Marion Bradley always knew that getting breast cancer was a possibility. After all, she had a family history of the disease, so she wasn’t shocked when she was diagnosed with an early stage of the cancer about five years ago.
But that didn’t make it any less scary.
“It was five dates in January I’ll never forget those dates, in 2014, because there’s some dates that you never forget,” she said, sitting in an armchair at her home in Beacon Falls. “And on January 24 is when I got the call that it was breast cancer.”
Bradley’s cancer was caught early through a mammogram — she eventually got a lumpectomy and radiation instead of harsh chemotherapy. One medication for her cancer treatment actually helped doctors discover existing uterine cancer, which was also in an early stage and quickly treated.
“It all goes back to the mammogram,” Bradley said, “because of the mammogram, (it) found the breast cancer, which started me on the tamoxifen, which found the uterine cancer.”
People like Marion have benefitted from living in a state like Connecticut, where a majority of doctors and diagnostic providers use the most advanced screening technology and therapies. Over the years, the state has also ramped up laws and policies aimed at expanding preventative screening. This year will mark the 10th anniversary of when Connecticut became the first state in the nation to require doctors to notify women if they had dense breast tissue, and therefore may need an ultrasound to get an accurate screening.
And last month, Connecticut again became a leader in prevention when Gov. Ned Lamont signed a law that will require health insurers to eliminate copays, deductibles and other costs for those ultrasounds. The goal is to remove financial barriers that may prevent women who can't afford the screenings they need.
“Because so many women, yeah, they know they have dense tissue, they know they can get the ultrasound, but their deductibles are so high,” Bradley said. “We have insurance, but the deductibles are so high that they won’t get the ultrasound done. And that’s unfortunate.”
Breast cancer is common in women — there are about 3,500 new cases of breast cancer in Connecticut every year. Studies show that survival rates are at an all-time high due to improvements in treatment and early detection.
But outside of Connecticut, women may not have the same preventative care options. A recent study by Yale researchers found that access to potentially better diagnostic technology like 3D mammography varied across the country.
The use of 3D mammograms is still considered new, but so far, doctors say that it reduces false positives and catches more hidden cancers than a traditional 2D mammogram would by providing radiologists with clearer x-rays of the breasts.
Many providers in the Northeast and Northwest parts of the country have already adopted the technology, according to the Yale study. But southern states as well as rural areas have been slower in offering this type of screening test to patients.
“Disparities in the way that health care is delivered are really deep and ingrained in pattern,” said Dr. Illana Richman, of Yale School of Medicine, “so even before a technology has the strongest evidence behind it, we already see evidence of disparities in the way that it’s adopted.”
Richman worked on the study with Dr. Regina Hooley, a radiologist and breast imager at Yale School of Medicine. They agreed more long-term research is needed to figure out whether the use of 3D mammograms over 2D mammograms actually decrease mortality rates.
In the meantime, women who have access to 3D mammograms may have an advantage in getting an early diagnosis of breast cancer.
Even though federal laws like the Affordable Care Act have made traditional mammograms a free, preventative service, Hooley said, “(3D mammography) was not always covered by insurance companies, so there might have been an out-of-pocket payment. And so, it’s a combination of factors of whether or not women would receive that mammogram.”
But even with coverage and access to 3D mammograms, that still might not help women with dense breast tissue. Joe Cappello says 10 years of mammograms didn’t detect his wife Nancy’s breast cancer — she had dense tissue and eventually got an ultrasound, which found late-stage breast cancer in 2004. Joe said they were dumbfounded.
“The shocking part of this was she had a mammogram for the past 11 years, and just had one just prior to her diagnosis,” he said. “So the question remains at the time, how could this be?”
Joe and Nancy founded the Are You Dense education and advocacy foundation in Connecticut, which expanded to an international reach. They championed laws requiring women to be notified that they have dense tissue, which were adopted by 36 states, and insurance coverage for those additional tests.
Nancy beat breast cancer, but died in November from an infection related to a blood cancer caused by the chemo and radiation she received in 2004. She was 66 years old.
In February, President Donald Trump signed into law a national version of Connecticut’s dense breast tissue notification legislation. It’ll go into effect next year.
Joe hopes that new federal and state laws will lead to more early diagnosis and spare other women what his wife went through.
“You ask the question, is early detection important? Early detection is everything,” he said. “You may not be able to stop cancer, but if you have it, you want to find it early and early matters.”