National Defense Authorization Act for Fiscal Year 2013
Floor Speech
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Ms. JACKSON LEE of Texas. I thank both the ranking member and the chair.
I have so much to say about this very passionate issue. I will quickly say that I have two amendments. One deals with outreach on behalf of small and minority businesses for defense contracts, and I truly believe it is enormously important for the vast number of those businesses; but I really rise today to talk about triple negative breast cancer, which has killed so many women.
I am very, very pleased to say that my amendment, with the Office of Health within the Department of Defense, will identify specific genetic and molecular targets and biomarkers for triple negative breast cancer, provide information useful in biomarker selection, drug discovery, and clinical trial design that will enable both triple negative breast cancer patients to be identified in the progression of the disease and also to provide for therapies.
I do this in the loving memory of Yolanda Williams, whose funeral I spoke at last year. She was the daughter of Dr. Lois Moore and the wife of Mr. Williams, and she had two beautiful daughters. This wonderful, caring woman died so quickly because of triple negative breast cancer. Also, in the loving memory of Betty Sommer's daughter, Stacey Michelle Gaecke, she shares her story that she also died from triple negative breast cancer.
I ask for the support of my amendment.
Mr. Chair, I rise today in support of my amendment # 91 to H.R. 4310 ``National Defense Authorization Act,'' which would direct the Department of Defense Office of Health to work in collaboration with the National Institutes of Health to identify specific genetic and molecular targets and biomarkers for Triple Negative Breast Cancer, TNBC. In addition, my amendment is intended to result in information useful in biomarker selection, drug discovery, and clinical trials design that will enable both TNBC patients to be identified earlier in the progression of their disease and develop multiple targeted therapies for the disease.
Triple negative breast cancer is a specific strain of breast cancer for which no targeted treatment is available. The American Cancer Society calls this particular strain of breast cancer ``an aggressive subtype associated with lower survival rates.''
I offer this amendment in hopes that through a coordinated effort DOD and NIH can develop a targeted treatment for the triple negative breast cancer strain.
Breast cancers with specific, targeted treatment methods, such as hormone and gene based strains, have higher survival rates than the triple negative subtype, highlighting the need for a targeted treatment.
Today, breast cancer accounts for 1 in 4 cancer diagnoses among women in this country. It is also the most commonly diagnosed cancer among African American women. The American Cancer Society estimates that in 2011, more than 26,000 African American women will be diagnosed with breast cancer, and another 6,000 will die from the disease.
Between 2002 and 2007, African American women suffered a 39% higher death rate from breast cancer than other groups.
African American women are also 12% less likely to survive five years after a breast cancer diagnosis. One reason for this disparity is that African American women are disproportionally affected by triple negative breast cancer.
More than 30% of all breast cancer diagnoses in African Americans are of the triple negative variety. Black women are far more susceptible to this dangerous subtype than white or Hispanic women.
THE STORY OF YOLANDA WILLIAMS
Mr. Chair, last year, I spoke at a funeral for Yolanda Williams, one of my constituents in the 18th Congressional District of Texas. Yolanda died from her battle with triple negative breast cancer. Like many other women who are diagnosed with this aggressive strain, she did not respond to treatment. Yolanda, wife and mother of two daughters, was only 44 years old.
This strain of breast cancer is not only more aggressive, it is also harder to detect, and more likely to recur than other types. Because triple negative breast cancer is difficult to detect, it often metastasizes to other parts of the body before diagnosis. 70% of women with metastatic triple negative breast cancer do not live more than five years after being diagnosed.
Research institutions all over the nation have started to focus on this dangerous strain of breast cancer. In my home city of Houston, Baylor College of Medicine has its best and brightest minds working tirelessly to develop a targeted treatment for the triple negative breast cancer subtype. It is time for the Department of Defense to follow that example and commit additional funding to study the triple negative strain.
I urge my colleagues to join me in protecting women across the nation from this deadly form of breast cancer by supporting my amendment.
(Fast Facts)
Breast cancer accounts for 1 in 4 cancer diagnoses among women in this country.
The survival rate for breast cancer has increased to 90% for White women but only 78% for African American women.
