Hospitals and insurers restrict access to a faster breast cancer therapy.
Many women facing breast cancer in the United States are being blocked from a treatment that doctors around the world view as a major advance. The procedure, called intraoperative radiation therapy, or IORT, delivers a single dose of radiation directly to the area where a tumor has been removed. A much faster tretment, it replaces weeks of traditional radiation sessions and is less demanding for patients, both physically and financially. Yet while hospitals in Europe, South America, and Asia have adopted IORT for years, its use in the U.S. has declined.
Surgeons who work with breast cancer patients say the reason is simple: money. Traditional radiation therapy can bring in thousands of dollars in hospital and physician fees. IORT, by contrast, costs far less and requires fewer appointments. For hospitals that depend on repeated radiation visits for revenue, there’s little incentive to promote a treatment that patients only need once.
Dr. Phillip Ley, a cancer surgeon in Mississippi, often treats women who travel long distances for care. He says IORT has been life-changing for those who can’t afford to drive to daily radiation sessions. Still, many hospitals don’t offer it anymore. Medicare records show radiation oncologists receive about $525 for performing IORT, compared with more than $1,700 for multiple rounds of whole-breast radiation. “This is about money and greed,” Ley said. “Patients lose when decisions are made this way.”
IORT has been approved by the Food and Drug Administration since 1999, but it’s meant for a specific group: postmenopausal women with early-stage cancer and no signs of lymph node spread. Studies have shown that recurrence rates can be slightly higher than with traditional radiation, though long-term survival rates are the same. The treatment also avoids some of the serious side effects linked to weeks of external radiation, such as burns and heart or lung damage.
Despite these findings, the American Society for Radiation Oncology (ASTRO) discourages doctors from using IORT outside of research trials. The group argues that the data does not yet justify broad use. But some surgeons believe financial concerns play a hidden role. Dr. Alice Police, who has launched several IORT programs across the country, says radiation oncologists resist it because it disrupts a profitable system. “Even though the data is strong and patients love it, they call it experimental,” she said. “That keeps insurers from paying for it.”
Insurance coverage has become a major barrier to faster treatment. Medicare and Medicaid approve IORT, but many private plans do not. That forces patients to pay thousands out of pocket if they want the one-time treatment. Some, like Louisiana resident Amy Slaton, decide it’s worth it. After choosing IORT, she returned to work within two months, something that would have been impossible with weeks of radiation. “I don’t understand why insurance wouldn’t cover something that gets people healthy faster,” she said.
Patients who have experienced both types of radiation often describe this faster option as far less punishing. California resident Heidi Toplansky, who had cancer in both breasts, received IORT on one side and traditional radiation on the other. The difference, she said, was night and day. The IORT side healed quickly, while the other left burns and scarring that later required laser treatments.
Surgeons and patients say it’s frustrating to see the treatment so widely accepted abroad but still limited at home. They argue that a health system built on billing volume, not patient convenience, is holding it back. A 2018 study estimated that IORT could save the U.S. health system more than a billion dollars over five years if it were more widely used. Yet most hospitals continue to promote the older, more expensive method.
Doctors like Dr. Sheldon Feldman in New York believe change will only come if patients push for it. “Like many advances in breast cancer care, it will take advocacy,” he said. “The science is there. What’s missing is the will to make it accessible.”
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U.S. women are increasingly shut out of a breast cancer treatment valued around the world
How some U.S. women are shut out of a breast cancer treatment, IORT, valued around the world
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