[Congressional Record (Bound Edition), Volume 155 (2009), Part 23]
[House]
[Pages 31871-31878]
[From the U.S. Government Publishing Office, www.gpo.gov]




                   BREAST CANCER SCREENING GUIDELINES

  Mrs. CAPPS. Mr. Speaker, I move to suspend the rules and agree to the 
resolution (H. Res. 971) expressing the sense of the House of 
Representatives regarding guidelines for breast cancer screening for 
women ages 40 to 49.
  The Clerk read the title of the resolution.
  The text of the resolution is as follows:

                              H. Res. 971

       Whereas the United States Preventive Services Task Force 
     (USPSTF), an independent panel of experts in primary care 
     prevention and evidence-based medicine, issued guidelines on 
     November 16, 2009, regarding mammography screening for women, 
     including women age 40 to 49;
       Whereas these guidelines reflect a change from USPSTF 
     mammography recommendations issued in 2002;
       Whereas the new guidelines have caused concern among many 
     health providers and confusion among many women age 40 to 49;
       Whereas the Department of Health and Human Services has 
     stated that while the USPSTF has presented some new evidence 
     for consideration, the policies of the Department remain 
     unchanged; and
       Whereas the Department of Health and Human Services has 
     stated that there is a great need for more evidence, more 
     research, and more scientific innovation to help women 
     prevent, detect, and fight breast cancer: Now, therefore, be 
     it
       Resolved, That it is the sense of the House of 
     Representatives that--
       (1) the guidelines of the United States Preventive Services 
     Task Force (``USPSTF'') would not prohibit an insurer from 
     providing coverage for mammography services in addition to 
     those recommended by the USPSTF and should not be used by 
     insurers to deny coverage for services that are not 
     recommended on a routine basis; and
       (2) the National Cancer Institute should continue to invest 
     and provide leadership regarding research to develop more 
     effective screening tools and strategies for improving 
     detection of breast cancer.

  The SPEAKER pro tempore. Pursuant to the rule, the gentlewoman from 
California (Mrs. Capps) and the gentlewoman from Tennessee (Mrs. 
Blackburn) each will control 20 minutes.
  The Chair recognizes the gentlewoman from California.


                             General Leave

  Mrs. CAPPS. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend remarks and 
include extraneous material in the Record.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from California?
  There was no objection.
  Mrs. CAPPS. Mr. Speaker, I yield to myself such time as I may 
consume.
  Mr. Speaker, I rise today in support of House Resolution 971. This 
resolution expresses the sense of the House of Representatives that the 
U.S. Preventive Services Task Force guidelines would not prohibit an 
insurer from providing coverage for mammography services beyond those 
recommended by the task force.
  It further states that these guidelines should not be used by 
insurers to deny coverage for these services.
  It also expresses the sense of the House that the National Cancer 
Institute should continue to invest and provide leadership regarding 
research to develop more effective screening tools and strategies for 
improving the detection of breast cancer.
  On November 16, 2009, the U.S. Preventive Services Task Force issued 
a series of six recommendations regarding breast cancer screening, 
three of which pertain to mammography screening among women of various 
age groups. At a recent hearing in our Energy and Commerce Committee's 
Health Subcommittee, the task force representatives acknowledged that 
they should have done a better job communicating their findings to the 
public. Unfortunately, this failure in communication has led to much 
concern and confusion about what their findings and recommendations are 
and what the implications would be.
  Mr. Speaker, this task force is not suggesting that women in their 
forties forego mammography. The task force is recommending that women 
in their

[[Page 31872]]

