The Breast and Cervical Cancer Treatment Act, legislation providing Medicaid coverage to low-income women found to have breast or cervical cancer through a federal screening program, was approved by the House of Representatives on May 9 by a vote of 421-1. Included in this otherwise extremely popular bill is a controversial provision relating to human papillomavirus (HPV), which was added at the insistence of Rep. Tom A. Coburn (R-OK) but is opposed by key public health and medical groups, including the American College of Obstetricians and Gynecologists ("Wanted: A Balanced Policy and Program Response to HPV and Cervical Cancer," TGR, December 1999, page 1). In addition to requiring the Centers for Disease Control and Prevention to study the prevalence of HPV and to outline the steps needed to make HPV a reportable disease, the Coburn provision would mandate that condoms carry a warning that they are not effective in preventing HPV and that HPV can lead to cervical cancer. It also would require the Department of Health and Human Services and all of its grantees to state in any sexually transmitted disease or condom-related information materials "the effectiveness or lack of effectiveness of condoms in preventing the transmission of HPV, herpes and other sexually transmitted diseases."
Calling the Coburn approach "misguided" from a public health perspective, Rep. Diana DeGette (D-CO) argued that the condom labeling requirement "may very well have the unintended consequence of discouraging condom use, which, as we all know, is very effective in preventing other diseases, including HIV/AIDS." She also contended that taking steps to make HPV a reportable disease "does not make sense, since most all of these cases do resolve on their own and only a very small percentage lead to cervical cancer." DeGette said that instead of "trying to instill panic here..., we should be trying to encourage every American woman to have regular Pap smear examinations, which are still the state of the art."
The Senate is likely to take up its own version of the bill, which does not include the HPV language, sometime before Congress adjourns this fall.