For Women Only

Breast cancer is a disease that affects more than 200,000 American women each year. The good news is that the outcomes are much better than ever. Today, early detection and new therapies offer women better chances at long-term survival and less invasive surgeries with fewer complications.

For women who choose not to have reconstructive surgery, the need for quality post-mastectomy products is strong. The challenge to the HME industry is to ensure women have the choices they need.

Listening and Responding

Consumer demand, advancing technology and competition among manufacturers drives product improvement in the women’s health sector, according to market experts. The shift in surgical procedures to include more lumpectomies also has had a significant impact.

“We have definitely seen an increase in need for partial products,” says Nikki Giamarino, breast care product manager for Camp Healthcare. “There is a change in surgery trends where there seems to be an increase in partial lumpectomy surgery versus full mastectomy surgery.”

That doesn’t mean there is no longer a need for full-size prostheses. “The ladies who had their surgeries in the past still need to replace their products annually or every two years,” Giamarino notes.

Capital Marketing Technologies President Judi Simon says there are several reasons why consumers also have taken an interest in lightweight forms, explaining their shape has improved over older models — there is less material to accommodate the less radical surgeries. She adds the combination of materials results in a breast form that more closely mimics aging skin and muscle tone, which is appealing for older customers.

“Technology has now allowed us to do different things with silicone that make the breast forms feel more like a 65- or 70-year-old breast,” explains Simon. “Because these lighter-weight forms tend to mimic older breasts, they are very soft and pliable.” She adds that the original form styles are still available, and that requests vary among customers. The company will introduce a new adaptable form at Medtrade this month.

Christine Voet, product manager for Airway, a division of Surgical Appliance Industries, says today’s lightweight forms are significantly lighter than previous products, and that these improvements are in line with what women want. “Customers are becoming more selective, more discriminating and more discerning because they’re learning about the features and benefits themselves,” she says.

Cindy Ciardo, CEO of Knueppel HealthCare Services and manager of vendor services for Essentially Women Group Purchasing Organization, adds that one breast form recently introduced by Amoena is an interesting new choice. She says the two-part form has a removable “climate control” pad. A gel layer absorbs body heat from the chest wall, and a layer of soft fabric wicks moisture away from the chest wall.

The market is also seeing an increased interest in custom-made breast prostheses. According to Giamarino, Camp’s custom prosthetics are made differently than its standard artificial prosthetics. “Our artificial prosthetics have a polyurethane bag filled with silicone; our custom product is actually like a silicone matrix,” she explains. “This is why the weight of the product remains really low.”

Giamarino adds that the additional reduction in weight of custom prostheses makes them beneficial for large-breasted women, women with lymphedema who should not have any added weight on their surgical side, and those with arthritis, scoliosis or other conditions who are unable to tolerate the weight of a standard or even a lightweight silicone prosthesis.

Mimi San Pedro, president of ContourMed, a custom prosthesis manufacturer, says the company listens closely to its customers — and they have a lot to say. “The good thing about that is that we are providing them with an alternative based on what it is they say they need to improve their lifestyle or get them back to their lifestyle,” she says. “The difficult thing about that is they are expecting so much more when it comes to custom.”

San Pedro acknowledges that it is good the consumer voice is so strong. She applauds survivors for no longer “just accepting what is available” but asking for breast forms with a more natural shape and feel. ContourMed recently introduced a new custom prosthesis that offers a choice of 16 skin tones and incorporates the use of materials that have a more tactile feel.

Customers are also showing interest in more fashionable post-mastectomy lingerie. Airway’s Voet says the company’s newest bra closely mimics what is being offered in the consumer fashion market. “We now offer a bra that has interchangeable straps; one set is made of traditional elastic and the other is clear, which allows women to wear more revealing outfits,” she explains. “We are trying to accommodate our customers’ wants. They shouldn’t have to compromise their fashion sense because they have had a mastectomy.”

Filling All Needs

Being successful in post-mastectomy products may depend on the other products providers carry.

Ciardo believes it is important for providers to offer a full line of women’s health care products. “The most successful stores will cater to all women’s needs and carry a comprehensive line of products,” she says. “Using post-breast surgery products as a base, it is important to carry products for lymphedema management, skin care, swimsuits, hats and turbans, and wigs if you have the expertise.”

Additionally, she recommends expanding offerings to cover a more complete line of women’s health products, including compression hosiery, maternity garments, breast pumps and breastfeeding supplies, incontinence undergarments and pads, and light orthopedic products such as osteoarthritis supports, lumbar supports, carpal tunnel braces and orthopedic pillows.

Voet agrees that a full selection is not only smart but practical. “I am finding there really aren’t that many providers who only offer a select group of products,” she says. “Maybe their original intent was only to offer specialties, but they wind up enhancing their line … because of customer requests and needs.”

Capital’s Simon adds that when providers give excellent service to a woman who needs post-mastectomy products, they open the door to serve her — and her family’s — needs for the future. But there is a caveat: Providers must learn to think in terms of retail sales to make this approach a success.

“HME providers and pharmacies have to think like a retail business — the store should not look commercial,” Simon says. “People want to be pleasantly surprised and see a nice store that looks pretty. When you think about how women do most of the buying for the family, it makes sense to appeal to their senses.”

Voet says she has seen an increase in the number of HME providers who are enhancing the look of their stores to make them more welcoming to breast cancer survivors. She points out that this shift also can make a favorable impression on all their customers.