forties determine when to begin screening and base this decision on a 
conversation with their doctors or health providers. And we can all 
agree that women in their forties should have access to mammography if 
these women and their physicians decide it's right for them. I think we 
can also agree that while mammography is still the best tool that we 
have to detect breast cancer in its earliest stages, it is, by every 
means, an imperfect tool. We need continued research into more 
effective screening tools and strategies to improve the detection of 
breast cancer.
  Breast cancer is the second most common cancer among United States 
women, and it is the leading cause of cancer death for women between 
the ages of 29 and 59. This year, new cases of breast cancer among 
American women will reach an estimated 192,370, and over 40,000 women 
will die from breast cancer this year. The American Cancer Society 
estimates that one in 8 women will have invasive breast cancer at some 
point in her lifetime. These statistics illustrate that breast cancer 
continues to be a major health issue, despite recent declines in breast 
cancer mortality rates.
  But beyond these statistics, cancer is a very personal situation for 
many of us in this Chamber, whether it has affected a mother, a 
daughter, a wife, a friend, a colleague or, as it has for me, my own 
sister. I want to commend my colleague, Debbie Wasserman Schultz, for 
introducing this resolution and for being so forthcoming about her very 
personal experience being diagnosed with and treated for breast cancer.
  I reserve the balance of my time.
  Mrs. BLACKBURN. Mr. Speaker, I do rise in support of the resolution, 
and I yield myself such time as I may consume.
  I am pleased to see this resolution before us, and I want to commend 
Congresswoman Wasserman Schultz and also Congresswoman Capps for their 
work on this issue. I appreciate their leadership to raise awareness, 
and I have grave concerns, very grave concerns on how this issue 
translates into the health reform bills that are currently before us. 
While I do rise in support of this, I do think that it is important, it 
is imperative, as a matter of fact, that we revisit why we are here and 
why we are having this discussion today. And it's important that we 
realize that, even with the resolution before us, it is not going to 
get to the crux of the issue, but it is a good, solid first step.
  With or without a government-run health plan, H.R. 3962 would still 
be a massive takeover of health care. Government bureaucrats will be 
charged with making decisions of what can be in your health plan, and 
they can make it illegal for a health plan to cover anything not 
approved by the government. In the House version of the Democrats' 
health reform, the U.S. Preventive Services Task Force and its 
successor organization are cited over a dozen times and given 
disturbing new authority over coverage decisions regarding breast 
cancer screening.
  For example, on page 1,762 of the Democrat health reform bill, the 
U.S. Preventive Services Task Force is given the authority to 
determine, and I'm quoting, ``the frequency'' and ``the population to 
be served.'' And quoting again from the bill, ``The procedure or 
technology to be used for breast cancer screenings covered under the 
Indian Health Service Act.'' Section 303 of H.R. 3962 states that the, 
and I'm quoting again, ``Commissioner shall,'' which is a mandate, Mr. 
Speaker, ``shall specify the benefits to be made available under 
exchange participating health plans.''
  In plain English, that means the new health choices commissioner will 
determine what preventive services, including mammography, are covered 
under your health insurance based on what the task force says is right. 
Passing a resolution and passing this resolution before us, as I said, 
is a good, solid first step. However, I do believe to strike at the 
heart of the problem we, indeed, need to move forward on a motion to 
instruct conferees to make certain that we revisit this issue.
  Under the Democrats' bill, the task force will set government policy 
and will determine what is covered and make it illegal for plans to 
cover other items. All recommendations of the Preventive Services Task 
Force and the Task Force on Community Preventive Services as in 
existence on the day before the date of the enactment of this act--
which would be H.R. 3962--shall be considered to be recommendations of 
the Task Force on Clinical Preventive Services.
  Mr. Speaker, in order to prevent any type of rationing, that is why 
we need to take even further steps. I commend my colleagues for their 
diligent work on this issue. It is the right first step, and I 
encourage all of us to continue to work to resolve the issue.
  I reserve the balance of my time.
  Mrs. CAPPS. Mr. Speaker, I wish to remind my colleagues that in the 
health reform bill, as it was considered in the House of 
Representatives, once the essential benefits package is established, it 
acts as a floor, not as a ceiling. And with regard to preventive 
services, the bill says that recommended items and services with a 
grade of A or B from the U.S. Preventive Services Task Force shall be 
covered as part of the essential benefits package, with no cost-
sharing, and that the Secretary may approve such coverage, regardless 
of what the task force or the benefits advisory committee says.
  And at this point I'm very pleased to yield to Representative 
Wasserman Schultz, the sponsor of this legislation, 5 minutes.
  Ms. WASSERMAN SCHULTZ. Mr. Speaker, today I rise to support House 
Resolution 971, which underscores the importance of access to breast 
cancer screening for all women.
  As many of you know, last month the United States Preventive Services 
Task Force issued guidelines regarding mammography screening for women. 
These guidelines reflect a change from USPSTF mammography 
recommendations that were issued in 2002, in that they recommend 
against routine screening mammography for women ages 40 to 49. But the 
new guidelines conflict with many of the well-established 
recommendations from the American Medical Association, the National 
Comprehensive Cancer Network, the American Cancer Society, and Susan G. 
Komen for the Cure.
  In addition, numerous studies and scientific research over the past 
20 years have confirmed that annual mammograms are of value to women 
ages 40 to 49. In fact, the task force itself concluded that screening 
women in their forties would reduce their risk of death from breast 
cancer by 15 percent, while finding that screenings for women in their 
fifties would reduce their risk of death from breast cancer by 14 
percent. As a result, many young women and health care providers have 
been left feeling uncertain and concerned.
  Recommendations like those the task force made are supposed to 
provide clarity for doctors and their patients. Unfortunately, the 
guidelines issued by the task force left most women and oncologists 
baffled. Currently, there is no available breast cancer screening tool 
that is perfect, but what is clear is that intervention through routine 
screening for breast cancer using mammography can save the lives of 
women at a time when medical science is unable to prevent this disease.

                              {time}  1345

  At the end of the day, mammography screening saves lives. And I offer 
this resolution to underscore the House's commitment to expanding 
access to preventive health care for women. This resolution underscores 
the sense of the House that the task force recommendations must not be 
used by insurers who are, at the end of the day, getting in between 
women and their doctors and getting women the access that they need to 
preventive services, and that they must not be used by insurers to deny 
women coverage for routine screenings.
  It also urges the National Cancer Institute to invest and provide 
leadership to provide research to develop more effective research tools 
and strategies for

[[Page 31873]]

