H. R. 1394
To establish a comprehensive interagency response to reduce lung
cancer mortality in a timely manner.
IN THE HOUSE OF REPRESENTATIVES
April 6, 2011
Mrs. CHRISTENSEN (for herself and Mr. LOBIONDO) introduced the following
bill; which was referred to the Committee on Energy and Commerce, and in addition
to the Committees on Armed Services and Veterans' Affairs, for a period to
be subsequently determined by the Speaker, in each case for consideration
of such provisions as fall within the jurisdiction of the committee concerned
To establish a comprehensive interagency response to reduce lung
cancer mortality in a timely manner.
Be it enacted by the Senate and House of Representatives of the United
States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the `Lung Cancer Mortality Reduction Act of 2011'.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Lung cancer is the leading cause of cancer death for both men and women,
accounting for 28 percent of all cancer deaths.
(2) The National Cancer Institute estimates that in 2010, there were 222,520
new diagnoses of lung cancer and 157,300 deaths attributed to the disease.
(3) According to projections published in the Journal of Clinical Oncology
in 2009, between 2010 and 2030, the incidence of lung cancer will increase
by 46 percent for women and by 58 percent for men. The increase in the incidence
of lung cancer among minority communities during that time period will range
from 74 percent to 191 percent.
(4) Lung cancer causes more deaths annually than the next 4 leading causes
of cancer deaths, colon cancer, breast cancer, prostate cancer, and pancreatic
(5) The 5-year survival rate for lung cancer is only 15 percent, while the
5-year survival rate for breast cancer is 89 percent, for prostate cancer
99 percent, and for colon cancer 65 percent. Yet in research dollars per
death, lung cancer is the least funded of the major cancers.
(6) In 2001, the Lung Cancer Progress Review Group of the National Cancer
Institute stated that funding for lung cancer research was `far below the
levels characterized for other common malignancies and far out of proportion
to its massive health impact' and it gave the `highest priority' to the
creation of an integrated multidisciplinary, multi-institutional research
program. No comprehensive plan has been developed.
(7) While smoking is the leading risk factor for lung cancer, the President's
National Cancer Advisory Board Report of 2010 identified radon as the second
leading cause of lung cancer and listed 15 other environmental contaminants
strongly association with lung cancer, and there is accumulating evidence
that hormonal and genetic factors may influence the onset.
(8) Lung cancer is the most stigmatized of all the cancers and the only
cancer blamed on patients, whether they smoked or not.
(9) Nearly 20 percent of lung cancer patients have never smoked. Sixty percent
of individuals diagnosed with lung cancer are former smokers who quit, often
(10) Lung cancer in men and women who never smoked is the sixth leading
cause of cancer death. Of individuals diagnosed with lung cancer who have
never smoked, 2/3 of are women.
(11) Lung cancer is the leading cause of cancer death in the overall population
and in every major ethnic grouping, including White, African-American, Hispanic,
Asian and Pacific Islander, American Indian, and Alaskan Native, with an
even disproportionately higher impact on African-American males that has
not been addressed.
(12) Military personnel, veterans, and munitions workers exposed to carcinogens
such as Agent Orange, crystalline forms of silica, arsenic, uranium, beryllium,
and battlefield fuel emissions have increased risk for lung cancer.
(13) Only 16 percent of lung cancer is being diagnosed at an early stage
and there were no targets for the early detection or treatment of lung cancer
included in the Department of Health and Human Services's `Healthy People
2010' or `Healthy People 2020'.
(14) An actuarial analysis carried out by Milliman Inc. and published in
Population Health Management Journal in 2009 indicated that early detection
of lung cancer could save more than 70,000 lives a year in the United States.
(15) A National Cancer Institute study in 2009 indicated that while the
value of life lost to lung cancer will exceed $433,000,000,000 a year by
2020, a 4-percent annual decline in lung cancer mortality would reduce that
amount by more than half.
(16) In 2010, the National Cancer Institute released initial results from
the National Lung Screening Trial, a large-scale randomized national trial
that compared the effect of low-dose helical computed tomography (`CT')
and a standard chest x-ray on lung cancer mortality. The study found 20
percent fewer lung cancer deaths among study participants screened with
the CT scan.
SEC. 3. SENSE OF THE CONGRESS CONCERNING INVESTMENT IN LUNG CANCER RESEARCH.
