As the founder of a company focused on empowering cancer patients with information, I support the bill. To
me, nothing justifies withholding potentially life-saving information from
patients.
The simple, central issue is
that today most women are not being informed about a serious health risk: dense
breast tissue. According to a recent poll, 95 percent of women ages 40+ don’t
know their breast density and close to 90 percent don’t know it increases the
risk of developing breast cancer. Yet the medical community has known
about this issue for over a decade.
What are the arguments against the bill? I’ll use the CMA as a proxy for the opposition. In their press release, the CMA states that
there isn't yet clarity on what "dense breasts" means, nor on what should be done clinically with the information. But
"clarity" is a vague term. In fact, there's well over a decade of
research about the risks associated with dense breast tissue and on the
value of supplemental screening. It’s common sense that imaging the
breast using different, proven methods will increase the likelihood of finding an
abnormality. But we don't have to rely on common sense. Recent
studies published in high quality medical journals come to the same
conclusion.
In fact, as an argument
against the bill, the CMA's press release says that breast density is already
reported to physicians in mammography reports. Isn't this an admission
that there is a workable way to measure breast density and that the information
has clinical relevance?
One can concede that the
measurement of breast density is an ongoing area of research. And one can
concede that the value of different supplemental screening methods is still
being quantified. The CMA's policy statement says that, "the science is still
out on this matter." Yes, science is never finished. It's always still out on every matter.
Another CMA argument
cites the bill's impact on patients (they'll be scared) and
physicians (they'll face practical and legal problems).
Possibly. But these are secondary issues--consequences of communicating
the facts. The truth can't be sacrificed for the sake of convenience. The
priority must be patients' health, not shielding them from worry or
protecting physicians.
Finally, one can argue that what's needed is better cost-benefit data regarding supplemental screening of women with dense breast tissue. But the bill doesn't involve changes to reimbursement.
Maybe it should. But right now it's only about communicating information. Once they're informed, women can do their own cost-benefit analysis with their doctor. They can weigh in their other risk factors, their anxiety level about developing breast
cancer, their level of concern about a possible unnecessary biopsy, and their
ability to pay for supplemental screening if it isn't covered.
This is a decision that
women need to have the opportunity to make. The bill ensures that they will.
Without the notice that the bill requires, we know that many women with very dense breasts who aren't aware of this issue will be at risk while we wait years for the
results of more definitive randomized controlled trials. SB 971 is important for the simple reason that people have the right to make decisions about their health based on the
best available information.
Tomorrow I'll go into what I view as another reason why it's important to empower patients with this kind of
information.
