Breast Cancer Experts Push for Innovation

Less invasive procedures and more health coverage needed in the fight, international panel urges

SUNDAY, Oct. 14, 2001 (HealthDayNews) -- An international panel of breast-cancer specialists is pushing for wider adoption of innovative, less invasive procedures -- and more money from insurance companies for mammograms, breast surgery and clinical trials.

In a paper published in a recent issue of the Journal of the American College of Surgeons, the group stressed the critical role that mammography has played in increasing the survival rate of breast cancer patients, and how such techniques as needle biopsies have reduced the number of women going to the operating room.

"Why should I go to the operating room to make a diagnosis when I can do it with a needle? It's ridiculous," says Dr. Melvin Silverstein, chairman of the panel and director of the Harold E. and Henrietta C. Lee Breast Center at the University of Southern California/Norris.

"Within the next couple of years, I won't be surprised if they're willing then to say this is the standard of care. That's clearly where it's headed," he adds.

The 22 members of the panel, all breast cancer experts from the United States and Europe, encouraged wider adoption of such promising procedures as sentinel node biopsy to determine if cancer has spread to the lymph nodes, and partial breast irradiation instead of weeks of demanding radiation therapy. They also recommended a closer working relationship with plastic surgeons for breast reconstruction.

That's welcome news to Dr. William Armiger, former governor of the Maryland chapter of the American College of Surgeons and now medical director of Chesapeake Plastic Surgery Associates in Baltimore.

"I'm delighted this is more accepted now," Armiger says. "As patients are more aware that they can get better reconstructive surgery, they'll get treated more and be more amenable to the concept. It's a very, very good thing.

"When I can talk with the surgeon ahead of time about the type of tumor, its position in the breast, whether the cancer is in the lymph nodes, the patient's age and general health, I can help him plan an initial incision to give the patient something that will look good," he adds.

The panel also strongly urged the insurance industry to increase the reimbursement to doctors for both mammography and breast surgery, saying that continued improvement in screening and treatment "is threatened by inadequate reimbursement for diagnostic radiology, pathology and surgery." Already, mammography centers in the United States are shutting down because the reimbursement rates don't cover costs of the procedure, according to the panel's paper.

The fact that monetary issues are even mentioned in a medical journal article is evidence of the severity of the problem, Silverstein says.

"Ten years ago, there would have been no room [in a paper] for anything financial," he says. "It wasn't academic, so what did it matter? We've gotten to the point where we can't ignore it. Women can't get screened."

That's a major source of frustration for Dr. Toncred Styblo, associate professor of surgical oncology at Emory University School of Medicine in Atlanta. At her hospital and many others across the country, there's a shortage of doctors who interpret mammography X-rays because of the low reimbursement rates, among other reasons. Meanwhile, mammography is a vital tool for detecting breast cancer at its earliest -- and most treatable -- stages.

"It's been a nightmare," Styblo says. "It's a struggle to fill the spots. Anywhere you go, they're going to tell [a patient] that we can't work you in for a mammogram tomorrow. Reimbursement is a very, very, very limiting issue. We'd like to screen way more women than we do. If we want high-quality care for breast cancer, we need to reimburse people at a reasonable level so they don't lose money."

What to Do: For more information about breast cancer, visit the Web sites sponsored by the American Cancer Society. And you can get details on support groups at the National Alliance of Breast Cancer Organizations.

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