BlueCross BlueShield of Illinois adds coverage for MammoSite

Sep 20 2006

BlueCross BlueShield of Illinois after meeting with experts last week has decided to cover the partial-breast radiation therapy known as MammoSite for patients with early stage breast cancer, officials for the insurer said, the Chicago Sun-Times reports (Rackl, Chicago Sun-Times, 9/17).

MammoSite uses an approach called brachytherapy -- an internal treatment in which an inflatable balloon is surgically inserted into the breast.

A thin tube is attached to the balloon and for 10 minutes two times a day a radioactive seed is inserted into the balloon that fills the tumor cavity.

The treatment, which FDA approved in 2002, takes an average of five days to complete and costs about $2,500 more than standard radiation therapy.

FDA has said that the device has not been proven in clinical trials to replace standard radiation therapy (Kaiser Daily Women's Health Policy Report, 9/14).

According to the Sun-Times, BCBS of Illinois officials said they decided to add the coverage after hearing the recommendations of experts and reviewing "the most current scientific evidence."

Michael Kinney, an Arlington Heights, Ill.-based breast cancer surgeon who had called for BCBS of Illinois to add the coverage, said the decision on whether to use MammoSite can now be "a medical decision, not a financial one" for patients who are covered by the insurer.

Stan Borg, chief medical officer for BCBS of Illinois, said, "It's important to note there is still a level of uncertainty among physicians ... regarding long-term outcomes of this treatment" (Chicago Sun-Times, 9/17).