[Congressional Record Volume 141, Number 80 (Monday, May 15, 1995)]
[Extensions of Remarks]
[Pages E1034-E1035]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


SCREENING FOR COLORECTAL CANCER: THE PATIENT AND THE PHYSICIAN'S RIGHT 
                               TO CHOOSE

                                 ______


                     HON. LOUISE McINTOSH SLAUGHTER

                              of new york

                    in the house of representatives

                          Monday, May 15, 1995
  Ms. SLAUGHTER. Mr. Speaker, I rise today to discuss the Colorectal 
Cancer Screening Act of 1995, and why I became a cosponsor 
[[Page E1035]] of this legislation. The bill, H.R. 1046, is intended to 
establish the basis for a comprehensive colorectal cancer screening 
program in the United States. The bill is designed, however, to leave 
the important decision about how to screen for colorectal cancer where 
it belongs--with the patient and his or her physician, not the Federal 
Government.
  Colorectal cancer screening is, as the saying goes, ``an idea whose 
time has come.'' A number of recent medical studies confirm that the 
best way to reduce the mortality rate for colorectal cancer is to 
ensure that more of the approximately 60 million Americans between the 
ages of 50 and 75 follow the recommendations of the American Cancer 
Society and be screened every 3 to 5 years for early signs of 
precancerous polyps in the colorectal area. About 150,000 new cases of 
colorectal cancer are diagnosed in the United States each year, and 
more then 60,000 Americans will die from this disease. Thousands of 
these deaths could be prevented by catching the disease at the earliest 
possible stage through screening.
  The Colorectal Cancer Screening Act of 1995 amends the Social 
Security Act to include coverage for periodic colorectal cancer 
screening as a covered benefit under the Medicare Program. This will 
ensure coverage for screening individuals over the age of 65, and 
hopefully will lead private health care plans to establish screening 
programs that start at age 50.
  Equally important, the Colorectal Cancer Screening Act of 1995 does 
not force the Federal Government into the physician-patient 
relationship with regard to the decision on how to screen for 
colorectal cancer. The bill permits a number of current screening 
procedures to be used, and establishes a mechanism through which new 
technologies can be included as they are developed and can be provided 
within the reimbursement levels set pursuant to the legislation.
  It is critical that we leave the decision on how to screen to the 
physician and the patient for a number of reasons. First, with regards 
to current technologies, the medical literature indicates that 
colorectal cancer screening can be accomplished with a number of 
different procedures, each of which has distinct advantages and 
disadvantages. For example, screening with sigmoidoscopy is generally 
seen as more convenient than the other procedures because it can be 
performed by a general physician during a comprehensive physical, and 
costs about $125 to $200. The clear disadvantage of sigmoidoscopy, 
however, is that it reaches only one-half of the colon and, 
therefore, is incapable of finding about 50 percent of the cancers and 
precancerous polyps. As a result, it is impossible for a physician to 
tell a patient who has been screened with sigmoidoscopy that they do 
not have colon cancer or precancerous polyps in their colon.
  By contrast, the barium sulfate enema examination and colonoscopy are 
capable of examining the entire colon and can detect between 90 and 95 
percent of the polyps and lesions. The disadvantages of these 
procedures are cost--barium enema charges are about $200 to $350, and 
colonoscopy charges commonly exceed $1,000--and convenience. In 
addition, the risks of perforation from colonoscopy are about 10 times 
greater than for the barium sulfate examination. The Colorectal Cancer 
Screening Act of 1995 keeps the Federal Government out of the process 
of deciding which procedure is right for each patient.
  The other critical reason to leave individual screening decisions to 
physicians and patients is that it allows for the development of new 
technologies. For example, a number of research centers in the United 
States are working on a new technology for colorectal cancer screening 
that uses computers to create a virtual reality image of the colon and 
colorectal area from a single 45-second CAT scan. It has the potential 
to make colorectal cancer screening more cost-effective, and more 
accepted by patients than the current alternatives. Unlike other 
proposals for colorectal cancer screening, the Colorectal Cancer 
Screening Act of 1995 encourages research and development on these new 
technologies because it provides a mechanism to have the procedures 
covered under Medicare when it is ready for patient use.
  In conclusion, medical research has provided the evidence to make 
clear that it is time for the United States to develop a program for 
colorectal cancer screening. Today, less than 1 percent of all 
Americans over the age of 65 have ever been screened for colorectal 
cancer. That has to change.
  The goal of the Colorectal Cancer Screening Act of 1995, H.R. 1046, 
is to cut by 50 percent the number of Americans who die of colorectal 
cancer--30,000 lives. Including colorectal cancer screening as a 
covered benefit under Medicare will establish the beginning of a 
program that can accomplish this goal. I urge my colleagues to examine 
this legislation, and hope that you will join me as a cosponsor of the 
bill.


                          ____________________