[Congressional Record Volume 153, Number 55 (Thursday, March 29, 2007)]
[Senate]
[Pages S4188-S4191]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. FEINSTEIN (for herself and Mr. Brownback):
  S. 1056. A bill to provide for a comprehensive Federal effort 
relating to early detection of, treatments for, and the prevention of 
cancer, and for other purposes; to the Committee on Health, Education, 
Labor, and Pensions.
  Mrs. FEINSTEIN. Mr. President, I rise, along with my Senate Cancer 
Coalition cochair, Senator Brownback, to introduce the National Cancer 
Act of 2007, a bipartisan blueprint for winning the war against cancer.
  It includes: grants for targeted drug development; creating ``cancer 
quarterbacks'' in Medicare; Medicaid coverage for smoking cessation 
treatments; pilot projects for expanding colorectal cancer screening in 
underserved populations; continued research into the possible benefits 
of early detection for lung cancer; loan repayment assistance for 
cancer prevention researchers; incentives for research into drugs that

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prevent cancer from developing and spreading in the first place; 
provisions to promote the collection and storage of tissue sample, to 
give researchers the tools they need to use genomic research to create 
individualized cures; promoting access to clinical trials, as well as 
investigational therapies for those who are terminally ill; addressing 
the health needs of the growing number of cancer survivors.
  Just over 35 years ago, President Nixon signed into law the original 
National Cancer Act, creating the National Cancer Institute and making 
cancer research a priority of the Federal Government. This work has led 
to tremendous breakthroughs against cancer, including innovative drugs, 
treatments, and a better understanding of the factors that lead to 
cancer in the first place. Last year, death rates decreased for 11 of 
the 15 cancers most common in men, and 10 of the cancers most common in 
women.
  Sixty-five percent of people diagnosed with cancer can now expect to 
survive at least 5 years. This is good news. But it is not enough. The 
cost of cancer, in both human and economic terms, remains staggering.
  An estimated 1,399,790 Americans were diagnosed with some form of 
cancer last year.
  Approximately 1 of 3 women will develop cancer at some point in her 
lifetime; for men, the risk is slightly less than 1 in 2.
  The National Institutes of Health estimated the overall cost of 
cancer in 2005 at $209.9 billion.
  The price of inaction is too steep. Cancer is, first and foremost, a 
disease of aging. About 76 percent of cancer cases are diagnosed in 
patients at age 55 or older. If no fundamental changes are made, the 
aging of the Baby Boom generation will bring a 20 percent increase in 
cancer diagnoses.
  In the face of these challenges, the National Cancer Institute, NCI, 
with broad support in the cancer community, set the ambitious goal of 
ending death and suffering from cancer by 2015. This goal has generated 
unprecedented excitement and unity, with over 80 Members of the United 
States Senate signing a letter in support of the effort.
  It is time to reexamine and reorient our Nation's cancer policy to 
meet this ambitious goal. This does not mean that cancer will be 
eradicated by 2015. As our population ages, cancer will not go away. 
But we can change the meaning of a cancer diagnosis, and that is what 
the 2015 goal is about.
  Meeting this goal will take a comprehensive approach. It requires 
detecting cancer earlier, before it spreads and becomes harder to 
treat. It requires targeted therapies, capable of killing cancer cells 
while leaving healthy cells intact. We must provide access to high 
quality cancer care for those who do get sick. We must also understand 
more about why people get cancer in the first place, and ways it can be 
prevented.
  Our legislation takes a multifaceted approach to changing the very 
nature of a cancer diagnosis. The National Cancer Act of 2007 will do 
the following:
  Authorize grants for the development of targeted drugs.
  New drug therapies continue to lead us closer to the day in which 
cancer is a treatable, chronic condition controlled with a simple pill 
or injection. It has now been 5 years since the drug company Novartis 
won approval for Gleevec, a targeted drug that has saved the lives of 
countless patients with Chronic Myeloid Leukemia, CML.
