Last month we covered prostate cancer. This month the focus is on breast cancer. Prostate cancer is the most common non-skin cancer among men, with approximately 1 in 8 men in
the U.S. diagnosed during their lifetime. Breast cancer is highly common, representing the most frequently diagnosed cancer in women worldwide and in the U.S., excluding skin cancers. Approximately 1 in 8 women (about 13%) in the United States will develop invasive breast cancer during their
lifetime. Breast Cancer Diagnosis and TreatmentMedicare covers breast cancer diagnosis and treatment, including mammograms (screening/diagnostic), biopsies, chemotherapy, radiation, and surgery, generally under Parts A and B. Costs are typically shared, with Medicare paying 80% of the approved amount for
outpatient services after the deductible, while Part D covers prescription drugs. https://www.medicare.gov/coverage/mammograms Medicare covers annual screening mammograms for women 40+ at no cost if the doctor accepts assignment. Diagnostic mammograms, ultrasounds, and MRIs are covered if medically necessary. Part A
(Inpatient): Covers hospital stays, surgery (e.g., lumpectomy, mastectomy), and inpatient care. Part B (Outpatient): Covers doctor visits, chemotherapy (infusion), radiation therapy, and outpatient surgery. Medicare covers breast prostheses and, if a mastectomy is covered, reconstructive breast surgery is also covered. Drugs (Part D): Prescription drugs, including oral chemotherapy and anti-nausea medications, are usually covered under a separate Part D plan Medical necessity is determined by your doctor if you have OM (Original Medicare). Medicare Advantage (Part C) plans, not your doctor, decide medical necessity to determine diagnosis and treatment, often using prior authorization to manage your care. CANCER AND MEDICARE ADVANTAGE What is Medicare Advantage? Unlike original Medicare that comes directly from the federal government, Medicare Advantage (Part C) plans are offered by private insurance companies. These private insurers are approved by Medicare—and they must
cover all the same services original Medicare does. Instead of being able to see any provider accepting Medicare assignment, you’ll need to use the plan’s network of doctors and hospitals (except in emergencies). Many plans have a $0 monthly premium, but you are still responsible for paying the Part B premium. Medicare Advantage plans come with an annual out-of-pocket maximum.. This can help protect you from very high medical bills. In 2026, the out-of-pocket maximum
is $9,250 for approved services (but individual plans can set lower limits if they want to). Medicare supplement plan G limits your out-of-pocket maximum for medical care to the prevailing Part B deductible. https://www.ncoa.org/article/original-medicare-vs-medicare-advantage-whats-the-difference/ How is Breast Cancer Diagnosed?Breast cancer can be diagnosed through multiple tests, including a mammogram, ultrasound, MRI, and biopsy. Breast cancer screening can detect
cancer before signs or symptoms develop. While breast cancer screening cannot prevent breast cancer, it can help find breast cancer in its earliest and most treatable stage. When detected in the localized (early) stage, breast cancer has a 5-year relative survival rate of 99%, according to the American Cancer Society. A mammogram is an x-ray of the breast. While screening mammograms are routinely performed to detect breast cancer in women who have no apparent symptoms, diagnostic mammograms are used after suspicious results on a screening mammogram or after some signs of breast cancer alert the physician to check the tissue. When a suspicious area is detected in your breast through a breast self-exam or on a screening mammogram, your doctor may request an ultrasound of the breast tissue. A breast ultrasound is a scan that uses penetrating sound waves that do not affect or damage the tissue and cannot be heard by humans. A breast biopsy is a test
that removes tissue or sometimes fluid from the suspicious area. The removed cells are examined under a microscope and further tested to check for the presence of breast cancer. A biopsy is the only diagnostic procedure that can definitely determine if the suspicious area is cancerous. If you are diagnosed with breast cancer, your doctor will
order additional lab tests to assist with prognosis. The two most common lab tests, known as prognostic factors, are the hormone receptor test and the HER2/neu test. Results from these tests can provide insight into which cancer treatment options may be most effective for you. https://www.nationalbreastcancer.org/breast-cancer-diagnosis/ Medicare covers hormone receptor tests (ER/PR) and specific genomic tests for breast cancer, such as the Breast
Cancer Index (BCI), under Local Coverage Determinations (LCD) when deemed medically necessary for treatment planning. Coverage typically includes ER/PR status and HER2 testing to determine eligibility for endocrine therapy or chemotherapy. https://www.breastcancer.org/screening-testing/breast-cancer-index-test How is Breast Cancer Treated?If you’ve been diagnosed with breast cancer, your cancer care team will discuss your treatment options with you. It’s important that you think carefully about each of your choices and weigh the benefits of each treatment option against the possible risks and side effects. Some treatments, like surgery and radiation, are local, meaning they treat the tumor without affecting the rest of the body. Most women with breast cancer will have some type of surgery to
remove the tumor. Depending on the type of breast cancer and how advanced it is, you might need other types of treatment as well, either before or after surgery, or sometimes both. Drugs used to treat breast cancer are considered systemic therapies because they can reach cancer cells almost anywhere in the body. Some
can be given by mouth, injected into a muscle, or put directly into the bloodstream. Depending on the type of breast cancer, different types of drug treatment might be used, including: chemotherapy, hormone therapy, targeted drug therapy and immunotherapy. https://www.cancer.org/cancer/types/breast-cancer/treatment.html DARK CHOCOLATE THINGS YOU MIGHT NOT KNOWhttps://www.facebook.com/share/p/16xKrtdkPu/ If You Are Diagnosed With Cancer . . . If you or
