Sec. 10413. Young women’s breast health awareness/support

Judy1992

A Moment in History ... An Introduction and an Invitation:  

A moment in history:  On October 18, 1993, more than 1,000 Coalition supporters marched from the National Museum of Women in the Arts to the Ellipse, behind a Coalition banner with the message 'End the Breast Cancer Epidemic,' while more than 200 Coalition members met with President Clinton, Hillary Rodham Clinton and Secretary Donna Shalala in the East Room of the White House to present the signatures.

An Introduction:  When I was first diagnosed in 1992 at the age of 46 I knew nothing about breast cancer - I felt betrayed by my body because the bc had been there for years and I never knew.  And as things happened to me that shouldn't have ... i.e., my lump was missed by a female surgeon because when asked if she wanted to see my films before she started the biopsy (I was awake and heard her response)  she responded "no, I know where I'm going" ... when a surgical oncologist who was considered one of the top 4 in the nation kept me waiting over 2 hours to be seen, lost my mammograms and dismissed me with a shake of his head when I self-referred for a second opinion because I could still feel a lump.... that voice inside my head said ... I don't want this to happen to another woman ... there has to be something I can do ... so I started a local support group .... but that's another story for another time.  As I educated myself about breast cancer I learned about a statewide coalition that was being formed and became a founding member .... I also learned about a new national coalition that wanted to raise awareness about breast cancer .... specifically that nothing had changed in the way of treatment in over 30 years and we women .... mothers, daughters, wives, sisters, friends ... were dying.  I was very new to all things political ... and had never participated in a march or a rally ... until October 1993.  Our state goal was to collect 180,000 signatures (the number of women diagnosed with breast cancer in PA) ... we collected 310,000.  The march was unbelievable - women of all ages,  in various stages of treatment.  Husbands who had lost their wives, dads who lost their daughters ... carrying posters with pictures of their loved one ... we marched ... arm in arm ... hand in hand right down Pennsylvania Avenue.... people in their offices were holding pink paper against their windows, cars - limos - busses beeping - rolling down their windows - cheering  ... one of my most memorable sights was a beautiful older women (one of those amazing - throw a rag on her and she looks gorgeous) standing on the corner applauding us with tears rolling down her cheeks ... still makes me weep.  As written, we rallied on the ellipse and then did legislative visits - and yes, the meeting in the East Room did happen.... so well organized ... one voice ... one message.  Since then there have been changes - we stopped the drive through mastectomies, we changed policy so that insurance companies could not deny a woman reconstruction by calling the procedure "cosmetic surgery", we increased funding for research , we found ways in our states to make sure uninsured women could have a mammogram and if needed a biopsy and treatment .... that was then .... this is now.  I originally came back to the internet because in September 2009 I was diagonsed with Stage IV breast cancer, and I wanted to make informed decisions about my treatment.  I've been able to accomplish some of that, but in the midst of my research I found the "What Americans Think of the Health Care Bills" thread.  I have posted there on two occasions.  I've been thinking a lot about the thread - its' still filled with raw emotion, rage, misinformation ...what saddens me is it also has all those "lurkers" (in quotes because I was only recently introduced to the word) .... women reading the thread who are being frightened by what's being written, who every once in while try to ask a question about what's in the recently passed Health Care Reform act.  Yes, I know no one is forced to read a thread, but I also remember when I was first diagnosed and how "hungry" I was for information ... I read everything!

An Invitation:  I invite all women - to share their knowledge and experiences so that we can become educated, engaged and empowered together ... we need to learn about the components of the HCR (Sec. 10413. Young  women's breast health awareness and support of young women diagnosed with breast cancer) and also learn about coverage and best practices in other countries so that we can make a difference for ourselves, for our sisters, daughters,grandaughters and friends - I'm not asking people to march, to call a legislator or donate money ...nor am I asking women to express their frustrations, anger or disgust with what they feel isn't in the HCR.   I'm inviting my sisters to become informed and ......as the late Nkosi Johnson (age 12) said .."Do all you can with what you have in the time you have in the place you are."  

lewing

Judy, what an awesome post.  I hope it starts a good conversation.  Having a historical perspective is so important.  Of course, when you step back and try to get the big picture - the full sweep of where we've been as a country, what's happened to our own individual bodies, what we would hope for our sisters and daughters - it can be SO big that it's hard to know where to start.

