[House Report 116-538]
[From the U.S. Government Publishing Office]


116th Congress   }                                            {    Report
                         HOUSE OF REPRESENTATIVES
 2d Session      }                                            {   116-538

======================================================================



 
                   EARLY ACT REAUTHORIZATION OF 2019

                                _______
                                

 September 25, 2020.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

 Mr. Pallone, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 4078]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 4078) to reauthorize the Young Women's Breast 
Health Education and Awareness Requires Learning Young Act of 
2009, having considered the same, reports favorably thereon 
without amendment and recommends that the bill do pass.

                                CONTENTS

                                                                   Page
  I. Purpose and Summary..............................................1
 II. Background and Need for the Legislation..........................2
III. Committee Hearings...............................................3
 IV. Committee Consideration..........................................3
  V. Committee Votes..................................................3
 VI. Oversight Findings...............................................3
VII. New Budget Authority, Entitlement Authority, and Tax Expenditures4
VIII.Federal Mandates Statement.......................................4

 IX. Statement of General Performance Goals and Objectives............4
  X. Duplication of Federal Programs..................................4
 XI. Committee Cost Estimate..........................................4
XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits......4
XIII.Advisory Committee Statement.....................................4

XIV. Applicability to Legislative Branch..............................4
 XV. Section-by-Section Analysis of the Legislation...................5
XVI. Changes in Existing Law Made by the Bill, as Reported............5

                         I. Purpose and Summary

    H.R. 4078, the ``EARLY Act Reauthorization of 2019'', 
introduced by Representatives Debbie Wasserman Schultz (D-FL) 
and Susan Brooks (R-IN), on July 25, 2019, reauthorizes the 
``Young Women's Breast Health Education and Awareness Requires 
Learning Young Act of 2009''. This program, which is aimed at 
educating young people and those at risk about breast cancer, 
was authorized and funded at $4.9 million for each of fiscal 
years 2015 through 2019. The bill would increase the 
authorization to $9 million for each of fiscal years 2020 
through 2024.

                II. Background and Need for Legislation

    Tragically, one in eight women in the United States will be 
diagnosed with breast cancer over their lifetime.\1\ Breast 
cancer is the most common form of cancer in women and the 
second leading cause of cancer death in women.\2\ From 2013 to 
2017, breast cancer death rates in older women declined 1.3 
percent per year. Breast cancer death rates, however, have 
remained steady in younger women.\3\
---------------------------------------------------------------------------
    \1\American Cancer Society. How Common Is Breast Cancer? Jan. 2020. 
Available at: https://www.cancer.org/cancer/breast-cancer/about/how-
common-is-breast-cancer.html.
    \2\Id.
    \3\Id.
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    Breast health education, awareness, and screening save 
lives.\4\ When breast cancer is detected early and quality 
treatment is received, the five-year relative survival rate is 
nearly 100 percent for all women. As breast cancer becomes more 
advanced, however, the chances of survival greatly decrease.\5\
---------------------------------------------------------------------------
    \4\https://www.cancer.gov/types/breast/patient/breast-prevention-
pdq.
    \5\Id.
---------------------------------------------------------------------------
    Health inequalities underscore the importance of the Young 
Women's Breast Health Education and Awareness Requires Learning 
Young Program. Black women develop breast cancer on average 
five to seven years younger than White women.\6\ Young Black 
women are also more likely than young White women to develop 
breast cancer.\7\ Further, Black women are 40 percent more 
likely than White women to die of breast cancer.\8\ These 
disparities exist in large part because Black women are more 
likely to be diagnosed with more aggressive forms of breast 
cancer and less likely to receive the most effective 
therapeutics for their cancer diagnosis.\9\
---------------------------------------------------------------------------
    \6\https://www.cdc.gov/cancer/dcpc/research/articles/
breast_cancer_rates_women.htm.
    \7\Id.
    \8\Id.
    \9\https://www.cdc.gov/cancer/dcpc/research/articles/
breast_cancer_rates_women.htm.
---------------------------------------------------------------------------
    In 2009, Congress passed the ``Young Women's Breast Health 
Education and Awareness Requires Learning Young Act of 
2009''.\10\ This law created an outreach and education campaign 
through the Centers for Disease Control and Prevention (CDC) 
highlighting breast cancer risks for young people and those at 
increased risk of developing the disease. The funds authorized 
through this law support CDC's work in identifying breast 
cancer risk knowledge gaps among young women and education gaps 
among health care providers. It also supports young survivors 
through grants to organizations focused on helping those coping 
with breast cancer-related challenges.
---------------------------------------------------------------------------
    \10\https://www.govinfo.gov/content/pkg/PLAW-113publ265/html/PLAW-
113publ265.htm.
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    The program's statutory authorization expired in 2019. It 
has, however, continued to receive annual appropriations. H.R. 
4078 would reauthorize the program at $9 million for each of 
fiscal years 2020 through 2024.

