I can't afford to have cancer
Knowledge is power
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I cannot afford to have cancer!

First published in Buddies for Life magazine, Summer 2011

A diagnosis of cancer can be one of the most stressful experiences of life. In addition to the worries over survival and treatment, many patients find that they have additional concerns over the cost of medical treatment. In South Africa, 80% of patients are managed within the government health service, and 20% have medical insurance that means they can be treated in private hospitals. Many people find that they have let medical aid run out, or are not covered in a way they thought they were. If you do have medical aid, there are a number of considerations to remember in case you have a diagnosis of breast cancer in your life.

Navigating Medical Aids

All medical aids, even hospital plans, have to provide some cancer cover. This will include in-patient care but may also include specialist fees, chemotherapy and cover for radiation and medications. The amount and type of treatments covered tends to depend on the medical aid plan that you are on, and it may require you to register for a cancer scheme after diagnosis. Check when you are considering starting or changing medical aids what type of treatments you are covered for. Fortunately medical aids are not allowed to refuse cover for a patient with a pre-existing condition and that includes cancer. Remember to always mention these conditions to your medical aid so that you gain access to appropriate care and do not disqualify yourself.

Check your policy too as many companies encourage good health by funding screening mammography and Pap smears even to patients without day-to-day benefits.

What if I don't have a Medical Aid?

There are many excellent public hospitals and superb academic cancer specialists who work in government hospitals. As with all times of illness: knowledge is power, therefore knowing what management you should be expecting will help you navigate through the system. Books, magazines like this one and the internet can help you get more information to help you in your journey. There are many organisations that wish to help patients who do not have the resources for travelling to a hospital or managing treatments.

What is the difference between public and private breast care?

Many women are worried about the government health system in South Africa, and when they do not have medical aid for any reason they ask: Should you come to a private facility at huge costs instead of receiving treatment at a state facility at a fraction of the cost? The answer is that sometimes the only possible difference between state and private facilities is convenience. In a public hospital, due to resource constraints on staff and facilities a patient might have to wait longer for a treatment then in public- but in most specialist breast care centres in South Africa this should never be longer than international guidelines.

In private you can see the specialist the next day where as in public the clinic may only run once or twice a week. Other than this, breast specialists believe patients should have access to exactly the same standard of healthcare in public and in private: the same expertise, the same research trials, the same support groups and psychological care for cancer survivors. And all oncology specialists strive for this.

The Helen Joseph Breast Care Centre is a government hospital unit which strives for excellence but affordable care for women in Johannesburg. It was set up in 2005 with a vision to provide world-class breast care to the women of Johannesburg, delivered in a provincial hospital setting. Units like this allow women (and men) access to all the available methods of breast pathology diagnosis and treatment through an integrated, education orientated, multidisciplinary approach; ensuring cost effective service delivery and high quality patient care.

The HJBCC sees 500-750 patients each month in two weekly clinics. They diagnose 10-15 new cancers each week and operate on 15-25 breast cases, both benign and malignant each week. The centre includes a strong reconstructive surgery department with more than100 reconstructions carried out each year. Many patients have immediate reconstruction with oncologic surgery and reconstruction carried out by different teams at the same operation. There is one important breast care drug- Herceptin- which offers hope to patients with a type of aggressive breast cancer however, that is unavailable in the public sector.

There is also a strong connection between many public breast units and Breast Health Foundation of South Africa, with counselors available to guide and support patients through diagnosis, treatment and recovery, allowing for seamless care and follow-up. It is easy for patients in our time- and economically-constrained community to ‘fall through the gaps’ of cancer treatment, and the counselors form an important safety-net to prevent this.

Integral to the central functioning of a specialist breast unit, whether in public or in private, is ensuring appropriate clinical assessment of women presenting with breast health concerns is achieved throughout the country. This allows correct referrals to be made to appropriate screening and diagnostic facilities.

The problem is that clinics which do not have specialist-based supervision often result in inappropriate patient management. This is not just a problem of an under-resourced state system but the same for public and private surgeons. In order to be really good at something, whether it is driving a car, raising a family or managing cancer, you have to practice. Every mother can tell you horror stories and mistakes she made when she was a new mum. But over the days and years she has ‘seen it all’ and knows how to deal with every mood and every tantrum her children can have. It is the same with breast cancer: with the more patients you see the unusual becomes usual and nothing can surprise you. That means you are better at dealing with all the many faces cancer can have. That is what makes a specialist and why specialist units tend to manage patients in a more holistic way.

If you do not have medical aid, it is important not to be afraid. There are a number of specialist breast units in South Africa that can treat you well and manage your breast cancer without leaving you in debt. Call the Breast Health Foundation helpline (0860 buddie) for more information and advice on how to find your nearest clinic.

Most importantly remember: you cannot afford NOT to be treated for breast cancer.