[Congressional Record Volume 157, Number 49 (Wednesday, April 6, 2011)]
[Senate]
[Pages S2208-S2210]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mrs. FEINSTEIN (for herself, Mr. Isakson, and Mr. Kerry):
  S. 752. A bill to establish a comprehensive interagency response to 
reduce lung cancer mortality in a timely manner; to the Committee on 
Health, Education, Labor, and Pensions.
  Mrs. FEINSTEIN. Mr. President, I rise to call for a new effort to 
combat an often deadly form of cancer--by re-introducing the Lung 
Cancer Mortality Reduction Act. I am pleased to be joined by my 
cosponsors, Senator Isakson and Senator Kerry on this very important 
bill.
  This bill will renew and improve Federal government's efforts to 
combat lung cancer. It will: set a goal to reduce lung cancer mortality 
by 50 percent by 2020; establish a Lung Cancer Mortality Reduction 
Program, with comprehensive interagency coordination, to develop and 
implement a plan to meet this goal; improve disparity programs to 
ensure that the burdens of lung cancer on minority populations are 
addressed; create a computed tomography screening demonstration project 
based on recent science; and establish a Lung Cancer Advisory Board, 
which will provide an annual report to Congress on the progress of the 
Mortality Reduction Program.
  We have made great strides against many types of cancer in the last 
several decades. However, these gains are uneven.
  When the National Cancer Act was passed in 1971, lung cancer had a 5-
year survival rate of only 12 percent. After decades of research 
efforts and scientific advances, this survival rate remains only 15 
percent.
  In contrast, the 5 year survival rates of breast, prostate, and colon 
cancer have risen to 89, 99 and 65 percent respectively.
  Lung cancer is the leading cause of cancer death for both men and 
women, accounting for 28 percent of all cancer deaths.
  Lung cancer causes more deaths annually than: colon cancer, breast 
cancer, prostate cancer, and pancreatic cancer combined.
  A National Cancer Institute study in 2009 indicated that the value of 
life lost to lung cancer will exceed $433 billion annually by 2020.
  A four percent annual decline in mortality would reduce this amount 
by more than half.
  A lung cancer diagnosis can be devastating. The average life 
expectancy following a lung cancer diagnosis is only 9 months.
  This is because far too many patients are not diagnosed with lung 
cancer until it has progressed to the later stages. Lung cancer can be 
hard to diagnose, and symptoms may at first appear to be other 
illnesses, such as bronchitis, chronic obstructive pulmonary disease, 
or asthma.
  As a result, only 16 percent of lung cancer patients are diagnosed 
when their cancer is still localized, and is the most treatable.
  When I introduced this legislation in 2009, lung cancer lacked early 
detection technology, to find the cancer when it was most treatable. 
Now, however, preliminary results show a screening method with a 
demonstrated reduction in mortality for lung cancer.
  In 2010, the National Cancer Institute released initial results from 
the National Lung Screening Trial, a large-scale study of screening 
methods to detect lung cancers at earlier stages.
  The National Lung Screening Trial found a 20 percent reduction in 
lung cancer mortality among participants screened with the computed 
tomography screening versus a traditional X-ray.
  This is the first time that researchers have seen evidence of a 
significant reduction in lung cancer mortality with a screening test.
  This is why this legislation also includes the creation of a computed 
tomography screening demonstration project, to assess public health 
needs of screening for lung cancer, and develop the most effective, 
safe, equitable, and efficient process to maximize the benefit of 
screening.
  Efforts to fight lung cancer lag behind other cancers, in part, due 
to stigma from smoking. Make no mistake, tobacco use causes the 
majority of lung cancer cases.
  Tobacco cessation is a critical component of reducing lung cancer 
mortality. Less smoking means less lung cancer. Period.
  But tobacco use does not fully explain lung cancer. Approximately 20 
percent of lung cancer patients never smoked.
  Two-thirds of individuals diagnosed with lung cancer who have never 
smoked are women.
  60 percent of lung cancer patients are former smokers who quit, often 
decades ago.
  These patients may have been exposed to second hand smoke, or they 
may have been exposed to radon, asbestos, chromium, or other chemicals. 
There could be other causes and associations that have not yet been 
discovered, genetic predispositions or other environmental exposures.
  The President's National Cancer Advisory Board Report of 2010 
identified radon as the second leading cause of lung cancer after 
smoking and listed 15 other environmental contaminants strongly 
associated with lung cancer.
  I believe that we have the expertise and technology to make serious 
progress against this deadly cancer, and to reach the goal of halving 
lung cancer mortality by 2020.
  We need this legislation to ensure that our government's resources 
are focused on this mission in the most efficient way possible.
  Agency efforts must be coordinated, and all sectors of the federal 
government that may have some ideas to lend should be participating. 
That is what the Lung Cancer Mortality Reduction Program will 
accomplish.
  In this bill the Secretary of Health and Human Services is tasked to 
work

