Guest on the Show: When Will the Government Listen to Those Affected by Breast Cancer?

An article from the magazine “Mājas Viesis” is available in PDF format here.

Cancer patients are hoping for a government-funded breast reconstruction program

An article in the magazine “Mājas Viesis” titled “When the State Will Hear the Voices of Those Affected by Breast Cancer” provides a detailed account of the challenges faced by breast cancer patients. It is 2021, but since 2009, breast cancer patients have been hoping that, just as in other European Union countries, state-funded breast reconstruction using a method tailored to each individual patient will become available in Latvia as well.

Inete Ielīte, board member of the European Women’s Lobby and chair of the board of the Latvian Women’s NGO Network told “Mājas Viesim” that this year the Women’s Network undertook to promote a Latvian citizens“ initiative in the Saeima regarding state-funded breast reconstruction surgeries, which had been signed on the portal ”ManaBalss.lv,” which had been signed by nearly 13,000 Latvian citizens.

“The past six months have been eventful. Working together with doctors” and patients’ organizations and our network members, we compiled a list based on publicly available information and data that sets out the myths and the facts regarding this issue. Unfortunately, the information available to senior officials at the Ministry of Health (VM) is incomplete and contains a fair amount of misinformation. To address this issue, we invited Ombudsman Juris Jansons to a dialogue. We informed him that the discussion is not only about a lack of communication between institutions, but also about the inaccessibility of information to the public, as well as the services that are and are not available at various medical institutions, especially when a cancer patient wishes to receive a service that is covered by the state,” explained Inete Ielīte.

The chair of the board of the Latvian Women’s Non-Governmental Organizations Network has revealed that the government still owes a debt related to the breast reconstruction program, since the global economic crisis of 2009, when the reconstruction program for breast cancer patients in Latvia was suspended.

A debt that has accumulated over more than ten years must be repaid.

We must achieve not only the best medical outcome, but also the most cost-effective one

Breast cancer patients who cannot afford to have their removed breasts reconstructed using their own funds lose their families, develop depression, and experience other health problems.

Surgeon Kalvis Pastars, director of the Microsurgery Center, has also been dealing with these issues for many years: “The government has now announced that it will cover the cost of these surgeries without allocating separate funding. What does this mean? Last year, more than 100 patients underwent breast reconstruction. The problem

The fact is that the least expensive method of breast reconstruction is using a tissue expander. The average cost of this procedure is around 2,700 euros, but the state covers between 1,089 and 1,597 euros for this procedure—regardless of the reconstruction method used—depending on which DRG group the procedure falls into. Thus, the remaining amount must be covered by the hospital from its own internal resources. These surgeries result in losses for hospitals, as the actual costs of the service are not covered. Hospitals, in an effort to adapt, use

”only the least expensive breast reconstruction methods are available to a limited number of patients, and patients are required to purchase the implants themselves."

Similarly, every woman should undergo the breast reconstruction method that is best suited for her, in order to achieve not only the best medical outcome but also the most cost-effective result. This way, the patient won’t have to undergo ten surgeries. For example, breast reconstruction using a tissue expander or implant is not suitable for women who have undergone radiation therapy, as the scarred tissue prevents the use of this method. These patients require breast reconstruction using tissue flaps. There are several methods for performing breast reconstruction using well-vascularized tissue.

The director of the Latvian Microsurgery Center, who has been performing breast reconstruction surgeries for many years, recommends that breast cancer patients undergo all necessary surgeries in a single stage. “This means that,

where the tumor is removed and the breast is reconstructed immediately. It can also be performed in two stages. In the first stage, the breast cancer is treated by removing the breast, followed by chemotherapy and radiation therapy, and once the patient is clinically free of breast cancer, the second stage follows—breast reconstruction surgery. If I’m not mistaken, not a single breast reconstruction surgery was performed between 2009 and 2016. During this time, according to our estimates, there are already approximately 3,000 patients who have not undergone breast reconstruction surgery. These women don’t even know that this option exists, and even if they do, they are offered the cheapest method involving implants or expanders, without taking their individual circumstances into account. So the main problem is that breast reconstruction surgeries are currently performed on a very limited number of patients and are carried out without following the state-approved guidelines for breast reconstruction.”

The Minister of Health promises that breast reconstructive surgery will be one of the priorities

Health Minister Daniels Pavļuts has also been informed on several occasions about the issues faced by breast cancer patients. Commenting on this situation, he says: “To address the situation, the National Health Service (NVD), together with industry specialists, is working on revising reimbursement rates and developing an appropriate payment model for breast reconstruction surgeries. To address this issue, the Ministry of Health will request additional funding in next year’s budget. The development of breast reconstructive surgery is also included in the new

”in the 2022–2024 oncology plan, which will be one of the most important priorities for me and for the entire healthcare sector during the government’s negotiations on next year’s draft budget."

Ginta Ozoliņa, a representative of the National Health Service (NVD), explains that patients must receive high-quality care appropriate to their needs and health condition. “Therefore, if any patient has doubts

”If you have any concerns about the quality of the service, please let the NVD know," she suggests.