Breast cancer awareness bill for young sparks concern

WASHINGTON - A seemingly harmless breast cancer bill sponsored by Sen. Amy Klobuchar is proving once again that in Congress, few things are as simple as they appear.

The bill, intended to fund a public education campaign and research on breast cancer in women younger than 45, was introduced four months ago at an emotional news conference by Klobuchar and House sponsor Debbie Wasserman Schultz, a Florida Democrat who had recently overcome her own battle with the disease at age 42.

But it wasn't long before the proposal sparked a firestorm of debate among advocacy groups about the effectiveness of teaching women ages 15 to 45 about the disease, given the scant science surrounding breast cancer in young women and their low risk of contracting it.

Several mainstream cancer organizations have said that such an awareness campaign, if not properly designed, could do more harm than good.

"There's just no evidence to indicate that such a campaign would result in less breast cancer or fewer deaths from breast cancer," said Dick Woodruff, director of federal relations for the American Cancer Society's Cancer Action Network. "But there are serious concerns that it will lead to a lot of unnecessary anxiety."

In Washington, it's not an uncommon story -- especially when politics bumps up against a health care dispute.

"With every piece of legislation ... there's always controversy," Klobuchar said.

The American Cancer Society is officially neutral on the Klobuchar bill, though its chief medical officer warned in a letter to a volunteer that it "can actually cause harm" if written incorrectly.

Some say that too much anxiety resulting from such a campaign, along with excessive screening in young women, could result in a lot of false positives and unnecessary biopsies -- an invasive procedure to determine whether a growth is malignant.

Others fear that the bill could lead to unwarranted and drastic preventive measures.

The debate over the education campaign highlights how little is known about breast cancer in younger women.

Though the stakes are relatively small -- the bill would allocate $36 million over four years for a variety of initiatives -- advocates say they don't want to go down this path without the right information.

But Klobuchar, D-Minn., said in an interview that people should have more faith that doctors won't perform unnecessary surgery and that the CDC will stick to the facts to educate people about the disease.

"I think what will really happen is, it will be targeted education in groups that are more likely to get it," Klobuchar said, referring specifically to African-Americans and Ashkenazi Jews such as Wasserman Schultz, who are advised to get screened at an earlier age.

Klobuchar added that "to get it passed, I think we're going to have to make some changes."

Hazy science

The bill emphasizes "evidence-based" education, but the science behind breast cancer in young women is somewhat hazy. Many experts are unsure about what to tell women younger than 40 about preventing breast cancer and detecting it early.

Yee said some parts of the bill are "outstanding," but he understands how an education campaign could be problematic.

"I think if we've learned anything, we've learned that breast cancer in young women is not just the same breast cancer post-menopausal women get at an earlier age," Yee said.

Supporters of the bill in its current form, however, say there's no need to delay doing something so important.

"We agree that we don't have all the answers now," said Shelley Fuld Nasso, director of public policy at Dallas-based Susan G. Komen for the Cure, the world's largest breast cancer charity.

"But we don't think that we need to wait until we have all the answers to start making women aware."

Language already has been added to the Senate version of the bill to ensure that the campaign meets the most up-to-date guidelines for breast cancer detection. Klobuchar said that she would be open to raising the minimum target age above 15.

The bill has more than 300 sponsors in the House and 13 sponsors in the Senate, and probably will change more as it reaches the health committees.

Many groups are working with the congressional offices to reach compromises on the legislation, which they feel is a worthwhile effort. At least one vocal expert would like the whole bill to be scrapped, however.

"My conclusion is, let the scientists do the science," said Leslie Bernstein, director of the Department of Cancer Etiology at City of Hope, a cancer treatment and research center near Los Angeles. "Provide funding through agencies like the National Institutes of Health ... but don't try to mandate [in legislation] how we're going to do this."