When Susan Grover was diagnosed with breast cancer four years ago, she wanted to have just the lump removed, but a surgeon recommended a mastectomy — full removal of the breast.
"It just didn't feel right. It just went against everything," she says.
Sometimes mastectomy is the best treatment. But experts like Dr. Patrick Borgen of Memorial Sloan Kettering say simple removal of the lump followed by radiation is often better. And it involves far less potential long-term effects.
"Absolutely, yes. Less scarring, less untoward sensations," says Borgen. "Less pain. Quicker return to work. Quicker return to life activities."
There are many reasons why breast cancer patients may not get optimal care, but one of them is financial. Doctors usually get reimbursed far less for simple procedures that have fewer side effects.
Dr. Anthony Lucci of MD Anderson Cancer Center has studied the issue. He points out that Medicare pays almost twice as much for a mastectomy and private insurers usually follow Medicare's lead. The reason is that the mastectomy takes longer, but Lucci says that should not be the major factor in determining payment.
"We're trying to get paid for doing better work, smarter work and work that requires more intellectual and technical skill rather than just something that's just brute force work," says Lucci.
Grover ultimately got the less-invasive surgery. In fact, she's looking forward to breast feeding her next child.
Medicare officials say they are looking for ways to encourage such good outcomes. They are studying methods of reimbursing doctors not just for their work, but for the quality of the care.