Findings from University of Maryland Update Knowledge of Cancer (Contralateral Prophylactic Mastectomy In the Setting of Breast Cancer Diagnosis and Their Insurance Coverage In the United States): Cancer

2021 OCT 13 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Investigators publish new report on Cancer. According to news reporting originating from Baltimore, Maryland, by NewsRx correspondents, research stated, “Contralateral prophylactic mastectomy (CPM) is more common in the United States than the rest of the world. However, the benefit of this procedure is still under question in many breast cancer scenarios.”

Our news editors obtained a quote from the research from the University of Maryland, “CPM utilization in the United States is in part dependent on a patient’s health insurance coverage of breast oncology surgery and any desired reconstruction. However, there are great discrepancies in the coverage provided by insurers. The authors conducted a cross-sectional analysis of insurance policies for a CPM in the setting of diagnosed breast cancer. One hundred companies were selected based on their state enrollment and market share. Their policies were identified through a Web-based search and telephone interviews, and their medical necessity criteria were extracted. Of the 100 companies assessed, 36 (36%) had a policy for CPM. Within those, significantly more provided coverage than denied the procedure (72% vs. 25%, p< 0.0001), with the remainder providing case-by-case coverage. Eleven criteria were identified from preauthorized policies, the most common prerequisite was breast cancer diagnosis under 45 years old (n = 9, 35%). Most policies did not differentiate between gender in their policies (n = 25, 69%), but of those that did, 100% (n = 11) provided coverage for men and women, with 82% (n = 9) requiring further criteria from the female patients. The coverage of CPM in the United States varies from complete denial to unrestricted approval. This may be due to conflicting reports in the literature as to the utility of the procedure.”

According to the news editors, the research concluded: “The decision to undergo this procedure must be taken with thoughtful consideration and the support of a multidisciplinary approach.”

This research has been peer-reviewed.

For more information on this research see: Contralateral Prophylactic Mastectomy In the Setting of Breast Cancer Diagnosis and Their Insurance Coverage In the United States. The Breast Journal, 2021. The Breast Journal can be contacted at: Wiley, 111 River St, Hoboken 07030-5774, NJ, USA.

The news editors report that additional information may be obtained by contacting Yvonne M. Rasko, University of Maryland, School of Medicine, Dept. of Surgery, Division of Plastic Surgery, Baltimore, MD 21201, United States. Additional authors for this research include Michael Ha, Ledibabari M. Ngaage, Marissa Klein, Annie Yang, Sheri Slezak, Shannon M. Colohan, Suliat M. Nurudeen and Julia H. Terhune.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1111/tbj.14280. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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