October is Breast Cancer Awareness month and according to the South African Government, breast cancer is one of the most common and increasing cancers among South African women. The National Cancer Registry states that breast cancer affects about one in 33 women in their lifetime. Its prevalence rate has shown a consistent increase over the last decade as the urban population increased, says Jaco Visagie, director and financial advisor at FinSafe. Ladies are therefore encouraged by various organisations, such as CANSA and PinkDrive, to go for regular examinations and mammograms to ensure effective treatment and diagnosis.
The implications of breast cancer are far-reaching. Breast cancer is not only life threatening, but also has significant financial implications. There are many stories of husbands taking out loans to pay for the medical treatment of their wives. Take the case of Sally Grey* – after several chemo courses not delivering the necessary results, there was only one other option left: chemo at a cost of R250,000 per month. Naturally, the medical aid declined to fund this and her husband re-mortgaged their home in an attempt to save his wife’s life.
Liberty Life’s claims statistics for 2015 indicate that cancer was the cause of 25,8% of death claims that were received and 11,8% of these death claims were related to breast cancer. Of the 63,8% critical illness claims received (relating to cancer), 48,5% was specifically for breast cancer.
Recent discussions and information alerts about medical schemes’ tariffs reveal a substantial increase for 2017. Zeeva, a debt counselling firm especially for women, emphasises that with statistics like the above in mind, it is critical that every woman knows exactly what her medical scheme will cover should she be diagnosed with breast cancer. Visagie shares some valuable advice to ensure that you are covered in the event of a breast cancer diagnosis:
The odds of surviving a dread disease
Among newly-diagnosed cancer patients aged 20 to 40 years, over 50% of men and 65% of women diagnosed can expect to live five years longer than their peers not receiving treatment.
Costs associated with the treatment of breast cancer
According to several sources, the cost of treating breast cancer in South Africa will always vary as every patient is treated differently, Visagie says. There are different costs that have to be taken into account at different stages of a patient’s treatment:
Breast cancer is usually diagnosed after a clinical examination and various tests are done by a doctor. A general consultation costs on average around R590, which excludes materials or procedures.
Doctors use the results from a mammogram, an ultrasound as well as the pathology results from a biopsy to make a diagnosis. An image-guided core biopsy is the recommended procedure, however, in some circumstances a surgical biopsy may also be required. The average cost for a breast biopsy is in the region of R17,000.
MRI scan biopsies are often required and in some cases patients need to undergo genetic testing on breast cancer biopsies (called a Mammoprint or Oncotype DX) to later decide on the best chemotherapy treatment. Visagie says the above costs involved for biopsies can escalate well over R30 000 according to Sanlam’s and Liberty Life’s 2015 statistics.
Visagie mentions that once a patient is admitted to the hospital the costs can stack up quickly. The most common types of surgery are:
- a lumpectomy – a surgical procedure during which a lump is removed from the breast, typically when cancer is present but has not spread;
- a mastectomy – a surgical procedure to remove a whole breast including all of the breast tissue and nearby tissues (basically removing as much of the cancer as possible). Some women choose to remove the entire breast, especially when there is a history from a mother or grandmother that had breast cancer. There are five different types of mastectomy: “simple” or “total” mastectomy, modified radical mastectomy, radical mastectomy, partial mastectomy, and subcutaneous (nipple-sparing) mastectomy; and
- a double mastectomy – a surgical procedure to remove both breasts.
Extra costs are also incurred if a patient then opts for reconstructive surgery, which is a common procedure option after mastectomies. During 2015 the cost of a mastectomy was approximately R62,000 and the typical cost for reconstructive surgery varied between R50,000 and R140,000, the cost depending on the complexity of the reconstruction.
Cancer treatment offered before or after surgery includes systemic therapy such as:
- Chemotherapy, with or without hormonal manipulation;
- Targeted biologic treatment; and
- Radiation therapy.
Hormonal therapy may be prescribed for a period of five to ten years and will cost on average between R650 and R2,500 per month. Conventional chemotherapy will cost on average around R25,000 for four treatment cycles, whilst six cycles of therapy will cost approximately R140,000.
Radiation therapy costs on average between R51,000 and R112,000, for five and six weeks of treatment depending on the complexity of the condition as well as the type of therapy administered. Biological therapies such as Herceptin, which some patients may require up to 16 times (shots) per year, may cost R25,000 per shot. At a rate of 16 shots per year that comes to a shocking R400,000 per year. Visagie explains these drugs are used to treat rare conditions and cancer subtypes; hence they come at a much higher cost than conventional drugs.
Covering yourself against the risk
- Life, Disability and Critical Illness Insurance
People predominantly buy life and disability cover to avoid debt and protect the income of the breadwinner, while a dreaded disease like cancer isn’t something they plan for financially. Cancer patients often get an unpleasant surprise when they discover that the costs of their fight against cancer extend far beyond the pure ‘medical costs’. These additional costs include travelling fees (to see specialists who are often not close by), rehabilitative treatment, private nursing costs and employing a nanny to take care of the children. According to Visagie, these costs are just a few of the things survivors say they didn’t anticipate.
- Medical Aid
Only 16% of South Africans are covered by a medical aid according to Visagie. The good news is that cancer is one of the conditions covered under prescribed minimum benefits (PMB), which means that all medical schemes in South Africa must cover members according to the standard treatment offered in state facilities. However, Visagie points out that patients should educate themselves about the limits applicable to their medical aid cover and any co-payments that they may be liable for.
Plan of action
Female patients need to speak to a licensed financial advisor to make sure their immediate medical expenses are covered and taken care of. Visagie advises women to also add GAP cover to their medical aid in order to make provision for co-payments that may occur. This will ensure that patients have adequate medical aid cover in place should the unforeseen happen.
Comprehensive medical aid is critical to get the necessary treatment to fight high-risk diseases such as breast cancer. So get the best you can and make sure you know exactly what you’re getting. Prevention is still the most affordable cure, and Zeeva wants to encourage all women to use October to not only do self-examinations and go for mammograms where relevant, but to also ensure that their medical cover for breast cancer is sufficient.
*Please note that Sally Grey is used as an alias.