U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON : 

For sale by the Superintendent of Documents, U.S. Government Printing Office

Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800

Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001

74–102 2012

H.R. 1740, THE BREAST CANCER EDUCATION 

AND AWARENESS REQUIRES LEARNING YOUNG 

ACT OF 2009; H.R. 1691, THE BREAST CANCER 

PATIENT PROTECTION ACT OF 2009; H.R. 2279, 

THE ELIMINATING DISPARITIES IN BREAST 

CANCER TREATMENT ACT OF 2009; AND H.R. 

995, THE MAMMOGRAM AND MRI AVAILABILITY ACT OF 2009 

HEARING 

BEFORE THE

SUBCOMMITTEE ON HEALTH 

OF THE

COMMITTEE ON ENERGY AND 

COMMERCE 

HOUSE OF REPRESENTATIVES 

ONE HUNDRED ELEVENTH CONGRESS 

FIRST SESSION 

OCTOBER 7, 2009 

Serial No. 111–69 

( 

Printed for the use of the Committee on Energy and Commerce 

energycommerce.house.gov 


jbell on DSK7SPTVN1PROD with HEARING
COMMITTEE ON ENERGY AND COMMERCE 

HENRY A. WAXMAN, California, Chairman 

JOHN D. DINGELL, Michigan 

Chairman Emeritus 

EDWARD J. MARKEY, Massachusetts 

RICK BOUCHER, Virginia 

FRANK PALLONE, JR., New Jersey 

BART GORDON, Tennessee 

BOBBY L. RUSH, Illinois 

ANNA G. ESHOO, California 

BART STUPAK, Michigan 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

Vice Chairman 

LOIS CAPPS, California 

MICHAEL F. DOYLE, Pennsylvania 

JANE HARMAN, California 

TOM ALLEN, Maine 

JANICE D. SCHAKOWSKY, Illinois 

CHARLES A. GONZALEZ, Texas 

JAY INSLEE, Washington 

TAMMY BALDWIN, Wisconsin 

MIKE ROSS, Arkansas 

ANTHONY D. WEINER, New York 

JIM MATHESON, Utah 

G.K. BUTTERFIELD, North Carolina 

CHARLIE MELANCON, Louisiana 

JOHN BARROW, Georgia 

BARON P. HILL, Indiana 

DORIS O. MATSUI, California 

DONNA M. CHRISTENSEN, Virgin Islands 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

CHRISTOPHER S. MURPHY, Connecticut 

ZACHARY T. SPACE, Ohio 

JERRY MCNERNEY, California 

BETTY SUTTON, Ohio 

BRUCE BRALEY, Iowa 

PETER WELCH, Vermont 

JOE BARTON, Texas 

Ranking Member 

RALPH M. HALL, Texas 

FRED UPTON, Michigan 

CLIFF STEARNS, Florida 

NATHAN DEAL, Georgia 

ED WHITFIELD, Kentucky 

JOHN SHIMKUS, Illinois 

JOHN B. SHADEGG, Arizona 

ROY BLUNT, Missouri 

STEVE BUYER, Indiana 

GEORGE RADANOVICH, California 

JOSEPH R. PITTS, Pennsylvania 

MARY BONO MACK, California 

GREG WALDEN, Oregon 

LEE TERRY, Nebraska 

MIKE ROGERS, Michigan 

SUE WILKINS MYRICK, North Carolina 

JOHN SULLIVAN, Oklahoma 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 

MARSHA BLACKBURN, Tennessee 

PHIL GINGREY, Georgia 

STEVE SCALISE, Louisiana 

(II) 


jbell on DSK7SPTVN1PROD with HEARING
(III) 

SUBCOMMITTEE ON HEALTH

FRANK PALLONE, JR., New Jersey, Chairman 

JOHN D. DINGELL, Michigan 

BART GORDON, Tennessee 

ANNA G. ESHOO, California 

ELIOT L. ENGEL, New York 

GENE GREEN, Texas 

DIANA DEGETTE, Colorado 

LOIS CAPPS, California 

JANICE D. SCHAKOWSKY, Illinois 

TAMMY BALDWIN, Wisconsin 

MIKE ROSS, Arkansas 

ANTHONY D. WEINER, New York 

JIM MATHESON, Utah 

JANE HARMAN, California 

CHARLES A. GONZALEZ, Texas 

JOHN BARROW, Georgia 

DONNA M. CHRISTENSEN, Virgin Islands 

KATHY CASTOR, Florida 

JOHN P. SARBANES, Maryland 

CHRISTOPHER S. MURPHY, Connecticut 

ZACHARY T. SPACE, Ohio 

BETTY SUTTON, Ohio 

BRUCE L. BRALEY, Iowa 

NATHAN DEAL, Georgia, 

Ranking Member 

RALPH M. HALL, Texas 

BARBARA CUBIN, Wyoming 

JOHN B. SHADEGG, Arizona 

STEVE BUYER, Indiana 

JOSEPH R. PITTS, Pennsylvania 

MARY BONO MACK, California 

MIKE FERGUSON, New Jersey 

MIKE ROGERS, Michigan 

SUE WILKINS MYRICK, North Carolina 

JOHN SULLIVAN, Oklahoma 

TIM MURPHY, Pennsylvania 

MICHAEL C. BURGESS, Texas 


jbell on DSK7SPTVN1PROD with HEARING

jbell on DSK7SPTVN1PROD with HEARING
(V) 

C O N T E N T S 

Page 

Hon. Frank Pallone, Jr., a Representative in Congress from the State of 

New Jersey, opening statement .......................................................................... 1 

Prepared statement .......................................................................................... 4 

Hon. Nathan Deal, a Representative in Congress from the State of Georgia, 

opening statement ................................................................................................ 10 

Hon. Roy Blunt, a Senator in Congress from the State of Missouri, prepared 

statement .............................................................................................................. 11 

Hon. Jane Harman, a Representative in Congress from the State of California, opening statement .................................................................................... 12 

Hon. Phil Gingrey, a Representative in Congress from the State of Georgia, 

opening statement ................................................................................................ 35 

Prepared statement ..........................................................................................

Hon. John D. Dingell, a Representative in Congress from the State of Michigan, opening statement ....................................................................................... 36 

Hon. Michael C. Burgess, a Representative in Congress from the State of 

Texas, opening statement .................................................................................... 38 

Hon. Kathy Castor, a Representative in Congress from the State of Florida, 

opening statement ................................................................................................ 41 

Hon. Donna M. Christensen, a Representative in Congress from the Virgin 

Islands, opening statement ................................................................................. 44 

Hon. Joe Barton, a Representative in Congress from the State of Texas, 

prepared statement .............................................................................................. 157 

Hon. Bruce L. Braley, a Representative in Congress from the State of Iowa, 

prepared statement .............................................................................................. 160 

Hon. Joseph R. Pitts, a Representative in Congress from the Commonwealth 

of Pennsylvania, prepared statement ................................................................. 163 

WITNESSES

Hon. Jerrold Nadler, Member of Congress ............................................................ 45 

Prepared statement .......................................................................................... 48 

Hon. Rosa L. DeLauro, Member of Congress ........................................................ 51 

Prepared statement .......................................................................................... 53 

Hon. Debbie Wasserman Schultz, Member of Congress ....................................... 56 

Prepared statement .......................................................................................... 59 

Stephen Taplin, M.D., M.P.H., Chief of the Applied Cancer Screening Research Branch, Division of Cancer Control and Population Science, National 

Cancer Institute, National Institutes Of Health ............................................... 62 

Prepared statement .......................................................................................... 65 

Otis Webb Brawley, M.D., Chief Medical Officer, American Cancer Society ..... 79 

Prepared statement .......................................................................................... 82 

Jennifer Luray, President, Susan G. Komen for the Cure Advocacy Alliance ... 91 

Prepared statement .......................................................................................... 94 

Debra L. Ness, President, National Partnership For Women And Families ...... 107 

Prepared statement .......................................................................................... 109 

George W. Sledge, Jr., M.D., Ballv ́e Professor of Oncology, Indiana University 

Medical Center, Cancer Pavilion ........................................................................ 112 

Prepared statement .......................................................................................... 114 

Fran Visco, J.D., President, National Breast Cancer Coalition ........................... 119 

Prepared statement .......................................................................................... 121 

Marisa C. Weiss, M.D., President and Founder, Breastcancer.org ..................... 135 

Prepared statement .......................................................................................... 138 


jbell on DSK7SPTVN1PROD with HEARING
Page

VI 

SUBMITTED MATERIAL

Statement of United Jewish Communities ............................................................ 13 

Statement of Lifetime Networks, submitted by Ms. Sutton ................................ 164 


jbell on DSK7SPTVN1PROD with HEARING
(1) 

H.R. 1740, THE BREAST CANCER EDUCATION 

AND AWARENESS REQUIRES LEARNING 

YOUNG ACT OF 2009; H.R. 1691, THE BREAST 

CANCER PATIENT PROTECTION ACT OF 

2009; H.R. 2279, THE ELIMINATING DISPARITIES IN BREAST CANCER TREATMENT ACT 

OF 2009; AND H.R. 995, THE MAMMOGRAM 

AND MRI AVAILABILITY ACT OF 2009 

WEDNESDAY, OCTOBER 7, 2009 

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON HEALTH, 

COMMITTEE ON ENERGY AND COMMERCE, 

Washington, DC. 

The Subcommittee met, pursuant to call, at 11:47 a.m., in Room 

2123 of the Rayburn House Office Building, Hon. Frank Pallone, 

Jr. [Chairman of the Subcommittee] presiding. 

Members present: Representatives Pallone, Dingell, DeGette, 

Schakowsky, Baldwin, Matheson, Harman, Barrow, Christensen, 

Castor, Sarbanes, Space, Sutton, Braley, Deal, Whitfield, Shimkus, 

Blunt, Pitts, Wilkins Myrick, Burgess, Blackburn, Gingrey and 

Barton (ex officio). 

Staff present: Sarah Despres, Counsel; Anne Morris, Professional 

Staff; Elana Leventhal, Policy Advisor; Alvin Banks, Special Assistant; Allison Corr, Special Assistant; Aarti Shah, Counsel; and Chad 

Grant, Legislative Analyst. 

OPENING STATEMENT OF HON. FRANK PALLONE, JR., A REPRESENTATIVE IN CONGRESS FROM THE STATE OF NEW JERSEY 

Mr. PALLONE. We will start the hearing, and I do apologize for 

the delay. 

Today the Subcommittee is meeting to review four bills relating 

to breast cancer: H.R. 995, the Mammogram and MRI Availability 

Act of 2009, sponsored by Congressman Nadler of New York; H.R. 

1691, the Breast Cancer Patient Protection Act of 2009, sponsored 

by Ms. DeLauro of Connecticut; H.R. 1740, the Breast Cancer Education and Awareness Requires Learning Young Act of 2009 by 

Congresswoman Wasserman Schultz from Florida; and H.R. 2279, 

the Eliminating Disparities in Breast Cancer Treatment Act of 

2009 sponsored by our own Member, Congresswoman Castor also 

from Florida. And I want to thank all the sponsors of these bills 


jbell on DSK7SPTVN1PROD with HEARING
2 

for the hard work on raising awareness about these very important 

issues, and I should also point out that they have been spending 

some time over the last 6 months trying to have this Subcommittee 

have this hearing and the reason for the delay was of course we 

were dealing with health care reform. 

Now, aside from the non-melanoma skin cancer, breast cancer is 

the most commonly diagnosed cancer in women. The NIH estimates 

that over 190,000 new cases of breast cancer will be diagnosed in 

women in 2009, and though we have seen breast cancer death rates 

decline since 1990, still approximately 40,000 women will succumb 

to the disease this year. And that is the work of advocacy groups 

and the key sponsors of the bills today is so crucially important. 

We have made great strides in detecting and treating breast cancer 

but there is still much more to be done and much more to learn. 

Although all of these bills address concerns related to breast cancer, they all focus on different aspects of the disease from screening 

and early detection to treatment and quality improvement, and all 

they all raise very important issues with respect to how breast cancer patients or any other patients for that matter are being treated 

in the medical environment we live in today. Not every American 

has access to good preventive services. Not every American has the 

good fortune to have an insurance plan that covers the medical 

care they need, and that is why we are working hard trying to pass 

health reform legislation that will improve access to quality and affordable health care for every American. If enacted, health care reform legislation will dramatically improve our efforts in the battle 

against breast cancer. 

Particularly important are the insurance reforms. In drafting 

America’s Affordable Health Choices Act, we took the same tack as 

Ms. DeLauro did in taking decision-making authority out of the 

hands of health insurers and putting it back in the hands of patients and their doctors where it belongs. In addition, the subsidies 

offered in the exchange and expansion of the Medicaid program 

under health care reform will cover childless adults and mean that 

many low- and middle-income women who might not have access 

to health insurance today will be covered in the future for the first 

time, and that means they will be able to access a doctor and receive treatment when they need it. 

A key component to winning the battle against breast cancer is 

effective and appropriate screening, which both Ms. Wasserman 

Schultz and Mr. Nadler’s bill seek to address. Early detection of 

breast cancer has long been acknowledged as an effective way to 

improve outcomes. In fact, studies have shown that the 5-year survival rate in women who have received timely treatment due to 

early detection is at 98 percent, and that is why the U.S. Preventative Services Taskforce has recommended that all women over the 

age of 40 have a mammography screening every 1 or 2 years. Now, 

I agree with my colleagues that early detection and prevention is 

key to survival, and that is why in health reform we bolster the 

very important work that the U.S. Preventative Services Taskforce 

does by providing increased funding so that they can analyze more 

studies and make more prevention recommendations. The evidencebased recommendations that receive the highest ratings from the 

taskforce such as mammography screenings will be covered by all 


jbell on DSK7SPTVN1PROD with HEARING
3 

insurance carriers participating in the health insurance exchange 

and by Medicaid, and while Medicare already covers these services 

under health reform, beneficiaries would no longer face cost-sharing requirements to receive them. 

In addition in health reform, we must also improve the quality 

of care that is provided in this country as Ms. Castor is seeking to 

do with her bill. Tens of thousands of Americans die to preventable 

medical errors every year. Billions of dollars are wasted on lowquality care. We as a Nation must do better. Improving quality is 

a concept we picked up in health reform as well. We require the 

Secretary to establish national priorities for quality improvement 

and we also create a center for quality improvement. This center 

will develop and encourage the use of best practices for quality assurance and will provide implementation grants to those who are 

already doing innovative work to improve the quality of care. Using 

breast cancer as an example, we can and must do better to ensure 

that all Americans receive the highest quality care and that we collect data that will help us continuously improve as more information becomes known about the medical system and specific diseases. 

I want to thank all of our witnesses. I know we are going to start 

after opening statements with the Members’ panel. I would say I 

guess it is clear from my opening statement that in many cases 

some of the things in these bills hopefully will be addressed in the 

larger health care reform bill but I don’t mean to suggest that that 

takes away from the need for us to have this hearing today or to 

move forward with these bills. It may very well be that some things 

are included and some are not, and so this is a legislative hearing 

and the intention would be to move these bills, but we also have 

to see what is included in the health care reform as well. 

[The prepared statement of Mr. Pallone follows:] 


jbell on DSK7SPTVN1PROD with HEARING
4 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 8 here 74102A.001
5 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 9 here 74102A.002
6 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 10 here 74102A.003
7 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 11 here 74102A.004
8 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 12 here 74102A.005
9 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 13 here 74102A.006
10 

Mr. PALLONE. So thank you, and with that I would yield to our 

ranking member, Mr. Deal. 

OPENING STATEMENT OF HON. NATHAN DEAL, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF GEORGIA 

Mr. DEAL. Thank you, Chairman Pallone. Thank you for holding 

the hearing and thanks to our colleagues for appearing before us 

today and all the other distinguished witnesses whose testimony 

we will certainly look forward to hearing. 

