[Congressional Record (Bound Edition), Volume 145 (1999), Part 5]
[Extensions of Remarks]
[Pages 6546-6548]
[From the U.S. Government Publishing Office, www.gpo.gov]




          H.R. 1285, THE CANCER SCREENING COVERAGE ACT OF 1999

                                 ______
                                 

                        HON. CAROLYN B. MALONEY

                              of new york

                    in the house of representatives

                       Wednesday, April 14, 1999

  Mrs. MALONEY of New York. Mr. Speaker, I rise today to discuss a very 
important bi-partisan piece of health legislation--H.R. 1285, The 
Cancer Screening Coverage Act of 1999 (CASCA). This bill was recently 
introduced by myself and Representative Sue Kelly. It provides coverage 
for cancer screening to private insurance patients.
  Cancer is extremely prevalent in the United States. It is the second 
leading cause of death in the United States and, according to the 
Centers for Disease Control, almost half of these deaths are among 
women. One out of every 4 deaths is from cancer. The American Cancer 
Society has said that approximately 563,100 Americans will die from 
this disease this year. That's 1,500 cancer-related deaths per day. 
Everyone is at risk. Men have a 1 in 2 lifetime risk of developing or 
dying from cancer and women have a 1 in 3 lifetime risk. Those are 
pretty high odds.
  Cancer also costs both individuals and our society a great deal. The 
National Institutes of Health has estimated that cancer has an annual 
lost productivity cost due to premature death of $59 billion.
  Since 1990, approximately 5 million people have died from cancer. In 
this day and age, getting diagnosed with cancer is not necessarily a 
death sentence. Treatments are being improved every day and the overall 
survival rate has increased dramatically in the last decade. However, 
according to the American Cancer Society, treatments are most effective 
if cancer is caught at an early stage. Early detection has been a 
particular problem for minorities. Cancers among African Americans are 
more frequently diagnosed after the cancer has metastasized.
  The first step that needs to be taken to reduce the number of cancer 
related deaths is to increase access to screening exams in the private 
sector. We have already increased access for those over 65. In 1997, 
Congress gave Medicare patients many of the same benefits that are 
included in my bill. Americans under the age of 65 deserve this same 
benefit.
  Cancer screening and early detection offer many benefits. Screening 
is the search for disease in persons who do not have symptoms or who do 
not recognize that they have the disease. Early detection can extend 
life, reduce treatment, and improve cancer patients'

[[Page 6547]]

