I 

113TH CONGRESS 

1ST SESSION H. R. 1984 

To amend the Public Health Service Act to raise awareness of, and to 

educate breast cancer patients anticipating surgery, especially patients 

who are members of racial and ethnic minority groups, regarding the 

availability and coverage of breast reconstruction, prostheses, and other 

options. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 15, 2013 

Mr. LANCE (for himself and Mrs. CHRISTENSEN) introduced the following bill; 

which was referred to the Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act to raise awareness 

of, and to educate breast cancer patients anticipating 

surgery, especially patients who are members of racial 

and ethnic minority groups, regarding the availability 

and coverage of breast reconstruction, prostheses, and 

other options. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Breast Cancer Patient 

5 Education Act of 2013’’. 

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1 SEC. 2. FINDINGS. 

2 Congress makes the following findings: 

3 (1) The American Cancer Society estimates 

4 that in 2013, about 232,340 new cases of breast 

5 cancer will be diagnosed in American women. 

6 (2) Breast cancer has a disproportionate and 

7 detrimental impact on African-American women and 

8 is the most common cancer among Hispanic women. 

9 (3) African-American women under the age of 

10 40 have a greater incidence of breast cancer than 

11 Caucasian women of the same age. 

12 (4) According to the Health Resources and 

13 Services Administration, women residing in rural 

14 areas may have lower rates of mammography screen15 ing compared to non-rural women because of bar16 riers to health care, such as greater distances to 

17 medical facilities and lower educational, income, and 

18 health insurance levels. 

19 (5) Individuals undergoing surgery for breast 

20 cancer should have the opportunity to give due con21 sideration to the option of breast reconstructive sur22 gery, either at the same time as the breast cancer 

23 surgery or at a later date. 

24 (6) According to the American Cancer Society, 

25 immediate breast reconstruction offers the advan26 tage of combining the breast cancer surgery with the 

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1 reconstructive surgery and is cost effective, while de2 layed breast reconstruction may be advantageous in 

3 women who require post-surgical radiation or other 

4 treatments. 

5 (7) A woman who has had a breast removed 

6 may not be a candidate for surgical breast recon7 struction or may choose not to undergo additional 

8 surgery and instead choose breast prostheses. 

9 (8) The Women’s Health and Cancer Rights 

10 Act of 1998 (WHCRA; Public Law 105–277) re11 quires health plans that offer medical and surgical 

12 benefits with respect to a mastectomy to also provide 

13 coverage for all stages of reconstruction of the 

14 breast on which the mastectomy has been performed, 

15 surgery and reconstruction of the other breast to 

16 produce a symmetrical appearance, prostheses, and 

17 physical complications of mastectomy, including 

18 lymphedemas. 

19 (9) A 2007 study by Amy Alderman, M.D. at 

20 the University of Michigan reported that up to 70 

21 percent of women eligible for breast reconstruction 

22 are not informed of their reconstructive options by 

23 their general surgeon. 

24 (10) A 2003 study by Alderman and others 

25 found that race is a significant predictor of reconmstockstill on DSK4VPTVN1PROD with BILLS

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1 struction. Compared with the odds of reconstruction 

2 for Caucasians, the odds of reconstruction for Afri3 can-Americans, Hispanics, and Asians are signifi4 cantly less. 

5 (11) A 2007 study by Caprice Greenberg, M.D. 

6 of the Dana–Farber Cancer Institute and others 

7 found that Hispanic patients were less likely to re8 ceive reconstruction. This may be because of lan9 guage barriers between the patient and provider. Al10 though 72 percent of patients who primarily spoke 

11 English went on to receive reconstruction after dis12 cussing it with their providers, no patient in the 

13 study with a primary language other than English 

14 went on to receive reconstruction. 

15 (12) A 2009 study by Alderman and others also 

16 found that the relationship between race and recon17 struction rates persisted when demographic and clin18 ical factors were controlled for. Minority women are 

19 significantly less likely than Caucasians to see a 

20 plastic surgeon before initial surgery, were most like21 ly to desire more information about reconstruction, 

22 and satisfaction was lowest among minority women 

23 without reconstruction. 