All of us, I think, understand the importance of the topic that is 

before us today. Many of us have cosponsored many of the legislative agenda items that are before the Committee. I for one have cosponsored H.R. 1740 because I think it is important for early diagnosis and treatment of breast cancer as well as the continued effort 

to educate young women about this particular disease. Now, we 

have dealt with a variety of issues over the years and most recently 

highlighted by testimony from Ranking Member Barton about a 

constituent who in the midst of dealing with breast cancer had her 

policy canceled. The House has dealt with that when we passed 

H.R. 758 by an overwhelming vote of 421 to 2, so we have begun 

the process, I think, of dealing with many of the issues surrounding 

the treatment and diagnosis of breast cancer. 

But as we continue to deal with how we can best combat this disease, I believe that as stewards of the taxpayers’ dollars that we 

must make sure that these dollars are being most in the most appropriate way, particularly those that are with the NIH and CDC. 

We must assure that these limited resources are appropriately expended to fight all diseases including breast cancer, and I have 

particular concerns about some of the expenditures in both NIH 

and CDC that would appear to be far beyond the normal pale of 

what people regard as important research for those two agencies to 

be supervising. 

So I look forward to the testimony and I welcome our colleagues 

on the first panel. I yield back. 

Mr. PALLONE. Thank you, Mr. Deal. 

Let me mention to everybody, that is just a recess. We are not 

voting, just so you know. 

I recognize the gentlewoman from Colorado, Ms. DeGette. 

Ms. DEGETTE. Thank you very much, Mr. Chairman, and out of 

respect for our intrepid and courageous witnesses in our first 

panel, I will waive my opening statement and submit my very excellent statement that everyone will be able to read in the record. 

Thank you. 

Mr. PALLONE. Thank you. 

Next is the gentleman from Missouri, Mr. Blunt. 

Mr. BLUNT. Thank you, Mr. Chairman. I do have a statement. I 

will submit it for the record as well. I am pleased we are having 

this hearing. I am pleased to be a cosponsor of H.R. 1740, the 

EARLY Act, with my good friend, Ms. Wasserman Schultz, and 

look forward to the hearing. 

[The prepared statement of Mr. Blunt follows:] 


jbell on DSK7SPTVN1PROD with HEARING
11 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 16 here 74102A.007
12 

Mr. PALLONE. Thank you. 

The gentlewoman from California, Ms. Harman. 

OPENING STATEMENT OF HON. JANE HARMAN, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF CALIFORNIA 

Ms. HARMAN. Thank you, Mr. Chairman. I will be brief but I 

want to salute our colleagues but especially our colleague, Debbie 

Wasserman Schultz, for her courage, her passion and her example. 

Many of us wore pink today in solidarity with her. We are strong 

supporters of her bill. Hopefully we will find a way now that it is 

in acceptable form to Committee staff to include it in the health 

care bill with the robust public option that we are going to pass on 

the House Floor one of these days. 

Just briefly, I have a brother who is an oncologist. I couldn’t 

have been prouder when he was given the Healer of the Year 

award by Marin County, California, for his work on breast cancer. 

Breast cancer attacks oldies, grandmas like me, but it also attacks 

beautiful young women like Debbie Wasserman Schultz and hopefully not my daughters, who are a bit younger than she is, and 

hopefully not my granddaughter, who is a lot younger then she is. 

So this is something we all have experience with. All of us know 

people who have breast cancer. Hopefully they all will be survivors 

and most of us are very responsive to the Susan G. Komen and 

other efforts to raise awareness. 

I just want to say that these bills are all good. I am rousingly 

enthusiastic about Debbie Wasserman Schultz’s bill and in that 

context I would like to ask unanimous consent to insert in the 

record a statement by the United Jewish Communities in support 

of that bill. 

[The information follows:] 


jbell on DSK7SPTVN1PROD with HEARING
13 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 19 here 74102A.008
14 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 20 here 74102A.009
15 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 21 here 74102A.010
16 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 22 here 74102A.011
17 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 23 here 74102A.012
18 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 24 here 74102A.013
19 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 25 here 74102A.014
20 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 26 here 74102A.015
21 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 27 here 74102A.016
22 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 28 here 74102A.017
23 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 29 here 74102A.018
24 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 30 here 74102A.019
25 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 31 here 74102A.020
26 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 32 here 74102A.021
27 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 33 here 74102A.022
28 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 34 here 74102A.023
29 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 35 here 74102A.024
30 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 36 here 74102A.025
31 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 37 here 74102A.026
32 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 38 here 74102A.027
33 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 39 here 74102A.028
34 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 40 here 74102A.029
35 

Mr. PALLONE. Without objection, so ordered. I guess I didn’t get 

the memo to wear the pink. I see Jerry did. But I was given a pink 

bat in lieu of a gavel today, so maybe we will use that. 

Ms. HARMAN. Well, Jerry Nadler represents two of my kids on 

the west side of New York, one of whom is female, so it is a good 

thing that he has high awareness of this. I just want to add a couple of facts. One, advances in cancer research and treatments have 

greatly improved survival rates. In the 1960s, a woman diagnosed 

with breast cancer had only a 63 percent chance of living longer 

than 5 years. Now it is 89 percent. Hispanic and African-American 

women have a lower survival rate than the rest of the population, 

so clearly we have a lot of work to do on reducing racial disparities. 

And finally, next Friday, October 16, is National Mammography 

Day. It is a day when radiologists provide free or discounted 

screening mammograms, and hopefully the women in my district 

and all those can hear us at this hearing will take advantage of 

this. Breast cancer is a terrible opponent but it is a beatable one. 

I yield back, Mr. Chairman. 

Mr. PALLONE. Thank you. 

Next is the gentleman from Georgia, Mr. Gingrey. 

OPENING STATEMENT OF HON. PHIL GINGREY, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF GEORGIA 

Mr. GINGREY. Mr. Chairman, thank you. I did have an opening 

statement I would like to give. 

Deaths from breast cancer among women have dropped more 

than 2 percent each year since 1990 due in large part to the intervention of improved treatments and early detection of the disease. 

A study published in 2008 found the United States has the highest 

rate of survival for breast and prostate cancers in the world. These 

statistics are just a small example of the quality that makes our 

health care system a leader throughout the world. Unfortunately, 

being the best is not the entire story. While our health care system 

is a benefit to many with breast cancer, the disease is still the second most common cancer that women are forced to deal with in the 

United States. It is estimated that 192,000 new cases of invasive 

breast cancer are expected to be diagnosed this year and roughly 

40,000 women are expected to die from the disease in 2009, 40,000. 

These are sobering statistics that beg our thoughtful consideration. 

Therefore, I would like to commend the efforts of our panelists 

and all those who strive each and every year to bring attention and 

awareness to a disease that has impacted many of our friends and 

colleagues, some of whom are sitting here with us today as we well 

know. I applaud their efforts to raise the awareness and early detection of breast cancer among our Nation’s patients, and I look forward to hearing their testimony today. 

However, we must also take a step back and look at the legislation before us in the context of the overall reform plan reported 

from this Committee at the end of July. From what I surmise, two 

of the bills before us today address federal requirements on insurance plans that would in essence I think, become moot because of 

H.R. 3200. If H.R. 3200 were to become law, this Congress would 

not be deciding what benefits insurance companies must contain or 

what measures should be used to ensure non-citizens cannot use 


jbell on DSK7SPTVN1PROD with HEARING
36 

taxpayer dollars to purchase health insurance. Those would be the 

purview of a political appointee with little regard for the will of the 

people. 

After the outpouring of concern and constructive criticism for the 

President’s plan during the August recess, I had hoped to come 

back to these hallowed walls and found a new Congress open and 

willing to work in a bipartisan fashion for the benefit of our constituents. Today as we sit here with the specter of H.R. 3200 hanging over our heads, it is looking more and more that that hope to 

be a false one. Mr. Chairman, it seems the lessons of August have 

not been learned by some of my colleagues on the other side of the 

aisle. I yield back my time. 

Mr. PALLONE. Thank you, Mr. Gingrey. 

Next is our chairman, Mr. Dingell. 

OPENING STATEMENT OF HON. JOHN D. DINGELL, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF MICHIGAN 

Mr. DINGELL. Mr. Chairman, I thank you. Good morning. 

I would first like to thank you for holding this hearing. It is an 

important one and it is an opportunity to learn more about the four 

breast cancer bills before us today. Breast cancer is the second 

most common type of cancer amongst women in the United States 

so it is important for us to continue a vigorous examination of how 

to best prevent and treat this disease. In 2009, an estimated 

192,370 new cases of invasive breast cancer will be diagnosed 

among women, and approximately 40,107 of these women are expected to die from the disease. An additional 1,920 cases of breast 

cancer are expected to occur amongst men. In my home State of 

Michigan alone, there will be an estimated 6,480 new cases this 

year and 1,350 deaths. It is estimated that about $8.1 billion is 

spent in this Nation every year for the treatment of breast cancer. 

While real strides are being made against the disease, the 5-year 

survival rate is 98 percent when detected early but too many 

women continue to lose the battle against breast cancer for want 

of proper treatment and proper early diagnosis. 

H.R. 995 would require a group health plan that provides diagnostic mammography for women over 40 to also cover an annual 

screening mammography and an MRI for high-risk women. The 

National Cancer Institute has recommended that women 40 and 

over should have a mammogram once every 1 or 2 years. Doctors 

and patients should make the decision whether to have a mammogram based on risk factors, not the cost. 

Another bill under consideration is H.R. 1691, the Breast Cancer 

Patient Protection Act, of which I am a sponsor. H.R. 1691 would 

ensure that women undergoing mastectomies would be guaranteed 

48 hours of hospital care unless the provider and the patient determine a shorter stay is appropriate. This is again aimed at dealing 

with the problem of drive-through mastectomies and other things 

of that character as provided by the health insurance providers of 

this country. The legislation would also protect physicians who provide quality care for breast cancer patients from retaliation by 

health maintenance organizations and other insurance companies 

seeking to maximize profits at the expense of patient care. This bill 


jbell on DSK7SPTVN1PROD with HEARING
37 

is of great importance to me because a member of my staff in 

Michigan was a victim of these unscrupulous insurance company 

practices when she was sent home after a mastectomy in considerable pain with no support to manage her condition. She ultimately 

succumbed to her cancer but the heartless way in which her insurance company treated her was an outrage. Guaranteeing that 

treatment decisions are made by the provider in consultation with 

the patient, taking into account the patient’s unique medical needs, 

is the cornerstone of good, successful and, believe it or not, inexpensive or the least expensive medical care. 

H.R. 1740 would direct the CDC to develop and implement a national education campaign about the threat that breast cancer 

poses to young women of all ethnic and cultural backgrounds and 

the particular heightened risks of certain groups of our women. It 

is important that we examine the ways to educate our young 

women and medical professionals about breast cancer in young 

women. 

The final bill considered today, H.R. 2279, would address the disparities in breast cancer diagnosis and treatment by requiring providers to report their practices to encourage doctors to offer adequate care to all irrespective of race, income, age or health insurance status. 

Together these bills will protect women from drive-through 

mastectomies as well as advanced breast cancer protection and 

treatment amongst high-risk communities, young populations and 

minorities. This hearing coincides with National Breast Cancer 

Awareness Month and will shine light on issues of great importance to women and their families. I look forward to the testimony 

of today’s witnesses and I commend you for the hearing, and I 

thank you, Mr. Chairman. 

Mr. PALLONE. Thank you, Chairman Dingell. 

Next is one of the sponsors of the bill—oh, I am sorry. Next is 

the gentleman from Texas, Mr. Burgess. 

Mr. BURGESS. Mr. Chairman, in the interest of time, and I know 

we have got votes, I will submit my statement for the record. 

[The prepared statement of Mr. Burgess follows:] 


jbell on DSK7SPTVN1PROD with HEARING
38 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 44 here 74102A.030
39 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 45 here 74102A.031
40 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 46 here 74102A.032
41 

Mr. PALLONE. Thank you, Dr. Burgess. 

Next is one of our prime sponsors of the legislation, the gentlewoman from Florida, Ms. Castor. 

OPENING STATEMENT OF HON. KATHY CASTOR, A REPRESENTATIVE IN CONGRESS FROM THE STATE OF FLORIDA 

Ms. CASTOR. Chairman Pallone, thank you very much for convening this timely hearing on breast cancer legislation during National Breast Cancer Awareness Month. 

Breast cancer is still a brutal killer in America but we are going 

to continue to fight and we are going to make progress, and we are 

going to make progress due in large part to the leaders who are 

here today, to my colleagues here on the Health Subcommittee but 

to these brave Members of Congress that represent hundreds of 

thousands of people and many, many women who have struggled 

with breast cancer. Congresswoman Rosa DeLauro, Congressman 

Jerry Nadler and my good friend from Florida, Congresswoman 

Debbie Wasserman Schultz. Congresswoman Wasserman Schultz 

has been a fine example of perseverance and a great role model for 

anyone that has been diagnosed with breast cancer, and I am 

proud to be a cosponsor of her bill. 

I am also eager to hear from the top experts in the field today 

on our latest legislation, and Mr. Chairman, our colleague, Congresswoman Dr. Donna Christensen, is my partner on my bill, H.R. 

2279, the Eliminating Disparities in Breast Cancer Treatment Act, 

that we will consider today. I would like to thank her for all of her 

attention to disparate diagnosis and treatment that still plagues 

health care in America. 

It is not secret that quality health care in the United States is 

not equally accessible to all of our communities. As a Committee, 

we have worked diligently for the better part of this year to improve health care in America and to make quality care affordable 

and accessible for all, and we are closer to that than ever before 

but we still have these underlying issues of disparate diagnosis and 

treatment that must be addressed directly, and one of the most disturbing involves breast cancer in women of color. Overall breast 

cancer survival rates in the last two decades have improved with 

one exception: minority women. Women of color suffer from significantly higher death rates after diagnosis than white women. The 

American Cancer Society reports that delays in receiving care after 

breast cancer diagnosis are greater for African-American women 

than for white women. African-American women with breast cancer 

are less likely to receive standard therapy than white women. African-American and Hispanic patients are significantly more likely 

than white patients to be diagnosed at a more advanced stage of 

breast cancer. And regardless of insurance status, African-American women are almost two times more likely to be diagnosed with 

an advanced stage of breast cancer than white women and Hispanic women are about one and a half times more likely to be diagnosed with an advanced stage of breast cancer than white women. 

African-American women are 10 percent more likely not to receive 

tests to determine if breast cancer has spread to axillary underarm 

lymph nodes. This screening is essential to preventing the spread 

of cancer to other parts of the body. Health insurance status, race, 


jbell on DSK7SPTVN1PROD with HEARING
42 

income and educational background are directly linked to irregularity in administering this vital screening. Substantial disparities 

remain regarding cancer diagnosis and treatment. 

So in order to eliminate this unacceptable variance in treatment 

and quality care, it is necessary that we create real incentives and 

requirements for medical professionals to provide the best care. All 

patients should receive the most modern and high-standard treatment for their conditions. So our bill seeks to put an end to the inequities in treatment for breast cancer and will help ensure that 

every patient has access to the most appropriate care. The legislation will implement breast cancer treatment performance measures, requiring the Secretary of HHS to work with a national quality forum to develop standard best practices for breast cancer treatment. These measures will address patient outcomes, the process 

for delivering medical care related to breast cancer treatment, patient counseling and engagement in decision-making, overall patient experience, physician care coordination and then the Secretary will develop a 6-year breast cancer treatment quality performance initiative. In years 1 through 3, physicians will be encouraged to follow the new recommendations and report their practices on a voluntary basis. In years 3 through 6 reporting will be 

required and the Secretary will evaluate the care that is furnished 

to patients. Low-quality treatment from providers will result in reduced Medicare payments for those physicians. Improvements in 

treatment will be recognized and payments will be scaled based on 

the care provided. The Secretary will be required to report to Congress so we can keep track of the progress. 

Mr. Chairman, this legislation will help eliminate disparities in 

the treatment of breast cancer. We must continue to use all of our 

expertise and modern tools to fight this brutal killer, improve diagnosis and improve treatment. It will save lives, it will save money 

and it will save heartache. 