It is the sense of the Congress that--
(1) lung cancer mortality reduction should be made a national public health
(2) a comprehensive mortality reduction program coordinated by the Secretary
of Health and Human Services is justified and necessary to adequately address
all aspects of lung cancer and reduce lung cancer mortality among current
smokers, former smokers, and non-smokers.
SEC. 4. LUNG CANCER MORTALITY REDUCTION PROGRAM.
Part P of title III of the Public Health Service Act (42 U.S.C. 280g et seq.)
is amended by adding at the end the following:
`SEC. 399V-6. LUNG CANCER MORTALITY REDUCTION PROGRAM.
`(a) In General- Not later than 180 days after the date of enactment of the
Lung Cancer Mortality Reduction Act of 2011, the Secretary, in consultation
with the Secretary of Defense, the Secretary of Veterans Affairs, the Director
of the National Institutes of Health, the Director of the Centers for Disease
Control and Prevention, the Commissioner of Food and Drugs, the Administrator
of the Centers for Medicare & Medicaid Services, the Director of the National
Center on Minority Health and Health Disparities, and other members of the
Lung Cancer Advisory Board established under section 7 of the Lung Cancer
Mortality Reduction Act of 2011, shall implement a comprehensive program to
achieve a 50-percent reduction in the mortality rate of lung cancer by 2020.
`(b) Requirements- The program implemented under subsection (a) shall include
at least the following:
`(1) With respect to the National Institutes of Health--
`(A) a strategic review and prioritization by the National Cancer Institute
of research grants to achieve the goal of the lung cancer mortality reduction
program in reducing lung cancer mortality;
`(B) the provision of funds to enable the Airway Biology and Disease Branch
of the National Heart, Lung, and Blood Institute to expand its research
programs to include predispositions to lung cancer, the interrelationship
between lung cancer and other pulmonary and cardiac disease, and the diagnosis
and treatment of these interrelationships;
`(C) the provision of funds to enable the National Institute of Biomedical
Imaging and Bioengineering to expedite the development of screening, diagnostic,
surgical, treatment, and drug testing innovations to facilitate the potential
of imaging as a biomarker and reduce lung cancer mortality, such as through
expansion of the Quantum Grant Program and Image-Guided Interventions
programs of the National Institute of Biomedical Imaging and Bioengineering;
`(D) the provision of funds to enable the National Institute of Environmental
Health Sciences to implement research programs relative to lung cancer
`(E) the provision of funds to enable the National Institute on Minority
Health and Health Disparities to collaborate on prevention, early detection,
and disease management research, and to conduct outreach programs in order
to address the impact of lung cancer on minority populations.
`(2) With respect to the Food and Drug Administration, the provision of
funds to enable the Center for Devices and Radiologic Health to--
`(A) establish quality standards and guidelines for hospitals, outpatient
departments, clinics, radiology practices, mobile units, physician offices,
or other facilities that conduct computed tomography screening for lung
`(B) provide for the expedited revision of standards and guidelines, as
required to accommodate technological advances in imaging; and
`(C) conduct an annual random sample survey to review compliance and evaluate
dose and accuracy performance.
`(3) With respect to the Centers for Disease Control and Prevention--
`(A) the provision of funds to establish a Lung Cancer Early Detection
Program that provides low-income, uninsured, and underserved populations
that are at high risk for lung cancer access to early detection services;
`(B) the provision of funds to enable the National Institute for Occupational
Safety and Health to conduct research on environmental contaminants strongly
associated with lung cancer in the workplace and implement measures to
reduce lung cancer risk and provide for an early detection program; and
`(C) a requirement that State, tribal, and territorial plans developed
under the National Comprehensive Cancer Control Program include lung cancer
mortality reduction measures commensurate with the public health impact
of lung cancer.
`(4) With respect to the Agency for Healthcare Research and Quality, the
annual review of lung cancer early detection methods, diagnostic and treatment
protocols, and the issuance of updated guidelines.
`(5) The cooperation and coordination of all programs for women, minorities,
and health disparities within the Department of Health and Human Services
to ensure that all aspects of the Lung Cancer Mortality Reduction Program
adequately address the burden of lung cancer on women and minority, rural,
and underserved populations.
`(6) The cooperation and coordination of all tobacco control and cessation
programs within agencies of the Department of Health and Human Services
to achieve the goals of the Lung Cancer Mortality Reduction Program with
particular emphasis on the coordination of drug and other cessation treatments
with early detection protocols.'.
SEC. 5. DEPARTMENT OF DEFENSE AND THE DEPARTMENT OF VETERANS AFFAIRS.
