[Congressional Record Volume 144, Number 143 (Sunday, October 11, 1998)]
[Extensions of Remarks]
[Pages E2073-E2074]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




SENSE OF THE HOUSE REGARDING IMPORTANCE OF MAMMOGRAPHY AND BIOPSIES IN 
                         FIGHTING BREAST CANCER

                                 ______
                                 

                               speech of

                            HON. TOM BLILEY

                              of virginia

                    in the house of representatives

                       Thursday, October 8, 1998

  Mr. BLILEY. Mr. Speaker, the attached letters are submitted for 
inclusion in the Record.

                                                 October  6, 1998.
     Hon. Tom Bliley, Chairman,
      House Committee on Commerce, Washington, DC.
       Dear Chairman Bliley: On behalf of the National Breast 
     Cancer Coalition (NBCC), I am writing to thank you for your 
     support and leadership in reauthorizng the Mammography 
     Quality Standards Act (MQSA). By adopting national standards 
     for the provision of mammography, the Congress has helped 
     ensure that women get the highest quality screening.
       We would also like to commend your leadership for working 
     so hard to include a direct notification provision in this 
     year's reauthorization. This is a very important issue for 
     women. As you know, NBCC believes along with the Agency for 
     Health Care and Policy Research (AHCPR) that the best public 
     health policy is for women to receive direct written 
     notification of the results of their mammogram. Direct 
     notification will permit women to make informed medical 
     decisions at a critical time.
       Our experience as activists and consumers is that without a 
     requirement that facilities provide direct written 
     notification to patients--it won't always happen. Without 
     direct reporting, some women, waiting to hear from their 
     physician may make the tragic assumption that ``no news is 
     good news.'' It is for that reason that your leadership on 
     including this requirement is so significant.
       Thank you again for your commitment to this issue. We look 
     forward to continuing to work with you to eradicate breast 
     cancer.
           Sincerely,
                                                 Frances M. Visco,
                                                        President.


     
                                  ____
                                                  August  3, 1998.
     Hon. Tom Bliley,
     Chairman, Committee on Commerce,
     Washington, DC.
       Dear Representative Bliley: On behalf of the National 
     Breast Cancer Coalition (NBCC), I want to thank you for your 
     leadership in the reauthorization of the Mammography Quality 
     Standards Act (MQSA). This program, which establishes minimum 
     national quality standards for mammography facilities and 
     personnel as well as a rigorous annual inspection program to 
     ensure those standards are being met, is an important 
     component in the arsenal for fighting breast cancer.
       The NBCC is extremely pleased that the Committee has 
     included language that would require facilities to provide 
     direct written notification of mammographic results to all 
     patients. We join the Agency for Health Care Policy Research 
     (AHCPR) and other experts and consumers in believing that 
     direct notification is the best public policy.
       We also understand that the bill includes language that 
     would permit the Food and Drug Administration (FDA) to 
     conduct a limited demonstration project to determine the 
     feasibility of inspecting high-performing mammography 
     facilities on a less than annual basis. While we have 
     concerns about backing away from annual inspections, we have 
     been working with the Committee to ensure that any 
     demonstration project is done on a restricted basis with 
     regard to the facilities that are selected for inclusion in 
     the program. Moreover, the demonstration, not to begin before 
     April 1, 2001, should be constructed with the utmost caution 
     to ensure facilities continue to adhere to tough national 
     mammography standards.
       We look forward to working with the Committee to continue 
     to find ways to improve the MQSA program. Thank you again for 
     your leadership and support.
           Sincerely,
                                                       Fran Visco,
                                                        President.


     
                                  ____
   Statement of Christine Brunswick, Vice President, National Breast 
                  Cancer Coalition, September 23, 1998

