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F I S C A L I M P A C T R E P O R T

SPONSOR Carraro

DATE TYPED 2-14-05

HB

SHORT TITLE Breast Cancer Study

SB 387

ANALYST Collard

APPROPRIATION

Appropriation Contained Estimated Additional Impact Recurring

or Non-Rec

Fund

Affected

FY05

FY06

FY05

FY06

$1,600.0

Recurring General Fund

(Parenthesis ( ) Indicate Expenditure Decreases)

Relates to SB 386

SOURCES OF INFORMATION

LFC Files

Responses Received From

Department of Health (DOH)

Health Policy Commission (HPC)

SUMMARY

Synopsis of Bill

Senate Bill 387 appropriates $1.6 million from the general fund to DOH for the purpose of con-

ducting a study in FY06 and FY07 in partnership with HPC and the University of New Mexico,

to review the environmental and physiological impacts on the causation of breast cancer. DOH

shall provide a written report to the governor and the legislative Health and Human Services

Committee by September 1, 2006.

Significant Issues

DOH states the bill addresses concerns related to the causation of breast cancer. Currently, the

environmental and physiological causal pathways of breast cancer are studied nationwide and at

the New Mexico Tumor Registry and are widely published in peer reviewed journals such as the

Journal of the National Cancer Institute. This bill provides for interviews with victims of breast

cancer and the compilation of existing research and recommendations for ongoing education by

the state.

Senate Bill 387 -- Page 2

DOH indicates interviewing victims of breast cancer involves issues of patient privacy and hu-

man subject research and would be subject to approval in accordance with legal requirements.

PERFORMANCE IMPLICATIONS

HPC indicates it will expend budget and resources for staff to attend meetings, participate in re-

search and writing, and take on other duties as required to meet the conditions of this bill. HPC

has participated in numerous healthcare related studies as a lead agency; has monitored and par-

ticipated in the process of interviewing and collection of data; and has conducted analysis on

findings and outcomes.

FISCAL IMPLICATIONS

The appropriation of $1.6 million contained in this bill is a recurring expense to the general fund.

Any unexpended or unencumbered balance remaining at the end of FY07 shall revert to the gen-

eral fund.

ADMINISTRATIVE IMPLICATIONS

DOH notes additional staff time would be needed to accomplish the requirements of the bill,

which is included in the total appropriation. The type of research study suggested in this bill

may require a multi-year plan for instrument development, data collection, analysis and report-

ing.

RELATIONSHIP

Senate Bill 387 relates to Senate Bill 386, which proposes to develop and implement a statewide

voucher program to provide baseline mammograms to women in low-income households.

OTHER SUBSTANTIVE ISSUES

DOH notes breast cancer is a significant public health issue. Breast cancer was the second lead-

ing cause of cancer death among women, and the leading cause of new cases of cancer in women

with 1,000 new cases of breast cancer diagnosed in New Mexico each year.

The environmental and physiological causal pathways of breast cancer are well documented. In

a study of breast cancer cases in the United States, it was determined that 45 percent to 55 per-

cent of cases can be explained by established environmental and physiological risk factors such

as income, reproductive factors, and family history. In addition, between 1969 and 2000, re-

searchers at UNM Health Sciences Center published 15 articles based on studies of breast cancer

among New Mexican women. A handbook for health care providers, entitled “Breast Cancer in

New Mexico,” was published in 2000, which also addresses risk factors for the development of

breast cancer, as well as provides a list of existing research and educational information regard-

ing breast cancer.

HPC notes the "State of the Evidence 2004: What Is the Connection Between the Environment

and Breast Cancer." reported the following:

.

In the past 50 years, a woman's lifetime risk of breast cancer more than tripled in the United

States, to one in seven today, which parallels the increase of chemicals in the environment.

Senate Bill 387 -- Page 3

Such chemicals include but are not limited to: medical X-rays, pesticides, household cleaning

products, personal care products and some pharmaceuticals; and chlorinated chemicals found

in drinking water and many industrial processes such as computer component manufacturing.

.

Less than one in 10 cases of breast cancers occur in women born with a genetic predisposi-

tion for the disease.

.

As many as 50 percent of breast cancer cases remain unexplained by personal characteristics

and other traditionally accepted risk factors.

.

Epidemiologists and other scientists believe many cases are linked to environmental factors.

Additionally, toxic waste sites and other “unfriendly environments” are often located close to

those who are least likely to have access to health care facilities, insurance, and financial re-

sources to fight for clean air, water and air. For example, low-income populations living in

communities comprised of poorly built homes and no running water are at greatest risk for poor

health and early mortality.

ALTERNATIVES

DOH suggests convening an expert panel to review the literature associated with the causal

pathways associated with breast cancer and reviewing these in the context of recent research on

social determinants of health. This type of review might support more effective programmatic

targeting.

HPC suggests UNM become the lead agency. An expert group of experienced scientists and re-

searchers are in place at the UNM New Mexico Environmental Health Sciences Center. Addi-

tionally, UNM has a strong statewide community outreach and education program, with numer-

ous partners, to improve environmental health. It has invested in state of the art information

technology and has developed and conducted numerous studies on cancers and the environment.

KBC/yr