Maryland state Del. William R. McCaffrey (D-Prince George's) was a cosponsor of a new law that will require Maryland doctors to give written information to breast cancer patients about treatments. A story last week was incorrect in stating that he had cosponsored another bill.
Maryland Gov. Harry Hughes signed legislation last week aimed at promoting earlier detection of breast cancer and allowing women with the disease to make more informed choices.
The laws will take effect July 1 next year.
"We've been working for this since 1981 and finally, this year, we got it through," said Del. Joan B. Pitkin (D-Prince George's). She sponsored the bill requiring doctors to give written information to breast cancer patients about the various available treatments. Several other states, including Virginia, already have such a law.
The law states that women must be allowed at least five days between the diagnosis and the treatment to think about the treatment they want and to get a second opinion. The five-day rule may be eliminated only if the doctor can show that it would be life-threatening to delay action.
Pitkin cosponsored a second bill, along with Del. William R. McCaffrey (D-Prince George's), that requires Medicare supplemental policy coverage to pay $100 toward the cost of X-ray mammography for breast cancer patients.
Among those who have helped in the crusade for the legislation is Kensington resident Rose Kushner. She has built a national reputation as an advocate for the right of women to have access to information about breast cancer and to participate in the decisions about their treatment.
Breast cancer is expected to account for 18 percent of the cancer deaths among U.S. women this year, exceeded only by lung cancer, which is expected to account for 19 percent, according to the American Cancer Society.
Partly through the efforts of Pitkin and Kushner to make information about breast cancer more widely available, the Maryland Medical and Chirurgical Faculty has compiled a brochure to help women understand the diagnosis of breast cancer and treatment choices.
Entitled "What you're about to read on breast cancer could save a life . . . YOURS!" the brochure is available in many doctors' offices and through local medical association offices, said Elza Davis, acting executive director of the Medical and Chirurgical Faculty. A copy also can be ordered by calling (301) 539-0872; the toll-free number in Maryland is (800) 492-1056.
The brochure cites Pitkin and members of the House Environmental Matters Committee for their assistance.
Davis said that about 100,000 of the brochures were printed last year. But it isn't clear how many have actually reached the breast cancer patients for whom they were intended.
Each brochure has a postage-paid card that the patient is asked to fill out and mail to the Medical and Chirurgical Faculty, so the society can determine the distribution.
But at one legislative hearing this year, when a question about distribution was raised, the Medical and Chirurgical Faculty said it had received only 81 card replies.
"So Joan and I got up and said that this marvelous information ought to be mandated . . . that the Maryland law should require doctors to give this written information to their patients, and it went through," Kushner said.
" . . . If you have had the options explained to you in the beginning, you know the risks and the procedures, and you are not so angry," said Kushner, who has campaigned against traditional medical handling of breast cancer treatment since 1974, when she was diagnosed as having the disease.
Kushner says she called 19 doctors before she found one who would separate the biopsy from any surgical procedure that might be required to treat her cancer.
Too often, Kushner said, women suspected of having breast cancer are wheeled into the operating room for an initial biopsy and, when tumors are found to be cancerous, wake up with part or all of the breast removed. While some women may prefer the one-step procedure, others want time between biopsy and surgery to think about the treatment and to seek a second opinion, she said.
"The important thing is the waiting period," she said. "There is no other disease where they combine diagnosis and treatment in one procedure, including uterine cancer."
In the past, doctors preferred the one-step procedure because they thought it was the best way to treat cancer. But, as the Maryland medical brochure notes, "recent studies have shown that treatment can safely follow a biopsy by a week or two -- even if the lump is cancerous."
Kushner also has sought to spread the message that the Halsted radical mastectomy is among the least desirable treatments for breast cancer. The Halsted procedure involves removal of the entire breast, the nipple, some overlying skin, underlying chest muscles, nearby soft tissue and lymph nodes.
Other less radical methods include the modified radical mastectomy, in which the chest muscles are left intact; the simple mastectomy, in which the underlying chest muscles and armpit nodes are left in place, and the segmental mastectomy, in which only the segment of the breast containing the tumor is removed.
Breast cancer also may be treated with radiation therapy, chemotherapy and hormonal therapy, depending on the nature of the cancer, according to the the Medical and Chirurgical Faculty.
In the past, doctors have opposed legislation requiring them to give breast cancer patients information about the range of treatments, Pitkin said, "on the grounds that the legislature had no business telling doctors what to do . . . that for us to tell them how to run their show impacted on the physician-patient relationship."