Cooling caps, additional breast cancer screenings required to be covered under new law

When Diane Anderson was diagnosed with stage 1 breast cancer late last year, she wanted to keep her hair while undergoing treatment.

"I figured with this disease, it’s the only thing I can control," she said.

On Friday at Mount Sinai South Nassau hospital in Oceanside, she donned a "cold cap" device on her head which helps prevent hair loss from chemotherapy treatments.

The procedure could cost between $1,500 to $3,000 for patients who don't have insurance, and Anderson said she was only about to afford it because she was covered by a hospital grant.

But a new state law that went into effect Jan. 1 requires large group insurance companies to cover the cooling cap treatment, meaning more patients will have access to the device.

It’s one of two new legislative changes designed to help cancer patients in the state. The other requires individual, group and nonprofit health insurance plans to cover additional breast cancer screenings such as breast ultrasounds and MRIs if it is deemed necessary by a physician.

Medicare and Medicaid already pay for cooling cap treatments but before the legislative change, it was out of reach for many patients whose insurance didn't cover it.

Cancer experts said loss of hair isn’t just about vanity for patients, but one more burden while they are going through lengthy, painful therapies.

"Anything we can do to minimize a change, whether it be physical or emotional, will make them go through the treatment process better," said Dr. Veena John, system head for gynecologic and medical oncology at the Northwell Health Cancer Institute. "Hair loss is one of the most devastating side effects that I have to discuss with my patients."

John noted that some of her patients who go through chemotherapy have minimal or no physical side effects, except for hair loss.

"It’s a constant reminder and a big emotional factor," she said. "We want them to focus on their treatment with a positive mind, so they have a better outcome."

While the cold caps do not prevent hair loss in all patients who use them, various studies have shown they can help preserve 50% or more of patients' hair.

Dr. Richard Lee, chief of oncology and hematology at Mount Sinai South Nassau, said cooling cap therapy has many benefits for patients, especially now that studies have refuted concerns that they interfere with cancer treatments.

"When these first came out, there was some worry that by freezing the scalp, tumor cells would not be treated with the chemotherapy," Lee said. "Meta-analyses have shown there’s no increased risk of metastatic disease in the scalp."

Lee pointed out that while it was considered safe and approved by federal officials, it was not well-covered by insurance.

"It’s important for patients because keeping your hair and keeping your appearance helps your quality of life," he said. "How a patient feels about their quality of life when they're going through this difficult cancer journey makes a big difference in how they tolerate treatment and in their psychological well-being."

Since 2023, Mount Sinai South Nassau has been able to offer the cold cap treatment to 46 women — including Anderson — who had no insurance or partial insurance through a partnership with the Rockville Centre Breast Cancer Coalition. A total of 290 treatments were given, according to hospital spokeswoman Dana Sanneman.

While these new laws are embraced by cancer patients and their providers, insurance companies have expressed concerns in general about mandates that could lead to higher health care costs.

In a statement, the New York Health Plan Association, which represents insurance companies, said the "collective impact of mandated benefits contributes to the growth in health insurance premiums, adding to the cost of coverage for everyone — consumers, employers, union benefit funds and the state."

The law that expands breast cancer screening coverage will help women who need additional diagnostic imaging to find signs of cancer not always visible on a traditional mammogram. That can include patients with dense breast tissue and a family history of breast cancer.

"Mammography has been shown to save lives, but it may not be enough for some women," Dr. Jocelyn Park, chief of breast imaging at Northwell Health, said in an interview. "For higher-risk women, breast MRI is recommended as a supplement to mammography. Dense breast tissue can obscure cancers. Those patients could also benefit from breast ultrasound or MRI."

She said since coverage for these additional tests has varied; some women who cannot afford it sometimes pay out-of-pocket or delay or skip imaging, which "can lead to later-stage diagnoses and worse outcomes."

For Anderson, her thick hair is "kind of sacred" to her, so she's happy the treatment seems to be successful.

"It’s working for me," she said. "It doesn’t work for everybody, but it’s working for me."