Scrapping US$45 fee boosts 3D mammogram access

Removing a US$45 patient fee led to a significant rise in access to 3D mammography, with the greatest benefits seen among racial minorities and non-English speakers, new research suggests.

Use of digital breast tomosynthesis – a type of 3D mammogram that provides clearer images to aid cancer detection and reduce false positives – rose by 7.8 percentage points after the fee was dropped.

The increase was particularly notable in groups historically underserved by healthcare systems. Asian, Black and Hispanic women saw additional increases of 5.0, 6.2 and 6.2 percentage points respectively, beyond the gains seen in white patients.

Researchers from UCLA analysed screening mammography data from 13,284 women screened between March 2018 and August 2022 at a multi-site academic medical centre.

Until January 2021, patients were charged a US$45 fee for digital breast tomosynthesis, which was refunded if insurance later paid.

The fee was removed once most insurers began offering full coverage.

All women were screened at locations offering both 3D and traditional 2D mammograms, allowing them to choose their preferred option.

Researchers used a statistical method called difference-in-difference analysis to examine how the institutional change affected access across patient groups based on race, ethnicity, language, insurance status and socioeconomic background.

Overall uptake of 3D mammography rose from 83.7 per cent to 91.5 per cent after the fee was removed.

Non-English-speaking patients showed a 7.1 percentage point greater increase in use compared with English-speaking patients.

Patients with Medicaid insurance and those from more socioeconomically disadvantaged areas also saw greater improvements.

However, some disparities remained, suggesting that removing financial barriers alone may not fully equalise access.

Nina M. Capiro, lead author and diagnostic radiologist at UCLA Health, said: “These findings demonstrate that even modest out-of-pocket costs can create meaningful barriers to accessing advanced screening technology.

“While we saw encouraging improvements across all groups after removing the fee, persistent disparities indicate that additional approaches are needed to ensure truly equitable access.

“This research shows how policy changes can have measurable impacts on health equity, but it also reminds us that eliminating financial barriers alone may not be sufficient to address all access challenges.”