[Congressional Record Volume 155, Number 189 (Monday, December 14, 2009)]
[House]
[Pages H14862-H14867]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                     PREVENTIVE SERVICES TASK FORCE

  The SPEAKER pro tempore. Under the Speaker's announced policy of 
January 6, 2009, the gentlewoman from Ohio (Mrs. Schmidt) is recognized 
for 60 minutes as the designee of the minority leader.
  Mrs. SCHMIDT. Mr. Speaker, I rise tonight to speak about a very 
important issue, it's about breast cancer and my expressed 
disappointment and disagreement with the recent set of recommendations 
issued by the United States Preventive Services Task Force, this simple 
little 12-page study that, quite frankly, has angered millions of women 
across the United States. I highly recommend people to take the 15 
minutes that it will take to read this report and see just how flawed 
it really is.
  As most Americans know, especially women, breast cancer represents a 
major health threat both in this country and across the world. Breast 
cancer is one of the most frequently diagnosed forms of cancer for 
women, and it ranks second only to lung cancer in terms of cancer-
related deaths.
  In 2008, an estimated 250,000 cases of breast cancer were diagnosed 
in the United States, and 40,000 women lost their lives to this 
terrible disease. These 40,000 deaths represent, however, a significant 
reduction in mortalities compared to 20 years ago. In fact, since 1990, 
the mortality rate for breast cancer has decreased approximately 30 
percent. Medical experts attribute this dramatic decrease to both 
improved treatment methods and to the widespread and regular use of 
early detection techniques such as mammograms.
  Despite these positive gains and despite the thousands of lives that 
breast cancer screening has saved during the past two decades, the 
United States Preventive Services Task Force recently issued new 
recommendations advocating, get this, against routine mammograms for 
women younger than 50, biannual mammograms for women 50 to 75, no 
mammograms at all for women older than 75, and actually recommended 
against teaching women the proper and important method of self breast 
examinations; they don't want medical experts to show them how to do a 
self breast exam.
  In coming to these conclusions, the Task Force--which, by the way, 
did not include a single expert in mammography or oncology--reasoned 
that the physical and psychological harms associated with breast cancer 
screening outweigh the benefits for women younger than 50 years of age. 
The task force then explained that the harms it was concerned about 
included unnecessary tests and biopsies, and the general inconvenience, 
stress, and--get this--anxiety caused by potentially false positive 
screening results.
  Personally, I was appalled and shocked to think that we might have a 
little bit of anxiety thinking that we might have felt something in a 
self breast cancer exam or that a mammography might have showed a 
shadow that was a little inconclusive and that we might need follow up, 
that we might have anxiety with that. And since for most of us it will 
be a false positive, we really don't need to have that anxiety. I was 
appalled because, yeah, you have a little anxiety, but think of the joy 
that you have realizing it was a false positive. And think about the 
relief that you have knowing that you now have the ability to fight a 
disease when you find it at its earliest and most preventable stage.
  My concern is what these recommendations will do for women who should 
be receiving annual breast exams both now and in the future. Because 
what the government report is essentially telling women is that they 
should forgo proven methods of detecting breast cancer because in the 
aggregate screening methods don't save enough lives to outweigh the 
discomfort, inconvenience, and yes, the report talks about the cost.
  Quite frankly, this is not just bad advice, this is awful advice. And 
I believe it will result in countless unnecessary and preventable 
deaths for women who do not avail themselves of screening techniques 
that could and would detect breast cancer at its earliest and most 
treatable stages and, yes, save lives.
  For example, the task force downplayed the importance of self breast 
examinations. In doing so, the task force reasons that having a medical 
professional demonstrate the proper method of self-examination is 
insignificant to the cancer detection, and that too many women would 
suffer, again, anxiety from false positive results. But the report 
ignored a very important question; how many women have had their lives 
saved because of a simple self breast exam?
  Perhaps the anxiety for those who don't understand what they have 
uncovered is less important than the one person who actually finds 
something and saves his or her own life because, yes, men also get 
breast cancer.
  I also oppose the task force's recommendations because they represent 
an unfortunate and dangerous step back in the fight for health care 
equality for women. I was in the State legislature in Ohio for 4 years, 
and I uncovered this. It was through my insistence that insurance 
companies in Ohio pay the true cost for mammograms for women in Ohio. 
Recommendations like this task force's will serve to weaken State 
mandates like Ohio's, and they will ultimately lead to a rationing of 
preventative care across the country.
  For example, according to language in the health care bill just 
passed by the House, the task force's recommendations could give the 
Secretary of Health and Human Services the power to exclude mammograms 
and other breast cancer screening techniques from any government-run 
health care plan or exchange. If you read pages 1317 and 1318 of the 
bill, you will see that the language in there suggests a slippery slope 
where this could occur.
  Now, yes, it talks about testing and demonstration projects, but it 
says, the Secretary of Health and Human Services shall ensure that a 
subsidy or reward is provided only if a government task force 
recommendation is rated as A or B. Well, this task force only graded 
breast cancer screening for women 40 to 49, as a C, so this bill may 
not require the Federal Government to cover the cost of preventative 
care.
  The Federal Government may not be required to cover annual screenings 
for women 50 and older. And the task force recommends that screening 
should be done biannually for this age group, and not for women over 75 
at all. But the Senate bill is even more alarming. Comparable 
provisions were also included in the Senate proposed health care bill 
until an amendment was adopted last week.
  For example, 2713 of the bill requires that private insurers cover 
only preventative services that receive a rating of A or B from the 
task force. Section 4105 of the bill granted the Secretary of Health 
and Human Services the ability to modify any government coverage of 
preventative services if consistent with recommendations of the task 
force. In fact, there were more than a dozen occasions in the Senate 
bill when recommendations from the task force would influence the 
availability of health care.

