Senate Bill S6993B

                                 BILL NUMBER:  S6993

 TITLE OF BILL :
An act to amend the public health law, in relation to information and
access to reconstructive surgery following breast cancer surgery


 PURPOSE :
To ensure that information relating to the availability and access to
reconstructive surgery following breast cancer surgery is provided to
all breast cancer surgery patients.

 SUMMARY OF PROVISIONS :
Amends section 2803-o of the Public Health Law to require hospitals to
provide certain specified information concerning reconstructive
surgery to patients before they undergo mastectomy surgery, lymph node
dissection or a lumpectomy following a diagnosis of breast cancer

 EXISTING LAW :
While existing federal and state law mandates insurance coverage for
reconstructive surgery, no requirement currently exists that would
ensure that women have the necessary information about reconstructive
surgery options that they might wish to consider nor about their
potential access to such services.

 JUSTIFICATION :
              

240,000 women will be diagnosed with breast cancer this year in the
United States and approximately 40,000 women will die of the disease.
Over the last forty years, considerable progress has been made in the
diagnosis, detection, and treatment of breast cancel.  Genetic testing
for susceptibility genes like BRCA, targeted chemotherapeutics like
Herceptin, and microsurgical reconstructive techniques have given
women more hope, more options, and a better chance of not only
surviving but recovering from this disease.

Breast cancer care, at the highest level, is delivered by a
multi-specialty group of physicians and surgeons that include a
medical oncologist, a breast Surgeon, a radiation oncologist, and a
reconstructive surgeon. Despite the advances and the progress, there
remains a significant disparity in the care provided to women with
breast cancer, particularly with respect to access to reconstructive
surgery.

Reconstruction of the breast after cancer surgery has not always been
the standard-of-care. With the development of improved reconstructive
techniques during the last two decades, we entered a new era in breast
cancer care. Reconstruction has repeatedly been shown to improve the
quality of life and overall well-being of women who have been treated
for breast cancer. However, it is not for everyone; there are some
women who undergo surgery for breast cancer who either do not want or
are not candidates for reconstruction.

In the 1990s, studies showed a great disparity among women who
received reconstruction and those who did not. This disparity related
to the patient's socioeconomic and educational status as well as to
the breast surgeon's practice setting. When breast reconstruction was
viewed as a cosmetic procedure, insurance companies were not compelled
to pay for it.  Poor women often could not afford to pay out-of-pocket
for the procedure. To address this disparity, Congress passed the
Women's Health and Cancer Rights Act in 1998. This legislation
guaranteed universal coverage for reconstruction after surgery for
breast cancer and comparable provisions were added to New York State
Insurance Law to ensure that coverage was extended here in New York.

Despite these laws, however, disparities in access to reconstructive
surgery remain.  Several important national studies conducted under
the leadership of Amy Alderman at the University of Michigan and
Caprice Greenberg at Dana Farber analyzed why many women did not
receive reconstruction.  The two dominant causes were their failure to
understand their options and breast surgeons' failures to refer their
patients to a reconstructive surgeon.  According to a recent report by
Greenberg, the greatest predictor of reconstruction was a documented
discussion about reconstruction between the breast surgeon and
patient. This critical discussion is not taking place often enough.

Statistics on the type of treatment women receive for breast cancer
care at a particular hospital or in a particular region are not
publicly available. The best surrogate is to compare the patient
population of interest with a similar one from a studied database.
The Surveillance, Epidemiology, and End Results (SEER) cancer
registry, run by the National Cancer Institute (NC1), provides this
opportunity. Analysis of treatment received by women in different
settings provides stark contrasts. The SEER database looks at women
treated in a variety of geographic settings, with attention paid to
factors such as level of education, socioeconomic status, type of
medical center (cancer center vs community hospital), and a variety of
other factors. Multiple analyses show that poor, uneducated women are
far less likely to receive reconstruction. Their breast surgeons are
less likely to discuss it with them. They are less likely to receive
treatment at a dedicated cancer center. They are more likely to
receive a lumpectomy and radiation than to undergo a mastectomy
followed by reconstruction. Greenberg et al. reported the disturbing
fact that women with Medicare had a reconstruction rate of 11%
compared with women with managed care or indemnity insurance who
received reconstruction approximately 54% of the time. Nationally,
across multiple socioeconomic groups and different treatment
environments, only 33% of women undergoing surgery for breast cancer
will receive reconstruction.

The bill is designed to educate women regarding the availability of
reconstructive surgery and enhance access to these services. When a
woman is diagnosed with breast cancer, she will be given information
that clearly explains her rights to coverage and her options as they
relate to reconstruction. This is akin to the informed consent a
patient must sign before undergoing any operation.

The bill will also require that the patient receive information
relating to the option of referral to a reconstructive surgeon at the
time of diagnosis or shortly thereafter if she chooses. Because
important decisions on cancer care, such as the choice between having
a mastectomy or a lumpectomy, are influenced, in large part, by the
patient's understanding of reconstructive options, the reconstructive
surgeon must be part of this discussion from the very beginning.

 LEGISLATIVE HISTORY :
None.

 FISCAL IMPLICATIONS :
None.

