Younger women may face higher costs for breast cancer care than older patients at least in part because they’re diagnosed when tumors are more advanced and require more aggressive treatment, a recent US study suggests.
For younger women aged 21 to 44, average treatment costs in the first year after a breast cancer diagnosis were US$97,486 higher than average medical costs for similar women who didn’t have breast cancer, the study found.
By contrast, older women aged 45 to 64 had average treatment costs in the first year after a breast cancer diagnosis that were US$75,737 more than their peers without breast cancer spent on healthcare in a year.
About 40% of the young cancer patients were diagnosed with what’s known as stage two tumors, when cancer has spread to lymph nodes surrounding the breast while just 34% of older women were diagnosed when cancer had reached stage two.
“Some of the difference in costs may be due to younger women being diagnosed at a higher stage of disease,” said Stacie Dusetzina, a pharmacy and public health researcher at the University of North Carolina at Chapel Hill who wasn’t involved in the study.
“However, younger patients may also be more likely to have faster growing cancers or to have more intense treatment,” Dusetzina said by email. “They may also receive higher intensity treatment because they are generally healthy and their doctors may be less concerned about the impact of treatment on other conditions.”
For the study, Benjamin Allaire of RTI International in Durham, North Carolina, and colleagues examined data from the North Carolina cancer registry linked to claims data from private health insurers from 2003 to 2010.
The analysis of treatment costs in the first year after a breast cancer diagnosis included 955 women with these tumors who were under age 45 as well as 134,427 similar women who weren’t diagnosed with breast malignancies.
It also included 4,082 women aged 45 to 64 with breast cancer and a comparison group of 299,663 similar women who weren’t diagnosed with these tumors.
Regardless of age, the cost of physician office and hospital outpatient visits accounted for roughly 90% of the difference between costs for women with and without breast cancer, researchers report in Breast Cancer Research and Treatment. Inpatient treatments and prescription drugs contributed just a small portion of the excess costs.
One limitation of the study is that researchers only examined data from one state involving women with one type of health benefit, the authors note. Results might look different for women in other parts of the US or for patients with government health coverage like Medicare or people who were uninsured.
Researchers also didn’t have enough data on women with the most advanced types of breast cancer to compare costs by age for these malignancies.
Costs might also be higher for younger women because they’re more likely to choose a mastectomy to remove the breast, particularly if they have a genetic risk, said Dr. Anees Chagpar, director of the Breast Center at Smilow Cancer Hospital at Yale-New Haven in Connecticut. Younger women may also be more likely to opt for breast reconstruction surgery, Chagpar, who wasn’t involved in the study, said by email.
“When you add up the costs for aggressive chemotherapy, surgery, reconstruction, and potentially radiation as well, this adds up to significant financial toxicity,” Chagpar said.
Beyond getting more intense care, younger women may also face higher out-of-pocket costs because they’re more likely to opt for insurance plans with lower monthly premiums and bigger co-payments or deductibles, said Dr. Alana Biggers, a researcher at the University of Illinois-Chicago College of Medicine who wasn’t involved in the study.
“Women should look for insurance that will pay for preventive measures such as mammograms,” Biggers said by email. “Also, women can reduce their risk of breast cancer by eliminating smoking, maintaining a healthy weight, and exercising.”