Category Archives: Patient Rights

Medical Costs: Still a Guessing Game?

The same drug, the same procedure, the same test but prices can vary greatly depending on who provides the service. Patients have a RIGHT to know the price so they can make smart choices or set up a payment plan.

Any consumer knows that the secret to staying on a budget is comparing prices when you shop.  In today’s world, the internet gives us excellent resources to do this easily. We search for the best price. That’s easier said than done in America’s Health Care System, where the prices for doctor visits, diagnostic tests and surgical treatments can be hard to find out in advance. 

Only 14 of 50 states in America have laws that call for “Price Transparency” – knowing the cost of care before it’s done. 

Now President Trump has proposed “Price Transparency” for all healthcare providers.  The goal is to help patients shop around for a CT scan, MRI scan, or even a hip replacement; the same way they shop for food, clothing, and shelter. 

Ohio politicians also dipped their toes in the “Price Transparency” swamp.  The Ohio House of Representatives and Senate unanimously passed the Healthcare Transparency Law in June 2015.  Gov. Kasich promptly signed the bill shortly thereafter. 

But the Ohio Hospital Association (OHA), joined by the Ohio State Medical Association (OSMA), had a judge issue an order preventing the law from going into effect on January 1, 2017-an astounding 18 months after it was enacted. In 18 months, these groups could not establish regulations that insurers agreed upon. Everyone is looking out for themselves regardless of what is best for the patient.

All parties involved have given lip service to this Healthcare Transparency Law yet it has been legally blocked from taking effect. They claim the problem is lack of  available information because of too many contracts with different prices.  It’s hard to believe that Big Hospitals do not know the upfront costs of their own CT scans, cardiac stress tests or hip replacements.  It just does not ring true.

Smaller practices typically use the same 25 medical codes, so they should be able to easily create a cost estimator for those top codes. The patient will need to understand that this is simply an estimate. Once the claim is filed the insurance carrier could leave more or less responsibility to the patient.  A reasonable percentage of variance should be easy to establish. Typically an estimate is just that – it could vary 5% more or 5% less.

There’s just no need to keep healthcare prices a guessing game.  Our Governor, The Honorable John Kasich, needs to hear from you.

Governor Kasich can be reached at 614-466-3555. Call him or his staff and tell them how you feel about this issue. Your voice really does matter. 

And don’t just stop there.  Next time you are at a doctor’s office or getting a CT scan or having surgery, ask what your out-of-pocket cost will be.  You do have time to shop around.  Medical costs should not be a guessing game any longer. 

I know what I am talking about.  First Dayton Cancer Care has been providing upfront, out-of-pocket cost for patients since opening in 2003.  It is just the right thing to do. 

If you have any questions about your cancer, its diagnosis or its treatment, call me, Dr. Edward Hughes, at 855-DAYTON1.

America: Time to Take Back Your health Care

“We will no longer accept politicians who are all talk and no action, constantly complaining but never doing anything about it.  The time for empty talk is over.  Now arrives the hour of action.” President Donald J.  Trump Inaugural Address 2017

 The Action 

Ohio State House representative Jim Butler, R-Oakwood in Kettering, is a politician who is taking action.  Rep.  Butler introduced the Healthcare Price Transparency Law in June 2015.  Remember that date-  June 2015, over 18 months ago.  The law passed unanimously, and was signed by Governor Kasich.

 The Reaction  

Yet the Ohio Hospital Association (OHA), joined by the Ohio State Medical Association (OSMA), filed a lawsuit in late 2016 to block the law from starting on January 1, 2017.  The OHA and OSMA claim they need more time.  As if 18 months is not enough. 

The Old Game of Hide and Seek  

Patients have a right to know the cost of their healthcare.  Would you shop at Kroger or Elder-Beerman only to know the price 30 to 60 days later?  Would you by a house only to know the price 30 to 60 days later after closing?  So why is the price of healthcare any different than the cost of food, clothing, and shelter?  The Ohio Hospital Association and the Ohio State Medical Association want to keep the price of their services far from transparent. 

Trying to find the true cost of your medical care-before the procedure-is difficult to say the least.  What makes it even more stressful is that you are doing this when you are sick.  The cost of healthcare seems the least of your worries in a crisis. 