       Thank you very much for the opportunity to speak today. On 
     behalf of the National Breast Cancer Coalition, I want to 
     begin by thanking Chairman Bliley, Chairman Bilirakis, and 
     the Members of the House Commerce Committee for their 
     leadership in reauthorizing H.R. 4382, the Mammography 
     Quality Standards Act. MQSA establishes minimum national 
     quality standards for mammography facilities and personnel 
     and also includes a rigorous annual inspection program to 
     ensure those standards are met. These are essential 
     components in the fight against breast cancer.
       H.R. 4382 improves mammography screening by providing all 
     patients--for the first time ever--with direct written 
     notification of their mammography test results. NBCC believes 
     that women are entitled to know the results of their own 
     mammograms and that they should not have to rely solely on 
     their physicians to notify them of their results.
       NBCC believes that written notification is the right public 
     policy. It permits women to make informed medical decisions 
     at a critical time. Public health organizations and consumer 
     advocates have stressed consistently that women are entitled 
     to know the results of their exams and that it is the 
     facilities' responsibility to provide direct written 
     notification of mammography results to all patients. For 
     numerous reasons, many health care providers do not always 
     communicate the results of mammograms to patients. And some 
     women, waiting to hear from their physician, may make the 
     tragic assumption that ``no news is good news.''
       As the Mammography Quality Standards Act was originally 
     adopted into law, there was already a requirement for self-
     referred women to be directly notified about the results of 
     their mammography. Without a requirement that all patients 
     are notified directly, the concern is that women may not hear 
     about their mammography results until its too late.
       NBCC is not alone in supporting direct written 
     notification. Based on extensive review of the literature, 
     expert testimony, and contributions of an independent 
     multidisciplinary panel of private-sector clinicians, other 
     experts and consumers, the Agency for Health Care Policy 
     Research (AHCRP) strongly recommended direct written 
     notification in the Clinical Practice Guideline:
       ``Any written communication must have language that is 
     carefully constructed to impart results without causing undue 
     anxiety, to promote a relationship between the woman and 
     health care provider, and to encourage the woman to take the 
     next step.''
       The Food and Drug Administration (FDA) has stated that it 
     ``continues to believe that written notification of 
     mammographic results is the most reliable way to guarantee

[[Page E2074]]

     that each patient is notified of results and that any 
     necessary follow up will occur,'' and that it ``agrees with 
     consumer groups that written notification of mammographic 
     results represents the `best practices' in ensuring that each 
     and every woman is clearly and effectively notified of the 
     results of her mammogram . . .''
       I am here today on behalf of the National Breast Cancer 
     Coalition to ask the Senate to adopt the re-authorized 
     version of MQSA that has already been passed by the House. 
     While the Senate re-authorized the MQSA (of 1992) last year, 
     that legislation did not include a direct notification 
     requirement. H.R. 4382 would require that written 
     notification be provided to every patient in terms easily 
     understood by the general public.
       Our experience as activists and consumers is that without a 
     requirement that facilities provide direct written 
     notification to patients--it won't happen.
       On behalf of NBCC, I am pleased to join Chairman Bliley, 
     Chairman Bilirakis, and sponsors of H.R. 4382 in asking that 
     the Senate pass the House passed MQSA reauthorization into 
     law this year.


     
                                  ____
                                               September 21, 1998.
     Hon. Thomas J. Bliley, Jr.,
     Chairman, Committee on Commerce,
     U.S. House of Representatives.
     Hon. Michael Bilirakus,
     Chairman, Subcommittee on Health and the Environment.
       Dear Gentlemen: The National Alliance of Breast Cancer 
     Organizations (NABCO) is extremely grateful for your 
     continued support of the National Mammography Quality 
     Standards Act and efforts to assure its reauthorization as 
     soon as possible. Additionally, we were pleased by the 
     outcome of the Committee's August 5th deliberations and 
     report including certain amendments, and have encouraged 
     Senators Jeffords, Kennedy, and Mikulski to promote the 
     adoption of the House language into the Senate bill. In our 
     opinion, the House Commerce Committee's amendments offer 
     strong enhancements to the original language of the Act and 
     will benefit women throughout the country by further 
     improving the quality of their mammography screening.
       First, an increasing number of women are now receiving the 
     results of their mammograms directly from their mammography 
     provider, but it is not mandatory for the providers to do so 
     in most cases. In the unanimous opinion of the Quality 
     Determinants of Mammography Guideline Panel convened by the 
     Agency for Health Care Policy and Research ``A report should 
     be sent to the health care provider and results passed on to 
     the woman.'' NABCO strongly supports every woman's right to 
     receive the results of her screening mammogram directly, in a 
     timely manner, and in language that is meaningful to her.
       Second, although the implementation of the Act is not yet 
     fully realized, lessons learned from the on-site inspection 
     process highlight the opportunity to improve on the 
     efficiencies of resources dedicated to assuring the high 
     standards of mammography quality the Congress intended. To 
     that end, we support the concept of demonstration projects 
     which will provide further analysis of the relationship 
     between duration and frequency of those on-site inspections.
       Finally, the provision strengthening the independent and 
     objective role of reviewing mammographers lends further 
     credence to the specific training they receive, which women 
     want, deserve and expect from facilities certified by the 
     Federal Government.
       Many thanks for your support of the breast cancer cause. 
     Please do not hesitate to contact us if we may be of 
     assistance in any breast cancer issues that come before you.
           Sincerely,
                                                  Kimberly Calder,
                                MPS, Associate Executive Director.