The Secretary of Defense and the Secretary of Veterans Affairs shall coordinate
with the Secretary of Health and Human Services--
(1) in developing the Lung Cancer Mortality Reduction Program under section
399V-6 of the Public Health Service Act, as added by section 4;
(2) in implementing the demonstration project under section 6 within the
Department of Defense and the Department of Veterans Affairs with respect
to military personnel and veterans whose smoking history and exposure to
carcinogens during active duty service has increased their risk for lung
(3) in implementing coordinated care programs for military personnel and
veterans diagnosed with lung cancer.
SEC. 6. LUNG CANCER SCREENING DEMONSTRATION PROJECT.
(a) Sense of the Congress- It is the sense of the Congress that a national
computed tomography lung cancer screening demonstration project should be
carried out expeditiously in order to assess the public health infrastructure
needs and to develop the most effective, safe, equitable, and efficient process
that will maximize the public health benefits of screening.
(b) Demonstration Project in General- Not later than 1 year after the date
of enactment of this Act, the Secretary of Health and Human Services (referred
to in this Act as the `Secretary'), in consultation with the Secretary of
Defense, the Secretary of Veterans Affairs, the Director of the National Institutes
of Health, the Director of the Centers for Disease Control and Prevention,
the Commissioner of Food and Drugs, the Administrator of the Centers for Medicare
& Medicaid Services, and the other members of the Lung Cancer Advisory
Board established under section 7 of the Lung Cancer Mortality Reduction Act
of 2011, shall establish a demonstration project, to be known as the Lung
Cancer Computed Tomography Screening and Treatment Demonstration Project (referred
to in this section as the `demonstration project').
(c) Program Requirements- The Secretary shall ensure that the demonstration
(1) identifies the optimal risk populations that would benefit from screening;
(2) develops the most effective, safe, equitable and cost-efficient process
for screening and early disease management;
(3) allows for continuous improvements in quality controls for the process;
(4) serves as a model for the integration of health information technology
and the concept of a rapid learning into the health care system.
(d) Participation- The Secretary shall select not less than 5 National Cancer
Institute Centers, 5 Department of Defense Medical Treatment Centers, 5 sites
within the Veterans Affairs Healthcare Network, 5 International Early Lung
Cancer Action Program sites, 10 community health centers for minority and
underserved populations, and additional sites as the Secretary determines
appropriate, as sites to carry out the demonstration project described under
(e) Quality Standards and Guidelines for Licensing of Tomography Screening
Facilities- The Secretary shall establish quality standards and guidelines
for the licensing of hospitals, outpatient departments, clinics, radiology
practices, mobile units, physician offices, or other facilities that conduct
computed tomography screening for lung cancer through the demonstration project,
that will require the establishment and maintenance of a quality assurance
and quality control program at each such facility that is adequate and appropriate
to ensure the reliability, clarity, and accuracy of the equipment and interpretation
of the screening scan and set appropriate standards to control the levels
of radiation dose.
(f) Timeframe- The Secretary shall conduct the demonstration project under
this section for a 5-year period.
(g) Report- Not later than 180 days after the date of enactment of this Act,
the Secretary shall submit a report to Congress on the projected cost of the
demonstration project, and shall submit annual reports to Congress thereafter
on the progress of the demonstration project and preliminary findings.
SEC. 7. LUNG CANCER ADVISORY BOARD.
(a) In General- The Secretary of Health and Human Services shall establish
a Lung Cancer Advisory Board (referred to in this section as the `Board')
to monitor the programs established under this Act (and the amendments made
by this Act), and provide annual reports to Congress concerning benchmarks,
expenditures, lung cancer statistics, and the public health impact of such
(b) Composition- The Board shall be composed of--
(1) the Secretary of Health and Human Services;
(2) the Secretary of Defense;
(3) the Secretary of Veterans Affairs;
(4) the Director of the Occupational Safety and Health Administration;
(5) the Director of the National Institute of Standards and Technology;
(6) one representative each from the fields of clinical medicine focused
on lung cancer, lung cancer research, radiology, imaging research, drug
development, minority health advocacy, veterans service organizations, lung
cancer advocacy, and occupational medicine to be appointed by the Secretary
of Health and Human Services.
SEC. 8. AUTHORIZATION OF APPROPRIATIONS.
To carry out this Act (and the amendments made by this Act), there are authorized
to be appropriated such sums as may be necessary for each of fiscal years
2012 through 2016.