Legislature(1999 - 2000)

03/21/2000 03:04 PM HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
txt
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.                                                                          

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