quality of life. When conducted regularly by a health care 
professional, screening examinations can result in the detection of 
cancers of the breast, colon, rectum, cervix, and prostate at earlier 
stages, when treatment is most likely to be successful. More than forty 
percent of all cancer cases occur in these screening-accessible cancer 
sites.
  Another benefit is that screening tools allow for the detection of 
cancer in its early form, when treatment costs are less expensive. With 
an increased availability of screening, the economic and social costs 
of cancer are kept to a minimum. We know that cancer screening and 
early detection not only improve the chance of survival and quality of 
life but also save money. For example, patients diagnosed through colon 
cancer screenings at a cost of $125-$300 have a 90% chance of survival. 
Yet, if a patient is not diagnosed until symptoms are apparent, the 
chance of survival drops to 8% and care during the remaining 4-5 years 
of life can cost up to $100,000. Similarly, the initial cost of 
treating rectal cancer that is detected early is about $5,700. This is 
approximately 75% less than the estimated $30,000-$40,000 that it costs 
to initially treat rectal cancer that is detected further in its 
development. As a society, we can't afford not to screen.
  Mr. Speaker, I would like to read into the record a statement by a 
woman who spoke about her own life saving experience with cancer 
screening at a press conference I recently held in New York City on 
this bill. This woman had the most advanced form of pre-invasive 
cervical cancer. If she had waited only a little longer for her 
screening, it may have been too late.
  ``Hi, my name is Theresa Nygard. I am someone who knows first hand 
the benefit of cancer screening tests. In November 1991, nine months 
after the birth of my second child, I received the news that my Pap 
smear showed an irregularity. I had gone for a regular check-up, 
suspecting nothing, and came away with the news that I had what is 
called a `level three displasia,' or a `carcinoma in situ.' When my 
doctor, Dr. Goldstein, called to deliver the news, we immediately 
scheduled an in-office laser surgery for him to remove the cancerous 
tissues (that same day). In retrospect, this potentially devastating 
bit of news was almost rendered a non-event. I had the surgery, and 
beyond some lingering anxiety about having `missed a bullet,' my life 
continued as if nothing had happened. In fact something very 
significant did happen--my life was saved.''
  ``I know how lucky I am. When I was nineteen I lost my mother to 
ovarian cancer. I saw what cancer can do. To a person's health and 
vigor, to their family and friends. When I put my experience in the 
context of that knowledge I am incredibly thankful that this absolutely 
routine testing saved me from my own ignorance. I had never thought to 
fear cervical cancer. Since my mother's death I have been concerned 
(maybe even obsessed) with fears of contracting ovarian cancer, but I 
had never even thought of the danger of cervical cancer. I had 
specifically sought out Dr. Goldstein because I had heard that he was 
an expert on ovarian cancer detection. I thought I was being vigilant, 
but in fact I was simply lucky. Lucky that this form of cancer 
screening test was conducted as a routine part of my regular exam and 
lucky that my mother's experience has at least taught me to assume 
nothing about my health. I had no clue, no symptom, no ache or pain 
that would have compelled me to make a special appointment in 1991. 
Only because this testing had become a routine part of my life was my 
condition rendered a completely curable `non-event.' I wish that this 
could have been so for my mother, as I wish it were so for all women 
faced with this sort of discovery.''
  Another woman, Lee Ann Taylor, also shared her story about cervical 
cancer screening at the New York City press conference. I would also 
like her statement placed into the Record.
  ``Hi--my name is Lee Ann Taylor and I would like to briefly explain 
how pre-cancer screening tests or preventive care has helped me lead a 
normal life.''
  ``I have been a patient of Dr. Goldstein for over 10 years. With Dr. 
Goldstein's guidance and recommendation I have diligently followed a 
regimen of annual PAP tests are now semi-annual tests. During these 
years there has been a number of times when abnormal cells have been 
detected in early stages.''
  ``My family also has a history of breast cancer. Once again annual 
mammograms and now at the age of 40 and over, a semi-annual sonogram 
test is recommended for women with a family history of breast cancer.''
  ``For me, these annual/semi-annual pre-cancer screening tests have 
detected abnormal cell changes in such early stages that only minor 
procedures had to be performed to correct the problem.''
  ``I strongly believe that pre-cancer screening tests are absolutely 
necessary and have helped me lead a normal active life. I have two 
beautiful healthy children and I want to think that I am doing 
everything that I can to prevent any unnecessary risk to my health and 
to my family's health.''
  Mr. Speaker, most insurance companies provide coverage for some 
cancer screening. The problem is that coverage is very inconsistent and 
plans do not always provide coverage for the appropriate type of 
screening test given a person's risk level. For example, some New York 
City health plans have made mammographies available, but would deny 
coverage for a colonoscopy to a woman with a family history of 
colorectal cancer.
  Studies have shown that there is a direct correlation between the 
utilization of preventive services and the level of service provided by 
health insurance coverage. The more comprehensive an individual's 
health insurance coverage is, including cancer screening, the more 
likely that the person will use these important preventive services. 
Health insurance, covered items and services, deductibles, coinsurance, 
and other co-payments all affect care seeking behavior.
  My bill assures that all individuals with health insurance are 
guaranteed coverage for important cancer screening tools used for the 
detection of breast, cervical, colorectal, and prostate cancers. 
Science has shown that the screening exams contained in my bill are 
effective. If a physician and patient have decided that a patient would 
benefit from a screening exam, insurance companies should not deny 
access to this exam. This bill will saves lives and lower the cost of 
treating cancer by increasing the rates of early detection.
  Mr. Speaker, I would like to share the following facts and statistics 
on these four cancers with you and my colleagues.
  Breast cancer is the second most common cause of cancer-related 
deaths among American women. This type of cancer also strikes men. The 
American Cancer Society has estimated that there will be 175,000 new 
invasive cases of breast cancer in 1999 among women and about 1,300 new 
cases among men. 43,700 people will die of breast cancer in this year. 
Regular mammography screening has been shown to reduce breast cancer 
mortality significantly by at least 30% in women aged 50 and older. 
Recent scientific evidence has also shown that women in their 40s also 
benefit from regular mammography.
  My bill provides annual mammograms for women ages 40 and over and for 
women under 40 who are at high risk of developing breast cancer. Annual 
clinical breast exams will also be provided for women ages 40 and over 
and for women between the ages of 20 and 40 who are at high risk of 
developing cancer and every three years for women in the 20 to 40 age 
group who are at normal to moderate risk.
  An estimated 4,800 women will die from cervical cancer this year. 
When detected at an early stage, invasive cervical cancer is one of the 
most successfully treatable cancers. The five year survival rate for 
localized cancer, cervical cancer that is detected in the early stage, 
is 91%. According to the CDC, the costs of diagnosis, treatment, and 
follow-up associated with early stages of cervical cancer are $4,359, 
whereas the same costs for late, invasive cervical cancer are more than 
triple that amount. CASCA ensures that women ages 18 and over and women 
who are under age 18 and are or have been sexually active will have 
coverage for annual pap tests and pelvic exams.
  Colorectal cancer is the third leading cause of cancer-related deaths 
in the United States. While colorectal cancer is often thought of as a 
men's disease, women are almost equally affected by it. Early detection 
is essential for survival of colorectal cancer. When colorectal cancers 
are detected in an early, localized stage, the 5-year relative survival 
rate is 91%; however, only 37% of colorectal cancers are currently 
discovered at that stage.
  There are several tests that can be used to screen for colorectal 
cancer. Only a physician can determine in consultation with the patient 
which test is appropriate. My bill ensures coverage for the appropriate 
test for men and women ages 50 and those under 50 who are at high risk 
for an annual screening fecal-occult blood test and a screening 
flexible sigmoidoscopy every four years or a screening barium enema. 
Because science has demonstrated the effectiveness of colonoscopy in 
detecting colon cancer throughout the entire colon, coverage for this 
exam is ensured for men and women at high risk in any age group.
  In the past five years, more than 20,000 American men lost their 
lives to prostate cancer. About one in four prostate cancer cases

