New HMSA rules cut back women’s cancer screenings

Everyone agrees on the benefits of the early detection of cancers, but the medical community and insurers have dialed back their guidelines for tests to detect those cancers.

Their reason: Frequent screenings are often unnecessary — and possibly bad for you.

This year the Hawaii Medical Service Association, the state’s largest health insurer, decreased coverage of women’s health screenings to align with industry standards.

That has raised concern among some patients who only recently found out about the benefit changes.

Pap smear screenings used to detect cervical cancer are no longer covered annually for women between 21 and 65. The new standard is every three years.

And mammograms, used to diagnosed breast cancer, are covered only for women ages 40 and older — no longer for those between 35 and 39, HMSA said in benefit change documents.

The health insurer said it made the changes based on recommendations by the U.S. Preventive Serv­ices Task Force, an independent panel of national experts, which relies on scientific evidence.

Doctors say the changes are in line with industry standards for at least the last five years, though HMSA has been paying for the benefits up until this year.

Several patients who spoke to the Honolulu Star-Advertiser, including Aiea resident Shelly Kuni­shige, 37, recently found out about the benefit changes and are concerned about the reduction in screenings because many younger women battle breast, ovarian and cervical cancers. They say there was minimal outreach done to notify HMSA members about this change in coverage, and fear this could discourage women from getting annual checkups, or they may be surprised with a large bill if they aren’t aware of the changes.

“It was a little concerning to me because I had ovarian cancer and actually had an abnormal Pap smear in the past,” she said. “My worry is if I hadn’t had that screening — say I waited another two years to have a screening — how much would those cells have spread?”

“I remember getting my first Pap smear when I turned 17. With HPV (human papilloma virus) and all those other concerns, I would want my daughters to have that same access to care that I did,” she added. “I don’t know why you wouldn’t want to have somebody checking and catching things early.”

HMSA, which in recent years has made a large push toward prevention and early detection of chronic diseases, said it “relies on medical evidence and best practices to develop medical policies that will keep our members in the best health.”

“In general, annual Pap smears are no longer recommended by any medical society or medical association because the potential harm outweighs the benefits,” the insurer said. “However, we also recognize that each member’s health is unique. Our teams work with doctors to make adjustments to our policy whenever a member’s health or history makes this appropriate.”

For instance, those changes do not apply to women with a family history of the relevant cancers.

Dr. David Grossman, chairman of the U.S. Preventive Services Task Force, said the task force in 2012 recommended screenings every three years for cervical cancer and has always advised mammograms after age 40, consistent with other medical organizations.

“Insurers essentially have options. We consider our recommendations to be the floor, not the ceiling, with regard to coverage,” he said. “We certainly do not use in any way, shape or form cost or coverage considerations when we make a decision. Every screening test has not only benefits, but potential harm. Sometimes doing too much screenings actually can pose a harm to a patients.”

In the case of cervical cancer screening, screening more often than every three years meant some women were getting false positives, which led to further unnecessary procedures that could harm them. In addition, too many screenings could lead to procedures that weaken the cervix, potentially causing premature births, he said.

“One potential harm is where you’re essentially over-intervening,” Grossman said. “Nothing has changed with our recommendations. The recommendation we issued for breast cancer screening in 2016 was the same as 2009. It may be it’s taken them (the insurers) a while to update some of their benefit policies.”