Legislature(1999 - 2000)
03/21/2000 03:04 PM HES
* first hearing in first committee of referral
= bill was previously heard/scheduled
= bill was previously heard/scheduled
HB 416 - PROSTATE CANCER SCREENING CHAIRMAN DYSON announced the first order of business as House Bill No. 416, "An Act relating to insurance coverage for prostate cancer screening." Number 0062 MICHAEL H. MILLER came forward to testify in support of HB 416 and read the following testimony: I am an advanced prostate cancer patient and a prostate cancer advocate. I became a four-year survivor of prostate cancer on January 17, 2000. At the time of my diagnosis in 1996, I was given 17 to 35 months to live. An aggressive clinical trial program has enabled me to be here today to urge your support for HB 416. (However, I must say I've had some side effects through a program that involved a drug called Suramin, and I've lost hearing in my right ear, and I'm wearing the sunglasses because I have light sensitivity problems. I also have bone cancer as well as osteoporosis, and adrenal deficiency syndrome, which means my adrenal gland system will shut down due to treatment.) In 1996, the legislature passed SB 253, a bill requiring insurers to cover the cost of annual prostate cancer screening for men 50 years or older. House Bill 416 would amend that law by requiring this screening be covered at age 40, and at age 35 for men at high risk of contracting this disease. "High risk" is defined in the bill as a person who is an African-American or who has a family history of prostate cancer. According to the American Cancer Society, this year 1.2 million Americans will contract cancer, which is every 25 seconds somebody will be diagnosed; and 552,000 will die of the disease, which is every 56 seconds. In our state, an estimated 1,500 Alaskans, or four a day, will contract cancer this year, 200 more people on an annual basis than three years ago. An estimated 700 Alaskans will die of cancer this year, 2 per day, or 58 per month. Prostate cancer accounts for 29 percent of all the male-related cancers and 11 percent of cancer-related deaths in men. This year, approximately 715 men in Alaska will be diagnosed with cancer, nearly one quarter with prostate cancer. Of the estimated 354 men that will die of cancer this year in Alaska, about 5 percent will die from prostate cancer. African- American men have a 32 percent higher risk of contracting this disease than others. In 1979, Dr. Gerald Murphy, a Seattle oncology/urologist, developed the Prostate Specific Blood Antigen [PSA] test to help diagnose prostate cancer ... The test became available to all doctors in 1990. A decade old, this test has led to a decrease in the prostate cancer mortality rate. In 1976, there was a 30 percent mortality rate for men with prostate cancer. In 2000, that mortality rate is expected to drop to 17.7 percent, due in large part to the PSA test. Today, more and more young men are being diagnosed with prostate cancer. According to the American Cancer Society, 209,900 men in the United States were diagnosed with prostate cancer in 1997, and 41,800 died of the disease. About 23 percent or 47,600 of those diagnosed that year were under age 65. As a patient who was diagnosed with prostate cancer at age 43, I know that prostate cancer in men under 65 tends to be more aggressive in nature. Early detection, especially for men who are high risk, is the best way to save lives. I have a vested interest in this legislation because my two sons have up to a six times higher risk of contracting prostate cancer because I have the disease. They now know with me, I was as young as 34. Located in your packet is a page listing statistical information ... which is the third page in, under the reference material, from the 1999 Alaska Cancer Registry reported data from 1996, and the 2000 American Cancer Society-Cancer Facts and Figures indicating the prostate cancer risk by age groupings. Statistics for 1999 and 2000 show that less than one in 10,000, a man is predicted to contract prostate cancer before age 40. In 1999, statistics for the 40 to 59 age group show one in 57 will contract the disease. In 1996, this was one in 59. The 2000 statistics show a greater occurrence in this age group, with one in 53. Four years ago the statistics in the 40 to 59 age group were one in 59. If this trend continues, in 2008, men in this age group will have a one in 35 chance of contracting prostate cancer. With an aging baby-boomer society, more and more men will be diagnosed with prostate cancer. It would be prudent for the State of Alaska and the insurance industry to make an investment in preventative health care maintenance for men starting prostate cancer screening at the age of 35 for those at high risk and age 40 for others. House Bill 416 will help men be diagnosed at a younger age, saving both lives and money. In 1999, Alaska Cancer Registry report shows that only two men, ... 