24 (13) The low use of reconstruction for minori25 ties is not explained by lower demand for the procemstockstill on DSK4VPTVN1PROD with BILLS

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1 dure. Lower health literacy, financial issues, and less 

2 access to plastic surgeons emerged as barriers to re3 construction in the 2009 Alderman study. These re4 sults suggest that there is a substantial unmet need 

5 for information, especially among racial and ethnic 

6 minority groups regarding reconstruction options 

7 and coverage required by the Women’s Health and 

8 Cancer Rights Act of 1998. 

9 (14) A 2010 study by Warren H. Tseng, M.D. 

10 and others at the University of California, Davis 

11 found that patients from rural areas are less likely 

12 to undergo breast reconstruction following mastec13 tomy for breast cancer than their urban counter14 parts. 

15 SEC. 3. BREAST RECONSTRUCTION EDUCATION. 

16 Part V of title III of the Public Health Service Act 

17 (42 U.S.C. 280m; programs relating to breast health and 

18 cancer) is amended by adding at the end the following: 

19 ‘‘SEC. 399NN–1. BREAST RECONSTRUCTION EDUCATION. 

20 ‘‘(a) IN GENERAL.—The Secretary shall provide for 

21 the planning and implementation of an education cam22 paign to inform breast cancer patients anticipating sur23 gery regarding the availability and coverage of breast re24 construction, prostheses, and other options, with a focus 

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1 on informing patients who are members of racial and eth2 nic minority groups. 

3 ‘‘(b) INFORMATION TO BE DISSEMINATED.— 

4 ‘‘(1) SPECIFIC INFORMATION.—Such campaign 

5 shall include dissemination of the following informa6 tion: 

7 ‘‘(A) Breast reconstruction is possible at 

8 the time of breast cancer surgery, or at a later 

9 time. 

10 ‘‘(B) Prostheses or breast forms may be 

11 available. 

12 ‘‘(C) Federal law mandates both public 

13 and private health plans to include coverage of 

14 breast reconstruction and prostheses. 

15 ‘‘(D) The patient has a right to choose a 

16 provider of reconstructive care, including the 

17 potential transfer of care to a surgeon that pro18 vides breast reconstructive care. 

19 ‘‘(E) The patient may opt to undergo 

20 breast reconstruction some time after the time 

21 of breast cancer surgery for personal or medical 

22 reasons, during treatment or after completion 

23 of all other breast cancer treatments. 

24 ‘‘(2) OTHER INFORMATION.—In addition to the 

25 information described in paragraph (1), such cammstockstill on DSK4VPTVN1PROD with BILLS

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1 paign may include dissemination of such other infor2 mation (whether developed by the Secretary or by 

3 other entities) as the Secretary determines relevant. 

4 ‘‘(3) REQUIRED PUBLICATION.—The informa5 tion required to be disseminated under paragraph 

6 (1) and any information disseminated in accordance 

7 with paragraph (2) shall be posted on the Internet 

8 Web sites of relevant Federal agencies, including the 

9 Office of Women’s Health, the Office of Minority 

10 Health, and the Office of Rural Health Policy. 

11 ‘‘(4) RESTRICTION.—Such campaign shall not 

12 specify, or be designed to serve as a tool to limit, the 

13 health care providers available to patients. 

14 ‘‘(c) CONSULTATION.—In developing the information 

15 to be disseminated under this section, the Secretary shall 

16 consult with appropriate medical societies and patient ad17 vocates related to breast cancer, breast reconstructive sur18 gery, breast prostheses, and breast forms and with patient 

19 advocates representing racial and ethnic minority groups 

20 with a special emphasis on African-American and His21 panic populations. 

22 ‘‘(d) DEFINITIONS.—In this section, the terms ‘racial 

23 and ethnic minority group’ and ‘Hispanic’ have the mean24 ings given such terms in section 1707. 

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1 ‘‘(e) REPORT.—Not later than 2 years after date of 

2 enactment of the Breast Cancer Patient Education Act of 

3 2013 and every 2 years thereafter, the Secretary shall sub4 mit to the Committee on Health, Education, Labor, and 

5 Pensions of the Senate and the Committee on Energy and 

6 Commerce of the House of Representatives a report de7 scribing the activities carried out under this section during 

8 the preceding 2 fiscal years, which shall include an evalua9 tion of the extent to which such activities have been effec10 tive in improving the health and well-being of racial and 

11 ethnic minority groups.’’. 

Æ 

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