Thank you very much. I look forward to hearing from the panels. 

Mr. PALLONE. Thank you. 

The gentleman from Illinois, Mr. Shimkus. 

Mr. SHIMKUS. Thank you, Mr. Chairman. I want to welcome my 

colleagues here. They are all sincere and respected public policy experts, and I appreciate their attendance, and I yield back my time. 

Mr. PALLONE. Thank you. 

The gentlewoman from Illinois, Ms. Schakowsky. 

Ms. SCHAKOWSKY. Thank you, Mr. Chairman. I will put my full 

statement in the record, but I do want to thank all of my colleagues, Debbie Wasserman Schultz and Rosa DeLauro and Jerry 

Nadler and Kathy Castor for the wonderful bills that I am proud 

to be a cosponsor of. 

I just do want to tell you that Chicago has one of the largest disparities in death rates as a result of breast cancer. A report released in 2007 showed that breast cancer kills minority women at 

a rate of 68 percent higher than white women, mostly because of 

inequities and access to quality and affordable care. And I want to 

give a shout-out to an organization. We are actually going to have 

a briefing with them next week. Pin-A-Sister is a Chicago-based organization started by Access Community Health Center. Every 

Mothers Day the organization coordinates an event in black and 


jbell on DSK7SPTVN1PROD with HEARING
43 

Latino churches. The women in the congregation are invited to 

place a pin on a sister to empower her to learn more about breast 

cancer and to show she is not alone in her experience with breast 

cancer. But they need help. 

These bills that you have sponsored and that I feel certain that 

will pass are really going to help them and all women, those facing 

breast cancer and potentially those who may face it in the future. 

Thank you very much. I yield back. 

Mr. PALLONE. Thank you. 

The gentlewoman from Tennessee, Ms. Blackburn. 

Mrs. BLACKBURN. Thank you, Mr. Chairman, and I thank our 

colleagues for the good work that they have done and the attention 

that they have brought to this issue and we are delighted that you 

are here. I will place my full statement in the record. 

I do want to highlight some of our volunteers in Tennessee that 

have done exceptional work on the issue of breast cancer. Our Tennessee Breast Cancer Coalition really has taken the lead in Tennessee. We do know that the work we did last year on the Breast 

Cancer Environmental Research Center Act was very important. 

This is something the environmental pressures that come to bear 

on Tennessee women is something that has gained a lot of attention in our State and has caused a lot of concern, and we have several facilities that are doing a great deal of wonderful research— 

the UT Cancer Institute, the Vanderbilt Ingram Cancer Center and 

the Minnie Pearl, Sarah Cannon Center and so I highlight the good 

work that is being done there. 

In Tennessee, we have 3,970 new cases of breast cancer that will 

be diagnosed this year, and 910 women will probably end up losing 

their life to this disease. We note the legislation before us will help 

assist the good ongoing research equally in the manner that the 

legislation we passed last year did and we look forward to eradicating the disease and certainly making a difference in the lives of 

men and women that are affected by this, and I thank you for the 

hearing and yield my time. 

Mr. PALLONE. Thank you. 

The gentleman from Utah, Mr. Matheson. 

Mr. MATHESON. Thanks, Mr. Chairman. I will submit my full 

written statement for the record, but just very briefly, I would 

point out that it is appropriate we have four different bills today. 

This is a complicated issue and there are a lot of aspects in terms 

of addressing and trying to fight this disease that we should consider as a Committee, and I want to thank the lead sponsors, Representative Castor, Representative Nadler, Representative DeLauro 

and Representative Wasserman Schultz for championing this issue. 

Congresswoman DeLauro has been such a great advocate and I 

was an original cosponsor. I remember we passed this in the House 

last time and hopefully we get it across the finish line this time. 

You know, a lot of people point out different populations that are 

affected differently, and I would just highlight one interesting demographic in my home State where in Utah the incidence of breast 

cancer is actually much lower than the national average and yet 

the mortality rate is about the same, and that is because we have 

a problem where it is usually diagnosed at later stages. That is 

why Congresswoman Wasserman Schultz’s bill is of particular inVerDate Mar 15 2010 04:11 Aug 18, 2012 Jkt 074102 PO 00000 Frm 00049 Fmt 6633 Sfmt 6633 E:\HR\OC\A102.XXX A102

jbell on DSK7SPTVN1PROD with HEARING
44 

terest to me that will help in my State. And it just points out that 

you hear these opening statements from people around the country 

with different constituencies and whatnot and there are so many 

ways we need to try to attack this issue. 

I commend the Committee for holding this hearing and bringing 

all these folks together. I look forward to advocating for all these 

bills. Mr. Chairman, I want to once again thank my colleagues for 

being here and I will yield back my time. 

Mr. PALLONE. Thank you. 

The gentlewoman from the Virgin Islands, Ms. Christensen. 

OPENING STATEMENT OF HON. DONNA M. CHRISTENSEN, A 

REPRESENTATIVE IN CONGRESS FROM THE VIRGIN ISLANDS 

Mrs. CHRISTENSEN. Thank you, Mr. Chairman, and I thank you 

and the ranking member for holding this hearing on such an important issue and making, we hope, this Breast Cancer Awareness 

Month a decisive one in the fight against breast cancer. I would 

like to welcome my colleagues as well. 

With these bills, we not only expand access to mammography 

and other often lifesaving screening technologies but we protect 

and ensure the health care coverage for breast cancer patients, 

educate women earlier about breast cancer and eliminate the 

breast cancer disparities that have a disastrous impact on far too 

women of color. I would like to thank Representatives Nadler, 

DeLauro, Castor, with whom I worked on 2279, and especially Congresswoman Debbie Wasserman Schultz, herself a breast cancer 

survivor, especially for your bill’s emphasis on educating younger 

women earlier about breast cancer. 

It is unacceptable that today one in every eight women will have 

invasive breast cancer at some point in her life and that breast 

cancer remains the second leading cause of cancer death for women 

in this country, but as grim as these statistics are, they are even 

worse when you consider racial and ethnic disparities in breast 

cancer incidence and mortality and prevention. For example, while 

African-Americans have lower breast cancer incidence rates than 

their white counterparts, they are more likely to die from the disease. Latina, American Indian and Asian-American women are not 

only disproportionately more than likely than their white counterparts to not have a mammogram in the recent 2 years, but finally, 

while breast cancer death rates have been on the decline since 

1990 overall, we find that that the 5-year breast cancer survival 

rate for American Indian women is lower than any other population group of women. 

So these statistics suggest that while we have made great 

progress in the fight against breast cancer much to the credit of the 

witnesses we will hear from today and continuing with the legislation before us. We have a long way to go and I look forward to today’s testimonies and discussions and anticipate that this hearing 

will serve as the impetus needed to take our collective fight against 

breast cancer and every cancer really to the very next level, and 

I thank you. I yield back. 

Mr. PALLONE. Thank you. 

The gentleman from Maryland, Mr. Sarbanes. 

Mr. SARBANES. Thank you, Mr. Chairman. I will be very brief. 


jbell on DSK7SPTVN1PROD with HEARING
45 

These are all incredibly important measures, and I just want to 

salute our colleagues and my colleague, Kathy Castor, for their 

work on this. I am embarrassed, Debbie, that I am not wearing any 

pink today, but I am turning pink with embarrassment at that, so 

that will have to do. 

Anyway, congratulations on your work. We look forward to your 

testimony. 

Mr. PALLONE. Thank you. 

The gentleman from Georgia, Mr. Barrow. I will mention to 

members that we have three votes, a 15—I am sorry, four votes. 

There is a 15 and then three 5s. Mr. Barrow, if you would like to 

make an opening, go ahead. 

Mr. BARROW. Thank you, Mr. Chairman. I would. 

It is estimated that one in eight women will develop breast cancer over their time and it is the leading cause of death among 

women age 45 and older. This disease is far too preventable and 

too treatable for these numbers to be so high. I know because my 

mother, who turns 89 years of age today, is a 35-year survivor of 

breast cancer. Curing breast cancer is a huge challenge and it can 

only happen with good science, adequate funding, effective treatments and greater awareness and education. 

These bills we are addressing here today represent small but important steps along the way. October is National Breast Cancer 

Awareness Month. This gives us an excuse to come here today and 

work on this legislation but I look forward to the day when this 

month will not be a time to raise awareness but a time to celebrate 

how our collective efforts actually led to the eradication of breast 

cancer. I want to thank Chairman Pallone and Ranking Member 

Deal for addressing this important issue in our Subcommittee as 

well as Representatives Nadler, DeLauro and especially my colleagues, Congresswoman Wasserman Schultz and Congresswoman 

Castor, for introducing these critical bills that promote breast cancer prevention, research, treatment and quality of care. Thank you, 

and I yield back. 

Mr. PALLONE. Thank you. I think that concludes our opening. 

Now, we could get a couple of you in. I don’t think we can get all 

three of you. I will dispense with my remarks other than to say the 

three of you are wonderful, and two of you are cancer survivors. All 

three of you have been champions of this and other issues so effectively. If anybody can get anything done, it is the three of you, and 

I start with Congressman Nadler. 

STATEMENTS OF THE HONORABLE JERROLD NADLER, MEMBER OF CONGRESS; THE HONORABLE ROSA L. DELAURO, 

MEMBER OF CONGRESS; AND THE HONORABLE DEBBIE 

WASSERMAN SCHULTZ, MEMBER OF CONGRESS 

STATEMENT OF JERROLD NADLER 

Mr. NADLER. Thank you, Chairman Pallone, Ranking Member 

Deal and the members of the Subcommittee. Thank you for convening this hearing and for inviting me to testify today about H.R. 

995, the Mammogram and MRI Availability Act. 

I also want to thank the breast cancer advocacy groups for coming to testify about the work they do, the problems we face in the 


jbell on DSK7SPTVN1PROD with HEARING
46 

fight against breast cancer and the ways in which they and their 

organizations are helping to educate, screen, treat and care for 

women living with and at risk of developing breast cancer. 

We all know people near and dear to us who have battled breast 

cancer, my wife among them for the last 3 years. We all know the 

statistics. Breast cancer is the second leading cause of death of 

women in the United States, the leading cause of death of women 

age 40 to 49. This year alone, more than 40,000 women in the 

United States will die from breast cancer. More than 192,000 new 

cases will be discovered. 

We also know that in addition to the need to find a cure, prevention is the difference between life and death. In 2005, the National 

Institute of Cancer Study confirmed that mammograms contributed 

to a pronounced drop in the number of breast cancer deaths. Study 

after study has found that yearly mammograms, annual mammograms done from age 40 on help find tumors at their smallest and 

most treatable stage. That is why the American Cancer Society and 

others recommend that women age 40 and older should have yearly 

mammograms, and that is why I introduced H.R. 995, a bipartisan, 

commonsense bill to ensure coverage of annual mammograms for 

this population of women. 

While many insurance plans cover diagnostic mammograms, that 

is, mammograms used to diagnose whether an already known mass 

or tumor is cancerous, many insurance plans do not cover screening 

mammograms for the purpose of detecting tumors in the first place. 

Based on the research and what we know about breast cancer, this 

is simply unacceptable, and women and their families deserve better. We would save many, many lives if all plans covered annual 

screening mammograms for women of age 40 and above. 

As we have learned, mammograms on their own do not detect 

every malignant tumor. For women at particularly high risk of 

breast cancer, women who have a strong family history of breast 

cancer where a woman’s mother, grandmother, sister or daughter 

was diagnosed with breast cancer or those women with a BRCA1 

or 2 genes who have a genetic predisposition to developing the disease, MRIs help detect more tumors at their earliest, most treatable stages that mammograms cannot detect. For this population 

of women who are particularly susceptible and at high risk of developing breast cancer, the American Cancer Society recommends 

an annual mammogram and an annual MRI. As with coverage for 

mammograms, insurance companies do not routinely cover screening MRIs, even for this high-risk population of women. 

H.R. 995 would make these important screening exams available 

to the women who need them most. So, in other words, what this 

bill would do is to say that any health insurance plan that provides 

coverage for diagnostic mammograms must provide coverage for 

screening mammograms for women annually over 40 and for the 

high-risk population of women over 40 for MRIs annually as well. 

While women should consult a doctor before undergoing a mammography or MRI, nothing in this bill requires a woman to seek 

a doctor’s referral prior to receiving one of these lifesaving screening exams nor does the bill require women to undergo any tests unless she chooses to do so. 


jbell on DSK7SPTVN1PROD with HEARING
47 

As the Subcommittee well knows, Congress is on course to pass 

historic health care reform bill this year. That legislation contains 

important provisions that would eliminate copays and deductibles 

for recommended prevention services. These recommendations 

should include screening mammograms. However, neither House of 

Congress has passed the legislation. Furthermore, even if passed, 

delays upward of 5 years or more could continue to limit women’s 

access to these exams. Therefore, passage of major health reform 

won’t necessarily prevent these women from continuing to fall 

through the cracks. Additionally, the prevention measures likely to 

be included in the final health care reform package do not currently include coverage for MRIs for high-risk women. Thus, the 

women most at risk, the women with a strong family history of the 

presence of breast cancer as well as those who are genetically predisposed to the disease will continue to be left without access to 

these lifesaving exams. Only passage of H.R. 995 either as a standalone bill or by inclusion of its provisions in the comprehensive bill 

that this Committee is helping to shape now will ensure that these 

women have the coverage they need on which their lives may very 

well depend. 

Mr. Chairman, with the passage of this bill or with its inclusion 

in the overall bill when that passes, women age 40 and older as 

well as those women at particularly high risk of developing breast 

cancer will no longer continue to fall through the cracks. With this 

legislation, these women will be guaranteed coverage for life-saving 

screening exams. As we wait to find a cure, ensuring coverage for 

screening mammograms for all women age 40 or older and where 

indicated for the high-risk population of women over 40 for MRIs 

as well could mean tremendous benefits for many, many women 

and their families in the fight against breast cancer. 

Mr. Chairman, I thank you again for giving me an opportunity 

to discuss this bill, H.R. 995, the Mammogram and MRI Availability Act, and for holding this important hearing on women’s 

health. I look forward to working with you as well as my colleagues 

on the Subcommittee to pass this legislation in one or the other 

form. Thank you very much. 

[The prepared statement of Mr. Nadler follows:] 


jbell on DSK7SPTVN1PROD with HEARING
48 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 54 here 74102A.033
49 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 55 here 74102A.034
50 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 56 here 74102A.035
51 

Mr. PALLONE. Thank you. 

Congresswoman DeLauro. 

STATEMENT OF ROSA L. DELAURO 

Ms. DELAURO. Thank you very much, Mr. Chairman, and thank 

you, Ranking Member Deal, for hosting this effort today. I also 

want to say thank you to this Subcommittee and to the full Committee on a bipartisan basis that have supported the Breast Cancer 

Patient Protection Act, and I appreciate that as the women around 

the country do. Also, my colleagues, Jerry Nadler, Debbie 

Wasserman Schultz, all of whom have—Kathy Castor, Donna 

Christensen, try to come to grips with what is a singularly big 

health issue for women around the country, and I would just say 

to Debbie that her courage and her tenacity in this effort is well 

known, and she clearly is a voice for young women. To all of the 

advocates who are here today, thank you. We can’t do this without 

you. It is an honor to work with you and your efforts again also 

keep us strong and determined to make sure we pass good legislation. 

It was 13 years ago that Dr. Kristin Zarfos, who is a Connecticut 

breast surgeon, told me that HMOs were forcing her to discharge 

her patients before they were ready, sometimes just hours after a 

mastectomy. She testified before this Subcommittee last year that 

insurers suddenly refused to pay for reasonable hospital stay regardless of any underlying or complex medical problems that patients might have—diabetes, heart disease. This is still happening. 

