County moves to make breast cancer screenings more accessible
SAN JOSE – On Wednesday, the Santa Clara County Health and Hospital Committee (HHC) approved plans to make breast cancer screenings more accessible to more County residents, improving the detection of breast cancer through earlier identification, particularly for women with dense breast tissue.
In response to a proposal by County Supervisor Joe Simitian, who serves as Chair of the County’s Health and Hospital Committee, County officials provided HHC with an update on current appointment wait times for breast cancer screening, planned upgrades and service expansion throughout the County.
In simple terms, Simitian said he wanted the County to “provide more patients with more screenings” in an effort to ensure early detection whenever possible. County staff responded with a proposal to do just that by:
Acquiring additional breast cancer screening equipment;
Upgrading/modernizing screening options;
Providing more screening locations around the County;
Increasing hours of operation;
Training additional staff to provide screening services; and,
Undertaking public awareness campaigns to ensure the public is aware of the breast cancer screening options available throughout the County.
County staff also provided an update on existing programs that help support screening costs for patients unable to afford these services, as well as opportunities for increased public outreach to expand awareness of the importance of screening.
“Early detection is crucial,” said Simitian. “If breast cancer is found early, there are more treatment options available and better chances for survival.”
As a member of the California State Senate, Simitian authored Senate Bill 1538, which required that, following a mammogram, women are notified if they have dense breast tissue, and that there are a range of screening options available to them. Dense breast tissue – present in nearly half of women over 40 – makes abnormalities like cancer more difficult to see on a mammogram and is an indicator of a woman’s increased risk of breast cancer.
The challenge of early detection for women with dense breast tissue is in part what spurred Simitian to push for the service expansion at the County. “Mammograms are essential tool,” he noted, “but I want all these options available for our residents.”
The notice requirement provided for Californians as a result of Simitian’s 2012 legislation will be in place this fall on a national level as a result of federal action – more than a decade after California began providing such notice pursuant to Simitian’s legislation.
While several types of diagnostic imaging are available for early detection, selecting the appropriate method depends on various factors, including the patient's risk profile, age, and medical history.
County facilities are in the process of implementing a workflow that prioritizes patients with emergent needs. One such effort to expand South County access includes Valley Health Center (VHC) Morgan Hill extending its weekday hours and introduce weekend availability for breast screenings this spring.
Additionally, efforts are underway to install Digital Breast Tomosynthesis at VHCs - East Valley, Gilroy, Milpitas, and Tully facilities with the goal of having all locations offer 3-D breast mammography by spring 2025. The County’s new North County health care clinic (currently under construction) is expected to have digital breast tomography capabilities when it opens in late summer 2024. This new technology replaces existing mammography equipment in most locations.
SCVMC’s two mammography machines will also be upgraded to digital breast tomography technology with a new Stereotactic system to support biopsies on the new instruments. One of these machines will be equipped with an upright biopsy attachment, further enhancing diagnostic capabilities for challenging to reach lesions.
Several financial assistance programs offering services critical in early breast and cervical cancer detection and prevention are available to patients who can’t afford the associated costs of these exams, or their follow up recommended procedures.
Primary Care Access Program (PCAP) is a coverage program providing primary health care services for low-income adults living in Santa Clara County without health insurance.
The Healthcare Access Program (HAP) offers emergency and essential medical services at reduced or no cost for qualified patients, addressing the needs of both uninsured individuals and insured individuals facing high out-of-pocket medical expenses.
Every Woman Counts (EWC) is a comprehensive state program designed to aid uninsured and underinsured individuals in accessing high-quality cancer screening and follow-up services. The program is offered at Community Health Partnership (CHP). To determine eligibility and schedule an appointment, residents can contact EWC's consumer line at 800-511-2300.
According to the American Cancer Society (ACS), breast cancer is a leading form of cancer in women, accounting for 30% of new cancers each year and the second-leading cause of cancer deaths. Black women are 40% more likely to die from breast cancer than white women and have the lowest five-year relative breast cancer survival rate of any racial or ethnic group. For Hispanic women, breast cancer is the leading cause of cancer death. In all, about 42,000 women and 500 men in the U.S. die each year from breast cancer.
“The goal is that by increasing access to early detection, patients are empowered to seek treatment early and, fingers crossed, achieve eventual remission,” said Simitian. “Early treatment can help folks preserve their quality of life and avoid the heavy financial burdens that often accompany more invasive treatments.”
Simitian’s proposal for expanded breast cancer screening received support from Cancer CAREpoint, Are You Dense, Inc. and Are You Dense Advocacy, Inc., Community Health Partnership, Asians Americans for Community Involvement, Latinas Contra Cancer, and Bay Area Cancer Connections.
ADDITIONAL BACKGROUND
The most commonly used breast imaging tests used at County facilities at this time are:
1. Mammography: This is the most common screening method and is commonly covered by health insurance plans. It involves X-ray imaging of the breast to detect abnormalities like tumors or microcalcifications. Digital mammography and 3D mammography (tomosynthesis) are advanced forms of this technique. Mammography screenings are available at Valley Health Clinic (VHC) Milpitas, VHC Tully, VHC East Valley, and VHC San Jose.
2. Ultrasound: Ultrasound uses sound waves to create images of breast tissue. It is often used to further evaluate abnormalities found via mammography or in women with dense breast tissue. Ultrasounds are available at Santa Clara Valley Medical Center (SCVMC) and may be covered by health insurance.
3. Magnetic Resonance Imaging (MRI): MRI uses powerful magnets and radio waves to generate detailed images of the breast. It is particularly useful for women at high risk of breast cancer and in cases where additional information is needed after mammography or ultrasound. MRI screenings are exclusively offered at SCVMC and may be covered by health insurance.
4. Tomosynthesis: This technologically advanced mammogram detects breast cancer, especially in dense breast tissue. Breast tomosynthesis is also known as digital (3D) mammography because it uses a series of two-dimensional images to build a three-dimensional image of the breast. This screening is currently provided at VHC Downtown, VHC Morgan Hill, and St. Louise Regional Hospital (SLRH). This screening is covered by insurance when clinically necessary.