Breast cancer is a political issue. The majority of funding for breast cancer research comes through the Federal Government. A federal agency, the Food and Drug Administration, approve new drugs for breast cancer. Reform and regulation of the insurance industry happens through federal and state regulations. In fact, every aspect of breast cancer is touched by public policy.
For example, laws were passed in the 1990s mandating that insurance companies pay for bone marrow transplants outside of clinical trials, even though we did not have the evidence that this treatment was better than standard of care. We did know that the treatment was highly toxic. In part because of these laws, women did not have the treatment in clinical trials and it took many, many years to find the answer. It turned out that bone marrow transplant was NOT more effective than standard treatment, but it was more toxic and in fact women died from the treatment itself.
Even today, there remain a number of misconceptions and misunderstandings about breast cancer, some of which continue to be perpetuated by elected officials who are not fully informed on all aspects of breast cancer. Government officials may believe that they are helping women when they pass legislation that supports and/or funds mammography screening programs for young women or programs that speak only to benefit and not harm. Screening mammography – mammograms for healthy women with no symptoms – is not without its harms. False positive results may lead to unnecessary, intrusive surgical interventions (including removal of the entire breast), while false negative results will not find cancerous tumors. Since evidence does not currently significantly support, nor disprove the effectiveness of this test, receiving a screening mammogram should be a personal choice, not a medical mandate or the centerpiece of a public health campaign.
Breast cancer is a complex disease and there are no easy answers to understanding how best to prevent, detect or even treat breast cancer. It takes time and effort to review the evidence that currently exists, learn how to understand and apply the evidence and identify the gaps. By educating Members of Congress and other elected officials about breast cancer and the evidence that exists, you can help to ensure that public policy is guided by facts and truth, not just by what is popular or sounds good to voters. We need the commitment of our government – at all levels – to support the types of research and policies that are backed by science and evidence. Then, together, we can end breast cancer forever.