Patients continue to be discharged with no consideration for adverse reactions to anesthesia, postoperative pain or even when they 

are awake enough to understand their discharge instructions. At 

the Subcommittee hearing last year that was convened, we had a 

breast cancer patient, Alva Williams. She testified she had a mastectomy on March 6, 2006, was sent home several hours after surgery. The insurance company would not cover an overnight stay. 

The family didn’t receive proper training on how to care for her. 

She developed an infection in the incisions and recovering from 

that infection caused Ms. Williams’ chemotherapy treatments to be 

delayed 6 weeks. Arizona—a woman’s story on Lifetime TV 

website: ‘‘I had a double bilateral mastectomy in June of this year. 

I was discharged within 2 hours after surgery. I had severe complications that later resulted in being readmitted to the hospital 

within the first week post surgery.’’ The stories go on, and my testimony has been submitted. There is a woman in Kansas City whose 

husband was a physician and she found that it was difficult even 

with a caregiver who was a physician. 

So this is happening across the Nation, which is why in my view 

we need to pass the Breast Cancer Patient Protection Act. It says 

that simply, very simply, adequate recovery time in the hospital 

should not be negotiable. The last thing that any woman should be 

doing at this time is fighting with their insurance company. The 

bill does not mandate, it does not mandate a 48-hour hospital stay. 

If a patient chooses to go home sooner, fine. Nor does it set 48 

hours as a maximum amount of time a woman can stay in the hospital. It says that any decision in favor of shorter, longer hospital 


jbell on DSK7SPTVN1PROD with HEARING
52 

stay would be made by a patient and her doctor and not by an insurance company. 

I have been in the hospital many months, and let me just tell 

you, it is not for everyone. It is not where you want to spend your 

time. But it is important to know that successful outpatient mastectomy programs have been extremely careful to empower their 

patients through education, monitoring outcomes and working intensely to minimize complications. 

Last year, 421 Members of Congress voted to enact this legislation, bipartisan support. We introduced it this year, my colleague, 

your colleague, Joe Barton. Mr. Dingell has spoken out on it. Lifetime Television has a petition calling for the Breast Cancer Patient 

Protection Act’s passage. Nearly 24 million people have signed on 

to this petition. We have 236 cosponsors. Senator Snowe, Senator 

Landrieu, 17 cosponsors in the Senate. We are ready to do this. We 

need to move forward. We have a number of supportive advocacy 

groups out there. 

I will just conclude by saying to you that let us do this. Let us 

do this for the women of this Nation. What happened on the Senate 

side to us last year was the insurance companies. We passed it 421 

votes. That tells you something about the need. It tells you something about the support. Let us do it again in the House and let 

us make sure that our Senate colleagues do the same thing. Thank 

you so much for letting me speak to you. 

[The prepared statement of Ms. DeLauro follows:] 


jbell on DSK7SPTVN1PROD with HEARING
53 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 59 here 74102A.036
54 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 60 here 74102A.037
55 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 61 here 74102A.038
56 

Mr. PALLONE. Thank you, and thank you for your passion, really. 

We only have about a minute left. I was going to suggest we 

come back, if that is okay. All right. We will reconvene after those 

votes with Congresswoman Wasserman Schultz. The Committee is 

in recess. 

[Recess.] 

Mr. PALLONE. The Subcommittee will reconvene, and we had our 

Members’ panel, and you ended up last, I guess. I apologize for 

that, Congresswoman Wasserman Schultz. But let me say, since we 

have a little time, thank you so much. You are like a hero. You 

really are. Or heroine, I guess, is the word. I mean, I don’t know 

all the details but I remember the speech when you came to the 

Floor that one day and it was just amazing. All that you do, I don’t 

know how you find the time, but thank you. 

STATEMENT OF DEBBIE WASSERMAN SCHULTZ 

Ms. WASSERMAN SCHULTZ. Thank you so much, Mr. Chairman. 

I am happy to bat cleanup today for the Member panel, and Chairman Pallone and Ranking Member Deal when he comes back and 

the distinguished members of the Subcommittee that are here with 

us, it really is an honor to be here and to testify in front of the 

Health Subcommittee of Energy and Commerce, and Mr. Chairman, thank you very much for holding this hearing during Breast 

Cancer Awareness Month. I think that is a particularly important 

symbol. It is fitting that we review what is needed in the fight 

against breast cancer during this special month when, although we 

pay special attention to breast cancer awareness during the month 

of October, it is important that we focus on that awareness and 

help women pay attention to their breast health throughout the 

year. 

Before I go further, I really want to give my deepest gratitude 

and thanks to the efforts of three of my colleagues, Sue Myrick, 

Rosa DeLauro and Donna Christensen, who embraced this legislation months ago before I publicly shared my own battle with breast 

cancer, and it was an honor to testify by the side of my friend and 

colleague, Rosa DeLauro, and Sue, you are just superhuman. I 

think there was one day when you got 45 cosponsors for this bill 

in one small series of votes. It is hard for me to express how much 

I appreciate your support for me and the fact that I was able to 

share my story and talk to you about our mutual experience before 

I shared it with everyone else. Thank you very, very much. You 

have been there for me every step of the way. 

Breast cancer strikes women from all backgrounds, all races, all 

ages and all ethnicities. It strikes black and white, rich and poor, 

those with access to quality health care and those without. But 

many women, too many women do not know their specific risk factors or their family history, and this is especially true with young 

women who see breast cancer as an older woman’s disease. Many 

young women think breast cancer will never happen before they 

turn 40 but we know that young women can and do get breast cancer. In fact, each year nearly 24,000 women under 45 are diagnosed 

with breast cancer in the United States. While incidence rates of 

breast cancer are much lower in young women than older women, 

young women’s breast cancers are generally more aggressive, they 


jbell on DSK7SPTVN1PROD with HEARING
57 

are diagnosed at a later stage and they result in higher mortality 

rates. After talking with many health care professionals, advocates 

in the breast cancer community and the Centers for Disease Control and Prevention, it became clear that there was an urgent need 

to help build awareness among this often overlooked group. These 

conversations led to H.R. 1740, the Breast Health Education and 

Awareness Requires Learning Young Act, or the EARLY Act. This 

bill will empower young women to learn the facts, know their bodies, speak up for their health and embrace support. The truth is, 

we all need to be better informed about our own health. We must 

empower each other to know and reduce our risks. 

Recently I learned I had more personal risks than I was aware 

of. Almost 2 years ago, as most of you know now, only 6 weeks 

after a clean mammogram, I found a lump in my breast while 

doing a routine self-exam. My doctor diagnosed me with breast cancer when I was only 41. As a legislator, I have been in the fight 

against breast cancer for a long time. In Florida, I was the lead 

sponsor of the drive-through mastectomy law, the focus of Rosa’s 

bill. I never dreamed I would need its protection myself. I thought 

I knew all of my risk factors. That is why I chose to perform selfexams and saw my doctor regularly. But after I was diagnosed, I 

learned I had more risk factors than I was aware of. I had no idea, 

for example, that as an Ashkenazi Jewish woman, I was five times 

more likely than the general population to have a BRCA1 or 

BRCA2 gene mutation. I didn’t know that that mutation gave me 

as much as an 85 percent chance of developing breast cancer during my lifetime. Too many young women are unaware of their risk. 

The EARLY Act will give all young women the tools and information they need to take more control of their health. It will raise 

awareness of their personal risks and the importance of paying attention to their breast health. It will encourage young women to be 

familiar with the look and feel of their breasts. By knowing what 

feels normal, a young woman has a better chance of knowing when 

something feels different, and I can tell you that that is how it was 

for me. Because I did self-exams on a fairly regular basis, I was 

familiar enough with what my breasts normally felt like so that 

when I felt that lump, I knew it didn’t belong there. The EARLY 

Act will teach young women and medical professionals about the 

importance of family history, warning signs of breast cancer and 

predictive tools such as genetic testing that can help some highrisk women make informed decisions about their health. It will also 

provide grants to organizations dedicated to supporting young 

women diagnosed with breast cancer. These grants will help young 

women tackle the unique challenges that they face like fertility 

preservation, body image and self-esteem as well as help them 

manage and understand their risks. And again, when a young 

woman is diagnosed with breast cancer, I mean, at 28 years old, 

for example, if they don’t even have a boyfriend and they are faced 

with breast cancer and having a double mastectomy and dealing 

with chemotherapy and facing their own mortality, on top of that 

having to think about how to preserve their fertility, that is a 

unique challenge that young women who are diagnosed with breast 

cancer face that older women simply do not, and younger women 


jbell on DSK7SPTVN1PROD with HEARING
58 

have to face many more years as survivors which presents in and 

of itself unique challenges. 

So we have 371 cosponsors in the House including nearly all 

members of this Subcommittee and 34 cosponsors in the Senate. 

The EARLY Act has garnered broad public support from more than 

40 advocacy and health organizations, many of whose representatives are behind me here today, and I just cannot thank these 

groups enough for their support, for their expertise and their guidance in helping to craft this legislation, but also for their personal 

support of me because it has just been very moving and special for 

me. 

Some say that we shouldn’t be talking to young women about 

breast cancer at all because it might scare them. Well, I find this 

quite simply patronizing. Young women and providers can handle 

the truth. They can and should be empowered with the knowledge 

that while only 15 percent of breast cancer cases are in women 

under 45, eight of these women die every here in America. Having 

no information when you are 35 about breast cancer and finding 

a lump in your breast, that is what is really scary. 

Over the past year I have met with oncologists and other health 

care professionals that work with breast cancer patients, whether 

at MD Anderson Cancer Center in Houston, the Dana Farber Cancer Institute at Harvard or the Cancer Center at Memorial Regional Hospital in my district in Florida, the message is clear: too 

often a diagnosis of breast cancer is delayed or missed in young 

women. A Harvard study of young women with breast cancer found 

26 percent delayed seeking medical attention and 27 percent experienced a delay in diagnosis after seeking medical attention. This 

means that more than half of young women are not receiving the 

timely treatment that they need. We must do better. By encouraging young women to know their bodies and their family history 

and by teaching young women how to effectively talk with their 

doctors and their doctors with them, we can transform how we approach the fight against breast cancer. 

Every young woman that I know has the goal of becoming an old 

woman. With the passage of the EARLY Act, we can help more 

young women in America reach their goal and give them powerful 

tools to take control of their own health for a lifetime. Thank you 

very much. 

[The prepared statement of Ms. Wasserman Schultz follows:] 


jbell on DSK7SPTVN1PROD with HEARING
59 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 66 here 74102A.039
60 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 67 here 74102A.040
61 

Mr. PALLONE. Thank you so much. Really, you know, even now 

you have given me a lot more insight into what needs to be done 

and what we need to do, and I just want to stress again, I know 

that there has been some discussion today about what is in the 

health care reform bill and how some of these bills relate and some 

parts of them actually are included, but as I said earlier, this is 

a legislation hearing and so we do intend to move the bills, and we 

will look and see what is in the health reform and what isn’t and 

take that all into account. 

Ms. WASSERMAN SCHULTZ. Mr. Chairman, I have been a legislator for a long time. Any which way this bill becomes law is fine 

with me. Thank you very much, and thank you to the Committee 

staff because they have been an incredible source of support and 

guidance as we move through the process too. Thank you. 

Mr. PALLONE. Take care. 

Now, what we are going to do with our second and third panel 

is that the panelists have agreed, actually on their own initiative, 

to put the two panels together, so we are just going to have one 

panel. This way we can save time and have a series of questions 

that way. So I would ask the second and third panel members to 

come forward, if you would. Welcome. Let me say that the normal 

practice is that Administration witnesses have a separate panel, 

which is why Dr. Taplin from NIH would normally have had the 

second panel, so I want to thank you for suggesting that you be 

with the other panel, but I don’t want anyone to think that that 

prejudices what we do in the future. We understand that the Administration is normally not part of another panel. 

So let me introduce everyone. Starting on my left is Dr. Stephen 

Taplin, who is chief of the Applied Cancer Screening Research 

Branch, Division of Cancer Control and Population Science for the 

National Cancer Institute, which is part of the National Institutes 

of Health. Then we have Dr. Otis Webb Brawley, who is chief medical officer for the American Cancer Society; Ms. Jenny Luray, who 

is president of the Susan G. Komen for the Cure Advocacy Alliance; 

Debra L. Ness, who is president of the National Partnership for 

Women and Families; Dr. George W. Sledge, Jr., who is Ballv ́e Professor of Oncology at Indiana University Medical Center in the 

Cancer Pavilion; Ms. Fran Visco, who is president of the National 

Breast Cancer Coalition, and finally, Dr. Marisa C. Weis, who is 

president and founder of Breastcancer.org. So thank you all for 

being here, and I think you know we have 5-minute opening statements that become part of the record. I would like you to try to 

keep your comments to the 5 minutes if you could. You may get 

questions from the panel that you have to get back to later in writing too, but we would like you to try to answer the questions today. 

So we will start with Dr. Taplin from NIH. Thank you. 


jbell on DSK7SPTVN1PROD with HEARING
62 

STATEMENTS OF STEPHEN TAPLIN, M.D., M.P.H., CHIEF OF 

THE APPLIED CANCER SCREENING RESEARCH BRANCH, DIVISION OF CANCER CONTROL AND POPULATION SCIENCE, 

NATIONAL CANCER INSTITUTE, NATIONAL INSTITUTES OF 

HEALTH; OTIS WEBB BRAWLEY, M.D., CHIEF MEDICAL OFFICER, AMERICAN CANCER SOCIETY; JENNIFER LURAY, 

PRESIDENT, SUSAN G. KOMEN FOR THE CURE ADVOCACY 

ALLIANCE; DEBRA L. NESS, PRESIDENT, NATIONAL PARTNERSHIP FOR WOMEN AND FAMILIES; GEORGE W. SLEDGE, 

JR., M.D., BALLVE PROFESSOR OF ONCOLOGY, INDIANA UNIVERSITY MEDICAL CENTER, CANCER PAVILION; FRAN 

VISCO, J.D., PRESIDENT, NATIONAL BREAST CANCER COALITION; AND MARISA C. WEISS, M.D., PRESIDENT AND FOUNDER, BREASTCANCER.ORG 

STATEMENT OF STEPHEN TAPLIN 

Dr. TAPLIN. Thank you, Mr. Chairman Pallone, and Committee 

members. Thank you for the opportunity to speak today. I have 

also provided a written document that elaborates on my testimony 

with greater detail. As you have heard, I am Dr. Stephen Taplin, 

the chief of the Applied Cancer Research Branch at the National 

Cancer Institute. Before coming to NCI, I spent 20 years as a practicing family physician while also managing an organized breast 

cancer screening program and conducting screening research at 

Group Health Cooperative, an integrated health plan in Seattle, 

Washington. 

There is more than 50 years of research in breast cancer screening and treatment that is now having a positive impact on the lives 

of women. Research shows that the breast cancer incidence increases markedly. Each year among 100,000 women, 1.4 cancers 

are diagnosed in the age group 20 to 24, but as you can see here 

in figure 1, the rate rises to a peak of 454 in women ages 75 to 

79. The benefit of research for these women is that breast cancer 

death has fallen across all age groups since 1975. Since 1990, the 

rate of decline has accelerated and the annual percent reduction in 

mortality has been a fairly consistent 2 to 3 percent per year over 

the last 10 years. However, let me be clear that I understand it is 

not the research that changed the lives, it is the choices women are 

making and the changes in therapy that physicians that are implementing that have had the impact. The key is those changes are 

guided by evidence from research. 

The mortality reduction we are seeing is due to both improvements in treatment and improvements in screening. An elegant set 

of modeling studies demonstrated approximately half the reduction 

in mortality among women ages greater than 40 is due to screening, that in fact screening has become a large part of health in the 

United States since evidence from randomized trials showed that 

mortality reductions were possible. However, the integration of 

screening into care has not been simple because the evidence was 

sometimes ambiguous. The results from breast cancer screening 

trials show less benefit for women ages 40 to 49. Furthermore, the 

benefit appears much later in the lives of these women. Ultimately, 

however, the results of randomized trials led to national recommendations and increases in breast cancer screening among avVerDate Mar 15 2010 04:11 Aug 18, 2012 Jkt 074102 PO 00000 Frm 00068 Fmt 6633 Sfmt 6633 E:\HR\OC\A102.XXX A102

jbell on DSK7SPTVN1PROD with HEARING
63 

erage-risk women in the United States beginning at age 40. The 

U.S. Preventative Services Taskforce, as you have heard, suggests 

considering screening every 1 to 2 years starting at age 40. Screening rates are at about 66 percent within the last 2 years in the 

United States today. 