[[Page S2209]]

in consultation with Secretaries and Directors from the Department of 
Defense, Veterans Affairs, the National Institutes of Health, the 
Centers for Disease Control and Prevention, and Food and Drug 
Administration, the Centers for Medicare and Medicaid, and the National 
Center on Minority Health and Health Disparities.
  This means that each agency with an expertise on lungs, imaging, and 
cancer will be included in this long overdue process.
  We can do better for Americans diagnosed with lung cancer. I ask my 
colleagues to support this legislation.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 752

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Lung Cancer Mortality 
     Reduction Act of 2011''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) Lung cancer is the leading cause of cancer death for 
     both men and women, accounting for 28 percent of all cancer 
     deaths.
       (2) The National Cancer Institute estimates that in 2010, 
     there were 222,520 new diagnosis of lung cancer and 157,300 
     deaths attributed to the disease.
       (3) According to projections published in the Journal of 
     Clinical Oncology in 2009, between 2010 and 2030, the 
     incidence of lung cancer will increase by 46 percent for 
     women and by 58 percent for men. The increase in the 
     incidence of lung cancer among minority communities during 
     that time period will range from 74 percent to 191 percent.
       (4) Lung cancer causes more deaths annually than the next 4 
     leading causes of cancer deaths, colon cancer, breast cancer, 
     prostate cancer, and pancreatic cancer, combined.
       (5) The 5-year survival rate for lung cancer is only 15 
     percent, while the 5-year survival rate for breast cancer is 
     89 percent, for prostate cancer 99 percent, and for colon 
     cancer 65 percent. Yet in research dollars per death, lung 
     cancer is the least funded of the major cancers.
       (6) In 2001, the Lung Cancer Progress Review Group of the 
     National Cancer Institute stated that funding for lung cancer 
     research was ``far below the levels characterized for other 
     common malignancies and far out of proportion to its massive 
     health impact'' and it gave the ``highest priority'' to the 
     creation of an integrated multidisciplinary, multi-
     institutional research program. No comprehensive plan has 
     been developed.
       (7) While smoking is the leading risk factor for lung 
     cancer, the President's National Cancer Advisory Board Report 
     of 2010 identified radon as the second leading cause of lung 
     cancer and listed 15 other environmental contaminants 
     strongly association with lung cancer, and there is 
     accumulating evidence that hormonal and genetic factors may 
     influence the onset.
       (8) Lung cancer is the most stigmatized of all the cancers 
     and the only cancer blamed on patients, whether they smoked 
     or not.
       (9) Nearly 20 percent of lung cancer patients have never 
     smoked. Sixty percent of individuals diagnosed with lung 
     cancer are former smokers who quit, often decades ago.
       (10) Lung cancer in men and women who never smoked is the 
     sixth leading cause of cancer death. Of individuals diagnosed 
     with lung cancer who have never smoked, \2/3\ of are women.
       (11) Lung cancer is the leading cause of cancer death in 
     the overall population and in every major ethnic grouping, 
     including white, African American, Hispanic, Asian and 
     Pacific Islander, American Indian, and Alaskan Native, with 
     an even disproportionately higher impact on African American 
     males that has not been addressed.
       (12) Military personnel, veterans, and munitions workers 
     exposed to carcinogens such as Agent Orange, crystalline 
     forms of silica, arsenic, uranium, beryllium, and battlefield 
     fuel emissions have increased risk for lung cancer.
       (13) Only 16 percent of lung cancer is being diagnosed at 
     an early stage and there were no targets for the early 
     detection or treatment of lung cancer included in the 
     Department of Health and Human Services's ``Healthy People 
     2010'' or ``Healthy People 2020''.
       (14) An actuarial analysis carried out by Milliman Inc. and 
     published in Population Health Management Journal in 2009 
     indicated that early detection of lung cancer could save more 
     than 70,000 lives a year in the United States.
       (15) A National Cancer Institute study in 2009 indicated 
     that while the value of life lost to lung cancer will exceed 
     $433,000,000,000 a year by 2020, a 4 percent annual decline 
     in lung cancer mortality would reduce that amount by more 
     than half.
       (16) In 2010, the National Cancer Institute released 
     initial results from the National Lung Screening Trial, a 
     large-scale randomized national trial that compared the 
     effect of low-dose helical computed tomography (``CT'') and a 
     standard chest x-ray on lung cancer mortality. The study 
     found 20 percent fewer lung cancer deaths among study 
     participants screened with the CT scan.

