When NFL players take the field dressed in pink, you know something has changed. We've come a long way from the days when breast cancer was a taboo subject. In this 25th-anniversary year of Breast Cancer Awareness Month, the ubiquitous pink ribbons remind us that we need to keep pushing for a cure, because we know that close to 200,000 women in this country will be diagnosed with breast cancer this year (and 1 in 8 over their lifetimes).

That's the bad news. The good news is that the death rate from breast cancer has declined by about 2 percent every year since 1990. And that's because of advocacy. All those ribbons, all those road races, all those walks, all those donations to organizations fighting breast cancer have worked. They have raised millions of dollars, and spurred federal funding to underwrite research that has led to lifesaving treatments.

But still. It would be nice to go through one October without another friend learning that she has breast cancer. It would be wonderful to go through a year without losing another friend, often many years after the initial diagnosis. And it would be gratifying to see every woman receive the kind of first-rate treatment that Cokie has received as one of the 2.5 million women in the country living with a history of breast cancer.

The disparities, first in detection and then in care, lead to vast disparities in outcomes. Though the death rates for Hispanic and African-American women have declined along with those for white women, African-American women remain 40 percent more likely to die of the disease, accounting for a disproportionate share of the more than 40,000 U.S. women who will lose their lives to breast cancer this year.

Legislation introduced by Rep. Kathy Castor, D-Fla., aims at eliminating the disparities in treatment. It's one of four pieces of legislation that a House subcommittee held a hearing on last week. The bills deal with specific problems in the breast-cancer population, and the congresswomen supporting them arrived in the committee room decked out in pink. They also arrived with personal stories.

Rep. Debbie Wasserman Schultz, D-Fla., told of finding a lump only six weeks after a mammogram detected nothing. At 41, she was lucky to have had a mammogram at all. Though the evidence clearly shows that mammograms save lives, the percentage of women who regularly receive them has been dropping, and breast cancer is now the leading cause of death for women aged 40 to 49. Wasserman Schultz's bill would promote awareness among young women, whose cancers are likely to be more aggressive and diagnosed at a later stage.

A bill sponsored by Rep. Rosa DeLauro, D-Conn., a survivor of ovarian cancer, seeks to stop so-called "drive-through mastectomies." DeLauro wants to stop insurance companies from telling mastectomy and lumpectomy patients that they can't stay in the hospital overnight. Her legislation, which passed the House with only two dissenters in the last Congress, and enjoys bipartisan Senate support, would let doctors and patients -- not the insurance companies -- decide when a hospital stay should last 48 hours. Rep. Joe Barton of Texas, DeLauro's Republican co-sponsor, said he was sympathetic to the bill because "my sister is a breast-cancer survivor."

So is Rep. Jerry Nadler's wife. And the New York Democrat is encouraging Congress to pass a measure to ensure yearly screenings for women with a high risk of breast cancer. Those mandates are unlikely to be included in the big health-reform bill that's working its way through Congress, Nadler says.

Personal experience with breast cancer is now so widespread that lawmakers' willingness to draw on it has become a familiar part of the debate. It hasn't always been that way. It has taken 25 years of promoting awareness to make the disease something talked about in hearing rooms rather than whispered about in hospital rooms. First ladies Betty Ford and Nancy Reagan can take a lot of the credit for bringing breast cancer into the open. When they talked about cancer, they gave permission to other women to talk about it as well.

And advocates like Nancy Brinker, who started the Susan G. Komen Foundation, have helped raise the money for the research that is prolonging lives. But they are still lives disrupted by the blight of breast cancer and the fears of its recurrence. So keep running, keep walking, keep pinning on ribbons, keep those football players suiting up in pink, and keep the pressure on Congress to pass legislation. We need to do it all until we find the cure.

Cokie and Steve Roberts can be reached at stevecokie@gmail.com.

(Oct. 16, 2009)