So how does Ohio rate compared to other states as far as healthcare cost transparency?  In 2016, the Healthcare Incentives Improvement Institute gave Ohio a solid “F” along with 42 other states.  That’s right, in the vast majority of states in the US, the cost of healthcare is far from transparent. 

The Hour of Action  

So what can you do as the patient?  Most of your health care visits and procedures are “elective” or non-urgent, in medical terms.  So you have time to find out.  You have the right to know from your hospitals and your doctors the out-of-pocket expenses to you before the procedure.  It is your health and your money in the end. 

But don’t wait for politicians to solve your life and death problems.  Take back your life and take back your health care.  Demand the costs of your health care before the procedure.  You will be shocked at the price differences among hospitals and doctors. 

First Dayton Cancer Care has been providing out-of-pocket cost estimates for patients at the start of their care since 2003.  It can be done, despite what the Ohio Hospital Association and the Ohio State Medical Association will lead  you to believe. 

If you have any questions about your cancer, please feel free to call me, Dr. Edward Hughes at 855-Dayton 1

Ohio’s Healthcare Price Transparency Law- What are the Hospitals Afraid of?

Price Transparency advocacy is not new and not just in Ohio. This graphic is from a 2013 Forbes article.You can read here.

In June 2015, the Senate and House of Representatives in the state of Ohio passed unanimously the Healthcare Price Transparency Law. The law was signed by Governor John Kasich shortly thereafter. This law would require hospitals and physicians to provide a reasonable estimate to patients prior to procedures and tests. This would allow the patient to make decisions on whether or not to have the services, to shop for a lower price, or to determine how they are going to pay for this bill.

Our own local State Representative Jim Butler, Republican from Oakwood and Kettering, offered and sponsored the law. Mr. Butler has worked with the Ohio State Medical Association (OSMA) and the Ohio Hospital Association (OHA), as well as a number of lobbying organizations to help implement the Healthcare Transparency law so it is workable for both healthcare providers and patients. Jim Butler’s letter to the President of the OHA can be found on his website.

Now 18 months later, OSMA recently joined a lawsuit with the OHA to block the implementation of the law. They argue that it is not possible to get this reasonable estimate in a timely manner because insurance carriers determine the out of pocket cost and there are simply too many insurance plans. In late December, Williams County Common Pleas Court judge J.T. Stelzer issued a 30 day restraining order blocking the law from taking effect on January 1, 2017.

PATIENTS HAVE A RIGHT TO KNOW THE COST

The Ohio Hospital Association now argues that insurance carriers ‘set the price’ and the hospitals have no control over these prices. But this is false. It is the hospitals who negotiate a contract with the insurance carriers to determine the cost of each and every procedure. While the insurance carrier negotiates a contract with the patient regarding co-pays and deductibles, it is the hospitals who are responsible for the cost. Most people do not realize that the same test procedure will cost different amounts from one facility to another. Sometimes up to 75% more. For those with health insurance such as Medicare where you have a 20% responsibility, a $2500 CT scan and a $400 CT scan is a significant difference; a $500 out of pocket bill in the hospital or a $80 bill at an independent outpatient facility.  People have a right to shop around for quality and cost.

A staff member of mine recently sent her son to a physical therapist at a local hospital while she herself was seeing a physical therapist in an independent practice. Her son’s bill for a 15 minute appointment to have his pinky finger worked on cost her $250. While her 1 hour appointment for her back cost only $65 at the independent practice. She tells me had she known the high cost with the therapist working for the hospital, she would definitely made him go to the other facility.

THE INFORMATION IS READILY AVAILABLE

Those opponents argue that this will delay treatment because the information is not readily available. This is not true. Most insurance carriers have online system that practices can use to plug in the patient’s exact insurance plan along with the ICD-10 procedure codes that will be used. That system , in existence for years, will provide an estimate of cost based on the current contract with that facility.

