Breast Cancer and the Evolving Health Care System: Why Health Care Reform Is a Breast Cancer Issue

  • Ellen R. Shaffer
Chapter

Abstract

A former vice president of Genentech, described her first treatment for breast cancer:

I had world class health insurance. I was referred to an excellent general surgeon, who did not specialize in breast cancer. He recommended surgical biopsy and mastectomy, as soon as possible. He gave me no information about the illness or other options for treatment. I was terrified. I found my way to a breast cancer clinic in San Francisco, and paid out-of-pochet for a second opinion. This time the surgeon talked to me for over an hour. We discussed my particular condition, the pros and cons of various treatments, and the options for reconstructive surgery. She told me to take my time and make a decision I’d be happy with in ten years. (She also explained a new procedure that minimized the disabling side effects of diagnosing metastasis to the lymph nodes, a procedure the first surgeon didn’t know about.) I quit Genentech and took a pay cut to get a job at the clinic, helping others get the kind of care I got. (Allen, 1998)

Breast cancer is a complex and deadly disease. Chillingly, although we know a great deal about who gets the illness and who dies from it, we do not know the causes of breast cancer, and we cannot prevent it.

This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Allen, Judi. 1998. Personal communication.Google Scholar
  2. Angell, Marcia, and Jerome P. Kassirer. 1996. “Quality and the Medical Marketplace—Following Elephants.” New England Journal of Medicine 335:883–85.CrossRefGoogle Scholar
  3. Ayanian, John Z., Betsy A. Kohler, Toshi Abe, Arnold M. Epstein. 1993. “The Relation Between Health Insurance Coverage and Clinical Outcomes Among Women with Breast Cancer.” New England Journal of Medicine 329:326–31.CrossRefGoogle Scholar
  4. Ballard-Barbash, Rachel, Arnold L. Potosky, Linda C. Harlan, Susan G. Nayfield, and Larry G. Kessler. 1996. “Factors Associated with Surgical and Radiation Therapy for Early Stage Breast Cancer in Older Women.” Journal of the National Cancer Institute 88:716–27.CrossRefGoogle Scholar
  5. Barr, Donald A. 1995. “The Effects of Organizational Structure on Primary Care Outcomes Under Managed Care.” Annals of Internal Medicine 122:353–59.CrossRefGoogle Scholar
  6. Bates, David W., Lucian L. Leape, and S. Petrycki. 1995. “Incidence of Adverse Drug Events and Potential Drug Events: Implications for Prevention.” Journal of the American Medical Association 274:29–34.CrossRefGoogle Scholar
  7. Bernstein, Amy B. 1996. “Women’s Health in HMOs: What We Know and What We Need to Find Out.” Women’s Health Issues 6:51–59.CrossRefGoogle Scholar
  8. Bloom, Felicia B., Sharon J. Rolnick, Kristine K.J. Fortman, and Barbara D. Lardy. 1998. “Advancing Women’s Health: Health Plans’ Innovative Programs in Breast Cancer. Survey Results and Case Studies.” American Association of Health Plans, New York, September.Google Scholar
  9. Brady, Judy (ed.). 1991. One in Three: Women with Cancer Confront an Epidemic. Pittsburgh: Cleis Press.Google Scholar
  10. Brink, Susan. 1995. “Tragedy at Dana-Farber: Betsy Lehman’s Shocking Death isGoogle Scholar
  11. Still Roiling the Medical Community.” U. S. News and World Report (July 24) 119:53.Google Scholar
  12. California Healthline. 1999. “HMO Finances: Most Floundered in Red Last Year.” National Journal Group, Washington, D.C., August 10.Google Scholar
