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.