So I guess I'll just plunge in . . .

Reading your story, I was struck by the fact that I was also diagnosed at age 46, except for me that was in 2008.  I wonder if there's  anything to be learned from comparing our experiences, 16 years apart?  Obviously, a lot of the differences are going to be due to idiosyncratic, individual factors . . . but still.

I was diagnosed by a routine screening mammogram (digital), which I'd been faithfully getting every year since I turned 40.  Even so, the diagnosis was almost by accident: the tumor was lurking behind an incidental cyst, and it was the cyst, not the tumor, that showed up.  After multiple follow-up ultrasounds and two MRIs (the second being an MRI-guided biopsy), I was found to have two small invasive tumors and a whopping big area of DCIS.  I was told this meant I was not a candidate for breast conserving surgery (my original plan), and so I ended up having a unilateral mastectomy.  (I found this out a week before my original surgery date.)

One thing that strikes me -- colored by my individual experience, so I'm sure others will have additional/different thoughts -- is that we've gotten a lot better at finding breast cancer over the last decade and a half (digital mammograms, MRIs) than we have at knowing what to do with those findings.  Did I really need to lose my breast because of DCIS?  Given the current state of our knowledge, I did . . . I'd hope, though, that in another decade, women will have more options.

I don't think we've made much progress at all in understanding the origins of breast cancer, and how it might be prevented.  I live in an area (the Great Lakes basin) that has a higher-than-average incidence of this disease.  Are environmental factors contributing to that?  How might they be remediated?  We don't know.

We've got new treatments since 1992, but still no cure.

I do think we've made lots of progress in destigmatizing this disease.  We don't have to lower our voices when we talk about it anymore.  That's not a cure, obviously, but it sure is progress.  The march you were part of in 1992 was a big part of that: so thank you.

I love Audre Lord's vision of an army of one-breasted women.  (That's a metaphor, gals: it also includes no-breasted and reconstructed-breasted and breasted-with-divots.)  Sign me up!

Linda

Judy1992

Hi Lewing .... thanks so much for your post, and especially for sharing your experience.  Yes, I think it is important to first find our common ground.  That will help us share our knowledge and our concerns which will take us to identifying the issues that are most important to us as a bc sister.  I was also having mammograms every two years.   I remarried in 1986 and had a tubal ligation ... my periods prior to that were very irregular ... after the tubal ligation ... like clockwork ... I've often wondered if that played a part ... since I am ER/PR positive and in that situation the estrogen is like a fertilizer - and most breast cancers are old when diagnosed ... and I was diagnosed in 1992.

To say there are lots of issues with this incidious disease is an understatement. 

Here are a few to think about ...diagnostic tools .... mammogram ... CT ... MRI   - back in the beginning of my journey we felt relieved when the tools expanded ... now some flags of caution are being raised about how often to use them, if they are needed, when they are needed, and if any of them cause cumulative harm ... a scary issue, especially for younger women being diagnosed and trying to make informed choices about their treatment.

There is still the issue of what part does the environment play (back in my day we would reference back to Rachel Carson and her book Silent Spring) we noticed back then that all reproductive cancers were on the rise including prostate.  Also know a woman who had bladder cancer and wrote a book ... Living Downstream ... she went on to have a child after treatment .. her book is thought provoking. 

We also saw the beginning of health care providers adding not only their expertise, but their resources to help us - this website is but one example.   There's lots more ... but I want this thread to be a place where we can share our listening ears (in this forum "reading eyes?") and caring hearts.  Together we can make a difference. 

Looking forward to your posts!  

Edited to stay on topic.

gsg

Hey Judy.  I had the honor of reading Section 10413 into the record last December on the Senate floor...a few days prior to the health care reform vote.  I have a thread about it in here.  It was pure accident that I ended up reading that part of the health care bill into the record.  Very moving for me and quite an honor as a breast cancer survivor.  There's a 9-minute youtube video of my reading that my son made.  I actually read for 30 minutes.  This section starts about 59 seconds into the video.

