Paul Goldberg, the intrepid editor of The Cancer Letter, reports that Sen. Amy Klobuchar, D-Minn., and Rep. Debbie Wasserman Schultz, D-Fla., have watered down both the House and Senate versions of their controversial breast-cancer bill in order to get the votes needed for the legislation to pass.
Since the bill — now apparently renamed as the Young Women’s Breast Health (rather than Breast Cancer) Education and Awareness Requires Learning Young, or EARLY, Act — was introduced last spring, Wasserman Schultz has wrangled enough votes in the House to ensure its passage there. Klobuchar, however, experienced no such luck in the Senate. The bill has been stuck in the Senate’s Committee on Energy and Commerce Health, Education, Labor and Pensions.
Why? Largely because of opposition from leading breast-cancer scientists and women’s-health advocates, who argued that the bill is based on the mistaken premise that risk factors for breast cancer in young women (those under age 45) are firmly understood and modifiable.
As the well-known women’s health advocate Dr. Susan Love wrote in a letter to Wasserman Schultz earlier this year:
A diagnosis of breast cancer in a young woman is never welcome but this bill takes the wrong tack. It assumes that we have some knowledge of risk factors, methods of early detection and understanding of genetics that do not currently exist. … What is really needed is more research on what the cause and prevention of breast cancer really is.
The EARLY Act does have its supporters, however, including the advocacy group Susan G. Komen for the Cure.
And now that the language of the bill has been softened, the American Cancer Society has finally said it will support the legislation, reports Goldberg.
So what is different in the amended version of the bill? Most notably, the new version — including its title — refers to “breast health awareness” rather than to “breast cancer awareness.”
The new version also no longer includes one of its most highly contentious provisions: the promotion of breast self-exams for girls under the age of 15.
Most experts agree that breast self-exams have not been shown to be effective at reducing breast cancer deaths in women of any age — and may even be harmful by causing unnecessary worry and medical procedures.
Other changes in the bill:
“The former version of the bill surprised breast cancer experts by proposing a specific agenda — such as ‘blood component analysis,’ genetic testing and lowering of breast cancer risk through changes of lifestyle, including diet, exercise, and environmental factors,” writes Goldberg. “Experts in breast cancer prevention noted that no such strategies exist. The new version of the bill crossed out the most puzzling of these proposals.”
In addition, under the new version, the mandated advisory committee that would help the Centers for Disease Control and Prevention (CDC) design an educational campaign would be expanded to include experts in public health and survivorship.
A better bill?
It’s still too early to tell if these changes will persuade enough of Klobuchar’s Senate colleagues to support the EARLY Act, particularly in these recessionary times. To launch all its educational efforts, the bill allocates to the CDC $9 million annually for five years.
Not all breast-cancer experts and advocates think that the EARLY Act is the best breast-cancer use of that money.
“As a taxpayer, I don’t believe that the amended version of the EARLY Act is a responsible use of $45 million over a 5-year period,” wrote Christine Norton, co-founder of the Minnesota Breast Cancer Coalition, in an e-mail to me on Monday. “A lot of money will be spent on surveys, media campaigns, and follow-up surveys to determine if the media campaigns were successful. [And] as a former high school teacher, I strongly object to beginning the public education campaigns with 15-year-old freshman and sophomores.”
(You can find and download a copy of the National Breast Cancer Coalition’s analysis of the original EARLY Act here.)