Gail’s Law Expands Access To Life Saving Breast Cancer Testing
Guest Contributor
Wisconsin is making a significant change to how breast cancer is detected and treated, and it centers on a new law often called “Gail’s Law.” Under this policy, more patients with dense breast tissue or an elevated risk of breast cancer will have access to supplemental breast cancer screenings such as ultrasounds and MRIs. For many families, this could mean earlier diagnoses, more effective treatment, and better outcomes.
The core of Gail’s Law is straightforward. For any patient whose doctor determines they have dense breast tissue or are at higher risk for breast cancer, all state-regulated health insurance plans in Wisconsin must now cover medically necessary supplemental breast cancer screenings. That includes additional imaging like breast ultrasounds and breast MRIs, which can reveal cancers that a standard mammogram might miss. The issue of dense breast tissue and cancer risk has been discussed for years, but this law directly addresses the financial barriers that often kept patients from getting the recommended tests.
Dense breast tissue plays a key role in why these expanded benefits are so important. According to the Breast Cancer Research Foundation, about 50% of women in the United States have dense breast tissue. On a mammogram, fatty tissue appears dark, which creates good contrast for spotting suspicious white areas that could indicate cancer. Dense fibroglandular tissue also appears white, which makes tumors harder to detect. As one UW Health radiologist, Dr. Mai Elezaby, explained, trying to spot a white tumor in white dense tissue is like trying to see white on white. In patients with dense tissue, mammograms simply do not perform as well as they do in patients whose breasts are mostly fatty tissue.
Dense breast tissue is not only a detection problem, it is also a risk factor. Patients with more fibroglandular tissue have a higher baseline risk of developing breast cancer. That means they face what Elezaby described as a double problem. Their chances of developing cancer are higher, and the most common screening tool used to find cancer, the mammogram, is less effective for them. This combination can delay diagnosis and push more patients into later stages of cancer before it is discovered.
The timing of diagnosis matters. According to the National Institutes of Health, 27% of women with breast cancer are not diagnosed until they have already reached stage 3. At that stage, tumors have typically invaded nearby tissues, even if they have not yet spread throughout the body. Earlier detection makes less aggressive treatments possible and significantly increases cure rates. Elezaby emphasized that catching cancer at an earlier stage allows many patients to avoid the most aggressive forms of treatment and dramatically improves the odds that treatment will be successful.
Access to supplemental screening has long been shaped by cost. Before Gail’s Law, many patients who were told they should get a breast ultrasound or MRI had to decide whether they could afford it. Without insurance coverage, a breast MRI can cost around $1,000 and a breast ultrasound about $500 at an independent clinic, and up to $1,000 at a hospital outpatient department. Those amounts are out of reach for many people. Elezaby noted that some of her patients declined additional recommended tests simply because of the price. I found this detail striking because it illustrates how often life saving care depends on whether patients can pay, not just on what medicine can do.
The new law aims to close that gap. For patients on Medicaid, the expansion of benefits took effect July 1. For residents with governmental self-insured health plans, small group health plans through their employers, and individual market health insurance plans, the changes will take effect on January 1. The expectation among doctors and advocates is that once cost is removed as a barrier, more patients at high risk or with dense breasts will follow through on additional imaging recommendations, leading to more cancers caught at earlier stages.
Who qualifies for these supplemental screenings under Gail’s Law depends on medical assessment. Patients at high risk of developing breast cancer or those with dense breast tissue are eligible for the expanded insurance coverage. Elezaby encourages patients to talk with their primary care physicians about their individual risk. Factors can include family history, known genetic mutations, and other clinical considerations. For example, current recommendations from major medical organizations suggest that women without documented high risk should begin screening mammograms at age 40. Those with a confirmed genetic mutation that can cause breast cancer are advised to start at age 30. Patients with a strong family history but no identified genetic mutation are usually told to begin 10 years earlier than the youngest age at which a first degree relative, such as a parent, child, or sibling, was diagnosed.
Gail’s Law is named in honor of Gail Zeamer, a Neenah resident whose experience helped drive this policy change. Zeamer was diagnosed with stage 3C breast cancer in 2016. Her cancer later returned and spread to her brain, and she died in 2024. She learned only after her original diagnosis that she had dense breast tissue. Before this current legislation, an earlier step in Wisconsin was the Breast Density Notification Law, signed in 2017. That law required doctors to inform patients if their mammogram showed dense breast tissue. While that transparency mattered, Elezaby and other advocates recognized that simply telling patients about their risk was not enough if they still could not afford the recommended follow-up tests.
In that context, Gail’s Law is seen as a significant next step that moves from awareness to action. It not only informs patients about dense breast tissue and breast cancer risk but also supports them with coverage for the imaging tools doctors know can detect cancer earlier. Elezaby described it as beneficial not only for patients and their families but also for health care providers and communities who would rather focus on early stage disease than on advanced cancer. With the financial barrier lowered, more people in Wisconsin who have dense breasts or higher risk factors may have a better chance at early diagnosis and, ultimately, improved outcomes.