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[House Report 115-301]
[From the U.S. Government Publishing Office]

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115th Congress    }                                  {         Report
                        HOUSE OF REPRESENTATIVES
 1st Session      }                                  {         115-301
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                FIREFIGHTER CANCER REGISTRY ACT OF 2017

                                _______
                                

 September 8, 2017.--Committed to the Committee of the Whole House on 
            the State of the Union and ordered to be printed

                                _______
                                

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

                              R E P O R T

                        [To accompany H.R. 931]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 931) to require the Secretary of Health and 
Human Services to develop a voluntary registry to collect data 
on cancer incidence among firefighters, having considered the 
same, report favorably thereon with an amendment and recommend 
that the bill as amended do pass.

                                CONTENTS

Purpose and Summary..............................................     3
Background and Need for Legislation..............................     4
Committee Action.................................................     4
Committee Votes..................................................     4
Oversight Findings and Recommendations...........................     4
New Budget Authority, Entitlement Authority, and Tax Expenditures     5
Congressional Budget Office Estimate.............................     5
Federal Mandates Statement.......................................     6
Statement of General Performance Goals and Objectives............     6
Duplication of Federal Programs..................................     6
Committee Cost Estimate..........................................     6
Earmark, Limited Tax Benefits, and Limited Tariff Benefits.......     6
Disclosure of Directed Rule Makings..............................     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............     7

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Firefighter Cancer Registry Act of 
2017''.

SEC. 2. POPULATION-BASED REGISTRY FOR FIREFIGHTER CANCER INCIDENCE.

  (a) In General.--The Secretary of Health and Human Services, acting 
through the Director of the Centers for Disease Control and Prevention, 
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 history 
and occupational information of such firefighters that can be linked to 
available cancer registry data collected by existing State cancer 
registries.
  (b) Use of Firefighter Registry.--The Firefighter Registry shall be 
used for the following purposes:
          (1) To establish and improve collection infrastructure and 
        activities related to the nationwide monitoring of the 
        incidence of cancer among firefighters.
          (2) To collect, consolidate, store, and make publicly 
        available epidemiological information related to cancer 
        incidence and trends among firefighters.
  (c) Relevant Data.--
          (1) In general.--In carrying out the voluntary data 
        collection for purposes of inclusion under the Firefighter 
        Registry, the Secretary should seek to include the following 
        information:
                  (A) Identifiable information from a representative 
                sample size, as determined by the Secretary under 
                subsection (d)(2)(A), of volunteer, paid-on-call, and 
                career firefighters, independent of cancer status or 
                diagnosis.
                  (B) With respect to individual risk factors and work 
                history of firefighters, available information on--
                          (i) basic demographic information, including 
                        the age of the firefighter involved;
                          (ii) a listing of status of the firefighter 
                        as either volunteer, paid-on-call, or career 
                        firefighter;
                          (iii) the number of years on the job and a 
                        detailing of additional employment experience 
                        that was either performed concurrently 
                        alongside firefighting service, before, or 
                        anytime thereafter;
                          (iv)(I) a measure of the number of fire 
                        incidents attended as well as the type of fire 
                        incidents (such as residential house fire or 
                        commercial fire); or
                          (II) in the case of a firefighter for whom 
                        information on such number and type is not 
                        available, an estimate of such number and type 
                        based on the method developed under subsection 
                        (d)(2);
                          (v) a list of additional risk factors, 
                        including smoking or drug use, as determined 
                        relevant by the Secretary; and
                          (vi) other physical examination and medical 
                        history information relevant to a cancer 
                        incidence study or general health of 
                        firefighters not available in existing cancer 
                        registries.
                  (C) Any additional information that is deemed 
                necessary by the Secretary.
          (2) Diagnoses and treatment.--In carrying out the data 
        collection for purposes of inclusion under the Firefighter 
        Registry, with respect to diagnoses and treatment of 
        firefighters diagnosed with cancer, the Secretary shall enable 
        the Firefighter Registry to link 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 information on--
                  (A) administrative information, including 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) Methods.--
          (1) In general.--For the purposes described in subsection 
        (b), the Secretary is authorized to incorporate questions into 
        public health surveys, questionnaires, and other databases.
          (2) Required strategy.--The Secretary shall develop a 
        strategy, working in consultation with the stakeholders 
        identified in subsection (e), to maximize participation in the 
        Firefighter Registry established under this Act. At minimum, 
        the strategy shall include the following:
                  (A) Identified minimum participation targets for 
                volunteer, paid-on-call, and career firefighters.
                  (B) A strategy for increasing awareness of the 
                Firefighter Registry and maximizing participation among 
                volunteer, paid-on-call, and career firefighters to 
                meet minimum participation targets.
                  (C) Additional steps that may be required to ensure 
                the equitable representation of groups identified in 
                paragraph (5).
                  (D) Information on how the Secretary will store data 
                described in subsection (c)(1) and provide links to 
                relevant health information described in subsection 
                (c)(2).
                  (E) 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.
          (3) Report to congress.--The Secretary shall submit the 
        strategy described in paragraph (2) 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.
          (4) 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.
          (5) Ensuring representation of underrepresented groups in 
        registry.--In carrying out this section, the Secretary shall 
        take such measures as the Secretary deems appropriate to 
        encourage the inclusion of data on minority, female, and 
        volunteer firefighters in the Firefighter Registry established 
        under this section.
  (e) Consultation.--The Secretary shall, on a regular basis, seek 
feedback regarding the utility of the Firefighter Registry established 
under this section and ways the Firefighter Registry can be improved 
from non-Federal experts in the following areas:
          (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.--The Secretary shall develop and make 
public a process for de-identifying data from the Firefighter Registry 
and making such data available without a fee for research or other 
purposes. Such process shall provide that such data shall be made 
available for such research purposes only if there is an agreement to 
make findings, journal articles, or other print or web-based 
publications derived from such research public or available to the 
relevant stakeholders identified in subsection (e).
  (g) Privacy.--In carrying out this Act, the Secretary shall apply to 
the Firefighter Registry developed under subsection (a) data security 
provisions and privacy standards that comply with the best practices of 
the Centers for Disease Control and Prevention and provide for data 
privacy and security standards similar to those in the HIPAA privacy 
regulation, as defined in section 1180(b)(3) of the Social Security Act 
(42 U.S.C. 1320d-9(b)(3)).
  (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.