 For some reason I can't post the link here.  But if you look in this section...you'll see my thread with a link to the youtube video.  The thread is called "breast cancer section of the health care bill."  Last post was January 14th of this year.

I don't understand why I can no longer post links.  Anyone else having that problem? 

Judy1992

Hi gsg ...I had the honor of listening to you read that section on your thread, and it was another motivator to start this thread so that maybe we could take a breath from the emotional discourse and start moving ourselves toward discussing what we can do to make sure breast cancer prevention, diagnosis, treatment and I hope some day a cure continues to be addressed in any and all legislation.  We have taken the first step to address a broken system and there will be opportunities to support changes ... we owe it ourselves and all women to be part of the voice.  I just read violet7's post that she had to endure drive through bilateral mastectomies because of insurance ... I didn't realize insurance had found yet another loop hole .. tragic! .. and so very wrong!

Thank you for you post ... please keep trying to move the link here... thanks gsg,

gsg

www.youtube.com/watch?v=sthmSZ6PxB8

 still not working, so i typed it out. I'll also bump the thread.

Thanks for your sweet words, Judy.  I would love to join in with you discussing this topic, but am afraid I must remain neutral in my public statements.  What I can say though is this is a very important section as education is so important in the war on breast cancer.

Judy1992

Thanks!  I fully understand your limitations in participating.  Thanks again for the gift of the recording!  Much appreciated. 

Judy1992

A Quick Data Refresher and history on insurance pools.....

Stats from our website hosts:

Breast cancer incidence in women in the United States is 1 in 8 (about 13%). In 2009, an estimated 192,370 new cases of invasive breast cancer were expected to be diagnosed in women in the U.S., along with 62,280 new cases of non-invasive (in situ) breast cancer. About 40,170 women in the U.S. were expected to die in 2009 from breast cancer, though death rates have been decreasing since 1990. These decreases are thought to be the result of treatment advances, earlier detection through screening, and increased awareness. For women in the U.S., breast cancer death rates are higher than those for any other cancer besides lung cancer. Besides skin cancer, breast cancer is the most commonly diagnosed cancer among U.S. women. More than 1 in 4 cancers are breast cancer. As of 2008, there are about 2.5 million women in the U.S. who have survived breast cancer. About 90% of breast cancers are due not to heredity, but to genetic abnormalities that happen as a result of the aging process and life in general. The most significant risk factors for breast cancer are gender (being a woman) and age (growing older).

Stats: Network of Strength  http://www.networkofstrength.org/information/bcnews/stats.php

Patients with private insurance from all racial/ethnic groups are more likely to be diagnosed with stage I breast cancer and less likely to be diagnosed with stage III and IV than those who were uninsured or who had Medicaid insurance. While 89 percent of patients with private insurance survived five years, only 77 percent of uninsured and 75 percent of Medicaid patients passed the five year mark.

Link to information about the insurance pools -

National Association of State Comprehensive Health Insurance Plans

http://naschip.org/portal/

Judy1992

http://kff.org/healthreform/sidebyside.cfm       .... learning together

Kaiser Side by Side Comparison

This interactive side-by-side provides detailed, up-to-date summaries of the new health reform law, the reconciliation bill and other comprehensive reform proposals put forward during the year-long reform debate. In the health reform debate, many proposals for overhauling our health care system have been advanced The online tool allows users to compare the law and other plans with one another across key characteristics. In addition to the summaries offered here, the Foundation also has prepared detailed descriptions of the Medicare and Medicaid provisions, and a summary of the coverage provisions in the law and other legislation.

Judy1992

Another resource  http://healthyamericans.org/assets/files/Summary.pdf

Trust for America's Health (TFAH) is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

From anthrax to asthma, from chemical terrorism to cancer, America is facing a crisis of epidemics.

