107th Congress

Breast Cancer -- Hearing Before the Senate Committee on Appropriations -- Subcommittee on Labor, Health and Human Services, and Education -- May 9, 2001

Members Present

Arlen Specter, (R-PA), Chairman; Tom Harkin (D-IA), Ranking Member; Senator Patty Murray (D-WA).

Witnesses

Panel One: Dr. Richard Klausner, Director, National Cancer Institute (NCI); Dr. James Marks, Director, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention.

Panel Two: Ms. Nancy Brinker, founding chairwoman of the Susan G. Komen Breast Cancer Research Foundation; Ms. Christine Carpenter, member of the National Breast Cancer Coalition; Ms. Peri Gilpin, actor and member of the National Breast Cancer Coalition; Dr. Lasalle Leffall, Chair-Elect of the Susan G. Komen Breast Cancer Research Foundation; Dr. John Seffrin, CEO, American Cancer Society; Ms. Fran Visco, president, National Breast Cancer Coalition.

Purpose of Hearing:

The Subcommittee on Labor, Health and Human Services, and Education convened this hearing to discuss progress in breast cancer research.

Opening Remarks

Senator Specter began the hearing by praising the NIH as the "crown jewel of the federal government," and outlined the efforts he and Senator Harkin have made over the past years to double the NIH budget. He cited progress in stem cell research as one of the "remarkable results" of NIH's increased funding and mentioned that he has a bill pending that would remove prohibitions to conducting this research.

Senator Harkin thanked the breast cancer advocates for their efforts to eradicate breast cancer. He mentioned that his sister had died of breast cancer, and how proud he was to note that ten years ago funding for breast cancer research totaled $90 million, but this fiscal year, the funding for breast cancer research at the Department of Defense and NIH would total $600 million. He credited Senator Specter and Senator Inouye (D-HI) for the success in increasing funding for breast cancer research and praised the leadership of Dr. Klausner for his work at NCI and Dr. Marks for his efforts with CDC's cancer screening program.

Statements of Witnesses:

Panel One

Dr. Klausner:

Dr. Klausner highlighted some of the fruits of cancer research to date, citing that mortality rates for breast cancer are dropping at a rate of 3.5 percent per year, stating that survival is definitely improving and lauding dissemination efforts. He spent his remaining time discussing how advances in molecular biology have redefined the very nature of breast cancer. Klausner remarked that "Six months ago we didn't know that breast cancer is not just one disease, but many different diseases - at least six - all with different outcomes. Now we have new targets for treatment and new drugs must be directed for each of those targets." He emphasized how important it will be to be able to direct the right treatments to the right diseases, and said that currently there are 130 trials focused on 68 new targets.

Dr. Marks:

Dr. Marks discussed the CDC's National Breast and Cervical Early Detection Program, a program which provides free cancer screening services to underserved and uninsured women, including older women, women with low incomes, and women of racial and ethnic minorities. He reported that the program has completed over 3 million screenings since its inception over a decade ago. He concluded with a story of a woman who once regularly obtained mammograms, but stopped when her husband lost his job and insurance. He stressed the importance of spreading the wORD about this program and its availability to anyone who needs it.

Panel Two

Ms. Nancy Brinker:

Ms. Brinker, a breast cancer survivor herself, founded the Susan G. Komen Breast Cancer Research Foundation in memory of her sister, who died of breast cancer in 1980 at the age of 36. The Foundation is the largest private funder of breast cancer research with $68 million research grants awarded. Ms. Brinker stressed the value of public-private partnerships; the importance of increasing public awareness and early detection; the lag between what scientists know and what the community knows; and the necessity of focusing on the immediate needs of women with breast cancer. She urged a 16.7 percent funding increase for NCI to bring it to $5 billion, and an increase of $210 million for the CDC's screening program.

Ms. Christine Carpenter:

Ms. Carpenter is also a breast cancer survivor and member of the National Breast Cancer Coalition. In 1997 she founded an education and advocacy group to help women diagnosed with breast cancer make decisions about health care. Ms. Carpenter is from Cedar Rapids, Iowa, and was especially welcomed to the hearing by Senator Harkin.

Ms. Peri Gilpin:

Ms. Gilpin, actor, described her mother's death due to breast cancer and urged support for more breast cancer research. She also participated in the press conference earlier in the day that announced the introduction of the Breast Cancer and Environmental Research Act of 2001 sponsored by Senators Harry Reid (D-NV) and Lincoln Chafee (R-RI), and Representatives Nita Lowey (D-NY) and Sue Myrick (R-NC).

