[Congressional Record Volume 143, Number 36 (Wednesday, March 19, 1997)]
[Extensions of Remarks]
[Pages E520-E521]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




              THE COLORECTAL CANCER SCREENING ACT OF 1997

                                 ______
                                 

                         HON. ALCEE L. HASTINGS

                               of florida

                    in the house of representatives

                       Wednesday, March 19, 1997

  Mr. HASTINGS of Florida. Mr. Speaker, I am today introducing the 
Colorectal Cancer Screening Act of 1997 in order to establish 
colorectal cancer screening as a covered benefit under the Medicare 
program. Colorectal cancer screening is an important element of what 
should be a comprehensive program of preventive health care for our 
senior citizens. Unfortunately, the current Medicare program provides 
little incentive for Medicare recipients to have regular check-ups and 
undergo the routine tests that will prevent serious illnesses and 
detect diseases at their earliest, most treatable stage. This 
legislation, if enacted, would encourage Medicare recipients to be 
screened for colorectal cancer by providing Medicare coverage of those 
tests. I am pleased to be joined by 14 cosponsors in introducing this 
important legislation.
  It is particularly timely that this legislation be considered at this 
time. Over the past 2 to 3 years, there has been a significant amount 
of work done within the medical community to develop Guidelines and 
recommendations on how to screen for colorectal cancer. Several new 
screening guidelines and revised screening recommendations have been 
released within the past two months, and new screening recommendations 
are expected to be issued within the next few weeks by the American 
Cancer Society. These Guidelines and recommendations indicate that 
there is an emerging consensus that there are a number of different 
procedures that can be used to screen for colorectal cancer. This 
legisaltion is based upon that consensus.
  The move to develop new screening guidelines really started in the 
spring of 1995 with the release of the ``Guide to Clinical Preventive 
Services'' by the U.S. Preventive Services Task Force. In this report, 
the Task Force reversed the position taken in its 1989 report and 
concluded that there was a sufficient scientific basis upon which to 
recommend colorectal cancer screening, starting at age 50 for most 
individuals. The report specifically recommended screening average risk 
individuals with two procedures--FOBT and sigmoidoscopy--though it 
raised concerns about the limited effectiveness of these procedures and 
questioned the willingness of patients to comply with these tests. The 
report also noted discussed screening with colonoscopy and the barium 
enema, and concluded that there was insufficient evidence to recommend 
for or against screening with either test. The report also raised 
questions regarding the overall cost and risks of screening, 
particularly with regard to colonoscopy.
  Many of the questions raised by the U.S. Preventive Services report 
have been answered. The release of the Task Force report prompted the 
Agency for Health Care Policy and Research [AHCPR] of the Department of 
Health and Human Services to initiate a 2-year project to examine the 
scientific and medical literature on all available options for 
colorectal cancer screening and to develop Clinical Practice Guidelines 
on colorectal cancer screening. The AHCPR terminated the development of 
specific screening recommendations last April, but has completed an 
``Evidence Report'' summarizing the current evidence on the various 
screening procedures. A summary of this report, released in February, 
concludes that there is evidence to support colorectal cancer screening 
with all of the screening procedures identified in the Preventive 
Services Task Force report--FOBT, sigmoidoscopy, the barium enema and 
colonoscopy. I ask unanimous consent that the Summary of the AHCPR 
Evidence Report be included in the Record with these remarks.

