Op-Ed 
                 "Breast Cancer War Must Go On"
                        Donna E. Shalala
             Secretary of Health and Human Services
                         Chicago Tribune
                          March 5, 1995

     For the first time in four decades, American women can
celebrate winning a battle in the war against breast cancer, and
we need to work with all women to continue the fight.  

     The good news is that the death rate from breast cancer is
finally dropping.  A new study shows that overall death rates
declined nearly five percent from 1989 to 1992.  And for those
women between the ages of 30 and 39 who developed breast cancer,
death rates fell even more -- 18 percent since 1987.  Now we must
build on this progress. 

     There are multiple reasons for our success.  Advances in
treatment, like chemotherapy and hormonal therapy after breast
cancer surgery, may be responsible.  

     Adjuvant chemotherapy -- which attacks minuscule deposits of
cancer -- is widely available but not used enough, especially for
women without health insurance.  In addition, increased public
awareness about self-exam and mammography screening, coupled with
changes in diet and exercise, may have contributed to survival
rates.

     These gains didn't happen by accident.  

     During the 1980s, women called on all of us to open our
eyes, and recognize the pain and misery inflicted by this
disease.  Women demanded more research, more national public
education campaigns, and a comprehensive federal effort to find
answers about the causes of the disease and to discover new
treatment and prevention strategies.

     Juliet Wittman, a breast cancer survivor and author, is one
of many women who channeled her pain into a movement for change.

     "We must take our mutilated bodies and our bald heads, our
tears and our anger out into the streets and tell the others,"
she wrote in Breast Cancer Journal.  "First comes a time for
introspection.  Then comes the time to act."

     When President Clinton took office, this Administration took
action.  

     While cutting the deficit by more than 700 billion dollars,
President Clinton increased research into the causes of breast
cancer by 64 percent, to $375 million in fiscal year 1995 alone. 

     This investment has produced real results:

     In the last year, the National Institutes of Health has made
major breakthroughs -- including the discovery of the BRCA-1
gene, which will help us understand hereditary risks, and
possibly more.

     We found that mammography screening rates were far too low,
and added funds for education and outreach efforts at both the
Centers for Disease Control National Breast and the Cervical
Cancer Program and the National Cancer Institute.  Screening
rates are now at their highest levels ever -- although still not
high enough.  Screenings are lowest among the very women most
likely to benefit -- only 50 percent of older women in this
country have had a mammogram in the last year.    

     We also found that women were receiving unreliable
mammograms and were not getting appropriate exams, and we stepped
in.  The 10,000 mammography facilities around the country must
now be certified by the FDA, but we didn't stop there.  We also
developed guidelines for the prompt notification of mammography
results, so women get notice within 10 days.

     In addition, we saw the need for greater partnerships in
research, both in the public and private spheres.  Now the
defense, space, and intelligence industries are working with us
to adapt the technology that enables us to spot missiles from
thousands of miles above the earth to detect tiny tumors in the
breast.  

     And finally, we asked advocates, scientists and policymakers
to pool their knowledge, and talents.  Just over a year ago, we
convened the major players to devise a National Action Plan on
Breast Cancer.

     This landmark plan has laid out the first nationwide
strategy to explore and expand research into the causes of breast
cancer.  It has sought to involve more women, especially minority
women, in clinical research trials, and it is developing a tissue
and data resource bank to increase knowledge about the causes of
breast cancer.
     
     Yet, even as we celebrate our successes, there is much more
to do.

     While it is true that the overall death rates for breast
cancer declined, breast cancer death rates actually increased 2.6
percent among African-American women.  This disparity must end.

     About 46,000 American women will die from breast cancer in
1995.  It may be someone you know.   There may be something you
can do to help out. 
     
     We need to recruit private companies and non-profit groups
to promote greater public awareness.  Women must examine their
breasts monthly, ask for clinical breast exams, and have regular
mammogram screenings if they're over 50, or at younger ages if
their doctors recommend it.

     Many women are not taking these simple steps to protect
themselves.  This is not only dangerous -- it could be deadly.

     Let us learn from our recent gains against breast cancer.
This is a case where government has effectively teamed up with
citizens, scientists, and the private sector to get demonstrable
results for the American people.  

     In Washington, as we continue to debate the role of the
federal government in the months ahead, we are certain to find
more strength and more successes in situations where we lock arms
in partnership.  By working together, we can realize safer,
healthier futures for all Americans.