BILL ANALYSIS Ó Senate Appropriations Committee Fiscal Summary Senator Christine Kehoe, Chair SB 1538 (Simitian) - Mammograms Amended: March 27, 2012 Policy Vote: Health 9-0 Urgency: No Mandate: No Hearing Date: April 30, 2012 Consultant: Brendan McCarthy This bill meets the criteria for referral to the Suspense File. Bill Summary: SB 1538 would require facilities that perform mammograms to include a specified notice with the reports that are sent to certain patients. The notice would tell the patient that she has dense breasts and may benefit from supplemental screening. Fiscal Impact: Increased costs to state health programs due to requests for additional screening from participants. Assuming that 10 percent of women who receive the required notice request additional screening, costs to state health programs would be: Medi-Cal: about $1.8 million per year (50% General Fund and 50% federal funds) Every Woman Counts Program: about $1.6 million per year (General Fund) CalPERS: about $1.7 million per year (55% General Fund and 45% special funds) Background: Federal law requires facilities that perform mammograms to provide a written report of the mammogram examination to both the patient and the referring health care provider. Included in the report to the health care provider is information on the patient's breast density. Proposed Law: SB 1538 requires facilities that perform mammograms to include a specified notice in the reports that are provided to women who are classified as having dense breasts. (Whether or not a woman is classified as having dense breasts is based on a classification system developed by the American College of Radiology.) The notice states: "Because your mammogram demonstrates that you have dense breast SB 1538 (Simitian) Page 1 tissue, which could hide small abnormalities, you might benefit from supplementary screening tests, depending on your individual risk factors. A report of your mammography results, which contains information about your breast density, has been sent to your physician's office and you should contact your physician if you have any questions or concerns about this notice" The bill would take effect on April 1, 2013 and would sunset on January 1, 2019. The bill further specifies that it does not impose any liability on a health care facility that does not comply with its provisions before April 1, 2013. Related Legislation: SB 173 (Simitian, 2011) was substantially similar to this bill and included the same notice. That bill was held in the Assembly Appropriations Committee. SB 791 (Simitian, 2011) was also substantially similar to this bill and included the same notice. That bill was vetoed by Governor Brown. Staff Comments: Roughly 50 percent of women who receive mammograms have breasts that would be classified as dense, under the provisions of the bill. The fiscal estimates above assume that ten percent of the women who receive the required notice would request additional screening from their provider. Most health plans will cover breast ultrasound if referred by a provider, whereas breast magnetic resonance imaging scans are not generally covered without prior authorization. This analysis assumes that only breast ultrasounds are used for supplemental screening. If either the rate of requests for supplemental screening or the use of breast magnetic resonance imaging is higher, costs to public programs would be higher. According to an analysis of SB 173 by the California Health Benefits Review Program: there is insufficient evidence that breast ultrasound improves the sensitivity of screening for asymptomatic women with dense breasts; breast ultrasounds yield false positives at twice the rate of mammograms; and there is insufficient evidence that breast ultrasound screening decreases mortality or improves health outcomes. In addition, the analysis found that: breast magnetic resonance imaging may be useful to identify cancer in women with high risk factors; false positive rates are twice as high as for SB 1538 (Simitian) Page 2 mammograms; and there is insufficient evidence that breast magnetic resonance imaging screening reduces mortality or improves outcomes. Therefore, there is not enough available evidence to determine whether additional screening requested due to the bill will result in improved health outcomes or reduced long-term healthcare costs.