On May 9, the Senate Appropriations Subcommittee on Labor, Health and Human Services, and Education held a hearing to discuss funding for breast cancer research. Subcommittee Chair Arlen Specter (R-PA), a long-time supporter of doubling the budget for the National Institutes of Health (NIH), opened the hearing, saying, “This subcommittee has been directly involved in seeing that breast cancer is a congressional funding priority from both a research and patient care perspective.”
Dr. Richard Klausner of the National Cancer Institute (NCI) at the NIH discussed current research underway and reiterated the need for further scientific investigation. He told the subcommittee that mammography screening is “the most effective technology presently available” to screen for breast cancer. However, he added that the technology needs to be improved. “Problems with screen-film conventional mammography include difficulty in detecting early lesions in women with dense breast tissue, false negatives with up to 10-20 percent of breast cancers detected by physical examination not being visible on screen-film, and false positives with only 5-40 percent of lesions detected by mammography being malignant on biopsy,” he said.
Dr. Klausner said that the NCI is currently developing a clinical trial that will begin this summer to examine conventional screen-film mammography and digital mammography. Additionally, the NCI is exploring other ways “to improve imaging methods for breast cancer screening.”
Other areas of research discussed by Dr. Klausner included research to enhance early detection and risk assessment through the use of biomarkers, or molecular tools that can detect a cell’s progression towards cancer; research on the role of exogenous hormones; research into environmental factors; research on therapeutic choices for treating breast cancer; and research on the etiology of the disease.
James Marks of the Centers for Disease Control and Prevention noted the importance of the National Breast and Cervical Cancer Early Detection Program in providing breast and cervical cancer screenings to low-income, underserved, and uninsured women. The program, established in 1990 under the Breast and Cervical Cancer Mortality Prevention Act (P.L. 101-354), has served more than 1.8 million women and provided more than 3 million screening tests through September 2000.
Saying that “the program’s success is due in part to the dedication of a large network of professionals, coalitions and national organizations devoted to detecting breast and cervical cancer early,” Dr. Marks added: “The percentage of women ages 40 and older who reported ever having a mammogram increased from 64 percent in 1989 to 85 percent in 1997, and the percentage of women who reported receiving a mammogram within the previous two years increased from 54 percent in 1989 to 71 percent in 1997.” He also added that the “disparity rates for mammography utilization among most minority groups have either been eliminated or reduced.” Dr. Marks stated that the program is now able to provide treatment due to the enactment of the Breast and Cervical Cancer Prevention and Treatment Act (P.L. 106-354). Under the new law, states have the option of providing Medicaid coverage to women who are diagnosed through the program. Three states—Maryland, New Hampshire, and West Virginia—have received approval from the Department of Health and Human Services (HHS) to provide expanded Medicaid coverage. Rhode Island has submitted an application to HHS to expand its Medicaid coverage. Additionally, more than half of the states have either introduced legislation, revised regulations, or submitted applications to HHS.
John Seffrin of the American Cancer Society detailed the statistics on breast cancer, saying that in 2001, an estimated 40,600 women will die from breast cancer, and 192,000 new cases will be diagnosed. “Regrettably, many of these deaths and cases will occur disproportionately among women from predominantly low-income and medically underserved communities,” he said, adding: “An estimated 19,300 new cases of breast cancer and 5,800 deaths are expected to occur among African-American women in 2001.” Also, “an estimated 8,600 Hispanic women will be diagnosed with breast cancer and 1,800 will ultimately lose their battle with this disease,” he said.