BILL ANALYSIS                                                                                                                                                                                                    



                                                                     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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