     SEC. 3. SENSE OF THE SENATE CONCERNING INVESTMENT IN LUNG 
                   CANCER RESEARCH.

       It is the sense of the Senate that--
       (1) lung cancer mortality reduction should be made a 
     national public health priority; and
       (2) a comprehensive mortality reduction program coordinated 
     by the Secretary of Health and Human Services is justified 
     and necessary to adequately address all aspects of lung 
     cancer and reduce lung cancer mortality among current 
     smokers, former smokers, and non-smokers.

     SEC. 4. LUNG CANCER MORTALITY REDUCTION PROGRAM.

       Part P of title III of the Public Health Service Act (42 
     U.S.C. 280g et seq.) is amended by adding at the end the 
     following:

     ``SEC. 399V-6. LUNG CANCER MORTALITY REDUCTION PROGRAM.

       ``(a) In General.--Not later than 180 days after the date 
     of enactment of the Lung Cancer Mortality Reduction Act of 
     2011, the Secretary, in consultation with the Secretary of 
     Defense, the Secretary of Veterans Affairs, the Director of 
     the National Institutes of Health, the Director of the 
     Centers for Disease Control and Prevention, the Commissioner 
     of Food and Drugs, the Administrator of the Centers for 
     Medicare & Medicaid Services, the Director of the National 
     Center on Minority Health and Health Disparities, and other 
     members of the Lung Cancer Advisory Board established under 
     section 7 of the Lung Cancer Mortality Reduction Act of 2011, 
     shall implement a comprehensive program to achieve a 50 
     percent reduction in the mortality rate of lung cancer by 
     2020.
       ``(b) Requirements.--The program implemented under 
     subsection (a) shall include at least the following:
       ``(1) With respect to the National Institutes of Health--
       ``(A) a strategic review and prioritization by the National 
     Cancer Institute of research grants to achieve the goal of 
     the lung cancer mortality reduction program in reducing lung 
     cancer mortality;
       ``(B) the provision of funds to enable the Airway Biology 
     and Disease Branch of the National Heart, Lung, and Blood 
     Institute to expand its research programs to include 
     predispositions to lung cancer, the interrelationship between 
     lung cancer and other pulmonary and cardiac disease, and the 
     diagnosis and treatment of these interrelationships;
       ``(C) the provision of funds to enable the National 
     Institute of Biomedical Imaging and Bioengineering to 
     expedite the development of screening, diagnostic, surgical, 
     treatment, and drug testing innovations to facilitate the 
     potential of imaging as a biomarker and reduce lung cancer 
     mortality, such as through expansion of the Quantum Grant 
     Program and Image-Guided Interventions programs of the 
     National Institute of Biomedical Imaging and Bioengineering;
       ``(D) the provision of funds to enable the National 
     Institute of Environmental Health Sciences to implement 
     research programs relative to lung cancer incidence; and;
       ``(E) the provision of funds to enable the National 
     Institute on Minority Health and Health Disparities to 
     collaborate on prevention, early detection, and disease 
     management research, and to conduct outreach programs in 
     order to address the impact of lung cancer on minority 
     populations.
       ``(2) With respect to the Food and Drug Administration, the 
