BILL ANALYSIS �
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|SENATE RULES COMMITTEE | SB 173|
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THIRD READING
Bill No: SB 173
Author: Simitian (D), et al.
Amended: 5/31/11
Vote: 21
SENATE HEALTH COMMITTEE : 7-1, 04/27/11
AYES: Hernandez, Strickland, Alquist, Blakeslee, De Le�n,
DeSaulnier, Wolk
NOES: Anderson
NO VOTE RECORDED: Rubio
SENATE APPROPRIATIONS COMMITTEE : 6-2, 05/26/11
AYES: Kehoe, Alquist, Lieu, Pavley, Price, Steinberg
NOES: Walters, Runner
NO VOTE RECORDED: Emmerson
SUBJECT : Health care coverage: mammograms
SOURCE : Author
DIGEST : This bill requires, as provided under the
Knox-Keene Health Care Service Plan Act, a health care
practitioner who performs a mammography examination, if a
patient has heterogeneously dense breasts or extremely
dense breasts based on the Breast Imaging and Reporting
Data System established by the American College of
Radiology, to include a specified notice in the summary of
a written report sent to the patient regarding a
mammography examination.
CONTINUED
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ANALYSIS : Existing federal law defines, under the
Patient Protection and Affordable Care Act (PPACA) (Public
Law 111-148), as amended by the Health Care Education and
Reconciliation Act of 2010 (Public Law 111-152), a list of
essential health benefits, which health insurance coverage
and group health plans must provide beginning in 2014.
Existing state law:
1.Provides for the regulation of health care service plans
by the Department of Managed Health Care (DMHC) and
individual or group health insurers (insurers) by the
California Department of Insurance (CDI).
2.Requires health plans, individual or group health
insurance policies and self-insured employee welfare
benefit plans to provide coverage for mammograms, upon
the referral of a physician, nurse practitioner, or
certified nurse-midwife, for breast cancer screening and
diagnostic purposes.
3.Requires individual or group health insurance policies
and self-insured employee welfare benefit plans, upon
referral, to provide at least a baseline mammogram for
women ages 35 through 39, inclusive; a mammogram for
women ages 40 through (49, inclusive, every two years or
more, depending on a physician's recommendation; and, a
mammogram every year for women age 50 and over.
4.Provides for the regulation of health care practitioners,
as defined.
This bill requires a health care practitioner who performs
a mammography examination, if a patient has heterogeneously
dense breasts or extremely dense breasts based on the
Breast Imaging and Reporting Data System established by the
American College of Radiology, to include in the summary of
the written report sent to the patient, as required by
federal law, the following notice:
"Because your mammogram demonstrates that you have
dense breast tissue, which could hide small
abnormalities, you might benefit from supplementary
screening tests, depending on your individual risk
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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 report."
Background
Breast Imaging Reporting and Data System
BIRADS is a quality control system established by the
American College of Radiology. In day-to-day use, the term
refers to mammography assessment categories: standardized
numerical codes typically assigned by a radiologist after
interpreting a mammogram. The assessment categories were
developed for mammography and later adapted for the MRI and
ultrasound. The summary of each category is identical for
all three modalities, as follows:
0: Incomplete
1: Negative
2: Benign finding(s)
3: Probably benign
4: Suspicious abnormality
5: Highly suggestive of malignancy
6: Known biopsy - proven malignancy
Breast composition categories:
1: Almost entirely fat
2: Scattered fibroglandular densities
3: Heterogeneously dense
4: Extremely dense
FISCAL EFFECT : Appropriation: No Fiscal Com.: No
Local: No
SUPPORT : (Verified 5/27/11)
Association of Women's Health, Obstetric and Neonatal
Nurses
Breast Cancer Fund
California Association of Health Underwriters
California Communities United Institute
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California Nurses Association
OPPOSITION : (Verified 5/27/11)
California Medical Association
The American Congress of Obstetricians and Gynecologists,
District IX
California
California Radiological Society
ARGUMENTS IN SUPPORT : Proponents of SB 173 state that
this bill will lead to more women surviving breast cancer
by helping to catch cancer early when it is more treatable
and curable, and in the long run will lead to safer methods
of detecting breast cancer.
The California Organization for Women points to
calculations provided by the University of California San
Francisco's Breast Cancer Research Program in 2001, stating
that the total direct costs of breast cancer were $279
million for that year, each life lost prematurely to breast
cancer represents lost productively of $272,000 to the
state, and costs increase dramatically with delay in
treatment, from $16,063 for treatment in the earliest
stages to $49,383 for women with late-stage breast cancer.
ARGUMENTS IN OPPOSITION : The California Radiological
Society (CRS) points out that there is significant observer
variability in the assignment of a breast density category
among radiologists. CRS argues that the notification of
breast-density could lead to more confusion than
clarification and runs the risk of giving a false sense of
security to women who are told their breast tissue is not
dense. CRS argues that BIRADS recommends that all
mammography reports given to referring providers include a
description of breast density and the patient's physician
should use this information to discuss the appropriate
options given other circumstances such as medical history
and high-risk factors.
California Medical Association (CMA) states that this bill
in its current form disrupts the physician-patient
relationship by mandating that all women, whether or not
their treating physician believes it is clinically
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indicated, be given a specific notice regarding breast
density and potential supplemental screening procedures
like MRI and ultrasound. CMA argues that there remains
debate within the scientific community as to the link
between density and breast cancer risk.
CTW:nl 5/27/11 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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