                              {time}  2115

  Now, not surprisingly, the Obama administration and the Secretary of

[[Page H14863]]

Health and Human Services have attempted to deflect the public outroar 
about this task force's recommendations, stating that the task force 
does not set Federal policy, that it does not determine what services 
are covered by the Federal Government. They also have claimed that the 
Federal Government's policy concerning breast cancer screening coverage 
will not change as a result of the task force's recommendations. 
Insurance companies have made similar promises, assuring their 
customers that they will continue to pay for annual mammograms as well, 
but it begs the question:
  For how long?
  The language contained in the House and the Senate bill speaks for 
itself, and it speaks loud and clear. There is simply no guarantee that 
the administration, that the Secretary of Health and Human Services, 
and that the insurance companies won't change their positions in the 
future, and there is no guarantee that mammograms will continue to be 
covered.
  Fortunately, the task force's recommendations have been strongly 
rejected by a litany of respected medical organizations, including, 
notably, the American Cancer Society and the American College of 
Radiology. The recommendations also run contrary to positions taken by 
the American Medical Association, the American College of Obstetrics 
and Gynecology, and the National Cancer Institute. I have some of these 
publications here, and in a little while, I will read from them.
  Right now, I am really hopeful that women ignore this task force's 
recommendation. It is for their health and for their safety, and it is 
also for the health and the safety of their families. I would also hope 
that, as we debate this health care bill, that we ensure that we do not 
look at cost and then look at treatment and decide that cost outweighs 
treatment. Yes, there is a limited amount of money out there, but 
nobody's health should be put on the line because of the dollars that 
are involved.
  So I hope that women tonight will listen to their doctors--not to the 
government, not to the insurance companies, and certainly not to this 
task force--and will make the right decisions for all of their health 
care. There simply is no room for a government bureaucrat in a woman's 
decision to screen for breast cancer.
  Right now, I have my good friend from Pennsylvania's Fifth 
Congressional District, Congressman Glenn Thompson, who wants to weigh 
in on this.
  Mr. THOMPSON of Pennsylvania. I thank the gentlelady from Ohio for 
yielding and for hosting this Special Order this evening on what is 
truly such an important topic. I don't think there is anyone here in 
this Chamber or anyone across the United States who, through family or 
friends, has not been touched by breast cancer in their families or 
within their networks of friends.
  I came here in January. Prior to that, I had worked in health care 
for 28 years, in rehabilitation services. I was a rehabilitation 
professional, working, actually, as a rehab services manager for most 
of that time. During that time, I had my staff. They were wonderful, 
caring, compassionate individuals who were true professionals. I worked 
with just a tremendous number of women who were breast cancer survivors 
postmastectomy. I was developing innovative rehabilitation techniques 
and exercises, and I really tried to touch the lives of people who were 
facing this devastating disease.
  You had talked about these recommendations that were put out, and I'm 
sure you're going to go into detail on this, but I pulled a document, 
and it was one of those that you referenced.
  Truly, when I think of cancer, I think of an organization such as the 
American Cancer Society, which just offers their expertise. Their 
researchers do just a tremendous job on awareness and on prevention and 
on treatment all across the board. In their 2009 Cancer Prevention and 
Early Detection Facts and Figures, just go to page 35. It talks about 
what their recommendations are. It is very specifically that 
mammographies begin at age 40, and it's annually. Those are not dated 
recommendations. Those are not dated screening guidelines. Those are 
2009.
  You know, breast cancer, as the gentlelady mentioned, is the second 
leading cause of death in American women. In 2008, there were over 
40,000 deaths in this country. Certainly, breast cancer also touches 
the lives of men in much smaller numbers, but it does have a presence. 
In the United States, women get breast cancer more than any other type 
of cancer except for skin cancer. Breast cancer is only second to lung 
cancer as the cause of death in women. Breast cancer does occur in men, 
but as I said before, the numbers of cases are certainly small.
  Now, age and health history certainly can have an effect on the risk 
of developing breast cancer. Anything increases your chance of getting 
a disease. It's called a ``risk factor.'' Having a risk factor does not 
mean that you will get the cancer, but not having risk factors does not 
mean that you will not get the cancer.
  People who think they may be at risk certainly need to talk to their 
doctors as the relationship between the patient and the physician is 
just so important. We've talked about that relationship so many times 
in this health care debate. One of my biggest fears isn't the cost of 
health care. Really, my biggest fear is when the government or a 
bureaucrat becomes a wedge between the decisionmaking relationship of 
the patient and the physician. Certainly, when it comes to risk 
factors, touching base and communicating with one's physician is so 
important. People who think they may be at risk should discuss this 
with their doctors, and they should discuss all of the risk factors 
that are present.
  Cancer prevention is certainly very important. Cancer prevention is 
an action taken to lower the chance of getting cancer. By preventing 
cancer, the number of new cases of cancer in a group or in a population 
is lowered. Hopefully, this will lower the number of deaths caused by 
cancer. To prevent new cancers from starting, scientists look at risk 
factors and protective factors. That's where the value of these regular 
screenings comes in. Anything that increases your chance of developing 
cancer is called a ``cancer risk factor,'' and anything that decreases 
your chance of developing cancer is called a ``cancer protective 
factor.''
  Now, some factors for cancer can be avoided, but many cannot. For 
example, smoking and inheriting certain genes are risk factors for 
certain types of cancer, but only smoking can be avoided. As for 
regular exercise and a healthy diet, neither of those really fit well 
into the lifestyle one has while working in Congress. I've found, since 
January, neither a healthy diet nor exercise, but both of those can be 
protective factors for some types of cancers. Avoiding risk factors and 
increasing protective factors may lower your risk, but it does not mean 
that you will not get cancer. Different ways to prevent cancer are 
being studied, including changing one's lifestyle, eating habits, 
avoiding things known to cause cancer, taking medication to treat a 
precancerous condition or to keep cancer from starting.
  Certainly, breast cancer screenings have been shown to reduce breast 
cancer mortality. In the United States, death rates from breast cancer 
in women have been declining since 1990. I think that's a track record 
we can be very proud of, and it's a trend line that is just so 
important. Most of that has been due, in large part, to early detection 
by mammography screening and by improvements in treatment.

