Expanding Breast Cancer Imaging Through Public Policy 

[00:00:00] Adam Walker: From Susan G Komen, this is Real Pink, A podcast exploring real stories, struggles, and triumphs related to breast cancer. We’re taking the conversation from the doctor’s office to your living room.

Welcome to the Komen Health Equity Revolution podcast series. Each month we invite in patients, community organizations, healthcare partners, researchers and policy advocates to discuss strategies and solutions that drive the health equity revolution forward for multiple populations experiencing breast health inequities.

Widespread access to preventative screening mammography without cost sharing is available to millions of women as a result of the Affordable Care Act, ACA. Unfortunately, some individuals at a higher risk of breast cancer or those requiring follow-up imaging due to abnormal mammogram results face hundreds to thousands of dollars in patient cost sharing.

Susan G Komen is committed to championing legislation that addresses this disparity in health insurance coverage to ensure all cancer patients have fair and equitable access to breast imaging that may save their lives. Here today to discuss Komens public policy efforts at the state level are California State Senator Anthony Portantino and Rebecca Birtch, Komen’s director of State Policy and advocacy.

Welcome to the show, Senator Portantino and Rebecca. 

[00:01:27] Rebecca Birtch: Hi. Thank you for having us. 

[00:01:29] Senator Portantino: Fantastic. Thanks Adam. Thanks, Rebecca.

[00:01:32] Adam Walker: Well, I’m glad to be here. This is such an important conversation to have. I think a lot of people don’t realize some of the financial burden that, women end up underneath because of these things, and so I’m glad we’re bringing light to it.

So, Rebecca, let’s start with you. Can you tell us more about some of the barriers that exist for those impacted by breast cancer and explain Komens approach to addressing these barriers through public policy. 

[00:01:55] Rebecca Birtch: Absolutely. So we hear from patients every day from those impacted by breast cancer that they don’t have access to affordable healthcare services. That they’re, you know, many of them are faced with the decision of paying rent, paying childcare before they get their medical care and others are faced with burdensome, barriers that keep them from getting the most effective treatment. So Komen’s committed to ensuring access to vital safety net programs across the board so that they can access it and to working on policies to alleviate that patient burden, whether it be high out-of-pocket cost or those burdens and restrictions, to accessing the treatments that they need.

[00:02:34] Adam Walker: I love that. I love that. And so, so Rebecca, just continue here for a moment. So championing a health equity revolution is clearly woven into Komens public policy and advocacy priorities. Can you tell us more about Komens efforts to champion health equity at a state policy level? 

[00:02:50] Rebecca Birtch: Absolutely. So at the state level, we work to expand access to those vital safety net programs, whatever they might be, so that those that are at our most vulnerable have access to basic healthcare services.

We also work on policies that eliminate and remove those re burdens and restrictions. One of our key issues that we’ve been working on that really we think helps address some of that equity is the diagnostic and supplemental imaging legislation that we’ve kind of worked across the board and have had the pleasure of working with Senator Portantino in California on, but really it looks at eliminating that cost.

We know that once a patient forgoes or waits to delay the screening, many times because of the high out-of-pocket cost, that they have a higher chance of, being, diagnosed at a later stage. And at that point in time, you have a much more costly treatment and sometimes it’s much more deadly for the patient.

So we’ve been working to eliminate those out-of-pocket costs for the medically necessary diagnostic and supplemental imaging, so that they can access, the services they need and hopefully get to a, an earlier diagnosis and a better outcome for them. 

[00:03:56] Adam Walker: Yeah, I mean, that’s so important. ’cause no, no woman should have to choose between childcare and getting the healthcare that they need. That’s not a, that’s not a good choice. or any other kind of care. 

[00:04:06] Rebecca Birtch: Right. And we see that day after day and, you know, it could be a hundred dollars, but it could be thousands of dollars out of pocket. And for some people, a hundred dollars might as well be 10,000. So we really work to eliminate that cost altogether so they can get to the services they need.

