BILL ANALYSIS                                                                                                                                                                                                    �




                   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 








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          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 








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          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.