[House Report 118-247]
[From the U.S. Government Publishing Office]


118th Congress   }                                       {      Report
                        HOUSE OF REPRESENTATIVES
 1st Session     }                                       {     118-247

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



 
        FIREFIGHTER CANCER REGISTRY REAUTHORIZATION ACT OF 2023

                                _______
                                

October 25, 2023.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

Mrs. Rodgers of Washington, from the Committee on Energy and Commerce, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 3821]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 3821) to reauthorize the Firefighter Cancer 
Registry Act of 2018, having considered the same, reports 
favorably thereon without amendment and recommends that the 
bill do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     1
Background and Need for Legislation..............................     2
Committee Action.................................................     2
Committee Votes..................................................     2
Oversight Findings and Recommendations...........................     5
New Budget Authority, Entitlement Authority, and Tax Expenditures     5
Congressional Budget Office Estimate.............................     5
Federal Mandates Statement.......................................     5
Statement of General Performance Goals and Objectives............     5
Duplication of Federal Programs..................................     5
Related Committee and Subcommittee Hearings......................     5
Committee Cost Estimate..........................................     6
Earmark, Limited Tax Benefits, and Limited Tariff Benefits.......     6
Advisory Committee Statement.....................................     6
Applicability to Legislative Branch..............................     6
Section-by-Section Analysis of the Legislation...................     6
Changes in Existing Law Made by the Bill, as Reported............     6

                          Purpose and Summary

    H.R. 3821 reauthorizes funding for the voluntary registry 
for firefighter cancer incidents under the Centers for Disease 
Control and Prevention (CDC) for fiscal years 2024 through 
2028.

                  Background and Need for Legislation

    The program reauthorized under the Firefighter Cancer 
Registry Reauthorization Act of 2023 is intended to build upon 
current work and fill in the knowledge gaps of the current 
national cancer registry, which is a voluntary online 
enrollment system to help support and understand the link 
between cancer and the fire service. Between 2010 and 2015, the 
National Institute for Occupational Safety and Health (NIOSH) 
launched the largest study of American firefighters ever taken. 
A multi-year study, the goal was to examine whether 
firefighters have a higher risk of cancer and other causes of 
death due to job exposures. The study examined both deaths from 
cancer, as well as the specific type of cancer diagnosis.\1\ 
The study found a greater number of cancer diagnoses and 
cancer-related deaths amongst firefighters. The highest 
prevalence was digestive, oral, respiratory, and urinary 
cancers. There were also more cases of certain cancers among 
younger fire fighters than would otherwise be expected.\2\
---------------------------------------------------------------------------
    \1\Firefighter Resources, Cancer and Other Illnesses, Centers for 
Disease Control and Prevention, https://www.cdc.gov/niosh/firefighters/
health.html.
    \2\Findings from a Study of Cancer among U.S. Fire Fighters, 
Centers for Disease Control and Prevention, https://www.cdc.gov/niosh/
pgms/worknotify/pdfs/ff-cancer-factsheet-final-508.pdf.
---------------------------------------------------------------------------

                            Committee Action

    On June 14, 2023, the Subcommittee on Health held a hearing 
on H.R. 3821. The hearing title was ``examining Proposals that 
Provide Access to Care for Patients and Support Research for 
Rare Diseases.'' The Subcommittee received testimony from:
           Dr. Elizabeth Cherot, MD, MBA, Senior Vice 
        President and Chief Medical Health Officer, March of 
        Dimes;
           Dr. Alexis A. Thompson, MD, MPH, Chief of 
        Division of Hematology, Elias Schwartz MD Endowed Chair 
        in Hematology, Children's Hospital of Philadelphia, 
        Professor of Pediatrics, University of Pennsylvania 
        Perelman School of Medicine;
           Dr. Meredithe McNamara, MD, MS, FAAP, 
        Assistant Professor, Yale School of Medicine;
           Dr. Miriam Grossman, MD, Child, Adolescent, 
        and Adult Psychiatrist;
           Mr. George Manahan, Parkinson's Advocate and 
        Patient; and
           Mr. Kevin O'Connor, Assistant to the General 
        President for Government Affairs and Political Action, 
        International Association of Fire Fighters.
    On July 13, 2023, the Subcommittee on Health met in open 
markup session and forwarded H.R. 3821, without amendment, to 
the full Committee by a record vote of 28 yeas and 0 nays.
    On July 19, 2023, the full Committee on Energy and Commerce 
met in open markup session and ordered H.R. 3821, without 
amendment, favorably reported to the House by a record vote of 
51 yeas and 0 nays.