improving the detection of breast cancer.
  While we develop better tools for screening, we cannot leave certain 
women, particularly young women, with nothing, which is what the task 
force recommendations essentially did.
  To be sure, while we have come a long way in the fight against breast 
cancer, we still have a long way to go. This year, in the United States 
alone, over 190,000 women will be diagnosed with breast cancer; 40,000 
of them will not survive. That is why we cannot rest in our efforts to 
fund research and find a cure for this vicious disease, and it is why 
we cannot rest in our efforts to provide education and awareness for 
all women. We must ensure that they have access to screening and 
treatment, and we must ensure that we do all we can to support the more 
than 2\1/2\ million survivors that live in our country alone today.
  As many of you know, and has been gratefully acknowledged, I recently 
had my own battle with breast cancer, and I am so grateful and humbled 
to count myself among this growing group of survivors. I was fortunate 
to have the access to the treatment and support that I needed to win my 
own fight. I urge my colleagues to vote in favor of this resolution to 
make sure that everyone has that same opportunity.
  Mr. Speaker, since the task force issued these guidelines, I have 
spoken to so many young survivors who have been left feeling so 
frustrated and as if their lives somehow mattered less than the lives 
of older women. And this resolution sends a message to those young 
women across America today that that is not so, that the House of 
Representatives, that the United States Government, cares about all 
women's lives.
  And with all due respect to my good friend, Mrs. Blackburn, whom I 
greatly respect and I appreciate your support for this resolution, what 
this resolution does not do, and what the task force guidelines do not 
do, and what our health care reform bill does not do, is it does not 
ration health care. The gentlelady, if she reads the text of the health 
care reform legislation more clearly, will see that our language in our 
health care reform bill is a floor. The gentlelady should know that the 
Secretary of Health and Human Services can go beyond the task force's 
recommendations, that they can go further, and that at the very least 
the health care reform bill that we passed off the floor of this House 
ensures that women get access, all women get access to the appropriate 
preventive screening that they need and ensures that that coverage is 
free. And the Health and Human Services Secretary can go even further 
than those task force recommendations that are labeled at an A and at a 
B level.
  And with that, Mr. Speaker, I appreciate the indulgence of the 
leadership and the support of my colleagues. And I want to particularly 
single out the colleague that sits to the left of me for being a leader 
on issues that are important to young women who are diagnosed with 
breast cancer. He has been an incredible advocate for young women 
survivors, and I greatly appreciate it.
  Mrs. BLACKBURN. Mr. Speaker, at this time, I am pleased to yield 2 
minutes to the gentlewoman from North Carolina (Mrs. Myrick), who has 
been a true champion of women and breast cancer issues and has really 
led on our side of the aisle as we have worked to deal with so many of 
these issues.
  Mrs. MYRICK. Mr. Speaker, I thank my friend for yielding. I also 
thank my friends on the other side of the aisle, Debbie Wasserman 
Schultz and Lois Capps in particular. The two of them have been very, 
very up front and aggressive in leading the charge on these issues, and 
I'm grateful for it.
  As you have already heard, the government's Preventive Services Task 
Force recently advised that women under 50 don't need mammograms, that 
those over 50 don't need them every year, and that doctors shouldn't 
encourage breast self-exams due to false positives. This is really 
shocking, because what message does that send to women?
  We all know mammograms aren't perfect, and we hope that before long 
we are going to have better technology that will do the job. But cancer 
is a tricky disease, and breast cancer exams, sure, could lead to some 
tests that maybe aren't necessary, and the same with mammograms, and 
some people can say it's all nerve-racking to do it. But as a breast 
cancer survivor, I know that screening works. It saves lives.
  And it's not always easy. I had to go to several doctors before my 
cancer was detected. If I hadn't been persistent and sought the timely 
screening which did find mine, I might not be standing here today. The 
simple truth is that screening does save lives. It makes a difference 
for many women, whether they are 40 years old, 65 years old, or 70 
years old. It doesn't matter. Many women look for excuses anyway. They 
don't want to get screened for cancer. They really don't like to do it. 
And some of them say, I don't even want to know. Well, this 
recommendation certainly doesn't help that problem.
  Statistically, maybe mammograms are a bit more likely to save your 
life if you're over 50, but they save lives for those under 50 every 
day, and we know that. What if your 45-year-old sister or daughter or 
your mother doesn't know she has cancer until it's too late? And as I 
said before, the recommendation even advised doctors to discourage 
breast self-exams. Come on. What more sensible, simple tool do women 
have to guard against what can be a very aggressive disease? After all, 
we don't know what causes cancer. And women need to pay close 
attention.
  The SPEAKER pro tempore. The time of the gentlewoman has expired.
  Mrs. BLACKBURN. I yield the gentlewoman 30 additional seconds.
  Mrs. MYRICK. Women need to pay close attention to their bodies, 
because if something is wrong, they need to be aggressive about testing 
and finding the answers, and it doesn't matter how old you are. As was 
mentioned, too, so many younger women are getting cancer today, so many 
more than ever did before, and we need to find out why. But in the 
meantime, we need to give them the options that they need.
  And this resolution is a sense of Congress that these new 
recommendations shouldn't be used to deny women coverage or screening 
tests, and I urge my colleagues to support it.
  Mrs. CAPPS. Mr. Speaker, may I inquire of the remaining time on this 
side?
  The SPEAKER pro tempore. The gentlewoman from California has 11\1/2\ 
minutes remaining, and the gentlewoman from Tennessee has 14 minutes 
remaining.
  Mrs. CAPPS. At this time, it's my pleasure to acknowledge and I yield 
to the Congressman from New York (Mr. Engel) 2\1/2\ minutes.
  Mr. ENGEL. Mr. Speaker, I want to thank my colleague from the Health 
Subcommittee on the Energy and Commerce Committee, Lois Capps, who is 
always a leader in issues like this. And I want to commend Debbie 
Wasserman Schultz, the gentlewoman from Florida, for her courage in 
talking personally, as well as Congresswoman Sue Myrick from North 
Carolina for speaking personally. This is obviously a disease that 
affects so many Americans and their families personally, so I rise in 
strong support of this resolution on the U.S. Preventive Services Task 
Force breast cancer screening guidelines.
  As the second most common cancer among women in the U.S. and a 
leading cause of cancer death for women under 60, breast cancer is an 
issue that resonates with us all. The recent changes in recommendations 
for breast cancer screenings made by the U.S. Preventive Services Task 
Force on November 16 have been met with considerable attention and 
consternation nationwide. I can say quite frankly that I was extremely 
concerned that news reports related to these screenings would cause 
some women in their forties to no longer get mammograms annually for 
breast cancer.
  I think what was announced was a mistake. This would really be a 
travesty if women were prevented from getting mammograms annually. We 
know that declines in breast cancer death rates since 1990 are 
primarily attributed to early detection and improvement in treatment. 
In fact, about 15,000