  Gleevec demonstrates the promise of this new kind of drug therapy. It 
blocks the enzymes that help cancer cells grow and divide, leaving 
healthy cells untouched. When this drug was first introduced, CML 
patients who were near death recovered and left the hospital. Yet it 
could not be determined if their remission would last, or if long-term 
use of this revolutionary drug would prove safe.
  We now know that Gleevec is fulfilling this early promise. Before the 
advent of this drug, CML patients would often suffer a relapse after 2 
or 3 years. But a recent study of CML patients taking Gleevec has 
demonstrated a remarkable 89 percent survival rate after 5 years. The 
cancer progressed to a more serious stage in only 7 percent of patients 
during this time period, and only 5 percent were forced to discontinue 
treatment because of side effects.
  These results suggest that patients may be able to stay on Gleevec 
indefinitely, keeping this formerly deadly cancer under control while 
leading full and productive lives.
  Targeted therapies are now offering hope to patients with many 
different kinds of cancer: Herceptin for some breast cancers, Iressa 
for those with small cell lung cancer, Avastin for colorectal cancer. 
Avastin can extend survival by interfering with the growth of blood 
vessels that feed the tumor, literally starving it.

  These drugs are the future of cancer research. We need more drugs 
like Gleevec, which transform cancer from a killer to a controllable 
health condition. This legislation would authorize NCI to make grants 
to further develop these treatments.
  To help with the development of targeted drugs, the bill also calls 
for the establishment of a task force on surrogate endpoints and 
biomarkers. They are the mechanisms for measuring the efficacy of 
cancer treatment at the molecular level, allowing doctors to precisely 
gauge how a patient is reacting to a treatment, or if a cancer is 
progressing.
  Developing biomarkers for different types of cancer is an essential 
step, and our bill will establish a program to develop the biomarkers 
with the most immediate clinical promise.
  The bill will also create special reimbursements for coordinating 
physicians, or ``cancer quarterbacks'' in Medicare. Successful cancer 
treatment is increasingly complex, reaching across the entire spectrum 
of the medical profession. It can involve lab tests, CT-scans, surgery, 
chemotherapy, and a full team of specialists who offer this care. Many 
patients have no single physician who can guide them through the 
complicated and sometimes contradictory course of cancer treatment, no 
professional to advise them what is best.
  This bill would require Medicare to pay oncology doctors or nurses to 
become the overall managers of patients' care, in effect providing 
every cancer patient with a ``cancer quarterback'' physician to help 
them coordinate care and make the necessary decisions.
  This cancer quarterback can direct care in the manner that best meets 
the patient's needs, instead of focusing on only a small segment of his 
or her care.
  This legislation requires that State Medicaid drug programs cover 
smoking cessation treatments in the same manner as all other approved 
therapies. I have long believed that we will not truly address the 
burden of cancer until we address tobacco use. I have asked all kinds 
of cancer experts about what we can do to stop death from cancer, and 
their answer is always the same: Stop tobacco use.
  Tobacco causes 30 percent of cancer deaths and 1 in 5 of all deaths 
in the United States. It is the leading cause of preventable death. 
Smoking related costs total $167 billion annually.
  According to the CDC, more than 70 percent of American smokers would 
like to quit. Studies indicate that tobacco use treatment, including 
smoking cessation aids, will double their chances of success.
  Yet under current law, State Medicaid programs are exempted from 
providing coverage of smoking cessation agents in the same way as they 
provide coverage of other drugs. Other exemptions include fertility 
treatments, drugs to promote hair growth, and drugs for erectile 
dysfunction.
  Simply put, smoking cessation aids, which are FDA approved and proven 
to be effective, do not belong on this list. Denying people access to 
treatments to help them break a deadly and expensive addiction is 
flawed policy.
  Our bill will remove tobacco cessation products from this list of 
exemptions, leveling the playing field with other FDA approved 
products.