  13. Campbell, Jennifer A. 1999. “Health Insurance Coverage, Consumer Income, 1998.” Current Population Reports. Rockville, Md: U.S. Census Bureau.Google Scholar
  14. Carrasquillo, Olveen, David Himmelstein, and Steffie Woolhandler, 1998. “Can Medicaid Managed Care Provide Continuity of Care to New Medicaid Enrollees? An Analysis of Tenure on Medicaid.” American Journal of Public Health 88:464–66.CrossRefGoogle Scholar
  15. Chevarley, Frances, and Emily White. 1997. “Recent Trends in Breast Cancer Mortality Among White and Black U.S. Women.” American Journal of Public Health 87:775–81.CrossRefGoogle Scholar
  16. Collins, Karen Scott, Diane Rowland, Alina Salganicoff, and Elizabeth Chait. 1994. “Assessing and Improving Women’s Health.” Pp. 109–53 in The American Woman 1994–9: Where We Stand, ed. C. Costello and A. J. Stone. New York: W. W. Norton.Google Scholar
  17. Costanza, Mary E., and K. L. Edmiston. 1997. “Breast Cancer Screening: Early Recognition.” Comprehensive Therapy 23:7–12.Google Scholar
  18. Davis, Karen, Karen Scott Collins, Cathy Schoen, and Cynthia Morris. 1997. “Choice Matters: Enrollees’ Views of Their Health Plans.” Health Affairs vol. 14, no. 2, 99–112.CrossRefGoogle Scholar
  19. Degner, Lesley F., Linda J. Kristjanson, David Bowman, Jeffrey A. Sloan, K. C. Carriere, John O’Neil, Barbara Bilodeau, Peter Watson, and Bryan Mueller. 1997. “Information Needs and Decisional Preferences in Women with Breast Cancer.” Journal of the American Medical Association 277:1485.CrossRefGoogle Scholar
  20. Diamond, Randy. 1999. “Aetna Acquires Pru’s HMO.” The Record Online, August 7. At www.bergen.com/biz/aaetnaardl99908071.htm.
  21. Dingle, Lenox. 1995. “Testimony to Maryland State Legislature, House Economic Matters Committee, Regarding House Bill 1210, Health Care Provider Panels.” Criteria and Procedures, February 28.Google Scholar
  22. Doyal, Lesley. 1995. What Makes Women Sick: Gender and the Political Economy of Health. New Brunswick: Rutgers University Press and London: Macmillan.CrossRefGoogle Scholar
  23. Eisenberg, Leon. 1996. “The Social Construction of the Human Brain.” American Journal of Psychiatry 153:1373–74.CrossRefGoogle Scholar
  24. Erikson, Jan. 1999. “HMO Directors Willing to Pay for Cancer Trials.” Arizona Daily Star, August 16. At http://www.azstarnet.com/publicnews/127–6270.htm.
  25. Estrin, Diane. 1998. Personal communication.Google Scholar
  26. Fisher, Bernard, Madeline Bauer, Richard Margolese, Roger Poisson, Yosef Pilch, Carol Redmond, Edwin Fisher, Norman Wolmark, Melvin Deutsch, Eleanor Montague, Elizabeth Saffer, Lawrence Wickerhasm, Harvey Lerner, Andrew Glass, Henry Shibata, Peter Deckers, Alfred Ketcham, Robert Oishi, and Ian Russell. 1985. “Five-Year Results of a Randomized Clinical Trial Comparing Total Mastectomy and Segmental Mastectomy With or Without Radiation in the Treatment of Breast Cancer.” New England Journal of Medicine 312:665–73.CrossRefGoogle Scholar
  27. Flocke, Susan A., Kurt C. Stange, and Stephen J. Zyzanski. 1997. “The Impact of Insurance Type and Forced Discontinuity on the Delivery of Primary Care.” Journal of Family Practice 45:129–35.Google Scholar
  28. Goodwin, Jan. 1997a. “A Program that Takes the Stress and Pain Out of Same-Day Surgery.” Good Housekeeping (July) 225:80–85.Google Scholar
  29. Goodwin, Jan. 1997b. “Surgery to Go.” Good Housekeeping (July) 225:80–85.Google Scholar