  The effort to develop Clinical Guidelines for Colorectal Cancer 
Screening did not, however, end with AHCPR's decision not to complete

[[Page E521]]

the project. Colorectal Cancer Screening Guidelines based on the AHCPR 
project were completed and published in the February 1997 issue of the 
medical journal ``Gastroenterology.'' The 16 members of the 
multidisciplinary expert panel first assembled by the AHCPR were listed 
as the authors of the Guidelines, and the project was completed under 
the direction of the American Gastroenterological Association and a 
consortium of four other gastroenterology organizations that had served 
as the contractor to the AHCPR. These new Guidelines are endorsed by 
the American Cancer Society, American College of Gastroenterology, 
American Gastroenterological Association, American Society of Colon and 
Rectal Surgeons, American Society for Gastrointestinal Endoscopy, 
Crohn's and Colitis Foundation of America, Oncology Nursing Society and 
the Society of American Gastrointestinal Endoscopic Surgeons.
  The Colorectal Cancer Screening Act of 1997 embodies the screening 
recommendations included in the clinical Guidelines and supported by 
the AHCPR Evidence Report. It should be noted that the legislation 
includes the option for individuals at average-risk and high-risk to be 
screened with the barium enema. It does so because providing patients 
and their physicians with the option of being screened with the barium 
enema is fully supported by these reports, and by the scientific and 
medical literature that provides the basis for the recommendations. To 
be specific with regard to the Clinical Practice Guidelines published 
in Gastroenterology:
  The Clinical Practice Guidelines recommend screening people at 
average risk for colorectal cancer with double-contrast barium enema 
every 5-10 years;
  The Clinical Practice Guidelines recommend use of the barium enema 
for screening individuals at high risk for colorectal cancer--
individuals with close relatives who have had colorectal cancer or an 
adenomatous polyp and people with a family history of hereditary 
nonpolyposis colorectal cancer--and
  The Clinical Practice Guidelines recommend use of the barium enema or 
colonoscopy for surveillance of people with a history of adenomatous 
polyps or colorectal cancer.
  Although they have not yet been finalized, I understand that the 
American Cancer Society will soon issue new recommendations for 
colorectal cancer screening. The legislation that I introduce today is 
consistent with the approach that has been taken by the American Cancer 
Society in developing these new recommendations.
  One final consideration guided the development of this colorectal 
cancer screening legislation, and it is that the colorectal cancer is a 
particularly deadly disease for African-Americans. This is discussed in 
the Summary of the AHCPR Evidence Report, which notes that the National 
Cancer Institute and other medical journals have found that black men 
and women with colorectal cancer have a 50 percent greater probability 
of dying of colon cancer than do white men and women. The medical 
literature indicates that this is caused, at least in part, by the fact 
that African-Americans tend to get colorectal cancer in the right--
proximal--portion of the colon--the portion that is not reached by 
sigmoidoscopy, the most common screening procedure currently in use. 
The Colorectal Cancer Screening Act of 1997 provides individuals the 
option of a full colon screening with the barium enema in order to 
assure that the screening program we establish in the Medicare program 
is adequate for African-Americans. It also should be noted that this 
option is particularly important for other Americans as well, given 
that it has been shown to be significantly more effective than 
screening only one-half of the colon with sigmoidoscopy. Moreover, in 
addition to being effective, the barium enema is one of the most cost-
effective screening procedures for both average-risk and high-risk 
individuals.
  In conclusion, I would like to emphasize for my colleagues the cost-
effectiveness of this legislation. According to the Office of 
Technology Assessment, colorectal cancer screening is capable of saving 
thousands of American lives at a cost of only about $13,250 per life 
year saved. Colorectal cancer screening is also cost-effective when 
compared with other Medicare-covered procedures such as kidney 
dialysis--$50,000 per life year saved--and mammography--$40,000 per 
life year saved. I cite these figures not to argue against these other 
life-saving devices and procedures, but rather to provide a comparison 
that demonstrates the importance of Medicare coverage for such cost-
effective procedures as colorectal cancer screening at a time when we 
are working hard to reduce the level of spending in the overall 
Medicare program.
  In the end, however, the Colorectal Cancer Screening Act of 1997 is 
not about cost-effectiveness and economics--it is about saving lives 
that are unnecessarily lost to this disease. Colorectal cancer strikes 
about 145,000 Americans each year, and about 55,000 Americans die of 
the disease each year. This legislation can save many of these lives, 
and I urge my colleagues to join me in seeking its enactment.

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