As a nation, we are stuck in a "disease du jour" mentality, which means we lose sight of the bigger picture: building a public health defense that is strong enough to cover us from all points of attack - whether the threats are from a bioterrorist or Mother Nature.

By focusing on PREVENTION, PROTECTION, and COMMUNITIES, TFAH is leading the fight to make disease prevention a national priority, from Capitol Hill to Main Street. We know what works. Now we need to build the resolve to get it done.

Enjoyful

Judy -

Thank you so much for starting this thread and for sharing the wonderful resources!

My journey began in 2004 when I was diagnosed with stage III disease.  Like Lewing, I had annual or semi-annual digital mammograms and ultraounds.  The mammograms and ultrasounds found a cyst, but never found the tumor behind it, nor the tumor behind THAT one, nor the other tumor....  How could they miss three tumors?  I'd always been told that my breast tissue was dense but despite my repeated questions, was also told that it was not a risk factor.  Now we know better.

Diagnosed with Stage IV in August 2009, had 6 rounds of chemo (after three "second opinions"), and am now NED.

Things I've learned along the way:

1.  Doctors are no smarter than we are.  Question authority!  If something doesn't make sense to you, it's probably wrong.  Get a second, third, or fourth opinion if necessary.

2.  Accept help from others.  This is too difficult a journey to go it alone.  Call on people who say "let me know if I can do anything."  Accept offers to clean your house, run errands, or provide financial assistance.  It allows your friends and family to feel useful rather than helpless, and gives you a much-needed break.

3.  Don't assume that your doctor knows the latest research.  Doctors are busy with their patients and administrative issues and aren't always up on the latest research or clinical trials.  Be your own advocate and keep informed.  Bring things to your doctor's attention.

4.  Pay attention!  Doctors, nurses and techs are people, too, and they make mistakes.  Every doctor I've had  has made a mistake ranging from small (incorrect personal info on radiology reports) to scary (incorrect positioning of the radiation machine). 

5.  Enjoy life.  Focus on the important stuff and try not to get annoyed with small things.  I'm still working on that one!

6.  Everybody's dealing with something, so be forgiving.  You have cancer.  The grumpy cashier at the grocery store might, too.  Or diabetes.  Or marital problems.  Still working on this one, too.  ;-)

As far as best practices within the medical field, these are things I like:

1.  Knowledgeable navigators to help you understand the disease, the process, the treatments, available resources, and help with insurance issues when necessary.

2.  Comprehensive cancer centers that offer holistic resources.

3.  Medical oncologists, radiation oncologists, surgeons, and primary care doctors who communicate with each other.

I hope this is helpful and on-topic.  Judy, thank you for starting this thread!

E

Judy1992

Dr. Weiss provided testimony on a number of bills regarding the EARLY Act, the Mammogram and MRI Availability Act, the Eliminating Dispartities in BC treatment Act and the Breast Cancer Patient Protection Act ... her testimony follows:

 

House Committee on Energy and Commerce Health Subcommittee Testimony Marisa Weiss, M.D., Breast Oncologist and President and Founder of Breastcancer.org Thank you Chairman Pallone, sub-committee members, and other panelists. It's a privilege and honor to be here to talk about breast health and breast cancer-issues that have been my core professional focus and driving mission and passion for over 20 years, but more importantly, issues that directly affect about half of the United States population and arguably impact all of us. My name is Dr. Marisa Weiss. I am a breast oncologist at Lankenau Hospital in the Philadelphia area and founder and president of the nonprofit Breastcancer.org, the world's most utilized online resource for breast health and breast cancer, reaching eight million individuals annually. I am also founder and past president of the nonprofit organization Living Beyond Breast Cancer and author of several books on these subjects. I've had the honor of taking care of thousands of women with breast cancer and have been witness to the profound and devastating effects of this disease. I remain committed to improving the diagnosis and care for every woman and am also dedicated to research and education to improve the long-term breast health of women and girls.

