Beyond the headlines: Finances and disparities in breast cancer
LBBC’s views on breast cancer news
Spring is in bloom at our home office outside Philadelphia, and the rising temperatures and longer days fuel the energy we need to track the news we bring you this month.
With Thriving Together: 2023 Conference on Metastatic Breast Cancer right around the corner, we’ve been discussing policies that positively impact people with stage IV breast cancer, including the Metastatic Breast Cancer Access to Care Act. Our April issue covers this legislation as well as health inequities in screening, for older adults, and Black people. There’s also promising news for CDK inhibitors in early breast cancer and a celebration of our LBBC Leadership Volunteers who continue to inspire the next generation of advocates.
Financial toxicity from breast cancer
Pressure is mounting for policy makers to address concerns about the financial impacts of breast cancer. In March, the Metastatic Breast Cancer Access to Care Act was re-introduced to both the U.S. House and Senate. This legislation, which LBBC supports, would waive the 5-month and 24-month waiting periods for eligible people with stage IV breast cancer to access Social Security Disability Insurance and Medicare benefits. But Medicare coverage alone won’t solve the problem: one study showed that older adults who had comprehensive Medicare plans still struggled to afford breast cancer care and depended on financial assistance for access.
Our CEO Jean Sachs continues to speak publicly about financial toxicity as an equity issue; our local NPR station recently interviewed her about coding changes in breast reconstruction that puts the cost of DIEP flap surgery out of reach for some people. Our advocacy is making a difference – we just learned that Cigna, one of the largest U.S. health insurance companies, agreed to delay changing its coding policy for tissue-based breast reconstruction and will remedy member payments for DIEP flap surgeries that have been performed since March 12, 2023.
The coding change is certainly making a really good option not accessible to everybody.
- The Metastatic Breast Cancer Access to Care Act (Senate.gov)
- The government must act now to improve the lives of people with terminal breast cancer (The Hill)
- Breast cancer costs linger for many women as Medicare falls short (Detroit Free Press)
- Breast cancer survivors, surgeons worry new medical codes will limit access to DIEP reconstruction surgery (WHYY)
Related LBBC content
Make dense breast screening affordable
It’s good policy to make women aware of their breast density. It’s a better policy to ensure they can afford to monitor it. A recent analysis compared past medical records of more than 1 million women who had either traditional two-dimensional or 3D mammograms and found the newer technology more effective at detecting cancers. Though this study showed no differences in detection between dense and non-dense breasts, other research shows 3D to be more effective for young women and those with high breast density. Now that mammographers are required to inform about breast density, LBBC will advocate for health insurance to cover the costs of additional screening recommended by doctors to ensure cancers are found when they are more easily treated.
Breast cancer detection is becoming an individualized experience and each patient in conjunction with their personal physician and radiologist may benefit from adjunct screening tools–such as ultrasound screening and Breast MRI.
- Breast cancer: 3D mammogram better than 2D scan for screening, study finds (Medical News Today)
- Mammographic screening in routine practice: Multisite study of digital breast tomosynthesis and digital mammography screenings (Radiology)
- New FDA rules may help with prevention, detection of breast cancer (The Harvard Gazette)
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Racial disparities in health outcomes
We believe overcoming racial disparities requires commitment to change at every level of health care, from medical training to clinical research to treatment delivery. That view is supported by a remarkable analysis showing that in U.S. counties with more Black primary care doctors, Black people lived longer and had lower death rates overall—even if there was only a single Black doctor. Those same counties also saw smaller disparities in health outcomes between Black and white residents. A much smaller, interview-based study showed differences between the way white and Black women view risks for breast cancer and found Black women were more likely to rely on primary care doctors for prevention advice. LBBC will continue to elevate the voices of Black doctors throughout LBBC’s programs to support the delivery of more equitable care for all Americans.
Community involvement and advocacy by Black physicians may change the social drivers of health for the populations most vulnerable to their health effects.
- In counties with more Black doctors, Black people live longer, ‘astonishing’ study finds (STAT)
- Increasing representation of Black primary care physicians—a critical strategy to advance racial health equity (JAMA Network Open)
- Racial differences influence breast cancer risk management in white, Black women (Oncology Nurse Advisor)
Related LBBC content
- Black with breast cancer (hub)
- Young Black women: Check your risk (news)
- Equity matters (news)
- From physician to breast cancer patient: Cheryl’s story (podcast)
Kisqali in early HR+ breast cancer
Between 20% and 30% of early breast cancers can recur, or metastasize, years after treatment. Finding methods to prevent metastases is a priority in all forms of breast cancer, including hormone receptor-positive, HER2-negative, the most common diagnosis. Early results from the NATALEE clinical trial showed adding the CDK 4/6 inhibitor ribociclib (Kisqali) to anti-estrogen therapy prevented more recurrences than giving hormonal therapy alone. That finding was consistent, even when cancer was in the lymph nodes. We’ll learn more once the study is published, but these results suggest Kisqali could be a new CDKi option for early-stage disease, alongside abemaciclib (Verzenio). Novartis, the manufacturer of ribociclib, plans to apply soon for FDA approval.
- Kisqali plus endocrine therapy may reduce breast cancer recurrence risk (Cure)
- Novartis reports positive topline results for NATALEE, phase 3 trial of ribociclib in early breast cancer (American Journal of Managed Care)
Related LBBC content
- Targeted therapy for hormone receptor-positive breast cancer (About)
- Ribociclib (About) and Abemaciclib (About)
- Be informed to live longer (blog)
- Making choices at the crossroads of breast cancer treatment (blog)
(Our) people are talking
This National Poetry Month, we’re celebrating LBBC Hear My Voice graduate Jenny Burkholder (above), who was recently named Poet Laureate for Montgomery County, Pennsylvania. Her application included works about her breast cancer experience. Meanwhile on SHARE’s Our MBC Life podcast, Abigail Johnson, Janice Cowden, Stephanie Walker, Lesley Glenn, and Miranda Gonzales, all graduates of LBBC programs, explored their paths to advocacy. Also in that episode: our colleague Catherine Ormerod shared what drove her to establish the Hear My Voice Metastatic Advocacy program in 2015. Over on YouTube LBBC board member and co-founder of For the Breast of Us Marissa Thomas launched her Love & Cancer series to uncover how thrivers navigate post-breast cancer relationships.
I thought, let’s try offering a program for the metastatic community. We found people were hungry to find their own voice, to contribute, and to come together as a community.
Kudos to two members of our medical advisory board: Karen Winkfield, MD, PhD, appointed by President Biden to NCI’s National Cancer Advisory Board, and Angela DeMichele, MD, MSCE, who will receive the Gianni Bonadonna Breast Cancer Award at the 2023 ASCO meeting for her practice-changing research.
- National Poetry Month: When breast cancer and poetry meet (Overexpressed)
- MBC advocacy: Finding purpose in advocacy (Our MBC Life)
- Love & Cancer (For the Breast of Us)
Related LBBC content
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