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Midwest Democracy | Delay in Kansas breast cancer bill criticized

A bill aimed at better protecting women from breast cancer is running into trouble in the Kansas Legislature, apparently after becoming entangled in a political rivalry.

The bill would require medical personnel to inform women that they have dense breast tissue that can hide cancer detection during a mammogram.

Federal law currently requires radiologists to send mammogram results to a woman and her physician. But nothing requires the report to contain details about the density of her breast tissue. Experts maintain that puts some women at risk of a missed cancer diagnosis.

The measure won unanimous support in the Senate in February, but within weeks ran aground in the House.

Critics claim that’s because the chair of the House Health and Human Services Committee — conservative Republican Rep. Brenda Landwehr — wants to run later this year against the bill’s sponsor, Jean Schodorf, a moderate Republican senator. Both women are from Wichita.

“I think it stalled for political reasons,” said state Rep. Barbara Bollier, a Mission Hills Republican and a member of the House health committee. “I think it stalled because of a race between Brenda and Jean Schodorf. What else would it be?”

But Landwehr disagreed, saying the bill was backed up behind important proposals related to Medicaid reform.

Politics had nothing to do with it, she insisted.

“We deal with people’s lives,” Landwehr said of her committee. “I don’t play politics with people. I see those people. I visit these people. I meet with these people. I know the human side of it.”

Schodorf, who suspects politics may be at play, said her bill is about giving women information so they can make their own decisions about their health.

“I have to wonder why Brenda wouldn’t give (the bill) a hearing. I just have to assume it was because of politics,” Schodorf said.

The Kansas bill is part of a national trend aimed at patients with dense breast tissue, a risk factor for cancer that’s believed to be present in about 40 percent of women.

Three states, Connecticut, Texas and Virginia, already have passed similar laws to the one proposed in Kansas. Similar bills are pending in 15 other legislatures, including Missouri.

Breasts are considered to be dense if they consist mostly of connective rather than fatty tissue. Dense breast tissue can disguise cancer because it appears white on the mammogram image, just as cancer would.

As a result, experts said that a mammogram can give women with dense tissue a false sense of security because the chances of finding cancer are about as good as a coin-flip.

“How do you send a woman a letter that says ‘normal negative’ when you’re the radiologist and you know there’s a 50-50 shot that letter is wrong?” asked JoAnn Pushkin, executive director of Are You Dense Advocacy Inc., which lobbies for such laws at the state and national level.

“As women become aware of this, there’s no shortage of women diagnosed with later-stage cancers because they were missed year after year after year in a mammogram.”

But last fall, Gov. Jerry Brown vetoed a California bill similar to the one proposed in Kansas. The Democratic governor agreed that patients should be provided more information, but was worried that the notification might lead to unnecessary medical testing.

The California bill, which was opposed by some medical groups, would have told women that they could benefit from supplementary screening such as an ultra-sound exam.

By contrast, Connecticut — the first state to pass such legislation — went further by requiring insurance companies pay for an ultra-sound exam if a woman was found to have dense breast tissue.

The Kansas legislation doesn’t go nearly as far. It only requires that women should be told that they have breast tissue that could hide abnormalities and they should contact their doctor if they have questions. It doesn’t suggest additional testing.

Missouri’s bill, however, suggests that women might benefit from more tests and spells out specific options, such as an ultra-sound or a magnetic resonance imaging exam.

While it’s believed that dense breast tissue heightens the risk of cancer, how much has been widely debated, leading to questions about the effectiveness of such laws, and whether would they would just send anxious women rushing to doctors for more tests.

“There’s a down side to it,” acknowledged Barbara Monsees, professor of radiology at Washington University Medical Center in St. Louis. “It may be so misleading in that it might not give (women) enough information to make a decision.”

Monsees chairs the American College of Radiology’s Breast Imaging Commission. She said the college supports giving density information to a woman’s physician so it can be shared with the patient and discussed along with other risk factors such as family history.

Marc Inciardi, assistant professor of radiology at the University of Kansas Medical Center, told senators an ultra-sound test in addition to a mammogram could boost the chances of finding cancer by 50 percent.

Schodorf recently wrote Landwehr asking for a 30-minute hearing on the bill, but met with no success.

With the bill languishing, Republican state Rep. Pat Colloton of Leawood stepped in because she believed the bill was too important to linger as the session wound down.

In a move that angered Landwehr, Colloton went outside protocol and held a hearing in the Corrections and Juvenile Justice Committee that she chairs. The committee, which generally does not hear health-related issues, passed the bill.

But it won’t be heard on the House floor because the panel acted on the legislation over Landwehr’s objection.

“There’s a lot of frustration that we have a very important bill — that is a life and death matter for women’s health — and the chairman has had a very slow process of giving this a fair hearing,” Colloton said.

The bill could still be rescued if it can be inserted into another health-related bill pending in the Legislature.

But Landwehr said she is not sure she supports the measure. She wants to talk with physicians about its ramifications before taking a position.

Bollier, meanwhile, has been pushing for a hearing as well to address concerns she has about the Legislature getting involved in the practice of medicine.

“The question is: Is it a bad deal necessarily to say women need to get a report that says the mammogram might not be telling them if they have breast cancer?” said Bollier, an anesthesiologist by profession.

“I don’t know that there is a problem with that.”

But she’s worried that women might end up undergoing tests they don’t need, or can’t afford.

“There are things people know they could do (about dense tissue), but we don’t have any agreement in the medical world about what absolutely should be next.”

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