[Congressional Record Volume 143, Number 67 (Tuesday, May 20, 1997)]
[Extensions of Remarks]
[Pages E988-E989]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]


  SUPPORT OF THE SCREENING APPROACH ADOPTED IN THE COLORECTAL CANCER 
                        SCREENING ACT, H.R. 1128

                                 ______
                                 

                         HON. ALCEE L. HASTINGS

                               of florida

                    in the house of representatives

                         Tuesday, May 20, 1997

  Mr. HASTINGS of Florida. Mr. Speaker, I rise today to discuss 
important information on the issue of colorectal cancer screening. 
Earlier this year, I introduced the Colorectal Cancer Screening Act, 
H.R. 1128, which would provide Medicare coverage for all available 
colorectal cancer screening procedures including the fecal occult blood 
test, sigmoidoscopy, the barium exam, and colonoscopy. I hope that 
Congress will soon consider colorectal cancer screening as part of a 
package of preventive benefits to be included in Medicare reform 
legislation.
  The purpose of my remarks today is to share with my colleagues 
important recent statements in support of the colorectal cancer 
screening approach taken in H.R. 1128 by the American Cancer Society, 
former Virginia Governor L. Douglas Wilder, and the Washington D.C. 
Chapter of the NAACP. The Colorectal Cancer Screening Act is the only 
legislation in the House which provides coverage for all available 
colorectal cancer screening procedures, including the barium exam, 
allowing doctors and patients to choose procedures, rather than the 
Federal Government. H.R. 1128 is also important because it is the only 
House legislation which assures that adequate screening options will be 
available to meet the screening needs of African-American Medicare 
recipients.
  In remarks submitted last Congress, I cited several medical studies 
which show that African-Americans disproportionately develop cancer in 
the right side of the colon, the portion of the colon that is beyond 
the reach of sigmoidoscopy, a common screening procedure. These studies 
make clear that a procedure, such as the barium exam, which can screen 
the entire colon, must be made available to meet the needs of African-
American patients. The barium examination is the safest and most cost-
effective way to screen the entire colon, and is one of only two 
procedures which can image the entire colon. The studies also indicate 
that colorectal cancer screening programs that do not include barium 
exams are inadequate for African-Americans.
  The American Cancer Society recently released its new colorectal 
cancer screening guidelines. These screening recommendations were 
produced as a result of a comprehensive examination of all available 
information regarding the cost and availability of various screening 
procedures. One of the significant changes from earlier versions is 
that the ACS now recommends the barium enema as one of the options for 
the initial screening of average and moderate-risk individuals over age 
50. The American Cancer Society recommendations are as follows:

       * * * the National Board of the American Cancer Society 
     recently approved new colorectal guidelines which provide 
     clear guidance to practitioners and their patients for the 
     early detection of colorectal polyps and cancer at various 
     levels of risk. These guidelines include the following:
       For average risk individuals (65 percent-75 percent of 
     cases), the American Cancer Society recommends annual fecal 
     occult blood test plus sigmoidoscopy every 5 years; or 
     colonoscopy every 10 years or double contrast barium enema 
     every 5 to 10 years. Testing should begin at age 50.
       For moderate risk individuals (20 percent-30 percent of 
     cases), the American Cancer Society recommends colonoscopy or 
     a total colon exam, which includes colonoscopy or double 
     contrast barium enema, depending on family history and the 
     size of the polyps. Testing interval and age to begin depend 
     on initial diagnosis and family history.
       For high risk individuals (5 percent-8 percent of cases) 
     with a history of familial adenomatous polyps, the Society 
     recommends early surveillance with endoscopy, counseling to 
     consider genetic testing, and referral to a specialty center. 
     Testing should begin at puberty. For high risk individuals 
     with a family history of hereditary non-polyposis colon 
     cancer, the Society recommends colonoscopy and counseling to 
     consider genetic testing. Testing should begin at age 21.

  In addition, former Governor L. Douglas Wilder recently wrote a 
commentary in the Richmond Times Dispatch, which discussed the 
importance of prostate and colorectal cancer screening procedures. His 
comments support the colorectal cancer screening approach adopted in 
H.R. 1128. Governor Wilder's commentary follows.
  Finally, the Washington Branch of the NAACP wrote a letter to the 
House Ways and Means Health Subcommittee on the importance of 
colorectal cancer screening for African-Americans. The letter written 
by the NAACP supports the screening provisions of H.R. 1128 and barium 
exams. The letter follows.
  I commend Governor Wilder and the Washington Branch of the NAACP for 
their involvement in this issue, and I urge my colleagues to read and 
examine all of the aforementioned statements.
  Mr. Speaker, colorectal cancer screening is an important part of 
providing preventive services to our Nation's seniors, a concept which 
I strongly support. However, it is also important that colorectal 
cancer screening legislation meet the needs of our Nation's seniors. 
There is an emerging consensus that barium exams must be included in 
colorectal cancer screening legislation. I urge my colleagues to join 
this consensus by supporting the provisions of H.R. 1128, the 
Colorectal Cancer Screening Act.

