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Breast Cancer Screening and Treatment – What form it takes under healthcare reform is up to you!

This guest editorial is written by Christine Granger, Executive Director of the Northern California Affiliate of Y-ME National Breast Cancer Organization.

Breast cancer is the most commonly diagnosed cancer in women. For women in California aged 65 and younger, it is the second leading cause of cancer deaths.  Nearly 20,000 Californians will be diagnosed with breast cancer this year alone and more than 4,200 will die from the disease. (American Cancer Society’s California Cancer Facts and Figures 2007, California Cancer Registry, California Department of Health Services)

Since the early 1990s, California has lead the way in ensuring all women over 40 can receive screening for breast cancer and, if diagnosed, are provided with treatment regardless of their ability to pay.  This is accomplished through California’s Every Woman Counts Program.  As a state we also lead the way in breast cancer research -- setting aside millions of dollars each year for the California Breast Cancer Research Program.

Many California based companies lead the way in developing new drugs, treatments and customized disease analysis for individuals facing breast cancer.  Yet in this “Golden State” for breast cancer screening and treatment, too many California residents are still left behind.  Several factors shape these disparities in diagnosis, treatment and survival.

According to the National Cancer Institute (NCI), a person’s gender, age, ethnicity, education, income, social class, disability, geographic location, or sexual orientation can determine if an individual is more likely to:

  • Receive a diagnosis of late-stage cancer normally detectable through regular screening.
  • Obtain no treatment or treatment that does not meet current accepted standards of care.
  • Suffer from cancer without the benefit of pain control and other palliative care.

Women also may face one or more of the following barriers to obtaining screening including:  fear of mammograms or finding cancer; lack of transportation, a personal physician for referral or child care; and communication, language and cultural barriers.  (California Department of Health Services, Cancer Detection Section Cancer Detection Programs: Every Woman Counts).

Incidence and risk of death varies by ethnicity/race and age.  Caucasian women are more likely to get breast cancer but African American women have the highest rate of death.  African American women under the age of 50 have a death rate double that of other women in the same age group.  The biggest disparities in breast cancer screening are found between the insured and uninsured.

In FY 2006 “less than a third (30.2 percent) of uninsured California women age 40 and older had a mammogram within the last year, compared to 64 percent of insured women.”   (California Department of Health Services, Cancer Detection Section Cancer Detection Programs: Every Woman Counts).

Currently our state legislators and the Governor are engaging in discussions of reform of California’s Health Care system.  The health care reform debate focuses heavily on making our health care system more efficient.  For those people facing breast cancer, our questions are different and we focus on improving quality, increasing access to care as well as managing costs.  We ask…

  • How do we decide where we should invest our treasure and talent in continuing the battle against breast cancer in our communities? Screening? Treatment? Support/Access? All of the above?
  • How can we ensure that no one is forced to opt for inadequate screening, substandard care or treatment because there is no local facility to provide quality health care or because they can’t afford to pay for it? 
  • How do we ensure that everyone has access to state of the art treatments and clinical trials? 
  • How do we create continued incentives to develop new drugs and treatments, yet hold healthcare costs down for all of us?

For those of us who work daily to support people with breast cancer and/or to advocate for a cure, we need some common guiding principles to ensure the policy makers shaping health care reform really do address our questions. 

The National Breast Cancer Coalition (NBCC) has developed a set of principles for evaluating quality health care.  Adopted in 2003, NBCC suggests applying these principles in the discussion of “creating a fair and effective health care system.“

  1. Health care is a basic human right.
  2. Health care is fundamental to maintaining a productive society.
  3. Health care coverage must be guaranteed for everyone.
  4. The coverage package must provide the same comprehensive benefits to everyone and must meet the public’s reasonable expectations.
  5. The health care system must be redesigned so that treatment and coverage decisions are based on evidence and best practices.
  6. All individuals must financially contribute to the system, based on ability to pay.
  7. The health care system must be easy to use for patients and providers, and easy to administer.
  8. The health care system must incorporate a vision of quality care (see NBCC’s vision of quality care on their website) and reflect the following core values: access, information, choice, respect, accountability and improvement. 

(from National Breast Cancer Coalition, Position Statement on Principles for Achieving Guaranteed Access to Quality Health Care for All, December 2007)

As we celebrate and educate during breast cancer awareness month it is important to pay attention to how the current health care reform proposals will affect breast cancer screening and treatment.  How will these decisions affect the many people suffering from this disease today and our daughters and granddaughters who will be diagnosed with it in the coming years?  

Christine Granger is the Executive Director of the Northern California Affiliate of Y-ME National Breast Cancer Organization.  Y-ME provides information, empowerment and peer support so no one faces breast cancer alone. Their 24/7 Peer Support Hotline(1-800-221-2141) is staffed by Breast Cancer Survivors in English and Spanish, with interpretation available  in 150 languages.  Y-ME National Breast Cancer Organization is a founding member of the National Breast Cancer Coalition.

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