                            Committee Votes

    Clause 3(b) of rule XIII requires the Committee to list the 
record votes on the motion to report legislation and amendments 
thereto. The following reflects the record votes taken during 
the Committee consideration:

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                 Oversight Findings and Recommendations

    Pursuant to clause 2(b)(1) of rule X and clause 3(c)(1) of 
rule XIII, the Committee held a hearing and made findings that 
are reflected in this report.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    Pursuant to clause 3(c)(2) of rule XIII, the Committee 
finds that H.R. 3821 would result in no new or increased budget 
authority, entitlement authority, or tax expenditures or 
revenues.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII, at the time this 
report was filed, the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974 was not available.

                       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.

         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 funding for the voluntary registry for firefighter 
cancer incidents under the CDC for fiscal years 2024 through 
2028 to support and understand the link between cancer and the 
fire service.

                    Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 3821 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.

              Related Committee and Subcommittee Hearings

    Pursuant to clause 3(c)(6) of rule XIII, the following 
related hearing was used to develop or consider H.R. 3821:
           On June 14, 2023, the Subcommittee on Health 
        held a hearing entitled ``Examining Proposals that 
        Provide Access to Care for Patients and Support 
        Research for Rare Diseases.'' The Subcommittee received 
        testimony from:
                   Dr. Elizabeth Cherot, MD, MBA, 
                Senior Vice President and Chief Medical Health 
                Officer, March of Dimes;
                   Dr. Alexis A. Thompson, MD, MPH, 
                Chief of Division of Hematology, Elias Schwartz 
                MD Endowed Chair in Hematology, Children's 
                Hospital of Philadelphia, Professor of 
                Pediatrics, University of Pennsylvania Perelman 
                School of Medicine;
                   Dr. Meredithe McNamara, MD, MS, 
                FAAP, Assistant Professor, Yale School of 
                Medicine;
                   Dr. Miriam Grossman, MD, Child, 
                Adolescent, and Adult Psychiatrist;
                   Mr. George Manahan, Parkinson's 
                Advocate and Patient; and
                   Mr. Kevin O'Connor, Assistant to 
                the General President for Government Affairs 
                and Political Action, International Association 
                of Fire Fighters.

                        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. At the time this report was 
filed, the estimate was not available.

       Earmark, 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. 3821 contains no earmarks, limited 
tax benefits, or limited tariff benefits.

                      Advisory Committee Statement

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

                  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.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 provides a short title of ``Firefighter Cancer 
Registry Reauthorization Act of 2023''.

Section 2. Reauthorization of voluntary registry for firefighter cancer 
        incidence

    Section 2 amends Section 2(h) of the Firefighter Cancer 
Registry Act of 2018 to reauthorize the voluntary registry for 
firefighter cancer incidence for fiscal years 2024-2028.

         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):

                FIREFIGHTER CANCER REGISTRY ACT OF 2018




           *       *       *       *       *       *       *
SEC. 2. VOLUNTARY REGISTRY FOR FIREFIGHTER CANCER INCIDENCE.