                        III. Committee Hearings

    For the purposes of section 103(i) of H. Res. 6 of the 
116th Congress, the following hearing was used to develop or 
consider H.R. 4078:
    The Subcommittee on Health held a legislative hearing on 
July 29, 2020, entitled, ``Improving Access to Care: 
Legislation to Reauthorize Key Public Health Programs,'' to 
consider H.R. 4078, the ``EARLY Act Reauthorization of 2019''. 
The Subcommittee received testimony from the following 
witnesses:
           Robert Boyd, M.C.R.P., M.Div., President, 
        School-Based Health Alliance
           Linda Goler Blount, M.P.H., President and 
        CEO, Black Women's Health Imperative
           Nancy Goodman, M.P.P., J.D., Founder and 
        Executive Director, Kids v. Cancer
           Aaron Seth Kesselheim, M.D., J.D., M.P.H., 
        Professor of Medicine, Harvard Medical School
           Brian Lindberg, Chief Legal Officer and 
        General Counsel, National Bone Marrow Donor Program
           Travis T. Tygart, Chief Executive Officer, 
        U.S. Anti-Doping Agency

                      IV. Committee Consideration

    Representatives Wasserman Schultz (D-FL) and Brooks (R-IN) 
introduced H.R. 4078, the ``EARLY Act Reauthorization of 
2019'', on July 25, 2019, and the bill was referred to the 
Committee on Energy and Commerce. H.R. 4078 was then referred 
to the Subcommittee on Health on July 26, 2019. A legislative 
hearing was held on the bill on July 29, 2020.
    On September 9, 2020, H.R. 4078 was discharged from further 
consideration by the Subcommittee on Health as the bill was 
called up for consideration by the full Committee on Energy and 
Commerce. The full Committee met in virtual open markup session 
on September 9, 2020, pursuant to notice, to consider H.R. 
4078. There were no amendments offered to H.R. 4078. Upon 
conclusion of consideration of the bill, the full Committee 
agreed to a motion on final passage by Mr. Pallone, Chairman of 
the committee, to order H.R. 4078 reported favorably to the 
House, without amendment, by a voice vote, a quorum being 
present.

                           V. Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list each record vote 
on the motion to report legislation and amendments thereto. The 
Committee advises that there were no record votes taken on H.R. 
4078, including the motion for final passage of the bill.

                         VI. Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII and clause 2(b)(1) 
of rule X of the Rules of the House of Representatives, the 
oversight findings and recommendations of the Committee are 
reflected in the descriptive portion of the report.

 VII. New Budget Authority, Entitlement Authority, and Tax Expenditures

    Pursuant to 3(c)(2) of rule XIII of the Rules of the House 
of Representatives, the Committee adopts as its own the 
estimate of new budget authority, entitlement authority, or tax 
expenditures or revenues contained in the cost estimate 
prepared by the Director of the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974.
    The Committee has requested but not received from the 
Director of the Congressional Budget Office a statement as to 
whether this bill contains any new budget authority, spending 
authority, credit authority, or an increase or decrease in 
revenues or tax expenditures.

