[Congressional Record Volume 161, Number 62 (Tuesday, April 28, 2015)]
[Extensions of Remarks]
[Page E592]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




INTRODUCTION OF THE SUPPORTING COLORECTAL EXAMINATION AND EDUCATION NOW 
                          (SCREEN) ACT OF 2015

                                  _____
                                 

                          HON. RICHARD E. NEAL

                            of massachusetts

                    in the house of representatives

                        Tuesday, April 28, 2015

  Mr. NEAL. Mr. Speaker, I rise today to introduce the Supporting 
Colorectal Examination and Education Now (SCREEN) Act of 2015. This 
legislation promotes access to critical colorectal screening procedures 
by removing barriers to one of the most effective preventive health 
screenings available. Simply put, colon cancer screening tests like 
colonoscopy save lives by detecting and preventing cancer, also 
reducing costs for individuals, their families, the Medicare program, 
and the health care system as a whole.
  The likelihood of developing colorectal cancer is greater than one in 
twenty; meaning that 133,000 Americans will be newly diagnosed this 
year. The American Cancer Society (ACS) estimates that 2,550 new cases 
of colorectal cancer will be diagnosed in my home state of 
Massachusetts this year and 930 Bay-Staters will die from this deadly 
disease. Among all cancers, colorectal cancer is the number two killer 
of Americans. This year alone, approximately 50,000 Americans will die 
from colorectal cancer.
  Despite these daunting statistics, I am encouraged by the 
opportunities for improvement as colorectal cancer is among the most 
preventable of all cancers. Unlike most other cancer screenings 
designed to detect cancer at an early stage, colorectal cancer 
screenings can actually prevent cancer from occurring in the first 
place. If found early through screening tests like colonoscopy, pre-
cancerous growths called polyps can be removed, thus halting the 
progression to colorectal cancer. Therefore the way to beat this deadly 
disease is to ensure Medicare beneficiaries are screened regularly 
through a variety of detection methods, including colonoscopy. In fact, 
a recent study in the New England Journal of Medicine concluded that of 
the nearly 50,000 people expected to die of colorectal cancer this 
year, screening colonoscopy could save more than 50 percent of these 
deaths.
  The month of March was ``National Colorectal Cancer Awareness Month'' 
and, I think, an appropriate time to reflect on some of the strides we 
have made as a nation in confronting colorectal cancer. While it 
remains the second leading cause of cancer deaths among men and women 
combined, both the incidence and death rate have been steadily 
declining in recent years. This is a budding public health success 
story due to improvement in screening rates, demonstrating the power of 
preventive medicine. Yet there is much more to accomplish. The federal, 
state and local governments, as well as other stakeholders have come 
together and pledged their efforts to achieve the goal of 80 percent of 
eligible Americans screened by 2018.
  The screening rate for those in the target populations has increased 
nearly 10 percent over the past decade. In Massachusetts, we can boast 
one of the highest screening rates in the country at 75 percent. 
However, that still means that one out of every four eligible people is 
not getting screened. Furthermore, screening rates for recommended 
tests remain unacceptably low across the country, highlighting the need 
for public policies to help us achieve this collaborative national goal 
of 80 percent screened by 2018. In particular, the Medicare-age 
population, which is at the greatest risk for developing colorectal 
cancer, has screening rates far below this goal. CMS should be 
commended for implementing policies to increase screening utilization 
rates. However, Medicare beneficiaries make up two-thirds of all new 
cases of colon cancer, and the number is expected to increase by more 
than 50 percent by 2020.
  Accordingly, the SCREEN Act is designed to enhance Medicare 
beneficiaries' ability to access colorectal cancer screening by fixing 
coverage gaps and disincentives under the benefit. Medicare currently 
covers certain colon screening services, but Medicare beneficiaries are 
not appropriately using this benefit for various reasons, including 
out-of-pocket costs and fear of the procedure itself. Medicare waives 
cost-sharing for cancer screenings recommended by the U.S. Preventive 
Services Task Force (USPSTF), which assigns an ``A'' rating for 
colorectal cancer screening. However, if a doctor finds and removes a 
pre-cancerous polyp during a screening colonoscopy--the whole point of 
the procedure in the first place--Medicare no longer considers it a 
``screening'' and the beneficiary is required to pay co-insurance. The 
SCREEN Act waives cost-sharing under this scenario, as well as the 
necessary follow-up colonoscopy upon a positive finding of other 
recommended colorectal cancer screening tests covered by Medicare. 
These changes will help achieve this ``80 percent by 2018'' goal and 
will ensure there are no financial barriers for Medicare beneficiaries 
across this screening continuum in colorectal cancer prevention. 
Relatedly, the SCREEN Act would stabilize Medicare reimbursement for 
screening tests for the next three years to encourage Medicare 
providers to participate in nationally recognized quality improvement 
registries and screening initiatives as we strive towards the ``2018 
goal.'' This bill would ensure that the Medicare colorectal cancer 
screening benefit works for both patients and the physicians treating 
Medicare beneficiaries.
  Unfortunately, fear of the screening colonoscopy test itself 
undermines the goal of increasing colorectal cancer screening 
utilization rates. This fear has also undermined screening rates for 
another public health epidemic in Medicare, Hepatitis C. Medicare has 
concluded that our nation's veterans and baby boomers are most at risk 
for Hepatitis C. Baby boomers--who make up about 30 percent of the U.S. 
population--account for two-thirds of the people with Hepatitis C in 
the U.S. CMS also notes that roughly 85 to 90 percent of those infected 
with Hepatitis C are asymptomatic, meaning they have no outward signs 
of disease. The Centers for Disease Control (CDC) and USPSTF recommend 
age-based screening for both colorectal cancer and Hepatitis C, even if 
the Medicare beneficiary has no symptoms. Just like colorectal cancer 
screening, we must do more to increase screening for Hepatitis C.
  The SCREEN Act recognizes the critical role that doctors play in 
providing information, alleviating fears, and encouraging patients to 
ask questions, and thus establishes a demonstration project to allow 
Medicare beneficiaries the opportunity to discuss these screening 
procedures with the provider performing the procedure. Thus, allowing 
the Medicare beneficiary the option to be screened for Hepatitis C at 
the same time the beneficiary is undergoing a screening colonoscopy. 
One recent study has demonstrated that more patients will agree to get 
a Hepatitis C screening while they are undergoing a screening 
colonoscopy.
  In addition to raising awareness, now is the time to redouble our 
commitment to preventing and beating and preventing colorectal cancer. 
I therefore urge my colleagues to join me in supporting the SCREEN Act.

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