If Hillary Clinton were to break through the nation’s highest glass ceiling, she would be positioned to bring extraordinary attention to breast cancer — not only as the first female president, but as an advocate with decades of experience in the fight against the disease.

Breast cancer research hasn’t been a major part of the Democratic front-runner’s platform in 2016. It’s not featured in her campaign ads and lacks the base-energizing controversy of, say, funding for Planned Parenthood. But over the past 25 years, Clinton has devoted more attention to the issue of breast cancer research than any presidential candidate before her.

Interviews with key figures close to Clinton and a STAT review of documents from Bill Clinton’s White House archives show a determined advocate who has achieved victories in her fight for breast cancer research but who has also endured significant setbacks. It’s also clear that, should Clinton win the presidency, she would confront a research landscape far different than the one she saw when she began her work.

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In 1985, only 78 percent of women survived five years after their initial breast cancer diagnosis. That figure is now up to more than 90 percent. Today, scientists have a far more sophisticated understanding of how genetics factor into a woman’s risk and the different kinds of breast cancer they are contending with.

For all those achievements, today, 1 in 8 women will still develop breast cancer in their lifetimes. And more than 40,000 women die every year from the disease. Federal investment, though significant, has stagnated.

Vice President Joe Biden has grown fond of saying that “cancer politics” are more intractable than he expected when he took over the Obama administration’s cancer initiative. Getting researchers and drug companies to collaborate is tricky. After years of austerity, billions of dollars in new funding for government research can’t be guaranteed.

Those are challenges Clinton knows well.

When she traveled to Cedar Falls, Iowa, in September, Christine Carpenter, a 67-year-old breast cancer survivor, asked if Clinton would endorse the National Breast Cancer Coalition’s goal of determining by 2020 how to end breast cancer — a deadline that would mark the end of her first-term presidency, should she attain it.

“Yes,” Clinton said, almost before Carpenter finished her question. “I endorse bold ideas in research and science to go after diseases, and breast cancer is one I feel passionately about.”

A pivotal encounter

As recalled all these years later, the story of Clinton’s initial interest in breast cancer research has an almost mythical quality.

In October 1992, just weeks before Bill Clinton was elected president, a few dozen members of the National Breast Cancer Coalition planned to head from Washington to Williamsburg, Va., for a press conference with the Democratic candidate. When Bill’s sore throat forced the campaign to cancel, a meeting with Hillary Clinton was offered as a consolation.

So the members of the group bordered a charter bus for the three-hour drive. Then their bus broke down, about 30 minutes from their destination.

Fran Visco, the president of the NBCC and the trip’s organizer, remembers catching a ride with a farm worker in a pickup truck; the driver volunteered to take a few of the group’s leaders the rest of the way. Others flagged down a young man driving home from a Grateful Dead concert.

At the end of the journey, they received a police escort to the Williamsburg Inn, where Hillary Clinton was waiting.

Clinton had gotten wind of the group’s travails. Her team had allotted 45 minutes for the meeting, but as she listened to the advocates, many of them suffering from breast cancer, she kept shooing away her minders, Visco recalled in an interview. “Oh, no, I want to hear what everyone has to say,” Clinton told her staff as they tried to end the meeting.

“Her people were clearly trying to pull her out of the room,” Visco said, “but she was determined to stay and hear from everyone.”

The meeting lasted more than twice as long as scheduled.

“It wasn’t just emotion. It was really, ‘Oh, my God, this is horrible and what can we do about it as a nation?’ That was the conversation with her,” said Visco, who would become one of Clinton’s top confidantes on the issue. “That’s not a conversation we had very often in those days because people didn’t really understand the political implications and the public policy needs.”

Clinton was still referencing that story in speeches years later, toward the end of her time as first lady.

The media at the time often attributed her focus on breast cancer to the stinging defeat she suffered as the White House’s lead advocate of health care reform legislation. Breast cancer was, after all, safer ground. But the Williamsburg meeting and the death of Bill’s mother from the disease in January 1994 gave her plenty of personal motivation.

She was a regular public spokesperson for the President’s Cancer Panel, which delivered an extensive report on breast cancer research and treatment in October 1993. The White House pursued better Medicare coverage for mammograms, sought to raise awareness about the need for regular checkups, and created a postal stamp to raise money for research.

Melanne Verveer, who was Clinton’s chief of staff, linked the first lady’s persistent interest in those years directly to the Williamsburg meeting.

“Don’t underestimate what happens in campaigns,” she said in an interview. “This was a deep commitment, one that came from hearing personally firsthand from so many women in the course of the campaign and after.”

Clinton and Princess Diana at a White House breakfast Clinton hosted as first lady to raise funds for breast cancer research in September 1996. Jamal Wilson/AFP/Getty Images

One fight in particular helped define Clinton’s work on breast cancer as first lady.