[[Page 31874]]

breast cancer deaths this year were prevented in part due to an 
expanded access to mammography. While our screening tools are not 
perfect, they are valuable, and leading medical advocacy groups, 
including the American Cancer Society, the American Medical 
Association, and Susan B. Komen for the Cure, continue to recommend 
annual mammography for women starting at age 40, not 50.
  The USPSTF has since clarified that it never meant to send the 
message that women shouldn't get breast cancer screenings, but that in 
certain age groups women should consult with their personal physician 
about the benefits, risks, and limitations of mammography. 
Unfortunately, and the task force admitted this at a hearing in our 
Energy and Commerce Committee, this message has largely been lost in 
the media.
  I therefore again commend the gentlewoman from Florida for her 
resolution today and really her work all year, guided by her personal 
experience, to improve education and awareness of the benefits of 
breast cancer screening. The guidelines of the USPSTF should certainly 
not be interpreted as prohibiting a health care insurer from providing 
coverage for mammography services and should not be used by insurers to 
deny coverage for services that are not recommended on a routine basis.
  We recently marked the 25th anniversary of the National Breast Cancer 
Awareness Month, which celebrated great strides. We must continue that, 
and I urge support of the resolution.
  Mrs. BLACKBURN. Mr. Speaker, at this time, I yield 3 minutes to the 
gentleman from Michigan (Mr. Rogers), who has been a leader in the 
health care debate on our Energy and Commerce Committee.
  Mr. ROGERS of Michigan. Mr. Speaker, I want to thank Debbie Wasserman 
Schultz for her courage to get up here and talk about her ailment. I, 
too, am a cancer survivor, and it is a difficult process. But my 
concern is greater than even our own personal experiences. It is what 
is the actual result of that health care reform bill that leads us to 
this resolution.
  We are scrambling around on the floor today to say that a government-
appointed commission, this task force, has made a recommendation based 
on quality of year lives and cost, not good science, not that what 
saves lives, that women between 40 and 49 need not get mammograms. And 
you say, listen, that doesn't mean rationing. It doesn't mean anything. 
It doesn't have any weight of law. But guess what? The health care 
reform bill that passed this House makes those recommendations law.
  Let me read a couple of quick things, Mr. Speaker, if I may. By the 
way, you have to go to three different sections, two different complete 
books, to understand how this impacts real women in America, some 2,000 
pages into it.
  One section: Limitation on individual health insurance coverage may 
only be offered on or after the first day of year one as an exchange-
participating health care plan. Pretty fancy Washingtonspeak.
  Let me tell you what it means in another section of the bill about 
1,000 pages later: A health plan is prohibited from offering coverage 
for benefits not included in the essential benefits package.
  And you say, Oh, no that's a floor.
  It's not a floor. The language in the bill goes on further. And do 
you know what it does? It says that the only difference between the 
levels of plans is the amount of cost sharing, not what it covers.
  Here is the scary part, of which I don't think you all realize that 
you did to about 47,000 women in America: All recommendations of the 
Preventive Services Task Force and the Task Force on Community 
Preventive Services as in existence on the day before the date or the 
enactment of this Act shall be considered to be recommendations.
  The bill goes on to say that they must use that in the calculation of 
benefits. Guess what? Forty-seven thousand women who are under the age 
of 50 today will be diagnosed with late-stage breast cancer because of 
your bill. It's in your bill. It's in your language. Do you know what 
that means? Eighty percent of them will die because of their diagnosis.
  Do you realize that more women will die because of this bill than we 
lost men in the Korean War? And I know you think, Oh, scare tactics.
  No. It's the bill. But do you know what? You can't read it on page 1 
or 2. You have to keep going back and forth in 2,000 pages to 
understand the full impact of what will happen to women who are 40 to 
49 years old.
  You did it in your bill.
  I am going to plead with you. For the lives of 37,000 women who will 
die and 47,000 women, according to the recommendations of this task 
force which you make law----
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mrs. BLACKBURN. I yield the gentleman 30 additional seconds.
  Mr. ROGERS of Michigan. I am going to plead with you, please read the 
bill, not just 1 to 2,000. Go back to the other sections and understand 
its full impact.
  And you say, It won't happen in America. Guess what? This task force 
recommendation resulted on December 2 in California prohibiting low-
income women under the age of 50 from receiving mammograms. It is 
happening today. This task force is doing it today. With your bill, it 
becomes law. They are prohibited. And it is illegal for them to get 
coverage other than what the government says they can get. And guess 
what? Mammograms don't qualify for women 40 to 49. Please think of 
those women and those families.


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore. The Chair reminds Members that they are to 
address their comments to the Chair.
  Mrs. CAPPS. Mr. Speaker, I would remind my colleague that at the 
hearing 2 weeks ago at the Energy and Commerce Committee, the breast 
cancer stakeholders were asked a simple question: Would H.R. 3962, the 
health reform bill, help women with breast cancer? Every witness on 
that panel, including the American Cancer Society, Komen, the National 
Breast Cancer Coalition, the American College of Physicians, every 
witness on the panel agreed that this bill, the health reform bill, 
will help women to prevent and women who already have breast cancer.
  And at this point, I'm very pleased to yield 2 minutes to my 
colleague and a big supporter of the Breast Cancer Caucus, Jerry 
Nadler.