[00:04:20] Adam Walker: That’s such important work. I love what you’re doing. That’s so great. Senator Portantino, let’s hear from you here, about the important work you’re doing. So what spurred you to introduce SB 257 and can you tell us more about your efforts to expand access to medically necessary breast imaging in California and what kind of impact that could have for patients?

[00:04:40] Senator Portantino: First of all, thank you, Rebecca, for doing everything that you’re doing in Komen, you know, is doing to expand access and making sure that, you know, it’s one thing to have great research and great technologies and great preventative treatments and then, you know, acute treatments. But if people don’t have access to them, you know, we’re not helping those individuals.

And certainly Komen is at the forefront of making sure that, you know, people have access to this lifesavingtreatments and diagnostics. For me, you know, as a senator of the 25th District, which is a, you know, north Los Angeles County primarily, I get a lot of emails, a lot of phone calls, a lot of contacts from constituents, and many of ’em are about healthcare issues. And in this particular case, a woman named Guyana sent me an email and, outlined the dilemma that she was going through, in that her routine mammogram was covered by her insurance, but the follow-up imaging, as Rebecca said, even though it was medically necessary and needed to properly diagnose, her issue was not covered by insurance.

And so, she brought that issue to my attention and we decided that, you know, there was a lot of merit to that. You know, you think about it, you have your routine mammogram for a reason to see if you have an issue, and if your doctor determines that there’s an issue,and says, “You know what; you need further testing to, to see whether it’s serious or not serious or what, you know, treatment then would come next. It makes no sense that follow-up medically necessary, doctor prescribed image would not be covered by all insurance coverage.” And then as you pointed out, you know, many women will sit there and go, “You know what: I can’t afford the $800 and so I’ll wait till next year. I’ll wait to see if my lump gets bigger, because obviously I’m gonna go back next year for my routine mammogram.” And you know, what, that year could be the difference between that, that woman’s survival or not survival because delaying, further diagnosis delays care and delays you know, the whole point of the routine mammogram is to early detect a problem and if you’re not investigating it further, you’re not doing that patient justice. And so, you know, we’re determined to get that through. We’ve got a great partnership, with Komen and Rebecca and her team. We’re gonna put it on the governor’s desk and hopefully get a signature. And the other thing I, you know, say to people is don’t be shy in interacting with your legislators.

you know, you all have personal experiences. you know, I’m a male politician, you know, I don’t get a routine mammogram. But you know, having constituents who come up to me and share their personal experience is gonna lead to changing law, which is gonna lead to better treatment of people. So it’s a public discourse, it’s a political process.

We represent people, you know, don’t be shy. 10 years ago when I was in the assembly, several women, very similar issue, went at 40 to get their first mammogram, and several of them actually had cancer detected that first time. And they said, you know what? “Waiting until 40 was too late.” So based on those personal experiences, again, we changed state law to allow risk factors and family history to be a determining factor of who should get mammograms at an earlier age. And so that came at a out of a conversation in a post office with several, women. So my message is this is your state, your government, you know, be active participants in it, whether it’s through Komen, through an advocacy organization or a direct conversation with an elected official. You know, don’t let your personal stories go unheard and, unfollowed up.

[00:08:08] Adam Walker: Yeah, that’s great. That’s great advice. And I really appreciate you, you know, advocating for interaction with lawmakers. ’cause I think that’s so important. And you mentioned, the partnership with Komen. So Rebecca, I wonder if you could talk a little bit more about how Komen partners with lawmakers like Senator Portantino and introduce legislation across the U.S. 

[00:08:26] Rebecca Birtch: Yeah, absolutely. And I just want to say, the partnership with Senator Portantino has been amazing. He’s been an amazing champion for, for California and for the women of California, so thank you. For your support as well. But we work through champions similar to Senator Portantino across the country, trying to make sure that they understand. I think the biggest piece is to make sure they understand the issues, to make sure how those issues are impacting their constituents, and then how do we address those through policy. And so one of the big ways that we’ve been doing it is through the diagnostic and supplemental imaging legislation. To date, 20 states have passed.

