¶ … H.R. Health Policy and Politics

In Support of H.R. 80: Triple-Negative Breast Cancer Research and Education Act of 2013

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Honorable Kathy Castor

14th District of Florida

4144 N. Armenia Ave., Suite 300

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In Support of H.R. 80: Triple-Negative Breast Cancer Research and Education Act of 2013

Dear Mrs. Castor:

I am writing to urge your support for H.R. 80, a bill sponsored by Representative Sheila Lee (D, TX) and introduced into the House Energy & Commerce Committee on January 3, 2013. The title of the bill is "Triple-Negative Breast Cancer Research and Education Act of 2013" and its goal is to provide funding for additional research into triple-negative breast cancer. The bill also authorizes funding to support the gathering of evidenced-based information about triple-negative breast cancer and its dissemination to the public and medical care providers, with the goal of increasing early detection and lowering the prevalence of triple-negative diagnoses.

According to breast cancer researchers and clinicians at the H. Lee Moffitt Cancer Center & Research Institute, triple-negative breast cancer represents a more advanced and therefore more lethal form of breast cancer (Ismail-Khan, Roohi and Bui, 2010). While other forms of breast cancer are often responsive to targeted therapies, no such therapies exist for triple-negative. Women who receive a diagnosis of triple-negative breast cancer will face a harder road during treatment, one that frequently includes a poor prognosis. Remissions, if they occur, will be shorter and the chances of survival, slimmer.

An important clue into why this disease is so prevalent has been provided by studies that revealed how socioeconomic disparity can decrease a patient's chances of survival (Vona-Davis and Rose, 2009). Within the United States, 10.4% and 20.8% of Caucasian and African-American women who are diagnosed with breast cancer will have the triple-negative form of the disease (Morris et al., 2007). Still more troubling is the finding that 39% of premenopausal African-American women with breast cancer will be diagnosed with triple-negative. African-American women who develop breast cancer are therefore three times more likely overall to present with the triple-negative form of the disease. While this evidence suggests there is a significant genetic component controlling the prevalence of this type of breast cancer, access to medical care has been shown to play a dominant role.

Vona-Davis and Rose (2009) conducted a systematic review of the literature concerning the importance of socioeconomic status and noted that impoverished Caucasian women also suffer from lower chances of survival following a diagnosis of breast cancer. This finding was confirmed in a recent study that examined the outcomes of a large, multi-racial, indigent, patient population being treated for triple-negative breast cancer (Chu, Henderson, Ampil, and Li, 2012). In the absence of a significant difference in socioeconomic status, the overall survivability was not significantly different between Caucasian and African-American women. These findings suggest that the increased susceptibility of African-American women to triple-negative breast cancer is largely due to inadequate medical care, which can provide early detection and increased survivability.

Best estimates suggest that regular screenings, early detection, and effective treatment lower the risk of mortality from breast cancer by 20% (Independent UK Panel, 2012). With approximately 230,000 new cases of breast cancer diagnosed each year in the U.S., of which about 15% involve triple-negative tumors (Ismail-Khan, Roohi and Bui, 2010), the potential savings in health care costs are significant. Current estimates suggest that a breast cancer patient with disease will be faced with medical bills totaling somewhere between $30,000 and $60,000 dollars (Foster, 2011). The combined medical costs for treating newly diagnosed triple-negative breast cancer patients each year would therefore be somewhere between $1 and $2 billion dollars. The savings conferred by early detection could theoretically provide an overall direct medical care cost savings of $200 to $400 million dollars nationally each year, thereby benefitting both patients and health insurance providers. In Florida, this would translate into cost savings between $12 and $24 million.

H.R. 80 represents a plan to improve the survivability of breast cancer patients with a triple-negative diagnosis, in part by increasing NIH funding of triple-negative research. This goal will help patients in the future, but the public needs guidance now about the importance of early detection through regular screenings. Towards the latter goal, H.R. 80 provides funding for gathering evidence-based information about triple-negative breast cancer and its dissemination to the public and medical care providers. This education campaign should improve patient self-efficacy and physician awareness.

On a more personal level, I am a nurse enrolled in an advanced practice course of study in your district....