First Dayton Cancer Care has been providing these estimates to our patients since opening in 2003. Radiation therapy is one of the most complicated set of billing codes in any specialty, yet we manage to provide estimates within 24 hours. Most of our patients appreciate knowing what their out of pocket expense will be so that they can begin planning for it. Many insurance carriers provide a website where their members can do a cost estimator and it will show them what each facility in their surrounding area charges. The information is readily available. In the past 13 years our billing company, MAXX Medical states that providing these estimates has gotten easier. They are able to provide an estimate within an average of +3%.

THE PATIENT IS A CONSUMER

I do agree that there are specifics to the Healthcare Price Transparency law that need to be worked out. But the state of Ohio, the OHA and OSMA have had 18 months to work this out. The state needs to establish guidelines that relieve some of the burden on the provider and to ensure that the language protects the provider if the insurance carrier provides incorrect information. However, the OSMA and the OHA needs to be advocating for the patient first. Patients do not have lobbyists fighting for them. They need to be told of their right to ask for a cost estimate.

Patients also need to respect that when an estimate is given, it does not mean that we value their payment more than we do providing quality care. We feel by providing this estimate we are helping the patient make informed decisions about both about their health and their family finances. But in all things you purchase, you demand quality and a fair price. Your health should be no different. Price transparency in healthcare is critical in today’s world.

If you are in need of excellent cancer care, call me today at 1-855DAYTON1. Not only will I see you in 1-3 days for an initial visit, but I will provide you with an estimate before treatment begins!

Breast Conserving Therapy vs. Mastectomy?

Are cancer patients listening to the media more than their own doctors? Angelina Jolie's double mastectomy is not the right choice for most woman.

Are cancer patients listening to the media more than their own doctors? Angelina Jolie’s double mastectomy is not the right choice for most woman.

The past year America has been overwhelmed by the race for the Presidency.  Every day we hear speeches from the Presidential candidates.  The next day we hear from the “fact-checkers” who disprove a lot of the candidates’ claims.  But do facts really make a difference anymore?

That’s the question I have been asking for the past 25 years about lumpectomy and radiation therapy(breast conserving therapy) for early stage breast cancer patients.  Do the facts really make a difference anymore in a country where more and more early stage breast cancer patients undergo mastectomy?

Breast Conserving Therapy vs. Mastectomy

In a landmark study of 7,552 Dutch women with early-stage breast cancer (T1 N0), Dr. M.C. van Maaren and co-workers showed that women treated with lumpectomy and radiation therapy had a significantly better 10 year metastasis-free survival compared with those women treated with mastectomy.  Their study was published in the internationally prestigious journal Lancet Oncology, June 22, 2016 issue.

Are these new and surprising facts?  Not at all.  For the past 25 years, study after study-many with level I evidence, the best medical evidence-have shown that lumpectomy and radiation therapy is at least equivalent to mastectomy in terms of breast cancer control and survival.  Yet the number of women undergoing mastectomy in America continues to increase.

Why Not Mastectomy?

Mastectomy has profound side effects, both physically and emotionally.  But the facts have shown for decades that breast conservation with lumpectomy and radiation therapy is just as good as mastectomy, if not better.  The new Dutch study confirms that it is better for those women with small breast cancers, less than 2 cm and without spread to the lymph nodes.

I believe it is by duty as a breast cancer specialist to make my patients aware of the facts, and not give in to the current, popular trends.

If you have any questions about your breast cancer, please feel free to call me, Dr. Edward Hughes, at 855 Dayton 1.  I have a ‘no excuses’ approach to cancer care, one that beings with the patient and ends with wellness for a better quality of life.

I have written about lumpectomy and radiation therapy being at least as good if not better than mastectomy in a number of my previous blogs. Learn more by reading posts on January 19, 2016October 13, 2015; and August 4, 2015.

The Fight for Freedom from Insurance Companies

USA-Independence-day-best-greetings-2014Independence is the freedom from dependence on or control by another person, organization, or state. Unfortunately today physicians and patients have lost their independence. Physicians are now controlled by hospital administration, government policies, and insurance companies. Patients are dependent on their insurance company. This lack of independence has placed a great strain on how medical care is given in the United States of America. First Dayton Cancer Care is fighting for the right to practice medicine in a way that is best for our patients, not someone’s bottom line.