It is clear that not everyone is at average risk. As our knowledge 

of the genetic determinates of cancer has grown, there has been increased concerning regarding the high-risk populations. The ACS 

has provided recommendations that women at greater than 25 percent lifetime risk for breast cancer should consider magnetic resonance imaging. This is about 1 to 2 percent of women. These recommendations are based on observational studies showing that 

technology has a higher sensitivity in dense breast tissue. Unfortunately, it also shows more false positive tests than occur with 

mammography. We need national work to show that use of MRI in 

high-risk women actually affects mortality. NCI is sponsoring studies on how to reduce the false-positive testing with MRI but it continues to be a limitation. One approach around the problem is to 

examine biomarkers and biomarker profiles that may identify the 

lethal cancers or become a screening test. 

Access across most races and ethnicities including whites, women 

in lower socioeconomic groups are less likely to be screened, in 

large part because they do not have access to preventive care. People with less than 12 years of education are one of the groups in 

the United States who have not seen a significant drop in breast 

cancer mortality. The Centers for Disease Control and Prevention 

has managed a program to encourage access to screening among 

low-income populations. That is a step towards addressing access. 

Access to medical care is critical to screening because it is a process, not a test. The screening process has multiple steps as shown 

in figure 2, and these steps are managed in clinical trials but not 

necessarily in usual practice in the United States. 

To achieve the full potential of screening in the United States, 

we must consider how to improve the entire process. We must also 

consider the effects of the process on all the women, even those 

who will not get cancer. Some have argued that healthy people 

should be very skeptical of screening because most people will not 

have cancer even with a positive test. Improving the screening 

process means finding better tests and better diagnostic procedures. NCI is supporting research in key areas relevant to optimizing the screening process for breast cancer including risk estimation using biomarkers as a genetic profile, comparative effectiveness studies to evaluate MRI, 3D ultrasound and emerging technologies and the comparison of alternative screening and diagnostic 

strategies. 

In closing, I want to emphasize three points, that fewer women 

have died of breast cancer because research has led to progress in 

breast cancer screening and treatment, that the research provides 

evidence for women and their physicians to choose wisely among 

options they face but it is their behavior that changes care and improves outcomes, and three, that we have much more research to 

do to understand the screening process, how to affect behavior, to 

identify biomarkers of risk, cancer progression and treatment reVerDate Mar 15 2010 04:11 Aug 18, 2012 Jkt 074102 PO 00000 Frm 00069 Fmt 6633 Sfmt 6633 E:\HR\OC\A102.XXX A102

jbell on DSK7SPTVN1PROD with HEARING
64 

sponse and to use all of this information to begin to personalize 

screening. 

Thank you for the opportunity to testify. 

[The prepared statement of Dr. Taplin follows:] 


jbell on DSK7SPTVN1PROD with HEARING
65 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 72 here 74102A.041
66 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 73 here 74102A.042
67 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 74 here 74102A.043
68 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 75 here 74102A.044
69 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 76 here 74102A.045
70 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 77 here 74102A.046
71 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 78 here 74102A.047
72 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 79 here 74102A.048
73 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 80 here 74102A.049
74 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 81 here 74102A.050
75 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 82 here 74102A.051
76 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 83 here 74102A.052
77 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 84 here 74102A.053
78 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 85 here 74102A.054
79 

Mr. PALLONE. Thank you, Dr. Taplin. 

Dr. Brawley. I see your nametag says ‘‘Brawler’’ but it is Brawley, right? It is Brawley. 

Dr. BRAWLEY. It is correct on this. 

Mr. PALLONE. Thank you. 

STATEMENT OF OTIS WEBB BRAWLEY 

Dr. BRAWLEY. Thank you, Mr. Chairman, and good afternoon, 

distinguished members of the Committee. I am Dr. Otis Brawley, 

the chief medical officer of the American Cancer Society. I am a 

medical oncologist by training and a practicing physician, and I am 

professor of hematology, medical oncology, medicine and epidemiology at Emory University. On behalf of the 11 million cancer patients and survivors in America today, the American Cancer Society thanks you for your continued leadership in the fight against 

cancer and commitment to enacting comprehensive health care reform this year. 

I greatly appreciate the opportunity to testify today on federal 

initiatives to help fight breast cancer in the United States. Dr. 

Taplin’s comments were quite wise, by the way. Breast cancer is 

an amazingly devastating disease. It is also a very complicated disease. Too often we do a disservice to women who we want to help 

by simplifying the concepts of this disease with very simple messages. Sometimes simple messages actually end up doing harm. 

This year, breast cancer will take the lives of approximately 40,000 

women in the United States. This is particularly disheartening because we know that if every woman had access to accurate information about the disease, good science-driven early detection and 

quality and timely treatment, more of them would survive this disease. 

Members of the Committee today quoted a lot of American Cancer Society-generated statistics. One statistic generated by the 

same ACS epidemiologist that I would like to quote is the fact that 

with halfhearted approaches to breast cancer from 1991 to 2005, 

55,000 to 60,000 women’s lives or deaths were averted. We averted 

55,000 to 60,000 breast cancer deaths by really in essence 

halfheartedly approaching this disease and not getting serious 

about it. At a time when at least a third and indeed in the 1990s 

perhaps 50 percent of women who should have been getting 

screened were not getting screened, and even today a substantial 

number of women who were screened and found with an abnormality get less than good treatment for the disease. Unfortunately, 

not all women have access to adequate health coverage with the 

public health programs that have been proven to help save lives. 

The consequences can be devastating in terms of prognosis. 

My testimony today will highlight four priority areas that are essential to improved breast cancer outcomes in the United States. 

Priority one: You must ensure access to quality health care for all 

Americans. Our current health care system fails to meet the needs 

of far too many people. Research has made clear that lack of health 

insurance can be deadly. Studies have documented that uninsured 

breast cancer patients are more likely to be diagnosed at a later 

stage of disease and have lower survival rates than women who are 

privately insured. That is a polite way of saying the uninsured are 


jbell on DSK7SPTVN1PROD with HEARING
80 

more likely to die. Continued progress against breast cancer requires that we give all cancer patients an equal opportunity to battle this disease by making sure they have access to quality and 

timely medical care. 

Priority two: We need to ensure that we apply what we know 

about evidence-based prevention and early detection and make 

these services available to all Americans. Breast cancer is one of 

the few cancers early through evidence-based screening tests. Absent these screenings, women are at risk of being diagnosed at 

later stages of the disease when it has spread and become more difficult and more expensive to treat and chances of survival drop precipitously. Now is the time to transform our current sick care system into one that also focuses on prevention and wellness. This requires making evidence-based and early detection services affordable and accessible to all populations. Ironically, not doing so increases our Nation’s overall health care costs. 

Priority three: Clinical decisions must be patient-centered and 

made through strict rational and orthodox interpretation of the 

most current scientific evidence. This is particularly important in 

the context of a serious illness like breast cancer or any cancer. As 

practitioners, we need to strive to consistently do a better job of explaining the evidence and the options for screening treatment and 

care as understandably as possible to help patients make informed 

decisions together with their health care teams. 

Priority four: Finally, we must do a better job of addressing the 

health disparities that exist in our Nation. Recent studies have 

shown differences in quality of care provided among certain populations that are of particular concern. For example, Congresswoman Castor actually quoted a study that I published together 

with colleagues last year that showed that black women were five 

times more likely to experience huge delays in starting breast cancer treatment compared to white women. We also found that black 

women were significantly less likely to receive appropriate surgery. 

Seven and a half percent of black women and 11⁄2 percent of white 

women with a locally staged potentially curable breast cancer did 

not get breast surgery, research completed by Halstead in 1903 

that was not practiced in the year 2006. It is well documented that 

insurance status and poverty are principal determinates in cancer 

disparities. We simply must do a better job in providing access to 

appropriate early diagnosis and cancer treatment services for all 

women. 

In closing, it is gratifying that since 1990 we have been seeing 

a rise in the number of women surviving breast cancer each year, 

and as I said, 55,000 to 60,000 deaths averted. But that success is 

not enough. All women must have access to accurate information, 

existing and future early detection methods and quality treatment 

and care. The number of deaths averted if all women who should 

have gotten screening and should have gotten accurate diagnosis 

and should have gotten accurate treatment, the number of deaths 

averted would have easily doubled over that 55,000 to 60,000. 

The Society appreciates the leadership and commitment of the 

Energy and Commerce Committee in helping eliminate suffering 

from breast cancer through the work that will be described today 

and through health care reform. My colleagues at the American 


jbell on DSK7SPTVN1PROD with HEARING
81 

Cancer Society Cancer Action Network, ACS CAN, and I look forward to working with you as we look ahead to help create a world 

with less cancer. 

Thank you again for inviting me here today. I would be happy 

to answer your questions, sir. 

[The prepared statement of Dr. Brawley follows:] 


jbell on DSK7SPTVN1PROD with HEARING
82 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 89 here 74102A.055
83 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 90 here 74102A.056
84 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 91 here 74102A.057
85 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 92 here 74102A.058
86 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 93 here 74102A.059
87 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 94 here 74102A.060
88 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 95 here 74102A.061
89 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 96 here 74102A.062
90 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 97 here 74102A.063
91 

Mr. PALLONE. Thank you, Dr. Brawley. 

Ms. Luray. 

STATEMENT OF JENNIFER LURAY 

Ms. LURAY. Mr. Chairman and members of the Committee, thank 

you for the opportunity to testify today about the four breast cancer 

bills before your Committee. My name is Jennifer Luray and I am 

president of the Susan G. Komen for the Cure Advocacy Alliance 

and vice president of Government Affairs and Public Policy for 

Susan G. Komen for the Cure. 

This year marks the 25th anniversary of National Breast Cancer 

Awareness Month. It is an opportunity to reflect on what we have 

accomplished and to work even harder to fight the war on breast 

cancer. Before the Nation celebrated breast cancer awareness, we 

practiced denial. We didn’t talk about breast cancer, didn’t understand it, did little to find out how to prevent and treat it. This was 

the world that Susan Komen lived in when she heard those dreaded words at age 33: ‘‘You have breast cancer.’’ Her sister, Nancy 

Brinker, founded Susan G. Komen for the Cure, and a promise 

made between two sisters to end breast cancer forever has become 

the promise of millions. Thanks to events like the Race for the 

Cure, we have invested almost $1.5 billion in cutting-edge research 

and community programs and have pledged another $2 billion over 

the next decade. The Komen Advocacy Alliance, the sister organization that I am proud to lead, mobilizes a network of 250,000 advocates, men and women, at the State and national level to promote 

important policy change. Our promise is to leave few scientific opportunities or community needs untouched. 

Yet, to make the most of these investments, we need to first empower women to be advocates for their own health, second, to expand access to health care, and third, to improve the quality of care 

that women receive, and we need the help of Congress to do that. 

That is why I am so pleased to be here today, because of these bills 

before the Committee helps us to move closer to these goals. 

I will first discuss the Breast Cancer EARLY Act, H.R. 1740. The 

Komen motto is that information empowers women to be their own 

best advocates yet too many don’t receive information about breast 

cancer until their doctor recommends their first mammogram at 

age 40, and that is just too late for information. Each year, 25,000 

women in this country under age 45 are diagnosed with breast cancer, and sadly, almost 3,000 under age 45 will die. That is approximately 10 percent of all breast cancer diagnoses this year, certainly 

not a trivial number. A carefully targeted, evidence-based public 

health effort will inform young women and importantly their providers that unfortunately breast cancer does occur in young 

women. It will help women to establish good lifelong breast health 

habits like regular exercise and to be empowered to seek care when 

they suspect that something is wrong. It will also prevent fewer 

young women with breast cancer from being overlooked by the 

medical system and left undiagnosed until their disease is tragically advanced. We have had an outpouring of support from young 

women around the country for this bill. We are working with the 

bill’s sponsor to ensure that funding for the EARLY Act won’t come 


jbell on DSK7SPTVN1PROD with HEARING
92 

from existing funds for the CDC’s breast and cervical cancer program. 

Let us now turn to the Breast Cancer Patient Protection Act, 

H.R. 1691. To be truly empowered, women also need to the ability 

to impact decisions. That is why the Komen Advocacy Alliance has 

consistently supported this bill by Representatives DeLauro and 

Barton. Decisions concerning a women’s care after a complicated 

medical procedure should be made between the woman and her 

doctor and not dictated by an insurance company. 

H.R. 995, the Mammogram and MRI Availability Act, introduced 

by Representative Nadler, brings us closer to the second goal I 

mentioned, which is expanding access to health care. At Komen, we 

believe that all women should have access to recommended 

screenings including cancer survivors who need follow-up testing 

and surveillance. Guidelines recommended by the American Cancer 

Society and the National Comprehensive Cancer Network state 

that women at high risk should receive annual screening mammograms and an MRI every year. Importantly, women undergoing 

screening tests should do so in conjunction with their doctor. When 

we talk about improving access to care, we mean quality care for 

all women, our third goal. So we commend Congresswoman Castor 

and Congresswoman Christensen for their attention to the issue of 

disparities in breast cancer. Low-income women should have access 

to the same quality care as higher-income women so that they can 

benefit from the same positive outcomes. Improving the quality of 

cancer care across income, race and ethnicity has long been a focus 

of Komen. We recently joined with the American Society of Clinical 

Oncologists to collect data that can be used for quality improvement. This type of data collection is needed for any performance or 

quality-based payment system. 

In addition to these bills specific to breast cancer, we want to 

thank Congresswoman Capps for her leadership on two comprehensive cancer bills, one to revamp research and the other to improve 

care. The Komen Advocacy Alliance also strongly supports the insurance reforms in H.R. 3200 that would prevent patients from 

being denied coverage due to preexisting conditions, protect patients from high out-of-pocket costs and dramatically improve access to mammograms. Before Congress reconvened this fall, we 

asked our advocates to share their personal experiences. Nearly 

60,000 women and men from around the country contacted their 

representatives. Their heart-wrenching stories call out the need for 

health care reform. Breast cancer patients turned down for insurance turn destitute after paying for their care and turn sicker because they couldn’t afford screening or treatment. 

In conclusion, I want to thank you again for the opportunity to 

testify before your Committee. As we mark the 25th anniversary of 

National Breast Cancer Awareness Month, we take a hard look at 

what we have accomplished and where we need to be. The stigma 

surrounding breast cancer in our country is largely gone, a fact 

that makes us the envy of women the world over. In the United 

States, more women are being screened and living longer as a result, and we have made progress on key scientific fronts. Yet, if we 

are one day to end the suffering and death from breast cancer, we 

must continue to make investments across the entire cancer specVerDate Mar 15 2010 04:11 Aug 18, 2012 Jkt 074102 PO 00000 Frm 00098 Fmt 6633 Sfmt 6633 E:\HR\OC\A102.XXX A102

jbell on DSK7SPTVN1PROD with HEARING
93 

trum to prevent and better detect and treat the disease, and we 

must always trust the women to be our partners in this fight. Information empowers women to be their best advocates. 

We look forward to working with you and our partners in the 

cancer community as we continue this important race forward. 

Thank you, Mr. Chairman. 

[The prepared statement of Ms. Luray follows:] 


jbell on DSK7SPTVN1PROD with HEARING
94 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 101 here 74102A.064
95 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 102 here 74102A.065
96 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 103 here 74102A.066
97 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 104 here 74102A.067
98 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 105 here 74102A.068
99 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 106 here 74102A.069
100 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 107 here 74102A.070
101 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 108 here 74102A.071
102 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 109 here 74102A.072
103 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 110 here 74102A.073
104 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 111 here 74102A.074
105 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 112 here 74102A.075
106 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 113 here 74102A.076
107 

Mr. PALLONE. Thank you. 

