July 24, 2025
Missouri Law Expanding Mammography Coverage Linked to Increased Screening and 3D Breast Tomosynthesis Use
A new Harvey L. Neiman Health Policy Institute study found increased utilization of screening mammography as well as an increased share of this screening through digital breast tomosynthesis (DBT) following Missouri’s legislative expansion of mammography screening coverage. Effective 2019, Missouri law changed to require coverage for (1) annual screening mammography beginning at age 40 (previously biennial starting at age 50) and (2) DBT (i.e., 3D mammography) in addition to full-field digital mammography (i.e., 2D mammography). This study, published in the Journal of the American College of Radiology (JACR), was based on more than 1 million women, and compared women under the law’s jurisdiction to women unimpacted by the law.
The researchers focused on the impact of the new law on women insured by Medicaid, which is governed by state policy, whereas Medicare falls under federal rules. “Among women in Missouri, we found that those with Medicaid insurance were 45% more likely to have screening mammography after the law change compared with women insured through Medicare Advantage,” stated Eric Christensen, PhD, research director at the Neiman Institute and study senior author. “To ensure the observed increase in screening was the result of the law versus insurance policy differences, we also tested comparisons among women with Medicaid, comparing Missouri women to those in border states with Medicaid. In these analyses, we found that women in Missouri were 9% more likely to have screening mammography after the law change compared with the bordering states.”
“This study shows that policy change matters—and can improve access to lifesaving screening,” said lead author Amy K. Patel, MD, Medical Director of The Breast Care Center at Liberty Hospital, Chair of the American College of Radiology Radiology Advocacy Network/RADPAC, and Immediate Past President of the Missouri Radiological Society. “In Missouri, where we face some of the nation’s worst disparities in breast cancer outcomes, this legislation is moving the needle in the right direction.”
The researchers extended their comparisons to a commercially insured population but found a lesser effect than observed for the historically underserved Medicaid population. Missouri women with commercial insurance were 5% more likely to have screening after the law change compared with the Medicare Advantage group in Missouri, no difference when compared to women in border states with commercial insurance. “The lesser impact of the law for increasing screening among commercially insured women was expected. Laws dictate minimum coverage only, and commercial insurers often offer coverage that exceeds these requirements,” said Dr. Christensen.
As for DBT, a newer screening technology that has shown to increase cancer detection rate, the authors found the Missouri law change was associated with increased use. There was also an increased likelihood of DBT use after the law change compared to its border states, Missouri women’s use of DBT being 64% higher in Medicaid and 24% in commercial patients, respectively. DBT is recommend over FFDM for the about one-half of women with dense breasts and delayed access to the newer technology has introduced disparities, according to prior Neiman Institute research.[1]
“We now have clear evidence that increasing coverage for breast cancer screening—particularly for underserved women—leads to real gains in screening rates and access to better technology,” Dr. Patel said. “With the observed impact both for the expanded age range and frequency of screening, and coverage of DBT, the new policy is associated with favorable screening trends with the potential to reduce disparities and save lives.”
“The results of our study deserve notice by other states considering similar legislation to Missouri’s. State policy change has now shown to increase breast cancer screening and access to newer technology, particularly among underserved women,” said Dr. Patel. “The goal is increasing annual screening for a broader base of women to increase years of life saved from breast cancer. As a specialty, broadening the reach of screening mammography generally, as well as DBT specifically, is an important health policy and population health focus for radiologists.”
To arrange an interview with a spokesperson, contact Nichole Gonzalez at ngonzalez@neimanhpi.org.
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About the Harvey L. Neiman Health Policy Institute
The Harvey L. Neiman Health Policy Institute is one of the nation’s leading medical imaging socioeconomic research organizations. The Neiman Institute studies the role and value of radiology and radiologists in evolving health care delivery and payment systems and the impact of medical imaging on the cost, quality, safety and efficiency of health care. Visit us at www.neimanhpi.org and follow us on X, LinkedIn and Facebook.
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[1] See (1) Christensen EW, Waid M, Scott J, Patel BK, Bello JA, Rula EY. The Relationship between Race and Access to Newer Mammographic Technology in Women with Medicare Insurance. Radiology, 2023; 306(2):e221153 and (2) Christensen EW, Rosenblatt RB, Patel AG, Rula EY, Carlos RC, Narayan AK, Patel BK. Differential Access to Breast Magnetic Resonance Imaging Compared with Mammography and Ultrasound. Am J Prev Med. 2024;67(6):897-905.