Blues re-evaluate cancer screening

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WEST FARGO (AP) - Officials of Blue Cross Blue Shield North Dakota say the insurer is convening an advisory panel to evaluate its policy on reimbursing screening procedures for breast cancer.

Blue Cross Blue Shield's current policy does not reimburse an MRI of the breast for patients with dense breasts.

"We're in the process of just re-evaluating this policy with the availability of new technology, even though the policy is just a year old," said Dr. Jon Rice, senior vice president and chief medical officer for the Blues. "Areas like this are in a state of flux."

North Dakota Insurance Commissioner Jim Poolman asked Blue Cross Blue Shield to assess the procedure. He was approached by women like Judy Carson, who said she was told she has solid, dense breast tissue that can make mammography an unreliable breast cancer detection tool.

Carson said she has no family history of breast cancer and had trusted her mammograms until she found the lump during a self-exam.

The mass didn't show up on the mammogram, but was confirmed by an ultrasound and easily seen on an MRI ordered by the oncologist, she said.

"I think if someone has dense breasts, they should at least have the option of the MRI," said Carson, who works as an X-ray technician.

Blue Cross covers the procedure for some patients. In March, the American Cancer Society released new MRI screening guidelines, recommending women who have a 20 percent or greater lifetime risk of developing breast cancer receive an annual mammogram and MRI.

Women at a moderately increased risk should talk to their doctors about adding an MRI screening to their yearly mammogram, the cancer society said. Yearly MRIs are not recommended for women with a lifetime risk less than 15 percent. The risk is based on a number of factors, including genetic mutation, family history, age of first menstruation, previous breast biopsies and age of first live birth, said Dr. Anu Gaba, a medical oncologist and hematologist with MeritCare's Roger Maris Cancer Clinic in Fargo.

Gaba said requiring MRIs for all women could be dangerous because MRIs have a higher rate of false positive diagnoses, possibly setting off a trail of further tests and biopsies, and causing unwarranted anxiety.

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