If you said breast cancer awareness, you would be right. Consider: October is Breast Cancer Awareness Month; lemons are the stars in a clever award-winning international advertisement campaign educating women about recognizing the signs of breast cancer; and Angelina Jolie announced in a New York Times op-ed earlier this year that, faced with an 87 percent risk of breast cancer -- the disease that killed her mother at age 56 -- she has recently undergone a double mastectomy.
According to the most recent numbers from the CDC, in 2009 211,731 women and 2,001 men in the U.S. were diagnosed with breast cancer, and 40,676 women and 400 men died of the disease. Worldwide, breast cancer claims more than 450,000 lives a year, and each year 1.4 million will learn they have the disease. Among women, it is the second most prevalent cancer.
But, of course, the goal of Breast Cancer Awareness Month is not merely to acquaint the public with these grim statistics. It is, most crucially, to share this fact, as explained by the American Cancer Society: "The 5-year relative survival rate is 98 percent when breast cancer is detected at an early stage and only 24 percent for late-stage disease."
I don't know about you, but I would prefer the 98 percent survival rate. How fitting, then, that this year Breast Cancer Awareness Month also coincides with the launch of the Affordable Care Act's Health Care Marketplaces.
Why? Because among the 22 preventive health care services for women that all new insurance plans must provide under the ACA is breast cancer mammography screenings every one to two years for women over 40. This means that women can access these screenings -- which are designed to detect breast cancer at an early stage -- without any out-of-pocket costs, such as a co-insurance or co-pay, even if they have not met their deductible. (Diagnostic tests will likely still incur an additional charge.)
In addition, the ACA prohibits insurance companies from refusing to cover people, or charging more, based on any pre-existing conditions, which means that women with breast cancer will now have access to affordable health coverage.
For women at higher risk of developing breast cancer, the ACA also requires insurance plans to cover breast cancer genetic testing and counseling, as well as chemoprevention counseling. In Jolie's case, the discovery that she carried a faulty BCRA1 gene led her to decide, in consultation with her doctors, to undergo a preventive double mastectomy. (I am sure Jolie has excellent insurance, but all women should know that thanks to the 15-year-old Women's Health and Cancer Rights Act, any plan that covers a mastectomy must also cover reconstructive surgery.)
Of course, regular mammograms should not replace monthly self-exams, and they will not themselves cure breast cancer. For that we need to invest in medical research, clinical trials, and opportunities for doctors to share key insights and build on each other's discoveries. In these times of government shutdowns and slashed or stagnant budgets, those things are not going to happen soon enough.
There is worse news for women who earn less than 138 percent of the federal poverty level and live in a state that has refused to expand Medicaid under the ACA: because the law intended that they have Medicaid coverage, there is no provision for subsidies to help them afford an insurance plan in the health care marketplace. The effect on women of the states' refusal to expand Medicaid could be disastrous.
But I would prefer today to focus on the positive: the millions of women who are already able to access mammography screenings thanks to the protections of the Affordable Care Act. Here's hoping we save a few lives.