                              {time}  1400

  Mr. NADLER of New York. I thank the gentlelady for yielding.
  Mr. Speaker, I rise today in support of the resolution offered by our 
colleague, Representative Wasserman Schultz.
  With this resolution, which should have the full support of every 
Member of the House, we will be on record with our commitment not to 
allow women over 40 to go without the life-saving tests currently 
available to root out breast cancer at early stages. This resolution 
states our support for continued research into developing better tests 
so that no woman will face a death sentence due to a diagnosis of 
breast cancer.
  I thank my colleague, Representative Wasserman Schultz, for bringing 
this resolution to the floor; but, unfortunately, this resolution won't 
cure the potential problem created by, or actually highlighted by, or 
dampen the frustration sparked by the U.S. Preventive Services Task 
Force's decision a few weeks ago.
  Even before the recommendations of the task force, and having nothing 
to do with the recommendations of the task force, many insurance 
companies today deny coverage for screening mammograms to women over 
40. To deal with this problem, we should pass a bill that I introduced, 
H.R. 955, the Mammogram and MRI Availability Act, which would give 
assurance to women over 40 which would legally mandate that any 
insurance policy that covers diagnostic mammograms must also cover 
screening mammograms for all women over 40. Women

[[Page 31875]]

over 40 would have legal assurances that no insurance company would be 
allowed to deny her coverage for a mammogram.
  I hope this resolution will serve as a first step toward attaining 
adoption of mandatory legislation to guarantee annual mammography 
coverage to all women over 40 and MRIs to women who need it because 
they have a particular genetic or other family history indicating a 
specific susceptibility to breast cancer.
  I ask my colleagues to show their commitment to women's health by 
voting ``yes'' on this resolution and by joining me as a cosponsor of 
H.R. 995.
  Mrs. BLACKBURN. Mr. Speaker, at this time, I yield 3 minutes to Dr. 
Gingrey, the gentleman from Georgia who has practiced medicine, 
obstetrics and gynecology, has worked with women and women's health 
care issues, and joins us on the Energy and Commerce Committee.
  Mr. GINGREY of Georgia. I thank the gentlewoman for yielding.
  I do rise in full support of my good friend and colleague from 
Florida, Representative Debbie Wasserman Schultz, for introducing this 
resolution. I certainly encourage all of my colleagues to support it. I 
am sure if we have a recorded vote, the vote will be 100 percent in 
favor of this resolution.
  But, Mr. Speaker, as my colleague from Tennessee (Mrs. Blackburn) and 
my colleague from Michigan (Mr. Rogers), both members of the Energy and 
Commerce Committee, both, as well as myself, at that hearing when we 
heard from the American Cancer Society and when we heard from the other 
witnesses, such as Susan G. Komen for the Cure organization, and in 
talking with my own specialty society, the American College of 
Obstetrics and Gynecology, they will continue to recommend very 
strongly that women in their 40s continue to be screened, to have 
mammogram screening, maybe even digital mammogram screening, because 
they are at high risk.
  Mr. Speaker, as our colleagues have pointed out, the two in our body, 
our colleagues that are victims of breast cancer, God forbid if they 
had not gotten early detection, maybe their outcome would not be so 
great. I think that because of early detection their cure is probably 
almost 100 percent.
  So we are in a situation where physicians practicing across this 
country, they are sort of in a catch-22. If they don't follow these 
guidelines that will be passed in this bill, in the Senate version, 
when this United States Preventive Services Task Force will no longer 
be an organization making recommendations, but they will be making law, 
they will be issuing mandates, if a physician decides, well, my patient 
is in their 40s, I'm going to go ahead and order a mammogram anyway and 
that mammogram is suspicious and it leads to a needle biopsy, which may 
turn out to be negative, but it results in a complication, such as a 
breast abscess, that physician, Mr. Speaker, could be sued for 
practicing below the standard of government health care as established 
by this new massive bill that the Democrats want to force on the 
American public.
  So I stand here commending Representative Debbie Wasserman Schultz 
and this resolution; I am in favor of it. But I would also recommend 
that my colleagues on the Democratic side of the aisle instruct their 
conferees, if this massive health care reform bill goes to conference, 
to take this resolution with them and say, look, these are our 
concerns, change the language. That's my recommendation. That's what my 
colleagues can do for the women in this country, the 47,000 that 
Congressman Mike Rogers from Michigan was talking about.
  I think my colleagues on this side of the aisle are absolutely right 
as they point out in this legislation what the danger is.
  Mrs. CAPPS. Mr. Speaker, I am very pleased at this point to yield 1 
minute to our colleague from Indiana (Mr. Donnelly).
  Mr. DONNELLY of Indiana. Mr. Speaker, I want to support the 
resolution of my colleague, Debbie Wasserman Schultz, and support the 
importance of annual mammograms for women age 40 to 49. I, 
unfortunately, lost my mom to breast cancer when she was very young and 
when I was very young.
  These mammograms save lives. There is nothing more important than the 
health of our moms, our daughters, our wives, our friends, and our 
sisters. So I support this resolution. I support these annual 
mammograms so that we lose no more of our loved ones.
  Mrs. BLACKBURN. Mr. Speaker, at this time, I yield 1\1/2\ minutes to 
the gentleman from New Jersey (Mr. Lance).
  Mr. LANCE. Mr. Speaker, I rise today in support of the resolution 
offered by the gentlewoman from Florida, and I thank the gentlewoman 
from Tennessee for her leadership on this issue as well.
  I recently met with New Jersey cancer survivors, cancer care 
advocates for the Susan G. Komen for the Cure in New Jersey, and 
medical professionals at the Steeplechase Cancer Center at Somerset 
Medical Center in Somerset County, New Jersey. Constituents voiced 
their objections with the task force recommendations, including 
Kathleen Petrozelli of Whitehouse Station, Hunterdon County, who shared 
her personal story of being diagnosed in her 40s with breast cancer.
  I strongly oppose the task force recommendations against yearly 
screening in women 40 to 49. My mother died of breast cancer when my 
twin brother and I were 12. Her cancer was diagnosed when she was 47.
  Most disappointing about the task force conclusions is the fact that 
they come on the heels of the fall 2009 report published by the 
American Cancer Society indicating a large decline in breast cancer 
deaths in women under 50.
  Breast cancer continues to be the most common form of cancer in 
women. We should be promoting a Federal health policy of encouraging, 
not discouraging, mammography screening and self-examination for women 
40 to 49 years of age.
  Mrs. CAPPS. Mr. Speaker, I am now pleased to yield 1 minute to our 
colleague from Pennsylvania (Mrs. Dahlkemper).
  Mrs. DAHLKEMPER. Mr. Speaker, I rise today in support of this 
resolution.
  I thank Congresswoman Debbie Wasserman Schultz for her leadership on 
this issue, an issue that defends women across the United States and 
advocates for their health and well-being.
  Breast cancer is a real danger to women and their families; it is not 
an adversary to be underestimated. All in all, nearly 150,000 women 
will be diagnosed with breast cancer this year, and more than 40,000 
women will sadly succumb to the disease; but some of these deaths can 
be prevented by mammograms and regular breast cancer screenings.
  Let me tell you one story of a woman from my own district whose 
mammogram saved her life. Sue Kilburn of Meadville, Pennsylvania, was 
diagnosed with breast cancer when she was in her late 40s after an 
annual mammogram. Her doctor told her she had to choose between a 
lumpectomy and a mastectomy to treat the disease. Sue shared her 
journal with the Meadville Tribune newspaper. She writes: ``The words 
ring out unlike anything I have ever experienced before. I find no 
anger, just feel numb, dumbfounded, and questioning . . . how . . . 
when? It was just a routine mammogram.''
  Sue survived her battle with breast cancer because she had a 
mammogram.
  The SPEAKER pro tempore. The gentlewoman's time has expired.
  Mrs. CAPPS. I am pleased to yield the gentlewoman an additional 30 
seconds.
  Mrs. DAHLKEMPER. If she was one of the thousands of women in my 
district without health care coverage, would she still be with us 
today?
  Through this resolution and through passage of health care reform, we 
can ensure that the decision for mammogram testing remains between a 
woman and her doctor.
  I urge my colleagues to support this resolution.
  Mrs. BLACKBURN. At this time, I yield 1\1/2\ minutes to our ranking 
member on International Affairs, Ms. Ros-Lehtinen from Florida.

