Costs of cancer go beyond treatment
The financial cost of breast cancer can be staggering, even for those who have good health insurance.
The most common form of cancer except for skin cancer, breast cancer will kill an estimated 42,170 women in the United States this year and an estimated 279,100 will be diagnosed, according to the American Cancer Society.
About 1 in 4 will have to borrow money, go into debt or file for bankruptcy to pay for treatment, according to a 2019 report from the U.S. Centers for Disease Control and Prevention.
“Unfortunately, the costs of any complex treatment are a burden on Americans, irrespective of insurance,” said Dr. Derek Raghavan, president of the Levine Cancer Institute, Charlotte, North Carolina.
“Any kind of cancer is a big hit financially. If you have great health insurance it's less of a burden, but breast cancer affects women and their families in significant ways financially,” said Mark Pilon, executive director of Susan G. Komen Los Angeles.
Insurance almost never covers all costs, said Raghavan, referring to time away from work, transportation, babysitting and co-pays that can be substantial, especially with some newer drugs and treatments.
“Even with great insurance deductibles alone will be a big hit, $1,500 to $5,000 before treatment even starts,” Pilon said.
Complex care leads to financial hardship for many people.
“Transportation issues can have a significant impact on breast cancer patients undergoing radiation who must come from a distance daily for a period of weeks to receive treatment.
For rural patients this becomes even more of a challenge where public transportation will not travel outside of county lines or there is no public transport system,” Raghavan said,
Even if a woman has insurance she often must navigate various tactics insurance companies may use to avoid paying, such as very complex precertification forms, fine-print limitations to reimbursement that may not be clear when patients sign up, and health insurance running out, Raghavan said.
“We are recently seeing women with new plans on the market that advertise coverage at an affordable/ appealing cost for lower income earners, only to find that actual treatment is not covered, only screening,” Raghavan said.
Unexpected extras such as complications of care with hospitalization and blood tests that are not covered by insurance often emerge, Raghavan said.
Because of side effects women also need to purchase personal items that are not considered essential and, more often than not, fall outside insurance parameters. For example, a woman coping with alopecia during treatment may want to purchase a wig but she may not have the $375 or more it costs out of pocket.
The American Cancer Society recommends that at age 40 women begin getting screened annually for breast cancer, but for some women basic screenings can be a financial hardship, Pilon said.
“If breast cancer is diagnosed early women have good overall survival, but the cost of a screening can be prohibitive for some women,” Pilon said. Without insurance a mammogram can cost $100 or more depending on where a woman lives.
“Screening is generally available to women with insurance, although the U.S. Preventive Services Task Force has set age limits that prevent younger women from being screened by many programs,” Raghavan said.
“For uninsured women it can be a huge issue, as many states do not provide coverage.”
For example, in the Charlotte, North Carolina, region, a great deal of mammographic screening is supported purely by philanthropy, as the state and county have essentially run out of resources to provide mammography for all eligible and appropriate women, Raghavan said.
“For women near the poverty line, they simply cannot afford the cost of mammography,” he said.
COVID-19 is only making things worse, as screenings were deemed elective early on in the pandemic, which will lead to later detection and more costly treatment, Pilon said.
The Affordable Care Act provides free mammograms every one to two years for women 40 and over. The Susan G. Komen Foundation and the National Breast Cancer Foundation provide free and low-cost breast cancer screenings across the country.