                    VIII. Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

       IX. Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII, the general 
performance goal or objective of this legislation is to 
reauthorize the Young Women's Breast Health Education and 
Awareness Requires Learning Young Act of 2009.

                   X. Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 4078 is known to be duplicative of another Federal 
program, including any program that was included in a report to 
Congress pursuant to section 21 of Public Law 111-139 or the 
most recent Catalog of Federal Domestic Assistance.

                      XI. Committee Cost Estimate

    Pursuant to clause 3(d)(1) of rule XIII, the Committee 
adopts as its own the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974.

    XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits

    Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the 
Committee finds that H.R. 4078 contains no earmarks, limited 
tax benefits, or limited tariff benefits.

                   XIII. Advisory Committee Statement

    No advisory committee within the meaning of section 5(b) of 
the Federal Advisory Committee Act was created by this 
legislation.

                XIV. Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

           XV. Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 designates that the short title may be cited as 
the ``EARLY Act Reauthorization of 2019''.

Sec. 2. Reauthorization of the Young Women's Breast Health Education 
        and Awareness Requires Learning Young Act of 2009

    Section 2 amends section 399NN(h) of the Public Health 
Service Act by increasing the authorization level from $4.9 
million to $9 million for each of fiscal years 2020 through 
2024.

       XVI. Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, and existing law in which no 
change is proposed is shown in roman):

                       PUBLIC HEALTH SERVICE ACT



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TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE

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         PART V--PROGRAMS RELATING TO BREAST HEALTH AND CANCER

SEC. 399NN. YOUNG WOMEN'S BREAST HEALTH AWARENESS AND SUPPORT OF YOUNG 
                    WOMEN DIAGNOSED WITH BREAST CANCER.