  When you look at those trends, I find appalling the recommendations 
we've recently seen come out to not just move up the age of when 
mammographies would begin but the fact that they would go to every 2 
years versus an annual basis. Currently, 61 percent of breast cancers 
are diagnosed at a localized stage for which the 5-year survival rate 
is 98 percent. Again, within the United States, I think that's a 
statistic we can be very proud of. Further reductions in breast cancer 
deaths are possible by not spreading out but, rather, increasing 
mammography screening rates and by providing timely access to high-
quality follow-ups and treatment.
  Despite the relatively high prevalence of mammography screenings in 
the United States and within the document I made reference to 
previously--this is from 2006--I think that we've seen actual 
improvements in terms of access to screenings. Nationwide, for women 40 
years of age and older, 61.2 percent have had mammography and clinical 
breast exams. Ages 40 to 64 is

[[Page H14864]]

59.7 percent; 65 years of age and older is 64.6 percent. These are good 
numbers. They could be better. We could improve upon them. I don't 
think we can improve upon them by following those recommendations that 
were just recently put out.
  Recent studies suggest that many women are initiating mammographies 
later than recommended or are not having mammographies at all or are 
not having them at the recommended intervals or are not receiving 
appropriate and timely follow-ups of positive screening results. These 
indicators of inadequate screenings are associated with a more advanced 
tumor size and stage at diagnosis.
  In accordance with the American Cancer Society screening guidelines, 
it is important for women aged 40 and older to receive mammography 
screenings on an annual basis at an accredited mammography screening 
facility. For women with increased risks of breast cancer, the society 
recommends annual screenings using MRIs, or magnetic resonance imaging, 
in addition to the mammograms.
  I am very appreciative of my good friend from Ohio for, once again, 
taking the leadership on this very important topic and for allowing me 
to join in with you tonight.
  I yield back.
  Mrs. SCHMIDT. I thank you very much. This whole report concerns me on 
a multitude of levels.
  A few weeks ago, I and a group of women got together, and we held a 
press conference. At the press conference, when it was my turn to 
speak, I actually had a reporter who questioned what we were saying 
because we were not ``professionals'' in the field.
  I held up the report, and I said, Have you read it?
  Well, he hadn't read it. So I handed it to him and suggested that he 
read it; but you know, I'm not a professional. I don't have a medical 
background. I'm just a woman, and I'm a woman concerned about my 
friends who have had to undergo the fear of having breast cancer. With 
treatment and especially with early diagnosis, they are living very, 
very normal lives. I could go on and on.
  I have a friend who was 41. She missed her first mammography at the 
age of 40. She went, and she had a very, very small tumor, and she had 
it out. That was 4 years ago. She has a little girl. She's going to 
live to be a ripe old age. Thank God she was able to have that 
mammography, because there is no breast cancer in her family. So, 
according to this report, she shouldn't have had it until age 50 
because she's not at risk, but ah, indeed, 75 percent of people who get 
breast cancer do not have risk factors for cancer. Only 25 percent do.
  I want to read right now the report from the American College of 
Radiology. It's dated November 24, 2009. I want to read it because 
they're the scientists; they're the professionals--I'm not. I think 
that what you will see in this is an unraveling of the inconsistencies 
of this report.
  It says that several sections of the Senate health care reform 
legislation contain language stipulating that insurance entities, such 
as private insurers, Medicare and Medicaid, would only be required to 
cover services receiving a specific rate from the United States 
preventative service task force. Presently, this would exclude 
mammography services for the majority of women 40 to 49. It would only 
require coverage of biannual--that's every other year--coverage for 
women 50 to 74, and it would exclude coverage for those women 74 years 
of age and older. While the USPSTF recommendations may result in cost 
savings, a great many women will die unnecessarily from breast cancer 
as a result.
  These are not my words. These are the words of the American College 
of Radiology.
  It goes on to read that this is not a political argument. It is a 
matter of life and death. Congress needs to act to specifically protect 
annual mammography coverage for women ages 40 and older and for high-
risk women under 40 as recommended by their physician, said James T. 
Thrall, M.D., FACR, Chair of the American College of Radiology Board of 
Chancellors.
  If the cost-cutting USPSTF mammography recommendations are not 
excluded from health care reform legislation, the government or private 
insurers would be permitted to refuse women coverage for this 
lifesaving exam, turning back the clock on two decades of advances 
against the Nation's second leading cancer killer.
  These aren't my words. This is the American College of Radiology. 
They go on.
  The federally funded and staffed task force includes representatives 
from major health insurers, but it does not include a single 
radiologist, oncologist, breast surgeon or any other clinician with 
demonstrative expertise in breast cancer diagnosis or treatment.

