Disclosure of Options in Breast Cancer Treatment & Reconstruction

In the 1990’s Legislation initiated by the SCSPS was passed for mandatory insurance coverage for reconstructive surgery in women who had been diagnosed with Breast Cancer. This was one of the first public mandates for insurance carrier coverage for a medical/ surgical services. Latter that decade through the ASPS and the ACS the Legislation was passed at the Federal Level. The Women’s Health bs Cancer Rights Act of 1998 (WHCRA), Public Law 105-277, requires health plans that offer breast cancer coverage to also provide for breast reconstruction (http://www.ahrq.gov/consumer/brcanchoice.pdf).  It specified that all insurance carriers cover women for restorative surgery not only for the breast with cancer but also the contralateral breast for symmetry.

A decade latter several medical studies have shown 70 percent of women eligible for breast reconstruction are not being informed of their reconstructive options. The issue has become so concerning that California and New York in acted legislation requiring that women receive information on their breast cancer treatment and reconstruction options.

A 2009 study by Amy Alderman MD at the University of Michigan and Caprice Greenberg of The Dana Farber Institute determined the two dominant reasons why women did not undergo breast reconstruction: 1) the woman was not informed of her options and 2) the woman was not referred to a breast reconstruction surgeon. The Report by Greenberg indicated that women under Medicare undergo breast reconstruction at a rate of 11percent, women with managed care or indemnity insurance undergo reconstruction approximately 54percent. Nationally, only 33 percent of eligible women with breast cancer undergo breast reconstruction. In most cases the
discussion of possible breast reconstruction by the breast cancer surgeon was lacking. Often their was a failure by these patients to understand their options and/or they were not referred to a reconstructive surgeon.

The SCSPS recommends to better inform patients with breast cancer regarding their reconstructive options that:

The information required shall be provided to these breast cancer patient in writing and in advance of obtaining any consent for their surgical procedure and shall include at least the following:
(1) A description of the various types and timing of reconstructive options and the advantages and disadvantages of each;
(2) A description of the provisions assuring coverage by public and private insurance plans of the costs related to reconstructive surgery under federal law.
(3) A description of how a patient may access reconstructive care, including the potential of transferring care to a surgeon and/ or facility that provides reconstructive care or choosing to pursue reconstruction after completion of breast cancer surgery and chemo/radiotherapy, if warranted;
(4) A list of questions a patient should discuss with a reconstructive surgeon; and
Such other information as may be required by Law

Restorative Surgery for the patient with breast cancer is a SC and Federal Law. Yet, several studies indicate practitioners fail to inform patients of their health care options. The SCSPS strongly supports the disclosure of reconstructive surgical options in breast cancer patients.