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By Meghann Drella, CPC Outsource Strategies International (OSI) |
October is Breast Cancer Awareness Month: Promote Awareness about Breast Health

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October is Breast Cancer Awareness Month: Promote Awareness about Breast Health

Date Posted: Tuesday, September 14, 2021

 

Cancer arises when specific changes (called mutations) occur in the genes that regulate cell growth, causing the cells to divide and multiply in an uncontrolled way. There are more than 100 types of cancer, and the most common types are breast cancer, skin cancer, lung cancer, and colon cancer, among others. Breast cancer is by far the most commonly occurring cancer and the second most fatal cancer in women. With an objective to generate widespread global awareness of breast cancer, the month of October is observed as “National Breast Cancer Awareness Month (NBCAM)” in the United States every year. Sponsored by the American Cancer Society (ACS), the primary goal behind this observance is to involve as many people as possible in spreading awareness about breast cancer and generating funds to help support life-saving cancer research. 

Aprominent cause of premature mortality among women, breast cancer develops in the breast cells. The cells that grow or multiply in an uncontrolled way often tend to invade other healthy breast tissues and travel to the lymph nodes under the arms. The lymph nodes are a primary pathway that helps the cancer cells move to other parts of the body. The 2021 month-long observance aims to respect the resilience of breast cancer survivors and offer heartfelt support to those who are currently battling with this disease. It aims to encourage women to discuss with their physicians and identify their individual risks for breast cancer.

Even though most breast cancers occur entirely in women, men can also get breast cancer. Most breast lumps that occur are benign and non-cancerous (malignant). Non-cancerous tumors do not spread outside the breast and hence are not life-threatening. However, certain types of benign breast lumps can increase a woman's risk of getting breast cancer. 

Hence, any specific changes or lumps that appear in the breast tissue need to be immediately checked by a healthcare professional to verify whether it is benign or malignant (cancer) and whether it increases future cancer risk. The month-long NBCAM campaign has garnered significant support for breast cancer awareness and research funding, and thereby created advances in the diagnosis and treatment of breast cancer. These support and awareness initiatives have also brought about substantial increases in breast cancer survival rates, while the death rates associated with the condition have steadily declined. This is largely due to important factors, like early detection, new and personalized approach to treatment, and better knowledge about all aspects of the disease. 

Breast Cancer - How Prevalent Is It?
According to the World Health Organization (WHO), breast cancer is the most common cancer globally (as of 2021), accounting for 12 percent of all new annual cancer cases worldwide. In 2021, breast cancer has become the most diagnosed cancer among American women-with about 30 percent of newly diagnosed cancers in women being breast cancers. In fact, breast cancer death rates in U.S. women are higher than those for any other cancer, besides lung cancer. 

Per reports from BreastCancer.org:
  • In 2021, an estimated 281,550 new cases of invasive breast cancer are expected to be diagnosed in women, along with an additional 49,290 new cases of non-invasive (in situ) breast cancer in women. 
  • 1 in 8 U.S. women (about 13%) will develop invasive breast cancer over the course of her lifetime. 
  • About 2,650 new cases of invasive breast cancer are expected to be diagnosed in men in 2021. The lifetime risk of breast cancer in men is about 1 in 833. 
  • In 2021, about 43,600 U.S. women are expected to die from breast cancer. 
  • The overall death rate from breast cancer reduced by 1 percent per year from 2013-2018.
  • About 3.8 million women have a history of breast cancer in the U.S. (as of January 2021)-this includes women currently under treatment and women who have finished treatment. 
  • Among women below 45 years, breast cancer is more common in Black women than White women. 
  • More than 85 percent of breast cancers occur in women who have no family history of breast cancer. These may be due to genetic mutations that happen as a result of the aging process and life in general, rather than inherited mutations.
  • Where Does Breast Cancer Begin?
  • Typically, breast cancer can occur in different parts of the breast, which include: 
  • Within the lining cells (epithelium) of the ducts that carry milk to the nipple (ductal cancers)
  • Lobules in the glandular tissue of the breast 
  • Fatty or fibrous connective tissue within the breast area

Causes and Risk Factors 
In most cases, abnormal growth of breast cells is the most common cause of breast cancer. When compared to healthy cells, these abnormal cells divide more rapidly, forming a lump or mass. Over time, these cells may spread (metastasize) through the breast tissue toward the lymph nodes or to other parts of the body. Researchers have identified several factors, such as being female, increasing age, a personal/family history of breast cancer or breast conditions, obesity, hormonal imbalances, radiation exposure, late pregnancy, inherited gene mutations, and other lifestyle and environmental factors that tend to increase the chance of developing this type of cancer.