                              {time}  2130

  Despite demonstrations by their own analysis that screening annually 
beginning at age 40 saves most lives and most years of life, the task 
force recommended against mammography screening for women 40 to 49 
years of age, annual mammograms for women between 50 and 74--in favor 
of only every other year--and all breast cancer screening in women over 
74. These recommendations run counter to even the task forces own data 
and are out of touch with the long-proven policies of the American 
Cancer Society, the ACR, and other experts in the field.
  I have to digress for a moment because my very, very dear friend, her 
mother is 90. Her mother did a self-breast exam and noticed a lump, had 
a mammography. They did a lumpectomy. That was a few months ago.
  My very dear friend lost her father a couple of years ago. All she 
has is her mother and her brothers and sisters. She is delighted to 
know that her mother has a long life ahead of her and at least isn't at 
risk for this disease. But, again, according to what these 
recommendations are, she wouldn't have gotten a mammography and 
wouldn't have gotten a lumpectomy.
  I will go back to the American College of Radiology's report that 
strongly urges those in Congress to exclude the USPSTF guidelines from 
health care legislation and make changes to the task force membership, 
an operating process that will guard against such unacceptable 
recommendations moving forward without any input from experts in breast 
cancer diagnosis and treatment, said W. Phil Evans MD, FACR, president 
of the Society of Breast Imaging, SBI.
  This states that since the onset of regular mammography screening in 
1990, the mortality rate from breast cancer, which has been unchanged 
for the preceding 50 years, has decreased by 30 percent. Ignoring 
direct scientific evidence from large clinical trials, the task force 
based their recommendations to reduce breast cancer screening on 
conflicting computer models--conflicting computer models--and the 
unsupported and discredited idea that the parameters of mammography 
screening change abruptly at the age of 50.
  In truth, there are no data to support this premise.
  Let me continue, that allowing a small number of people with no 
demonstrative expertise in the subject matter to make recommendations 
regarding diagnosis of a disease which kills more than 40,000 women a 
year makes no scientific sense and is a mistake that many women will 
pay for with their lives--these are not my words. This is the American 
College of Radiology's words--and that lawmakers need to require that 
the task force includes experts from the field on which they are making 
recommendations and that its recommendations be submitted for comment 
and review to outside stakeholders in similar fashion to rules enacted 
by the Centers for Medicare and Medicaid Services, said Thrall.
  Before I continue with this, I just want to say that if we are going 
to base health care on any task force's grading system of an ``A'' or a 
``B,'' my fear is what kind of experts are going to be doing the 
grading and what kinds of outcomes are going to be there, because 
clearly, according to the American College of Radiology, this report is 
not true science.
  Let me continue, that it is well known that mammography has reduced 
the breast cancer death rate in the United States by 30 percent since 
1990, hardly a small benefit. Based on data on the performance of 
screening mammography as it is currently practiced in the United 
States, one invasive cancer is found for every 556 mammograms performed 
in women in their forties.

