I have a friend and fellow breast cancer sister who lives in Indiana. Because of cancer, she lost her job and her health insurance. She was forced to get her treatment through Indiana Medicaid. She was diagnosed with a type of breast cancer known as Triple Negative breast cancer.
This means that it is
1. not responsive to estrogen
2. not responsive to progesterone
3. not fueled by the Her2 oncogene.
If you have cancer that responds to estrogen or progesterone, you can take drugs following the end of your course of chemotherapy and radiation that "turn off" or block these hormones from feeding any future cancer. Women take these drugs for five years or more. Women who are Her2 positive have the benefit of Herceptin and a few newer drugs to keep this protein from encouraging more cancer growth.
All of these women, who are considered "positive" are also considered "in treatment" by virtue of the fact they are taking the drugs mentioned.
When a woman has triple negative breast cancer, there are no drugs to take. Since her cancer is not fueled by hormones and she does not carry the Her2 oncogene, she does not require anything further after her chemotherapy and radiation are completed. However, triple negative breast cancer is very aggressive and it has a high rate of recurrence. Because of this, doctors watch their triple negative patients very closely for the first few years post treatment to ensure that if anything should recur, they will catch it at its earliest stage.
Except if you live in Indiana and you are on Medicaid.
Indiana Medicaid tells its triple negative breast cancer patients that since they are not taking a drug for their cancer, they are no longer in treatment. That means that no follow up mammogram, breast mri, sonogram, PET scan, bone scan or any other screening tool required to follow these women will be covered. If you are on Medicaid, you cannot afford insurance. That would mean that you don't have the means to pay upwards of $1,500 for a PET scan out of pocket, either.
What is to become of these women? Are they being left out in the cold simply because their more aggressive cancer has no drug for them to take to help them fight recurrence? Women who are fortunate enough to benefit from post-treatment drugs, can have all the screenings they require, simply because they are considered "in treatment."
If you are on Medicaid and you are triple negative and about to complete treatment, you had better check to see if your state is like Indiana. If all the states in the union follow this logic, then it is time for us to rise up and demand that women who are under insured and rely on the Medicaid system, need to be followed by their doctor to help them stay alive. And Medicaid has to pay for the screening they require.