Ms. Ness. 

STATEMENT OF DEBRA L. NESS 

Ms. NESS. Good afternoon, Chairman Pallone, members of the 

Subcommittee. Thank you for this opportunity to testify. 

The National Partnership for Women and Families is a nonprofit, 

nonpartisan organization with more than three and a half decades 

of experience working on issues important to women and families. 

Over the years we have brought together a wide range of consumer 

voices to push for health reform that would expand affordable coverage, help us get costs under control, improve quality and reduce 

disparities. We are very pleased to support the efforts of this Subcommittee to enact comprehensive health reform this year. This is 

truly a historic moment. For the first time in decades, Congress is 

poised to enact comprehensive reform that would vastly improve 

the lives and well-being of America’s women and families. 

We are pleased to endorse H.R. 3200 for many reasons. It provides meaningful financial assistance to help low- and moderate-income families purchase insurance. It ensures adequate coverage 

and scope of benefits. It creates a health insurance exchange with 

strong patient protections. It prevents insurers from denying or 

dropping people from coverage because of their health status or 

raising rates based on gender. Very importantly, it charts a pathway for real delivery system reform. This pathway is key to ensuring that the reforms we enact today are meaningful and sustainable for the long haul. I believe H.R. 3200 lays the groundwork for 

a system that over time will deliver better care to patients and enable us to get more value for our health care dollars. It does this 

by shoring up primary care and encouraging better coordination 

through new payment models and it creates the necessary foundation for those models through things like comparative effectiveness 

research, workforce development, better data collection and quality 

measures and improvements. 

It is the development and use of quality measures that I want 

to particularly focus on today, not just for breast cancer care but 

for our system as whole. The use of measures to generate performance information about provider performance is critical to getting 

us to a system that at some point delivers on the promise of the 

right care to the right patients at the right time for the right reasons. Without measurements, we can’t know if the new models we 

are putting in place are actually resulting in better patient care. 

We can’t assess whether we are really eliminating disparities. 

Without measurement, we can’t tell if we are using our health care 

dollars effectively. We can’t transition to a system that is based on 

value rather than volume. Without good measures and good measurement and the quality improvement that they enable, we simply 

cannot achieve the high-quality, effective and equitable care that 

patients need and deserve. 

Congresswoman Castor, you have clearly recognized the importance of measurement in your bill, H.R. 2279, and we applaud your 

commitment and leadership on women’s health issues. We share 

your goals of rewarding value over volume, of incentivizing quality, 

of improving the patient’s experience of care and eliminating disVerDate Mar 15 2010 04:11 Aug 18, 2012 Jkt 074102 PO 00000 Frm 00113 Fmt 6633 Sfmt 6633 E:\HR\OC\A102.XXX A102

jbell on DSK7SPTVN1PROD with HEARING
108 

parities, and we particularly appreciate the provisions of your bill 

that move us toward quality measurement and public reporting at 

the individual provider level and that help us begin to align our 

payment system so that we have incentives that encourage better 

quality and practice that lives up to the best standards of care. 

These elements are essential to building a more effective delivery 

system and they should be integral not just to care for breast cancer but to the broader reforms that we all seek. We stand ready 

to work with you and your colleagues to implement a pathway for 

these reforms but we also urge that we do this in a way that benefits all patients no matter what their condition or diagnosis and in 

ways that are going to generate accountability for all providers 

across all settings. It is this vision that led the national partnership to work with the Stand For Quality Coalition, which is a 

broad group of about 200 health care stakeholders that include consumers, purchasers and providers to issue a set of recommendations that are now largely embodied in H.R. 3200. These recommendations call for a national comprehensive strategy that includes setting priorities for quality improvement and measurement, 

developing good measures and then endorsing and maintaining 

those measures as national standards, collecting and analyzing 

measurement data and then using that data for quality improvement, for public reporting and for payment. This broad coalition of 

stakeholders also called for a multi-stakeholder consultative process to provide input and make recommendations so that the implementation of this strategy would engage in reflective perspectives 

of all of us who have a stake in health care. 

So in closing, I want to say how pleased we are that H.R. 3200 

has incorporated these recommendations and I thank the members 

of this Subcommittee for their leadership in recognizing that a comprehensive quality strategy is the critical foundation for health reform that is meaningful, equitable and sustainable over the long 

term. Thank you. 

[The prepared statement of Ms. Ness follows:] 


jbell on DSK7SPTVN1PROD with HEARING
109 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 117 here 74102A.077
110 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 118 here 74102A.078
111 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 119 here 74102A.079
112 

Mr. PALLONE. Thank you. 

Dr. Sledge. 

STATEMENT OF GEORGE W. SLEDGE, JR. 

Dr. SLEDGE. Mr. Chairman Pallone, members of the Subcommittee, thank you for the opportunity to submit testimony 

today. My name is Dr. George Sledge. I am a medical oncologist 

from Indianapolis who specializes in the treatment of breast cancer. I also serve as professor of medicine at Indiana University’s 

Simon Cancer Center, and I am president-elect of the American Society of Clinical Oncology. ASCO’s mission is to ensure that the 

highest quality, evidence-based care is delivered to all people with 

cancer during all stages of their disease. We are especially pleased 

to speak at today’s hearing as it focuses on the cornerstones of 

ASCO’s mission: cancer prevention, quality, access to care and education. 

Many of us have been touched by breast cancer either personally 

or through family members’ or friends’ experiences. ASCO supports 

the underlying goals of all four bills being discussed today and we 

urge this Committee to ensure the resulting legislation is grounded 

in sound scientific evidence. In today’s testimony, I will focus on 

three areas that span the continuum of cancer care: patient access 

to appropriate screening, patient education and public awareness, 

and quality measurement in cancer care. 

The first is patient access to appropriate screening. Studies have 

shown the value of cancer screening, particularly mammography in 

women over the age of 40. ASCO supports provisions that prohibit 

health plans from establishing policies or barriers to medically appropriate testing. While MRI is a highly sensitive test, we should 

not overlook the potential risk of overdiagnosis that lead to additional diagnostic tests including biopsy. Tests and procedures cause 

anxiety and can lead to harms so we should be very clear about the 

associated costs, risks and benefits. The greatest utility for MRI appears to be for women who are at high risk for breast cancer such 

as individuals who have a strong family history. For women at 

high risk, detection of abnormalities is less likely to result in false 

positive findings. However, all women undergoing screening MRI 

should be informed about the odds of false positive findings and the 

potential adverse consequences of those findings. 

The second issue I will discuss is patient education and public 

awareness. With respect to educating young women on the causes 

and risks of breast cancer, such an endeavor must be evidence 

based. An informed patient has a critical advantage in cancer care 

treatment and the American Society of Clinical Oncology has directed considerable resources and expertise to informing patients 

through our cancer.net website. 

Finally, I would like to address quality measurement and reporting, which is at the very core of ASCO’s mission. More than 500 

oncology practices throughout the country participate in ASCO’s 

Quality Oncology Practice Initiative, or QOPI, a system for practicing oncologists to submit clinical data where practice-specific 

comparative data reports are generated. QOPI allows oncologists to 

systematically assess the quality of care they provide and engage 

in data-driven practice improvement activities. The majority of the 


jbell on DSK7SPTVN1PROD with HEARING
113 

80 quality measurements in QOPI are applicable to breast cancer 

patients and 14 are specific to breast cancer treatment. QOPI together with the breast cancer registry pilot made possible by generous support from the Susan G. Komen For the Cure will provide 

tremendous insight into how breast cancer patients receive care, 

where improvements are needed and strategies for breast cancer 

care. A project that tests well-designed quality measures in breast 

cancer would move the field forward. However, such a project must 

remain flexible, especially with respect to public reporting of quality information. Studies of quality performance suggest that the 

most important element is the very active measuring and sharing 

outcomes with physicians. Value-based purchasing that reduces 

payment for low-quality providers rather than rewarding highquality providers may have the unintended consequence of further 

stressing systems that are already struggling. The development 

and testing of quality measures would benefit from ASCO’s long 

history of work in this area. Some measures developed by ASCO 

have already been endorsed by the National Quality Forum but the 

number of NQF-endorsed measures for cancer is quite limited. Significant work will be required to expand this portfolio so that it includes the full range of measures required in H.R. 2279. ASCO 

would be delighted to provide its expertise in this area. 

In closing, ASCO appreciates the tremendous thought and attention the Subcommittee and sponsors of the four bills have devoted 

to the care of women with breast cancer. We look forward to working with you and our partners throughout the cancer community 

to achieve the important goals set out in these bills. Thank you 

very much. 

[The prepared statement of Dr. Sledge follows:] 


jbell on DSK7SPTVN1PROD with HEARING
114 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 122 here 74102A.080
115 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 123 here 74102A.081
116 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 124 here 74102A.082
117 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 125 here 74102A.083
118 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 126 here 74102A.084
119 

Mr. PALLONE. Thank you, Dr. Sledge. 

Ms. Visco. 

STATEMENT OF FRAN VISCO 

Ms. VISCO. Thank you. Thank you, Chairman Pallone, members 

of the Subcommittee. I appreciate very much the opportunity to 

testify today on behalf of the National Breast Cancer Coalition. 

I am a 22-year breast cancer survivor. I was diagnosed when I 

was 39 years old. My son, David, was 14 months old. I was a partner in a law firm in Philadelphia and I was fortunate that I became involved with a group of women who launched the National 

Breast Cancer Coalition and I soon left my law practice to devote 

my life to our mission to eradiate breast cancer. 

We are a coalition of organizations from across the country. Our 

board of directors is a board of 25 of these organizations representing the diversity that is breast cancer from the Women of 

Color Support Group, to Nueva Vida, to the Alamo Breast Cancer 

Coalition, to the California Alliance of Breast Cancer Organizations. Our national grassroots network consists of representatives 

of many different organizations. We set priorities. We educate our 

members to understand the language and the concepts of science. 

We know that women are quite capable of understanding these 

issues, of accepting the truth no matter how difficult that may be, 

and of speaking up for themselves. We critically analyze information. We critically analyze public policies before we set our priorities and before we take positions, and we have but one agenda and 

that is to eradicate breast cancer. 

I know the Committee today is focusing on a number of bills specific to breast cancer and we have submitted analyzes of some of 

those bills to members, and I will submit them for the record. But 

what I want to focus my remarks on today is our number one priority, and that is the bill that we believe will have the largest impact for all women at risk of and all women who have received a 

diagnosis of breast cancer and that is guaranteed access to quality 

health care for all. We followed our process of research of critical 

analysis. We spent several years educating our grass roots, looking 

at various health care systems, reading the literature, researching 

the system, and we developed our framework which was submitted 

with our written testimony to support guaranteed access for all, 

educated patient participation at all levels of the system, shared responsibility and benefits based on evidence. We strongly support 

comparative effectiveness research because we believe that it is 

necessary to help ensure quality and affordable health care for all. 

We need a high level of evidence for doctors and patients to choose 

which care is appropriate, for whom and under what circumstances. In addition, our framework calls for a significant number, and that is 25 percent of educated patient and consumer member on all committees, commissions and boards involved in health 

care including those established to review and assess the best evidence-based treatment options. 

We commend the Committee for its work on H.R. 3200, which 

achieves many of the benchmarks set forth in our framework, and 

we are pleased to endorse that bill and we look forward to working 

with you to ensure that all individuals have access to the comVerDate Mar 15 2010 04:11 Aug 18, 2012 Jkt 074102 PO 00000 Frm 00125 Fmt 6633 Sfmt 6633 E:\HR\OC\A102.XXX A102

jbell on DSK7SPTVN1PROD with HEARING
120 

prehensive quality care they deserve, quality care they need. Everyone should have access and it must be affordable, not just for 

the federal budget but to people. It must be affordable to individuals. We very much appreciate your interest and support of our 

shared goal to save lives and to end breast cancer. You have the 

power to make a real difference for all of us, and we know how 

complicated these issues are, how difficult your task is. We know 

how complex breast cancer is and how careful we all have to be to 

make certain that what we are doing is the right thing in terms 

of women’s lives. 

There are too many unfortunate examples of policy messaging 

and beliefs that have taken hold when there was in fact no real 

evidence behind it, and these actions resulted in harm to women. 

My written testimony describes them from bone marrow transplants to breast self-exams and hormone replacement therapy to 

the misuse of statistics by opponents to health care reform that are 

looking inappropriately at survival statistics that are outdated 

from different countries. All of that has been submitted with my 

written testimony. 

I know firsthand the horror of breast cancer and I see that horror over and over again for too many women of all ages, all races, 

all walks of life. That is why we are so firmly committed to the evidence-based approaches, to our passionate commitment to eradicating breast cancer. 

I want to take a moment to talk about Carolina Hinestrosa, a 

strong, passionate, unbelievable activist. She was the executive vice 

president of the National Breast Cancer Coalition. She founded 

Nueva Vida, a national support group for Hispanic women with 

breast cancer. She was diagnosed 15 years ago at the age of 35 and 

then again 6 years ago. She died in June of a soft-tissue sarcoma, 

a result of her treatment for breast cancer, not breast cancer, her 

treatment for breast cancer, just one more story of how complex 

this disease is, how complicated the issues are. I dedicate my testimony and my work to her memory, and I thank you again. 

[The prepared statement of Ms. Visco follows:] 


jbell on DSK7SPTVN1PROD with HEARING
121 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 130 here 74102A.085
122 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 131 here 74102A.086
123 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 132 here 74102A.087
124 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 133 here 74102A.088
125 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 134 here 74102A.089
126 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 135 here 74102A.090
127 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 136 here 74102A.091
128 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 137 here 74102A.092
129 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 138 here 74102A.093
130 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 139 here 74102A.094
131 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 140 here 74102A.095
132 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 141 here 74102A.096
133 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 142 here 74102A.097
134 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 143 here 74102A.098
135 

Mr. PALLONE. Thank you, Ms. Visco. 

Dr. Weiss. 

STATEMENT OF MARISA C. WEISS 

Dr. WEISS. Thank you, Chairman Pallone, Subcommittee members and other panelists. It is a true privilege for me to be here 

today to talk about breast health and breast cancer issues that 

have been my core professional focus and driving mission for over 

20 years, but more importantly, these issues directly affect about 

half the United States population and the rest of us who care for 

them. 

My name is Dr. Marisa Weiss. I am a breast oncologist and 

founder and president of the nonprofit Breastcancer.org. We are 

the world’s most utilized online resource for breast health and 

breast cancer information, reaching 8 million people annually. As 

a doctor, I have had the honor taking care of thousands of women 

with breast cancer and have seen up close its devastating effects, 

and our laws govern how I can best care for the unique needs of 

each individual that comes to me. 

Everyone here knows how much is at stake. The breasts are the 

favorite place for cancer to occur in women, often in their prime of 

their lives and when these women are most indispensable to so 

many. The bills before the Committee today represent critical ongoing efforts to improve diagnosis and patient care. I would like to 

start with the EARLY Act. I believe this legislation will do much 

to advance public health efforts and combat the threat of breast 

cancer, and I commend Congresswoman Wasserman Schultz for 

her leadership. There are concerns that outreach to young women 

will produce more harm than good by creating the fear of breast 

cancer, but what we have found is that fear already widely exists. 

Information about breast cancer is pervasive. Young women like 

the rest of us are bombarded by breast cancer messaging aimed at 

adult women. To better understand the impact, Breastcancer.org 

conducted a research project with 3,000 girls ages 8 to 18 across 

the country. Consistently, nearly 30 percent of girls feared that 

they may have had breast cancer. It was triggered by breast pain, 

a diagnosis in someone close to them, or mistaking the changes of 

normal breast development for signs of breast cancer. Over 70 percent of girls have someone close to them who has been diagnosed, 

a mother, grandmother, best friend’s mom, teacher or neighbor, 

and when breast cancer diagnosis strikes this close to home, their 

fears were magnified. Many young women think breast cancer messages in the media targeted to mature women directly apply to 

them as well, but they simply don’t have the resources to understand the meaning and relevance of these critical issues nor do 

they have the dialog skills or opportunities to discuss their fears 

or clarify breast cancer misinformation. Only 47 percent of the girls 

had talked to a parent, 40 percent to a doctor. 