[[Page H14865]]

  I want to repeat that, because, you know, this report says that for 
women under the age of 50 they are going to have anxiety and fear--
``Oh, my gosh, I might have breast cancer''--so why put them through 
it. Well, for 556 people that's true, but that one in 556 does have 
breast cancer. That one in 556 has the right to know it, know it in its 
earliest stages and get treated appropriately.
  Let me continue, that mammography only every other year in women 50 
to 74 would miss 19 to 33 percent of cancers that could be detected by 
annual screening.
  Let me digress, that's my age group. I am in my fifties. So I am not 
supposed to have this every year, this mammography? I am supposed to 
have it every other year? But that means my chances for finding early 
detection and living a long time would be decreased instead of helped.
  Then it continues that starting at age 50 would sacrifice 3 years of 
life per 1,000 women screened that could have been saved had screening 
started at the age of 40.
  Okay. I don't want to be that one life in 1,000 and neither does any 
other woman in America, but let me continue.
  Eighty-five percent of all abnormal mammograms would require only 
additional images to clarify whether cancer may be present or not. Only 
2 percent of women who receive screening mammograms eventually require 
a biopsy, but the task force data showed that the rate of biopsy is 
actually lower among younger women.
  The issue of overdiagnosis is controversial. By the task force's own 
admission, it is difficult to quantify and is less of a factor among 
younger women who have had many years of life expectancy.
  Weighing the significance, documented benefits of annual mammography 
screening against possible anxiety and the need for additional imaging 
or biopsy, it is difficult to understand how the task force reached its 
recommendations.
  Again, these aren't my words. These are the American College of 
Radiology, that these new recommendations have created a great deal of 
confusion among women, a situation that might have been avoided by 
consulting those of us in the field who actually care for women who are 
seeking detection, diagnosis, and treatment of breast cancer. The 
unfortunate result may be decreased utilization of this lifesaving 
tool.
  I urge insurers and Congress not to compound the problem by allowing 
the possibility of denying coverage to women who seek routine annual 
mammography starting at the age of 40 and continue for as long as they 
are in good health, said Carol H. Lee, MD, Chair of the ACR Breast 
Imaging Commission. The task force is a panel funded and staffed by the 
Health and Human Services Agency for Health Care Research and Quality.
  The Medicare Improvement for Patients and Providers Act of 2008 gave 
the U.S. Department of Health and Human Services the authority to 
consider the USPSTF recommendations in Medicare coverage 
determinations. Private insurers may also incorporate the task force 
recommendations as a cost-saving measure.
  I want to repeat that, because I think that's the most chilling 
revelation that I have uncovered in this whole breast cancer debate. 
The Medicare Improvement for Patients and Providers Act of 2008 gave 
the U.S. Department of Health and Human Services the authority to 
consider this task force's recommendation in Medicare coverage 
determinations. Private insurers may also incorporate the USPSTF 
recommendations as a cost-saving measure.
  I am quite alarmed, and I think most Americans are as well.
  I have been joined by my colleague from Wyoming, Ms. Cynthia Lummis.
  Mrs. LUMMIS. I would like to thank the gentlewoman from Ohio for 
bringing this issue to our attention once again this evening. You know, 
many of us have anecdotal information about friends, relatives, 
colleagues who have experienced the diagnosis of breast cancer in their 
forties simply because they went in to receive a routine mammogram.

  That was certainly the case with my sister-in-law who, in her 
forties, went in for a routine mammogram, had none of the genetic or 
typical markers that reveal the need to have mammograms, but, of 
course, since they were regularly recommended for women in their 
thirties and forties, she went in for her annual mammogram and was 
diagnosed with a very aggressive form of breast cancer. She was 
diagnosed, had her mastectomy, and began her chemotherapy all within 
the period of 30 days.
  Without that routine mammogram, that aggressive breast cancer would 
have had an opportunity to spread in a way that would have caused or 
exacerbated the chance that that cancer would not have been treatable 
and would not have saved her life.
  In fact, we learned during the health care debate in the House that 
in the United States both men and women have better rates of 
survivability for cancer in the United States than they do in Canada or 
in Europe. That is because cancer is routinely screened for and it is 
rapidly addressed following diagnosis. In fact, the opportunity in the 
United States to receive treatment quickly following diagnosis is 
directly related to the current health care system in the United 
States.
  As the gentlewoman from Ohio indicated, there are opportunities, due 
to the findings of this panel, for insurers to use it as a basis to 
decide not to provide covered health care insurance for breast cancer 
mammography screening for women in their forties.
  I believe that that is an indicator of how serious this issue is, and 
I want to particularly thank the gentlewoman from Ohio for calling it 
to our attention this evening.
  Mrs. SCHMIDT. Thank you so much, and I hope that your sister is doing 
well.
  Mrs. LUMMIS. She is doing very well. She is cancer free. And I would 
indicate, also, that it is, of course, just another example. But I am 
from Wyoming. One of our Senator's wives, Bobbi Barrasso, was also 
diagnosed with breast cancer in her forties as a result of a mammogram 
and is also doing well.
  You look at our tiny little congressional delegation that consists of 
one Member of the House and two Senators, and of those three people, 
two have examples of breast cancer within their own families that was 
diagnosed in women in their forties due to a routine mammogram. That 
gives, even though anecdotal, a couple of examples that are repeated 
all over the country by people who may be tuning in tonight on C-SPAN. 
Many of you know women who have been diagnosed and successfully treated 
for breast cancer in the United States.
  Part of the reason the prognosis has improved so dramatically in the 
United States for this very serious and, unfortunately, very common 
form of cancer is the fact that following routine screening, we have 
the opportunity to receive aggressive treatment in a health care system 
that, while in need of reform, is not in need of the kind of reform 
that would increase the period of time between when we are diagnosed 
and when we are treated.
  We know, from around the world, from systems of government in Europe 
and in Canada that have the form of health care that was being 
advocated in this body by the majority party and a form which, in fact, 
passed this body and is now being debated in the Senate, that, indeed, 
when you add more government to the health care system, you do add time 
lags between diagnosis and treatment. And that is something that we 
should be trying to encourage our colleagues to prevent and prevent 
especially because of the United States' superior record when compared 
to other nations around the world with regard to breast cancer.
  Mrs. SCHMIDT. Thank you so much.
  I want to continue to show that while I am not a medical professional 
and my dear colleague from Wyoming is not a medical professional, we 
are not just speaking from the heart and from our soul. We are also 
speaking from an intelligent position.
  The Washington Post had an article by Otis W. Brawley. Who is Otis W. 
Brawley? Well, he is the writer, is the chief medical officer of the 
American Cancer Society.
  Now I am not going to read this whole article that was in The 
Washington Post on November 19, but let me read some of the things from 
it.