Everyone here knows how much is at stake. The breasts are the favorite places for cancer to occur in women, often in the prime of their lives and when women are indispensable to so many other lives. There are 153 million women and girls in the U.S. today, and one in eight is projected to get breast cancer in the course of her lifetime. 2

The bills before the committee today represent critical ongoing efforts to improve diagnosis and patient care by promoting education among consumers and health care professionals and holding providers accountable for the quality of their care. The bills are all vitally important, touch on complex health issues, and deserve our full and serious consideration. EARLY ACT I would like to start with H.R. 1740, the EARLY Act-a bill that aligns with the results of Breastcancer.org's recent research in the area of breast health education and breast cancer risk reduction. The EARLY Act seeks to use education and breast health awareness of young women to promote healthy behaviors to modify or reduce established risk factors. 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. Concern: Creating Unnecessary Fears Opponents of the EARLY Act have expressed concerns that outreach to young women will cause more harm than good by creating fear of breast cancer. But that fear already widely exists. Information about breast cancer is pervasive. Young women-like the rest of us-are surrounded by breast cancer messaging aimed at adult women. To better understand the impact, Breastcancer.org conducted a research project with girls ages eight through 18 across the U.S. and their mothers. Over 3,000 girls have been surveyed. Nearly 30% of girls have already feared that they might have breast cancer-fears triggered by breast pain, diagnosis in someone close to them, or mistaking the changes of normal breast development for signs of breast cancer. Our data also indicate that over 70% of girls have someone close to them who has been diagnosed with breast cancer, such as a mother, grandmother, best friend's mom, teacher, or neighbor. And when a breast cancer diagnosis hit close to home, fears were greatly magnified. Girls also experienced significant fear by overestimating their mother's risk of breast cancer. 3

Many young women respond with fear to breast cancer messages in the media. Although targeted to mature women, younger women think these messages directly apply to them as well. They simply don't have the resources to understand the meaning and relevance of these critical issues, nor do they have the dialogue skills or opportunities to discuss their fears or seek clarification of breast health myths and misinformation. Overall, only 47% of girls have talked to a parent and 40% have talked with a doctor on this subject. African American girls were less likely to get their information from an adult and more likely to get it from a sister or friend. To resolve unrealistic fears, young women living in the breast cancer-awareness era need accurate information and reassurance that is age-appropriate and scientifically grounded. Education can arm them with the facts, inform them of what's normal and what's not, and empower them to take charge of their breast health future as they build their breast tissue using what they eat and drink, medicines they take, personal products they use, and by how they use their bodies. At this early point in life, young women are establishing their life-long behavioral patterns. Concern: Unsubstantiated Value and Content of Educational Programs Opponents of the EARLY Act have also expressed concerns about the value of educational outreach to low-risk populations in the absence of modifiable risk factors. I respectfully disagree.

Breast cancer is a complex disease with multiple causes, some proven and others suspect. Most 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 and agents: the first trimester of pregnancy during initial organogenesis, the four to 10 main years of breast organogenesis between adolescence and the twenties, as well as the stretch of time leading up to a woman's first full-term 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. 4

As others have pointed out, not all risk factors are created equal. Some risks-like being a woman, growing older, having a strong family history, and/or a specific breast cancer gene abnormality-carry more significance than others, such as obesity, physical inactivity, alcohol consumption, smoking, and an unhealthy diet. Some risk factors are modifiable, some are not. But even tiny risks can combine and really add up. Concentrated exposures, combined exposures, regular exposures over time-particularly during sensitive periods-can accumulate and collectively increase risk. For example, besides being a woman, growing older is the biggest risk factor for breast cancer. And while you can't control that you are aging, you can control how you age: how your inside environment interacts with the outside environment. We cannot undo past behaviors, but we can limit the damage by promoting a breast healthy lifestyle and behaviors starting as early as possible. Another example of a modifiable risk factor: the rising obesity epidemic across the U.S. in children, adolescents, and adults. This epidemic is associated with unhealthy factors that may increase the risk of breast cancer in adults. Extra fat makes extra hormones that can bring on earlier puberty and over-stimulate breast cell growth. In addition, fat stores hormonally active pollutants such as bisphenol A, atrazine, dioxins, and nonylphenols, which might further stimulate unhealthy breast cell growth and activity. Obesity is also associated with reduced physical activity. Moreover, obesity in childhood predicts for obesity in adults and obese mothers are more likely to raise obese daughters. Contrary to the claim that proven breast cancer risk factors can't be modified, our obesity epidemic is doing just that by accelerating the age of menarche. In the other direction, early education and behavior modification that increases athletic activity and healthy weight management can postpone the onset of puberty. Lessons learned from EARLY Act programs will benefit current and future generations, since women under the age of 45 are in the prime of their childbearing and parenting years. 5

