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June 3, 2013

Disparities in breast cancer treatment: Column

Nancy G. Brinker

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There is still a lot of work to be done in the fight against breast cancer, including making sure all women have the opportunity to make their own personal decisions about their medical future.

Angelina Jolie, at 37 years of age, performed a tremendous public service when she recently announced she had a preventive double mastectomy to minimize her risk of getting cancer. She explained that she did so because she carries the BRCA1 gene mutation, which significantly increased her chances of developing breast and ovarian cancer.

This was an extremely personal and difficult decision. I know, since I made a similar decision when I was in my late 30s after being diagnosed with breast cancer, which was determined years later that it was also from carrying the BRCA1 gene mutation.

Cancer has never been an easy topic to discuss and I commend Angelina for helping initiate a dialogue about some of the complex issues women face when it comes to making decisions about their health.

Thanks to years of research -- Susan G. Komen has invested more than $34 million in more than 100 grants focused on BRCA related research alone (out of our total $755 million research investment). Today we have a greater understanding of detecting, treating and preventing cancer in BRCA mutation carriers. This is good news for women like Angelina Jolie and me, who are extremely fortunate to have access to genetic screening and preventive treatment. However, the reality is that there are still far too many women today who don't have the resources to learn about their risk factors or have access to high-quality care.

We've made some progress recently under the Affordable Care Act, which requires that insurance policies after Aug. 1, 2012 cover the entire cost for BRCA testing and genetic counseling for women with a family history, when recommended by a health care provider.

But this assumes that a woman will have the opportunity to consult with her doctor for the risk factors identified and that the subsequent treatments are covered. Regrettably, for many low-income or underinsured women, this access is not available to them today and may not be available even under terms of the ACA.

Breast cancer is the most common cancer in women worldwide. In the United States, one case of breast cancer is diagnosed every two minutes, and one woman will die of breast cancer every 13 minutes. A lack of health insurance and living in lower-resource areas are both associated with lower survival rates among breast cancer patients, as well as the presence of other illnesses, unequal access to care and disparities in treatment.

Where a women lives and how much money she has should not determine whether she lives. We can substantially improve breast cancer outcomes by ensuring that all women have access to quality cancer care.

Angelina Jolie was able to make her difficult decision because she had the financial means to do so, and as important, has a strong support system. Finding out you are at risk for or have breast cancer and then having to make decisions that will affect the rest of your life is incredibly challenging. Angelina has mentioned how lucky she is to have her partner Brad Pitt by her side, and I was also lucky to have family by my side when I made similar decisions. Not all women are as fortunate.

At Komen, a major focus is on providing financial and social support to women in lower-income settings and ensuring that these women are provided a continuum of care -- the chain of events that begin with education and screening, and carry a patient through diagnosis, treatment, follow-up and hopefully remission. For many women, this can mean the difference between life and death.

We've made remarkable advancements in treating breast cancer over the last 30 years to ensure women like Angelina Jolie can proactively take control of their future. However, we must remain mindful that there is still a lot of work to be done in the fight against breast cancer, including making sure all women have the same opportunity to make their own personal decisions about their medical future.

Nancy G. Brinker is founder and CEO of Susan G. Komen.

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