Physicians question value of breast cancer legislation

Radiologists and surgeons doubt the potential value of federal legislation aimed at improved breast cancer awareness among young women and more extensive disease management for patients who undergo breast surgery.

In March, Rep. Debbie Wasserman Schultz (D-FL) introduced the Breast Cancer Education and Awareness Requires Learning Young Act of 2009. The bill would allocate $9 million to teach women aged 15 to 39 about breast cancer risks and lend support for young breast cancer patients.

Proponents argue many women express the first symptoms of breast cancer before they reach 40, the recommended age to begin routine breast screening. Critics, such as Pamela A. Wilcox, a member of the American College of Radiology's Breast Imaging Commission, complain that provisions such as teaching breast self-examination could lead to inappropriate imaging.

Self exams sound good, but may lead to unnecessary procedures, said Dr. Stamatia Destounis, a radiologist at Elizabeth Wende Breast Care in Rochester, NY. The American Cancer Society stopped recommending breast self exam as articles showed the rate of false-positive lumps led to unnecessary surgery, she said.

But funding for patient education covering breast cancer risk factors and the potential benefits of genetic testing and counseling for young patients would be money well spent, said Dr. Matthew Gromet, chief of breast imaging at Charlotte Radiology in Charlotte, NC.

A separate bill (HR 1691, Breast Cancer Patient Protection Act of 2009) seeks mandatory hospital stays of 48 hours for breast cancer patients who undergo mastectomies and lumpectomies and 24-hour stays after lymph node dissections.

The bipartisan bill passed the House with overwhelming support, but breast surgeons are not as enthusiastic. According to Dr. Gretchen Ahrendt, a surgeon at the University of Pittsburgh Medical Center, discharge planning requires medical judgment, not legislation. Mandating a 48-hour minimum hospital stay will increase care costs and is unlikely to lead to improved patient outcomes, she said.