The United States'

NATIONAL CANCER POLICY

[Legislative History]{.smallcaps}

**1937**

## National Cancer Institute Act of 1937 passed (P.L. 244)

-   Established NCI within Public Health Service

-   Directs Surgeon General to promote research

-   Established National Advisory Cancer Council

**1971**

***National Cancer Act of 1971* passed (P.L. 92-218)**

-   Established that NCI Director would be Presidentially-appointed and
    that NCI Director would prepare and submit Bypass Budget directly to
    the President

-   Established the President's Cancer Panel and the National Cancer
    Advisory Board

-   Directed NCI Director to expand and develop a coordinated cancer
    research program

-   Authorized the first cancer centers

-   Established the International Cancer Research Data Bank (ICRDB)

**1974**

***National Cancer Amendments of 1974* passed (P.L. 93-352)**

-   Authorized awards of construction grants for new
    construction/alteration/renovation of basic research laboratory
    facilities

-   Authorized expanded information dissemination activities for
    scientists, health professionals, and the general public

**1978**

***Community Mental Health Center Extension Act of 1978* and *Biomedical
Research and Research Training Amendments of 1978* passed (P.L.
95-622)**

-   Recodified 1971 Act, consolidating and reorganizing duties and
    functions of the NCI Director

-   Mandated an expanded research program for prevention of cancer
    caused by occupational or environmental exposure to carcinogens

-   Reduced minimum number of President's Cancer panel meetings from 12
    to 4 per year

-   Expanded the mission of cancer centers to include basic research and
    prevention

-   Added several ex-officio members to the NCAB, and required that five
    of appointed members be knowledgeable in environmental
    carcinogenesis

**1985**

***Health Research Extension Act* passed (P.L. 99-158)**

-   Established position of Associate Director for Prevention

-   Added to NCI's mission research on continuing care of cancer
    patients and their families

**1988**

***Health Omnibus Programs Extension of 1988* passed (P.L. 100-607)**

-   Added Rehabilitation Research to the umbrella of NCI's mission

-   Expanded NCI's information dissemination programs

\**As of this date, purpose of the National Cancer Institute, including
all amendments is as follows:*

*"The general purpose of the National Cancer Institute is the conduct
and support of research, training, health information dissemination, and
other programs with respect to cause, diagnosis, prevention, and
treatment of cancer, rehabilitation from cancer, and the continuing care
of cancer patients and the families of cancer patients." (42 USC 285)*

**1990**

***Breast and Cervical Cancer Mortality Prevention Act* passed (P.L.
101-354)**

-   Provides grants to states (via CDC) for the purpose of carrying out
    programs to: screen women for breast and cervical cancer as a
    preventive measure, provide referrals for follow up, improve
    training of health professionals in detection and control, provide
    for quality and accountability, and establish appropriate
    surveillance programs

-   Provides that priority will be given to low-income patients

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-   Provided as base for CDC's development of the National Breast and
    Cervical Cancer Early Detection program

**1992**

***Mammography Quality Standards Act* passed (P.L. 102-539)**

-   Regulates mammography screening facilities, providers and equipment

***Cancer Registries Amendment Act* passed (P.L. 102-515)**

-   Purpose of Act is to establish a national program of cancer
    registries, but in Findings section states that cancer control
    efforts are best addressed locally by State health departments that
    can identify unique needs

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-   Directs Secretary, acting through the Director of the Centers for
    Disease Control, to make grants to States for operation of state
    cancer registries

-   Directs Secretary to provide technical assistance to the States in
    their operation of statewide registries

**1993**

***The NIH Revitalization Amendments of 1993* passed (P.L. 103-43)**

-   Called for expanded research programs in both women's cancers and
    prostate cancer

-   Mandates a set-aside of NCI's appropriation for cancer control
    activities

-   Requires studies of potential environmental risk factors,
    specifically a case control study of elevated breast cancer rates on
    Long Island

**1997**

***Balanced Budget Act of 1997* passed**

(Subtitle B: Prevention Initiatives)

-   Screening mammography (sec. 4101): provides coverage for annual
    screening mammograms for all women 40 and over, and waives the Part
    B deductible for screening mammography. Effective Jan 1, 1998

-   Screening pap smear and pelvic exams (sec. 4102): provides coverage
    every 3 years for a screening pap smear and pelvic exam, or annual
    coverage for women (1) at high risk for cervical or vaginal cancer,
    or (2) of childbearing age who have had a pap smear during the
    preceding three years indicating the presence of cervical or vaginal
    cancer or other abnormality. Waives the Part B deductible for
    screening pap smears and pelvic exams. Effective Jan 1, 1998.