Beginning in 1993, Congress authorized as much as $200 million a year to start a breast cancer research program in the Pentagon. The original plan had been to transfer the money to the National Institutes of Health, but advocates like Visco eventually came to like the idea of keeping the program inside the Defense Department because researchers seemed more willing to pursue unconventional research.

Once Republicans seized control of Congress after the 1994 midterms, however, the push to keep the program at the Pentagon took on new urgency. Lawmakers who had just won over voters by running against big government weren’t likely to send more money to the NIH. But they also wouldn’t vote against military spending.

“We were in a world of sensitivity on deficit and debt,” Chris Jennings, President Clinton’s senior health care adviser, recalled. “You could find a way to get more funding out of DOD than you could once you reached your cap at NIH. This was viewed as one way to do it.”

 

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Then, on Feb. 10, 1995, that plan was suddenly in jeopardy.

The Washington Post had run a 1,000-word story alleging that the Pentagon might not spend the allocated breast cancer research money. Defense officials reportedly believed that the research wasn’t essential to the military.

That morning, Clinton saw the story; she also heard from Visco. Her aides raised the issue during the domestic policy council meeting that the White House held every morning.

The president and his top staff didn’t require any convincing on what should be done.

“This is something that’s really worth keeping,” Leon Panetta, President Clinton’s chief of the staff at the time, told STAT of the White House’s thinking. “It’s probably the only way you’re really going to provide the kinds of funds that are necessary right now.”

The very same day, Panetta sent a letter, which the White House then released publicly, emphasizing to Defense Secretary William Perry that President Clinton believed that the defense research program was a worthwhile investment. The money was spent and the program continues to this day.

“She made it happen,” Visco said.

Twenty years later, Clinton still uses the episode as evidence of her longstanding support for research.

“We got it in there, and it is still in there,” she said at the Cedars Falls event last fall. “And we’re still going to keep working to end breast cancer — by 2020, if we can make it.”

A major effort stalls

When Clinton moved from the White House to the Senate, breast cancer research remained a big part of her platform. One bill was a focal point: the Breast Cancer and Environmental Research Act, which had first been introduced by Representative Nita Lowey in 1999 and again had the backing of groups like the National Breast Cancer Coalition.

The legislation as originally written would have authorized $30 million in annual grants for breast cancer research centers probing environmental factors associated with the disease.

But the final outcome, which fell short in the eyes of some advocates, was a reminder that even something as uncontroversial as cancer research can come with pitfalls.

Clinton became Lowey’s co-sponsor after she was sworn into the Senate in 2001, and the duo, alongside supporters including Senator Harry Reid of Nevada, continued to introduce the bill again and again over the next decade.

Early in Clinton’s tenure, the bill never got far under the Republican-controlled Senate. It started to break through in June 2006 when it cleared the Senate health committee — only to be blocked by Senator Tom Coburn of Oklahoma, who said the bill would set “a dangerous precedent. … Federal research dollars should go to the science that will save the most lives, not the lobbyists or politicians who make the most noise.”

So the legislation stalled. But after Democrats took over the upper chamber in 2007, there was new optimism. It passed the committee again in February 2008. Senate and House Republicans, however, still harbored doubts about Congress dictating what kind of research scientists should be pursuing.

As supporters sought to win over Coburn and skeptics in the lower chamber, the Democratic presidential primary battle between Clinton and Obama was in full swing, limiting her time on Capitol Hill.

The bill that Republicans agreed to and that ultimately passed in September 2008 divided the breast cancer research community. The Susan G. Komen for the Cure advocacy group praised Congress for approving it. The National Breast Cancer Coalition disavowed it as a watered-down bill that didn’t achieve their stated goals.

The final bill “just created a committee that issued a report,” Visco said. “Waste of time and money, nothing at all to do with our original bill.”

Lowey put out a statement, hailing the legislation’s passage as the culmination of a nearly decade-long effort. While the congresswoman “would have much preferred that her original bill pass,” an aide told STAT, “in the face of Senator Coburn’s obstruction, she worked to reach a compromise to better guide federal research on environmental factors related to breast cancer.”

But Clinton’s Senate office was silent.

Clinton speaks at event hosted by the National Breast Cancer Coalition in Washington in March 2007. Nancy Ostertag/Getty Images

By that point, Clinton had already finished her first campaign for president — and lost.

During that first race, however, she did release her most comprehensive plan to date for breast cancer research. The plan would have increased federal funding by $300 million annually, across the whole field: research into environmental and genetics factors, research focusing on young women, and expanding the Defense Department program she helped start and save.

In the 2016 campaign, Clinton hasn’t talked as much about the issue and has not released a detailed plan. Her campaign declined to make her available for an interview.

In Cedar Falls, though, Carpenter didn’t seem deterred. She came back out for another campaign event at the end of January. She raved about Clinton’s endorsement of the 2020 deadline and her rescuing the Defense Department research funding.

With this long history, she said, Carpenter sees hope for a transformational presidency.

“It’s a huge factor,” she said. “She’s a friend.”

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