10-08-2026 1:52am

From Public Forum By Dr Shellie M Bowman Sr

John Williams Editor

October is Breast Cancer Awareness Month.

Pink ribbons appear on buildings, uniforms, products, social media pages, and community events. They serve an important purpose. Awareness encourages conversations about screening, treatment, survivorship, and the people whose lives have been changed by breast cancer.

However, awareness should also invite a deeper public-policy question.

What does breast cancer cost a society?

The answer cannot be found entirely in a hospital bill.

Breast cancer reaches into household savings, employment, caregiving, insurance, workplace productivity, public health systems, medical research, and the lives lost before families and communities were prepared to lose them.

That makes breast cancer more than a medical challenge. It is also a problem of public administration.

And once we understand the problem that way, government support for breast cancer research becomes more than an expenditure on science. It becomes an investment in public value.

The Disease Behind the Awareness

Breast cancer remains a substantial public-health burden in the United States.

According to the Centers for Disease Control and Prevention (CDC), 288,494 new breast cancers were reported among women in 2023, the most recent incidence data available, and 43,402 women died from breast cancer in 2024. About two-thirds of breast cancers diagnosed from 2019 through 2023 were detected while still localized, and five-year relative survival among female breast cancer patients overall was approximately 92 percent (CDC, 2026a).

Those numbers tell two stories simultaneously.

The first is progress. Many people diagnosed with breast cancer survive.

The second is unfinished work. More than 43,000 women died from the disease in a single recent year.

Moreover, the burden is not distributed equally. The latest Annual Report to the Nation on the Status of Cancer reports that Black women have a higher breast cancer death rate than women in other racial and ethnic groups (CDC, 2026b).

Consequently, the public-policy question is not simply whether progress has occurred.

It is whether we are prepared to continue the work required to extend that progress, understand disparities, prevent disease, improve treatment, and reduce mortality.

The Cost Does Not Stop at the Hospital Door

A cancer diagnosis creates medical costs, but medical costs are only one part of the economic burden.

Patients may face deductibles, coinsurance, prescription expenses, transportation costs, childcare expenses, and other costs associated with receiving treatment. At the same time, treatment may reduce the patient’s ability to work.

Then there is the family.

Someone may drive the patient to chemotherapy. Someone may leave work early. A spouse may reduce hours. A parent, adult child, sibling, or friend may become a caregiver.

The National Cancer Institute describes this phenomenon as financial toxicity, the financial distress associated with cancer and its treatment. Its consequences can include depleted savings, debt, difficulty paying for food or housing, and even bankruptcy. NCI also emphasizes that informal caregivers frequently share this burden through their own spending and lost work time (National Cancer Institute [NCI], n.d.).

This is important because conventional accounting can make disease appear less expensive than it actually is.

A medical bill records the cost of medical care.

It does not necessarily record the paycheck that did not arrive.

It does not record the vacation days exhausted during treatment.

It does not record the caregiver who reduced working hours.

And it cannot fully capture what happens when a household loses a mother, wife, daughter, sister, employee, caregiver, or primary wage earner.

Measuring What Households Actually Carry

Research helps make some of these hidden costs visible.

A major national analysis estimated that in 2019 cancer imposed approximately $21.1 billion in patient economic burden in the United States, including $16.2 billion in out-of-pocket costs and $4.9 billion in patient time costs. Breast cancer accounted for approximately $3.14 billion in out-of-pocket costs and $1.11 billion in patient time costs, or about $4.25 billion combined (Yabroff et al., 2022).

Those figures are estimates based on 2019 data, not current-dollar estimates for 2026, and they should be interpreted accordingly.

Nevertheless, they demonstrate something important.

The economic burden of breast cancer is borne partly inside the healthcare system and partly inside the household.

Research on metastatic breast cancer adds another dimension. A study examining productivity losses estimated hundreds of millions of dollars annually in lost work and household productivity and substantial losses associated with premature mortality, with particularly large economic consequences among working-age women (Trogdon et al., 2020).

These measures still cannot capture everything.

Economics can assign a value to lost productive time. It cannot assign a complete value to a life.

That distinction matters.

From Private Tragedy to Public Consequence

Public administration often begins where individual problems accumulate into collective consequences.

One household facing breast cancer experiences a deeply personal crisis.

Thousands of households simultaneously confronting treatment costs, interrupted employment, caregiving demands, insurance claims, disability, lost productivity, and premature death create something larger.

Healthcare systems absorb demand.

Employers absorb absences and workforce disruptions.

Insurance systems absorb claims.

Public programs interact with patients and families.

Researchers require sustained infrastructure and funding.

Public-health agencies collect the data needed to understand incidence, mortality, disparities, screening, and outcomes.

And households absorb what many formal systems do not.

That is why breast cancer belongs within a broader discussion of governance.

Government does not replace families, physicians, nonprofit organizations, universities, pharmaceutical companies, or private research institutions. Nor should every consequence of disease automatically become a governmental responsibility.

However, government occupies a distinctive position.

It can support research whose benefits may extend across populations and generations. It can maintain surveillance systems. It can fund scientific work whose eventual value cannot always be captured immediately by a private investor. And it can help build the evidence infrastructure from which prevention, diagnosis, treatment, and public policy improve.

Why Public Research Investment Matters

Federal support for breast cancer research occurs through multiple institutions.