  30. Gordon, Nahida H., Joseph P. Crowe, D. Jane Brumberg, and Nathan A. Berger. 1992. “Socioeconomic Factors and Race in Breast Cancer Recurrence and Survival.” American Journal of Epidemiology 135:609–18.Google Scholar
  31. Haas, Barbara K. 1997. “The Effect of Managed Care on Breast Cancer Detection, Treatment, and Research.” Nursing Outlook 45:167–72.CrossRefGoogle Scholar
  32. Hadley, Jack, and Jean M. Mitchell. 1997/1998. “Breast Cancer Treatment Choice and Mastectomy Length of Stay: A Comparison of HMO and Other Privately Insured Women.” Inquiry 34:288–301.Google Scholar
  33. Hewitt, Maria and Joseph Simone, eds. 1999. Ensuring Quality Cancer Care. National Cancer Policy Board, Institute of Medicine and Commission on Life Sciences, National Research Council. Washington, D.C.: National Academy Press.Google Scholar
  34. Hillner, Bruce E., Lynne Penberthy, Christopher E. Desch, M. Kathleen McDonald, Thomas J. Smith, and Sheldon M. Retchin. 1996. “Variation in Staging and Treatment of Local and Regional Breast Cancer in the Elderly.” Breast Cancer Research and Treatment 40:75–86.CrossRefGoogle Scholar
  35. Himmelstein, David, Steffie Woolhandler, Ida Hellander, and Sidney M. Wolfe. 1999. “Quality of Care in Investor-Owned vs. Not-for-Profit HMOs.” Journal of the American Medical Association 282:159–63.CrossRefGoogle Scholar
  36. HMO Group. 1998. “News Release: The HMO Group Plans Rank Among Best HMOs for Women, According to New Survey Data,” January 21, New Brunswick, N.J.Google Scholar
  37. Howard, Daniel L., Roy Penchansky, and Morton B. Brown. 1998. “Disaggregating the Effects of Race on Breast Cancer Survival.” Family Medicine 30:228–35.Google Scholar
  38. Hsu, Joe L., Sally L. Glaser, and Dee W. West. 1997. “Brief Communication: Racial/ Ethnic Differences in Breast Cancer Survival Among San Francisco Bay Area Women.” Journal of the National Cancer Institute 89:1311–12.CrossRefGoogle Scholar
  39. Hubbell, F. Allen, Leo R. Chavez, Shiraz I. Mishra, and R. Burciaga Valdez. 1996. “Differing Beliefs About Breast Cancer Among Latinas and Anglo Women.” Western Journal of Medicine 164:405–09.Google Scholar
  40. “Improved Cancer Care Offered for Cancer Patients.” 1997. Cancer Weekly Plus (June 30) 7.Google Scholar
  41. Kang, Soo Hyang, and Joan R. Bloom. 1993. “Social Support and Cancer Screening Among Older Black Americans.” Journal of the National Cancer Institute 85:737–42.CrossRefGoogle Scholar
  42. Kasper, Anne S. 1999. Personal communication.Google Scholar
  43. Kilborn, Peter T. 1998. “Reality of the HMO System Doesn’t Live Up to the Dream.” New York Times (October 5) 1.Google Scholar
  44. Kovner, Christine and Peter Gergen. 1998. “The Relationship Between Nurse Staffing Level and Adverse Events Following Surgery.” Image: Journal of Nursing Scholarship 30:315–21.Google Scholar
  45. Lannin, Donald R., Holly F. Mathews, Jim Mitchell, Melvin S. Swanson, Frances H. Swanson, and Maxine S. Edwards. 1998. “Influence of Socioeconomic and Cultural Factors on Racial Differences in Late-Stage Presentation of Breast Cancer.” Journal of the American Medical Association 279:1801–07.CrossRefGoogle Scholar
  46. Larkin, Howard. 1997. “Not All Health Plans Live Up to Potential.” American Medical News (October 27) 40:1.Google Scholar