INSURANCE PRIOR AUTHORIZATIONS

Any person with insurance who has tried to have a procedure should know the term prior-authorization. This is where the patient and the physician must ask the insurance carrier permission to give treatment. This authorization is solely based on the ‘plan’ that patient has contracted and the formulary that insurance carrier has established for the diagnosis and the treatment requested. They can deny authorization regardless of what the physician feels is the best medical choice. This authorization can take up to 30 days; if initially denied, the entire process can take 60 days. And if authorization is given, there is no guarantee of payment.

The Ohio State Medical Association (OSMA) and First Dayton’s practice manager have spent the past year fighting for Ohio Senate Bill 129 which would regulate how carriers handle prior authorizations. While not every agenda item was approved, we will see an improvement in this process over the next two years. The two key items that will affect the patient the most are more timely decisions and payment for authorized procedures and medications.

KEY CHANGES

Insurance carriers now must give authorization in a timelier manner. For urgent care services consideration must be given within 48 hours of initial request and within 10 calendar days for non-urgent care. This will allow the patient and the physician to move forward with treatment quicker so that a patient is not anxiously waiting to begin very important treatments like that for cancer.

If prior authorization was given, insurers will no longer be able to retroactively deny payment for a claim. This is excellent news for patients and physicians. It basically means that insurers must do what they promise and pay for what they should.

We hope that this change to the authorization process will help patients and physicians alike. Physicians have the training and experience to make the decisions for that individual patient. The doctor to patient relationship is so important to quality health care. We must continue to fight insurance carriers and the government from dismissing the importance of this relationship. The beauty of medicine is treating the entire person not simply the disease on paper. This can only be accomplished when a physician is able to get to know this individual person and work together for their health.

First Dayton stays independent of the hospital systems so that our patients maintain their right to choose the best radiation therapy available today and we will continue to fight insurance carriers for this choice.

Take Back Control of Your Healthcare from Insurance Companies

OSMA Logo w 3D State - Blk & Lt Blue - Drop ShadowPlease join the Ohio State Medical Association to take action today to stop Medical Insurance companies from practicing medicine!

OSMA Government Relations Team is working overtime to get SB 129 passed out of the Ohio House by the end of May.  We need your help to give one final push to your Representative to pass this legislation in the next three weeks! The insurance industry has continued to voice concerns with the bill following its unanimous passage out of the Ohio Senate. The current prior authoirzation system’s administrative burden and impediment to quality care must end.

Currently they require your physician to ask PERMISSION to treat you. The insurers decide what type of medical care you are allowed to receive.

Plus they may or may not pay for the services that they have promised to cover. This leaves you, the patient, with a huge bill or you the physician unpaid.

We are asking that insurers respond to the authorization request in a timely manner. In 2012 the average wait time for our patients was around 4 days. Now our patients wait on average of 23 days for authorization. This delays treatment and causes a lot of anxiety in people who are already anxious because they have cancer.

This Senate Bill is vital to health care in Ohio. While it doesn’t solve all of our problems with Prior Authorizations, it certainly is a giant step in the right direction. Insurance companies need to allow our physicians to treat our patients the way that their experience and expertise tells them is best for that individual person. Plus, our patients deserve timely answers and your doctors deserves to be paid what has been promised to care for you.

Senate Bill 129 will help us to achieve all of this. Please take a few moments to send a letter to let your voice be heard!

I also encourage you to send this email to everyone you know. Each one of us is a patient. Send it to everyone on your email list.

Let’s tell the insurance companies that we do not want them practicing medicine. Go to the OSMA Advocacy Center to send a letter to our government right now! Time is running out to have your voice heard.

WHO IS CARING FOR THE SURVIVORS CAREGIVER?

This blog was posted a while back, however, it rings true every day. Happy Mother’s Day to all the moms who took care of you.

