The Health Care Financing Administration (HCFA) last month decided to broadly expand Medicare reimbursement for PET (Positron Emission Tomography) scans for heart disease, epilepsy and many cancers, including lung, esophageal and melanoma. But HCFA, the federal agency that oversees both Medicare and Medicaid, completely ignored coverage for gynecological and breast cancers, even though the Food and Drug Administration has approved PET for all cancers.

As a breast cancer survivor and someone who has fought for women's health issues for many years, I am outraged by this latest decision. All women's health issues were conspicuously absent from this latest expansion of Medicare coverage.

The importance of PET in diagnosing women's cancers and determining how far the disease has spread has been extensively documented and presented to HCFA multiple times. PET is so vital because it allows doctors to examine the biological origins of disease so that it can be diagnosed and treated earlier and more effectively. PET is a powerful, proven imaging modality that displays the biological basis of how organ systems function normally and fail in disease. This cannot be done by any other imaging technologies.

PET can pinpoint the source of cancers, eliminating the need for redundant diagnostic tests and surgical procedures. PET provides physicians with images of the entire body so that all organ systems can be examined in a single procedure. PET was developed after many years of investment by the public in biology and biotechnology, and the public should now be able to receive the benefits it provides.

My personal experience with PET came in 1991. After two years of multiple, negative mammograms and ultrasound, I was sent for a PET scan, which picked up a cancerous tumor that measured more than three centimeters! Following a biopsy, I was diagnosed with infiltrating lobular breast cancer.

I was shocked and scared. I had previously been told that since nothing showed up in either the mammogram or ultrasound, I was probably fine. Obviously, I was not. I have heard similar stories many times from other breast cancer survivors.

I am not advocating that a PET scan replace mammography, but clearly it should be used to distinguish between malignant and benign lesions in women with dense or fibrous breasts, where other tests are ineffective. PET scans definitely should be used to determine how far breast cancer has spread.

HCFA's decision is especially disappointing for the women who need this technology the most. HCFA serves Americans over age 62 as well as those in low-income groups. The elderly and the underprivileged are being disregarded. Many private insurance companies already reimburse for PET scans because they recognize that an accurate diagnosis can significantly lower the cost of medical care. Even so, until HCFA approves PET for reimbursement for all who need it, many people will either have to pay for it themselves or live - or die - without it.

Kim Pierce is chief administrative officer for the Department of Molecular and Medical Pharmacology.