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By Sally C. Pipes
President, CEO, and Thomas W. Smith fellow in Health Care Policy, the Pacific Research Institute
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The cost of finding breast cancer late can be staggering–both in dollars and in years of life.
A new study by researchers at the National Cancer Institute and American Cancer Society found that, among Medicare beneficiaries, first-year oral prescription drug costs averaged roughly $700 for localized breast cancer—and about $25,000 after it had spread. Other cancer-attributable medical spending more than doubled after the disease had spread, from about $34,000 to more than $73,000.
Those figures underscore the enormous value of finding breast cancer sooner. Yet our health care system still makes timely screening and diagnosis harder than they should be.
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First lady Melania Trump's new women's health initiative offers an opportunity to change that. The administration's effort includes a focus on breast cancer screening and timely diagnostic follow-up. Achieving those goals will require greater patient freedom, less administrative friction, and fewer restrictions on competition.
There is little question that early detection saves lives. The breast-cancer death rate has fallen 44 percent since its 1989 peak, a decline the American Cancer Society attributes to earlier diagnosis and better treatment.
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American women also fare well compared with their foreign peers. In a major comparison of cancer-registry data, five-year breast-cancer survival was about 90 percent in the United States, 88 percent in Canada, 87 percent in France, and 86 percent in the United Kingdom.
Yet breast cancer diagnoses are becoming more common, partly because better screening and diagnostic technology find cancers that once went undetected and partly because of changes in risk factors such as obesity, alcohol consumption, and reproductive patterns. In recent years, diagnoses have risen about 1 percent annually overall and 1.4 percent annually among women younger than 50.
Too many women still encounter unnecessary friction in getting screened. In 2023, 79.8 percent of women aged 50 to 74 reported having a mammogram within the previous two years, a rate that has barely budged since 2019. Screening rates also vary considerably by state.
Federal rules allow women to obtain a mammogram without a physician referral. But some facilities do not accept self-referred patients. Facilities should make direct scheduling easy wherever possible. Women due for routine screening shouldn't need a referral just to book a mammogram.
Another obstacle can emerge after screening. Roughly 10 percent of women screened in the United States are called back for additional evaluation. Most will not have cancer but may need more imaging or a biopsy before they know that.
Research has identified delays caused by communicating results, scheduling additional testing, and obtaining new orders from referring physicians. At one breast-imaging center, some abnormal mammograms took more than 70 days to resolve before the facility streamlined the process.
When a radiologist calls for additional imaging, patients should be able to move directly to the appropriate test rather than begin another round of phone calls, referrals, and scheduling.
For the smaller share of patients who need advanced imaging such as breast MRI, insurer paperwork can add another hurdle. Cigna uses precertification for high-tech imaging, including MRI, under affected plans, while UnitedHealthcare requires prior authorization for certain advanced outpatient imaging services.
When the clinical need is clear, approvals should be automatic or immediate. Once screening raises a legitimate concern, needless paperwork shouldn't stand between a patient and a diagnosis.
A third barrier is geographic. A national study estimated that 8.2 million women ages 45 to 84 lived more than a 20-minute drive from the nearest mammography facility. Yet certificate-of-need laws in some states still regulate diagnostic-imaging facilities, MRI equipment, or MRI services.
States should remove rules requiring government approval before qualified providers add imaging capacity or enter the market. More competition means more options—and a better chance of getting a scan closer to home.
As the administration pursues its new women's health initiative, it should keep several principles in mind. Women need more control over their care. Providers and insurers should eliminate needless delays. And states should stop restricting competition that could make screening and follow-up imaging easier to obtain.
Breast Cancer Awareness Month is October. It offers an opportunity to take stock of the progress we've made—and the work that remains. Reminding women to get screened matters. So does giving them clear information about symptoms and making sure that, when something looks suspicious, they can move quickly toward a diagnosis.
We know the medical and financial value of finding breast cancer early. Our health care system should make it easier to do so.
Sally C. Pipes is president, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is The World's Medicine Chest: How America Achieved Pharmaceutical Supremacy—and How to Keep It (Encounter 2025). Follow her on X @sallypipes.
The views expressed in this article are the writer's own.
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