  (a) In General.--The Secretary of Health and Human Services 
(referred to in this section as the Secretary), acting through 
the Director of the Centers for Disease Control and Prevention 
and in coordination with other agencies as the Secretary 
determines appropriate, shall develop and maintain, directly or 
through a grant or cooperative agreement, a voluntary registry 
of firefighters (referred to in this section as the Firefighter 
Registry) to collect relevant health and occupational 
information of such firefighters for purposes of determining 
cancer incidence.
  (b) Use of Firefighter Registry.--The Firefighter Registry 
may be used for the following purposes:
          (1) To improve data collection and data coordination 
        activities related to the nationwide monitoring of the 
        incidence of cancer among firefighters.
          (2) To collect, consolidate, and maintain, consistent 
        with subsection (g), epidemiological information and 
        analyses related to cancer incidence and trends among 
        firefighters
  (c) Relevant Data.--
          (1) Data collection.--In carrying out the voluntary 
        data collection for purposes of inclusion under the 
        Firefighter Registry, the Secretary may collect the 
        following:
                  (A) Information, as determined by the 
                Secretary under subsection (d)(1), of 
                volunteer, paid-on-call, and career 
                firefighters, independent of cancer status or 
                diagnosis.
                  (B) Individual risk factors and occupational 
                history of firefighters.
                  (C) Information, if available, related to--
                          (i) basic demographic information, 
                        including--
                                  (I) the age of the 
                                firefighter involved during the 
                                relevant dates of occupation as 
                                a firefighter; and
                                  (II) the age of cancer 
                                diagnosis;
                          (ii) the status of the firefighter as 
                        either volunteer, paid-on-call, or 
                        career firefighter;
                          (iii) the total number of years of 
                        occupation as a firefighter and a 
                        detailing of additional employment 
                        experience, whether concurrent, before, 
                        or anytime thereafter;
                          (iv)(I) the approximate number of 
                        fire incidents attended, including 
                        information related to the type of fire 
                        incidents and the role of the 
                        firefighter in responding to the 
                        incident; or
                          (II) in the case of a firefighter for 
                        whom information on such number and 
                        type is unavailable, an estimate of 
                        such number and type based on the 
                        method developed under subsection 
                        (d)(1)(D); and
                          (v) other medical information and 
                        health history, including additional 
                        risk factors, as appropriate, and other 
                        information relevant to a cancer 
                        incidence study of firefighters.
          (2) Information on diagnoses and treatment.--In 
        carrying out paragraph (1), with respect to diagnoses 
        and treatment of firefighters with cancer, the 
        Secretary shall, as appropriate, enable the Firefighter 
        Registry to electronically connect to State-based 
        cancer registries, for a purpose described by clause 
        (vi) or (vii) of section 399B(c)(2)(D) of the Public 
        Health Service Act (42 U.S.C. 280e(c)(2)(D)), to 
        obtain--
                  (A) date of diagnoses and source of 
                information; and
                  (B) pathological data characterizing the 
                cancer, including cancer site, state of disease 
                (pursuant to Staging Guide), incidence, and 
                type of treatment.
  (d) Firefighter Registry Coordination Strategy.--
          (1) Required strategy.--The Secretary shall, in 
        consultation with the relevant stakeholders identified 
        in subsection (e), including epidemiologists and 
        pathologists, develop a strategy to coordinate data 
        collection activities, including within existing State 
        registries, for inclusion in the Firefighter Registry 
        established under this Act. The strategy may include 
        the following:
                  (A) Increasing awareness of the Firefighter 
                Registry and encouraging participation among 
                volunteer, paid-on-call, and career 
                firefighters.
                  (B) Consideration of unique data collection 
                needs that may arise to generate a 
                statistically reliable representation of 
                minority, female, and volunteer firefighters, 
                including methods, as needed, to encourage 
                participation from such populations.
                  (C) Information on how the Secretary will 
                store data described in subsection (c)(1) and 
                provide electronic access to relevant health 
                information described in subsection (c)(2).
                  (D) Working in consultation with the experts 
                described in subsection (e), a reliable and 
                standardized method for estimating the number 
                of fire incidents attended by a firefighter as 
                well as the type of fire incident so attended 
                in the case such firefighter is unable to 
                provide such information.
          (2) Report to congress.--The Secretary shall submit 
        the strategy described in paragraph (1) to the 
        Committee on Energy and Commerce of the House of 
        Representatives and the Committee on Health, Education, 
        Labor, and Pensions of the Senate not later than 30 
        days after the date of the completion of the strategy.
          (3) Guidance for inclusion and maintenance of data on 
        firefighters.--The Secretary shall develop, in 
        consultation with the stakeholders identified in 
        subsection (e), State health agencies, State 
        departments of homeland security, and volunteer, paid-
        on-call, combination, and career firefighting agencies, 
        a strategy for inclusion of firefighters in the 
        registry that are representative of the general 
        population of firefighters, that outlines the 
        following:
                  (A) How new information about firefighters 
                will be submitted to the Firefighter Registry 
                for inclusion.
                  (B) How information about firefighters will 
                be maintained and updated in the Firefighter 
                Registry over time.
                  (C) A method for estimating the number of 
                fire incidents attended by a firefighter as 
                well as the type of fire incident so attended 
                in the case such firefighter is unable to 
                provide such information.
                  (D) Further information, as deemed necessary 
                by the Secretary.
  (e) Consultation and Report.--The Secretary shall consult 
with non-Federal experts on the Firefighter Registry 
established under this section, and shall submit to the 
Committee on Health, Education, Labor, and Pensions of the 
Senate and the Committee on Energy and Commerce of the House of 
Representatives a report that includes, as appropriate, 
information on goals achieved and improvements needed to 
strengthen the Firefighter Registry. Such non-Federal experts 
shall include the following:
          (1) Public health experts with experience in 
        developing and maintaining cancer registries.
          (2) Epidemiologists with experience in studying 
        cancer incidence.
          (3) Clinicians with experience in diagnosing and 
        treating cancer incidence.
          (4) Active and retired volunteer, paid-on-call, and 
        career firefighters as well as relevant national fire 
        and emergency response organizations.
  (f) Research Availability.--Subject to subsection (g), the 
Secretary shall ensure that information and analysis in the 
Firefighter Registry are available, as appropriate, to the 
public, including researchers, firefighters, and national fire 
service organizations.
  (g) Privacy.--In carrying out this Act, the Secretary shall 
ensure that information in and analysis of the Firefighter 
Registry are made available in a manner that, at a minimum, 
protects personal privacy to the extent required by applicable 
Federal and State privacy law.
  (h) Authorization of Funds.--To carry out this section, there 
are authorized to be appropriated [$2,500,000 for each of the 
fiscal years 2018 through 2022] $5,500,000 for each of fiscal 
years 2024 through 2028.

                                  [all]