  Our bill establishes pilot projects for expanding colorectal cancer 
screening for low-income, uninsured individuals. The Breast and 
Cervical Cancer Early Detection Program has proven very successful in 
providing low income women with access to potentially life saving 
screenings. It is now time to provide similar access to colorectal 
cancer screening.
  The need is great. A 2006 study conducted by Northwestern University 
researchers found that only 7 percent of minority patients without 
regular

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health care access at risk for developing colon cancer are being 
screened. A 2005 study of New York City residents found that those 
least likely to have been recommended colorectal screening are low-
income or uninsured.
  Early detection allows physicians to identify patients with pre-
cancerous polyps, and treat them before cancer even develops. These 
pilot projects identify the best ways to provide access to this 
lifesaving care for those who are not currently receiving recommended 
screenings.
  This bill will authorize continued research on the potential of CT 
scans to detect lung cancer early. before it becomes fatal. Despite all 
the promising advances against many types of cancer, lung cancer 
remains the Nation's leading cause of cancer death in both men and 
women. About 20,000 people who have never smoked are diagnosed with 
lung cancer each year, and this number is increasing.
  We need to learn more about how to screen for lung cancer and detect 
it early, before it has advanced. There is much we need to learn before 
scientists can make a definitive recommendation about screening and its 
potential benefits for both smokers and non-smokers.
  To help scientists learn more, this bill will authorize funding to 
provide CT scans to those with a history of heavy smoking. This further 
study will help determine whether this promising technology is indeed 
the method we need to make progress against the leading cancer killer.
  This legislation expands the existing NIH loan repayment program to 
provide assistance to researchers who make a commitment to working on 
cancer prevention research. This will encourage the best and brightest 
to pursue work that will help us to better understand what causes 
cancer and how we can stop it from occurring.

  The bill will encourage and support research into new drugs and 
treatments, called chemopreventatives, which can stop precancerous 
cells from becoming tumors. Decades of research has enabled physicians 
to prescribe medications to prevent serious illness, such as statin 
drugs to lower cholesterol, and drugs to treat high blood pressure 
before it leads to strokes.
  Progress in drug development to stop cancer has been far more 
limited. The promise of this field was made clear when, last year, the 
Food and Drug Administration, FDA, licensed Gardasil, a vaccine to stop 
the spread of cervical cancer. Gardasil protects against the two forms 
of the human papillomavirus, or HPV, which causes approximately 70 
percent of cervical cancer cases. This vaccine could virtually 
eliminate cervical cancer during the lifetime of our daughters and 
granddaughters.
  We need more chemoprevention techniques like Guardasil to guard 
against other types of cancer. People at high risk for a specific type 
of cancer may one day take a daily pill to stop abnormal cells from 
progressing to full blown cancer. Though it will take a long time for 
these promises to become reality, this research is the future of cancer 
care.
  In order to encourage this work, our legislation would grant Orphan 
Drug Act protections to treatments designed to treat high-risk 
conditions in individuals who have not yet been diagnosed with cancer, 
but if left untreated, face a high risk of developing cancer.
  This research will require new resources in order to have the best 
chance of success. To build the foundations for success, our bill will 
encourage biospecimen collection.
  Scientists are beginning to understand the significant role that 
genetics plays in the development of cancer. To encourage further 
study, scientists need access to a variety of tissue, blood, and other 
samples from both cancer patients and those who are healthy. Our bill 
codifies guidelines for the collection of these samples and requires 
that the Medicare Payment Advisory Commission, MedPAC, draft a report 
examining potential payment systems for these activities.
  We are on the cusp of an age of personalized medicine, in which a 
cancer patient's tumor can be analyzed to determine what type of 
treatment will be most effective. Patients will no longer undergo round 
after round of chemotherapy or radiation in the hopes of finding a 
treatment regime that works. Collecting and storing blood and tissue 
samples will provide our researchers with the materials they need to 
make these important discoveries.
