An influential committee said bone marrow transplantation is as good a treatment for late-stage breast cancer as other therapies.
The statement is an important revision of opinion by the medical advisory panel of the Blue Cross and Blue Shield Association's technology assessment center. In a 1994 evaluation, the panel said studies hadn't proved that bone marrow transplantation helped women at any stage of breast cancer.
The center's opinions often influence the policies of Blues plans and other payers. It is based in Chicago.
The latest statement applies only to women with metastatic breast cancer, or cancer that has spread. The assessment was prompted by two recent studies that tracked women up to five years after transplantation. Use of the therapy on women with earlier stage disease wasn't evaluated.
Many insurers have considered bone marrow transplantation an experimental therapy for breast cancer and refused coverage. Their decisions have drawn a flood of lawsuits in courts across the country and extensive publicity.
In the treatment, high-dose chemotherapy is used to destroy cancer cells. Because it also destroys bone marrow, patients then are injected with cells previously drawn from their bone marrow or blood.
An estimated 1,000 to 2,000 women with metastatic breast cancer have received the treatment since 1988. Its cost now ranges from $60,000 to $120,000, the association said.
The panel warned that the therapy wasn't appropriate for all women with metastatic breast cancer. It also said there isn't evidence that bone marrow transplantation is more effective than other treatments.
"We still need to find out if (it) prolongs life, or at least the symptom-free period, better than standard therapy," said David Eddy, M.D., a senior scientist at the technology assessment center.
Said Susan Gleeson, an executive at the Blues association, "Based on this assessment, (the association) recommends that, if a Blue Cross and Blue Shield plan decides to provide benefits for this treatment, it should be at experienced centers with good outcomes and low mortality rates, and that they meet the most recent accreditation standards for bone marrow transplant centers."