Sec. 2. Findings

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Congress makes the following findings: The American Cancer Society estimates that in 2013, about 232,340 new cases of breast cancer will be diagnosed in American women. Breast cancer has a disproportionate and detrimental impact on African-American women and is the most common cancer among Hispanic women. African-American women under the age of 40 have a greater incidence of breast cancer than Caucasian women of the same age. 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.

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. 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.

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. 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.

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. 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. 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. 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. 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. 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.

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Pub. L. 105-277

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Sec. 2

Findings

Pub. L.Pub. L. 105-277

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