We at the Independent Women's Forum have been repeatedly, personally, and tragically affected by breast cancer. It is precisely because we love these women and care more about real lives and better care for all that we are trying to educate the public about what's at stake. A health care system based upon abstract ideas of social justice will lead to delayed and denied care - and that is unacceptable.
The Facts Behind the Tracy Ad:
300,000 American women might have died in the past 10 years
- The American Cancer Society estimates that there are 2.5 million breast cancer survivors in the United States.
- In 2009, the American Cancer Society estimates there will be 192,370 new cases of invasive breast cancer diagnosed among women in the United States.
- Using a five-year survival rate of 83.9%, 161,398 American women are expected to live for at least five years.
- If the same number of women were only given a five-year survival rate of 69.8% -- that of Britain - only 134,274 are expected to live for at least five years. That's a difference of 27,124 individuals.
- Aggregating those results over ten years would imply an additional 270,000 breast cancer victims in America.
- Per the National Institute of Health's department of Surveillance Epidemiology and End Results, breast cancer mortality rates in the United States have fallen over the past several years, so the difference would likely be even greater.
Couldn't IWF Have Chosen Different Countries with Government Health Systems and Different Statistics?
- Yes. There is no perfect statistic that controls for all of the many differences that exist between countries, populations, health systems and the many lifestyle factors that can affect health outcomes. Yet overwhelmingly, statistics suggest that the U.S. does a better job than any other country in treating breast cancer, and most other diseases.
- Even though the UK had one of the worse survival rates in Europe, the five year survival rate for all of Europe was 73.1, which is a lot worse than the U.S. survival rate, and which is actually closer to the UK statistic than the U.S. survival rate.
- Even if less than 300,000 American women could have died, as the ad says, under a government-run health care plan, the point remains: if we adopt a government-run health system the quality of care will suffer, treatment choices will be restricted, and the prognosis of women (and men) facing life-threatening diseases will be adversely affected.
Why are breast cancer survival rates in the United Kingdom significantly less than the United States?
- This can be linked to three crucial variables: delays in diagnosis, delays in treatment, and limited access to quality treatments.
- A 2007 article from the Lancet Oncology on different survival rates says that the differences in survival are due to a variety of reasons, Dr. Verdecchia and colleagues write. They include factors related to cancer services - for example, organization, training, and skills of healthcare professionals; application of evidence-based guidelines; and investment in diagnostic and treatment facilities - as well as clinical factors, such as tumor stage and biology.
- Delays in diagnosis:
- Early detection is crucial!
- In the U.S., the National Institute of Health recommends that women begin mammograms at age 40 and get checked every 1-2 years. In Britain, the National Health Service "invites" women between the ages of 50-70 for screenings every three years.
- Delays in treatment:
- Delays in radiation treatments for cancer in the UK are widely acknowledged. Britain's National Radiotherapy Advisory Group issued a 2007 report that stated "There is a large gap (63%) between current activity levels and optimal treatment levels, if radiotherapy were to be given to all who might benefit," and "the underestimate of need in the past, coupled with increasing demand, leaves the NHS with insufficient equipment and workforce to meet current and future need."
- A 1999 peer-reviewed article at the National Library of Medicine states that "Treatment protocols for breast cancer vary widely, and adherence to guidelines in the UK appears poor. The UK boasts fewer oncologists per head of population than most comparable European countries, and there is some evidence that breast cancer survival depends on access to a specialist. A recent audit in the UK showed that 28% of cancer patients waited longer to receive radiotherapy than the maximum acceptable delay set out in professional guidelines; this was attributed to lack of equipment and staff."
- There are delays in Canada too: Total waiting time between referral from a general practitioner and treatment, averaged across 12 specialties and 10 provinces, increased from 17.8 weeks in 2006 to 18.3 weeks in 2007, per a study by the Fraser Institute.
- Limited access to quality treatments:
- The British government's rationing board - the National Institute for Clinical Excellence, ironically shortened to NICE - denies treatments costing over £30,000, or about $49,000 USD at current exchange rates. In July 2009, The Wall Street Journal listed several treatments that have been refused, including two drugs, Lapatinib and Sutent, that prolong the life of those with certain forms of breast and stomach cancer. This followed on a 2008 ruling against drugs -- including Sutent, which costs about $50,000 -- that would help terminally ill kidney-cancer patients. The article quotes Peter Littlejohns, NICE's clinical and public health director, who said that "there is a limited pot of money," that the drugs were of "marginal benefit at quite often an extreme cost," and the money might be better spent elsewhere.
- The British government, laying out its cancer strategy in 1999, stated "It will require more rapid referral from primary care to hospital, more rigorous adherence to consensus guidelines, and, perhaps above all, the availability of resources for enough specialists to deliver the best available treatment to all breast cancer patients."
- After years of denying the drug to patients based on cost, Britain's National Health Service was forced to provide Herceptin - a drug proven effective at attacking breast cancer tumors - in 2006 after a woman sued to have access to the treatment.
- A patient's ability to choose different protocols based on individual need is an important aspect of treating breast cancer, and one that should be preserved. One-size fits all guidelines jeopardize that choice.