                          PURPOSE AND SUMMARY

    H.R. 931 was introduced on February 2, 2017, by Rep. Chris 
Collins (R-NY). The bill requires the Centers for Disease 
Control and Prevention (CDC) to develop and maintain a registry 
to collect data regarding the incidence of cancer in 
firefighters.

                  BACKGROUND AND NEED FOR LEGISLATION

    Firefighting is one of the most hazardous yet least studied 
occupations in terms of exposure effects and the relationship 
to occupational disease. Firefighters routinely work in 
environments where they come into contact with carcinogenic 
materials and toxic chemicals. According to research by the 
CDC's National Institute for Occupational Safety and Health, 
firefighters are at increased risk for developing cancer. 
Currently, the extent to which firefighters are at increased 
risk for cancer, and how that risk can be reduced in the future 
are not fully understood. Having better data to understand the 
overall epidemiological cancer trends among firefighters will 
lead to better protective measures and decontamination 
procedures, ultimately reducing some of the hazards these first 
responders face on the job.

                            COMMITTEE ACTION

    On May 17, 2017, the Subcommittee on Health held a hearing 
on H.R. 931. The hearing was entitled ``Examining Initiatives 
to Advance Public Health.'' The Subcommittee received testimony 
from:
           Kevin O'Connor, Assistant to the General 
        President, International Association of Fire Fighters;
           Cheryl D. Watson-Lowry, DDS; General 
        Dentist, American Dental Association;
           Martin S. Levine, DO, MPH, FACOFP, dist; 
        Interim Clinical Dean, Professor of Family and 
        Community Medicine, Touro College of Osteopathic 
        Medicine; and
           Jordan Greenbaum, MD; Medical Director, 
        Institute for Healthcare and Human Trafficking at 
        Children's Healthcare of Atlanta; Medical Director, 
        Global Initiative for Child Health and Well Being at 
        the International Centre for Missing and Exploited 
        Children.
    On June 29, 2017, the Subcommittee on Health met in open 
markup session and forwarded H.R. 931, as amended, to the full 
Committee by a voice vote. On July 27, 2017, the full Committee 
on Energy and Commerce met in open markup session and ordered 
H.R. 931, as amended, favorably reported to the House by a 
voice vote.

                            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. There were no record votes taken in connection with 
ordering H.R. 931 reported.

                 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. 931 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, the following is 
the cost estimate provided by the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974.

                                     U.S. Congress,
                               Congressional Budget Office,
                                   Washington, DC, August 31, 2017.
Hon. Greg Walden,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 931, the 
Firefighter Cancer Registry Act of 2017.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Rebecca Yip.
            Sincerely,
                                                        Keith Hall.
    Enclosure.

H.R. 931--Firefighter Cancer Registry Act of 2017

    H.R. 931 would require the Secretary of Health and Human 
Services, through the Centers for Disease Control and 
Prevention, to develop and maintain a voluntary registry to 
monitor cancer incidence among firefighters. The registry would 
incorporate relevant information--including demographic 
characteristics, number and type of fire incidents attended, 
and health information relevant to cancer incidence--that would 
be linked to state cancer registries. H.R. 931 would authorize 
the appropriation of a total of $12.5 million for fiscal years 
2018 through 2022 to carry out those activities.
    Based on historical spending for similar activities, CBO 
estimates that implementing H.R. 931 would cost $10 million 
over the 2018-2022 period; the remainder would be spent in 
years after 2022. Enacting H.R. 931 would not affect direct 
spending or revenues; therefore, pay-as-you-go procedures do 
not apply.
    CBO estimates that enacting the legislation would not 
increase net direct spending or on-budget deficits in any of 
the four consecutive 10-year periods beginning in 2028.
    H.R. 931 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would impose no costs on state, local, or tribal governments.
    The CBO staff contact for this estimate is Rebecca Yip. The 
estimate was approved by Holly Harvey, Deputy Assistant 
Director for Budget Analysis.

                       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 develop 
a centralized voluntary registry to collect data on the 
incidence of cancer among firefighters in order to improve 
occupational-associated cancer prevention and treatment.

                    DUPLICATION OF FEDERAL PROGRAMS

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 931 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.

                        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.

       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. 931 contains no earmarks, limited tax 
benefits, or limited tariff benefits.

                  DISCLOSURE OF DIRECTED RULE MAKINGS

    Pursuant to section 3(i) of H. Res. 5, the Committee finds 
that H.R. 931 contains no directed rule makings.

                      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 that the Act may be cited as the 
``Firefighter Cancer Registry Act of 2017.''

Section 2. Population-based registry for firefighter cancer incidence

    Section 2 authorizes the appropriation of $2.5 million for 
each of fiscal years 2018 to 2022 to establish a voluntary 
registry of firefighters, to be developed and maintained by the 
CDC, which will collect relevant history and occupational 
information that can be linked to available cancer data 
collected by existing State cancer registries.

         CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

    This legislation does not amend any existing Federal 
statute.

                                  [all]
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