someone you love has been diagnosed with cancer, deciding what’s next can be overwhelming. ACS CARES (Community Access to Resources, Education, and Support) is the only app that equips those facing cancer with curated content, programs, and services to fit their specific cancer journey. https://www.cancer.org/support-programs-and-services/acs-cares.html Who is at Risk for Breast Cancer?Everyone is at risk for breast cancer, but risk increases with age (most over 50), female gender, family history, and genetic mutations (e.g., BRCA1/2). Other key factors include dense breast tissue, personal history of breast cancer, early menstruation/late menopause, obesity, and
alcohol consumption. Certain factors may increase the chance of developing breast cancer, though these factors do not directly cause cancer. Some people with multiple risk factors never develop breast cancer while others who do not have any risk factors do develop breast cancer. Although some risk factors cannot be changed, such as a
person’s age or family history, there are some things you can do to help lower your risk, such as maintaining a healthy weight, being physically active and limiting alcohol consumption. The average woman has approximately a 12 percent chance of developing breast cancer. About 10 to 15 percent of breast cancers are driven by genetic
factors while the remaining are referred to as sporadic and risk is contributed to by a variety of factors. https://www.brighamandwomens.org/surgery/breast-surgery/breast-cancer-risk-factors-and-symptoms What are Symptoms That Indicate You Could Have Breast Cancer?Key symptoms of breast cancer include a new, often painless hard lump, swelling, skin irritation, dimpling (orange-peel texture), nipple pain, or
nipple retraction. Other indicators are nipple discharge (other than milk), redness/scaling of the skin, and unexplained changes in breast size or shape https://www.mayoclinic.org/diseases-conditions/breast-cancer/symptoms-causes/syc-20352470 Many symptoms are not cancer: These signs can be caused by benign (non-cancerous) conditions, but any new change should be checked by a doctor. Not all cases have symptoms: Some breast cancers are only found during routine mammograms before symptoms appear. https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection Can Breast Cancer be Cured?Breast cancer is highly curable, with over 90% of cases having a 5-year survival rate, especially when detected early (stages 0-III). While Stage IV (metastatic) cancer is generally not considered curable, it is highly treatable, allowing many to live for years
with a good quality of life Early Detection is Key: Stages 0, I, II, and III are considered potentially curable. Survival Rates: The overall 5-year survival rate is approximately 90%. Treatment Advancements: New therapies, including targeted medicine and immunotherapy, have significantly improved outcomes, even for advanced cases. Factors Affecting Cure: Curability depends on the
cancer type (e.g., HER2 positive, triple-negative), stage, and tumor aggressiveness. https://www.worldwidecancerresearch.org/cancer-and-research-information/types-of-cancer/how-curable-is-breast-cancer/ Medicare covers hormone receptor tests (ER/PR) and specific genomic tests for breast cancer, such as the Breast Cancer Index (BCI), when deemed medically necessary for treatment
planning in patients with early-stage, hormone-receptor-positive (HR+) disease. Coverage generally applies to post-menopausal women with specific node-negative or node-positive, HER2-negative, invasive breast cancer to guide chemotherapy and endocrine therapy decisions. Local Cancer Support GroupsLocal cancer
support groups in the Atlanta area offer free, in-person, and virtual,,, resources for patients and caregivers, including Cancer Support Community Atlanta, Piedmont Cancer Institute (locations in Atlanta, Fayetteville, Johns Creek, Locust Grove), and Wellstar Health System. These organizations provide counseling, educational workshops, wellness classes, and specialized support for various cancer types. https://www.cscatlanta.org/ Cancer Financial AssistanceCancer financial assistance is available through national non-profits and specialized organizations offering grants for treatment, medication, co-pays, and daily living expenses. Major resources include CancerCare (co-payment assistance), Cancer Financial Assistance Coalition (CFAC), and local
support like the Atlanta Cancer Care Foundation, which assists with housing, utilities, and food. https://www.georgiacancerinfo.org/cancer-resources/financial-assistance/6 PAGING DR. REDDITThe role of Reddit and LLMs in patients' health journeys Alex Bell
was diagnosed with stage 3 breast cancer at 32 years old. Her family and friends did not understand what she was going through. But she found a community on social media platform Reddit. The cancer journey left Bell wishing to help others' suffering, plus a focus on compassionate, evidence-based discussion and
moderator ethics. Since 2020, she has served as a moderator of multiple Reddit communities. She also founded a subreddit (the term for those communities) called r/doihavebreastcancer. “People really open up about their concerns, their fears, their health,” Bell, one of several panelists in a SXSW 2026 on trusting health
information in the age of artificial intelligence, said of Reddit. “It is incredibly healing to help people go through what you went through.” Reddit is distinct from other social media platforms because it features text-based, longer-form content (in addition to multimedia, external links and comment-based discussion). Therefore, the speakers
noted, it doesn't provide the same dopamine hit that leads to doomscrolling on social media. https://www.fiercehealthcare.com/health-tech/sxsw26-trusting-health-information-age-ai FYI . . .AI and social media are not subject to HIPAA. Information you share can end up in places where you don’t want it. Beware! Also, social media and AI answers are opinions (social media) and curated responses (AI) which may not be accurate!! DACHSHUNDS ARE FUNNY . . . https://www.facebook.com/share/r/18Eemg6hjX/ IN CLOSING . . .Another long one . . . sometimes I get wrapped up in research and don’t realize I can’t cover everything in one newsletter. I hope you learn something with every newsletter and topics like cancer can create a lot of stress. Feel free to pass this along to friends and relatives. Feedback is always appreciated. Blessings! Bob & Rachel |
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