Government control is the problem
- Those factors which are primarily cited as causing the difference in outcomes: wait times for diagnosis and care, and access to treatment, are very much driven by having a government system for which controlling costs is a key priority.
- Governments in the UK and Europe have a much greater degree of control as to the access to certain services and treatments, including the location and size of treatment centers. Cancer services are government driven and controlled in UK and Europe ... even tumor stage at diagnosis can often be due to the availability and access to screening services.
- Women in the US get diagnosed earlier because care is not delayed or denied.
- According to a 1999 peer-reviewed article at the National Library of Medicine, "International or regional differences in survival could be at least partly attributable to cultural differences that influence the stage at which disease is diagnosed, as well as to the different ways in which national health care systems are organized." The article continues: "the evidence suggests that many of the observed differences in breast cancer survival between countries, regions and population subgroups are systematic, and can be largely attributed to differences in access to health services, including delay in presentation and diagnosis, and to the overall quality of care."
Why do countries with government-run health care systems have similar or better life expectancy than the U.S.?
- There are a number of variables that factor into the length of a person's life - many related to lifestyle choices (diet, smoking, exercise, alcohol consumption). The most significant variable has been shown to be GDP per capita. Other factors include accidental deaths (e.g. auto accident rates) and violent death (e.g. crime) as well as tremendously differing practices between countries for what counts as a live birth.
- Unfortunately, just looking at "average life expectancy rates" is misleading, because these statistics are not directly correlated to a person's involvement with the health care system of their respective country. Also, after adjusting for crime rates, life expectancy in the U.S. climbs significantly.
- Statistics looking at mortality rates are difficult to compare across countries, as countries measure mortality differently.
- A WHO study - nearly ten years old and discredited - ranks the U.S. 37th. It has been acknowledged that the ranking is based on many factors such as egalitarian care. If all get equal care, rankings are elevated -- even if all only have access to poor care.
- As far as data analysis is concerned, mortality rates are not a superior metric to survival rates. Mortality rates confound medical care and incidence of disease. A country with a higher incidence of breast cancer will have a higher mortality rate, even if medical care is the best. No statistic is perfect, but that doesn't make it invalid.
But the current reform proposals don't say anything about a single-payer system!
- True, the words "single-payer system" do not appear in any legislation on the table. However, several government officials have signaled that that is their end goal.
- The public option, in its current form, is a slippery slope towards a single-payer system.
- Under Democrats' plan, over 88 million people could be forced on to government-run health insurance. According to John Shelis, vice president of the Lewin Group, "Under current law, there will be about 158.1 million people who are covered under an employer plan as workers, dependents or early retirees in 2011. If the act were fully implemented in that year, about 88.1 million workers would shift from private employer insurance to the public plan."
- Even if the current plan doesn't move us towards a single-payer system immediately, it certainly moves us closer to other European health care systems - which also have lower breast cancer survival rates.
What is IWF's vision for health reform?
- IWF wants to see policies that will increase affordability, access, quality, innovation, personal choice, and individualized care.
- Approaches to reform that protect the best part of our system while assisting those who truly need help.
- We can help those in need and improve our overall health care system without a wholesale government takeover of our health care system.
- Some strategies for reform:
- Allow for the purchase of affordable health insurance over state lines.
- Let individual citizens control their own health care dollars
- Reform tax treatment of health care
- Reform medical licensing laws
- Encourage state experimentation in high-risk pools and Medicare/ Medicaid vouchers
- Tort reform
- Reform Medicare and Medicaid
- A more consumer-centered health-care system would not rely on a single form of financing for health-care purchases; it would make use of different sorts of financing for different elements of care-with routine care funded largely out of our incomes; major, predictable expenses (including much end-of-life care) funded by savings and credit; and massive, unpredictable expenses funded by insurance
- Bottom Line: Your health and health care should not rest of having to "hope" some government bureaucrat sees fit to value your personal health conditions and circumstances.
What is Tracy's story?
- In June of 2008, at the age of 43, Tracy was diagnosed with breast cancer after a routine annual mammogram revealed an abnormal area of white spots. The mammogram was returned to her radiologist on a Friday afternoon. By Monday morning a needle biopsy with her surgeon had been scheduled for the following day. The results of the biopsy showed Tracy had ductal carcinoma. The prognosis was very good however, as the cancer had been detected in the early stages.
Her surgeon met with Tracy and her husband, Richard, to discuss her treatment options. The first option, a lumpectomy, would be followed by radiation treatment and tamoxifen, a drug which interferes with estrogen. While this treatment had a 95% survival rate for five years, there was a 40% chance of the cancer returning after the five years. And, in the event that the cancer did recur, a 70% chance that it would be invasive and Tracy would then be fighting for her life. The second option for Tracy was a double mastectomy which would prevent the cancer from ever returning.
Tracy and her husband discussed her options and did extensive research before sitting down once again with her surgeon to make a final decision. Having lost her mother to melanoma in 2003, Tracy concluded that she would rather undergo a double mastectomy and avoid any chance of cancer recurrence.
Today, Tracy is healthy and cancer-free. She and her husband live in North Augusta, South Carolina, where she home schools her five children and is active in her church.