Opponents cite the HPV vaccine to help prevent the leading cause of cervical cancer as an ideal and preferred approach to prevention. Relative to what we know about the dominant cause of cervical cancer, this is true; my own daughter was one of the first to be vaccinated. But the reality is that this vaccine is given to millions, yet the annual incidence of cervical cancer in this country is 11,270. There is at least the same opportunity to provide breast cancer reduction strategies in high risk women. With the consumer and healthcare education programs in the Early Act, the 5-10% of breast cancers due to an inherited breast cancer genetic abnormality-over 13,000 per year for women of all ages-would more likely be identified, giving these women a greater chance to reduce their risk of breast cancer by as much as 90% with prophylactic mastectomies or 50% with anti-estrogen therapy. They may even pursue embryo selection to essentially eliminate the risk of transmitting the gene to their offspring. It's imperative that we impart this knowledge, along with what we, the scientific and medical community, know are NOT risk factors for breast cancer. Fear breeds myths. In our survey, more than 20% of the girls surveyed believe that breast cancer is caused by infection, tanning, drug use, stress, and breast injury or bruising. Many girls also believe that only their mother's family history is important and that breast cancer skips generations. These myths were even more widely held by African American girls. And where mothers affected by breast cancer were close in age to their daughters, the daughters were fearful that they could have caught breast cancer from their mothers during pregnancy and breast feeding.

Education can change attitudes, knowledge, and behaviors. We simply must invest in education-from explaining normal breast development and function and imparting facts about breast cancer and breast cancer risk, to providing evidenced-based behaviors and lifestyles that promote breast health. We do a disservice to this and future generations by neglecting to provide this information and facilitate this dialogue. And what a perfect opportunity to reach younger women while they are students in high school and college. Our ability to reliably reach this population vanishes quickly once they are beyond their years of institutional education. Responsible live and print media outreach is also a critical approach. Both fall within the EARLY Act. 6

Education is Needed to Avoid Over-Reliance on Any Single Early Detection Tool I've seen how crucial early detection is to not only "survivorship," but to the quality of life. For many patients, early detection could mean not having to lose a breast with mastectomy or not having to experience aggressive chemotherapy. But as far as we've come, we still have a long way to go. There is no one or combination of perfect tests that can find all cancers early. Each breast cancer detection tool in the limited arsenal for early detection in the general population is both powerful and flawed: mammography, clinical and self breast examinations. This is particularly true in young women whose background dense breast tissue can easily distract or obscure early breast cancer detection. Yet for most women under 40, the use of breast self exams for breast self awareness and clinical exams are the only detection resources they have. A study from Harvard presented at the April 2009 American Society of Breast Surgeons' annual meeting found that 71% of women diagnosed with breast cancer at 40 or younger discovered their cancers through breast self-exam.

Education can help clarify the strengths, weaknesses and complementary properties of each detection method. The ability of "breast awareness" to detect breast cancer early is severely limited by the frequent absence of signs or symptoms. By the time cancers make their presence known through "breast awareness," they are usually later in stage and the opportunity for early detection has passed. The value of mammography in young women with dense breasts is limited by the thick curtain of breast tissue that may block a mammographer's ability to find the relatively infrequent number of breast cancers observed in young women. Prescribed to women age 40 and above and to women 10 years younger than their earliest affected family member, mammography might have to pull in other tests for backup. MRI is a powerful example. With sensitivity as its greatest strength-it's the best at finding invasive breast cancers in their earliest form-and the most guilty of ringing too many false alarms. Comparing and correlating findings of all detection methods require a significant investment of attention and time but will yield the best overall interpretation. 7