To resolve unrealistic fears, young women in this era need accurate information and reassurance that age-appropriate and scientifically grounded education can arm them with the facts of what is 

normal and what is not, empower them to take charge of their 

breast health. It is these girls during the ages of 8 to 18 and into 

their 20s that are using what they eat, what they drink, what they 


jbell on DSK7SPTVN1PROD with HEARING
136 

breathe in, medicines they take, personal products that they use to 

build their breast tissue, laying down the foundation of their future 

breast health. It is at this early point also that young women are 

establishing their lifelong behavioral patterns. 

Concerns have been raised about the value of education outreach 

to low-risk populations in the absence of modifiable risk factors, 

and we know how complex a disease breast cancer is with multiple 

causes, but most of these risks for breast cancer don’t begin at age 

45. Rather, they accumulate over a lifetime beginning at conception. There are periods when breast cells are hypersensitive to internal and external environmental insults: the first trimester of 

pregnancy, the 4 to 10 main years of breast organogenesis between 

adolescence and the 20s, as well as the stretch of time leading up 

to a woman’s first full-time pregnancy when breast cells are highly 

active and immature. So the behaviors of women under age 45 impact not only their own breast health but the future breast health 

of their daughters through pregnancy and modeled behaviors. Some 

risks are modifiable and some are not but even the tiny risks can 

combine and really add up, particularly during these sensitive 

times. An example of a modifiable risk factor is the obesity epidemic across the United States associated with an increase in risk 

of breast cancer in adult women. Extra fat makes extra hormones 

that could stimulate extra breast cell growth. In addition, fat stores 

hormonally active pollutants that are lipophilic such as bisphenol 

A, atrazine, dioxins, nonylphenols, which could potentially stimulate unhealthy breast cell growth. And moreover, obesity in childhood predicts for obesity in adults and obese mothers are more 

likely to raise obese daughters. And contrary to the claim that 

proven breast cancer risks can’t be modified, our obesity epidemic 

is doing just that, by accelerating the age of menarche. Early education and behavioral modification that increases athletic activity 

and health weight management early enough could postpone the 

onset of puberty, and lessons learned from the EARLY Act programs will benefit current and future generations since it is the 

women under the age of 45 who are in their prime childbearing 

and parenting years. 

Another example is the opportunity to provide breast cancer risk 

reduction strategies to high-risk women. In the EARLY Act, the 5 

to 10 percent of breast cancers due to an inherited breast cancer 

genetic abnormality, over 13,000 per year, would more likely be 

identified, giving these women a greater chance to reduce the risk 

of breast cancer by as much as 90 percent with prophylactic 

mastectomies or 50 percent with anti-estrogen therapies. 

It is important that we impart this knowledge along with what 

we, the scientific and medical community, know are not risk factors 

for breast cancer. Fear certainly breeds myths, and in our survey 

many young women believe that only their mother’s family history 

is important and that breast cancer skips generations. They also 

were fearful that they could have caught breast cancer from their 

mothers during pregnancy and breastfeeding. Education can 

change attitudes, knowledge and behaviors. We do a disservice to 

this and future generations by neglecting to provide this information and facilitate this dialog. 


jbell on DSK7SPTVN1PROD with HEARING
137 

I am also here today in full support of the Breast Cancer Patient 

Protection Act, the Mammogram and MRI Availability Act, and 

Eliminating Disparities in Breast Cancer Treatment. I am prepared to answer any questions about the medical content. 

And in conclusion, I thank the chairman, the Subcommittee and 

the panel for giving me the opportunity to speak to you today. 

Thank you. 

[The prepared statement of Dr. Weiss follows:] 


jbell on DSK7SPTVN1PROD with HEARING
138 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 147 here 74102A.099
139 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 148 here 74102A.100
140 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 149 here 74102A.101
141 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 150 here 74102A.102
142 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 151 here 74102A.103
143 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 152 here 74102A.104
144 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 153 here 74102A.105
145 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 154 here 74102A.106
146 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 155 here 74102A.107
147 

Mr. PALLONE. Thank you, Dr. Weiss. 

Now we will have questions from the members, and I will start 

myself, and I wanted to ask Dr. Taplin some questions initially. 

In fiscal year 2007, the National Cancer Institute invested nearly $600 million in breast cancer research. I understand the Institute 

devoted roughly the same amount of resources towards research on 

this topic in 2008. Can you describe, Dr. Taplin, the activities that 

NIH is supporting, understand how women can actually prevent 

breast cancer in the first place and how is NIH investing in research into improved breast cancer screening as well as into treatment of breast cancer once it has been diagnosed, in less than 2 

minutes? Whatever you can do. 

Dr. TAPLIN. There are many studies related to breast cancer at 

NCI. As you have already noted, we had $572.6 million and 2,146 

studies at NCI in fiscal year 2008. Those are concentrated in several areas but the ones relevant to your question are prevention, 

early detection and treatment. We spent approximately $27 million 

on prevention, $54 million on early detection and $169 million on 

treatment studies, so all of those are relevant to your question. I 

think probably the most interesting piece, and there are several, 

and many places we can go among the 2,146 studies we did. The 

most important, I think, is the Breast Cancer and Environmental 

Research Act, which came from you folks and resulted in a center, 

a set of centers to look at basic—the relationship between environment and biology of young women’s breast development, and so 

there are biologic studies in women, there is epidemiology study in 

young women and there is also a group of people looking, academicians and educators, looking at how you communicate these issues 

to women and to young women especially so that we can begin to 

adapt those message to the population that we are targeting. Those 

are some of the areas we are working on. 

Mr. PALLONE. All right. Thank you. 

Dr. Brawley, I wanted to ask you, the U.S. Preventative 

Taskforce recommends that women over 40 have annual or biannual mammograms. Your organization recommends annual mammograms for women over 40 and clinical breast examinations for 

women in their 20s or 30s. So unless a woman under 40 has an 

identified risk factor, there is no recommendation that she get a 

mammogram. Obviously, you know, this relates to Congresswoman 

Wasserman Schultz’s legislation. Would you elaborate on the challenges for women under 40 and what can we do for these women 

to detect their cancers as early as feasible? 

Dr. BRAWLEY. Yes, sir. Thank you for the question. Part of the 

answer to your question is mammography is a terrible test for 

women who have younger breasts and denser breasts. It is a terrible test for two reasons. Number one, it is very difficult for the 

radiologist to actually make an interpretation of that X-ray because 

of the breast density, and number two, radiation does cause some 

cancers and causes cancers in young breasts that are more active 

in terms of biology. So if you actually were to give radiation to the 

breasts of, say, 10,000 women who are under the age of 20 and do 

it on an annual rate, there are some people here—I am not one of 

them—but they can calculate how many breast cancers we will ultimately manufacture. Now, in randomized clinical trials of women 


jbell on DSK7SPTVN1PROD with HEARING
148 

who are older, in their 40s, 50s and 60s, we have evidence that 

mammography clearly saves lives in screening, so what we like to 

do is, if a woman has a mass and she is in her 20s or 30s, if she 

finds the mass or if someone finds it on clinical exam, a clinician, 

be it a nurse practitioner or a physician, then perhaps doing a 

mammogram is appropriate in that one particular individual. If 

you have someone who is at very high risk, perhaps the mammogram is appropriate or perhaps an MRI is, but to do mammography, mass mammography in the United States in younger 

women, it would be literally public health malpractice because we 

would actually manufacturing some breast cancers. 

Mr. PALLONE. Okay. I was going to ask a third question but I 

don’t have that much time left, so I will move to other members. 

The gentleman from Georgia, Mr. Gingrey. 

Mr. GINGREY. Mr. Chairman, thank you, and I will ask all of the 

panelists, and I thank you for being here, the same question, and 

I will start with Dr. Taplin. Some have said that this bill will 

spread fear of breast cancer among women who shouldn’t be concerned at such a young stage of their life. As physician, I believe 

that arming patients with medical information is a good practice as 

long as the message is, of course, well crafted and well delivered. 

Do you have any concerns that keeping this demographic well informed will cause more harm than good? 

Dr. TAPLIN. That is an excellent question. I think the problem is 

that we don’t have the evidence to give you the answer. The problem is that there is some evidence out there that there is a Ushaped curve, that there is a perfect amount of fear. A little bit of 

fear may be helpful. A little bit too much fear may be harmful, and 

we don’t really know where the balance is between those things 

and we don’t know enough about messaging from my standpoint to 

know what the answer is to the question you are posing, so that 

is part of why we are sponsoring the study that I have already 

mentioned. 

Mr. GINGREY. Dr. Brawley. 

Dr. BRAWLEY. Dr. Gingrey, part of the American Cancer Society’s 

early concern about this bill was that it wasn’t clear who was going 

to create the messages that were going to be conveyed to the population. Now that it is very clear that a committee of scientists appointed by the director of the CDC will be those that craft the messages that should be conveyed, we feel very comfortable with educating the population because we have some assurances that the 

messages will be created by experts. So yes, I am agreeing with you 

and I think that the messages that would be conveyed through the 

EARLY Act would be message that would be scientifically valid. 

Now, you are correct that the messaging to individuals, be they 

youth or be they people in their 50s, is sort of like a T1 line. The 

more health messages that you put forth, you diminish all the 

other health messages. Currently, the EARLY Act, as I see it, allows for messages about diet, messages about exercise and nutrition, and it actually may be more than a breast health act, much 

more a health act because it is going to—if the messages are received appropriately, it is going to prevent diabetes and heart disease which actually, by the way, kill more people in their 30s and 

40s, females in their 30s and 40s, than breast cancer. 


jbell on DSK7SPTVN1PROD with HEARING
149 

Mr. GINGREY. Ms. Luray. 

Ms. LURAY. Congressman, we agree with Dr. Brawley. We are 

pleased how the bill has evolved over time. One study of young survivors found that 40 percent didn’t believe that young women could 

even get breast cancer, so part of what we are looking for is a very 

targeted campaign that lets women know that while it is a very 

small risk, it is possible so that if they feel that lump, they don’t 

ignore it, or if they go into their doctor’s office and they say I feel 

like I have a lump and the doctor says oh, it is just dense breast 

tissue, don’t worry about it, they can’t pursue their concern, and 

again, based on factual information pulled together by the appropriate sources. 

Mr. GINGREY. Ms. Ness. 

Ms. NESS. I will just reinforce what my colleagues here have 

said. I think we can’t underscore enough the importance of basing 

what we do on evidence, and we need the research to tell us what 

makes us both in terms of medical practice but also in terms of 

how we educate and increase awareness. 

Mr. GINGREY. And Dr. Sledge. 

Dr. SLEDGE. Well, I think we all agree that knowledge is power, 

but it is only powerful to the degree to which it is accurate and we 

can act on it, and I think careful evidence-based data is actionable. 

The problem in younger women, to be honest, is that a lot of what 

we don’t know exceeds what we do in terms of prevention for young 

women in terms of early diagnosis, in terms of the health habits 

for these women. So I think physicians and all of us need to be 

very careful about pretending more than we currently know. 

Mr. GINGREY. Ms. Visco. 

Ms. VISCO. Well, I couldn’t have said it better than Dr. Sledge 

did. I think it is very important that message that we give out are 

based on evidence, that are factually correct and that there is 

something you can actually do about that information, but I want 

to make clear that the evidence of harms that some people are concerned about and we are concerned about certainly with giving 

messages about breast cancer to millions and millions of healthy 

women, the vast, vast majority of whom will never get breast cancer, is also the distinct and clear possibility that has been shown 

in clinical trials of unnecessary biopsies, that young women are 

going to feel things in their breasts, they are going to have biopsies. Those biopsies can result in infections and in further harm. 

So it is not just the issue of anxiety. That is why it is so incredibly 

complex. 

Mr. GINGREY. Dr. Weiss, before you respond, and as a breast cancer surgeon and having treated many, many patients, how young 

do you think we really should give this information to young 

women? At what age do you start doing that? 

Dr. WEISS. Well, this information becomes—it is important to deliver it when it is most relevant, and we find that girls are going 

through puberty earlier and earlier these days and their breasts 

are very much on their minds. I think the power of education is 

not just delivering education along the way but correcting this massive misinformation that is out there. Our surveys have shown that 

over 20 percent of girls think that antiperspirant use, getting 

bumped in the breast, infection, drug use, drinking coffee, wearing 


jbell on DSK7SPTVN1PROD with HEARING
150 

a bra, an underwire bra, increase the risk of breast cancer, and 

without the correct information that is well established today. So 

I do think that when you replace myths with facts that you do free 

these girls of some of the anxiety they have about growing up and 

going from a big girl to a young woman and a young woman to a 

mature woman, and I think that that is going to make them more 

engaged in proactive healthy behaviors through their life, and 

while they are in high school and college, they are in educational 

institutions, they are within a system where knowledge delivery 

is—— 

Mr. GINGREY. So educating them as teenagers but not necessarily 

preteens? 

Dr. WEISS. Well, we have found that a lot of misinformation, 

fears and questions present themselves upon adolescence, and 

whether or not you want to go back that early is a question that 

has to be studied, but those questions certainly exist, and they are 

inadequately addressed right now in current health classes within 

middle schools and high schools. 

Mr. GINGREY. Mr. Chairman, thank you very much, and thank 

all the panelists. I appreciate your response. 

Mr. PALLONE. Thank you. 

Ms. Castor. 

Ms. CASTOR. Thank you, Mr. Chairman, and thank you all. Your 

testimony was very insightful, everyone. 

Ms. Luray, I would like to thank you and the Susan G. Komen 

for the Cure Advocacy Alliance for extending your support to my 

Eliminating Disparities in Breast Cancer Act since it was first introduced last Congress, and I would like to return the thanks and 

commend you all for everything that you have done to raise awareness about disparities in access, access to screening, access to quality care and treatment. The work you have done both with the 

American Society of Clinical Oncologists and the Metropolitan Chicago Breast Cancer Taskforce to reduce disparities is very commendable. Could you discuss what you believe we can do further 

to educate women about the types of treatment that they should 

look to receive after diagnosis so that women are not in the dark 

and are empowered to take control of their health and diagnosis? 

And please explain how moving forwards towards rewarding providers for quality care and ensuring that providers are not rewarded for inadequate care will help to reduce disparities in treatment. 

Ms. LURAY. Thank you, Congresswoman, and we appreciate your 

leadership as well. I would like to take a minute just to talk briefly 

about our partnership with the Metropolitan Chicago Breast Cancer Taskforce because I think it is partnerships like this that will 

give us the data that then can be modeled by other communitybased programs to promote the type of quality breast cancer care 

you are talking about across common and racial ethnic lines. In 

Chicago, the breast cancer mortality rate for African-Americans is 

even worse than in the rest of the country. African-American 

women in Chicago have a 68 percent higher mortality rate than 

white women do, and the taskforce that we are involved in and are 

supporting developed an action plan for three main causes of the 

disparity, and it is almost like a tragic Rube Goldberg image beVerDate Mar 15 2010 04:11 Aug 18, 2012 Jkt 074102 PO 00000 Frm 00156 Fmt 6633 Sfmt 6633 E:\HR\OC\A102.XXX A102

jbell on DSK7SPTVN1PROD with HEARING
151 

cause first of all, they have to get access to mammography, and 

that is either physical, where it is, how do you get there, and economic, can they afford it. But then they have to make sure that is 

of high quality, and we as providers and advocates need to make 

sure that that mammography is of high quality. And then they 

have inadequate access to treatment, and then you have to ask the 

same questions about their treatment, is the treatment that they 

are getting at the same level of evidence and the same level of 

quality that higher-income women are getting. So again, there are 

so many barriers that need to be addressed in terms of ensuring 

that this disparity in care does not continue in communities. But 

we are very hopeful that what we are doing in Chicago and what 

we are funding in communities across the country can help to promote a very high-quality breast cancer treatment program. 