It is estimated that a woman's risk factor of breast cancer nearly doubles if she has a first-degree relative (mother, sister, daughter) who has been diagnosed with the same condition. In fact, less than 15 percent of women who get diagnosed with this condition have a relative family member diagnosed with the same condition. On the other hand, nearly 5-10 percent of breast cancers can be linked to known gene mutations inherited from one's mother or father. In several other cases, many women develop this type of cancer without any known risk factors other than simply being women. 

Different Types of Breast Cancer 
Breast cancers are divided into different categories: “invasive” and “non-invasive” or “in situ.” Invasive type of cancer tends to spread from the breast ducts or glands to other parts of the breast, whereas non-invasive cancer does not spread from the original tissue. 

In fact, these two categories are the main ground for classification of breast cancer types and include: 
  • Ductal carcinoma in situ (DCIS) - DCIS is the presence of abnormal cells inside a milk duct in the breast. In this non-invasive condition, the cancerous cells are confined to the ducts within the breast area and do not spread outside and invade the surrounding breast tissues. 
  • Lobular carcinoma in situ (LCIS) - An uncommon condition, LCIS develops in the milk glands (lobules) in the breast. The condition isn't cancer, but being diagnosed with LCIS can increase the potential risk of developing breast cancer. 
  • Invasive ductal carcinoma (IDC) - One of the most common types of breast cancer, IDC occurs in the breast's milk ducts and then tends to spread to other nearby organs and tissues. 
  • Invasive lobular carcinoma (ILC) - First developing in the breast tissues, ILC further invades or spreads to other nearby tissues. 

Apart from the above, other less common types of breast cancers include: 
  • Paget disease of the nipple - A rare form of cancer in the breast area, Paget's disease begins in the ducts of the nipple and spreads to the dark circle of skin (areola) around the nipple. 
  • Angiosarcoma - This type occurs within the lining of the blood vessels and lymph vessels in the breast area. 
  • Phyllodes tumor - This type of tumor grows in the connective tissue of the breast.
  • Inflammatory breast cancer - This is a rapid form of cancer that develops when cancer cells block the lymphatic vessels within the skin covering the breast, making the breast tender, red, and swollen. 
  • Recurrent breast cancer - As the name suggests, this type of cancer comes back after initial treatment.
  • Metastatic breast cancer - This type spreads from the breast area to other parts of the body, such as the bones, lungs, or liver. 

Stages of Breast Cancer 
There are different stages of breast cancer, which can be determined based on the size of the tumor and how much it has spread to other tissues or organs. Tumors that are relatively large or have severely spread to nearby tissues or organs are considered as "high stage or last stage." 

Oncologists and other physician specialists consider the following aspects before determining the stage of a breast cancer: 
  • Whether the cancer is invasive or non-invasive
  • Whether the lymph nodes are involved
  • Whether the cancer has spread to nearby tissues or organs
  • How large the tumor is

Generally, breast cancer is divided into 4 main stages-stage 0 to stage 4-which are discussed below: 

Stage 0 - Stage 0 is DCIS - wherein the cancer cells remain in the ducts in the breast and have not spread to nearby tissues. 

Stage 1 - This is further divided into two different categories - 
  • Stage 1A - In this stage, the primary tumor may be 2 centimeters (cm) wide or less, and the lymph nodes may not be affected.
  • Stage 1B - In this stage, either there may be no tumor in the breast or else the tumor will be smaller than 2 cm. In addition, the cancer is found in nearby lymph nodes in this stage. 

Stage 2 - Stage 2 is classified into two different categories - 
  • Stage 2A - In this stage, the tumor is either smaller than 2 cm and has spread to 1-3 lymph nodes or the tumor may be between 2-5 cm and does not spread to any lymph nodes. 
  • Stage 2B - The tumor size is between 2 and 5 cm and has spread to 1-3 axillary (armpit) lymph nodes, or it's more than 5 cm and hasn't spread to any lymph nodes.

Stage 3 - Stage 3 breast cancer is divided into three different categories - 
  • Stage 3A - The cancer has enlarged the internal mammary lymph nodes and gets largely spread to 4-9 axillary lymph nodes. Tumors remain higher than 5 cm. 
  • Stage 3B - Tumors affect the chest wall or skin and may or may not have spread to the lymph nodes. 
  • Stage 3C - Cancer gets detected in 10 or more axillary lymph nodes like near the collarbone or internal mammary nodes.