  Our bill will promote clinical trial enrollment. Patients willing to 
try these cutting edge cancer therapies as they emerge face a variety 
of obstacles. They, or their physicians, might not know what clinical 
trial opportunities exist. They may need to travel to a far away 
facility to participate. Our legislation requires the Director of the 
National Cancer Institute to create a clinical trials program, which 
includes: an outreach program, to assure that all patients, especially 
minorities, participate in trials; and a coordination program, to help 
patients with logistical challenges and the support costs of trial 
participation.
  Our bill creates an oncology compassionate access program. No patient 
should lose a battle with cancer because bureaucratic hurdles denied 
him or her access to a potentially lifesaving therapy. Our bill 
provides for the creation of a new compassionate access program to 
speed access of investigational therapies for terminally ill patients 
who have exhausted all other available treatment options.
  Our bill will address the needs of a growing number of cancer 
survivors. As cancer increasingly becomes a manageable, chronic 
condition, there will be an increasing number of cancer survivors 
confronting yet-unknown health challenges. Current cancer survivors 
number almost 10 million, and this number will only grow. This bill 
will: expand current cancer surveillance systems to track the health 
status of cancer survivors; implement a national cancer survivorship 
action plan, including post treatment health programs; require States 
to consider the needs of cancer survivors, and their families, in 
addition to current patients, when drafting their comprehensive cancer 
control plans.
  Require the National Cancer Institute and the National Institute of 
Environmental Health Sciences, NIEHS, to report on their strategies, 
benchmarks, and progress in meeting the 2015 goal. This will allow 
Congress to adjust policy as necessary to ensure that the promise of 
ending death and suffering from cancer is realized.
  The state of cancer care has changed drastically since 1971, and it 
is time that our Federal policies reflect these changes. The 2015 goal 
is ambitious, and it requires no less than ambitious legislation in 
response.
  I urge you to join me in supporting this legislation.
  Mr. BROWNBACK. Mr. President, today, I introduce the National Cancer 
Act of 2007, along with my colleague Dianne Feinstein. Thirty-five 
years ago, President Richard Nixon signed the original National Cancer 
Act, and today, we are moving forward with a new, comprehensive bill 
that takes us one step closer to ending death and suffering from cancer 
within 10 years. This bill addresses impact-oriented issues such as the 
development of cancer prevention drugs and a screening for the most 
lethal cancer.
  Lung cancer is the number one cancer killer in America. Individuals 
afflicted with lung cancer historically have had only 15 percent 
survival rate. Our legislation includes a new demonstration program to 
continue research on a screening that uses a spiral CT scan. Screenings 
using this tool and appropriate follow-up procedures have shown very 
encouraging results in early detection.
  We also include accountability mechanisms in this bill. We request a 
report from the Federal Government regarding the manner in which 
Federal cancer research funding is being spent by requiring an estimate 
of the number of individuals who have benefited from such investment 
and the number of new treatments developed.
  Another issue our legislation addresses is the fact that less than 5 
percent of adults diagnosed with cancer each year will be treated 
through enrollment in a clinical trial; this is often due to lack of 
awareness. Our bill creates an education program about the availability 
of clinical trials.
  Our legislation also includes efforts to ensure the availability of 
compassionate access options. Making decisions about treatment options 
for cancer is a decision best made between the cancer patient and their 
doctor. Compassionate access offers cancer patients, who have exhausted 
all of their

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treatment options, access to promising investigational treatments that 
have not yet received full approval by the Food and Drug 
Administration.
  Finally, our bill includes measures to accelerate the progress of the 
National Cancer Institute's initiative of mapping the genome of the 
most lethal cancers in America, which will lead to earlier cancer 
diagnosis and the use of personalized medicine.
  I look forward to working with my colleague Dianne Feinstein and 
others in moving forward with this legislation in the Senate.
                                 ______