Insurance law tied to more breast reconstruction

Many more breast cancer patients had breast reconstruction following a 1998 federal law mandating insurance coverage for the procedure, according to a new study.

"I think it's the first large-scale study that shows that, slowly, legislation like the Women's Health and Cancer Rights Act is having an effect," said Dr. Evan Garfein, a plastic surgeon who has helped to draft a New York law aimed at improving access to breast reconstruction but who was not involved in the new research.

The study's authors note that the greatest increases in reconstructions were among women on Medicaid and Medicare, suggesting that before the law, the uninsured cost of the procedure was an obstacle for many poor breast cancer patients.

But researchers cautioned against interpreting the study results to give all the credit to the legislation.

"The utilization of reconstruction overall has increased over the study time period because surgical techniques have changed and we've also expanded the people that are eligible for reconstruction compared to what was possible even 10 years ago," said Dr. Rachel Kelz, an assistant professor of surgery at the University of Pennsylvania in Philadelphia and one of the authors of the study.

Breast reconstruction is considered by many to be part of the recovery from breast cancer.

Mastectomy (surgical removal of the breast) "can be a fairly deforming operation," said Garfein, of New York's Montefiore Medical Center. "Reconstruction is helpful in restoring a sense of self, it's helpful in restoring a sense of sexuality, it's helpful in helping women move on from treatment of the disease."

In an effort to make sure all women have access to the procedure, Congress passed the Women's Health and Cancer Rights Act of 1998.

The law requires health insurance plans that cover mastectomy to also cover plastic surgery to reconstruct the breast.

Past research has shown that not all women are equally likely to get reconstruction; women with private insurance are more likely to have the surgery than women with Medicare and Medicaid, Garfein said.

To see whether those tendencies have been changing, Kelz and her colleagues gathered information from a large database of hospital patients' records.

Between the years 2000 and 2009, more than 168,000 women in the database underwent breast removal and 35,000 of them had breast reconstruction immediately following the cancer treatment.

As a percentage of all the women treated for breast cancer in a given year, the number who got reconstructions rose from roughly 13 percent in 2000 to 36 percent in 2009, the team reports in the medical journal Cancer.

The greatest increase in reconstruction rates over this decade was among women covered by Medicaid, the government-funded health insurance for the poor.