Dear Governor Brown,
I am writing in response to your veto message regarding SB 791, the breast density notification bill.
I am the person who brought the idea for the bill to Senator Simitian and the bill had tremendous personal importance to me. My own breast cancer diagnosis was delayed because I was never informed that I have dense breast tissue and was at an increased risk to develop breast cancer. I was also never informed that the annual mammogram screening I underwent had very little chance of detecting cancer due to my high breast density.
In your veto message, you cite the “unnecessary anxiety” that breast density notification would cause. I ask you for a moment to consider the “anxiety” of a late stage cancer diagnosis. As if that isn’t devastating enough, imagine learning that your cancer might very well have been detected at an earlier stage had you received notice that you have a condition that masks breast cancer. There is no comparison between the speculated “anxiety” that breast density notification would cause and the “anxiety” of a late stage cancer diagnosis.
Secondly, you state that you talked with doctors you respect to come to your decision. I wonder why you did not also talk with patients who have suffered the ramifications of lack of notification of their own breast density? Perhaps you could have spoken to their husbands, partners and children? To have a complete and balanced understanding of the issue, why didn’t you talk to the many doctors in California who have been voluntarily informing their patients of their breast density and offering supplementary screenings to them? They would have told you that in their practices, they are doubling the rate of cancer detection by using supplementary methods of imaging. The cancers these physicians are finding (in patients with negative mammogram results) are very small and have not yet traveled to the lymph system – an extremely favorable prognostic finding.
My father, the late Dr. Gene Feldman, was a doctor you respected. In 1976 under your first term as Governor, you appointed him to serve on the Board of Medical Quality Assurance. He proudly served under your leadership until 1983. A pediatrician deeply beloved by his patients and their families, he lived his life devoted to charitable works and public service. He believed in seeing the patient as a whole person and everything that goes along with it, most importantly, educating them to be full partners in their own health surveillance. He believed in every patient’s inherent right to information about their own physiology, especially information that poses a risk. One of his many gifts to me was the pursuit of social justice, and this is what compelled me to try to spare other women from experiencing what I have endured. My father passed away just a few months before my diagnosis and did not have to endure the agony of witnessing his child fight for her life. I can only imagine the sense of injustice he would have felt upon learning that it could have been diagnosed earlier and that a small, but critical piece of information had been withheld from me.
The American Medical Association Code of Ethics Opinion 8.082 states “Withholding medical information from patients without their knowledge or consent is ethically unacceptable”. This issue comes down to the basic right of a woman to know her breast density, information that could save her life. Legislation is necessary is because the medical community has been well aware of the problem for 35 years, yet the information is still not forthcoming. How many more women need to die before that standard changes?