            [From the Richmond Times-Dispatch, Apr. 6, 1997]

        Blacks Need Better Access to Screening Tests for Cancer

                         (By L. Douglas Wilder)

       Richmond.--A recent symposium on ``Race and Health Care as 
     We Approach the Twenty-First Century'' at Virginia 
     Commonwealth University was the first of what will

[[Page E989]]

     be annual topical discussions on matters of utmost concern to 
     all of us. I was privileged, in my post at the Center for 
     Public Policy, to convene the two-day meeting. Participants 
     included scholars who have achieved national acclaim for 
     providing solutions to the problems; they represented a broad 
     spectrum of women, minorities, academicians, practitioners, 
     and others. The participants discussed not only the unique 
     challenges faced by African Americans in health care, but 
     also the obstacles they face in gaining access to adequate 
     screening for certain kinds of cancer.
       At a time when President and Congress are considering 
     measures to provide preventive screening to the Medicare 
     population for certain cancers, it is essential that we 
     consider the differences in how cancer manifests itself in 
     American Americans, and what this means to appropriate 
     screening.
       The challenge is particularly acute for prostate and 
     colorectal cancers. The data on these diseases are clear and 
     simple: While the nation's focus has been on the 40,000 
     deaths each year from AIDS and the more than 44,000 deaths 
     each year from breast cancer in the United States, it is 
     important to recognize that colorectal cancer will claim more 
     than 50,000 and prostate cancer more than 42,000, Americans 
     in 1997. For African Americans, the statistics are 
     particularly frightening, as African Americans are struck 
     more frequently than, and differently from, other 
     Americans. And surprise, surprise, there are no genetic or 
     hereditary deficiencies that account for this.
       For prostate cancer, African Americans males have the 
     highest incidence in the world--66 percent higher than white 
     men, with a mortality rate more than two times higher. If 
     detected while localized, the five-year survival rate for 
     prostate cancer is 99 percent. For colorectal cancer, the 
     mortality rate among African Americans continues to rise, 
     even as the American Cancer Society reports declines in 
     colorectal cancer among other segments of the population.
       African Americans who get colorectal cancer are 50 percent 
     more likely to die of the disease than others in this 
     country. In addition, the disease affects African Americans 
     differently from the way it affects white Americans: The 
     National Cancer Institute's Black/White Cancer Survival Study 
     found that African Americans have a greater tendency to get 
     colorectal cancer in the right colon--the portion not reached 
     by sigmoidoscopy--than other Americans, explaining, at least 
     in part, the higher mortality rate from the disease. These 
     data illustrate the special importance of regular prostate 
     and colorectal screening for African Americans to detect 
     these cancers at the earliest stages and, to the extent 
     possible, correct the disparity in the incidence of the 
     disease.
       What can be done to meet the challenge of reducing the 
     mortality rate for these cancers among all segments of the 
     Medicare population? I am pleased to see that Medicare 
     coverage for preventive screening benefits is one area where 
     President Clinton and Republican congressional leaders appear 
     to agree. President Clinton has recognized the importance of 
     preventive screening, and his FY 1998 budget proposes to 
     extend Medicare coverage to including screening for prostate 
     and colorectal cancer, as well as other preventive benefits. 
     In addition, a group led by Republican Congressmen Bill 
     Thomas and Mike Bilirakis, who head the two key Health 
     Subcommittees in the House of Representatives, has introduced 
     legislation to provide similar benefits under Medicare. 
     Similar efforts are underway in the U.S. Senate as well. With 
     bipartisan support, these important screenings will be 
     available to all elderly Americans served by Medicare.
       The extension of Medicare coverage to include these new 
     benefits may screening of the entire colon--with colonscopy 
     or barium enema--possible for early detection of colorectal 
     cancer. Key members of the U.S. Congress have adopted an 
     approach that provides appropriate choice for patients in the 
     Medicare population, including the African Americans 
     population and other Medicare recipients who prefer a 
     comprehensive screening option. Congressman Norman Sisisky of 
     Virginia, himself a colorectal cancer survivor, has taken a 
     leading role in advocating regular preventive screening and 
     has indicated that his ``mission in the 105th Congress [is] 
     to enact Medicare coverage for colorectal cancer screening.''
       Congressman Sisisky has supported the excellent work of 
     Congressman Alcee Hastings and Senator John Breaux, who in 
     the 104th Congress introduced legislation in the House and 
     Senate to provide Medicare coverage for colorectal cancer 
     screening and who are likely to do so again in the 105th 
     Congress. Their approach has also been supported by a number 
     of members of the Congressional Black Caucus, including 
     the distinguished Ranking Member of the Ways and Means 
     Committee, Congressman Charles Rangel. Caucus members know 
     and understand the special needs of the African American 
     population and are personally committed to providing 
     appropriate screening options to accommodate those needs.
       Legislation alone will not be enough to persuade 
     Americans--including African Americans--to undergo preventive 
     screening. A broad public education campaign is needed to 
     foster serious discussion about the benefits of these 
     screening procedures for all Americans. I hope part of this 
     campaign will provide African Americans with information 
     about the special impact of these cancers on our population, 
     and about our special screening needs. I am pleased that the 
     American Gastroenterology Association recently published 
     recommendations for regular colorrectal cancer screening, 
     which recommended procedures appropriate for the African 
     American population. I understand the America Cancer Society 
     will also be issuing its recommendations for preventive 
     colorrectal cancer screening.
       It is vitally important that preventive screening be 
     covered by Medicare and that all Americans--have access to 
     affordable, appropriate screening methodologies. Now is the 
     time to act. I challenge President Clinton and the 
     Republican-led Congress to make good on their promise to the 
     American people that the next two years will be ones of 
     action rather than delay and partisanship.
       In this instance, the lives of tens of thousands of elderly 
     Americans could be saved and their quality of life improved 
     if President Clinton and the Congress have the courage to 
     meet the people's challenge to work together for the common 
     good.