     provision of funds to enable the Center for Devices and 
     Radiologic Health to--
       ``(A) establish quality standards and guidelines for 
     hospitals, outpatient departments, clinics, radiology 
     practices, mobile units, physician offices, or other 
     facilities that conduct computed tomography screening for 
     lung cancer;
       ``(B) provide for the expedited revision of standards and 
     guidelines, as required to accommodate technological advances 
     in imaging; and
       ``(C) conduct an annual random sample survey to review 
     compliance and evaluate dose and accuracy performance.
       ``(3) With respect to the Centers for Disease Control and 
     Prevention--
       ``(A) the provision of funds to establish a Lung Cancer 
     Early Detection Program that provides low-income, uninsured, 
     and underserved populations that are at high risk for lung 
     cancer access to early detection services;
       ``(B) the provision of funds to enable the National 
     Institute for Occupational Safety and Health to conduct 
     research on environmental contaminants strongly associated 
     with lung cancer in the workplace and implement measures to 
     reduce lung cancer risk and provide for an early detection 
     program; and
       ``(C) a requirement that State, tribal, and territorial 
     plans developed under the National Comprehensive Cancer 
     Control Program include lung cancer mortality reduction 
     measures commensurate with the public health impact of lung 
     cancer.
       ``(4) With respect to the Agency for Healthcare Research 
     and Quality, the annual review of lung cancer early detection 
     methods, diagnostic and treatment protocols, and the issuance 
     of updated guidelines.
       ``(5) The cooperation and coordination of all programs for 
     women, minorities, and health disparities within the 
     Department of Health and Human Services to ensure that

[[Page S2210]]

     all aspects of the Lung Cancer Mortality Reduction Program 
     adequately address the burden of lung cancer on women and 
     minority, rural, and underserved populations.
       ``(6) The cooperation and coordination of all tobacco 
     control and cessation programs within agencies of the 
     Department of Health and Human Services to achieve the goals 
     of the Lung Cancer Mortality Reduction Program with 
     particular emphasis on the coordination of drug and other 
     cessation treatments with early detection protocols.''.

     SEC. 5. DEPARTMENT OF DEFENSE AND THE DEPARTMENT OF VETERANS 
                   AFFAIRS.

       The Secretary of Defense and the Secretary of Veterans 
     Affairs shall coordinate with the Secretary of Health and 
     Human Services--
       (1) in developing the Lung Cancer Mortality Reduction 
     Program under section 399V-6 of the Public Health Service 
     Act, as added by section 4;
       (2) in implementing the demonstration project under section 
     6 within the Department of Defense and the Department of 
     Veterans Affairs with respect to military personnel and 
     veterans whose smoking history and exposure to carcinogens 
     during active duty service has increased their risk for lung 
     cancer; and
       (3) in implementing coordinated care programs for military 
     personnel and veterans diagnosed with lung cancer.

     SEC. 6. LUNG CANCER SCREENING DEMONSTRATION PROJECT.