[[Page 31876]]


  Ms. ROS-LEHTINEN. I thank my good friend for the time.
  I strongly support the resolution before us, Mr. Speaker, put forth 
by my good friend from Florida, Congresswoman Debbie Wasserman Schultz, 
related to breast cancer screening. It is through more effective 
screening strategies that we will save lives. Early detection makes the 
difference in surviving this terrible disease.
  As proven by the heroic fight that we heard this morning, the 
incredible stories of will and perseverance of our colleagues, 
Congresswomen Debbie Wasserman Schultz and Sue Myrick, screening must 
remain a priority; it must be our mission.
  Almost everyone in this country, unfortunately, knows someone who has 
suffered from breast cancer. But, as is becoming more and more likely, 
we also know someone who has survived breast cancer, and they have 
survived breast cancer due to routine screening and early screening and 
screening for young women.
  We must remain vigilant in our efforts to educate, to diagnose, and 
to treat. Let us make sure that our efforts to defeat this terrible 
disease is not put in jeopardy because insurance companies do not want 
to pay for routine screening for young women, screenings that could 
save their lives.
  Thank you, my good friend from Tennessee.
  Mrs. CAPPS. Mr. Speaker, may I inquire again as to the time that 
remains on our side.
  The SPEAKER pro tempore. The gentlewoman from California has 4 
minutes remaining, and the gentlewoman from Tennessee has 4\1/2\ 
minutes remaining.
  Mrs. CAPPS. Mr. Speaker, at this point, I am very pleased to yield 1 
minute to our colleague from Florida (Ms. Kosmas).
  Ms. KOSMAS. Mr. Speaker, I would like to thank my good friend, Debbie 
Wasserman Schultz, for her personal courage, but also for her focus on 
this very important issue and to commend her for introduction of this 
important resolution.
  Each of us knows, whether in our own personal lives or in that of our 
family and friends, how important it is that people get early detection 
and intervention for any type of cancer, but we know that breast cancer 
steals the lives of our women in this country--mothers, friends, 
sisters, and daughters.
  Despite the task force report, we need to listen to commonsense and 
scientific-based guidelines that tell us that breast cancer screening 
for women ages 40 to 49 is extremely important and should not be 
ignored, despite the recommendation of the task force. Because we know 
these things to be true, the resolution states that the task force 
would not be used for insurers to deny coverage for routine screenings.
  So through our support here of this resolution, my colleagues and I 
encourage all women to remain vigilant and to protect their health by 
getting regular mammograms at early ages.
  Mrs. BLACKBURN. At this time, I yield 1\1/2\ minutes to Mrs. McMorris 
Rodgers from Washington State, who is vice chair of our conference.
  Mrs. MCMORRIS RODGERS. I thank the gentlewoman for yielding.
  I, too, rise in support of this resolution and really do want to 
applaud the leadership of Representative Debbie Wasserman Schultz, 
Representative Lois Capps, and Representatives Marsha Blackburn and Sue 
Myrick.
  Last month, many of us stood and voiced concern over these 
recommendations by the U.S. Preventive Services Task Force because we 
believed that they would turn back the clock on the war on breast 
cancer, recommendations that would no doubt impact the United States' 
98 percent 5-year breast cancer survivability rate.
  Republicans over and over have expressed our concern that health care 
reform would shortchange women. Well, through these recommendations 
made by the United States Preventive Services Task Force, you start to 
see what rationed care looks like; and in this example the potential 
impact on women when the government is making health care decisions for 
them, how the doctor-patient relationship is jeopardized, how 
bureaucrats, using computer software and statistics, will be making 
critical life-and-death decisions for women. This is wrong.
  These recommendations mirror policies in single-payer nations like 
England, where women over 50 are invited once every 3 years to be 
screened. We cannot go down this same path. Yet this task force, which 
doesn't even include any oncologists or radiologists, recommended that 
women between ages 40 and 50 not get mammograms because saving one 
woman for every 2,000 screened was not worth the cost. Well, if you're 
that one woman, you might not see it that way. For that woman saved by 
early detection, the mammogram is well worth the cost.
  America's health care system has been based on saving lives. It's 
Great Britain's health care system that is based on saving cost.

