National Breast Cancer Coalition

Call to Action Online January 2017

Share your ACA Stories with NBCC

If Republican leaders in the House and Senate are successful in repealing the Affordable Care Act, many people with breast cancer could lose their coverage. The National Breast Cancer Coalition has advocated for guaranteed access to quality care for all since its inception in 1991. We believe access to care is a right, not a luxury, and as our top public policy priority, we developed the framework for what this legislative approach should look like. While we understand the ACA has not been a perfect plan, it has, without a doubt, saved lives.

We already know that repealing this important legislation would have devastating effects. The Congressional Budget Office recently released a report that details how repeal legislation would affect insurance coverage and the cost of premiums for the majority of Americans. According to the report, 18 million people will lose coverage the first year after the repeal bill is enacted, and that number will increase to 32 million uninsured by 2026. For those who will remain insured through individual policies, it’s estimated that premiums will rise 20 to 25 percent in the first year after enactment, rising to an increase of 50 percent following elimination of the Medicaid expansion by 2026. Why in the world would anyone think this is an acceptable solution?

For those who have benefited from enrolling in the Affordable Care Act, and/or expansion of Medicaid in your state, we want to hear from you. Send your personal stories to MyACAStory@breastcancerdeadline2020.org and we will share them through our social media channels and with Congress. If you and others in your community are involved in rallies or other events, we would also love to share your experiences through brief videos, which can be downloaded to this link. Thank you for taking the time to share your experiences and help us fight this crucial battle.

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One of the mistaken beliefs about mammography screening is that it finds breast cancer early and thus reduces the incidence of advanced tumors. A number of studies have questioned that perception and a recent study out of Denmark [1] adds evidence that it is incorrect, and that screening mammography results in overdiagnosis in one in three women ages 50 to 68.

Denmark is particularly appropriate for a study of mammography screening because for the past 17 years, women have been invited to screening in some regions of the country, but not others. The cohort study looked at all Danish women diagnosed with invasive breast cancer from 1980 to 2010, aged 35 to 85 years. The data show that breast cancer screening was not associated with lower rates of advanced cancer, but was clearly associated with increased rates of nonadvanced tumors and DCIS. In addition, detecting DCIS through screening did not reduce the incidence of invasive breast tumors. This supports the evidence that mammography screening is very good at finding small tumors that will not become lethal, resulting in overdiagnosis and thus unnecessarily subjecting many women to the harms of toxic therapies without any benefit.

1. Njor SH, Olsen AH, Blichert-Toft M, Schwartz W, Vejborg I, Lynge E. Overdiagnosis in screening mammography in Denmark: population based cohort study. The BMJ. 2013;346:f1064. doi:10.1136/bmj.f1064.

New Breast Cancer Incidence and Mortality Data

The 2017 U.S. breast cancer incidence and mortality statistics have been published by the American Cancer Society (ACS)[1]. Once again, there is an increase in incidence in women: this year 316,120 women will be diagnosed, 252,710 with invasive breast cancer and 63,410 in situ. In 2016 those numbers were 246,660 and 61,000, respectively. It is estimated that in 2017, 2,470 men will be diagnosed with breast cancer. In 2016 that number was 2,600. Estimated 2017 deaths from breast cancer are reported as 40,610 women and 460 men. The rate of decrease in mortality is 1.8%. Incidence and mortality vary according to race, as described in the previous issue of Call to Action. While there has been a decrease in mortality, there has been no acceleration in the rate of decrease.

The analysis of breast cancer mortality is based upon data from 1989 to 2014. Many in the cancer world tout the statistic that breast cancer mortality has declined 38% over this time period. That is a correct statistic, but it is important to look carefully at what it actually tells us. The annual percentage reported is the annual percent change (APC) based mortality rate, age adjusted to the 2000 US standard population. For the period 1990 to 1995, the APC was 1.8%; 1995 to 1998, 3.3%; 1998 to 2014, 1.8%. We must look at the actual numbers also which are reported per 100,000. In 1989 33.2 per 100,000 women died of breast cancer. In 2014, that number was 20.7 per 100,000 women (https://seer.cancer.gov/statfacts/html/ld/breast.html). We at NBCC do not believe this is a statistic to celebrate. While many scientists have analyzed the data to determine the cause of the reduction in mortality, there is no definitive answer. Most experts conclude that the reduction was predominantly (two thirds) the result of improved systemic therapy [2].

The ACS report does not include the in situ cases in its incidence total (it is reported in a footnote). Non-invasive in situ carcinoma is a condition where abnormal cells are found within the milk ducts or lobules and have not spread to the surrounding tissues in the breast or other parts of the body. In situ breast cancer is called Ductal Carcinoma in Situ, or DCIS. While it is referred to as "carcinoma" the consensus is that it is not cancer. DCIS may never invade beyond the duct into tissue. Yet, women who receive a diagnosis of DCIS often are treated in the same way as women who are diagnosed with invasive cancer – they have surgery to remove the DCIS and then radiation therapy. Some may receive chemotherapy. They even remove their breasts, sometimes both of them, all in the hopes that the DCIS will not spread to become invasive breast cancer, and then metastatic cancer that is lethal, when in fact DCIS will most likely not present a problem [3]. For these reasons, NBCC believes the statistics should include in situ breast cancer, to give the full story of what women face.

1. Siegel, R. L., Miller, K. D. and Jemal, A. (2017), Cancer Statistics, 2017. CA: A Cancer Journal for Clinicians, 67: 7–30.

2 H. Gilbert Welch, M.D., M.P.H., Philip C. Prorok, Ph.D., A. James O’Malley, Ph.D., and Barnett S. Kramer, M.D., M.P.H. Breast-Cancer Tumor Size, Overdiagnosis, and Mammography Screening Effectiveness. N Engl J Med. 2016; 375:1438-1447. DOI: 10.1056/NEJMoa1600249

3. Narod SA, Iqbal J, Giannakeas V, Sopik V, Sun P. Breast Cancer Mortality After a Diagnosis of Ductal Carcinoma In Situ. JAMA Oncol. 2015;1(7):888-896. doi:10.1001/jamaoncol.2015.2510

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NBCC President Fran Visco spoke with Kaiser Health News and National Public Radio (NPR) about the Danish mammogram study:

NPR
Danish Study Raises More Questions About Mammograms' Message

USA Today
Mammograms lead to unneeded treatment for some breast cancers

The New York Times
Fran also weighed in this month in a letter to the editor of The New York Times in response to an article entitled ‘Taxpayers Finance Cancer Drug, but the Profits Will Be Private.” The article highlighted problems in the system of research that results in drugs that do not save lives and that few can afford.
Fruitless Drug Research
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NBCC ADVOCATE LEADERSHIP SUMMIT & LOBBY DAY- Washington, DC May 20-May 23 2017

Do you want to be part of a social movement that makes a real difference? If you would like to expand your skills and make an impact as a breast cancer advocate, join us at the 2017 Advocate Leadership Summit in Washington, DC, May 20-May 23, at the Renaissance Capital View Hotel. Registration fee for this year’s Summit is $500, which entitles you to three days of outstanding programming, Summit materials, breakfast, lunches and refreshment breaks, an evening reception, and breakfast, lunch and transportation on Lobby Day. Hotel lodging is not included. On Tuesday, May 23, 2017 we will host a Lobby Day on Capitol Hill. Please note that there is no charge for participating in our Capitol Hill Lobby Day on May 23rd, even if you aren’t able to attend the Summit. Find out more here.