Experts say breast cancer scans are normally free – but not if you have symptoms or are under 40

After one 36-year-old woman was charged nearly $18,000 for a breast cancer check-up, concerns have been raised over how much it should really cost.

Breast cancer is the most common cancer among women in the United States — with 285,000 cases and 42,000 deaths a year — but if it is caught in the early stages almost every patient survives.

Doctors urge all women aged 50 to 74 years old to get screened for the disease once every other year, with those at a higher risk are advised to start getting the tests in their 40s.

Experts say the screening test — a mammogram — is generally free for all women who are more than 40 years old and have health insurance. But those who have symptoms or no coverage may need to fork out $200 to $400.

If no cancer is detected then no further action is needed. But women that have a warning sign spotted normally need to get their results confirmed with a biopsy, which has a cash price of between $1,000 and $2,000.

All the costs above are given as an average cash price. But these may be significantly lower for some women depending on their health insurance plans and the amount of their deductible they have paid. Some insurance plans – such as short term types – may not offer free breast cancer screenings

The above graph shows new cases of breast cancer among women as a rate per 100,000 people (light green line) and the death rate (as a dark green line). It reveals that deaths have been falling very gradually

The above chart shows the age groups where women are most likely to have a breast cancer diagnosis. This is around the age of 63 years. Medicare – for those over 65 years old – offers free breast scans

Women who go for breast cancer screenings will initially be sent for a mammogram, where low-dose X-rays are fired into the breasts to check for unusual growths or troubling to the tissue.

This is normally given as a 2D-scan, where the bottom and tops of the breasts are checked. But some hospitals also offer a 3D-scan, which will look at the sides of the breasts as well. Those under 40 years old may be offered an MRI, because their tissue may be too thick for the mammogram to penetrate.

Patients’ results are usually available about a week or two later, with most scans not detecting anything untoward that requires a further check.

Breast cancer is one of the most common cancers in the world 

Breast cancer is one of the most common cancers in the world, and the second most common among women in the U.S. behind 285,000 cases and 40,000 deaths a year.

What is breast cancer?

Breast cancer develops from a cancerous cell which develops in the lining of a duct or lobule in one of the breasts.

Most cases develop in women over the age of 50, but younger women are sometimes affected. Breast cancer can develop in men though this is rare.

Staging means how big the cancer is and whether it has spread. Stage 1 is the earliest stage and stage 4 means the cancer has spread to another part of the body.

What causes breast cancer?

A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply ‘out of control’.

Although breast cancer can develop for no apparent reason, there are some risk factors that can increase the chance of developing breast cancer, such as genetics.

What are the symptoms?

The usual first symptom is a painless lump in the breast, although most breast lumps are not cancerous and are fluid filled cysts, which are benign.

The first place that breast cancer usually spreads to is the lymph nodes in the armpit. If this occurs you will develop a swelling or lump in an armpit.

How is breast cancer treated?

Treatment options which may be considered include surgery, chemotherapy, radiotherapy and hormone treatment. Often a combination of two or more of these treatments are used. 

  • Surgery: Breast-conserving surgery or the removal of the affected breast depending on the size of the tumour. 
  • Radiotherapy: A treatment which uses high energy beams of radiation focussed on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. It is mainly used in addition to surgery. 
  • Chemotherapy: A treatment of cancer by using anti-cancer drugs which kill cancer cells, or stop them from multiplying.

How successful is treatment?

The outlook is best in those who are diagnosed when the cancer is still small, and has not spread. Surgical removal of a tumour in an early stage may then give a good chance of cure.

The routine mammography offered to women between the ages of 50 and 70 mean more breast cancers are being diagnosed and treated at an early stage.

But about one in ten will be called back to have a biopsy, to double-check something on the mammogram that has raised concerns. This involves a small piece of breast tissue being removed — often via a thin hollow needle — which is then analyzed in the lab to check for cancer.

Doctors say not to be too concerned if this happens, with the National Breast Cancer Foundation — a non-profit based in Texas — saying only one in five of these leads to a breast cancer diagnosis.

Dr Ge Bai, a health accounting expert at Johns Hopkins University, told that mammograms are generally free either every year or every other for insured women over 40 years old.

She said this was thanks to the Affordable Care Act (ACA) — also known as Obamacare — enacted in 2010 which required all health insurance companies to start offering them.

But the free offer comes with a number of caveats, Bai warned.

She said patients would be charged for the screening if they had any symptoms of breast cancer, were younger than 40 years, went more than once a year, or had the 3D-version instead of the 2D type.

