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The Economics of Breast Cancer Procedures

A new study shows that more women with breast cancer are choosing a mastectomy over a lumpectomy. Could money be playing a role in the decision?
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New research from the Dana-Farber Cancer Institute shows that young women with breast cancer are more likely to choose to have a mastectomy rather than a breast-conserving lumpectomy. After Angelina Jolie’s much discussed op-ed, in which she explained her decision for a preventative bilateral mastectomy, and with one in eight U.S. women developing breast cancer over the course of a lifetime, the study is a new influencer in the already-anxious debate that many women face: mastectomy or lumpectomy?

Reported this week at the 49th Annual Meeting of the American Society of Clinical Oncology, the report evaluated 277 women, ages 40 or below, who were diagnosed with breast cancer ranging from Stage 1 to Stage 3. Of these women, 172 (62 percent) opted to have a single or double mastectomy, a decision that worries some about the overuse of the procedure.

According to the Cancer Treatment and Prevention Fund, it is less expensive to perform a mastectomy than a lumpectomy.

Overall, survival rates for lumpectomy followed by radiation compared with mastectomy are the same. However, with lumpectomy there is a slightly higher rate of the cancer returning to the breast, according to the Susan G. Komen Foundation. Within the study, women with a mutation in their BCRA genes—those with a higher risk of cancer recurrence—were more likely to choose a mastectomy or double mastectomy. It’s possible, then, that mastectomies offer a greater peace of mind, as the study’s lead author Shoshana Rosenberg told NPR that women who scored high on a standard test for anxiety were more likely to choose mastectomy.

Another possible answer, which the study doesn’t address: money.

According to the Cancer Treatment and Prevention Fund, it is less expensive to perform a mastectomy than a lumpectomy. Some insurance plans do not cover all of the expenses of the lumpectomy or radiation therapy, because they can be considered out-patient procedures. However, under the Women’s Health and Cancer Rights Act, group insurance plans that cover mastectomies are required to also cover breast reconstruction by federal law.

A University of Louisville study examined data from the National Inpatient Sample, which includes millions of records on patients from 37 participating states and a stratified sample of hospitals. Author Beatrice Ugiliweneza concluded that the difference in expenses between a mastectomy and a more-expensive lumpectomy was greater than $10,000. A 2013 study published in JAMA Surgeryfound that of the sample of women who chose mastectomies, 39 percent had private insurance while 60 percent relied on Medicaid. (The study also revealed that surgeons are reimbursed about 40 percent less for a lumpectomy compared to a mastectomy, which is a whole other issue.)

While there’s certainly more than just cost—family history, fear of survival, possibility of recurrence—behind the decision between mastectomy and lumpectomy, it doesn’t seem like a factor we should simply ignore. The finances of such an intimate and life-changing decision are intrusive, but in a world where households headed by adults younger than 35 have 68 percent less wealth than their same-aged counterparts from the 1980s, they’re also very real.