"One person caring about another represents life's greatest value."- Jim Rohn

“One person caring about another represents life’s greatest value.”- Jim Rohn

A cancer diagnosis changes the lives of many. The patient is not the only person affected. Life also changes for those who care about and love the person with cancer especially for the person who will help the patient get through the cancer experience-the caregiver. Caregivers are the unsung heroes of cancer survivorship. Primary caregivers are a major part of the health care team because they are doing things like: giving medications on time, helping manage side effects, communicating with the physicians and nurses, taking the patient to appointments, and keeping other family and friends up to date on what is happening. This primary caregiver does all of this while trying to manage normal day to day activities. Becoming a caregiver is like taking on a second job. It is not an easy job. And it must be done with a positive attitude as the cancer patient often draws strength from the caregiver.

The question is “who is caring for the caregiver?” This is a role that a friend or a secondary family member can take on.

Depression and exhaustion are two major concerns with primary caregivers. The American Cancer Society has a Checklist for Caregivers that gives excellent advice. I strongly recommend that survivors, primary caregivers and family/friends utilize this resource. It offers tips and insights to keep the caregiver healthy inside and out.

The focus of course is to find excellent support for the cancer survivor, as it should be; but the caregiver will benefit from support too. They do not usually have time to join support groups in person, so the internet can be just what is needed. There are online support groups that are disease specific or simply cancer in general. Find the one that is easiest to use and has like-minded people. The chat rooms can be a great place to trade information and to learn from each other’s experiences. Sometimes it serves as a place to share your fears and frustrations with others who understand what you are going through. The right online chat room should be a safe place without judgment. I only ask that you use caution when taking advice regarding medical treatment and medication. Always seek the counsel of the patients health care professional. This includes beginning any new supplements. Some herbs and vitamins are very powerful and may interfere with some medications or treatments.

Know your Rights as a Caregiver. The Family and Medical Leave Act (FMLA) is a federal law that guarantees up to 12 weeks off from work per year to take care of a seriously ill family member. Your employer must hold your job and not penalize you. However, they are NOT required to pay you. FMLA only applies to companies that employ more than 50 employees or public agencies. Learn more here.

The caregiver is likely the point person for a number of legal issues as well. An Advanced Directive is a document that can help the patient to spell out their wishes in regards to their overall health care, with special attention to end-of-life care. The caregiver may also be asked to become the Durable Power of Attorney for health care decision. This has nothing to do with money or finances, but only to help carry out health care decisions. Ask your attorney or physician to help get these forms started. I recommend that these forms be completed early, while the patient is capable of making sound decisions. This really takes the pressure off of the caregiver and gives them the legal support that may be necessary when family members disagree.

Every cancer survivor needs a strong, compassionate caregiver. This caregiver needs special attention and care themselves.

Cancer Care in the US 2016: The Good, the Bad, and The Ugly

good-bad-uglyThe Good News

So the good news is that America is winning the war against cancer, slowly but surely, especially for the so-called “Big Four” – lung, breast, prostate, and colo-rectal cancer. Dr. Julie Vose, the current president of the American Society of Clinical Oncology, commented in her society’s recent report entitled “The State of Cancer Care in America, 2016”. Dr. Vose said last week “We have seen mortality rates decline on the average of 1.5% annually over the past decade, even greater declines for the 4 most common cancers.  Additionally, the number of survivors is expected to grow from 14.5 million to 19 million in 2024.”

The Bad News

Despite President Obama’s recent announcement of a near billion dollar “Moon-Shot” against cancer, Dr. Vose went on to say “However, all of the advances are set against the backdrop of unsustainable cost and a volatile practice environment.”

So what does that mean in plain English?  The cost of cancer care is skyrocketing, especially the cost of chemotherapy drugs.  And so many patients simply cannot afford to pay.  In fact, medical bills represent one of the single biggest causes of a family’s financial stress. Dr. Blase Polite, the immediate past chair of the American Society of Clinical Oncology’s government relations committee, said “It is the cost of cancer drugs themselves as well as the increased burden the patient’s face with rising deductibles and higher cost sharing by insurance companies.”

So in plain English again, insurance premiums are going up and deductibles are going up even faster-all costing the cancer patient more money.

The Ugly News

Whatever your politics, ObamaCare has dramatically changed the landscape of cancer care in America.  Independent community practices-once the mainstay of cancer care only a decade ago-are vanishing.  The independent cancer clinics are either closing or being bought out by hospitals where the cost of cancer care is much more.

