Law requires hospitals to discuss breast reconstruction surgery

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Law requires hospitals to discuss breast reconstruction surgery

by Heather Mayer, DOTmed News Reporter | August 23, 2010
A new law passed last week by New York Gov. David Paterson will require hospitals to inform breast cancer patients about their reconstruction surgery options and insurance coverage specifics.

The law, written by Montefiore Medical Center’s Dr. Evan Garfein, is intended to correct the issue of minority, poor and less-educated women not being aware of their surgery options and that plans like Medicaid and Medicare cover the procedure.

“It’s a pretty simple problem that needed to be addressed,” Garfein told DOTmed News. “If you’re wealthy and white and live in most parts of the U.S., you have reconstruction at one rate, and if you’re poor and black or Latina or another minority, you have reconstruction at another rate.”

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In 1998, Congress passed the Women’s Health and Cancer Rights Act, which guaranteed universal coverage for reconstruction after surgery. This law works to ensure women take advantage of that act.

“This seemed like a perfect law,” he said. “It doesn’t require additional funding. No one has to do anything differently except notify women of their options…It’s an easy, straightforward situation.”

Hospitals in New York are now required to discuss the range of reconstruction choices before the patient decides on either a mastectomy — total removal of the cancerous breast, or a lumpectomy — removal of part of the cancerous breast. The law states that this discussion should involve the cancer surgeon, the plastic surgeon and the patient.

Of the 250,000 breast cancer patients who undergo a mastectomy, 30 to 40 percent also receive breast reconstruction, according to Garfein. This percentage is even smaller among the poor, minority and less educated group. Garfein predicts that number will jump to about 70 percent if more women were aware of their options.

The American Cancer Society calls the new law a “meaningful step” in closing the gap between women who know to seek reconstruction surgery and the unaware population.

"We recognize reconstructive surgery post-mastectomy as the standard of care," said Peter Slocum, vice president of advocacy for the American Cancer Society's eastern division, in an e-mail to DOTmed News. “It’s very troubling that so many women in New York don’t realize that they have the option for this surgery simply because they’re uninformed.”

Lawmakers discussed in great lengths how the law would be enforced, said Garfein, but the answer is unclear. Health care providers will provide straightforward materials about reconstruction options to their patients — something easy to abide by.

“I don’t want this to be onerous,” said Garfein. “I don’t think it has to be onerous to anyone. I just think it’s unacceptable that in 2010 women in New York City come to my office, two, five, 10 years after a mastectomy, unreconstructed and [say] I was never told that this was an option.”

“I don’t want to make it more painful for doctors to practice,” he said. “But I don’t want to see patients like that.”