult to detect with standard mammograms.

Due to the insurance coverage gaps, many women currently face out-of-pocket costs upwards of $1,000 for supplemental imaging. State Rep. Amanda Nedweski ,R-Pleasant Prairie, is one of the co-sponsors of the bill.

She said the financial burden of additional screening costs should not discourage women from getting critical diagnostic tests.  “I think of the women out there who get that letter, and how many of them are following up with the secondary screening, and how many are blowing it off because they don’t have an extra $1,000 for an MRI right now,” Nedweski said.

“And then they have a diagnosis two years down the line, where they’re already in stage 3, where if they had just gone for that ultrasound early on, maybe they could have caught it early enough and could have avoided having to go through chemotherapy or radiation or treatment.”

Almost 99 percent of women diagnosed with breast cancer at the earliest stage live for 5 years or more, compared to about 32 percent of those diagnosed at the most advanced stage, according to the U.S. Centers for Disease Control and Prevention.

There is also a cost benefit for treating early. The average per-patient costs for medical services were highest for the end-of-life phase at $76,100. Early stage breast cancer treatment costs about $35,000, according to the CDC.

Dawn Anderson is the former executive director of the Wisconsin Breast Cancer Coalition. She now heads the coalition’s policy committee. Anderson said insurance companies have for years fought against required coverage of additional breast cancer screening.

But in the end, she said, companies spend more money treating late-stage cancer.

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