,,ii  #aacth ,,congress  #ast ,session  
,s4 #ica  ,,in ,,the ,,senate ,,of ,,the
 ,,united ,,states  ,may #ac1 #bjac ,mr4
 ,blunt 7for himself1 ,mr4 ,brown1 ,mr4 
,tester1 and ,mrs4 ,feinstein7          
introduced the following bill2 which was
 read twice and referred to the         
,committee on ,health1 ,education1      
,labor1 and ,pensions  ,a ,,bill  ,to   
amend the ,public ,health ,service ,act 
to raise awareness of1 and to educate   
breast cancer patients anticipating     
surgery1 especially patients who are    
members of racial and ethnic minority   
groups1 regarding the availability and  
coverage of breast reconstruction1      
prostheses1 and other options4  #a4     
,short title ,this ,act may be cited as 
the ,breast ,cancer ,patient ,education 
,act of #bjac4  #b4 ,findings ,congress 
makes the following findings3  7#a7 ,the
 ,american ,cancer ,society estimates   
that in #bjac1 about #bcb1cdj new cases 
of breast cancer will be diagnosed in   
,american women4  7#b7 ,breast cancer   

has a disproportionate and detrimental  
impact on ,african-,american women and  
is the most common cancer among         
,hispanic women4  7#c7                  
,african-,american women under the age  
of #dj have a greater incidence of      
breast cancer than ,caucasian women of  
the same age4  7#d7 ,according to the   
,health ,resources and ,services        
,administration1 women residing in rural
 areas may have lower rates of          
mammography screening compared to       
non-rural women because of barriers to  
health care1 such as greater distances  
to medical facilities and lower         
educational1 income1 and health         
insurance levels4  7#e7 ,individuals    
undergoing surgery for breast cancer    
should have the opportunity to give due 
consideration to the option of breast   
reconstructive surgery1 either at the   
same time as the breast cancer surgery  
or at a later date4  7#f7 ,according to 
the ,american ,cancer ,society1         
immediate breast reconstruction offers  

the advantage of combining the breast   
cancer surgery with the reconstructive  
surgery and is cost effective1 while    
delayed breast reconstruction may be    
advantageous in women who require       
post-surgical radiation or other        
treatments4  7#g7 ,a woman who has had a
 breast removed may not be a candidate  
for surgical breast reconstruction or   
may choose not to undergo additional    
surgery and instead choose breast       
prostheses4  7#h7 ,the ,women's ,health 
and ,cancer ,rights ,act of #aiih       
7,,whcra2 ,public ,law #aje-bgg7        
requires health plans that offer medical
 and surgical benefits with respect to a
 mastectomy to also provide coverage for
 all stages of reconstruction of the    
breast on which the mastectomy has been 
performed1 surgery and reconstruction of
 the other breast to produce a          
symmetrical appearance1 prostheses1 and 
physical complications of mastectomy1   
including lymphedemas4  7#i7 ,a #bjjg   
study by ,amy ,alderman1 ,m4,d4 at the  

,university of ,michigan reported that  
up to #gj percent of women eligible for 
breast reconstruction are not informed  
of their reconstructive options by their
 general surgeon4  7#aj7 ,a #bjjc study 
by ,alderman and others found that race 
is a significant predictor of           
reconstruction4 ,compared with the odds 
of reconstruction for ,caucasians1 the  
odds of reconstruction for              
,african-,americans1 ,hispanics1 and    
,asians are significantly less4  7#aa7  
,a #bjjg study by ,caprice ,greenberg1  
,m4,d4 of the ,dana ,farber ,cancer     
,institute and others found that        
,hispanic patients were less likely to  
receive reconstruction4 ,this may be    
because of language barriers between the
 patient and provider4 ,although #gb    
percent of patients who primarily spoke 
,english went on to receive             
reconstruction after discussing it with 
their providers1 no patient in the study
 with a primary language other than     
,english went on to receive             

reconstruction4  7#ab7 ,a #bjji study by
 ,alderman and others also found that   
the relationship between race and       
reconstruction rates persisted when     
demographic and clinical factors were   
controlled for4 ,minority women are     
significantly less likely than          
,caucasians to see a plastic surgeon    
before initial surgery1 were most likely
 to desire more information about       
reconstruction1 and satisfaction was    
lowest among minority women without     
reconstruction4  7#ac7 ,the low use of  
reconstruction for minorities is not    
explained by lower demand for the       
procedure4 ,lower health literacy1      
financial issues1 and less access to    
plastic surgeons emerged as barriers to 
reconstruction in the #bjji ,alderman   
study4 ,these results suggest that there
 is a substantial unmet need for        
information1 especially among racial and
 ethnic minority groups regarding       
reconstruction options and coverage     
required by the ,women's ,health and    