Stage 4 - At this stage, the tumor can be of any specific size and the cancer cells may have spread to nearby lymph nodes, as well as to other nearby organs.
 
Identifying the Signs and Symptoms 
In most cases, breast cancer in its early stages may not cause any specific signs and symptoms as the tumor may be too small to be felt. If a tumor can be felt, such as a new lump in the breast, it is one of the initial symptoms of this condition. However, it is not necessary that all lumps are cancerous (as lumps can also be caused by a benign cyst).  

The signs and symptoms depend on the type, stage, and severity of breast cancer, and include the following:
  • A breast lump or tissue thickening (that feels different than surrounding tissue)
  • Swelling in all or part of the breast
  • Redness or pitting of the skin over the breast
  • Peeling, scaling, or flaking of skin on the nipple or breast
  • Inverted nipple
  • Changes around the skin on the breasts
  • Breast pain
  • A lump or swelling under the arms
  • A change in the shape, size, or appearance of a breast
  • A bloody nipple discharge 

Preventing Breast Cancer - the Need for Early Detection, Diagnosis, and Treatment
To correctly diagnose whether the symptoms are caused by breast cancer or a benign breast condition, oncologists or other specialists may perform a detailed physical examination, which involves a breast exam and other diagnostic tests or procedures to correctly identify the type and stage of cancer. As part of the breast examination, physicians will check both breasts and lymph nodes in the armpit to identify any specific lumps or other abnormalities. 

Other tests and procedures that are used to diagnose the condition include breast ultrasound (to determine the density of the breast lump), mammogram (an X-ray of the breast), breast magnetic resonance imaging (MRI), and biopsy (removing a sample of breast cells for testing). Considered one of the most definitive ways to make a diagnosis of breast cancer, biopsy involves extracting a core of tissue or sample from the specific breast area. These samples are sent to the laboratory for a detailed analysis to confirm whether the cells are cancerous, and if so, the stage and severity of cancer and whether these cells have hormone receptors or other receptors that may influence future treatment options. 

Several tests and procedures are performed to identify the stage of breast cancer, and these include complete blood count test, breast MRI, mammogram, bone scan, computerized tomography (CT) scan, and positron emission tomography (PET) scan. However, not all women will need to undergo all these tests and procedures; physicians may select the appropriate tests based on the specific symptoms that patients may be experiencing. 

When identified at an early stage, breast cancer treatment can be highly effective, achieving survival probabilities of 90 percent or higher. Treatment modalities for breast cancer will be determined by considering several factors, such as the type of breast cancer, its stage, grade, and size (how likely it is to grow and spread). In addition, the physician will consider the overall health and personal preferences of the patient. In most cases, surgery is the most common treatment for breast cancer. 

Several types of surgery, such as lumpectomy, mastectomy, sentinel node biopsy, axillary lymph node dissection, and contralateral prophylactic mastectomy may be performed to remove the cancerous cells from the breast area. After surgery, patients may have to undergo additional treatments, such as chemotherapy, hormone therapy, or radiation. In certain situations, chemotherapy may also be used before surgery.

Documenting and Coding Breast Cancer 
As breast cancer is considered a primary cause of premature mortality among U.S. women, recognizing the prominent causes, stages, and symptoms of different types of cancer, and documenting them correctly, is important to ensure accurate coding of the progression of the condition and provide the appropriate care that patients require. Since diagnosing breast cancer at an early stage and receiving state-of-the-art cancer treatment are the most important strategies to reduce cancer morbidity and mortality, breast cancer screening is an important aspect for women's healthcare. 

Undergoing regular screening is the best way to detect the condition when it's in an early stage, before it causes any symptoms (like a lump that can be felt) and has not spread-as this helps in predicting the prognosis (outlook) of a woman with this disease and its successful treatment. 

However, the American Cancer Society (ACS) has set screening guidelines for women who are at average risk of developing breast cancer. To undergo screening, a woman is considered to be at average risk if she doesn't have a personal history of breast cancer, a and has not had chest radiation therapy before the age of 30. 

Other breast cancer screening recommendations include: 
  • Women aged between 40-44 years have the choice to start breast cancer screening with a mammogram every year. 
  • Women aged 45–54 years should be screened for mammograms every year. 
  • For women aged 55 years and older, screening with mammography is recommended once every two years or once a year. 
  • Women aged 75 years or older (with average risk) should continue screening with mammography as long as their overall health is good, and they have a life expectancy of 10 years or more.
  • For women with dense breasts, evidence is insufficient to recommend for or against yearly MRI screening. 

