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Largest U.S. Health Insurer Drops Coverage of Controversial Breast Cancer Treatment (dateline February 22, 2000)

Aetna/U.S. Healthcare, the United States’ largest health care provider, announced that it will no longer cover the cost of bone marrow transplants for women with breast cancer unless they receive the treatment in a federally sponsored clinical trial . The decision comes two weeks after a South African researcher admitted he falsified results of his study that claimed high dose chemotherapy followed by a bone marrow transplant benefited women with advanced breast cancer .

In May 1999, four large studies presented at the annual meeting of the American Society of Clinical Oncology (ASCO) showed no difference in survival between breast cancer patients who underwent high dose chemotherapy and those who tried less controversial treatments (such as standard chemotherapy or other drug therapies). Previous studies on high-dose chemotherapy have revealed that the therapy may have some effect on advanced breast cancer patients.

Patient advocacy groups and physicians are praising the insurance company’s decision. Fran Visco, president of the National Breast Cancer Coalition, said that her group does not believe bone marrow transplants are "quality health care" for women with breast cancer. The organization is urging women not to undergo the procedure unless they are part of a clinical trial. Aetna representatives will still cover bone marrow transplants for patients with other illnesses, such as leukemia, where there is a clear benefit. The number of bone marrow transplant operations on breast cancer patients has decreased dramatically after the studies were presented at the ASCO meeting last May.

The cost of a bone marrow transplant is over $100,000. Presently, spokespeople for United Healthcare, the United States’ second largest health insurance provider, said they will still cover bone marrow transplants for breast cancer patients at certain hospitals if the procedure is recommended by physicians. Several smaller insurance companies are expected to drop coverage of the procedure unless new research shows that high dose chemotherapy followed by bone marrow transplants improves a patient’s chances of survival.

Treatment with high dose chemotherapy followed by a bone marrow transplant is a complex procedure that involves several steps:

  • A sample of bone marrow cells is extracted from the body and frozen. Cells are usually taken from the top of the hipbone or other bone cavities.
  • High-dose chemotherapy is administered.
  • Preserved bone marrow cells are thawed, transfused into the body intravenously (through the vien), and naturally transported back to the bone cavities.
  • Newly injected bone marrow cells multiply and produce blood cells.

The side effects of this type of treatment can be harsh. Because a patient’s white blood cell count is very low in the weeks immediately following the operation, many women experience infections. The greatest risk of bone marrow transplants is that the newly injected cells will attack the patient’s natural cells, believing they are a foreign threat to the body. Approximately 12,000 women with breast cancer have had bone marrow transplants since the mid-1980s, according to the ASCO.

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