Even when they had good health insurance coverage, women with breast cancer reported having financial worries related to their care, and the vast majority said they preferred to know about treatment costs at the time of diagnosis.

Breast cancer is cancer that starts in the breast, usually in the inner lining of the milk ducts or lobules. There are different types of breast cancer, with different stages (spread), aggressiveness, and genetic makeup.

With the best treatment, 10-year disease-free survival varies from 98% to 10%. Treatment is selected for surgery, drugs (chemotherapy), and radiation. In the United States, there were 216,000 cases of invasive breast cancer and 40,000 deaths in 2004.

Breast cancer

Worldwide, breast cancer is the second most common type of cancer after lung cancer (10.4% of all cancer incidence, both sexes counted) and the fifth most common cause of cancer death. In 2004, breast cancer caused 519,000 deaths worldwide (7% of cancer deaths; almost 1% of all deaths).

The findings from a study by Duke Cancer Institute researchers highlight the importance of considering medical costs as women face breast cancer treatment decisions.

"Overwhelmingly, women cared about the cost of their breast cancer care and almost half reported considering costs when making treatment decisions," said Rachel Greenup, M.D., who is presenting the findings Sept. 29 at the ASCO Quality Care Symposium in Phoenix. "Despite this, 79% reported never discussing costs with their medical team."

The vast majority of women eight out of 10 said they preferred knowing the costs of treatment before embarking on cancer care. And 40% preferred that doctors consider costs when making treatment recommendations.

"Doctors and patients should be open to discussing the financial implications of treatment," Greenup said. In their study, the Duke team surveyed more than 750 women after breast cancer from the Army of Women and Sisters Network, national organizations of women after breast cancer.

All were women with a median age of about 50. Most had either private health insurance or Medicare and had an annual household income of more than $74,000.

Even within this group—financially better off than many cancer patients—nearly 16% reported significant to the catastrophic financial burden. Median reported out-of-pocket costs were $3,500, although 5% of women faced out-of-pocket costs over $30,000.

"Cost transparency could improve the quality of treatment decisions patients make and have the potential to reduce the risk of financial harm," Greenup said.