Yale’s School of Public Health and School of Medicine Researchers Find State Laws Have Some Impact on Breast Ultrasound and Cancer Detection Rates

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Participating in the Blue Cross Blue Shield Alliance for Health Research, Yale researchers accessed Blue Cross Blue Shield Axis®, the largest source of commercial insurance claims

CHICAGO – Some types of state breast density notification laws lead to further screening and can modestly boost cancer detection rates, according to a new study released today by researchers at Yale’s School of Public Health and School of Medicine (Yale), which used commercial insurance claims data from Blue Cross and Blue Shield (BCBS) companies. Yale researchers analyzed the data to determine if various state laws, such as ones that mandate that doctors recommend further screening procedures or those that simply require doctors to disclose additional information about dense breast tissue, make a difference in the number of breast ultrasounds provided and in cancer detection rates. 

In states with the law in place, the increases in ultrasound and cancer detection rates were modest, with about 10.5 more ultrasounds per 1,000 mammograms, and less than one additional breast cancer detected per 1,000 mammograms. Additionally, the team found no changes in clinical practice in states where laws only require physicians to provide more information about breast density. 

About half of American women in their 40s and 50s have dense breast tissue, which increases their risk of breast cancer and makes it more difficult to detect cancer on a mammogram. Many states passed laws requiring health care physicians to notify women about breast density after they undergo mammography, with some states also recommending women with high breast density to consider additional screening tests, such as ultrasounds and MRIs. 

“Although detecting cancers at an early stage should never be discounted, the main goal of a screening program is to stop the rates of advanced cancers and to save lives,” said Cary Gross, one of the study’s co-authors and professor of medicine at Yale. “Further studies need to be conducted to determine if additional and more aggressive forms of cancer screenings are actually contributing to that goal.” 

The Yale researchers, along with eight other leading U.S. institutions and health research programs, are members of the Blue Cross Blue Shield Alliance for Health Research (BCBS Alliance). This collaboration provides researchers with access to HIPAA-compliant data from Blue Cross Blue Shield Axis® (BCBS Axis) – the largest collection of commercial insurance claims, medical professional and cost of care information – through a secure data portal. 

“We believe it’s important for women to have all of the information they need when determining when to be tested and how often,” said Maureen Sullivan, chief strategy and innovation officer for the Blue Cross Blue Shield Association. “By working with Yale, and the eight other prestigious institutions participating in the BCBS Alliance, our goal is to analyze and learn from critical health issues and find meaningful solutions that improve care quality and affordability for all Americans.” 

The BCBS Alliance was established in 2016 to engage leading U.S. health care researchers to explore key questions and topics using BCBS Axis data. The researchers involved in this program come together periodically to share insights and discuss critical health and health system issues, helping advance improvements in health care nationwide. Participants in the BCBS Alliance include: Harvard Medical School, Princeton University, Rice University, Scripps Research Translational Institute, Stanford University, University of California Berkeley, University of Chicago, University of Oklahoma and Yale. 

For more information on the BCBS Alliance, visit https://bcbs.com/the-health-of-america/research-alliance

To read more about the report, which was published in the American Journal of Public Health, visit https://news.yale.edu/2019/03/21/breast-ultrasound-and-cancer-detection-increased-under-new-laws.  
 

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The Blue Cross Blue Shield Association is an association of 36 independent, locally operated Blue Cross and/or Blue Shield companies.