African American women are more likely to be diagnosed with larger tumors and more advanced stages of breast cancer.
Triple-negative breast cancer, TNBC, is a term used to describe breast cancers whose cells do not have estrogen receptors and progesterone receptors, and do not have an excess of the HER2 protein on their cell membrane of tumor cells.
Triple Negative Breast Cancer (TNBC) cells are:
Usually of a higher grade and size;
Onset at a younger age;
More aggressive;
More likely to metastasize.
TNBC also referred to as basal-like, BL, due to their resemblance to basal layer of epithelial cells.
There is not a formal detailed classification of system of the subtypes of these cells.
TNBC is in fact a heterogeneous group of cancers; with varying differences in prognosis and survival rate between various subtypes. This has led to a lot of confusion amongst both physicians and patients.
Apart from surgery, cytotoxic chemotherapy is the only available treatment, targeted molecular treatments while being investigated are not accepted treatment.
Between 10 17% of female breast cancer patients have the triple negative subtype.
Triple-negative breast cancer most commonly affect African-American women, followed by Hispanic women.
African-American women have prevalence TNBC of 26% vs 16% in non-African American women.
TNBC usually affects women under 50 years of age.
African American women have a prevalence of premenopausal breast cancer of 26% vs 16% for Non-African American women.
Women with TNBC are 3 times the risk of death than women with the most common type of breast cancer.
Women with TNBC are more likely to have distance metastases in the brain and lung and more common subtypes of breast cancer.
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Letter From Betty Sommer Causes for a Cure
It is with loving memory of my beautiful, loving, vivacious daughter, Stacey Michelle Gaecke, that I share her story. It is with great hope and fervent prayer that somehow, somewhere we will discover the unknown factors to be able to treat those unfortunate to be diagnosed with triple negative breast cancer.
I remember her sweet voice when she called to tell me that she had found a lump in her right breast, had made an appointment with her gynecologist, but was sure it wasn't anything and that I didn't need to come back to town to go with her as she would be fine. Of course, I was with her when her gynecologist acknowledged the mass in her breast, but indicated that because we had no history of breast cancer in our family and because of her tender young age, she truly felt that there was no reason for concern. Because my daughter-in-law was diagnosed with breast cancer at age 28, we knew that age and family history didn't mean there was no reason for concern. The doctor also agreed that next steps would be diagnostics.
On February 13, 2009 as she laid on the cold, hard table in the breast center, they told us, even before pathology, that they were relatively certain that it was breast cancer and that there was also lymph node involvement. I remember telling Stacey everything would be okay and with tears running down her cheeks, she said, ``I don't think so Mom.''
As anyone who has walked the cancer journey, the next weeks are a whirlwind of tests of all kinds, blood and lab tests and one doctor visit after another. When the path report came back and we were told that she had triple negative breast cancer, we knew it wasn't the best type to be diagnosed with, but had no idea how aggressive and deadly this sub-set of breast cancer is.
She had both a great oncologist and breast surgeon, but with the standard care of treatment currently administered; unfortunately, after weeks and weeks of chemo, this aggressive cancer began to grow again right before her bilateral mastectomy. After what appeared to be a successful surgery, although 9 of 13 lymph nodes showed involvement, she began with radiation that literally fried her skin and tissue to the point it looked like raw meat.
In October, 2009 her PET scan indicated that there was no cancer detected. We quickly learned not to use the words ``cancer free.'' In light of this great news, we took a family and friend cruise in November to celebrate her victory. It was a special time and even with the good news, I noticed that she was having trouble walking and complained of pain in her hips and legs. These symptoms continued, but none of the diagnostic testing showed any signs of cancer.
On Christmas Eve, 2009, Stacey ended up in the emergency room with a bad gallbladder and it was then doctors discovered that her breast cancer had metastasized to her lungs and her liver. When her surgeon showed our family pictures of her liver, it was unbelievable that in 2 short months her liver was close to 50% compromised. Triple negative breast cancer is extremely aggressive, fast spreading and seems to know how to dodge the chemicals and treatments that are currently given.