We hope California will be 21. 20 states have passed,passed legislation of to eliminate in some form or another the cost around diagnostic and supplemental imaging. So it is a effective way in making sure that we’re able to kind of address some of these barriers. It’s a, it’s, I think that, and we work across the board in other areas too.

You know, as I said, expanding access to vital safety net programs. But it starts with those stories. It starts with understanding and it starts with education. And so that’s what really what our team works on, is making sure that they know. The Senator Portantino can probably attest to. It’s difficult to know all of the issues that are going on and the breadth of things that legislators need to know, and so it’s important that we share that information and make sure that they’re aware and so that we can start to address it.

[00:09:49] Adam Walker: That’s great. That’s great. So Senator Portantino, I wonder, what policy advancements do you hope to see in California in the future that will improve health equity for breast cancer patients?

[00:10:00] Senator Portantino: Well, I think, you know, access to couple things. You know, access to cutting edge technology. We did a bill last year to make sure that, you know, when we do come up with, new ways of treating cancer, that the centers of excellence, that the, those cutting edge hospitals, aren’t just for their inner circle. We share, the benefits of our research and our science and our discoveries, making sure that everyone has access to the most current and best, treatments available.

I think that’s key. and Rebecca’s talking about access, and that’s something that Komen fights for. You know, we see tremendous disparities between geographic location, ethnicities, racial disparities, income disparities, all those things should not be barriers to getting treatment for yourself or for a loved one and I think that’s the key. You know, in rural parts of our state, making sure that we have a pipeline of physicians, making sure that we have, you know, people everywhere so folks can access their provider. You know, we can pass all the laws in the world, but if we don’t have healthcare providers, you know, and you have to wait six months to get an appointment: again, that six months, can be,a life or death situation. So what we have to do is make sure that we’re encouraging enough people to go into healthcare, that we’re recruiting a diverse,population of healthcare providers, and that we have fair and equitable access across the board to all of those cutting edge technology.

I mean, California developed so many things. I mean, we are, you know, the center, Of excellence and research and treatment. we just have to make sure that every Californian, can access all of the great discoveries that we make. And again, that’s why the partnership with Komen and their involvement in political process is so important.

[00:11:49] Adam Walker: I love that. That’s so great. That’s so great. And so I’d imagine there are probably some listeners that might want to get involved. so Rebecca, can you explain how listeners can get involved in advocating for similar legislation in their own states? 

[00:12:02] Rebecca Birtch: Absolutely. So the easiest way to get involved is to become an advocacy insider. As an advocacy insider, you have access to up-to-date information, you have the ability to take action through your phone or through your email to let legislators like Senator Portantino know that this is important to you so they understand it. And you can sign up to be an advocacy insider by texting KOMEN, so Komen to 4 0 6 4 9, and again, that’s KOMEN to 4 0 6 4 9. Please sign up. It’s the easiest way to get involved and you can make sure that your voice is heard. 

[00:12:41] Adam Walker: Wow. That’s great. I love that. I would encourage all of our listeners to get involved. This is important work and it needs more people like you.

So Rebecca, thank you for the work you’re doing. Senator Portantino, thank you so much for the legislation that you’re working through and the work that you’re doing as well. It’s making such a huge impact. 

[00:12:59] Rebecca Birtch: Thank you. 

[00:13:01] Adam Walker: Thank you for joining another episode of the Komen Health Equity Revolution podcast series. We will continue to galvanize the breast cancer community to support multiple populations experiencing breast health inequities to advance and achieve breast health equity for all. To learn more about health equity at Komen, Please visit komen.org/healthequity.

Thanks for listening to Real Pink, a weekly podcast by Susan G Komen. For more episodes, visit realpink.Komen.org. And for more on breast cancer, visit komen.org. Make sure to check out @SusanGKomen on social media. I’m your host, Adam. You can find me on Twitter (X) @AJWalker or on my blog adamjwalker.com.