       (a) Sense of the Senate.--It is the sense of the Senate 
     that a national computed tomography lung cancer screening 
     demonstration project should be carried out expeditiously in 
     order to assess the public health infrastructure needs and to 
     develop the most effective, safe, equitable, and efficient 
     process that will maximize the public health benefits of 
     screening.
       (b) Demonstration Project in General.--Not later than 1 
     year after the date of enactment of this Act, the Secretary 
     of Health and Human Services (referred to in this Act as the 
     ``Secretary''), in consultation with the Secretary of 
     Defense, the Secretary of Veterans Affairs, the Director of 
     the National Institutes of Health, the Director of the 
     Centers for Disease Control and Prevention, the Commissioner 
     of Food and Drugs, the Administrator of the Centers for 
     Medicare & Medicaid Services, and the other members of the 
     Lung Cancer Advisory Board established under section 7 of the 
     Lung Cancer Mortality Reduction Act of 2011, shall establish 
     a demonstration project, to be known as the Lung Cancer 
     Computed Tomography Screening and Treatment Demonstration 
     Project (referred to in this section as the ``demonstration 
     project'').
       (c) Program Requirements.--The Secretary shall ensure that 
     the demonstration project--
       (1) identifies the optimal risk populations that would 
     benefit from screening;
       (2) develops the most effective, safe, equitable and cost-
     efficient process for screening and early disease management;
       (3) allows for continuous improvements in quality controls 
     for the process; and
       (4) serves as a model for the integration of health 
     information technology and the concept of a rapid learning 
     into the health care system.
       (d) Participation.--The Secretary shall select not less 
     than 5 National Cancer Institute Centers, 5 Department of 
     Defense Medical Treatment Centers, 5 sites within the 
     Veterans Affairs Healthcare Network, 5 International Early 
     Lung Cancer Action Program sites, 10 community health centers 
     for minority and underserved populations, and additional 
     sites as the Secretary determines appropriate, as sites to 
     carry out the demonstration project described under this 
     section.
       (e) Quality Standards and Guidelines for Licensing of 
     Tomography Screening Facilities.--The Secretary shall 
     establish quality standards and guidelines for the licensing 
     of hospitals, outpatient departments, clinics, radiology 
     practices, mobile units, physician offices, or other 
     facilities that conduct computed tomography screening for 
     lung cancer through the demonstration project, that will 
     require the establishment and maintenance of a quality 
     assurance and quality control program at each such facility 
     that is adequate and appropriate to ensure the reliability, 
     clarity, and accuracy of the equipment and interpretation of 
     the screening scan and set appropriate standards to control 
     the levels of radiation dose.
       (f) Timeframe.--The Secretary shall conduct the 
     demonstration project under this section for a 5-year period.
       (g) Report.--Not later than 180 days after the date of 
     enactment of this Act, the Secretary shall submit a report to 
     Congress on the projected cost of the demonstration project, 
     and shall submit annual reports to Congress thereafter on the 
     progress of the demonstration project and preliminary 
     findings.

     SEC. 7. LUNG CANCER ADVISORY BOARD.

       (a) In General.--The Secretary of Health and Human Services 
     shall establish a Lung Cancer Advisory Board (referred to in 
     this section as the ``Board'') to monitor the programs 
     established under this Act (and the amendments made by this 
     Act), and provide annual reports to Congress concerning 
     benchmarks, expenditures, lung cancer statistics, and the 
     public health impact of such programs.
       (b) Composition.--The Board shall be composed of--
       (1) the Secretary of Health and Human Services;
       (2) the Secretary of Defense;
       (3) the Secretary of Veterans Affairs;
       (4) the Director of the Occupational Safety and Health 
     Administration;
       (5) the Director of the National Institute of Standards and 
     Technology; and
       (6) one representative each from the fields of clinical 
     medicine focused on lung cancer, lung cancer research, 
     radiology, imaging research, drug development, minority 
     health advocacy, veterans service organizations, lung cancer 
     advocacy, and occupational medicine to be appointed by the 
     Secretary of Health and Human Services.

     SEC. 8. AUTHORIZATION OF APPROPRIATIONS.

       To carry out this Act (and the amendments made by this 
     Act), there are authorized to be appropriated such sums as 
     may be necessary for each of fiscal years 2012 through 2016.

                          ____________________