                              {time}  1415

  Mrs. CAPPS. I am pleased now to introduce and to acknowledge my 
colleague from Virginia, Congressman Connolly, for 1 minute.
  Mr. CONNOLLY of Virginia. Mr. Speaker, I want to join in with my 
colleagues on the other side in rejecting the findings of the task 
force, all 16 members who were appointed by Republican President George 
Bush.
  Although the incidence of breast cancer in young women is much lower 
than that of older women, young women's cancers are generally more 
aggressive, are diagnosed at a later stage, and result in lower 
survival rates. In 2008 the American Cancer Society estimated there 
would be 182,460 new cases of breast cancer in women. Of these, more 
than 11,000 of these women would be under 40 years of age.
  While no currently available breast cancer tool is perfect, we know 
that intervention, through routine screening for breast cancer, using 
mammography, can save lives of women at a time when medical science is 
still unable to prevent the disease. This resolution expresses the 
sense of the House of Representatives regarding guidelines for breast 
cancer screening for women ages 40 to 49 and supports the importance of 
women's access to mammography screening.
  I urge my colleagues on a bipartisan basis to support the resolution 
and commend Representative Debbie Wasserman Schultz and Representative 
Lois Capps for their leadership.
  Mrs. BLACKBURN. I have an inquiry, Mr. Speaker. Is the gentlewoman 
from California prepared to close or does she have additional speakers?
  Mrs. CAPPS. I have two additional speakers.
  Mrs. BLACKBURN. I reserve the balance of my time.
  Mrs. CAPPS. I am very pleased to yield 1 minute to our colleague from 
Colorado, Congresswoman Markey.
  Ms. MARKEY of Colorado. Mr. Speaker, I rise today in support of 
mothers, daughters, sisters, aunts, nieces, and women across the 
country. Every person in this Chamber can name someone they know who 
has had breast cancer.
  I am honored to support the resolution by my good friend and 
colleague, Congresswoman Wasserman Schultz. Debbie's own courage and 
tenacity serve as an inspiration for all of us.
  Recently released guidelines regarding breast cancer screening for 
women between the ages 40 and 49 have caused confusion and concern. The 
U.S. Preventive Services Task Force has an important role in 
researching health care policies that will lower costs and improve 
results across the country.
  However, when early diagnosis and treatment has been proven to 
greatly reduce the risk of cancer, it's important that these decisions 
be made by women and their doctors, not a government task force. An 
early diagnosis of breast cancer can save a woman's life, and it's 
important that women can afford these screenings.
  For that reason, I urge my colleagues to support this resolution.
  Mrs. BLACKBURN. I continue to reserve the balance of my time.
  Mrs. CAPPS. I am now pleased, Mr. Speaker, to yield to our colleague 
from Illinois, Congresswoman Halvorson, 1 minute.
  Mrs. HALVORSON. Mr. Speaker, I rise today in support of women across

[[Page 31877]]

