Relates to information and access to breast reconstructive surgery

Existing law

While existing federal and state law mandates insurance coverage for reconstructive surgery, no requirement currently exists that would ensure that women have the necessary information about reconstructive surgery options that they might wish to consider nor about their potential access to such services.

Justification

240,000 women will be diagnosed with breast cancer this year in the United States and approximately 40,000 women will die of the disease. Over the last forty years, considerable progress has been made in the diagnosis, detection, and treatment of breast cancer. Genetic testing for susceptibility genes like BRCA, targeted chemotherapeutics like Herceptin, and microsurgical reconstructive techniques have given women more hope, more options, and a better chance of not only surviving but recovering from this disease.

Breast cancer care, at the highest level, is delivered by a multi-specialty group of physicians and surgeons that include a medical oncologist, a breast surgeon, a radiation oncologist, and a reconstructive surgeon. Despite the advances and the progress, there remains a significant disparity in the care provided to women with breast cancer, particularly with respect to access to reconstructive surgery.

Reconstruction of the breast after cancer surgery has not always been the standard-of-care. with the development of improved reconstructive techniques during the last two decades, we entered a new era in breast cancer care. Reconstruction has repeatedly been shown to improve the quality of life and overall well-being of women who have been treated for breast cancer. However, it is not for everyone; there are some women who undergo surgery for breast cancer who either do not want or are not candidates for reconstruction.

In the 1990s, studies showed a great disparity among women who received reconstruction and those who did not. This disparity related to the patient's socioeconomic and educational status as well as to the breast surgeon's practice setting. When breast reconstruction was viewed as a cosmetic procedure, insurance companies were not compelled to pay for it. poor women often could not afford to pay out-of-pocket for the procedure. To address this disparity, Congress passed the Women's Health and Cancer Rights Act in 1998. This legislation guaranteed universal coverage for reconstruction after surgery for breast cancer and comparable provisions were added to New York State Insurance Law to ensure that coverage was extended here in New York. Despite these laws, however, disparities in access to reconstructive surgery remain. several important national studies conducted under the leadership of Amy Adelman at the University of Michigan and Caprice Greenberg at Dana Farber analyzed why many women did not receive reconstruction. The two dominant causes were their failure to understand their options and breast surgeons' failures to refer their patients to a reconstructive surgeon. According to a recent report by Greenberg, the greatest predictor of reconstruction was a documented discussion about reconstruction between the breast surgeon and patient. This critical discussion is not taking place often enough.

Statistics on the type of treatment women receive for breast cancer care at a particular hospital or in a particular region are not publicly available. The best surrogate is to compare the patient population of interest with a similar one from a studied database. The surveillance, Epidemiology, and End Results (SEER) cancer registry, run by the National Cancer Institute (NCI), provides this opportunity. Analysis of treatment received by women in different settings provides stark contrasts. The SEER database looks at women treated in a variety of geographic settings, with attention paid to factors such as level of education, socioeconomic status, type of medical center (cancer center vs community hospital), and a variety of other factors. Multiple analyses show that poor, uneducated women are far less likely to receive reconstruction. Their breast surgeons are less likely to discuss it with them. They are less likely to receive treatment at a dedicated cancer center. They are more likely to receive a lumpectomy and radiation than to undergo a mastectomy followed by reconstruction. Greenberg et al. reported the disturbing fact that women with Medicare had a reconstruction rate of 11% compared with women with managed care or indemnity insurance who received reconstruction approximately 54% of the time. Nationally, across multiple socioeconomic groups and different treatment environments, only 33% of women undergoing surgery for breast cancer will receive reconstruction.

The bill is, designed to educate women regarding the availability of reconstructive surgery and enhance access to these services. When a woman is diagnosed with breast cancer, she will be given information that clearly explains her rights to coverage and her options as they relate to reconstruction. This is akin to the informed consent a patient must sign before undergoing any operation. The bill will also require that the patient receive information relating to the option of referral to a reconstructive surgeon at the time of diagnosis or shortly thereafter if she chooses. Because important decisions on cancer care, such as the choice between having a mastectomy or a lumpectomy, are influenced, in large part, by the patient's understanding of reconstructive options, the reconstructive surgeon must be part of this discussion from the very beginning.

Legislative history

None.

Fiscal implications

None.

Effective date

January 1, 2011.