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Patient Testimonials on Cancer:

Pat Graybill has been our patient since February 2003.  Last year, she had a couple of her friends diagnosed with cancer.  Through this difficult time with her friends, she has learned that early detection would have made a vast difference in dealing with the cancers, and that there are blood tests that actually detect abnormalities in the blood, which may indicate early onset of cancer.  She also learned that Medicare currently will only pay for a woman to have a CA125 (cancer antigen blood test) if she has currently, or personally, in the past had cancer relating to female organs.  She also learned that the equivalent men’s cancer detection, PSA, has a much broader allowable diagnosis range, so a man does not necessarily have to currently have or have had cancer, but does require a symptom to substantiate the need for such test. 

With Pat’s newfound knowledge, she decided to write to Senator Boxer, Senator Feinstein, and Congressman Kevin McCarthy.  We are proud of Pat and her efforts to have her voice be heard and to change Medicare, as we encourage all of our patients to be proactive in their healthcare, including dealing with insurance matters.  With Pat’s permission, we would like to share with you some of her letters 

January 10, 2007 

Senator Barbara Boxer
Senator Dianne Feinstein
Congressman Kevin McCarthy

Dear Senator Boxer, 

I am writing to you concerning an important blood test for cancer that women are being denied by Medicare.  It is called CA125 and is a test that shows up ovarian cancer, but fortunately it also detects other kinds of cancer.  The only time Medicare allows this test is in cases where a woman already has cancer or had it in the past.  Of course, the test is too late in this case. 

I would like to give you an example of this problem.  My friend, Marie had been suffering with back pain for months.  Many trips to doctors had given her no relief or reason for the pain.  I told her about my doctor, Dr. Castellanos in Templeton, Ca. who is very pro-active and believes in keeping his patients well and catching illness early.  She went to him, and he ordered the CA125 blood test.  For him, this is a routine test for his women patients.  The test revealed cancer.  It turned out that her hip was eaten through with a cancer tumor, and she had two spots of cancer on her lung.  Now it has spread to her spine.  She has stage four cancer and it is rapidly spreading even after radiation, hip removal, and chemo therapy.  A simple blood test done early could have saved her all this pain.  At this point only God knows the outcome.   

I would also like to point out that men are given a blood test to test for PSA by the doctor which can alert them to prostate cancer.  My husband was saved by this test.  There are multiple reasons that Medicare will cover the expense for men while to take the blood test for women, the criteria seems to be very narrow.  You must have cancer already, a history of cancer, or a mass on the genital organs.  Something should be done about this so that women will have a chance at early detection.   

I hope that you can help us with this situation. 
Thanks in advance for your help. 

Sincerely Yours, 
Patricia Graybill

February 5, 2007

Dear Patricia:

Thank you for contacting me regarding your concern about CA 125 tests not currently covered by Medicare.

As you are already aware, CA 125, a cancer antigen, is a protein that is a tumor marker or biomarker, which is a substance that is found in greater concentration in tumor cells than in other cells of the body. In particular, CA 125 is present in greater concentration in ovarian cancer cells than in other cells, and thus, its presence in testing may help diagnose this cancer quickly so it can be properly treated.

Currently, CA 125 has been deemed reasonable and necessary for surveillance of primary peritoneal carcinoma in Medicare beneficiaries following treatment. While coverage is not currently offered in the testing of ovarian cancer, I will forward your letter and my intent in this issue, to the Centers for Medicare & Medicaid Services which continually studies medical research and trials to see if its coverage policies should be changed or updated.

I appreciate you voicing your concern on this matter and will be keeping my eye on the issue for any updates during the 110th congress.

Sincerely,
KEVIN McCARTHY
Member of Congress

March 30, 2007

Dear Mrs. Graybill:

Thank you for writing to express your views on the high costs of health care. I appreciate hearing from you on this important issue.

I am pleased to tell you that Congress recently approved $1.9 billion to provide healthcare coverage to 1.2 million new patients and build or expand health centers across the country. The funding for public health programs was increased $207 million from last year and was included in the Continuing Resolution for fiscal year 2007. This legislation was signed into law on February 15, 2007.

For the past six years, the Bush Administration and the Republican Congress have failed to respond effectively to rising health costs. As you know, healthcare costs and insurance premiums have soared in recent years, putting heavy strains on employers, workers, and families who are struggling to keep up. The average annual premium for family coverage has skyrocketed 81 percent since the year 2000 to over $11,000 a year. Currently, over 46 million Americans have no type of health insurance at all.

President Bush recently proposed a healthcare initiative that would use tax subsidies to encourage more people to purchase their own health insurance while imposing additional taxes on those who have comprehensive health policies. The President's proposal, if implemented, would do little to help the uninsured, most of whom have limited incomes and are in low tax brackets.

I believe the healthcare crisis demands a comprehensive solution that lowers the costs of medical care and makes health coverage available to all Americans. I am hopeful that the new Congress will move beyond the President's inadequate proposal and continue to effectively work to meet the health care needs of hardworking Americans.

Thank you again for writing to me. Please do not hesitate to contact me again about this or any other issue.