Ms. CASTOR. Have you targeted other communities besides Chicago? 

Ms. LURAY. Yes, we have, and I would be happy to share that 

information with your staff. 

Ms. CASTOR. Terrific. 

The American Cancer Society found in 2007 that certain additional screenings after diagnosis and initial treatment are not 

equally administered among patients, particularly tests to ensure 

that cancer has not spread to nearby lymph nodes. Maybe Dr. 

Brawley, can you share with us, have you found that additional 

screenings after treatment that are considered essential are not always accessible? I think you testified to that account. 

Dr. BRAWLEY. Yes, ma’am. 

Ms. CASTOR. To what do you think that we can attribute the fact 

that some providers simply are not universally screening patients 

for potential spread of their cancer to other areas of the body? 

Dr. BRAWLEY. I think the likelihood—I don’t have a study that 

I can quote for you but I can tell you as someone who has practiced 

medicine, the likelihood is that there can be a couple different reasons, and what we are talking about there is follow-up exams after 

treatment to see if the disease has come back. Sometimes the physicians simply forget, which is unfortunate on the part of the physicians. Sometimes the patients are advised to get the test or it is 

prescribed and they don’t go and get the test. Sometimes, and this 

is the more common problem, there is an affordability problem, 

copays and other things that people are just unable to come up 

with, even if insured, and I am actually much more concerned very 

frequently about the insured individual who doesn’t have very good 

insurance than even the uninsured individual because quite a few 

people today—I just saw a figure, more than 60 percent of personal 

bankruptcies are due to health care costs. Quite a few individuals 

with breast cancer who need to get a chest X-ray or even just a 

simple liver function test that might cost $80 simply can’t afford 

the continued copays over time so they don’t get those therapies. 

Ms. CASTOR. Thank you, Mr. Chairman. 

Mr. PALLONE. Thank you. 

The gentlewoman from Ohio, Ms. Sutton. 

Ms. SUTTON. Thank you, Mr. Chairman. Before I begin, I could 

ask unanimous consent to enter into the record testimony from 

Lifetime Networks. 


jbell on DSK7SPTVN1PROD with HEARING
152 

Mr. PALLONE. Without objection, so ordered. 

Ms. SUTTON. Thank you. And before I turn to the panel, Mr. 

Chairman, if I could, I would also just like to recognize Kathy and 

Lee Giller, who are here from Akron, Ohio, my district, and they 

are town for the 3-day Susan G. Komen Walk, and Kathy was the 

number one fundraiser from Cleveland this year, and we are proud 

to have her here with us. 

As for the panel, thank you very, very much for your testimony, 

and it is hard to sit here without thinking about the people that 

we have known in our lives who have suffered from breast cancer, 

some who have been lost, some who are fighting the fight now, and 

of course, wondering about those who may encounter this battle in 

the future. Several of you in your remarks and in your testimony, 

you stress the need for the access to quality, affordable health care. 

Ms. Visco, you talk about quality, affordable health care for all. I 

appreciate that, and I concur. Dr. Brawley, you also talked a lot 

about the need to get health care for women. And Dr. Weiss, one 

of the things that you said that was striking to me and I think it 

is important is, you talked about the unique needs of patients because not always does one size fit all on this issue. And as I sit 

here, one of the people who comes to mind was a woman who I 

knew 10 years ago when I was working on these issues in the State 

legislature, and her name was Linda. She had breast cancer. Her 

mother had had breast cancer, her aunt. It was very pervasive in 

her family. Her doctor wanted to treat her aggressively because of 

the family history, a doctor attached to an institution that is of 

high renown when it comes to treatment, and the insurance company said no, we are not going to pay for coverage of that treatment. Her treatment was delayed because she had to raise money 

for the treatment. She ultimately succumbed to cancer. I went to 

her funeral and I listened to her young daughter get up and give 

a report about an essay that she wrote in school about how her 

mom was her hero because not only did she fight against breast 

cancer, she fought against the insurance company to try and make 

things better for other people in the future. 

So my question, I guess, is, that was a decade ago, is it better 

now? Are the treatments that the doctor is asking for, are they covered? Dr. Brawley, would you like to respond? 

Dr. BRAWLEY. Yes, and I get in trouble for just saying the flatout truth. There have been instances where the insurance companies have been wrong and there have been instances where the patients have been wrong and there have been instances where physicians have been wrong. Ms. Visco talked about bone marrow transplant for breast cancer. Very quickly, the thumbnail history of that, 

in the early 1990s many people thought high-does chemotherapy 

with bone marrow transplant would be beneficial for women at 

high risk for relapse of breast cancer. Many hospitals started these 

bone marrow transplant programs as a way of making money. Ten 

State legislatures passed laws saying that insurance companies 

had to pay for them. Many women sued their insurance companies 

because they didn’t want to pay for it. There was no scientific evidence to support it. Ultimately, this delayed the NCI studies that 

ultimately showed that bone marrow transplant in breast cancer 

was more harmful than helpful. This is when people stop being sciVerDate Mar 15 2010 04:11 Aug 18, 2012 Jkt 074102 PO 00000 Frm 00158 Fmt 6633 Sfmt 6633 E:\HR\OC\A102.XXX A102

jbell on DSK7SPTVN1PROD with HEARING
153 

entific and start practicing—you know, earlier I said in my statement that one of the problems with this disease is, it is a complex 

disease and we all want to make it very simple and we all want 

to have very simple messages. That is a darn good example of how 

the simple message, more chemotherapy must be better, actually 

killed women. It wasn’t that it was just a waste of money. It actually killed women. 

Ms. SUTTON. I appreciate your answer, and I think that again 

goes back to the point of, it isn’t simple. It is all very multi-faceted 

and there are unique considerations in every story right, so it is 

very difficult to— 

Dr. BRAWLEY. But Congresswoman Sutton, the answer to your 

question is what you described does happen where people want to 

get the right therapy and someone in an insurance company or others somehow decides that they should not get the right therapy. 

That does happen. 

Ms. SUTTON. It is one thing to make a determination based on 

health needs and it is another thing to make a determination based 

on money. 

Ms. LURAY. And Congresswoman, if I may add, there is the issue 

of access to experimental treatment and how that access is granted 

and whether or not it is based on scientific evidence but there is 

also access to ongoing treatment that many of our patients experience. There was a young woman here, Anna van Lear, who had to 

fight her insurer after being diagnosed with breast cancer, had to 

fight to get her MRI because of her age, and that occurs again an 

again, so the experimental treatments are one issue but it is the 

ongoing need for surveillance care, side effects, et cetera and having to battle the insurer every day, and of course the economic loss 

that they experience too because of the high out-of-pocket expenses. 

Ms. SUTTON. Thank you. 

Dr. Weiss. 

Dr. WEISS. The cost of negotiating with the insurance companies 

throughout each clinical day has lengthened my day by 2 hours 

and it has slowed down the urgent feeling a patient—you know, 

her ability to get what she needs when she needs it, and we have 

doubled our office staff just to get enough people on the phones to 

get the authorizations for tests or for treatment or see a new doctor 

or to get a second opinion and maybe even a third opinion in a 

complex case. So in terms of the cost of health care, I don’t think 

that these barriers are saving us money, I think that we need these 

laws today to give the physicians the ability to deliver the optimal 

care in terms of early detection, treatment and surveillance of 

women beyond their initial treatment. 

Ms. SUTTON. Thank you. 

Mr. PALLONE. Thank you. 

The gentleman from Iowa, Mr. Braley. 

Mr. BRALEY. Thank you, Mr. Chairman. 

Dr. Brawley, I want to follow up with your observation because 

you might find it interesting to note that I used the exact example 

that you were describing in an earlier markup we were having on 

health care in this same conference room, and one of the things we 

can’t ignore is sometimes the political implications of important 

public policy decisions we are making that involve academic reVerDate Mar 15 2010 04:11 Aug 18, 2012 Jkt 074102 PO 00000 Frm 00159 Fmt 6633 Sfmt 6633 E:\HR\OC\A102.XXX A102

jbell on DSK7SPTVN1PROD with HEARING
154 

search, scientific research, medical research and most importantly 

people. Because the story I used was from a book by Shannon 

Brownley. It was given to me by a family practice doctor, ‘‘Overtreatment’’ and this exact scenario that you were describing is 

mentioned at length in that book, and this very conference room 

was filled with women who were getting high-does chemotherapy 

with bone marrow transplants and the person who developed that 

treatment methodology was sitting in these witness chairs and 

turned with his back to members of Congress and had all those 

women stand up and then said to the members sitting in this hearing room, ‘‘Fifty percent of these women will be dead if you don’t 

approve funding for this treatment.’’ So we are really talking about 

a high-stakes poker game here, and I think what all of us want to 

get to is a health care delivery system that is based upon evidencebased decision making that makes sense for the greatest portion of 

the population. 

I had the opportunity before I came to Congress to represent a 

retired swimming coach who was diagnosed with prostate cancer, 

and the treatment of choice that he decided upon was not covered 

by Blue Cross/Blue Shield through an employer-sponsored health 

care plan, and after a lot of research and investigation, we determined that Blue Cross/Blue Shield was also the administrator for 

Medicare in the State of Iowa and covered that form of treatment 

as non-experimental. So when we are talking about making health 

care available to women who have been diagnosed with breast cancer, we all need to know the best evidence available and we also 

need to eliminate these bizarre distinctions between coverage options so that no woman who has been diagnosed with breast cancer 

is faced with the difficult decision of deciding how she is going to 

pay for treatment under one program that she could get if she was 

old enough to be covered under Medicare or something else. 

And so one of the things I would like to ask the panel about is 

why this particular class of women, younger women who do not fit 

traditional theories of who is most likely to be diagnosed with 

breast cancer, why are they more vulnerable than other segments 

of the population, if they are, and what types of attitudes do they 

bring to their treatment that make them more challenging as a 

group, if they are, than other groups of women? 

Dr. BRAWLEY. If I could start first, sir, and thank you. I truly do 

believe that adequate health care reform includes reforming how 

we consume health care. We have to all learn to be more scientific 

and appreciate the science and the evidence. One aspect of the 

EARLY bill which I think is important is, it actually puts aside 

some money to address the very questions that you just addressed: 

what is different about younger women, how can we help younger 

women who have this disease. That is actually some of the most 

important parts of the EARLY bill. The ACS had some difficulty 

with the bill early on because some of the messages that were in 

it were not messages that we thought we could support. We wanted 

evidence-based good messages. Now we have scientists and survivors in a committee coming up with what the evidence-based 

messages should be, but one thing this bill always had was research to look at the quality of life needs of women with breast 


jbell on DSK7SPTVN1PROD with HEARING
155 

cancer, women who have been diagnosed who are in their 20s, 30s 

and 40s. That has always been a very good part of this bill. 

Mr. BRALEY. Yes? 

Ms. VISCO. I would say that we don’t know very much about 

breast cancer in any age group. There are some data that younger 

women are more likely to be diagnosed with triple negative breast 

cancer, a specific type of breast cancer, for which we have treatments for estrogen receptor-positive breast cancer that work well. 

We have treatments for HER2 overexpressing breast cancer that 

works well. For triple negative, we don’t yet have targeted therapies that work well. So more research into looking at that type of 

breast cancer, although there are a number of new possibilities in 

clinical trials now. 

There is also the issue of fertility. I was 39 when I was diagnosed. I had chemotherapy. I did go into premature menopause. I 

didn’t have the opportunity to have more children. There are side 

effects with treatment no matter how old you are. That is a side 

effect of treatment for younger women. It is something we need to 

do more research on. But we just don’t have the information. We 

just don’t know enough about breast cancer and certainly not 

enough about breast cancer in younger women. 

Dr. SLEDGE. I can only add a little, but these women are vulnerable in many ways. One is, as Fran has just mentioned, they are 

biologically vulnerable. They tend to have much more aggressive 

cancers than do older women, cancers that grow rapidly, cancers 

that are more likely to spread to other parts of the body at an earlier point in time, cancers that are less targetable in terms of hormonal therapy or HER2-targeted therapy, so they are biologically 

vulnerable. They are economically vulnerable. These are women 

who by and large are less likely to have insurance just because 

they are at an earlier point in their life and they are not as far 

along up the chain that would allow them to have a good health 

care ability to cushion any blows. Economically, they can’t cushion 

the blows because they don’t have any money in the bank. Socially, 

they are vulnerable because they perhaps just started their family 

or just got married. They have to worry about these fertility issues 

that a woman who is 20 or 30 years older would not have to worry 

about. So across the board, Congressman, they are far more vulnerable than our older patients. 

Mr. BRALEY. Are the criteria that the AJCC staging manual is 

using for breast cancer adequate to try to delineate any of these 

specific concerns that you have mentioned here today or are they 

using broad groupings of women that don’t allow us to have the 

ability to drill down and define criteria that would be more age-appropriate for different segments of the population? 

Dr. BRAWLEY. Sir, I can only give my opinion as a physician who 

treats breast cancer patients. I think the AJCC which does the 

stating manual has done a good job although it actually being reevaluated right now as we speak. I think one of the great problems 

we have in breast cancer is, our definition of what cancer is actually comes from some German pathologist in the 1840s, and we 

have not actually brought the definition into a molecular or genetic 

age. We are still using the same science, looking at it under a microscope with a glass to say this is cancer that we used 160 years 


jbell on DSK7SPTVN1PROD with HEARING
156 

ago, and one of the challenges to us in science is to find a genetic 

way to look at a tissue and say that this particular tissue in this 

woman’s breast is going to behave in this particular way over the 

next 20, 30, 40 years and that is how we ought to treat it. This 

particular tissue is going to be very aggressive so we need to treat 

it aggressively. This other woman’s breast cancer is going to be less 

aggressive so we will treat it or maybe even watch it and be less 

aggressive. We have not gotten there but that is where hopefully 

the science is going to take us. That is hopefully where the sequencing of the human genome is going to take us, and maybe 20 

years from now we will be talking about those tests. 

Mr. BRALEY. Thank you. 

Dr. WEISS. I would just also add that in the care of any woman 

who has been diagnosed with breast cancer who is also a mother, 

one of her biggest concerns is, what does my diagnosis mean for the 

women in my family, and that question comes up all the time and 

so that is an area of research that I know we are all involved in 

that deserves much better answers because if you don’t deal with 

that profound fear and concern for her, you haven’t really taken 

care of the whole woman or her whole family. 

Mr. BRALEY. Thank you very much. 

Mr. PALLONE. Thank you all. I know it has been a long day. We 

had a delay and had votes and all that, but I thank you for bearing 

with us, and this was very enlightening in terms of the whole 

issue. As I said earlier, this was a legislation hearing so we are 

going to have to sift through all this and figure out what is in the 

health care reform and what isn’t, but we do intend to try to move 

the bills that were considered today. And let me just mention that 

members can still submit written questions to you. They are supposed to submit them within 10 days and then the clerk notifies 

you, so we may ask you to respond in writing to some additional 

questions. But thanks again, and without objection, this meeting of 

the Subcommittee is adjourned. 

[Whereupon, at 4:00 p.m., the Subcommittee was adjourned.] 

[Material submitted for inclusion in the record follows:] 


jbell on DSK7SPTVN1PROD with HEARING
157 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 167 here 74102A.108
158 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 168 here 74102A.109
159 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 169 here 74102A.110
160 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 170 here 74102A.111
161 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 171 here 74102A.112
162 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 172 here 74102A.113
163 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 173 here 74102A.114
164 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 174 here 74102A.115
165 


jbell on DSK7SPTVN1PROD with HEARINGInsert offset folio 175 here 74102A.116
166 

Æ 


jbell on DSK7SPTVN1PROD with HEARING