[Mb-civic] Illogical Cutbacks on Cancer By BOB HERBERT-NYTimes

[Michael Butler]

The New York Times
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March 20, 2006
Op-Ed Columnist
Illogical Cutbacks on Cancer
By BOB HERBERT

When I was a kid I had the wildest crush on my Uncle Breeze's wife, Betty.
She was beautiful and with all my heart I wanted to grow up and marry
someone just like her.

I remember acutely the sadness I felt some years later when my mother told
me that Aunt Betty was ill. She died not long after that. Cervical cancer.

This old memory was brought back to me by, of all things, a small but
telling item in President Bush's mammoth budget proposal.

The federal government has a national breast and cervical cancer early
detection program, run by the Centers for Disease Control and Prevention. It
provides screening and other important services to low-income women who do
not have health insurance, or are underinsured.

There is agreement across the board that the program is a success. It saves
lives and it saves money. Its biggest problem is that it doesn't reach
enough women. At the moment there is only enough funding to screen one in
five eligible women.

A sensible policy position for the Bush administration would be to expand
funding for the program so that it reached everyone who was eligible. It
terms of overall federal spending, the result would be a net decrease.
Preventing cancer, or treating it early, is a lot less expensive than
treating advanced cancer.

So what did this president do? He proposed a cut in the program of $1.4
million (a minuscule amount when you're talking about the national budget),
which would mean that 4,000 fewer women would have access to early
detection.

This makes no sense. In human terms, it is cruel. From a budget standpoint,
it's self-defeating.

"The program is really designed to help working women," said Dan Smith, a
senior vice president at the American Cancer Society. "They may be working
at a job that doesn't provide health insurance, but they're not the poorest
of the poor who would qualify for Medicaid."

In many cases, these are women who do not have family doctors who might
encourage them to be screened. The program offers free mammograms, Pap tests
and other early detection services. "If they're diagnosed," said Mr. Smith,
"there's a complementary program that allows them to be immediately insured
so they can actually have the coverage for their treatment. That's a great
program, as well."

"The early detection program is a good program because it has saved lives,"
said Dr. Harold Freeman, a senior adviser to the Cancer Society. "The women
who are served come from a population that has a proven higher death rate
from cervical and breast cancer."

He added: "It's hard to get into the health care system when you are
asymptomatic. It's much easier to get into the system if you're obviously
sick, if you're bleeding or in pain. But the problem with cancer is, if
you're going to be cured, you have to get in before those kinds of symptoms
occur. So these women need to be screened."

Dr. Freeman, a New York physician who has long specialized in the prevention
and treatment of cancer, made it clear that his first concern was the health
and quality of life of his patients. But then he addressed what he
characterized as the "shortsighted" economic rationale for the budget cut.

"It won't save money," he said. "You don't save money by not diagnosing
cancer early. You end up spending more money because anyone who develops
cancer will get into the health care system and they will be treated. And
the cost at that point will be a lot more. The logic here is very simple:
the later you diagnose cancer of the breast or cervix, the more expensive it
is to the country."

This is just one program in a range of cancer services that rely on support
from the federal government. As if immune to the extent of human suffering
involved, President Bush has proposed a barrage of cuts for these programs.

"What's really amazing," said Mr. Smith, "is that the president cut every
cancer program. He cut the colorectal cancer program. He cut research at the
National Cancer Institute. He cut literally every one of our cancer-specific
programs. It's incomprehensible."

A bipartisan movement is under way in the Senate to block the president's
proposed cuts. How that ultimately will fare is unclear.

What is clear is that cancer is a disease that horrifies most Americans, and
with good reason. One out of every two men will contract the disease in his
lifetime, and one out of every three women.

This is an area in which we need to be doing more, not less.

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