[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 931 Introduced in Senate (IS)]

113th CONGRESS
  1st Session
                                 S. 931

 To amend the Public Health Service Act to raise awareness of, and to 
    educate breast cancer patients anticipating surgery, especially 
    patients who are members of racial and ethnic minority groups, 
   regarding the availability and coverage of breast reconstruction, 
                     prostheses, and other options.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 13, 2013

  Mr. Blunt (for himself, Mr. Brown, Mr. Tester, and Mrs. Feinstein) 
introduced the following bill; which was read twice and referred to the 
          Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
 To amend the Public Health Service Act to raise awareness of, and to 
    educate breast cancer patients anticipating surgery, especially 
    patients who are members of racial and ethnic minority groups, 
   regarding the availability and coverage of breast reconstruction, 
                     prostheses, and other options.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Breast Cancer Patient Education Act 
of 2013''.

SEC. 2. FINDINGS.

    Congress makes the following findings:
            (1) The American Cancer Society estimates that in 2013, 
        about 232,340 new cases of breast cancer will be diagnosed in 
        American women.
            (2) Breast cancer has a disproportionate and detrimental 
        impact on African-American women and is the most common cancer 
        among Hispanic women.
            (3) African-American women under the age of 40 have a 
        greater incidence of breast cancer than Caucasian women of the 
        same age.
            (4) According to the Health Resources and Services 
        Administration, women residing in rural areas may have lower 
        rates of mammography screening compared to non-rural women 
        because of barriers to health care, such as greater distances 
        to medical facilities and lower educational, income, and health 
        insurance levels.
            (5) Individuals undergoing surgery for breast cancer should 
        have the opportunity to give due consideration to the option of 
        breast reconstructive surgery, either at the same time as the 
        breast cancer surgery or at a later date.
            (6) According to the American Cancer Society, immediate 
        breast reconstruction offers the advantage of combining the 
        breast cancer surgery with the reconstructive surgery and is 
        cost effective, while delayed breast reconstruction may be 
        advantageous in women who require post-surgical radiation or 
        other treatments.
            (7) A woman who has had a breast removed may not be a 
        candidate for surgical breast reconstruction or may choose not 
        to undergo additional surgery and instead choose breast 
        prostheses.
            (8) The Women's Health and Cancer Rights Act of 1998 
        (WHCRA; Public Law 105-277) requires health plans that offer 
        medical and surgical benefits with respect to a mastectomy to 
        also provide coverage for all stages of reconstruction of the 
        breast on which the mastectomy has been performed, surgery and 
        reconstruction of the other breast to produce a symmetrical 
        appearance, prostheses, and physical complications of 
        mastectomy, including lymphedemas.
            (9) A 2007 study by Amy Alderman, M.D. at the University of 
        Michigan reported that up to 70 percent of women eligible for 
        breast reconstruction are not informed of their reconstructive 
        options by their general surgeon.
            (10) A 2003 study by Alderman and others found that race is 
        a significant predictor of reconstruction. Compared with the 
        odds of reconstruction for Caucasians, the odds of 
        reconstruction for African-Americans, Hispanics, and Asians are 
        significantly less.
            (11) A 2007 study by Caprice Greenberg, M.D. of the Dana 
        Farber Cancer Institute and others found that Hispanic patients 
        were less likely to receive reconstruction. This may be because 
        of language barriers between the patient and provider. Although 
        72 percent of patients who primarily spoke English went on to 
        receive reconstruction after discussing it with their 
        providers, no patient in the study with a primary language 
        other than English went on to receive reconstruction.
            (12) A 2009 study by Alderman and others also found that 
        the relationship between race and reconstruction rates 
        persisted when demographic and clinical factors were controlled 
        for. Minority women are significantly less likely than 
        Caucasians to see a plastic surgeon before initial surgery, 
        were most likely to desire more information about 
        reconstruction, and satisfaction was lowest among minority 
        women without reconstruction.
            (13) The low use of reconstruction for minorities is not 
        explained by lower demand for the procedure. Lower health 
        literacy, financial issues, and less access to plastic surgeons 
        emerged as barriers to reconstruction in the 2009 Alderman 
        study. These results suggest that there is a substantial unmet 
        need for information, especially among racial and ethnic 
        minority groups regarding reconstruction options and coverage 
        required by the Women's Health and Cancer Rights Act of 1998.
            (14) A 2010 study by Warren H. Tseng, M.D. and others at 
        the University of California Davis found that patients from 
        rural areas are less likely to undergo breast reconstruction 
        following mastectomy for breast cancer than their urban 
        counterparts.

SEC. 3. BREAST RECONSTRUCTION EDUCATION.

    Part V of title III of the Public Health Service Act (42 U.S.C. 
280m; programs relating to breast health and cancer) is amended by 
adding at the end the following:

``SEC. 399NN-1. BREAST RECONSTRUCTION EDUCATION.

    ``(a) In General.--The Secretary shall provide for the planning and 
implementation of an education campaign to inform breast cancer 
patients anticipating surgery regarding the availability and coverage 
of breast reconstruction, prostheses, and other options, with a focus 
on informing patients who are members of racial and ethnic minority 
groups.
    ``(b) Information To Be Disseminated.--
            ``(1) Specific information.--Such campaign shall include 
        dissemination of the following information:
                    ``(A) Breast reconstruction is possible at the time 
                of breast cancer surgery, or at a later time.
                    ``(B) Prostheses or breast forms may be available.
                    ``(C) Federal law mandates both public and private 
                health plans to include coverage of breast 
                reconstruction and prostheses.
                    ``(D) The patient has a right to choose a provider 
                of reconstructive care, including the potential 
                transfer of care to a surgeon that provides breast 
                reconstructive care.
                    ``(E) The patient may opt to undergo breast 
                reconstruction some time after the time of breast 
                cancer surgery for personal or medical reasons, during 
                treatment or after completion of all other breast 
                cancer treatments.
            ``(2) Other information.--In addition to the information 
        described in paragraph (1), such campaign may include 
        dissemination of such other information (whether developed by 
        the Secretary or by other entities) as the Secretary determines 
        relevant.
            ``(3) Required publication.--The information required to be 
        disseminated under paragraph (1) and any information 
        disseminated in accordance with paragraph (2) shall be posted 
        on the Internet Web sites of relevant Federal agencies, 
        including the Office of Women's Health, the Office of Minority 
        Health, and the Office of Rural Health Policy.
            ``(4) Restriction.--Such campaign shall not specify, or be 
        designed to serve as a tool to limit, the health care providers 
        available to patients.
    ``(c) Consultation.--In developing the information to be 
disseminated under this section, the Secretary shall consult with 
appropriate medical societies and patient advocates related to breast 
cancer, breast reconstructive surgery, breast prostheses, and breast 
forms and with patient advocates representing racial and ethnic 
minority groups with a special emphasis on African-American and 
Hispanic populations.
    ``(d) Definitions.--In this section, the terms `racial and ethnic 
minority group' and `Hispanic' have the meanings given such terms in 
section 1707.
    ``(e) Report.--Not later than 2 years after date of enactment of 
the Breast Cancer Patient Education Act of 2013 and every 2 years 
thereafter, the Secretary shall submit to the Committee on Health, 
Education, Labor, and Pensions of the Senate and the Committee on 
Energy and Commerce of the House of Representatives a report describing 
the activities carried out under this section during the preceding 2 
fiscal years, which shall include an evaluation of the extent to which 
such activities have been effective in improving the health and well-
being of racial and ethnic minority groups.''.
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