The National Cancer Institute received approximately $7.2 billion in congressional appropriations for fiscal year 2025 across its broader cancer-research mission (NCI, 2026).

Breast cancer also receives targeted federal research support through the Department of Defense’s Congressionally Directed Medical Research Programs. The Breast Cancer Research Program reports $145 million in FY2026 funding and approximately $4.521 billion in congressional appropriations from FY1992 through FY2025. Its research priorities include prevention, understanding cancer initiation and susceptibility, distinguishing deadly from non-deadly cancers, addressing overdiagnosis and overtreatment, understanding metastasis and recurrence, improving treatment effectiveness while reducing toxicity, and eliminating mortality associated with metastatic breast cancer (Congressionally Directed Medical Research Programs [CDMRP], 2026).

Those objectives demonstrate why research should not be understood simply as searching for one dramatic “cure.”

Progress can also mean preventing disease.

Detecting dangerous cancers more effectively.

Understanding why cancer returns years later.

Reducing unnecessary treatment.

Developing therapies with fewer harmful effects.

Understanding disparities in outcomes.

Preventing metastasis.

Or turning a once-fatal diagnosis into a survivable one.

Research creates options that previous generations did not have.

Public Spending Still Requires Accountability

Calling research a public investment does not mean every research expenditure is automatically justified.

Public administration requires more discipline than that.

Research funding should be competitively allocated, scientifically reviewed, transparent, evaluated, and connected to legitimate public purposes. Duplication should be examined. Outcomes should be studied. Policymakers should ask whether public dollars are filling important knowledge gaps and whether the research portfolio reflects the disease burden and unresolved scientific questions.

In other words, supporting breast cancer research and demanding accountability for that support are not opposing positions.

They are complementary ones.

The relevant question is not simply:

How much did government spend?

It is:

What capacity did that spending create, what did we learn, what changed in prevention or treatment, and what remains unresolved?

That is the public-value test.

The Cost of Progress and the Cost of Stopping

There is another danger in successful public policy.

Progress can make the original problem appear less urgent.

When survival improves, it can become easy to forget that better outcomes did not happen spontaneously. Scientific knowledge accumulates. Clinical practice changes because evidence changes. New treatments emerge from years of laboratory investigation, clinical research, failures, refinements, and subsequent discoveries.

Today, federal breast cancer research continues to investigate prevention, metastasis, recurrence, treatment effectiveness, toxicity, and mortality.

The existence of progress therefore does not establish that the public investment has finished its work.

It may demonstrate precisely why sustained research capacity matters.

And yet, government funding should not be defended only because research has been funded before. The stronger argument is that the underlying public problem remains substantial, scientific questions remain unanswered, households continue to experience economic and human consequences, and further knowledge has the potential to reduce those burdens.

Beyond Awareness

Breast Cancer Awareness Month allows us to remember people.

Those undergoing treatment.

Those living in remission.

Those living with metastatic disease.

The families reorganizing their lives around appointments and caregiving.

And those whose families continue without them.

But public administration asks us to do something beyond remembrance.

It asks what institutions can learn from the problem and what measurable public value can be created through our response.

A breast cancer diagnosis produces a medical event.

It can also produce a financial event, an employment event, a caregiving event, and, for too many households, a mortality event.

So perhaps the public conversation should move beyond how much breast cancer research costs government.

We should also ask:

What does breast cancer cost when we fail to prevent it, detect it effectively, treat it successfully, or understand it completely?

A research appropriation appears on a government ledger.

The return is harder to capture on a single line.

It may appear as a treatment that is less toxic. A recurrence that does not happen. A diagnosis made earlier. A parent who returns to work. Savings that a family does not have to exhaust. A disparity finally understood. Or a person who survives long enough to experience years that once might have been lost.

That is where health policy becomes public administration.

And during Breast Cancer Awareness Month, it is worth remembering that the measure of our commitment is not simply whether we raised awareness.

It is whether, because of what we learned and what we did with that knowledge, something changed for the people.

References

Centers for Disease Control and Prevention. (2026a). U.S. Cancer Statistics female breast cancer stat bite. CDC breast cancer statistics

Centers for Disease Control and Prevention. (2026b). Annual report to the nation on the status of cancer. CDC Annual Report to the Nation

Congressionally Directed Medical Research Programs. (2026). Breast Cancer Research Program. U.S. Department of Defense. CDMRP Breast Cancer Research Program

National Cancer Institute. (2026). 2025 NCI budget fact book: Most recent reported fiscal year budget. National Institutes of Health. NCI Budget Fact Book

National Cancer Institute. (n.d.). Financial toxicity (financial distress) and cancer treatment. National Institutes of Health. NCI Financial Toxicity resource

Trogdon, J. G., Liu, X., Reeder-Hayes, K. E., Rotter, J., Ekwueme, D. U., Wheeler, S. B., & Reeder-Hayes, K. E. (2020). Productivity costs associated with metastatic breast cancer in younger, midlife, and older women. Cancer, 126(18), 4118–4125. PubMed record

Yabroff, K. R., Mariotto, A., Tangka, F., Zhao, J., Islami, F., Sung, H., Pisu, M., & Ekwueme, D. U. (2022). Annual report to the nation on the status of cancer, Part 2: Patient economic burden associated with cancer care. Journal of the National Cancer Institute, 114(12), 1670–1682. Full study