                              {time}  2145

  Studying cancer deaths among women in their forties reveals some

[[Page H14866]]

important trends. Death rates were dropping slightly in the 1970s, 
thanks to better awareness and better treatment. In 1983, the American 
Cancer Society began recommending that all women get screened beginning 
at the age of 40. By 1990, death rates began a steep decline that 
continues today. While some of that drop is due to improvements in 
treatment, conservative estimates are that about half is due to 
mammography. Without mammography, many women would not be candidates 
for breast-conserving therapy. You cannot treat a tumor until you find 
it, and we know that mammography has led to finding tumors when they're 
smaller and far more treatable.
  We think the task force may underestimate mammography's lifesaving 
value.
  It goes on.
  In the end he wraps up by saying, In the meantime the American Cancer 
Society continues to recommend annual screening using mammography and 
clinical breast examination for all women beginning at the age of 40. 
The test is far from perfect, but it's the best way we have to find 
tumors early. How many lives are enough to make routine screening worth 
it? How many mothers, sisters, aunts, grandmothers, daughters and 
friends are we willing to lose to breast cancer while the debate goes 
on about the limitations of mammography? Turning back the clock will 
add up to too many lives lost, and too many women finding their tumors 
later, when treatment options are limited. Our medical staff and 
volunteers overwhelmingly believe the benefits of screening women ages 
40 to 49 outweighs its limitations. Let's not behave as though we lack 
a tool with proven benefits to women.
  Again, these are not my words; these are the words a medical 
professional has written in the Washington Post. I could go on, because 
the American Medical News, I pulled this off line. I just want to read 
some of the things that it says in here.
  It says, Taking its concern a step further, the American College of 
Radiology asked that the recommendations be rescinded to prevent the 
possibility of the new guidelines influencing policymakers as they 
shape health system reform legislation.
  This was printed on November 30. This article goes on to say:
  Washington, D.C. radiologist Rachel Brem dismissed the potential harm 
when compared to the value of detecting cancer. ``Virtually all my 
patients would prefer the small anxiety of a false-positive with the 
possibility to diagnose an early breast cancer.''
  Oh, yes, Mr. Speaker, we women would prefer to have a little anxiety 
and find it early, find it, treat it appropriately, and live to a ripe 
old age.
  It goes on to say, Researchers of one study found that annual 
mammography screening for women ages 50 to 79 resulted in an 8 percent 
median increase in breast cancer mortality reduction. For screening 
every 2 years, it was 7 percent. So we lose a percent if we wait every 
2 years. For screening that begins at age 40 and continues to age 69, 
researchers found a 3 percent median breast cancer mortality reduction 
with either annual or biennial screening. Researchers concluded that 
greater mortality reductions could be achieved by stopping screening at 
an older age than by initiating screening at an earlier age. No 
recommendations were made for women 75 and older because, the task 
force said, there is insufficient evidence to assess the additional 
benefits and harms. But early detection is partially credited for the 
steadily falling breast cancer rate among women younger than 50, 
according to the American Cancer Society.
  It goes on to say that they, too, debunk the findings of this study.
  I also went through and looked at some of what was being said in my 
own hometown. On the editorial page on November 18, Krista Ramsey, I 
want to read this because it really has the sentiment of my heart:
  Tell us why we shouldn't feel betrayed.
  After decades of memorizing breast cancer's warning signs, training 
ourselves to do monthly self-exams, and guilting ourselves into annual 
mammograms, we women are now being told the exams are useless and 
mammograms unreliable.
  A Federal task force has reversed a decades-long campaign that 
trained women to make screenings a cornerstone of their self-care. It 
now recommends against routine mammograms for women in their forties, 
longer intervals between them for older women, and ditching the self-
exams.
  Intended or not, yanking away the tools we relied on to keep 
ourselves safe from this disease shakes the confidence that we can keep 
ourselves safe. And fear and confusion have always been breast cancer's 
best friend.
  Now we are left to reconcile two utterly conflicting messages--the 
task force cautioning against the test the American Cancer Society 
still calls lifesaving.
  As so often happens with debates over medical care, women can't help 
but feel like pawns. Experts told us to get smart about this disease 
and we did our homework. They told us to face it straight on--have the 
tests, entertain the thought it could happen to us--and we didn't 
flinch.
  For decades, we have walked against breast cancer, run against it, 
shopped and marched against it. We devoted a whole month to raising our 
awareness, nagging other females we loved to schedule mammograms. We 
pinned on looped ribbons, we donned hot pink--and nobody looks good in 
hot pink.
  Now it seems the message is sit back, don't worry and wait. The 
millions we raised for research on prevention went for this?
  The dueling medical experts are going to be the ones to feel the 
pinch if they think they can, just like that, back women off of 
mammograms. And they should be very careful about warning against 
screenings because the results could make us worry our pretty little 
heads.
  It's not that we shouldn't be disabused of reassuring but faulty 
medical advice. It's not that women have had a long history of being 
talked down to, and all around, when it comes to matters of their 
health. Still, our skepticism can kill us.
  It's well known that we women take better care of others than 
ourselves. It doesn't take much for us to rationalize resetting our 
priorities--I'll get that tooth fixed after we pay off some bills, I'll 
schedule that test after we finish soccer season.
  Leaving work for a mammogram has always been a hassle. Now we can 
justify waiting another year. And then, as our busy lives barrel on, 
that 1 year becomes 5. For many women, that 5-year gamble will do no 
harm. For some, it's a fatal bet. And nobody can say which one of us 
can afford to wait and which cannot.
  How much less painful this would be if we all couldn't name women who 
needed a mammogram earlier than she got it. How many children wish 
their mom could have been diagnosed in time so she could see them 
graduate from high school? Do we suspect this whole debacle is more 
about saving on health care costs than sparing us anxiety? You bet we 
do.
  Are we concerned that tightening the recommendations will, down the 
road, mean limiting our care? We're not stupid.
  We're sophisticated enough to understand cancer is a wily opponent 
that doesn't follow anybody's rules. But we're savvy enough to know 
that when it comes to our health, we only get the care we demand.

