Breast cancer is a disease that doesn’t play favorites.
“It’s so random if you’re going to get breast cancer,” said Stacey Lipton, the director of development for the Park City Institute, and a breast cancer survivor.
This year, it’s estimated that 2,030 women in Utah will be diagnosed with breast cancer, and 320 Utah women will die from it, according to the American Cancer Society.
There are moves at the federal level, and in many states across the country, to do more to detect breast cancer sooner — which will give women who are diagnosed with breast cancer a better chance of surviving it. The question is whether more can be done in Utah to support these efforts.
There’s plenty of good work being done on this front in Utah. Early this week, the Kathryn F. Kirk Center — a new expansion of the Huntsman Cancer Institute — opened. The Tribune reported the center has 48 inpatient rooms, four new operating rooms, a floor for treating breast and gynecological cancers, areas for treatment of blood and marrow transplant patients, and more screening space and access for new kinds of clinical trials.
The Huntsman Cancer Institute also has been a major player in cancer research, including work on tracing the genetic roots of cancer and identifying cancer-causing genes — including BRCA1 and BRCA2, the most well-known genes linked to breast cancer.
And yet, there are limits. Only a sliver of Utah’s population gets full access to Huntsman Cancer Institute, because of the byzantine way health insurance companies work — which is not as it should be.
A word of warning: What follows gets into aspects of female anatomy. If that makes you uncomfortable, it’s recommended that you summon your courage, read “Are You There God? It’s Me, Margaret” or watch the movie, and buckle up. If this doesn’t affect you personally, it likely affects someone close to you — your wife, your girlfriend, your friends, your sister, your mom.
The U.S. Preventative Services Taskforce — part of the U.S. Department of Health and Human Services — on Tuesday updated its recommendations for when women should get tested for breast cancer. The new guideline is that all women should start getting regular mammograms starting at age 40; the old guideline, established in 2009, was for every woman to start getting mammograms at age 50.
The reason for the change, according to The New York Times, was a rise in the number of breast cancer diagnoses among young women – and continual high death rates among Black women, which are twice as high as the rates for white women of the same age groups.
According to the American Cancer Society, 60% of Utah women, age 45 and up, were up-to-date on their mammograms in 2020 — below the national average of 67%.
Another recent federal rule change, from the Food and Drug Administration, covers a different issue with mammograms: The fact that they don’t work so well reading through dense breast tissue.
It’s an issue Lipton said she encountered when, at 42, she was diagnosed with breast cancer. She felt a lump in her right breast, and went to the doctor. She had a mammogram, and the cancerous tissue read as a white dot — but so did the dense tissue in her breast.
The FDA’s new rules would require mammogram providers across the country to notify women that they have dense breast tissue — and recommend they check with their doctor about additional screening, such as an ultrasound or an MRI.
Connecticut was one of the first states to require notification. It was championed by then-Gov. Jody Rell, herself a breast cancer survivor. According to DenseBreast-info.org, a health advocacy website, 38 states, including Utah, require this already.
That’s advice Lipton has taken since her diagnosis. She had a mastectomy and reconstruction of her right breast, and an implant in her left breast so they would match. The problem, she found, was that it was difficult to get her left breast, with the implant, into position on the plate for her mammogram.
“You’re not getting all of the tissue” into the device, Lipton said, noting that breast tissue is found from the clavicle down to under the arm.
When she lived in Florida, Lipton said, it was routine for her doctor to prescribe a mammogram and an ultrasound, and she could usually get both in the same visit.
When Lipton moved to Utah, she said she went in for her tests, and got her mammogram — and then was told she couldn’t get an ultrasound.
“I had to have a diagnosis [of cancer], and having a history of breast cancer wasn’t enough,” Lipton said.
Dr. Eugene Kim, medical director of Intermountain Health’s Breast Care Center in Murray, said women who are at high risk for breast cancer — as determined by a questionnaire they fill out when they get their mammogram — are recommended for additional screening.
Recently, Kim said via email, the center has been using a “FAST breast MRI,” which takes 10 minutes and costs much less than a standard MRI. That technology is available only at the Murray location, but will be available at other Intermountain hospitals along the Wasatch Front by year’s end, he said. Intermountain does not use ultrasound for breast cancer screening, but will use it for diagnostic purposes — like locating a lump found during a mammogram.
Lipton also discovered the ultrasound she wanted wasn’t covered by her health insurance in Utah. Ultimately, she flew to Florida to get the ultrasound, on her own dime.
DenseBreast-info.org reports that 17 states and the District of Columbia require health insurance to cover additional screening, like ultrasounds and MRIs, on top of mammograms. Utah is not among them.
The group behind DenseBreast-info.org is backing a bill before Congress, the Find It Early Act, that would make it mandatory for health insurance providers to cover all diagnostic breast imaging — mammograms, ultrasounds, MRIs — for women with dense breast tissue, with no out-of-pocket costs. The bill was introduced in December, and re-introduced this week, with bipartisan support and a celebrity boost from TV journalist Katie Couric.
Utah’s hospitals and health care providers don’t have to wait for Congress to take action. They can make it easier, and more affordable, for women to get additional testing after mammograms. Call it a Mother’s Day gift to all of Utah’s mothers, mothers-to-be and daughters of mothers — and all who love them.
Paul Huntsman, board chairman of The Tribune, is the son of the late Jon M. Huntsman Sr., who founded the Huntsman Cancer Institute.