National Breast Cancer Coalition

NBCC Testimony

Testimony of Fran Visco, President, NBCC
Before the House Oversight and Government Reform Committee
February 7, 2008
Washington, DC

Dear Chairman Waxman:

On behalf of the National Breast Cancer Coalition (NBCC), I am writing to thank you for holding a hearing on addressing the Screening Gap: The National Breast and Cervical Cancer Early Detection (January 29, 2008). We appreciate your continued commitment to ensuring that low-income women diagnosed with breast cancer have access to the care they deserve.

When Congress created the CDC Breast and Cervical Cancer Early Detection Program through passage of the bipartisan Mortality Prevention Act of 1990, it did so with the best intentions: to reduce mortality from breast cancer and save lives. NBCC appreciated Congress's efforts in this area, but we were concerned that the federal screening program did not have a federal treatment component. Detection alone does not save lives. The program's lack of support for a reliable system of care left many low-income women with nowhere to turn after they were diagnosed.

An NBCC member and advocate from California, Jan Eik-Swigart, first envisioned the solution that NBCC fought to enact. You were an important leader from the beginning in recognizing the need for the treatment component, and in working with us to push for passage of the Breast and Cervical Cancer Treatment Act (P.L. 106-354). As you know, enactment of this critical law allowed states to receive federal funding to help cover the cost of treatment through Medicaid for low-income, uninsured women who had been diagnosed with breast or cervical cancer through CDC's Early Detection Program thus repairing the flaw in the existing screening program.

Following passage of the Treatment Act, the Centers for Medicare and Medicaid (CMS) commended NBCC for encouraging a record number of states in less than a year to take advantage of the Medicaid waiver option. We are very proud that all fifty states and the District of Columbia opted to participate in the program. This success demonstrates the perseverance and dedication of women around the country who believe that a federal screening program should guarantee treatment.

NBCC remains committed to preserving the Breast and Cervical Cancer Treatment Program, as well as working to protect the Medicaid program overall and ultimately ensuring that all individuals have access to high quality healthcare. While we appreciated CDC's hearing testimony about the 4,000 women being diagnosed with breast cancer through the Early Detection Program, we should be asking questions that get to the core of our beliefs and yours: How well is the treatment program working? What is happening to these women? Are their survival rates improving? Is the limited investment of federal resources improving their quality of life? In short, are the screening and treatment programs achieving the goal of saving lives? During the hearing, CDC also testified about funding issues around the screening portion of the program. While funding is essential, it is but one aspect of a needed strategy to evaluate and improve both programs and ensure that they are adequately serving all eligible women. The National Breast Cancer Coalition has heard anecdotally that there are problems within the treatment program.

There is great variation between and even within states in how the program is implemented and how eligibility for treatment is determined. Some women who meet the eligibility requirements have been screened for breast cancer outside of the program and thus are technically ineligible for treatment. In these circumstances women and providers must resort to the system, by for example having women get a pap smear from the program so that they meet the definition of being screened by the program. Other women have been turned away because they have found a lump or suspect a problem and are told that they are ineligible for the screening program because they need a diagnostic mammogram rather than a screening mammogram.

Clearly, the vagaries of the process impede rather than advance the goal of helping this group of women.

We know that anecdotes are powerful but not sufficient evidence on which to base public policy. We would like to work with you to get more information and pinpoint the real problems, so we can work together to develop the right solutions and improve the program and the lives of the women who benefit from it.

Chairman Waxman, by convening this hearing you have demonstrated your continued commitment to strengthening this program and saving lives. We all need to know what is happening to women who are diagnosed through the screening program and if there is more we can do to help them. NBCC looks forward to working with you to examine the effectiveness and impact of the treatment program, and ultimately to ensure that all individuals have access to high quality health care.

We respectfully request that this letter be made a part of the hearing record. If you have any questions, please do not hesitate to contact me at (202) 296-7477.


Fran Visco


National Breast Cancer Coalition Fund