On May 21, the House Energy and Commerce Subcommittee on Health held a hearing on two breast cancer bills: H.R. 1157, the Breast Cancer and Environmental Research Act of 2007, and H.R. 758, the Breast Cancer Patient Protection Act. The Senate Health, Education, Labor, and Pensions Committee approved its version of H.R. 1157 (S. 579) in February (see The Source, 2/29/08).
Chair Frank Pallone (D-NJ) said, “While improved access to screening and treatment services have helped reduce breast cancer death rates over the past couple of decades, significant challenges still remain. For example, we’re still unsure about what causes breast cancer, or how to prevent it. While there have been a number of studies that have looked at various risk factors, we have not been able to draw any solid conclusions about what specifically causes breast cancer. H.R. 1157…is intended to address the need for more research in the hopes of discovering causes, possible preventative measures, and one day, a cure.”
Ranking member Nathan Deal (R-GA), speaking in support of H.R. 1157, stated, “Fortunately, great strides have really been made in the treatment of breast cancer, and as a result, the number of breast cancer survivors continues to increase. However, we must learn more about the causes and the treatments of this disease through continued research…I applaud the ongoing efforts of the NIH to research breast cancer, so we can continue to make life-saving advancements.”
In expressing his opposition to the legislation, Rep. Joe Barton (R-TX) said, “[D]isease-specific policy is bad for politics, bad for science, and we shouldn’t [pass it]…it’s counterproductive for Congress to politically micromanage the National Institutes of Health.” He added, “We should try to have a policy where we fund research, put priorities on certain research…and let NIH make the decisions.”
Deborah Winn, associate director of the Epidemiology and Genetics Research Program at the National Cancer Institute, stated, “We at NIH believe that the current Public Health Service Act, as amended by the NIH Reform Act of 2006, provides sufficient authority to address this area of research, as well as others…We know that the answers to the most vexing scientific questions involving one disease often come from areas of unrelated research. As scientists, we know that it would be a mistake to focus on one disease without understanding the underlying biological mechanisms that affect multiple diseases.”
Dr. Winn acknowledged NIH opposition to H.R. 1157 as currently drafted, but noted that NIH had withdrawn its opposition to the Senate version of the bill after language regarding peer review and the “parameters of the research that could be undertaken” had been modified. Dr. Winn also noted that NIH “would remain neutral if the House were to accept the Senate’s changes” and would no longer oppose H.R. 1157.
Fran Visco, president of the National Breast Cancer Coalition, explained that the bill, first introduced by Rep. Lowey in 1999, had evolved over the years to address concerns raised by NIH and the scientific community. She said, “It is most important to recognize that this bill will allow the scientific community to decide how the funds should be spent and will require that they be spent through a peer review process and a programmatic review that is based on proven, successful research programs. It would authorize $40 million a year for five years for the National Institutes of Health to develop a collaborative, peer-reviewed grant program to study environmental factors that may contribute to breast cancer. The grant-making model in this bill is based on the successful and internationally acclaimed structure of the Department of Defense (DOD) peer-reviewed Breast Cancer Research Program, which has been replicated in other areas of research.”
She further urged the committee to adopt the Senate changes to the bill, saying: “The Senate HELP [Health, Education, Labor, and Pensions] Committee approved S. 579 in February of this year. Prior to that mark up, changes in the bill were negotiated to respond to concerns expressed by NIH. As a result of those changes, NIH no longer opposes the Senate version of the bill. We hope that this Committee will approve the Senate version of the bill…we have done all that you ask, with this level of bipartisan support for the bill, with no administrative opposition. Women’s lives depend on your actions.”
H.R. 758, the Breast Cancer Patient Protection Act, is intended to protect women who could otherwise be subject to “drive-through” mastectomies. According to Kristen Zarfos, assistant clinical professor at the University of Connecticut School of Medicine and a fellow with the American College of Surgeons, “In mid-1996, without informing the patient, several insurance companies changed the provision of their contracts. Thus, women with newly diagnosed breast cancer, who had previously known other women who were admitted for 2-4 days after a mastectomy, now were shocked to be denied even 24 hours in the hospital, despite the contracted services they were still paying for…Government data showed that women with Medicare or Medicaid or no insurance at all were given the length of hospitalization after a mastectomy they needed, yet women paying for private health care were denied that.”
Dr. Zarfos continued, “This legislation does not mandate hospitalization, but instead restores the right for a woman and her doctor to choose whether she be hospitalized 24-48 hours if she needs it; hospitalization she has paid for through premiums for basic health care. Without protective legislation, women and their spouses will continue to pay double digit increasing health care premiums, yet be denied basic not embellished, superfluous, or elective health care at a time of crisis.”
Dr. Zarfos also noted that while “in 1997, 20 states responded to this issue by passing legislation in various forms…American women in 30 states and many in the 20 states where there are ineffective laws face [these] ‘drive-through’ mastectomies. Sixty five percent of the 125,000 women having mastectomies across America today leave the hospital within a few hours of their surgery, regardless of their physical health needs…Shouldn’t all American women and their families have the right to having basic health care they have paid for the day they face mastectomy?”
Asking Dr. Zarfos to speak directly to her experience, Rep. Pallone asked if the costs “[spiraled] out of control as a result of the state legislation, and [if] Connecticut’s law forced small businesses, or any other employers, to drop health care coverage.” Dr. Zarfos responded by noting that “the average length of stay [after a mastectomy] in Connecticut in 1996…was 2-4 days. So if insurance companies were paying for four days…this legislation is asking for 1-2 days, as necessary. So there, in fact, is a cost-saving for insurance companies.” Furthermore, Dr. Zarfos acknowledged that the cost of readmittance for infection, a “recurrent theme” among women who have received “drive-through” mastectomy, is roughly $4,000 higher than the cost of a one-night hospital stay for basic care.
Also testifying were Sheryl Crow, singer-songwriter and breast cancer advocate, H. Kim Lyerly, director of the Duke Comprehensive Cancer Center in North Carolina, and Alva Williams of Jacksonville, NC, a breast cancer survivor.