Outdated breast cancer screening could be putting LA women at risk

In an effort to save women from the second leading cause of death—cancer—it's time for a whistle-blow. With a fifteen year career in women’s healthcare, I’ve kept a close eye on Los Angeles’s technology and our health disparities and inequalities. Having worked throughout the US and abroad, I’ve noticed very few advancements in breast cancer screening in Los Angeles (relative to other cities).  Every year, I imagine this will improve, yet it has not. In hopes of saving just one woman’s life, I thought it was time for a whistle-blow from inside the industry.

First things first: Did you know the USA is ranked 11th in healthcare innovation and that only 4% of healthcare R&D is targeted specifically for women? Within this 4%, the US government does support breast cancer research by funding more than $550m per year – yet there are still 42k invasive breast cancer deaths a year, a rate which is increasing by half a percent each year.  Ladies, one in eight women will now be diagnosed with breast cancer. This makes my heart pound with emotion.  Is the USA focusing on all of the right things about breast cancer? I feel it's important that we focus on early breast cancer detection, as does USPSTF, who published NEW screening guidelines April 2024.  

If breast cancer is detected early (e.g. Stage 1 vs. Stage 4) it means the 5-year survival rate for women improves from a 22%-32% (Stage 4) survival rate to a 93% (Stage 1) survival rate. (The earlier cancer is detected, the lower the stage.)  It's been said that cancers can double in size/spread in just one year. *This number varies based on patient age and breast cancer type. I’m sure that if any of us women were told we have breast cancer, we’d prefer a 93% survival rate over a 22%.  Earlier breast cancer detection saves lives.  We can increase the rates of earlier detection with new technology. 3D mammograms (which is 2010-era technology) are proven to detect breast cancer 15 months earlier than 2D (1996 technology, NIH). Shouldn’t 3D (which has the same radiation dose as 2D) now be the standard of care?

Most women throughout the USA automatically receive a 3D mammogram because it’s a covered benefit by Medicare, Medicaid and most private insurances. Insurance plans provide coverage because 3D offers earlier and less costly treatment.  If you were a patient in Texas or any other state - the majority of all imaging centers offer 3D. However if you are a patient in Los Angeles, it’s a different story.  I estimate that nearly half of our imaging centers only offer 2D mammograms.  This is a travesty for healthcare in southern California. Do hospitals expect Angelenos not to raise an eyebrow? In a time and place where medical research is literally at our fingertips, we should not tolerate this level of care. 

As women, we expect we’re doing the right thing getting a mammogram annually. But would it surprise you to know that 3D mammography is not the standard of care in our city? Here in Los Angeles, very notable sites (Kaiser, Providence, Adventist, County, Dignity, Optum, etc) have locations that only offer 2D and justifying it with reasons like "our network can’t handle the large file size", "patients do not ask for it" or "it adds too much of a workload on our radiologists." My heart breaks knowing that hundreds of women are getting screened today and their cancer isn’t being caught at an early stage due to inferior 2D technology. Do women know? 

California cities are nearly always in the top 10 healthiest cities in the USA, so why are we lagging in FemTech? Is it because as women, we're not speaking up? Are we simply complying with what a hospital offers for preventative care even if it's decades old? For me, this is unacceptable. All hospitals should be offering standard of care technology with a focus on early detection or prevention. Perhaps this could lower the estimated 42k invasive breast cancer deaths a year in the USA (studies indicate tomosynthesis lowers invasive breast cancer detection by 40%).

The first step is to acknowledge that this is happening in Los Angeles. Next we need to make massive strides to fix it quickly. How do we do this? Please share your comments below on how to improve Female Healthcare in Los Angeles. If you want to know if your imaging center offers 3D versus 2D leave a comment and we’ll get you the information. There is a reason hospitals are scored on patient satisfaction scores; it drives best-in-class care. Healthcare has been a human right since 1948, let's stand up to cancer and ensure we're receiving the gold standard in healthcare.