 EFFECTIVE DATE :
January 1, 2011

                                 BILL NUMBER:  S6993A

 TITLE OF BILL :
An act to amend the public health law, in relation to information and
access to breast reconstructive surgery


 PURPOSE :
To ensure that information relating to the availability and access to
reconstructive surgery following breast cancer surgery is provided to
all breast cancer surgery patients.

 SUMMARY OF PROVISIONS :
Amends section 2803-o of the Public Health Law to require hospitals to
provide certain specified information concerning reconstructive
surgery to patients before they undergo mastectomy surgery, lymph node
dissection or a lumpectomy following a diagnosis of breast cancer

 EXISTING LAW :
While existing federal and state law mandates insurance coverage for
reconstructive surgery, no requirement currently exists that would
ensure that women have the necessary information about reconstructive
surgery options that they might wish to consider nor about their
potential access to such services.

 JUSTIFICATION :
              

240,000 women will be diagnosed with breast cancer this year in the
United States and approximately 40,000 women will die of the disease.
Over the last forty years, considerable progress has been made in the
diagnosis, detection, and treatment of breast cancer. Genetic testing
for susceptibility genes like BRCA, targeted chemotherapeutics like
Herceptin, and microsurgical reconstructive techniques have given
women more hope, more options, and a better chance of not only
surviving but recovering from this disease.

Breast cancer care, at the highest level, is delivered by a
multi-specialty group of physicians and surgeons that include a
medical oncologist, a breast surgeon, a radiation oncologist, and a
reconstructive surgeon. Despite the advances and the progress, there
remains a significant disparity in the care provided to women with
breast cancer, particularly with respect to access to reconstructive
surgery.

Reconstruction of the breast after cancer surgery has not always been
the standard-of-care. with the development of improved reconstructive
techniques during the last two decades, we entered a new era in breast
cancer care. Reconstruction has repeatedly been shown to improve the
quality of life and overall well-being of women who have been treated
for breast cancer. However, it is not for everyone; there are some
women who undergo surgery for breast cancer who either do not want or
are not candidates for reconstruction.

In the 1990s, studies showed a great disparity among women who
received reconstruction and those who did not. This disparity related
to the patient's socioeconomic and educational status as well as to
the breast surgeon's practice setting. When breast reconstruction was
viewed as a cosmetic procedure, insurance companies were not compelled
to pay for it. Poor women often could not afford to pay out-of-pocket
for the procedure. To address this disparity, Congress passed the
Women's Health and Cancer Rights Act in 1998. This legislation
guaranteed universal coverage for reconstruction after surgery for
breast cancer and comparable provisions were added to New York State
Insurance Law to ensure that coverage was extended here in New York.
Despite these laws, however, disparities in access to reconstructive
surgery remain. Several important national studies conducted under the
leadership of Amy Adelman at the University of Michigan and Caprice
Greenberg at Dana Farber analyzed why many women did not receive
reconstruction. The two dominant causes were their failure to
understand their options and breast surgeons' failures to refer their
patients to a reconstructive surgeon. According to a recent report by
Greenberg, the greatest predictor of reconstruction was a documented
discussion about reconstruction between the breast surgeon and
patient. This critical discussion is not taking place often enough.

Statistics on the type of treatment women receive for breast cancer
care at a particular hospital or in a particular region are not
publicly available. The best surrogate is to compare the patient
population of interest with a similar one from a studied database.
The Surveillance, Epidemiology, and End Results (SEER) cancer
registry, run by the National Cancer Institute (NCI) , provides this
opportunity. Analysis of treatment received by women in different
settings provides stark contrasts. The SEER database looks at women
treated in a variety of geographic settings, with attention paid to
factors such as level of education, socioeconomic status, type of
medical center (cancer center vs community hospital), and a variety of
other factors. Multiple analyses show that poor, uneducated women are
far less likely to receive reconstruction. Their breast surgeons are
less likely to discuss it with them. They are less likely to receive
treatment at a dedicated cancer center. They are more likely to
receive a lumpectomy and radiation than to undergo a mastectomy
followed by reconstruction. Greenberg et al.  reported the disturbing
fact that women with Medicare had a reconstruction rate of 11%
compared with women with managed care or indemnity insurance who
received reconstruction approximately 54% of the time.  Nationally,
across multiple socioeconomic groups and different treatment
environments, only 33% of women undergoing surgery for breast cancer
will receive reconstruction.

The bill is, designed to educate women regarding the availability of
reconstructive surgery and enhance access to these services. When a
Woman is diagnosed with breast cancer, she will be given information
that clearly explains her rights to coverage and her options as they
relate to reconstruction. This is akin to the informed consent a
patient must sign before undergoing any operation. The bill will also
require that the patient receive information relating to the option of
referral to a reconstructive. surgeon at the time of diagnosis or
shortly thereafter if she chooses. Because important decisions on
cancer care, such as the choice between having a mastectomy or a
lumpectomy, are influenced, in large part, by the patient's
understanding of reconstructive options, the reconstructive surgeon
must be part of this discussion from the very beginning.

 LEGISLATIVE HISTORY :
None.

 FISCAL IMPLICATIONS :
None.

 EFFECTIVE DATE :
January 1, 2011.