  47. Leape, Lucian L., David W. Bates, David J. Cullen, Jeffrey Cooper, Harold J. Demonaco, Theresa Gallivan, Robert Hallisey, Jeanette Ivies, Na Laird, Glenn Label, Robert Numeral, Laura A. Petersen, Kathy Porter, Deborah Serve, Brian F. She, Stephen D. Small, Bobbie J. Switzer, B. Taylor Thompson, and Martha Vender Let. 1995. “Systems Analysis of Adverse Drug Events.” Journal of the American Medical Association 274:35–43.CrossRefGoogle Scholar
  48. Lee-Feldstein, Anna, Hoda Anton-Culver, and Paul J. Feldstein. 1994. “Treatment Differences and Other Prognostic Factors Related to Breast Cancer Survival: Delivery Systems and Medical Outcomes.” Journal of the American Medical Association 271:1163–68.CrossRefGoogle Scholar
  49. Levitt, Larry, Janet Lundy, and Srija Srinivasan. 1999. “Trends and Indicators in the Changing Health Care Marketplace: Chartbook.” The Kaiser Changing Health Care Marketplace Project, Kaiser Family Foundation, Palo Alto, Calif.Google Scholar
  50. Love, Susan. 1997. “A Surgeon’s Challenge: We Need to do Better than the’ slash, Burn and Poison’ Approach to Breast Cancer.” Newsweek (Feb. 24) 60.Google Scholar
  51. Managed Health Care Improvement Task Force. 1997. Health Industry Profile, Background Paper, based on Interstudy Competitive Edge Survey, Sacramento, Calif.Google Scholar
  52. Matthews, Holly F., Donald R. Lannin, and James P. Mitchell. 1994. “Coming to Terms with Advanced Breast Cancer: Black Women’s Narratives from Eastern North Carolina.” Social Science and Medicine 38:789–800.CrossRefGoogle Scholar
  53. McCormick, Brian. 1995. “Breast Cancer Still Top Liability Risk; Cost of Claims Rising.” American Medical News (June 19) 38:23.Google Scholar
  54. Miller, Robert H., and Harold S. Luft. 1994. “Managed Care Performance Since 1980.” Journal of the American Medical Association 271:1512–19.CrossRefGoogle Scholar
  55. Myerson, Allen R. 1995. “Helping Health Insurers Say No.” New York Times (March 20) D1.Google Scholar
  56. Nattinger, Anne Butler, M. S. Gottlieb, Raymond G. Hoffman, A. P. Walker, and James S. Goodwin. 1996. “Minimal Increase in Use of Breast-Conserving Surgery from 1986 to 1990.” Medical Care 34:479–89.CrossRefGoogle Scholar
  57. Pollack, Ronald, and Lorie Slass. 1998. Premium Pay II: Corporate Compensation in American’s HMOs. Washington, D.C.: Families USA Foundation.Google Scholar
  58. Potosky, Arnold L., Ray M. Merrill, Gerald F. Riley, Stephen H. Taplin, William Barlow, Bruce H. Fireman, and Rachel Ballard-Barbash. 1997. “Breast Cancer Survival and Treatment in Health Maintenance Organization and Fee-for-Service Settings.” Journal of the National Cancer Institute 22:1683–91.CrossRefGoogle Scholar
  59. President’s Cancer Panel, National Cancer Program. 1996. “Fighting the War on Cancer in an Evolving Health Care System, 1996 Annual Report.” Advisory Boards and Groups, National Cancer Institute, Rockville, Md.Google Scholar
  60. Randolph, Laura B. 1995. “Why Breast Cancer Kills More Black Women.” Ebony (March) 50:122.Google Scholar
  61. Rauber, Chris. 1998. “Evolution or Extinction? Experts Say HMOs Must Reinvent Themselves if They Are to Survive.” Modern Healthcare (Oct. 19) 36.Google Scholar
  62. Riley, Gerald F., Arnold L. Potosky, Carrie N. Klabunde, Joan L. Warren, and Rachel Ballard-Barbash. 1998. “State at Diagnosis and Treatment Patterns Among Older Women with Breast Cancer.” Journal of the American Medical Association 281:720–26.CrossRefGoogle Scholar
