We pay for breast reconstruction after mastectomies for breast cancer. So why can’t women at risk of becoming infertile from the chemotherapy that saves their lives rely on insurance companies to help pay for the treatment to save their fertility?
More than 100,000 women had breast reconstruction last year after mastectomies for breast cancer. The cost: more than $1 billion, and health insurance paid a large part of it.
We estimate fertility preservation would be a fraction of the cost of breast reconstruction: $127 million for women under the age of 45 diagnosed with breast cancer who have not yet completed family building.
Legislation is pending in several states, including Illinois, to mandate insurance coverage for fertility preservation services for cancer patients. Cancer patients urgently need it. A federal-level legislative mandate to ensure cancer survivors also can conceive children could make all the difference.
Insurance companies typically require a year of unsuccessful attempts at conception before they will cover infertility services. That’s too late for most cancer patients. They need prophylactic treatment ovary stimulation, egg retrieval and cryopreservation of eggs or embryos before receiving chemotherapy, when their fertility can still be preserved.
With advances in assisted reproductive technologies, breast cancer patients can safely undergo egg retrieval without delaying necessary cancer treatment and the risk of excess estrogen exposure.
But these services are considered preventive interventions and ineligible for insurance coverage. The single greatest barrier to fertility preservation for cancer patients is cost.
Of the nearly 320,000 women diagnosed with breast cancer each year, 29,000 are 45 years old or younger. Thanks to advancements in breast cancer treatments and wider screening efforts, patients now live longer with the opportunity to enjoy many of life’s milestones. One of those is building families.
The risk of permanent infertility after chemotherapy ranges from 20 to 70 percent, depending on the patient’s age, type of breast cancer and treatment regimen. Hispanics and African-Americans have a higher risk for more aggressive forms of breast cancer requiring more toxic therapies.
Despite the legal precedent of coverage for breast reconstruction, there is no legislative requirement for insurance coverage of fertility preservation. In 2013, the California state legislature passed a bill mandating fertility preservation coverage, but it was vetoed by Gov. Jerry Brown. Currently, there are state-level bills in California, Hawaii, New York and Illinois attempting to mandate insurance coverage for fertility preservation services for cancer patients.
The Family Act was first introduced in 2013 in the U.S. House of Representatives to provide a tax credit to cover fertility services for cancer patients, but the bill never left the committee level. With only one Republican co-sponsor at the time, the bill has yet to be reintroduced in the House or Senate.
Major physician organizations have all recognized fertility counseling and preservation as an important component of comprehensive cancer care. Now legislators need to act.
Dr. Steve Xu is a resident physician in dermatology, and Dr. Jessica Walter is a resident physician in obstetrics and gynecology, both at Northwestern University Feinberg School of Medicine.
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