Thinking Differently

Product innovations in the post-mastectomy market are exciting, yet the variety of choices is often lost on breast cancer survivors and their physicians.

Unfortunately, say experts, the medical community is not well-informed about non-surgical solutions, so it is important that providers of post-mastectomy products take steps not only to educate women but also their referral sources and other health care providers on options for breast cancer patients.

“Health care providers themselves, unless they have personally known someone who has been affected or there is a mastectomy boutique in the health care facility they work in, do not even know these products exist,” says Giamarino.

Likewise, following diagnosis, many women are focused on survival and treatment and don’t research options on their own, relying mainly on their physician’s recommendation for reconstruction. But that may not always the best solution, says Giamarino. Often, she says, women still need a prosthesis to compensate for the surgical site, so there is a need for all options to be presented.

As providers make changes to meet the needs of their post-mastectomy customers, they must learn to think about this market differently — and encourage their customers to do the same.

Voet says many women are so used to having their post-mastectomy products covered by insurance that they don’t think about other options or about choosing the item they might rather have. For instance, she says a customer may not purchase the specialty bra she really likes if it is more expensive than her insurance or Medicare benefit will allow.

“It is confusing that they are not willing to buy a bra the way they did before their surgery,” she says.

At the same time, Voet adds, some providers are not used to selling. “Often, they are focused on insurance coverage and gearing all product choices towards that — and they’re forgetting to sell,” she says.

San Pedro says fitters often limit available choices because they are not used to working with the newest products. “There are some biases because of what they’re most comfortable fitting,” she says. “As new products come out, a lot of fitters are not comfortable with some of the new products, even if it’s from the same manufacturer.”

According to Giamarino, providers may hesitate to offer custom products because of confusion over reimbursement, but “most private insurance companies will cover the cost of custom products.”

She also says there is an option for Medicare beneficiaries who would benefit from a custom breast form using an Advanced Beneficiary Notice to give customers the choice to pay the upgrade amount. Giamarino explains how this works: “The provider will submit the claim as an L8035, which is the code for custom breast prostheses. Medicare will deny it or downgrade it to the L8030, which is the code for standard prostheses,” she says. “Then the customer can sign the ABN knowing she is going to have to pay the upgrade.”

Experts Interviewed:

Cindy Ciardo, CEO, Knueppel Healthcare Services, Milwaukee, Wis., and manager of vendor services, Essentially Women Group Purchasing Organization, Oxford, Mich.; Nikki Giamarino, breast care product manager, Camp Healthcare, Jackson, Mich.; Mimi San Pedro, president, ContourMed, Little Rock, Ark.; Judi Simon, president, Capital Marketing Technologies, Waco, Texas; and Christine Voet, product manager, Airway, a division of Surgical Appliance Industries, Cincinnati.

Marketing the Message

Cindy Ciardo, manager of vendor services for Essentially Women Group Purchasing Organization, says providers can use the following methods to educate women:

• Exhibit at local women’s health events
• Sponsor an event targeting breast cancer, such as a fashion show
• Host a fund raiser for a national or local breast cancer awareness/support group
• Advertise in community newspapers, especially in a special health editions
• Send press releases on new products to local media outlets
• Send mailings to all current customers promoting sales, news updates and new products
• Advertise on television, radio and billboards

And, says Ciardo, contact local support groups to host or attend a meeting. “Offer to educate the group and hand out a bag of information and a small gift to each group member attending,” she advises. “Offer to provide the breast care coordinator with extras for new members or those women who are newly diagnosed and awaiting surgery.”

Referral source marketing can be rewarding since this offers a connection to newly diagnosed women. Ciardo also recommends that providers join community and state organizations to take advantage of networking opportunities, as well as inviting referral sources to an open house at their facility. When they are there, display new products and educate them about new technology, new product availability and new insurance requirements, she advises.

“Nothing works better than getting nurses, case managers and other health care professionals into your store to secure their referrals,” Ciardo says.

October Is National Breast Cancer Awareness Month

For the 20th year, National Breast Cancer Awareness Month is reaching out to women to educate them about early breast cancer detection, diagnosis and treatment. Again in 2005, the program emphasizes the importance of early detection through annual mammography screening for women over 40. Mammography screenings are a woman’s best chance for detecting breast cancer early and, when coupled with new treatment options, can significantly improve her chances of survival.

In conjunction, the third Friday in October each year is National Mammography Day, first proclaimed by President Clinton in 1993. On this day and throughout the month, women are encouraged to make a mammography appointment. This year, National Mammography Day will be celebrated on Oct. 21.

For more about NBCAM and a Promotion Guide that provides information on how to reach out to the media in your community with materials and logos that you may use for your educational program, visit www.nbcam.com.

Breast Cancer Facts

• Other than skin cancer, breast cancer is the most common cancer in women.
• An estimated 211,240 new cases of invasive breast cancer are expected to appear among women in 2005.
• It is the second leading cause of cancer death after lung cancer.
• 40,410 women are expected to die from breast cancer in 2005.
• An estimated 1,690 new cases of breast cancer will be diagnosed in men in 2005, while 460 are expected to die from the disease.
• About 82 percent of breast cancers occur in women age 50 and older.

Source: National Breast Cancer Awareness
Month 2005 Promotion Guide