Despite the passage of ObamaCare, 35 million non-elderly people remain uninsured, and 31 million more are “underinsured” because their deductibles, the actual out-of-pocket costs, are many thousands of dollars.  A $5,000-$6,500 deductible with an ObamaCare insurance policy simply cannot be paid by many Americans.

And for our senior patients, Medicare Advantage programs that now comprise 30% of all Medicare patients can be problematic.  For example, our own senior men with prostate cancer are shocked when I tell them that I provide 3 different types of radiation for their prostate cancer, but their insurance companies will decide on whether or not they undergo Cyber Knife, IMRT, or implants.  So access to the right treatment is now a major concern. Often times insurance carriers ignore which treatment actually costs less and which is more effective.

So with more pressure on cost and access, can quality be far behind? Are we setting ourselves up for insurance carriers making your medical decisions? Simply put, I never thought I would be posing that question.  I wonder whether President Obama’s Moon Shot has already missed its target?

If you have any questions about your cancer, please feel free to call me, Dr. Edward Hughes, at 855-DAYTON1.

Prostate Cancer- The Government Did Make it a Federal Case

Is "Watchful Waiting" the best approach for Your Prostate Cancer?

Is  “Watchful Waiting” the best approach for Your Prostate Cancer? There is now a genetics test that can help answer your question.

1. PSA Screening Declines Following Government Mandate 

In late 2011, the US Preventative Service Task Force (USPSTF) recommended against routine PSA screening to detect prostate cancer in men without symptoms.  A new study from the Brigham and Women’s Hospital at Harvard, authored by Dr. Michael Zavaaski and colleagues, analyzed 27 million primary care visits by men ages 50-74 years old.  The major finding was a 57% drop in PSA screening by primary care physicians compared to only 4% in PSA testing by urologists.  Their study was published in the February 8, 2016 issue of JAMA Internal Medicine.  Dr. Zavaaski’s study compared PSA testing from 2010-2012, before and after the USPSTF guidelines were issued.  So it appears that primary care physicians really took the Federal government’s recommendation to heart.

Although I believe these results are dramatic, Medicare or CMS is now considering actually imposing a penalty on doctors who order PSA tests that do not meet the Federal government’s standards.  Certainly this is an unprecedented action and represents a very slippery slope for doctors as well as patients.  My fear is that the bed rock of medical practice-the concern and loyalty of a doctor to his or her own patients-will be trampled upon by the Federal government.  Doctors will now be judged and paid not by attention and concern for the individual patient sitting in front of them, but rather by how doctors treat “populations of patients.”  This is a profound shift in the doctor-patient relationship.  And it is already in Dayton, Ohio.  I just smiled when I received a request from one of the region’s hospitals to attend a new seminar entitled “Treating Populations of Patients in the Future.” To me patients are people, not ‘populations’.

2. Breakthrough Genetic Testing May Help You Choose the Best Prostate Cancer Treatment for You 

For those men who already have been diagnosed with prostate cancer, hope is on the way.  A number of genetic tests on the prostate cancer itself can help you and your cancer specialists judge whether you need treatment or not.  Once such test is the Oncotype DX prostate test.  The Oncotype score can be added to cancer stage, PSA level and Gleason score to help estimate how likely your prostate cancer is to spread to bone-a fatal complication.  I think the Oncotype adds key information that can help you decide whether a watch and wait approach is good for you.

Dr. Evans and colleagues looked at the genetic profiles over 1000 prostate cancers in men with high risk features.  Their study showed a number of genes responsible for DNA damage and repair may be used to help select those patients who need more than standard surgery or radiation-options like adding chemotherapy or hormonal therapy or both.  Their study was published in the Journal of the AMA Oncology January 7, 2016 issue.

And don’t forget-not all men have early-stage prostate cancer.  Now that routine PSA screening has declined, many patients are referred to urologists and radiation oncologists with high risk prostate cancer.  Men at high risk are those with a Gleason score 7 prostate cancer and a PSA of greater than 10 ng/ML or a Gleason 8-10 prostate cancer regardless of PSA level.

So What’s a Man to Do? 

