[Congressional Record Volume 143, Number 96 (Wednesday, July 9, 1997)]
[Senate]
[Page S7117]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. SPECTER:
  S. 999. A bill to specify the frequency of screening mammograms 
provided to women veterans by the Department of Veterans Affairs; to 
the Committee on Veterans' Affairs.


                       WOMEN VETERANS LEGISLATION

  Mr. SPECTER. Mr. President, I am today introducing legislation which 
would require the Department of Veterans Affairs [VA] to provide 
mammograms to women veterans in accordance with nationally accepted 
standards.
  Breast cancer is the second leading cause of death among women and 
the No. 1 killer of women ages 40 to 49. I am, and will continue to be, 
personally committed to ensuring that the women of this country receive 
mammography screening in accordance with the highest possible 
standards. Enactment of this legislation will ensure that our Nation's 
women veterans receiving care at Veterans Health Administration [VHA] 
treatment facilities will have access to mammography screening in 
accordance with accepted national policy.
  At issue is the question of how often women should receive screening 
mammography examinations and the age at which those examinations should 
begin. On March 23, 1997, the American Cancer Society [ACS] recommended 
that women begin annual mammography screening at age 40. On March 27, 
1997, after much deliberation, the National Cancer Advisory Board 
recommended that all women between 40 and 49 years receive regular 
mammogram screening every 1 to 2 years. The National Cancer Institute 
accepted the same recommendation, both recommendations being very close 
to the new ACS standard of annual screening beginning at age 40. In 
addition, the American College of Radiology Board of Chancellors 
approved revised guidelines in January 1997, affirming its support for 
yearly screening for women after the age of 40.
  The issue of mammography screening for women between the ages of 40 
to 49 has been an issue of particular interest to me and one that has 
occupied quite a bit of my time during the first half of 1997. In my 
capacity as chairman of the Appropriations Subcommittee on Labor, 
Health and Human Services and Education, I have already held four 
hearings this year addressing the importance of mammography screening 
for women ages 40 to 49; one here in Washington, DC on February 5, in 
Philadelphia, PA on February 20, in Pittsburgh, PA on February 24, and 
in Hershey, PA on March 3, 1997. I have heard testimony, from 
physicians and women alike, advocating mammography screening beginning 
at age 40. Currently, 40 States have enacted legislation, and 4 States 
have legislation pending, which would require either insurance 
reimbursement for, or mandatory provision of, routine mammogram 
screening of women ages 40 to 49. Obviously, our Nation sees the value 
of screening women early for breast cancer, and the impact that early 
detection can have on decreasing the mortality of this No. 1 killer of 
women between 40 and 49.
  It is estimated that last year 184,300 women were diagnosed with 
breast cancer, and this year nearly 44,000 women will die from the 
disease. Research indicates that regular mammograms for women in their 
40's can cut breast cancer mortality by 17 percent. When Dr. Vogel of 
the University of Pittsburgh Cancer Institute and Magee Women's 
Hospital testified at the February 24 hearing in Pittsburgh, PA, he 
stated that there are nearly 1 million women in Pennsylvania between 
the ages of 40 and 49, and that nearly 2,000 will be diagnosed with 
breast cancer this year. As many as 1,000 of these women will die. He 
stated that if women aged 40 to 49 were screened annually, this death 
toll could be reduced by 250.
  I am disappointed that VHA has refused to adopt this higher, now 
national, standard of mammography screening for our Nation's women 
veterans despite these research findings and national recognition that 
early mammography screening can save thousands of women's lives each 
year. In a report issued in April, 1997, VA's Inspector General Office 
of Health Care Inspections [OHI] offered their objective and critical 
assessment of the status of mammography services being provided to our 
Nation's women veterans receiving treatment at VA treatment facilities. 
Some of OHI's findings are particularly alarming. For example, only 36 
percent of women veterans treated in 1995 were even offered a mammogram 
and only 79 percent of the VHA facilities systematically recorded 
reviews of outcome data, including disposition of positive mammograms 
and correlation of surgical biopsy results with radiologic 
interpretations. Only 72 percent of VHA facilities assessed 
effectiveness using quality improvement or quality assurance monitors, 
and none of the VHA facilities assessed customer satisfaction, quality 
of final diagnostic product, or any other quality of care indicators 
for contracted providers of mammography services.
  The OHI recommended that VHA offer mammograms in accordance with ACS 
guidelines--yearly mammography screening, beginning at age 40. VHA, 
maintaining that mammography screening for women between the ages of 50 
to 69 is sufficient, rejected this recommendation. For this reason, I 
am compelled to introduce this legislation which will require the 
Department of Veterans Affairs to, at a minimum, offer mammograms in 
accordance with the most prudent guidelines, those of the American 
Cancer Society, which call for yearly mammogram screening starting at 
age 40.
  The women who receive treatment at any of our Nation's VA medical 
centers deserve mammography screening consistent with the accepted 
national standard--the highest standard, which is currently the 
recommendation of the American Cancer Society. As chairman of the 
Veterans' Affairs Committee, I urge my colleagues in the Senate to join 
me in supporting this legislation.

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