,cancer ,rights ,act of #aiih4  7#ad7 ,a
 #bjaj study by ,warren ,h4 ,tseng1     
,m4,d4 and others at the ,university of 
,california ,davis found that patients  
from rural areas are less likely to     
undergo breast reconstruction following 
mastectomy for breast cancer than their 
urban counterparts4  #c4 ,breast        
reconstruction education ,part ,v of    
title ,,iii of the ,public ,health      
,service ,act 7#db ,u4,s4,c4 #bhjm2     
programs relating to breast health and  
cancer7 is amended by adding at the end 
the following3  #cii,,nn-#a4 ,breast    
reconstruction education  7a7 ,in       
general ,the ,secretary shall provide   
for the planning and implementation of  
an education campaign to inform breast  
cancer patients anticipating surgery    
regarding the availability and coverage 
of breast reconstruction1 prostheses1   
and other options1 with a focus on      
informing patients who are members of   
racial and ethnic minority groups4  7b7 
,information ,to ,be disseminated  7#a7 

,specific information ,such campaign    
shall include dissemination of the      
following information3  7,a7 ,breast    
reconstruction is possible at the time  
of breast cancer surgery1 or at a later 
time4  7,b7 ,prostheses or breast forms 
may be available4  7,c7 ,federal law    
mandates both public and private health 
plans to include coverage of breast     
reconstruction and prostheses4  7,d7    
,the patient has a right to choose a    
provider of reconstructive care1        
including the potential transfer of care
 to a surgeon that provides breast      
reconstructive care4  7,e7 ,the patient 
may opt to undergo breast reconstruction
 some time after the time of breast     
cancer surgery for personal or medical  
reasons1 during treatment or after      
completion of all other breast cancer   
treatments4  7#b7 ,other information ,in
 addition to the information described  
in paragraph 7#a71 such campaign may    
include dissemination of such other     
information 7whether developed by the   

,secretary or by other entities7 as the 
,secretary determines relevant4  7#c7   
,required publication ,the information  
required to be disseminated under       
paragraph 7#a7 and any information      
disseminated in accordance with         
paragraph 7#b7 shall be posted on the   
,internet ,web sites of relevant        
,federal agencies1 including the ,office
 of ,women's ,health1 the ,office of    
,minority ,health1 and the ,office of   
,rural ,health ,policy4  7#d7           
,restriction ,such campaign shall not   
specify1 or be designed to serve as a   
tool to limit1 the health care providers
 available to patients4  7c7            
,consultation ,in developing the        
information to be disseminated under    
this section1 the ,secretary shall      
consult with appropriate medical        
societies and patient advocates related 
to breast cancer1 breast reconstructive 
surgery1 breast prostheses1 and breast  
forms and with patient advocates        
representing racial and ethnic minority 

groups with a special emphasis on       
,african-,american and ,hispanic        
populations4  7d7 ,definitions ,in this 
section1 the terms racial and ethnic    
minority group and ,hispanic have the   
meanings given such terms in section    
#agjg4  7e7 ,report ,not later than #b  
years after date of enactment of the    
,breast ,cancer ,patient ,education ,act
 of #bjac and every #b years thereafter1
 the ,secretary shall submit to the     
,committee on ,health1 ,education1      
,labor1 and ,pensions of the ,senate and
 the ,committee on ,energy and ,commerce
 of the ,house of ,representatives a    
report describing the activities carried
 out under this section during the      
preceding #b fiscal years1 which shall  
include an evaluation of the extent to  
which such activities have been         
effective in improving the health and   
well-being of racial and ethnic minority
 groups4  4