Medical Codes 
The diagnostic screening tests and other procedures performed for breast cancer patients need to be correctly documented using the right medical codes. In ICD-10, C-50 is the specific code category for Malignant neoplasm of breast. 

C50 Malignant neoplasm of breast
C50.0 Malignant neoplasm of nipple and areola
C50.01 Malignant neoplasm of nipple and areola, female
  • C50.02 Malignant neoplasm of nipple and areola, male
  • C50.1 Malignant neoplasm of central portion of breast
  • C50.11 Malignant neoplasm of central portion of breast, female
  • C50.12 Malignant neoplasm of central portion of breast, male
C50.2 Malignant neoplasm of upper-inner quadrant of breast
  • C50.21 Malignant neoplasm of upper-inner quadrant of breast, female
  • C50.22 Malignant neoplasm of upper-inner quadrant of breast, male
C50.3 Malignant neoplasm of lower-inner quadrant of breast
  • C50.31 Malignant neoplasm of lower-inner quadrant of breast, female
  • C50.32 Malignant neoplasm of lower-inner quadrant of breast, male
C50.4 Malignant neoplasm of upper-outer quadrant of breast
  • C50.41 Malignant neoplasm of upper-outer quadrant of breast, female
  • C50.42 Malignant neoplasm of upper-outer quadrant of breast, male
C50.5 Malignant neoplasm of lower-outer quadrant of breast
  • C50.51 Malignant neoplasm of lower-outer quadrant of breast, female
  • C50.52 Malignant neoplasm of lower-outer quadrant of breast, male
C50.6 Malignant neoplasm of axillary tail of breast
  • C50.61 Malignant neoplasm of axillary tail of breast, female
  • C50.62 Malignant neoplasm of axillary tail of breast, male
C50.8 Malignant neoplasm of overlapping sites of breast
  • C50.81 Malignant neoplasm of overlapping sites of breast, female
  • C50.82 Malignant neoplasm of overlapping sites of breast, male
C50.9 Malignant neoplasm of breast of unspecified site
  • C50.91 Malignant neoplasm of breast of unspecified site, female
  • C50.92 Malignant neoplasm of breast of unspecified site, male

CPT/HCPCS Codes to Report Screening Mammography
  • 77067 - Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed
  • +77063 - Screening digital breast tomosynthesis, bilateral (list separately in addition to code for primary procedure)
  • 77065 - Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral
  • +G0279 - Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)
  • 77066 - Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral
  • +G0279 - Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)

NBCAM - Widening the Path and Scope of Campaign 
The month of October serves as a unique reminder for women to get screened regularly for early cancer detection, which in turn will lead to more positive outcomes in the fight against breast cancer. The history of Breast Cancer Awareness campaigns date back to 1985, when the campaign was founded as a partnership between the American Cancer Society and the pharmaceutical division of Imperial Chemical Industries (now part of AstraZeneca, producer of several anti-breast cancer drugs). The campaign was initially planned as a week-long event in the United States in October. Later, it was extended to a month-long awareness observance to promote mammography as the most effective tool in the fight against breast cancer. 

Today, the scope of the campaign has widened with several non-profit organizations, government agencies, and medical societies working together to promote breast cancer awareness. As pink is the official color of the event, people wear pink ribbons to show their support for this campaign. Several other events-like hosting breast cancer walks, displaying posters, and distributing materials about breast cancer screening at local health fairs-will be conducted all over the U.S. Breast cancer patients and survivors will be encouraged to share their personal stories of cancer battles via different social media platforms. 

Even though there are several risk factors that cannot be controlled, incorporating simple but healthy changes in daily life, such as staying physically active, eating a healthy diet, limiting the use of alcohol, undergoing regular breast screenings, and taking preventive measures that physicians recommend, can help reduce the potential risk for developing breast cancer in the long run. 

Join the NBCAM campaign this October. Generate awareness about breast cancer among individuals, communities, and organizations, and emphasize the importance of early breast screenings. 


Meghann Drella, CPC, is a Senior Solutions Manager at Managed Outsource Solutions (MOS), and is responsible for practice and revenue cycle management in the Healthcare Division. She has a formal education in Medical Coding and Billing and over 12 years of hands on experience in the field. She holds a CPC certification with the American Academy of Professional Coders (AAPC). Meghann has a strong understanding of ICD-10-CM and CPT requirements and procedures, and regularly attends continuing education classes to stay up to date with any changes. 






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