40 to 44 were diagnosed with prostate cancer and ten in the 45 to 49 age group; I was one of those two men in 1996. At age 43 I was diagnosed with advanced prostate cancer. If the PSA test had been made available to me at age 40, I would probably have been diagnosed with early-state prostate cancer and my disease might not have spread. Over the weekend I spoke from a gentleman from North Pole ... he was diagnosed last April at the age of 48, and he was waiting for the age of 50 for the current screening to begin, with no known family history. I think that is a perfect example of why we might want to consider dropping this down to age 40 for that reason. Prostate cancer has left me unable to work. I, like many cancer survivors, [am] receiving Social Security Disability Income and State Disability Retirement. The average cost for prostate cancer treatment is $6,000 to $10,000 annually. My expenses are running $12,000 to $15,000 annually and that does not include the office visits; that's just medicine. It is cost-effective to catch and treat this disease early on, rather than pay for long-term cost of treatment estimated at $48,690 per person. If you refer to the first page of the reference material with the Pay Now or Pay Later diagram, ... it will show you that if a person from age 35 to 65 eats ten slices of low-fat cheese pizza per week, the tomato sauce contains cancer-fighting lycopene, which is a high anti-oxidant. ... The cost will be $18,720. But if you have or get prostate cancer, it will be $48,690 from diagnosis until death. Number 0660 House Bill 416 should not cause insurance premiums to increase. Although insurers generally oppose mandates, when SB 253 was passed in 1996, an Aetna representative testified that Aetna would not oppose this bill if the legislature felt the benefits of the screening would outweigh the small costs. He said an argument can be made that early detection should result in more efficient treatment and ultimately avoid high catastrophic treatment costs. Men dying of prostate cancer are leaving behind spouses, children and many family members and friends. While we have made great strides in the United States in cancer treatment research, too many men are still being lost at too young an age. An example I can give you: I was in attendance last year lobbying on Capitol Hill in Washington, D.C., with 100 other men and 18 spouses, and little Sebastian Hanson (ph) of Scottsdale, Arizona, stole everybody's heart. He was five months old when his father passed away of prostate cancer, and Sebastian Hanson (ph) will never, ever know what his father stood for. I lost a friend, ... Mark (indisc.) of Eugene, Oregon. He died at the age of 41 with advanced prostate cancer; and he left behind three children: a 10-year old daughter, a 14-year old son and a 16-year old son. Over the last four years approximately 700 Alaskan men have been diagnosed with prostate cancer. Many of their sons will also contract this disease. Let's give men an opportunity to be diagnosed at an earlier age. Those with a five-year survival rate from this disease have a 100 percent chance they will die of another cause. I would like to leave my two sons the best possible gift: an opportunity for them to be screened for prostate cancer at an earlier age, because the odds are that they will contract the disease at a younger age than I did. I urge your support of HB 416 for future health and well-being of all Alaskan families. Number 0795 MR. MILLER drew attention to the reference material, page 8, Cancer, Basic Facts. The material indicates if screenings are done for various cancers, the five-year relative survival rate for various cancers is about 80 percent. People who were diagnosed in 1995, there is an 80 percent success rate in 2000. If all Americans participate in a regular cancer screening, this rate would increase to 95 percent. Number 0874 REPRESENTATIVE GREEN asked Mr. Miller if there is a way to prevent prostate cancer. MR. MILLER said there is no way to prevent it. The lesions of prostate cancer start at puberty but are so minuscule they can't be measured. As a man ages, the level of prostate cancer will increase. In 1996, there were 9 to 11 million men walking around with prostate cancer. A doctor has said that figure is now 20 to 30 million. A low-fat diet is good; four years ago, [the effect of] diet was inconclusive, but diet is playing a factor. Diet and exercise are the least costly things that can be done to slow the onset of any disease. MR. MILLER thanked the committee for sponsoring this bill. He has spoken to 16,000 people in the last 43 months and over 14,410 Alaskans. In four different cases, he has run into men who are high risk; because they see an age limit, they are not going in to be tested. This bill will create more access and availability if men choose to be tested. Number 1035 REPRESENTATIVE BRICE asked if there have been any studies to cross-reference the preventative side and how those impact somebody who has the genetic predisposition to develop prostate cancer. Number 1062 MR. MILLER said there have been studies done on men to focus on diet, but how much that has slowed the onset of prostate cancer he doesn't believe has been that significant. It is just a matter of time that the majority of the men who have had family history are going to come down with it. He is encouraging his sons to watch their diets. He reported that canola oil, which is recommended as being good for the heart, has linoleic acid (as does red meat)in it, which is not advantageous for people that have family histories of prostate cancer because it promotes the onset of prostate cancer. CHAIRMAN DYSON asked Dr. Nakamura if this bill is good medical policy. Number 1183 DR. PETER NAKAMURA, Director, Central Office, Division of Public Health, Department of Health & Social Services, answered yes. He said he would support Mr. Miller in everything he said. Prostate cancer is a major problem and the sooner attention is paid to the problem, the better it will be. CHAIRMAN DYSON asked Mr. Evans if the insurance industry supports this. Number 1220 GORDON EVANS, Lobbyist, Health Insurance Association of America, answered yes. Number 1230 REPRESENTATIVE BRICE made a motion to move HB 416 out of committee with individual recommendations and indeterminate fiscal note. There being no objection, HB 416 moved from the House Health, Education and Social Services Committee.