Effective breast cancer treatment less common in US

Heidi Tolansky was preparing for a hip replacement surgery taking

care of her children and her dying mother

When all of a sudden I got this out of

the blue routine mammogram

Breast cancer diagnosis

She was diagnosed with two different cancers back in 2012

1 in each breast

For her left she qualified for a less common targeted

treatment known as intraoperative radiation therapy or IORT

The way it works is in my opinion ingenious and

amazing

Alice Police is a breast surgical oncologist

She started 3 different IORT programs in the United States

over the past 20 years

She's also Heidi's doctor

It's targeted radiation therapy to the lumpectomy cavity

In IORT the dose is delivered

Performing a lumpectomy right to the part of the breast

where a tumor was removed

It takes 18 to 40 minutes

It's not for everyone

It's generally meant for postmenopausal women with early stage small

cancers and in some cases may require additional radiation therapy

But the ease of the procedure and the lower cost

make it worthwhile for many patients

It is such a Wonderful

At roughly $8000 to $10,000 it costs much less than

traditional radiation therapy which requires multiple sessions

How did you pay for your IORT treatment My insurance

paid for it but that's not always the case

While Medicare and Medicaid cover the cost of IORT and

it's a more common treatment in other countries some private

insurers in the US and Medicare Advantage plans did not

Coverage

We know that the recurrence rate with intraoperative radiation therapy

is higher than with other methods of partial breast radiation

or whole breasts

Dr

Catherine Yashar is the president-elect of the American Society for

Radiation Oncology or ASTRO

The organization does not recommend IORT unless part of a

clinical trial or registry but NBC News spoke to roughly

a dozen breast cancer surgeons who say the economic Of

medicine is playing a major role

Medicare reimbursement data shows that for IORT oncologists receive less

than half what they get from traditional radiation

Hospitals also charge facility fees for repeated radiation sessions

Astro says that it's not a factor in their guidelines

We don't have control over what insurance companies decide to

cover or not cover

We also asked Astro whether they consider things like travel

time gas money

And having to take off work to get traditional treatment

we absolutely are sensitive to that the patient experience and

the socioeconomics and it is definitely more convenient for patients

But again I think that patients have to balance that

with the control rate

For about 80% of people who undergo IORT that's it

one and done

But for others sometimes we find a lymph node that's

positive

On final pathology which comes a week after surgery and

the patient will go back and have whole breast radiation

And that is what happened to Heidi Tolansky

Her full pathology report revealing additional cancerous cells after the

lumpectomy and she needed whole breast radiation

It's like you're a piece of hamburger on a barbecue

grill

So for months after the radiation I was exhausted

I mean the fatigue

The tired the scar tissue

What would you tell someone who was just diagnosed with

breast cancer if they had the potential to get IORT

Do it

Don't even think twice

Just do it

Surgeons NBC News spoke with encouraged qualifying patients to ask

their physicians about IORT

It isn't without consequence Heidi says scar tissue the size

of a golf ball developed in her left breast but

research shows IORT reduces the risk of possible heart and

lung problems associated with traditional radiation

So I just think that We are missing an opportunity

if we are not investing heavily in this

Now Heidi remains cancer-free thanks to modern medicine and like

many hopes one day IORT will be a first line

of defense in fighting breast cancer