  Tell us the truth. Tell us what you don't know. Put our lives before 
cost savings. Bring us fully into this discussion. And imagine that 
women who will be undiagnosed or wrongly diagnosed by your 
miscalculations is your daughter, your mother or your wife.
  I have now been joined by my very good friend, Dr. Burgess from 
Texas, and yield you as much time as you need.
  Mr. BURGESS. I thank the gentlelady for yielding. I thank you so much 
for taking the initiative to do this hour tonight. I think it is 
extremely important and extremely timely. Last month when the United 
States preventive service task force came out up with their guidelines, 
I went home from Congress to my desk and there was a copy of OB-GYN 
News that had just been delivered the week before these task force 
guidelines came out. This was the current state of the art, the current 
state of thinking just prior to these task force recommendations being 
made.
  In the article, and I am quoting here, the most effective method for 
women

[[Page H14867]]

to avoid death from breast cancer is to have regular mammographic 
screening, said Dr. Blake Cady at a breast cancer symposium sponsored 
by the American Society of Clinical Oncology. Interestingly, in their 
article they cite some statistics, and I'll be honest, these are 
statistics that I knew but I had forgotten. The rates of cancer deaths 
in the current study, 25 percent of them occurred in women who had 
regular screenings. Seventy-five percent occurred in women who did not. 
That's a 3-to-1 risk ratio of dying from breast cancer between those 
who were screened and those who were unscreened. In fact, they go on to 
say that amongst women who were unscreened, the 56 percent mortality is 
the same overall mortality we used to see in breast cancer up until 
1970 prior to the onset of widespread mammographic screening.
  Another piece of information I wanted to share tonight is from the 
American College of Obstetrics and Gynecology from their president, 
Gerald F. Joseph, who wrote to me December 4 of this year:
  As you know, the American College of OB-GYN expressed concern about 
the new breast cancer screening guidelines in a letter to the United 
States preventive service task force in May where we raised concerns 
that the C recommendation against routine screening mammography in 
women ages 40 to 49 would be misunderstood by clinicians, by patients, 
misunderstood by policymakers and insurers and ultimately this could 
prevent women in that age group from receiving important services. 
Immediately following the release of the new guidelines, the American 
College of OB-GYN instructed fellows of the college that it would 
continue to recommend routine screening for women in this age group.
  Here is probably the most critical point of Dr. Joseph's letter. In 
his last paragraph, This is especially critical right now as we caution 
Congress against giving the United States preventive service task force 
authority over women's health in health care reform.
  Today, these guidelines are simply that, they are just guidelines. 
Any doctor or patient is free to take them or disregard them, however 
it is their wish. Once this bill, as the gentlelady correctly pointed 
out, becomes law, no longer will that be an optional exercise. Those 
will be the mandated screening guidelines that will be established in 
law. And I will tell you as a physician, if an insurance company 
decides they're not going to cover something, the patient isn't going 
to get it done. It is just as simple as that. This is a step backward, 
as Dr. Cady pointed out. It is going back prior to 1970 when we had 
that 56 percent mortality prior to the institution of regular 
screenings. We don't need to do that. We don't need to do that as a 
country. We have the information, we need to act on the information, we 
need to keep patients involved in their own health care. I cannot tell 
you the number of people who came to me ultimately who had a diagnosis 
of breast cancer who found the cancer themselves. I didn't find it on a 
clinical exam. They found it on a breast self-exam. It wasn't detected 
on a mammogram. It may have occurred in that 2-year period between 
screens, but the patient found it herself. The earlier diagnosis was 
made possible by the patient's involvement in her own care. And to say 
that we are unnecessarily alarming patients by teaching them to be 
involved in their own care I think does women a great disservice.
  So I thank the gentlelady for bringing this to the floor of the 
Congress tonight. I am going to submit the letter from the American 
College of OB-GYN president for the Congressional Record, and I thank 
you for providing this very valuable service for women tonight on the 
House floor.