The EARLY Act addresses these complex issues by promoting education-not only to consumers, but among health care professionals who may dismiss early breast cancer signs and symptoms under the premise that breast cancer is rare in women under age 45. But 24,000 annual cases of breast cancer in women under age 45 does not make it rare. It is just relatively uncommon compared to the much higher incidence in women over 45 (since a woman's risk increases with age). Compared with other cancers, that incidence is not considered rare. When we factor in that breast cancer survival rates are lower for women under 45, we must be realistic about how vitally important the tenets of the EARLY Act are. Unique Concerns of Young Women with Breast cancer Special issues that uniquely affect young women with breast cancer will also be included in the EARLY Act. Beyond issues of quality of life and ability to fully function like fertility and cognition, there are issues that affect risk of recurrence and survival, such as, knowing how to get the full benefit of Tamoxifen without major interference from commonly used medicines that might be taken at the same time, like anti-depressants, Benadryl, and Lamisil. There are many issues to address with regard to the EARLY Act and I look forward to your questions. Breast Cancer Patient Protection Act of 2009 I've been a long-time champion for Congresswoman DeLauro's bill- H.R. 1691, the Breast Cancer Patient Protection Act of 2009. Mandatory "drive-through mastectomies" are an unconscionable practice that can endanger a woman's recovery and lead to avoidable complications.

A mastectomy and lymph node dissections are serious, invasive surgeries with profound physical and emotional impact. While many women are ready to go home after 24 hours, some need more time. They may experience unexpected complications or have no support at home, 8

and therefore they may require a longer stay to manage bleeding, pain, drains, and the risk of infection. When patients are turned out of the hospital because insurance refuses to cover necessary post-operative care, their physical and emotional health is further endangered by this unnecessary practice. There is no "one size fits all" solution. The decision about the length of needed in-hospital recovery time following breast surgery must be made within the sacred relationship between a woman and her doctor, not reduced to a business decision that overrides a doctor's best judgment and the patient's best interest. Breast cancer is a serious condition that requires serious-and sensitive-attention to the physical and emotional needs of each patient. As someone who has treated thousands of women, I know that the care of these women at this most vulnerable and high-risk time must be individualized. To suggest otherwise demeans the challenge these women face in their fight against breast cancer. I urge this committee to support this bill. It will not only improve patient lives, but potentially save them from preventable serious complications. Mammogram and MRI Availability Act of 2009 I am also highly supportive of Congressman Nadler's H.R. 995, the Mammogram and MRI Availability Act of 2009, which further requires providers to cover annual screening mammography for women 40 and older and diagnostic mammography, annual screening mammography, and annual magnetic resonance imaging for high risk women. Again, my support stems from the demonstrated survival and quality of life benefits of early detection-particularly for young, high-risk women for whom more sensitive tests may be necessary to find the most life-threatening types of cancer that can hide from standard imaging procedures. 9

Eliminating Disparities in Breast Cancer Treatment Act H.R. 2279, the Eliminating Disparities in Breast Cancer Treatment Act, sponsored by Congresswoman Castor, addresses a critical gap in the quality of medical care for all Americans. I've witnessed this on a daily basis in my clinical practice in the Philadelphia area. Sadly, African American women continue to have worse outcomes than Caucasian women: they tend to utilize mammography less, get diagnosed with more aggressive types and stages of cancer, and their treatment outcomes and survival are also significantly worse. These disparities are absolutely unacceptable and have persisted for far too long. I commend Congresswoman Castor for her efforts to improve a situation that will not otherwise resolve itself. In conclusion, I would like to thank the Chairman, the Subcommittee, and the panel for giving me the time to speak with you today. I applaud the efforts of the sponsors and supporters of these bills and am grateful for the platform to openly discuss these vitally important issues affecting so many precious Americans lives.

Judy1992

April 6, 2010

This afternoon, US Department of Health & Human Services Secretary Kathleen Sebelius delivered a speech entitled "Health Reform and You: How the New Law Will Increase Your Health Security."

http://www.healthreform.gov/forums/blog/index.html