[[Page 6548]]

strikes a man under the age of 65. The number of men in their 40s and 
50s who are battling prostate cancer is increasing, and clinicians 
around the country report seeing more aggressive forms of the disease 
in younger men. African American men are diagnosed with prostate cancer 
35% more frequently than Caucasians and are more than twice as likely 
to die of the disease. In fact, prostate cancer is the second leading 
cause of death among this group. Last year, the American Cancer Society 
reported a 23% rise in the prostate cancer death rate over a twenty 
year period. CASCA ensures coverage for annual digital rectal 
examination and/or annual prostate-specific antigen blood tests for men 
ages 50 and over. This specific provision is supported by not only the 
American Cancer Society, but also the American Urological Association.
  The provisions in CASCA are based on the latest scientific knowledge 
and have been shown to be effective in reducing cancer mortality. The 
bill is based on the guidelines of the American Cancer Society and 
follows the Medicare cancer screening benefits as provided by the 
Balanced Budget Act of 1997.

  The following 28 organizations have endorsed CASCA: The American 
Cancer Society, American Society of Clinical Oncologists, Society of 
Gynecologic Oncologists, Association of Reproductive Health 
Professionals, American Urological Association, American College of 
Obstetricians & Gynecologists, American Medical Women's Association, 
Cancer Research Foundation of America, American Public Health 
Association, American Society of Colon & Rectal Surgeons, American 
Nurses Association, National Alliance of Nurse Practitioners, American 
College of Nurse Practitioners, American Society of Reproductive 
Medicine, Cancer Care, Inc., Susan G. Komen Breast Cancer Foundation, 
Cure for Lymphoma Foundation, National Alliance of Breast Cancer 
Organizations, National Patient Advocate Foundation, National Coalition 
for Cancer Survivorship, Oncology Nursing Society, North American Brain 
Tumor Coalition, American College of Gastroenterology, Y-ME National 
Breast Cancer Organization, Alliance for Lung Cancer Advocacy, Support 
& Education, the Center for Patient Advocacy, the Kidney Cancer 
Association, and the National Cervical Cancer Coalition.
  ``The Cancer Screening Coverage Act of 1999'' is an important first 
step to ensuring that the goals of reducing cancer mortality and 
incidence, as well as improving the quality of life for all cancer 
patients, are met. Mr. Speaker, I hope my colleagues will join me in 
taking this opportunity to save almost 150,000 Americans a year.

                          ____________________