II 

114TH CONGRESS 

1ST SESSION S. 1192 

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

educate breast cancer patients anticipating surgery, especially patients 

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

availability and coverage of breast reconstruction, prostheses, and other 

options. 

IN THE SENATE OF THE UNITED STATES 

MAY 5, 2015 

Mr. BLUNT (for himself, Mr. BROWN, Ms. AYOTTE, Ms. HIRONO, Mrs. FEINSTEIN, Mrs. BOXER, Mrs. FISCHER, and Mrs. CAPITO) introduced the following bill; which was read twice and referred to the Committee on 

Health, Education, Labor, and Pensions 

A BILL 

To amend the Public Health Service Act to raise awareness 

of, and to educate breast cancer patients anticipating 

surgery, especially patients who are members of racial 

and ethnic minority groups, regarding the availability 

and coverage of breast reconstruction, prostheses, and 

other options. 

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

3 SECTION 1. SHORT TITLE. 

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

5 Education Act of 2015’’. 


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1 SEC. 2. FINDINGS. 

2 Congress finds as follows: 

3 (1) The American Cancer Society estimates 

4 that in 2015, about 231,840 new cases of breast 

5 cancer will be diagnosed in women in the United 

6 States. 

7 (2) Breast cancer has a disproportionate and 

8 detrimental impact on African-American women and 

9 is the most common cancer among Hispanic women. 

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

11 40 have a greater incidence of breast cancer than 

12 Caucasian women of the same age. 

13 (4) According to the Health Resources and 

14 Services Administration, women residing in rural 

15 areas may have lower rates of mammography screen16 ing compared to non-rural women because of bar17 riers to health care, such as greater distances to 

18 medical facilities and lower educational, income, and 

19 health insurance levels. 

20 (5) Individuals undergoing surgery for breast 

21 cancer should have the opportunity to give due con22 sideration to the option of breast reconstructive sur23 gery, either at the same time as the breast cancer 

24 surgery or at a later date. 

25 (6) According to the American Cancer Society, 

26 immediate breast reconstruction offers the advanVerDate Sep 11 2014 22:55 May 14, 2015 Jkt 049200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1192.IS S1192

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1 tage of combining the breast cancer surgery with the 

2 reconstructive surgery and is cost effective, while de3 layed breast reconstruction may be advantageous in 

4 women who require post-surgical radiation or other 

5 treatments. 

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

7 may not be a candidate for surgical breast recon8 struction or may choose not to undergo additional 

9 surgery and instead choose breast prostheses. 

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

11 Act of 1998 (Public Law 105–277) requires health 

12 plans that offer medical and surgical benefits with 

13 respect to a mastectomy to also provide coverage for 

14 all stages of reconstruction of the breast on which 

15 the mastectomy has been performed, surgery and re16 construction of the other breast to produce a sym17 metrical appearance, prostheses, and physical com18 plications of mastectomy, including lymphedemas. 

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

20 the University of Michigan reported that up to 70 

21 percent of women eligible for breast reconstruction 

22 are not informed of their reconstructive options by 

23 their general surgeon. 

24 (10) A 2003 study by Alderman and others 

25 found that race is a significant predictor of reconVerDate Sep 11 2014 22:55 May 14, 2015 Jkt 049200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1192.IS S1192

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1 struction. Compared with the odds of reconstruction 

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

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

6 of the Dana Farber Cancer Institute and others 

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

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

13 study with a primary language other than English 

14 went on to receive reconstruction. 

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

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

19 women are significantly less likely than Caucasians 

20 to see a plastic surgeon before initial surgery, are 

21 most likely to desire more information about recon22 struction, and satisfaction is lowest among minority 

23 women without reconstruction. 

24 (13) The low use of reconstruction for minori25 ties is not explained by lower demand for the proceVerDate Sep 11 2014 22:55 May 14, 2015 Jkt 049200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1192.IS S1192

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

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

5 for information, especially among racial and ethnic 

6 minority groups, regarding reconstruction options 

7 and coverage required under the Women’s Health 

8 and Cancer Rights Act of 1998. 

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

10 and others at the University of California Davis 

11 found that patients from rural areas are less likely 

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

15 SEC. 3. BREAST RECONSTRUCTION EDUCATION. 

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

17 (42 U.S.C. 280m) is amended by adding at the end the 

18 following: 

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

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

21 the planning and implementation of an education cam22 paign to inform breast cancer patients anticipating sur23 gery about the availability and coverage of breast recon24 struction, prostheses, and other options, with a focus on 


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1 informing patients who are members of racial and ethnic 

2 minority groups. 

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

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

5 shall include dissemination of the following informa6 tion: 

7 ‘‘(A) Breast reconstruction is possible at 

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

9 time. 

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

11 available. 

12 ‘‘(C) Federal law mandates both public 

13 and private health plans to include coverage of 

14 breast reconstruction and prostheses. 

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

16 provider of reconstructive care, including the 

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

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

20 breast reconstruction some time after the time 

21 of breast cancer surgery for personal or medical 

22 reasons, during treatment or after completion 

23 of all other breast cancer treatments. 

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

25 information described in paragraph (1), such camVerDate Sep 11 2014 22:55 May 14, 2015 Jkt 049200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1192.IS S1192

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

3 other entities), as the Secretary determines appro4 priate. 

5 ‘‘(3) REQUIRED PUBLICATION.—The informa6 tion required to be disseminated under paragraph 

7 (1) and any information disseminated in accordance 

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

9 Web sites of relevant Federal agencies, including the 

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

11 Health, and the Office of Rural Health Policy. 

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

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

14 health care providers available to patients. 

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

16 to be disseminated under this section, the Secretary shall 

17 consult with appropriate medical societies and patient ad18 vocates related to breast cancer, breast reconstructive sur19 gery, breast prostheses, and breast forms and with patient 

20 advocates representing racial and ethnic minority groups 

21 with a special emphasis on African-American and His22 panic populations. 

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

24 and ethnic minority group’ and ‘Hispanic’ have the mean25 ings given such terms in section 1707. 


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

2 enactment of the Breast Cancer Patient Education Act of 

3 2015 and every 2 years thereafter, the Secretary shall sub4 mit to the Committee on Health, Education, Labor, and 

5 Pensions of the Senate and the Committee on Energy and 

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

8 the preceding 2 fiscal years, and an evaluation of the ex9 tent to which such activities have been effective in improv10 ing the health and well-being of racial and ethnic minority 

11 groups.’’. 

Æ 


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