Some hospitals are pushing 3D mammograms — which look at the sides of breasts as well as the tops and bottoms — but the American Cancer Society says there is no evidence that these are more likely to detect a cancer that would otherwise be missed.

She added that some insurance plans would not comply with the ACA, however, and would not offer the free screening. This can vary by state.

Medicaid — the U.S. health insurance program for poorer Americans with 88million users — offers the free scans in most states, but will not cover them for better-paid women living in areas that have not adopted the ACA expansion — such as Texas, Florida and Alabama. Medicare — which insures Americans over 65 years old — also offers the free scans. 

Any further scans — such as biopsies — will not be offered for free, and will need to be paid for by the patient or their insurance.

Treatment costs also depend on the insurance status. 

Bai told ‘For a woman over 40, who is employed, if your employer is complying then you should pay nothing for a breast cancer scan.

‘But in many cases this is not the case, and you must then pay whatever amount it is before you reach your deductible.’

A spokeswoman for the American Cancer Society told ‘Generally, all ACA compliant plans provide no-cost coverage for breast cancer screenings (and other preventive services) based on the U.S. Preventive Services Task Force (USPSTF) guidelines.

‘[However,] there are a number of specific caveats and a host of non-compliant plans for which varying rules apply and where state variation may be more likely.’

They said that those under a short-term plan or one from Christian Sharing Ministries — which offer cost sharing for their members — may not be able to get screened for the cancer for free.

Bai urged all women worried about having to fork out for a breast cancer scan to ask hospitals for their cash prices — which is almost always lower than that offered to insurance. , which they are required to publish — although some still do not comply.

Asked how much a mammogram and biopsy should be, Bai pointed to a research letter that she helped write which was published last year in the journal JAMA Network Open.

For the paper the reserachers trawled through data from 900 hospitals on more than 70 procedures to establish the cash prices for each.

Results showed a mammogram for both breasts had a cash price of about $277, although this varied by between $190 and $400 depending on the hospital.

The team did not look at a biopsy for breast cancer, but Bai said the cost would likely be similar to biopsies done for other cancers such as bowel cancer. The cash price for this is about $2,000, ranging from $1,200 to $3,000.

Dani Yuengling, now 36 and a HR worker in South Carolina, was handed a bill totalling $17,979 (pictured) for an ultra-sound guided breast biopsy. After searching the hospital's own website she had expected to pay around $1,400 for the procedure

Dani Yuengling, now 36 and a HR worker in South Carolina, was handed a bill totalling $17,979 (pictured) for an ultra-sound guided breast biopsy. After searching the hospital’s own website she had expected to pay around $1,400 for the procedure

Yuengling ¿ who wanted to get a lump on her right breast checked ¿ said she was left unable to sleep and suffering migraines by the bill. She has refused to return to the hospital for a follow-up

Yuengling — who wanted to get a lump on her right breast checked — said she was left unable to sleep and suffering migraines by the bill. She has refused to return to the hospital for a follow-up

Insurance plans may offer a cheaper price for patients, as they may only be needed to pay a co-pay — a fixed amount to be paid for a covered health service — and part of their deductible — the amount patients pay before their health insurance kicks in.

Latest figures suggest that 76.4 percent of American women aged 50 to 74 years old are screened for breast cancer every year.

This is below the 80 percent target set by the federal Government.

President Joe Biden has made it one of the hallmarks of his presidency to fight a war on cancer, saying he aims to halve fatalities from the disease within the next 25 years.

This will be done in part through developing and rolling out screening tests that can use a single blood swab to detect cancers early, he said.

It comes after Dani Yuengling, from Conway in South Carolina, came forward last month to say she had been charged $18,000 for a breast biopsy despite already being insured.

The 36-year-old went to see her doctor early this year after noticing a lump on her right breast, fearing the worst because her mother had died from the disease five years earlier.

The HR worker was referred to the Grand Strand Medical Center in Myrtle Beach for a biopsy, with a quick check of the hospital’s expenses calculator suggesting she would be charged $1,400. Yuengling hoped her health insurance with Cigna, one of the nation’s largest, would help offset the costs.

But after having the test in February — and no cancer being found — she received a bill for $17,979. After ringing the hospital she was offered a 36 percent discount — taking it to $11,500 —, but is now refusing to return for a follow-up check.

Experts advised patients to always ask their healthcare providers for the cash price of a procedure, which is almost always lower than that offered to insurance. A spokeswoman for the Conway Medical Center, just 14 miles from the hospital where Yuengling was scanned, said they would charge $2,100 cash price for the same procedure.