Insurer Agrees to Fund Breast Cancer Research : Health: Blue Cross-Blue Shield was sued for not covering treatment, whose testers include Scripps Clinic.

Blue Cross-Blue Shield, which has been sued by patients nationwide who have demanded that the insurance company pay for an experimental breast cancer treatment, will now fund the treatment as part of a national study being conducted at Scripps Clinic and other facilities.

The action marks the first time a private insurer has agreed to fund experimental research, company officials said.

The research is part of a nationwide National Cancer Institute trial examining the use of high-dose chemotherapy with bone marrow transplants for breast cancer patients in the advanced stages of the disease.

Scripps and 39 other cancer research centers will participate in the four-year project to study 1,200 women. Of those women, 600 will receive the experimental treatment while the others are treated with standard chemotherapy. The experimental therapy, which requires much more hospitalization, can cost up to $150,000--or about four times the price of conventional chemotherapy.

In recent years, Blue Cross-Blue Shield has been hit with more than a dozen lawsuits in which patients sought to force the insurer to cover the higher costs. The company, one of the nation’s largest, lost half the lawsuits, said Cheryl van Tilburg, a spokeswoman for the Blue Cross and Blue Shield Assn., which licenses the use of the company’s name to its 73 chapters.

“The lawsuits are indicative of the amount of conflict and controversy about whether this procedure is effective,” Van Tilburg said. “We feel the courts are not the most appropriate place to be fighting this one out. Research is the only way we can find out once and for all.”

Much of the insurance industry regards the aggressive high-dose approach as far too experimental and unproven to be eligible for coverage. In fact, among the chapters of Blue Cross-Blue Shield, there is no clear consensus on whether to cover it. For example, California Blue Shield does not pay for the treatment while Blue Cross of California does.

Across the nation, 15 chapters of Blue Cross and Blue Shield--insuring about 21 million members--have opted to join in the NCI research. Each chapter has set aside $30 million to $40 million, Van Tilburg said.

Breast cancer strikes an estimated 150,000 women each year in the United States. When the cancer is located solely in the breast, surgery, chemotherapy and radiation can effectively halt its spread. At that early stage, the five-year survival rate is 90%, according to the American Cancer Society.

But, if the cancer has spread to other organs, the five-year survival rate plunges to 18%. Each year, breast cancer kills about 44,000 women nationwide; in California, the disease kills 4,200.

“Obviously, anything we can do to reduce the number of women who die would be very important, since so many women are diagnosed with breast cancer,” said Dr. Michael Friedman, associate director of the NCI’s cancer therapy evaluation program. “These are very important clinical studies. For (advanced-stage) cancer patients, we don’t currently have a way of curing the disease.”

High doses of chemotherapy kill malignant cancer cells, and the higher the dose, the less likely it is that the cells will develop a resistance to the drugs, according to recent studies. But those high doses also kill bone marrow, which produces crucial disease-fighting white blood cells.

In a treatment called autologous bone marrow transplantation, doctors use a needle to remove the patient’s own marrow. The marrow is frozen after being treated with a drug to wipe out renegade cancer cells.

Next, the patient is treated with massive doses of chemotherapy, about three to six times the standard amount, said Dr. Lawrence Piro, director of the Green Cancer Center at Scripps Clinic. In fact, the dose is so high that patients are usually hospitalized for about 30 days in an intensive-care unit--a measure that contributes a large portion to the overall cost.

After the chemotherapy, the frozen marrow is thawed and injected into the patient. According to a study conducted last year at Harvard Medical School, 58% of the patients who received this aggressive treatment at 13 medical centers had no cancer after one year. Under conventional therapy, fewer than 30% of patients had no cancer after one year.

At Scripps, the study will focus on women who have had breast cancer surgery but are at high risk for a recurrence of the disease, Piro said. This group will include women with advanced clinical stages of breast cancer, or cases where more than 10 lymph nodes were contaminated with cancer at the time of surgery, he said. Such women have a 50% chance of suffering a relapse.

In the war on cancer, this is a crucial group to reach: If the cancer returns, the patients can be treated but they cannot be cured, Piro said. The hope is that the aggressive treatment will prevent the disease’s return.

Piro and his colleagues will carefully monitor the patients in the trial--a group of about 30, he estimates--because breast cancer can recur up to 10 years after the initial treatment.

“This is an attempt to aggressively approach the odds and see if something can be done,” he said.

The NCI study, Piro and others say, will produce the type of conclusive results that will allow most insurance companies to decide whether the new procedure is more effective than standard treatment.

Most insurance companies decline to cover the new treatment because it is still regarded as experimental, said Van Tilburg of the Blue Cross and Blue Shield Assn.

“There’s enough controversy in the medical community about this treatment that it’s worth our while to participate in research,” she said. “Our recommendations aren’t written in stone.”

A number of the insurance companies say there simply haven’t been enough studies. Mike Odom, a spokesman for Blue Shield of California, which doesn’t cover the treatment, said that insurer will carefully watch the NCI research.

“We could possibly decide to join the project,” he said.