Caring for patients has brought me face-to-face with the suffering that patients and their families experience during diagnosis and treatment. A few years ago, a 39-year-old wife and mother died two years after being diagnosed with triple-negative breast cancer. She left behind a grief-stricken husband, two children, and a mountain of medical bills.
While a family with significant financial means may not be troubled by the financial aftermath of breast cancer treatment, a recent report found that 44% of American families do not have enough savings to survive for more than three months without income and nearly one third have no savings whatsoever (Fessler, 2013). Imagine the fate of low-income families, which often have only one parent, should they be faced with a diagnosis of triple-negative breast cancer. Please help these families survive the economic devastation that a diagnosis of triple-negative breast cancer could represent by supporting H.R. 80 during the current session of Congress.

Sincerely,

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Metastatic cancer is the second leading cause of death in the United States after cardiovascular disease (Hoyert and Xu, 2012). The three top cancers in terms of lethality are Lung, prostate, and breast cancer, in that order (NCI, 2012). Within the United States, 230,000 cases of breast cancer were diagnosed last year and 40,000 died of this disease. Over the course of a lifetime, 12.4% of women born today will develop this disease.

Compared to the rest of the United States, Florida has a slightly lower (-5.8%) incidence of new breast cancer diagnoses, while deaths from this disease are close to the national average (CDC, 2013). Since Florida is home to approximately 6.1% of the U.S. population (U.S. Census Bureau, 2013), then an estimated 13,200 Floridians developed this disease last year and another 2,450 lost their lives.

One of the more aggressive forms of breast cancer is the so-called triple-negative type (Fornier and Fumoleau, 2011). Its name is derived from the missing expression of three proteins that would otherwise render the disease susceptible to effective targeted interventions. Triple-negative breast cancer is therefore associated with a more advanced disease state, a poorer prognosis, faster progression, lower survival rates, and an increased tendency to metastasize to the gut and the brain.

The prevalence of triple-negative breast cancer is 10.4% and 20.8% in Caucasian and African-American patients, respectively (Morris et al., 2007). The prevalence of triple-negative breast cancer in premenopausal African-American women is even higher, reportedly reaching 39% (Ismail-Khan, Roohi and Bui, 2010). The increased susceptibility to triple-negative breast cancer that African-American women experience is believed to be due primarily to socioeconomic disparities in health and health care access, which results in seeking medical care only after the disease has become advanced (Vona-Davis and Rose, 2009; Chu, Henderson, Ampil, and Li, 2012). The discrimination inherent to the health care system is robbing these women of a mortality risk reduction estimated to be 20%, which is conferred by regular screenings, early detection, and effective treatment (Independent UK Panel, 2012).

Estimates for direct medical costs in the United States for treating breast cancer are between $30,000 and $60,000 per patient, depending to a large extent on which chemotherapy drugs are used and whether metastatic disease is present (Foster, 2011). If the patient dies, then the surviving loved ones are often burdened with paying for the costs of treatment with one less wage earner. Receiving a diagnosis of breast cancer is always devastating emotionally, but the economic burden can be devastating to the families for years afterward. This is especially true for low-income families.

Lowering the cost of breast cancer screening, treatment, and follow-up care will therefore have a direct impact on the prevalence of triple-negative breast cancer and the overall economic burden of this disease. The provisions contained in H.R. 80 will help to bring about this goal, by increasing the amount of funding allocated to researchers investigating new methods for detecting and treating this disease (Triple-Negative Breast Cancer Research and Education Act of 2013). H.R. 80 also makes funds available for gathering and disseminating evidence-based information to the public and health care providers, thereby helping to lower the barriers to patient self-efficacy, which may be a product of socioeconomic status.

References

CDC (2013). Age-adjusted invasive cancer incidence rates and 95% confidence intervals by state. National Program of Cancer Registries, Centers for Disease Control and Prevention. Retrieved 29 Jan. 2013 from http://apps.nccd.cdc.gov/uscs / cancersrankedbystate.aspx#Footnotes.

Chu, Quyen D., Henderson, Amanda E., Ampil, Fred, and Li, Benjamin D.L. (2012). Outcome for patients with triple-negative breast cancer is not dependent on race/ethnicity. International Journal of Breast Cancer, 2012, doc. # 764570.

Fessler, Pam. (2013, Jan.…