Local News

Quicker Breast Cancer Treatment Limited For Some By Insurance

Posted October 8, 2004

— Fighting breast cancer can be emotionally, physically and financially draining -- especially when certain treatments are not covered by insurance.

There are some relatively new breast cancer treatments that some health plans will not cover, and without insurance, treatment options for some women are out of reach.

Last July, Glenda Cox could only think of getting ready for the new school year. Then she found she had breast cancer.

"It hits you in the face and you have a lot of decisions to make," she said.

Instead of removing the whole breast, Cox chose a lumpectomy. Then she learned she was a good candidate for

MammoSite

, a quicker and more targeted treatment compared to traditional radiation, which takes several weeks.

After the lump is removed, the surgeon inserts a catheter. A balloon fills the lump cavity and a radioactive seed goes into the balloon, treating the area where cancer is most likely to return.

"I think that this method allows patients to condense the treatment and potentially get to the same end result," surgical oncologist Dr. Lisa Tolnitch said.

The best part is that the treatment takes only five days. So Cox went to her radiologist.

"I walk up to the desk and they hand me a piece of paper and it says your insurance doesn't cover this type of radiation therapy and your cost will be $30,000," Cox said.

Her insurance provider, Blue Cross Blue Shield of North Carolina, lists MammoSite as investigational therapy and is covered only if it is used in addition to traditional radiation.

The news surprised Tolnitch.

"It's the only one we've run into," she said. "It is approved by Medicare and all the other providers are covering it."

The maker of MammoSite says Blue Cross Blue Shield has never covered the procedure in three states -- Kansas, Arkansas and North Carolina.

Blue Cross affiliated plans in 16 other states have policies against covering MammoSite as stand alone therapy, but have covered the procedure on a case-by-case basis.

The medical director for the Blue Cross State Health Plan says there still has not been enough clinical research to support MammoSite as stand alone therapy.

"Even though the early studies show equal efficacy, that we don't know yet what the longer term is going to show for this modality," Dr. Jenie Komivies said.

The Food and Drug Administration approved MammoSite two years ago, but Cox was forced to choose the longer, traditional therapy.

Cox said she is angry -- and so are her doctors.

"This puts an unnecessary battle on the shoulders of the patient and the treating physician," Tolnitch said.

Blue Cross Blue Shield representatives say in the states that have covered MammoSite on a case-by-case basis, those patients have to meet strict criteria, and those cases are the exception, not the rule.

  • October 24, 2003:

    MammoSite A New Treatment Option For Some Women With Breast Cancer

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