October has been recognized as breast cancer awareness month for some time. The heightened awareness is marked by everything from athletes wearing pink, to increases public education. Because of these efforts more people are aware of the need for screening, research and the benefits of early detection. It’s time to reflect on the past progress and future hope for more effective treatments.
Cancers were first recognized thousands of years ago, but treatments remained primitive. For breast cancer, there was little that could be done until radical mastectomies came into practice in the late 1800s. Partial mastectomies, radiation, chemotherapy and antibody treatments emerged in the 20th century contributing to major decreases in mortality rates. Recent studies on the use of medications such as Tamoxifen to prevent breast cancer in women at risk reduced incidence by 50%.
Individualizing detection and treatment through genetic analysis is another area of tremendous promise. Even if breast cancer does not directly affect you directly, the knowledge gained from breast cancer research has benefited detection and treatment of several other forms of cancer which appear in 39% of men and 37% of women.
The progress in treatment has had a remarkable impact. The survival rate for breast cancer was only 25% in the 1950s. Five-year survival now exceeds 90% when detected by stage 2 and 72% in stage 3, but only 22% for those in stage 4.
It is difficult to really celebrate these advances as “good news” because the number of deaths each year remains too high. Over 330,00 women and 2,600 men are diagnosed with breast cancer each year, leading to over 42,000 deaths.
It is certainly not a celebration for me. Unfortunately, whatever has been or will be done for breast cancer had no effect on my aunt. She developed breast cancer at a young age, but it was not detected until she was forty years old when she had her first mammogram. By the time it was detected, it was too far advanced and she tragically died fifteen years ago. Insurance would not pay for her mammogram earlier. It makes me wonder, what good is all of this research, what good is this care if someone does not have access to it?
Many insurance companies will not pay for breast cancer mammogram screening before age 40, and only then because they are required to do so under the affordable care act. This is an absurd policy considering that 7% of breast cancers are diagnosed before age 40, and breast cancer accounts for 40% of all cancers on women under 40. Detection and treatment of breast cancer in younger women has its own challenges, but something is amiss when over 80% of the cases are first detected by the women herself. It begs the question: what could be done to improve survival had screening been earlier? It weighs heavily in my own heart for my aunt. Clearly more is needed to improve research, and clinical screening to detect breast cancer in its earliest stage.
Congress has an important role in enacting these improvements, and currently has three key bills introduced to combat this crisis.
- U.S. Representatives Susan Brooks (R-IN) and Debbie Wasserman-Shultz (D-FL) introduced the Protecting Access to Lifesaving Screenings (PALS) Act to continue mammogram access for women under the age of 40 years old.
- U.S. Senators Tammy Duckworth (D-IL) and Lisa Murkowski (R-AK), along with U.S. Representatives Judy Chu (D-CA-27) and Jackie Walorski (R-IN-2), introduced the Breast Cancer Patient Equity Act to fund breast prostheses. These prostheses are the only human body part not currently covered by Medicare.
- U.S. Senators Martha McSally (R-AZ) and Chris Murphy (D-CT) introduced The Metastatic Breast Cancer Access to Care Act to wave the five month wait before someone with breast cancer could access Social Security Disability Insurance. Treatment of breast cancer is both emotionally and economically devastating for a woman who characteristically finds herself buried in deductibles, co-pays and loss of income from missing work. Access to disability payments allow these patients to have some level of financial stability as they undergo treatment. U.S. Representatives Peter King (R-NY-2) and Kathy Castor (D-FL-14) introduced a similar bill in the House of Representatives.
Beyond these actions remains a massive need for prevention. Early detection greatly improves prognosis, but better prevention is essential. The best way to reduce mortality is to stop cancer from ever happening. Cancer rates have increased in recent years and we need to know why. We know that obesity, alcohol consumption and a sedentary lifestyle contribute to risk. We are getting better at understanding genetic risk, but are far from having the needed answers.
During this month, do more than wear a pink ribbon. Employers, the media, and medical providers can step up their efforts to inform women of the benefits of prevention, detection and treatment. But lets not make it just during the month of October. Cancer attacks year-round, and it is time we keep up. Sadly, the fight is too late for my aunt, but it is not too late for you.