     
                                  ____
                                               September 22, 1998.
     Hon. Tom Bliley,
     Chairman, House Commerce Committee,
     Rayburn House Office Building,
     Washington, DC.
       Dear Chairman Bliley: We want to thank you and the other 
     cosponsors of the Mammography Quality Standards Act for 
     legislation that offers millions of Americans a greater 
     measure of hope as we confront the battle against breast 
     cancer. The House acted wisely when it passed your bill.
       It is our sincere hope the Senate will act quickly to pass 
     the House version. While the Senate bill also takes steps to 
     advance mammography standards, it does not include the direct 
     notification provisions in the House version. Personal 
     notification of test results in terms women can understand 
     can help save lives and should be part of final legislation. 
     We urge Congress to pass a final bill this session.
       Thank you for your concern and efforts on this important 
     issue of public health.
           Sincerely,

                                    Susan N. Nathanson, Ph.D.,

                                               Executive Director,
                         Y-ME National Breast Cancer Organization.


     
                                  ____
 Statement by Jennie R. Cook, American Cancer Society Board Chair, on 
        Pending Action on the Mammography Quality Standards Act

       ``Good afternoon. I'm Jennie Cook, Chairman of the National 
     Board for the American Cancer Society. Let me first begin by 
     saying that it is an honor to be here today with so many 
     distinguished members of Congress. On behalf of the American 
     Cancer Society, I want to thank the U.S. Congress for all 
     efforts to promote the highest standards in quality 
     mammography. I also want to thank Chairman Bliley and 
     Representative Bilirakis and many other key members of the 
     committee for making this event possible. Without their 
     leadership, we wouldn't be here today.
       ``One of the first lines of defense in the fight against 
     breast cancer has been to encourage screening, earlier 
     diagnosis and prompt appropriate treatment. The American 
     Cancer Society strongly believes that every woman in this 
     country has a right to a mammogram of the highest standards 
     of quality, and we are committed to seeing that all women 
     have access to high quality mammography, as well as other 
     medical interventions that have been convincingly shown to 
     reduce morbidity and mortality from breast cancer.
       ``The five-year survival rate for a woman with localized 
     breast cancer has risen to about 97 percent today, largely 
     through the advent of early detection of the disease. The 
     potential for early detection to be effective is an empty 
     promise if the quality of mammography is low. Since early 
     detection is so important, all women should feel confident 
     that mammography facilities in their communities achieve high 
     standards. Just last week, the U.S. House of Representatives 
     helped make this goal achievable through the continuation of 
     Mammography Quality Standards Act.
       ``The Mammography Quality Standards Act, or MQSA, 
     represents an important milestone in the fight against breast 
     cancer. Women can now continue to have confidence in the 
     quality of their mammograms because mammography facilities 
     are being certified in accordance with federal standards. The 
     reauthorization process made it possible to enhance MQSA--to 
     make it even better than it was the first time around. We are 
     especially pleased that the U.S. House of Representatives 
     included a provision to directly notify women of their 
     mammogram results in easy-to-understand language--which is a 
     top priority of the American Cancer Society.
       ``Consumer and public health advocates have consistently 
     stressed that communicating mammography results directly to 
     women is a vital component of medical care and a necessary 
     quality standard. Women are entitled to timely, accurate and 
     easily understood information about the results of their 
     mammograms. Studies have shown that women believe their 
     mammography results are normal if they are not contacted 
     after their examination. If in fact the information about a 
     suspicious mammogram has fallen through the cracks, 
     appropriate follow-up care is often unnecessarily postponed. 
     A delay in diagnosis due to poor communication can have 
     adverse consequences for women and their doctors. For women, 
     it can mean fewer treatment options and reduced chances at 
     survival. For physicians, communication failures represent 
     system failures and, consequently, failures to meet the needs 
     of their patients. Thus, direct notification establishes that 
     the interpreting physician, the referring physician and the 
     woman all play a role in ensuring that appropriate follow-up 
     takes place.
       ``Once again, on behalf of the American Cancer Society, I 
     want to thank the U.S. Congress for taking up this important 
     legislation, and I urge the U.S. Senate to pass HR 4382 in 
     time for National Breast Cancer Awareness Month in October.''

     

                          ____________________