  (a) Public Education Campaign.--
          (1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and 
        Prevention, shall conduct a national evidence-based 
        education campaign to increase awareness of young 
        women's knowledge regarding--
                  (A) breast health in young women of all 
                racial, ethnic, and cultural backgrounds;
                  (B) breast awareness and good breast health 
                habits;
                  (C) the occurrence of breast cancer and the 
                general and specific risk factors in women who 
                may be at high risk for breast cancer based on 
                familial, racial, ethnic, and cultural 
                backgrounds such as Ashkenazi Jewish 
                populations;
                  (D) evidence-based information that would 
                encourage young women and their health care 
                professional to increase early detection of 
                breast cancers; and
                  (E) the availability of health information 
                and other resources for young women diagnosed 
                with breast cancer.
          (2) Evidence-based, age appropriate messages.--The 
        campaign shall provide evidence-based, age-appropriate 
        messages and materials as developed by the Centers for 
        Disease Control and Prevention and the Advisory 
        Committee established under paragraph (4).
          (3) Media campaign.--In conducting the education 
        campaign under paragraph (1), the Secretary shall award 
        grants to entities to establish national multimedia 
        campaigns oriented to young women that may include 
        advertising through television, radio, print media, 
        billboards, posters, all forms of existing and 
        especially emerging social networking media, other 
        Internet media, and any other medium determined 
        appropriate by the Secretary.
          (4) Advisory committee.--
                  (A) Establishment.--Not later than 60 days 
                after the date of the enactment of this 
                section, the Secretary, acting through the 
                Director of the Centers for Disease Control and 
                Prevention, shall establish an advisory 
                committee to assist in creating and conducting 
                the education campaigns under paragraph (1) and 
                subsection (b)(1).
                  (B) Membership.--The Secretary, acting 
                through the Director of the Centers for Disease 
                Control and Prevention, shall appoint to the 
                advisory committee under subparagraph (A) such 
                members as deemed necessary to properly advise 
                the Secretary, and shall include organizations 
                and individuals with expertise in breast 
                cancer, disease prevention, early detection, 
                diagnosis, public health, social marketing, 
                genetic screening and counseling, treatment, 
                rehabilitation, palliative care, and 
                survivorship in young women.
  (b) Health Care Professional Education Campaign.--The 
Secretary, acting through the Director of the Centers for 
Disease Control and Prevention, and in consultation with the 
Administrator of the Health Resources and Services 
Administration, shall conduct an education campaign among 
physicians and other health care professionals to increase 
awareness--
          (1) of breast health, symptoms, and early diagnosis 
        and treatment of breast cancer in young women, 
        including specific risk factors such as family history 
        of cancer and women that may be at high risk for breast 
        cancer, such as Ashkenazi Jewish population;
          (2) on how to provide counseling to young women about 
        their breast health, including knowledge of their 
        family cancer history and importance of providing 
        regular clinical breast examinations;
          (3) concerning the importance of discussing healthy 
        behaviors, and increasing awareness of services and 
        programs available to address overall health and 
        wellness, and making patient referrals to address 
        tobacco cessation, good nutrition, and physical 
        activity;
          (4) on when to refer patients to a health care 
        provider with genetics expertise;
          (5) on how to provide counseling that addresses long-
        term survivorship and health concerns of young women 
        diagnosed with breast cancer; and
          (6) on when to provide referrals to organizations and 
        institutions that provide credible health information 
        and substantive assistance and support to young women 
        diagnosed with breast cancer.
  (c) Prevention Research Activities.--The Secretary, acting 
through--
          (1) the Director of the Centers for Disease Control 
        and Prevention, shall conduct prevention research on 
        breast cancer in younger women, including--
                  (A) behavioral, survivorship studies, and 
                other research on the impact of breast cancer 
                diagnosis on young women;
                  (B) formative research to assist with the 
                development of educational messages and 
                information for the public, targeted 
                populations, and their families about breast 
                health, breast cancer, and healthy lifestyles;
                  (C) testing and evaluating existing and new 
                social marketing strategies targeted at young 
                women; and
                  (D) surveys of health care providers and the 
                public regarding knowledge, attitudes, and 
                practices related to breast health and breast 
                cancer prevention and control in high-risk 
                populations; and
          (2) the Director of the National Institutes of 
        Health, shall conduct research to develop and validate 
        new screening tests and methods for prevention and 
        early detection of breast cancer in young women.
  (d) Support for Young Women Diagnosed With Breast Cancer.--
          (1) In general.--The Secretary shall award grants to 
        organizations and institutions to provide health 
        information from credible sources and substantive 
        assistance directed to young women diagnosed with 
        breast cancer and pre-neoplastic breast diseases.
          (2) Priority.--In making grants under paragraph (1), 
        the Secretary shall give priority to applicants that 
        deal specifically with young women diagnosed with 
        breast cancer and pre-neoplastic breast disease.
  (e) No Duplication of Effort.--In conducting an education 
campaign or other program under subsections (a), (b), (c), or 
(d), the Secretary shall avoid duplicating other existing 
Federal breast cancer education efforts.
  (f) Measurement; Reporting.--The Secretary, acting through 
the Director of the Centers for Disease Control and Prevention, 
shall--
          (1) measure--
                  (A) young women's awareness regarding breast 
                health, including knowledge of family cancer 
                history, specific risk factors and early 
                warning signs, and young women's proactive 
                efforts at early detection;
                  (B) the number or percentage of young women 
                utilizing information regarding lifestyle 
                interventions that foster healthy behaviors;
                  (C) the number or percentage of young women 
                receiving regular clinical breast exams; and
                  (D) the number or percentage of young women 
                who perform breast self exams, and the 
                frequency of such exams, before the 
                implementation of this section;
          (2) not less than every 3 years, measure the impact 
        of such activities; and
          (3) submit reports to the Congress on the results of 
        such measurements.
  (g) Definition.--In this section, the term ``young women'' 
means women 15 to 44 years of age.
  (h) Authorization of Appropriations.--To carry out 
subsections (a), (b), (c)(1), and (d), there are authorized to 
be appropriated [$4,900,000 for each of fiscal years 2015 
through 2019] $9,000,000 for each of fiscal years 2020 through 
2024.

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