     
                                  ____
                                      National Association for the


                                Advancement of Colored People,

                                   Washington, DC, March 27, 1997.
     Hon. William Thomas,
     Chairman, Health Subcommittee, House Ways and Means 
         Committee, U.S. House of Representatives, Washington, DC.
       Dear Mr. Chairman: I would like to commend you for 
     convening a hearing on the issue of Medicare coverage for 
     preventive benefits. The legislation you have introduced, the 
     Medicare Preventive Benefits Improvement Act, H.R. 15, is a 
     good first step towards addressing the health concerns of 
     African Americans, who suffer disproportionately from 
     diseases such as breast cancer, prostate cancer, and 
     colorectal cancer. While I support the overall effort to 
     enact preventive benefits legislation represented by H.R. 15, 
     I believe that significant changes need to be made to address 
     the colorectal cancer screening provisions of this 
     legislation, which I believe are inadequate for screening the 
     African American population.
       You and I would agree that preventive screening is the key 
     to detecting colorectal cancer in its earliest stage, so 
     colorectal cancer can be treated and removed before it 
     becomes fatal. It is my understanding that over the years you 
     have supported several bills that provide Medicare coverage 
     for colorectal cancer screening, and I applaud your efforts.
       However, I am very concerned about the impact of H.R. 15 on 
     the African American community. As it stands now, African 
     Americans who develop colorectal cancer have a fifty percent 
     greater mortality rate than the general population. In 
     addition, medical studies have shown that African Americans 
     disproportionately develop cancer in the right side of the 
     colon, which means that African Americans need access to 
     screening procedures that can view the entire colon. 
     Legislation that provides for screening with only fecal 
     occult blood tests and flexible sigmoidoscopy is inadequate 
     to meet the screening needs of African Americans. In 
     addition, the high-cost and risk associated with colonoscopy 
     also make this procedure an inadequate solution for screening 
     African Americans for colorectal cancer. African American 
     patients and their doctors should be given a choice of all 
     available options.
       As mentioned, the issue of choice is crucial for African 
     American patients and their doctors when deciding which 
     procedures to use for colorectal cancer screening. The 
     Medicare Preventive Benefits Improvement Act (H.R. 15), does 
     not provide Medicare coverage for all commonly used 
     colorectal cancer screening procedures, and therefore, limits 
     the choices of doctors and patients. This legislation would 
     have a devastating effect on screening for African Americans, 
     who would be denied access to one of the most cost-effective 
     procedures for screening the entire colon, the barium enema. 
     This lack of access to such an important screening procedure 
     will needlessly cost thousands of lives.
       Colorectal cancer screening is an important issue for all 
     Americans, not only African Americans. Patients and doctors, 
     whether they are African American or not, should decide which 
     screening procedures are appropriate--not the federal 
     government.
       I urge you to support the provisions included in bi-
     partisan legislation introduced by Congressman Alcee Hastings 
     and co-sponsored by members of the Congressional Black Caucus 
     which provides Medicare coverage for colorectal cancer 
     screening using all commonly used procedures including fecal 
     occult blood tests (FOBT), flexible sigmoidoscopy, 
     colonoscopy, and the barium enema. Congressman Hastings' 
     legislation, the Colorectal Cancer Screening Act, provides 
     the same Medicare coverage for FOBT, flexible sigmoidoscopy, 
     and colonoscopy as H.R. 15, but also corrects a significant 
     omission in H.R. 15 by including the barium enema. I believe 
     that Congressman Hastings' provisions should be included in 
     H.R. 15 to give all Americans a complete choice of colorectal 
     cancer screening procedures.
       Once again, thank you for your work to support and promote 
     Medicare coverage for preventive benefits. As a supporter of 
     Medicare coverage for preventive services, I also thank you 
     in advance for pursuing the passage of inclusive colorectal 
     cancer screening legislation which is not biased against 
     African Americans.
       Please include these remarks in the record of your March 
     13, 1997 Health Subcommittee hearing.
           Sincerely,
                                           Rev. Morris L. Shearin,
                                                        President.