Roraback pledges to offer breast cancer proposal challenged by some medical groups
Updated Wednesday, Oct. 24, 8:19 p.m.
Torrington — The first bill Republican Andrew Roraback says he’ll introduce in Congress is a version of a Connecticut law that’s already been proposed by members of the other political party.
“I want women in Connecticut to know that what they have the benefit of today is something that every woman in America should have the benefit of,” he said Wednesday, explaining his support for a measure that would require women to be notified if they are found through mammograms to have dense breast tissue. The condition can make it more difficult for the tests to detect cancer.
Roraback said he also wants to require insurers to pay for follow-up screening.
Roraback, who is seeking the 5th District congressional seat being vacated by Democrat Chris Murphy, touted the idea during a visit Wednesday to a diagnostic center, where he was joined by former Gov. M. Jodi Rell — “Connecticut’s best-known breast cancer survivor,” Roraback dubbed her — and Nancy Cappello, a Woodbury woman whose experience with cancer spurred a major effort to educate women about breast density.
For Roraback, a state senator who is campaigning on his independence, the appearance with a popular ex-governor offered a way to position himself as a supporter of women’s health in a year when his party has faced attacks for its positions on issues related to women.
(His opponent, Democrat Elizabeth Esty, plans to offer a different take Thursday, highlighting Roraback’s support for repealing the federal health reform law and the negative consequences it could have for women. And U.S. Rep. Rosa DeLauro, D-3rd District, issued a press release Wednesday evening criticizing Roraback and noting that she had already introduced legislation requiring health care providers to give women information on breast density and cancer risks.)
The bill Roraback says would be his first draws on a concept that has netted bipartisan support, passing Connecticut’s legislature unanimously in 2009. Early data from the state, the first in the nation to require notification, has convinced some former skeptics that there’s merit to requiring women to be notified if they have dense breasts, which could lead them to get ultrasounds or MRIs.
But the concept has drawn words of caution from some medical authorities, including the national organization representing radiologists and the top medical officer at the American Cancer Society. They’ve warned that mandated notices could confuse women and lead to an unnecessary screening that hasn’t been shown to save lives.
“The significance of breast density as a risk factor for breast cancer is highly controversial,” the American College of Radiology said in an April statement. “For women with dense breasts, receipt of breast density information may create undue anxiety about their risk and worry that mammography may have missed a breast cancer.”
It’s not that anyone thinks women shouldn’t know about their breast density, said Dr. Carol H. Lee, head of the communications committee of the American College of Radiology’s breast commission, and attending radiologist at Memorial Sloan-Kettering Cancer Center.
“I’m all in favor of people, not just women, but people in general being aware of their individual health status and being very involved in their health care management,” she said. “I’m not sure that I think it’s a good idea to legislate this, because we still don’t know what we should do about breast density, if anything.”
Will screening save lives?
Ultrasounds and MRIs will pick up cancers that mammograms won’t, Lee said, but research hasn’t yet determined if that saves lives. It’s possible that the cancers those tests find could instead be detected by mammograms in later years, with no change in outcome for the patient, or might never progress. And ultrasounds and MRIs can produce false positives and biopsies that turn out to be negative.
Cappello offers her personal story as a counterpoint. She got mammograms faithfully for a decade, with clean results.
Then, within two months of a normal mammogram, she learned she had advanced breast cancer, a quarter-sized tumor missed on the mammogram because she had dense breasts. She went through seven surgeries, chemotherapy and radiation. She emerged as a leading advocate for notifying women about breast density.
“While mammogram is the first step, it’s not the last,” she said Wednesday. Because dense breast tissue appears white on mammograms, just like lumps that could be cancer, she quipped that the odds of the test finding cancer are worse than the odds at a casino.
Cappello’s advocacy helped produce Connecticut’s law, passed in 2009 and signed by Rell, that requires every mammography report given to patients to include information about breast density, and a notice that patients with dense breast tissue, “which could hide small abnormalities,” may benefit from additional screening. State law also requires insurance policies to cover screening ultrasounds if a mammogram has identified dense breast tissue.
Texas, Virginia, New York and California have since passed similar laws requiring that patients be notified about dense breasts.
‘More screening is more radiation’
Shortly after the California law was signed last month, Dr. Otis Brawley, chief medical and scientific officer at the American Cancer Society, expressed concerns about its potential implications, telling the Los Angeles Times that it would likely lead to more women being referred for additional tests.
“More screening is more radiation, which is actually for sure going to cause more cancer,” Brawley, a professor of medicine and epidemiology at Emory University in Atlanta, told the newspaper. “And it’s for sure going to cause more women to have false positives and get fed up with screening and say, ‘No more screening for me.'”
But some skeptics have changed their minds after seeing data about what’s happened in Connecticut since the law passed, Cappello said.
Convincing studies
One is Dr. Jean Weigert, a radiologist and director of women’s imaging at The Hospital of Central Connecticut. She testified against a proposal in the state legislature before the 2009 bill was passed.
She has since led a study that reviewed 72,030 screening mammograms performed after the notification law took effect. Of those, 12 percent of patients received screening ultrasounds, and 429 were recommended to have biopsies, of whom 28 had cancer.
In other words, the ultrasounds identified cancer in the equivalent of 3.2 out of 1,000 women who had dense breasts and normal mammograms.
Another study found the same rate of cancers detected among 935 women who went through ultrasound screening after the notification law passed. In that sample, three cancers were found. There were 44 false positives.
“I’ve converted,” Weigert said. “And my referring physicians at The Hospital of Central Connecticut, they certainly have been converted…They want all their patients to have it.”
In addition to finding more cancers, she noted, the ultrasounds found cancers in women who were not at high risk; only one of the 28 women in her study whose cancers were detected had a family history of breast cancer. And finding cancers early makes it more likely they will be treatable, she said.
“Intellectually, it makes sense that [finding] these cancers will save lives,” she said. “We don’t have that data yet, though.”
Lee, meanwhile, pointed to the lack of data on mortality rates, and said the Connecticut data show high rates of false positives and biopsies that turn out to be negative. She said she hears from friends in Connecticut who receive letters saying they have dense breasts and want to know what to do.
“I tell them to go talk to their doctor,” she said. “It’s really raised a lot of questions.”
Asked about the cautions raised by the radiologists’ group, Roraback cited Cappello.
“When Nancy comes to Washington, D.C., I am going to personally introduce her to the president of the American College of Radiology,” he said. “And by the time Nancy is done with him, he will be on our side.”