Dr. Lasalle Leffall:

As Chair-Elect of the Komen Foundation, Dr. Leffall expressed his intentions to funding non-duplicative breast cancer outreach projects for the medically underserved in their local communities. Dr. Leffall is a surgeon, oncologist, and medical educator and has been chairman of the department of surgery at Howard University for the past 25 years.

Dr. John Seffrin:

Dr. Seffrin, CEO of the American Cancer Society, discussed the incidence and prevalence rates of breast cancer, and highlighted disparities and the need to develop new drugs for breast cancer. He urged the committee to double the NIH budget by 2003, and recommended a budget of $27.3 billion for the NIH and $5 billion for NCI. He also urged an increase in CDC's early detection program to $315 million, citing only 15 percent of eligible women are reached through this program.

Ms. Fran Visco:

A fourteen year breast cancer survivor, Ms. Visco discussed the National Breast Cancer Coalition's new guide to quality health care. She lobbied for support of the Breast Cancer and Environmental Research Act of 2001 that would provide $30 million to NIEHS to study possible links between environmental toxins and breast cancer. She praised advances in research and discussed the complexity of the disease, but also expressed concern about discrimination in genetic research and breast cancer.

Questions:

Senator Specter:

Senator Specter remarked that the breast cancer news today was "very dramatic." He said that he is often asked if the $3.4 million increase for NIH is "too much too fast" to be assimilated into the NIH enterprise. He asked Dr. Klausner if the money is being used wisely and if progress is being made, when did he expect a cancer cure?

Dr. Klausner said that he expects that there will be multiple cures, but predicting exactly when is difficult. One problem is how quickly the new drug therapies targeted to the newly identified forms of breast cancer will get into clinical trials. He said that it will be no problem to use the increase wisely and that, in fact, he could use even more funding. Senator Harkin asked how much more, and Dr. Klausner said that a 20 percent increase over FY 2001 would fill the pipeline. Senator Specter asked Dr. Klausner to provide for the record:

What NCI has accomplished with this year's increase.
What NCI could accomplish with an 11.8 percent increase.
What NCI could accomplish with a 20 percent increase.

Senator Specter spoke about his support for health care coverage for mammograms for women ages 40-50. He asked for Dr. Marks' opinion and Dr. Marks' agreed that women in this age span should definitely be having mammograms. Senator Specter also expressed his concern about the racial and ethnic disparities in the prevention and treatment of breast cancer. Dr. Marks agreed that was still a problem, although progress is being made.

Senator Specter also asked Fran Visco to expand a bit on her views about the $30 million she was requesting for research at NIEHS on environmental toxins and breast cancer. She said that this money would be devoted to funding an overall strategy for research in breast cancer and the environment using multidisciplinary approaches.

Stem cell research was also brought up by Senator Specter. He discussed the extraORDinary promise that this research holds, and asked that breast cancer advocates support his legislation that would stop prohibitions to this research. He said he felt that there was no harm in using embryonic tissue that would be discarded. He asked Dr. Klausner if he supported stem cell research. Dr. Klausner said there were multiple ways that stem cell research might be beneficial and Dr. Marks agreed also.

Senator Tom Harkin:

Senator Harkin asked why more progress wasn't being made on getting breast cancer information to women in a meaningful manner and what Congress might do to help. Fran Visco said HCFA needed to do more. And she explained that without universal access to health care, many women who do not have health care coverage are afraid to be screened because they know that they do not have the means to do anything about the disease if they are diagnosed with it.

Senator Harkin asked what is happening in the clinical trials arena. Dr. Klausner said that progress is not as fast as it might be because they are still underfunded by a factor of two or three and so, the results of trials are too slow in coming.

Senator Harkin asked his constituent, Christine Carpenter, if she had any further thoughts. Ms. Carpenter, a school psychologist, said that although she would like to see prevention strategies for breast cancer begin in secondary schools, there is a sensitivity to talking about body parts. In addition, she felt that teachers had a real challenge in keeping up with the vast amount of new information and that adding new topics to school curriculums was difficult.

Senator Patty Murray:

Senator Murray said that she was a cosponsor of the Chafee bill that would direct the NIEHS to make grants regarding environmental factors related to the etiology of breast cancer. She said that what women want is for research to tell them what they can do to protect themselves. She also expressed concern about women and their post-operative care and the denial of reimbursement after mastectomies. Ms. Visco mentioned a set-aside of $20 million for post-operative care in DoD funding.

Ms. Klinger reiterated the need for translational research.

Prepared by: Susan Persons/OLPA