the country and protecting their access to cancer screenings. As the 
daughter of a breast cancer survivor--my mother got breast cancer under 
the age of 50--I understand the importance of regular mammograms and 
know they save lives.
  I have met so many women across my district who are still with us 
today because of preventive care. We should always encourage women to 
get screened, and we should never allow insurance companies to stand 
between a woman, her doctor, and a procedure which may save her life. 
This is a disease that has affected so many of us in this Chamber and 
so many of our constituents back home.
  I call on my colleagues to support this resolution and support 
women's health.
  Mrs. BLACKBURN. Mr. Speaker, I think that all of us come here because 
of our concern, great concern, about women and mammography and the 
health care issues that are found before us.
  When it comes to breast cancer, we are very grateful for early 
detection. We know it's important. Because of that, it is with great 
sadness that we have read what is in this bill.
  In H.R. 3962, it clearly shows how the recommendations will limit 
America's choices and women's choices. Reading through the bill, 
section 2301 does establish the Task Force on Clinical Preventive 
Services, and it clearly says that A and B are priority levels for 
these treatments. You can read on page 1,318, and I do, Mr. Speaker. It 
says in line 2, the Commissioner shall ensure--shall ensure--that A and 
B is going to be the rating that is covered, but C is not.
  What we are discussing in this 40 to 49 age group is those C ratings, 
and the Commissioner will not have the power to downgrade that 
decision. Section 222 of the bill--what you have in this resolution is 
going to be negated by section 222 of the bill that says the services 
designated A or B priority are part of the essential benefits package. 
So just saying that the guidelines would not prohibit an insurer from 
providing coverage, your own legislation is going to end up negating 
that, if that is signed into law.
  The language of this bill is clear. All insurance providers must 
offer A and B priority services. They have no incentive or a mandate to 
offer priority C or below. That is where it affects women under 50 and 
women over age 75, and those, indeed, are valuable lives.
  Mr. Speaker, we do look at this legislation. We look at section 2301 
where it says that, All recommendations of the Preventive Services Task 
Force and the Task Force on Community Preventive Services, as in 
existence on the day before the date of the enactment of this Act, 
shall be considered to be the recommendations of the Task Force on 
Clinical Preventive Services.
  At that point, Mr. Speaker, unfortunately, they are going to have the 
full weight of law behind them. It is in the bill.
  Yes, we look at this, and we see the bureaucrat in the exam room 
right here. We look at it, and we all know and have loved and have held 
family members in our arms that have been affected and would have lost 
their lives had they not had access to early detection. It concerns us.
  Do not ration health care. Support the resolution, but let's go 
further in getting out of the bill.
  I yield back the balance of my time.
  Mrs. CAPPS. Mr. Speaker, in yielding back our time, I remind our 
colleagues that the truth is, when enacted into law, H.R. 3962 will 
result in millions of uninsured Americans receiving their first 
mammogram and will no longer face being dropped by their insurance 
company if they are diagnosed with cancer.
  I wish to acknowledge and thank the leader of this resolution for her 
hard work, our colleague, Representative Wasserman Schultz.
  Ms. DeLAURO. Mr. Speaker, I urge my colleagues to support this 
resolution, H.R. 971, which helps to clarify much of the unnecessary 
furor over mammograms we have experienced of late.
  The recent breast cancer recommendations by the U.S. Preventive 
Services Task Force effectively said that women ages 40 to 49 should 
have a conversation with their doctors before deciding to have a 
screening mammograms. In other words, they were to attempt to put as 
much information as possible in the hands of women and their doctors, 
so they can assess their own risk and benefit.
  Now, whatever decision women come to on this important matter, they 
need two things to ensure they have access to mammography should they 
decide to get screened: One is a quality health coverage so they have a 
doctor they can go speak to. And the second is coverage for mammograms 
and other important preventative services. And, of course, some women 
will need coverage for treatment if a cancer is found.
  This is why I support this resolution, which argues that insurers 
should not deny coverage for mammograms for women ages 40 to 49 who 
decide to get screened. This is also why I support comprehensive health 
insurance reform, so that women can afford health care in the first 
place, and get coverage for that mammograms and any follow-up treatment 
they might need.
  We must redouble our efforts across the board to ensure that 
Americans are getting the appropriate preventive screenings. Right now, 
according to the Centers for Disease Control and Prevention, only 25.9 
percent of women ages 50 to 64 have received all the recommended 
preventive care for breast, cervical, and colorectal cancer, as well as 
influenza. Under health reform, women would finally get the preventive 
care they need.
  In the meantime, there is a great need for more information, more 
research, and more scientific innovation to help women prevent, detect, 
and fight breast cancer, the second leading cause of cancer deaths 
among women. This resolution also urges the National Cancer Institute 
to continue to invest in research toward more effective screening tools 
and strategies for improving detection of breast cancer.
  For all of these reasons, I strongly urge my colleague to support 
this resolution. Mammography is not perfect, but right now it is the 
best method we have to detect this killer in our midst. We need to make 
sure that as many women as possible have access to this important, 
life-saving procedure, and that better, safer screening procedures will 
soon be forthcoming.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I rise in support of H. Res. 
971, expressing the sense of the House of Representatives regarding 
guidelines for breast cancer screening for women ages 40 to 49. I 
appreciate the leadership of the bill's author, my Judiciary Committee 
colleague Representative Wasserman Schultz.
  This resolution was introduced on the heels of new breast cancer 
screening guidelines issued last month by the U.S. Preventive Services 
Task Force (the ``Task Force''), an independent panel of medical 
experts. These new guidelines have created cause for concern by some 
due to the change from the Task Force's 2002 mammography 
recommendations concerning mammography screening for women age 40-49.
  In light of this concern, this resolution underscores the sense of 
the House that the Task Force recommendations should not prohibit 
insurance companies from providing mammography services in addition to 
those in the Task Force recommendations, and should not be used by 
insurers to deny women coverage for routine screenings. This resolution 
also urges the National Cancer Institute to continue to invest and 
provide leadership regarding research to develop more effective 
screening tools and strategies for improving detection of breast 
cancer.
  This is not the first time recommendations about the use of 
mammography and breast self exams have been revisited--by the Task 
Force or NIH or any number of cancer-related research or advocacy 
groups. Just as we have seen with prostate cancer screening, 
immunization schedules, and other preventative care measures, new 
interpretations often result in a change in what experts tell us works 
most effectively. As the science of medicine evolves, so too, should 
the recommendations on the best use of that science.
  Evolution and improvement are what the U.S. Preventive Services Task 
Force set out to achieve in undertaking a review of its 2002 
mammography guidelines. The Task Force sought to take a fresh look of 
what has been learned over the last several years, and based upon that 
body of work, to provide its best professional judgment on what doctors 
and their patients should consider when they are making decisions about 
breast cancer screening. Despite the contention on this issue, I trust 
that the Task Force's deliberations and conclusions were driven by 
science and not by cost or insurance coverage.
  Not withstanding the scientific basis for these new guidelines, I 
share the concern of

[[Page 31878]]

Ms. Wasserman Schultz and others such as the Susan G. Komen for the 
Cure Advocacy Alliance who point out that one-third of all American 
women do not undergo regular screening. Many of those who go without 
screening are African American and younger women. According to the 
Susan G. Komen for the Cure Advocacy Alliance the failure of age-
appropriate women to undergo mammography costs lives and reflects 
problems with access to care and breast cancer education.
  Mr. Speaker, we need to work as rapidly as possible to correct these 
deficiencies, and continue to fund research and education designed to 
eliminate health care disparities. We want to eliminate any impediments 
to regular mammography screening for women age 50 and below. While 
there may be disagreement about the exact timing of breast cancer 
assessments, I believe there is unanimous consensus over the importance 
of guaranteeing access to screening.
  New screening approaches and more individualized recommendations for 
breast cancer screening are urgently needed. I support research 
initiatives designed to improve screening, and believe that it is 
imperative that this research move forward rapidly. Furthermore, I 
encourage African American and other women with unresolved questions 
about breast cancer screening to engage in discussion with their health 
care providers.
  If the new guidelines have done nothing else, I believe it has at 
least raised awareness, not only amongst women, but amongst all 
Americans. As such, I encourage my colleagues to support this bill.
  Mrs. CAPPS. I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentlewoman from California (Mrs. Capps) that the House suspend the 
rules and agree to the resolution, H. Res. 971.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mrs. CAPPS. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.

                          ____________________