                                           The American College of


                              Obstetricians and Gynecologists,

                                Ponchatoula, LA, December 4, 2009.
     Hon. Michael Burgess, M.D.FACOG,
     Cannon House Office Building,
     Washington, DC.
       Dear Dr. Burgess: On behalf of the American College of 
     Obstetricians and Gynecologists (ACOG), representing over 
     53,000 physicians and partners in women's health, thank you 
     for your remarks at the December 2nd Breast Cancer Screening 
     Recommendations hearing held by the Energy and Commerce 
     Subcommittee on Health. Your opening statement and questions 
     to the United States Preventive Services Task Force (USPSTF) 
     panel highlighted both the importance of the doctor-patient 
     relationship in making medical decisions, and the flaws in 
     the USPSTF recommendations process.
       Once again, your medical knowledge and expertise are 
     proving invaluable to Congress' development of good health 
     policy.
       As you know, ACOG expressed concern about the new breast 
     cancer screening guidelines in a letter to the USPSTF in May, 
     where we raised concerns that the C recommendation against 
     routine screening mammography in women ages 40-49 would be 
     misunderstood by clinicians, patients, policymakers, and 
     insurers and that ultimately, this could prevent women in 
     that age group from receiving important mammography services. 
     Immediately following the release of the new guidelines, ACOG 
     instructed its Fellows that the College would continue to 
     recommend routine screening for women in this age group.
       Your questions to the panel effectively highlighted the 
     flaws in the process by which the USPSTF makes 
     recommendations. Lack of transparency and public input are 
     part of the problem; there is no formal mechanism for the 
     public to comment on proposed guidelines, and comments that 
     the Task Force receives from experts are not often taken 
     seriously. We also appreciate your comment that the USPSTF is 
     comprised mostly of primary care doctors and includes only a 
     limited number of ob/gyns and other specialists. This point 
     is especially critical right now, as we caution Congress 
     against giving the USPSTF authority over women's health in 
     health care reform.
       Thank you again for your remarks and for always standing up 
     for women's health.
           Sincerely,
                                           Gerald F. Joseph, M.D.,
                                                  President, ACOG.

  Mrs. SCHMIDT. Thank you so much because you are the medical expert in 
the field and I'm so glad that you came here to share your testimony 
this evening, my good friend from Texas. Because as we continue with 
this health care debate, the one underlying theme that I think the 
American public has is, will this interfere with their health. And I 
think what we're seeing from this task force's recommendations is that 
when the government takes over the health care, it has the potential 
ability to do just that--interfere with our health. This task force had 
a flawed document, it was driven to say that the risks for women were 
anxiety, but it also said in the report that costs outweighed, were 
looked at in looking at when you should have the mammographies and when 
you shouldn't have the mammographies. This report clearly was driven by 
the fact that it costs money to have good health care, no matter where 
you are.

                              {time}  2200

  And so it showed if you eliminate mammography for women under the age 
of 50, you eliminate a whole lot of cost. And for 556 women, that is 
okay. But that unlucky one that's after 556, she's the one that is 
going to be missed.
  And so as we debate health care in this country, we should never put 
a price on it, and we should never allow government to interfere with 
our lives, especially when it comes to the care of our health and our 
family.
  So I hope that we take what's out there in the bills in the House, in 
the Senate, and we delete them and we start over with a commonsense 
approach to solving the problems with health care in this country 
because quite frankly, we have the best health care in the world. It 
needs tweaking, but what we're doing right now potentially would change 
it and change it in a fashion that I don't think any American wants.
  My good friend from Texas, if you don't have anything more to say, I 
think we will yield back our time.
  I yield back our time, Mr. Speaker.

                          ____________________