Breast Cancer Treatment. The Plan provides Benefits for breast cancer treatment, including prostheses and the following services:
Breast Cancer Treatment. The Plan provides Benefits for breast cancer treatment, including prostheses and the following services:
1. Inpatient care for a mastectomy, a lumpectomy, or a lymph node dissection for the treatment of breast cancer is covered for a period of time determined to be Medically Necessary by the attending Physician, Member following current Community Health Options managed care guidelines and policies to determine medical necessity.
2. If you elect breast reconstruction following mastectomy surgery, the Plan covers reconstruction in the manner you and your Provider choose. Coverage includes reconstruction of the breast on which the mastectomy was performed and surgery and reconstruction of the other breast to produce a symmetrical appearance. See section 4.B.11. As required by Maine and federal law, the Inpatient length of stay for a mastectomy, lumpectomy, or a lymph node dissection for the treatment of breast cancer will be decided by the attending Provider in consultation with you.
Breast Cancer Treatment. Clinically, there are 4 overarching therapies used to treat breast cancer: surgery, chemotherapy, radiotherapy, and hormonal therapy (Xxxxxx and Xxxxxxxx, 2013). There are novel therapies in clinical trials such as immunotherapy (Xxxxx and Xxxxxxxx, 2015), which is not widely available to general patients. Surgery has been the primary breast cancer treatment option. Xxxxxxx Xxxxxxx introduced radical mastectomy, which was the prevalent surgical method against breast cancer since the late 19th century until recent decades. Since then, less radical surgeries and breast-conserving procedures that are equivalent to radical mastectomy in terms of efficacy have developed and gained recognition. Surgery also gives access to the tumor itself, allowing for more accurate staging and molecular analysis (Xxxxxx and Xxxxxxxx, 2013). Chemotherapy remains widely used against breast cancer despite cancer heterogeneity. In particular, breast cancers that lack distinct markers, namely the TNBCs, are presented with only chemotherapy options. Chemotherapy is divided into neoadjuvant and adjuvant chemotherapies. Neoadjuvant chemotherapy is administered before surgery, while adjuvant chemotherapy is the same agent administered after surgery. The most common chemotherapy agent regardless of administration timing is anthracycline based. Studies suggest that Basal-like breast cancers, which have the poorest prognosis among all molecular subtypes, are more sensitive to neoadjuvant chemotherapy than Luminal breast cancers are (Xxxxx et al., 2007), although breast cancers that received neoadjuvant chemotherapy may have higher local recurrence after surgery than those that did not receive neoadjuvant chemotherapy (Early Breast Cancer Trialists’ Collaborative Group, 2018). Radiotherapy is also a common treatment option that is used in nearly half of breast cancer patients (Xxxxxx and Xxxxx, 2015). Radiotherapy uses ionizing radiation to target and eliminate cancer cells. Radiotherapy has been shown to lower both the recurrence and death rate in patients that received breast-conserving surgery (Early Breast Cancer Trialists’ Collaborative Group, 2011). The combination of radiation therapy and breast-conserving surgery also proves to be at least equivalent to mastectomy in terms of survival (van Xxxxxx et al., 2016). Hormonal therapy has been in use to treat breast cancers with distinct markers such as ER. Hormonal therapy such as aromatase inhibitor aims to block ER pathways that driv...