We took her home for Christmas knowing we would be lucky to have her with us for the next Holiday season. The following weeks revealed that there was also metastasis to the bones, which was what had been causing her pain even in November. From the time she came home at Christmas, she lived in constant pain and had to be sedated heavily to the point that she slept most of the time.
She started on a clinical trial about the third week of January and with any success and with great hope, we could have our sweet girl with us for an anticipated 6 to 9 months. Because this cancer is so aggressive and so deadly, we left for a regular treatment on Friday, February 5th and within hours she was having unusual symptoms that sent us for testing, then to the hospital and on Monday, February 8th at 8:30 am, she took her last breath. We buried her on Saturday, February 13, 2010 ..... exactly one year from her diagnosis at age 39, leaving behind a husband and two sons, ages 10 and 12.
Within a year from her passing, we had another close friend, a beautiful young mom nearly the same age who left behind 3 beautiful children who will grow up without their mother. Young women and mothers are dying because, at this time, we are still treating with standard care of treatment. The same treatment for every type of breast cancer isn't going to stop the deaths of these young women. Triple negative resists this standard care of treatment and research is needed to identify specific genetic and molecular targets and biomarkers.
It is a mother's plea that we continue to find innovative research to put an end to, not only triple negative breast cancer, but to hopefully eradicate cancer within our lifetime.
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Race/Ethnicity and Triple Negative Breast Cancer
Worse survival for African American women with breast cancer has been reported by the National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) registry, the Department of Defense database, large single-institution studies, and literature-based meta-analyses. After controlling for stage, demographics, socioeconomic variables, tumor characteristics, and treatment factors, racial disparity in survival existed among both premenopausal and postmenopausal women who were diagnosed with early-stage breast cancer. This racial disparity in survival among patients with early-stage breast cancer occurred in patients with both endocrine-responsive and nonresponsive tumors. African American women with breast cancer, especially those who are premenopausal, have a higher incidence of biologically more aggressive cancers with a basal-like subtype or that were triple negative (ie, lacking receptors for estrogen, progesterone, and HER2 neu).
The prevalence rates of the subtypes of breast cancer appear to differ by race. In studies of women in the United States and Britain, triple negative (or basal-like) tumors appear to be more common among black women, especially those who are premenopausal, compared to white women.
Distribution patterns of established breast cancer risk factors among 890 young breast cancer cases and 3,432 population-based controls
Mr. Chair, I rise to support my amendment #130 to H.R. 4310 ``National Defense Authorization Act,'' would require the Secretary of Defense prior to the awarding of defense contract to private contractors, to conduct an assessment to determine whether or not the Department of Defense has carried out sufficient outreach programs to include minority and women-owned small business.
Throughout my tenure in Congress, I have sponsored legislation that promotes diversity. I stand proudly before you today to call for renewed vigor in advocating and constructing effective policies that will make the United States the most talented, diverse, effective, and powerful workforce in an increasingly globalized economy.
This amendment will require the Department of Defense to consider the impact that changes to outsourcing guidelines will have on small minority and women owned business by requiring them to engage with these businesses.
Promoting diversity is more than just an idea it requires an understanding that there is a need to have a process that will ensure the inclusion of minorities and women in all areas of American life.
Small businesses represent more than the American dream--they represent the American economy. Small businesses account for 95 percent of all employers, create half of our gross domestic product, and provide three out of four new jobs in this country.
Small business growth means economic growth for the nation. But to keep this segment of our economy thriving, entrepreneurs need access to loans. Through loans, small business owners can expand their businesses, hire more workers and provide more goods and services.
The Small Business Administration, SBA, a federal organization that aids small businesses with loan and development programs, is a key provider of support to small businesses. The SBA's main loan program accounts for 30 percent of all long-term small business borrowing in America.
I have worked hard to help small business owners to fully realize their potential. That is why I support entrepreneurial development programs, including the Small Business Development Center and Women's Business Center programs.
These initiatives provide counseling in a variety of critical areas, including business plan development, finance, and marketing.
My amendment would require the Department of Defense to assess whether their outreach programs are sufficient prior to awarding contracts. The Department of Defense should investigate what impact their regulations have on minority and women owned small businesses.
Outreach is key to developing healthy and diverse small businesses.
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