  63. Roulidis, Zeses C., and Kevin A. Schulman. 1994. “Physician Communication in Managed Care Organizations: Opinions of Primary Care Physicians.” Journal of Family Practice 39:446–51.Google Scholar
  64. Sainbury, Richard, Bob Howard, Lesley Rider, Colin Johnston, and Caroline Round]. 1995. “Influence of Clinician Workload and Patterns of Treatment on Survival from Breast Cancer.” Lancet 345:1265–70CrossRefGoogle Scholar
  65. Segal, David. 1996. “HMOs: How Much, Not How Well.” Washington Post (January 19) F1, F3.Google Scholar
  66. Senie, Ruby T., Paul Peter Rosen, Martin L. Lesser, and David W. Kinne. 1982. “Breast Self-Examination and Medical Examination Related to Breast Cancer Stage.” American Journal of Public Health 71:583–90.CrossRefGoogle Scholar
  67. Sherrill, Robert. 1995. “Medicine and the Madness of the Market.” Nation (January 9/16) 44–72.Google Scholar
  68. Silverman, Elaine M., Jonathan S. Skinner, and Elliott S. Fisher. 1999. “The Association Between For-Profit Hospital Ownership and Increased Medicare Spending.” New England Journal of Medicine 341:420–26.CrossRefGoogle Scholar
  69. Simon, Michael S., and Richard K. Severson. 1996. “Racial Differences in Survival of Female Breast Cancer in the Detroit Metropolitan Area.” Cancer 72:308–14.CrossRefGoogle Scholar
  70. Simon, Michael S. 1997. “Racial Differences in Breast Cancer Survival: The Interaction of Socioeconomic Status and Tumor Biology.” American Journal of Obstetrics & Gynecology 176:S233–39.CrossRefGoogle Scholar
  71. Smith, Sheila, Stephen Heffler, Mark Freeland, and The National Health Expenditures Project Team. 1999. “The Next Decade of Health Spending.” Health Affairs (July/August) 18:86–94.CrossRefGoogle Scholar
  72. Stolberg, Sheryl G. 1998. “Cultural Issues Pose Obstacles in Cancer Fight.” New York Times (March 14) 1.Google Scholar
  73. Sugerman, D. 1997. “New Treatments Offer Hope.” MPLS-St. Paul Magazine (May) 25:108.Google Scholar
  74. Tokarski, Cathy. 1998. “In the Hot Seat.” American Medical News (March 23) 41:9–11.Google Scholar
  75. U.S. Bureau of the Census. 1998. Current Population Reports. Washington, D.C.Google Scholar
  76. Vistnes, Jessica P., and Samuel H. Zuvekas. 1999. “Health Insurance Status of the Civilian Noninstitutionalized Population: 1997. MEPS Research Findings No. 8; AHCPR Pub. No. 99–0030.” Rockville, Md: Agency for Health Care Policy and Research.Google Scholar
  77. Winn, Robert J. 1995. “The Role of Oncology Clinical Practice Guidelines in the Managed Care Era.” Oncology 9(11 Suppl.): 177–83.Google Scholar
  78. “Women with Breast Cancer Fare Better at Multi-Disciplinary Clinics.” 1997. Cancer Weekly Plus (June 9) 6–7.Google Scholar
  79. Woolhandler, Steffie, and David U. Himmelstein. 1998. For Our Patients, Not for Profits: A Call to Action. Chartbook and Slideshow, 1998 Edition. The Center for Health Program Studies, Cambridge, Mass.Google Scholar
  80. Wyn, Roberta, and E. Richard Brown. 1996. “Women’s Health: Key Issues in Access to Insurance Coverage and to Services Among Non-Elderly Women,” in Changing the U. S. Health Care System, ed. R. M. Andersen, Thomas H. Rice, and Gerald F. Kominski. San Francisco: Jossey Bass.Google Scholar
  81. Zaldivar, R. A. 1998. “American Lifestyle Tied to Immigrant Health Woes.” HHS-HEO News, #10, Part II.Google Scholar

Copyright information

© Anne S. Kasper, Susan J. Ferguson 2000

Authors and Affiliations

  • Ellen R. Shaffer

There are no affiliations available

Personalised recommendations