TMA Testimony: CSHB 669 Breast Reconstruction

Testimony:  Committee Substitute House Bill 669 by Rep. James White

House Public Health Committee  

By: Debra Ann Patt, MD, MPH
April 27, 2011

Good morning, Madame Chair Kolkhorst and members of the committee.  My name is Debra Ann Patt. I am a physician in private practice at the Texas Oncology Cancer Center in Austin. I am board certified in oncology and hematology and have been caring for cancer patients for many years.  I’m also a member of the Texas Medical Association’s (TMA’s) Committee on Cancer.  

It is a privilege for me to speak with you today on behalf of TMA, which represents 45,000 physicians and medical students. I am here today in support of the revised committee substitute for HB 669.  As physicians, my colleagues and I had serious concerns with earlier versions of the committee substitute language which mandated what had to be discussed with breast cancer patients.  These are the very patients I treat and care for every day and each one is unique in their breast cancer diagnosis. 

We appreciate Representative White’s willingness to work with the TMA on the revised committee substitute language before you today.  We agree that a woman facing surgery for breast cancer should be informed about appropriate treatment protocols for her specific stage of breast cancer---and, if appropriate, her options for breast reconstruction. This dialogue and exchange of information is an important step between the physician and each patient before she has any treatment, not just breast cancer surgery specifically.  CSHB 669 fosters that dialogue and is no longer prescriptive about what has to be discussed.  The new CSHB 669 language preserves the discretion of the physician for each specific patient needs, the ability to discuss appropriate treatment options pertinent to each patient for their diagnosis and stage of disease or current treatment protocol they have received.  At the same time it addresses the provision of information to the patients that was a concern voiced by Rep. White’s constituents.

This change in the substitute before you today is important for the following reasons:   

First- Some breast cancer surgery, such as a lumpectomy, is performed with the intention of conserving the breast. Breast reconstruction may not be necessary. We believe that providing so much information on all options may be confusing and even misleading to the patient.  

Second- breast cancer is personal. The discussion between a patient and her doctor on her options for breast reconstruction is extremely variable and individualized. No two patients or their breast cancer treatment is exactly the same. That’s why before discussing breast reconstructive surgery, we first must consider at least these factors:   

  • Age,
  • Overall health and prior medical history or surgeries,
  • Body shape and other factors such as a history of smoking,
  • Stage of her cancer and diagnosis for the woman and whether further cancer treatment is planned, and
  • Whether she wants breast reconstructive surgery immediately, at a later period, or if at all.

Every patient considering breast cancer surgery has many concerns and complex decisions to make. Breast reconstruction may not be an immediate concern for a woman who has just received a breast cancer diagnosis. Over the course of her breast cancer treatment, a strong relationship develops between the patient and her team of physicians and other health care workers. This team is critical in the management and coordination of her care.

The written summary of information to be provided to patients by the physician and surgeon is currently developed by the Department of State Health Services (DSHS).   It is our desire that more user friendly information be provided than the onerous seventy- plus page National Cancer Organizations manual DSHS currently makes available on their website.  CSHB 669 directs DSHS to re-evaluate this written summary information by January 1, 2012.  It also allows them to consider similar information that is used by other states if appropriate.  

Texas lawmakers have demonstrated a strong commitment to preventing and fighting breast cancer. Texas was among the first states to pass a law that all women should be told about reconstructive surgery coverage.  Lawmakers also chose to protect Texas’ low income women by authorizing expanded screening for breast and cervical cancer and treatment for their cancer under Medicaid. These efforts were based on dozens of peer-reviewed studies — some done in Texas that showed that low-income women did not have adequate access to breast cancer screening, diagnosis, and treatment. Hundreds of women are alive today because of the support you provided for this well-researched cancer screening and treatment program.   

I thank you for your attention and welcome any questions you may have.

82nd Texas Legislature Testimonies 


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