Sincerely,
Barbara Boxer
United States Senator

July 16, 2007

Dear Mrs. Graybill:

Thank you for taking the time to contact me regarding Medicare coverage of the CA125 blood test. I appreciate the time you took to write and apologize for the delay in my response.

Like you, I strongly believe that preventative measures should be taken to prevent, detect and treat illnesses. I understand your concern that Medicare does not cover the CA125 blood tests to help detect ovarian cancer. According to the National Cancer Institute, the CA125 blood test is currently not considered to be an effective general screening test for ovarian cancer. This is due to the high number of false positives and false negatives the test yields. You can find more information on the CA125 blood test by visiting the American Cancer Society's web site at www.cancer.org. Be assured, I will keep your comments in mind should the Senate consider legislation related to this matter.

I believe the early detection of cancer is essential. I was a cosponsor of the Gynecologic Cancer and Education Awareness Act of 2005, also known as Johanna's Law, to provide funding for programs to increase the awareness and knowledge of women and health care providers of gynecologic cancers. This legislation was signed into law on January 12, 2007.

As co-chair of the Senate Cancer Coalition, the study, treatment, early detection and prevention of cancer has been among my highest priorities since coming to the Senate. Preventative medicine is a cost-effective and life-saving way to improve the health of citizens. I have been active in efforts to increase public awareness about cancer and access to preventive health screenings to detect health problems early so that they may be appropriately treated. In addition, I have been a strong supporter of the National Breast and Cervical Cancer Early Detection Program, which helps low-income, uninsured women receive screening for early detection of breast and cervical cancer.

Again, thank you for writing. If you have any further questions or comments, please do not hesitate to contact my Washington, D.C. office at (202) 224-3841 or visit http://feinstein.senate.gov . Best regards.

Sincerely,
Dianne Feinstein
United States Senator

September 21, 2007 

Dear Congressman McCarthy: 

Thank you for responding to our patient’s concerns regarding Medicare and the current lack of benefits for the CA125 tests.  We certainly agree with Mrs. Graybill and are pleased that she has brought to you, an awareness that it is imperative that early cancer detection becomes a priority for Medicare.   

Our practice strives to encourage our patients to take a proactive approach to their healthcare and have established a website where we have posted Mrs. Graybill’s story, your response, and others, in hopes that citizens will become aware of the importance of this test, and that they will voice their opinions, and that we will in the near future see a change that will save lives.     

Sincerely,
Alexander Castellanos, M.D.

My name is Marisela and I have been a patient of Dr. Alexander Castellanos since he first opened his practice in Atascadero, CA. Both my husband and I feel very fortunate to have found him because he has such a passion for medicine and for keeping his patients healthy. His thoroughness in his exams and the patience to teach us how to take care of ourselves is stellar. There is one area of his practice that I would like to focus on in this letter, and that is the breast exam.

In my family, we have a history of breast cancer and I lost a cousin at the age of 24 yrs old. I also lost a very dear friend of mine to cancer about 8 years ago. I am very aware of the pain and needless suffering that misdiagnosis can cause. Both my cousin and good friend had their yearly check ups and in my cousins case she was good about checking her breasts every month, since her mom, my aunt, had breast cancer too. My girlfriend, who was older, had mammograms and breast exams routinely too. They both found lumps and went to their doctors for follow-up; both were told the same thing — "Let's keep an eye on it and check it again in 3 months." Mind you, my cousin lived in Guadalajara, Mexico and my girlfriend lived in Ventura County. My cousin's cancer spread so quickly that three months later cancer was found in her lymph nodes and she was dead within the year. My girlfriend followed the usual course of care which is mammogram, then ultra-sound, then biopsy. A total of 6 months lapsed from the time she felt the lump to the time she got the biopsy. She had cancer and for 4 years underwent chemo and radiation off and on. She lost her fight.
Just recently, I was having some discomfort in my right breast. I tried to ignore it at first because I was "too busy." My daughters and my husband insisted that I get it checked. After my exam, Doctor Castellanos did pinpoint an area where he could feel something that didn't seem right. He then went on to explain his philosophy of immediately doing a breast biopsy, rather than following the usual medical practices. I agreed to the procedure. Later that night, I received an email from a colleague who was sharing the news that she had breast cancer. She wrote in detail how months earlier she had found the lump and she was told the now infamous, "Let's keep an eye on it." Almost 6 months later, and only because her husband insisted, she got the biopsy and they found she had cancer. I was so grateful to have Doctor Castellanos on my team. I couldn't wait to share that story with him and now I couldn't wait to get the biopsy. I was still nervous about the procedure, and wasn't looking forward to the possible discomfort afterwards, but Dr. has magical hands. I felt no pain during or after the procedure. His practice truly thinks about the patients' state of mind as well. When I went into the room where the biopsy was going to be performed, there was some soft music on and the temperature was perfect. This all helped to calm me down and while we went through the procedure, Dr. Castellanos kept my mind off the "cutting" and on his great conversation. It was like visiting with a friend!

I am sharing this in hopes that you trust that this experience will be very comfortable and most importantly, can save your life. I received a phone call with the results, which by the way Dr. insisted on giving me himself. How's that for service! The biopsy proved to be cancer free!

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