From my experience as a cancer specialist as well as the patient, no man looks forward to the annual digital rectal exam.  Or even a needle stick in the arm for routine blood work.  But I would not be so quick to throw out either test so fast, despite what the Federal government says.  I still may be a “true believer” but I still hold that my job, my obligation if you will, is to the patient sitting in front of me, and not to the Federal government.  If my brother or father had prostate cancer, I would certainly be tested with PSA and undergo a yearly digital rectal examination. As a cancer specialist, it is remarkable to me that Medicare wants to halt PSA testing while, in the next breath, President Obama is launching a new “Moon Shot” in the war against cancer.  With all the talk about precision medicine, I hope that personalized medicine-putting the patient first and foremost-is not forgotten altogether.

If you have been denied a PSA and think you need one; or you have an elevated PSA and are not sure if watchful waiting is best for you, give me a call to set up a visit at 855-DAYTON1

 

The Disturbing New Trend in Breast Cancer Treatment

You have a right to ask a lot of questions to find what is best to treat your breast cancer.

You have a right to ask a lot of questions to find what is best to treat your breast cancer.

The Halsted radical mastectomy changed my grandmother’s life in the mid 1960’s. The Halsted radical was a disfiguring, morbid operation. And she was never the same woman again. She did survive her breast cancer, but the long-term effects of the operation, both physical and emotional, were devastating.

From 1895 to the mid 1970’s, the vast majority of women in the US with breast cancer underwent the Halsted radical mastectomy. Shocking as it now seems, American surgeons failed to analyze their results for nearly 75 years. But Dr. Bernard Fisher and his colleagues in Pittsburgh changed all that in the 1970’s with proven scientific techniques showing that lumpectomy and radiation had the same results as mastectomy, with far fewer side effects. And the woman was able to keep her breast. But in the beginning, Dr. Fisher was harshly criticized for his studies yet in the end he showed that more surgery is not always better.

More Chemo Is Not Always Better

Surprising as it seems to my breast cancer patients, chemotherapy is a relative newcomer to breast cancer treatment. The Halsted radical mastectomy was first performed in 1895 and the first patient treated with radiation therapy for cancer was in 1897. But over the past several decades, chemotherapy and targeted immune-therapy, like Herceptin, have yielded good results.

But the history of chemotherapy for breast cancer also had a dark side – in the late 1980’s the idea that “mega doses” of chemotherapy can cure breast cancer started to gain traction. In fact, the doses of chemotherapy were so high that a woman needed her bone marrow to be “rescued”  by a bone marrow transplantation. From the late 1980’s to the late 1990’s, bone marrow transplantation was big business and every hospital, whether community or academic, needed a transplant program. Yet, medical oncologist (chemotherapists) learned their lesson relatively quickly and proved that “mega doses” of chemotherapy were certainly not better than lower doses. So, in my mind, it’s remarkable that bone marrow transplantation for breast cancer had such a short survival. Remember that Halsted’s radical mastectomy had only been laid to rest 20 years earlier after 75 years of being the standard of care.

So What Will the Arc of History Say about Double Mastectomy?

Double mastectomies have now become disturbingly common. Movie star after movie star have announced their surgeries in great detail. I’ve yet to read a single article about what’s happened to them years later. I need to see the follow up data to be convinced that it does not cause other health problems later in life.

But even movie stars and cancer specialists cannot dispute the fact that double mastectomy does not increase breast cancer survival rates, not even by a single day. Just like bone marrow transplantation in the 1990’s, double mastectomy is big business for hospitals. Double mastectomy is a lot of surgery, both on the part of cancer surgeons as well as plastic surgeons. And most of the women need extensive rehabilitation once they leave the hospital. It’s been a big driver of breast cancer clinics at community and academic centers.

So will double mastectomy go the way of the Halstead radical mastectomy and bone marrow transplantation? Only time will tell. But at the end of the day, I cannot recall another type of cancer, in women or men for that matter, that’s had a 100 year history of overtreatment. Why that fact stands alone remains to be seen.

If you have any questions about your breast cancer, feel free to call me or make an appointment.  I’m Dr. Ed Hughes at 855-Dayton 1.