BILL ANALYSIS Ó
AB 990
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Date of Hearing: April 28, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB 990
(Bonilla) - As Amended April 20, 2015
SUBJECT: Women's health.
SUMMARY: Requires the Department of Public Health (DPH) to
include information regarding the increased risk of breast
cancer associated with obesity in any literature regarding
breast cancer they produce or update on or after January 1,
2016. Clarifies that DPH does not need to dispose of, or
refrain from disseminating existing published literature solely
for the purpose of complying with these provisions.
EXISTING LAW:
1)Establishes DPH which is charged with promoting healthy
lifestyles for individuals and families in their communities
and workplaces, and preventing disease, disability, and
premature death and reducing or eliminating health
disparities.
2)Requires DPH to develop a coordinated state strategy for
addressing the health-related needs of women, including
implementation of goals and objectives for women's health.
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3)Requires DPH to place priority on providing information to
consumers, patients, and health care providers regarding
women's gynecological cancers, including signs and symptoms,
risk factors, the benefits of early detection through
appropriate diagnostic testing, and treatment options.
4)Requires DPH to include in any literature it produces
regarding breast cancer, information that includes, but is not
be limited to, all of the following:
a) Summarized information on risk factors for breast cancer
in younger women, including, but not limited to,
information on the increased risk associated with a family
history of the disease;
b) Summarized information regarding detection alternative
to mammography that may be available and more effective for
at-risk women between the ages of 25 to 40 years;
c) Information on Internet Websites of relevant
organizations, government agencies, and research
institutions where information on mammography alternatives
may be obtained; and,
d) Requires the information provided to consumers and
others to be produced consistent with DPHs' protocols and
procedures regarding the production and dissemination of
information on breast cancer.
5)States that it is the intent of the Legislature that these
provisions apply to information that is distributed by any
branch of DPH, including, but not limited to, the Cancer
Detection Section and the Office of Health Equity.
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FISCAL EFFECT: This bill has not been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. The author states, according to the
California Cancer Registry, breast cancer is the most commonly
diagnosed cancer among women in California. The author
asserts studies have shown that significant weight gain
increases a person's risk for breast cancer, for example, a
study published in the Journal of the American Medical
Association found that women who gained 55 pounds or more
after age 18 had a 45% higher cancer risk. The author
concludes this vital information will enable individuals to
implement preventative measures and lead healthier,
cancer-free lives.
2)BACKGROUND. Obesity is a major public health problem
contributing to 112,000 preventable deaths each year. The
prevalence of obesity has increased dramatically in recent
decades, from 13% of adults in 1980 to 34% of adults in 2008.
Obesity is a condition in which a person has an abnormally
high and unhealthy proportion of body fat. To measure
obesity, researchers commonly use a scale known as the body
mass index (BMI). BMI is calculated by dividing a person's
weight (in kilograms) by their height (in meters) squared.
BMI provides a more accurate measure of obesity or being
overweight than weight alone.
According to the Centers for Disease Control and Prevention,
obesity contributes to the following health consequences:
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coronary heart disease; Type II diabetes; cancers -
endometrial, breast, and colon; hypertension; stroke; liver
and gallbladder disease; sleep apnea and respiratory problems;
osteoarthritis; and, gynecological problems such as abnormal
menses, and infertility.
A recent study, "The impact of obesity on US mortality levels:
the importance of age and cohort factors in population
estimates," American Journal of Public Health, vol. 103, no.
10,
pp. 1895-1901, 2013, estimated that one in five deaths in the
United States is associated with obesity, surpassing smoking
as Americans' number one killer. Health problems that can be
attributed to obesity include type II diabetes, cardiovascular
diseases, hypertension, and cancer of several organs. While
the relationship between obesity, diabetes, and cardiovascular
disease has been well studied and documented, the relationship
between obesity and cancer has only started to receive much
attention in recent years.
According to the National Cancer Institute, a projection of
the future health and economic burden of obesity in 2030
estimated that continuation of existing trends in obesity will
lead to about 500,000 additional cases of cancer in the U.S.
by 2030. This analysis also found that if every adult reduced
their BMI by 1 %, which would be equivalent to a weight loss
of roughly 1 kilogram (or 2.2 pounds) for an adult of average
weight, this would prevent the increase in the number of
cancer cases and actually result in the avoidance of about
100,000 new cases of cancer.
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Guidelines established by the National Institutes of Health
place adults age 20 and older into the following categories
based on their BMI:
-----------------------------------------
| BMI | BMI Categories |
| | |
| | |
|--------------------+--------------------|
| Below 18.5 | Underweight |
| | |
| | |
|--------------------+--------------------|
| 18.5 to 24.9 | Normal |
| | |
| | |
|--------------------+--------------------|
| 25.0 to 29.9 | Overweight |
| | |
| | |
|--------------------+--------------------|
| 30.0 and above | Obese |
| | |
| | |
-----------------------------------------
The relationship between obesity and breast cancer may be
affected by the stage of life in which a woman gains weight
and becomes obese. Weight gain during adult life, most often
from about age 18 to between the ages of 50 and 60, has been
consistently associated with risk of breast cancer after
menopause. The increased risk of postmenopausal breast cancer
is thought to be due to increased levels of estrogen in obese
women. After menopause, when the ovaries stop producing
hormones, fat tissue becomes the most important source of
estrogen. Because obese women have more fat tissue, their
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estrogen levels are higher, potentially leading to more rapid
growth of estrogen-responsive breast tumors. The relationship
between obesity and breast cancer risk may also vary by race
and ethnicity. There is limited evidence that the risk
associated with overweight and obesity may be less among
African American and Hispanic women than among white women.
3)SUPPORT. The American Cancer Society Cancer Action Network
(ASCAN) supports this bill stating, excluding skin cancer,
breast cancer is the most common cancer among U.S. women and
is responsible for 29% of newly diagnosed cases. ASCAN notes
breast cancer risk in postmenopausal women is 20% higher in
overweight women and approximately two times higher in obese
women than lean women. ASCAN also notes that obesity is also
a risk factor for type II diabetes, which some studies have
linked to modestly increased risk for postmenopausal breast
cancer. ASCAN concludes, while it is important for women to
receive regular breast cancer screenings, it is also important
to ensure they receive information about the causes of breast
cancer to fight cancer with preventative measures.
California Black Health Network and Latinas Contra Cancer
support this bill because breast cancer is the second-leading
cause of cancer deaths for women. These supporters note in
2011, there were a total of 24,798 breast cancer incidences,
of which 24,591 were women, and with the growing number of
breast cancer cases it is important that both women and men
are aware of the increased cancer risk associated with
obesity.
The Association of California Healthcare Districts supports
this bill because it will provide critical information on
breast cancer and better inform women on the risks of obesity.
The California Primary Care Association supports this bill
because they believe it is important to make the link between
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obesity and the increased risk of breast cancer in the minds
of their patients in order for them to be encouraged to make
life changes which are likely to improve their future health.
REGISTERED SUPPORT / OPPOSITION:
Support
American Cancer Society Cancer Action Network
Association of California Health Care Districts
California Black Health Network
California Communities United Institute
California Primary Care Association
Latinas Contra Cancer
Numerous individuals
Opposition
None on file.
Analysis Prepared by:Lara Flynn / HEALTH / (916) 319-2097
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