-   Prostate cancer screening tests (sec. 4103): provides coverage for
    annual prostate screening for men over age 50. Effective Jan 1,
    2000.

-   Coverage of colorectal screening (sec. 4104): Provides coverage for
    colorectal cancer screening procedures as the Secretary determines
    appropriate. Effective Jan 1, 1998 (except for a few rules effective
    Jan 1, 1999)

## Sense of the Senate Concerning Need for Guidelines for Breast Cancer Screening passed (S. Res. 47)

-   NIH reviewed findings but did not mandate reissue of guidelines

-   Resolved that: (1) need for more studies to determine benefits of
    mammography for women in their forties; (2) House urges NCI Advisory
    Panel to consider reissuing guidelines rescinded in 1993 for
    mammography for women between 40-49; (3) House directs the public to
    consider guidelines issued by other organizations

### ***National Tobacco Policy and Youth Smoking Reduction Act* introduced, not passed (S. 1415)**

-   Directs Secretary to take all actions necessary to ensure that
    reductions in underage tobacco usage are achieved, including legal
    action, allowance of block grants to states as incentives, and
    requiring random checks by states

-   Establishes the National Smoking Cessation Program

-   Requires revision of the warning labels on domestic cigarettes and
    smokeless tobacco

-   Mandates regulations requiring testing, reporting and disclosure of
    tobacco smoke constituents

-   Provides for the Women's Health and Cancer Rights Act of 1998, which
    requires minimum coverage of reconstruction after mastectomies (this
    provision appears to be the one tucked into the Omnibus funding bill
    passed by the 105^th^ Congress)

**1998**

***Mammography Quality Standards Reauthorization Act of 1998* passed
(P.L. 105-248)**

-   Mammography facilities to operate under high standards and
    appropriate federal guidelines

-   Patients to be notified of mammogram results and informed of whether
    they should seek follow-up care

***Women's Health Research and Prevention Amendments of 1998* passed
(P.L. 105-340)**

-   Reauthorized national program of cancer registries through 2003

-   Reauthorized the National Breast and Cervical Cancer Early Detection
    Program, and mandated inclusion of case management as a program
    component

## Breast and Cervical Cancer Treatment Act of 1998 introduced, not passed (H.R. 3779)

-   Provided for State Medicaid plans to provide coverage for breast or
    cervical cancer-related treatment services during a presumptive
    eligibility period

## Sense of the House Regarding Importance of Mammograms and Biopsies in Fight Against Cancer passed (H.Res. 565)

-   Included some compelling statistics regarding breast cancer
    incidence and mortality

-   Resolved that (1) all American women should perform self-examination
    and see physicians regularly; (2) the role played by community
    organizations and providers should be recognized; (3) the Federal
    government has a responsibility to raise awareness, continue to fund
    research and to make mammograms and biopsies more widely available

**1999**

***Patients' Bill of Rights Plus Act* (S.1344)**

-   Sec. 201: "Women's Health and Cancer Rights Act of 1999"

-   Sec. 715: Coverage for minimum hospital stay for lumpectomies, lymph
    node dissections, and coverage for secondary consultations

-   Sec. 730: Coverage for individuals participating in approved cancer
    clinical trials

The Breast and Cervical Treatment Act of 1999 (introduced 3/11 in House
and 3/18 in Senate)

-   Bill to provide an optional state Medicaid benefit for the coverage
    of certain women who were screened and diagnosed with breast or
    cervical cancer under the CDC National Breast and Cervical Cancer
    Early Detection program(introduced by Sen. Chafee and Reps Eshoo,
    Lazio, Capps, and Ros-Lehtinen)

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-   As of 10/29/99: Senate: in Finance Committee. House: bill reported
    favorably out of Commerce Committee.