I 

112TH CONGRESS 

1ST SESSION 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 

A BILL 

To establish a comprehensive interagency response to reduce 

lung cancer mortality in a timely manner. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Lung Cancer Mortality 

5 Reduction Act of 2011’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 


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1 (1) Lung cancer is the leading cause of cancer 

2 death for both men and women, accounting for 28 

3 percent of all cancer deaths. 

4 (2) The National Cancer Institute estimates 

5 that in 2010, there were 222,520 new diagnoses of 

6 lung cancer and 157,300 deaths attributed to the 

7 disease. 

8 (3) According to projections published in the 

9 Journal of Clinical Oncology in 2009, between 2010 

10 and 2030, the incidence of lung cancer will increase 

11 by 46 percent for women and by 58 percent for men. 

12 The increase in the incidence of lung cancer among 

13 minority communities during that time period will 

14 range from 74 percent to 191 percent. 

15 (4) Lung cancer causes more deaths annually 

16 than the next 4 leading causes of cancer deaths, 

17 colon cancer, breast cancer, prostate cancer, and 

18 pancreatic cancer, combined. 

19 (5) The 5-year survival rate for lung cancer is 

20 only 15 percent, while the 5-year survival rate for 

21 breast cancer is 89 percent, for prostate cancer 99 

22 percent, and for colon cancer 65 percent. Yet in re23 search dollars per death, lung cancer is the least 

24 funded of the major cancers. 


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1 (6) In 2001, the Lung Cancer Progress Review 

2 Group of the National Cancer Institute stated that 

3 funding for lung cancer research was ‘‘far below the 

4 levels characterized for other common malignancies 

5 and far out of proportion to its massive health im6 pact’’ and it gave the ‘‘highest priority’’ to the cre7 ation of an integrated multidisciplinary, multi-insti8 tutional research program. No comprehensive plan 

9 has been developed. 

10 (7) While smoking is the leading risk factor for 

11 lung cancer, the President’s National Cancer Advi12 sory Board Report of 2010 identified radon as the 

13 second leading cause of lung cancer and listed 15 

14 other environmental contaminants strongly associa15 tion with lung cancer, and there is accumulating evi16 dence that hormonal and genetic factors may influ17 ence the onset. 

18 (8) Lung cancer is the most stigmatized of all 

19 the cancers and the only cancer blamed on patients, 

20 whether they smoked or not. 

21 (9) Nearly 20 percent of lung cancer patients 

22 have never smoked. Sixty percent of individuals di23 agnosed with lung cancer are former smokers who 

24 quit, often decades ago. 


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1 (10) Lung cancer in men and women who never 

2 smoked is the sixth leading cause of cancer death. 

3 Of individuals diagnosed with lung cancer who have 

never smoked, 2 4 ⁄3 of are women. 

5 (11) Lung cancer is the leading cause of cancer 

6 death in the overall population and in every major 

7 ethnic grouping, including White, African-American, 

8 Hispanic, Asian and Pacific Islander, American In9 dian, and Alaskan Native, with an even dispropor10 tionately higher impact on African-American males 

11 that has not been addressed. 

12 (12) Military personnel, veterans, and muni13 tions workers exposed to carcinogens such as Agent 

14 Orange, crystalline forms of silica, arsenic, uranium, 

15 beryllium, and battlefield fuel emissions have in16 creased risk for lung cancer. 

17 (13) Only 16 percent of lung cancer is being di18 agnosed at an early stage and there were no targets 

19 for the early detection or treatment of lung cancer 

20 included in the Department of Health and Human 

21 Services’s ‘‘Healthy People 2010’’ or ‘‘Healthy Peo22 ple 2020’’. 

23 (14) An actuarial analysis carried out by 

24 Milliman Inc. and published in Population Health 

25 Management Journal in 2009 indicated that early 


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1 detection of lung cancer could save more than 

2 70,000 lives a year in the United States. 

3 (15) A National Cancer Institute study in 2009 

4 indicated that while the value of life lost to lung can5 cer will exceed $433,000,000,000 a year by 2020, a 

6 4-percent annual decline in lung cancer mortality 

7 would reduce that amount by more than half. 

8 (16) In 2010, the National Cancer Institute re9 leased initial results from the National Lung Screen10 ing Trial, a large-scale randomized national trial 

11 that compared the effect of low-dose helical com12 puted tomography (‘‘CT’’) and a standard chest x13 ray on lung cancer mortality. The study found 20 

14 percent fewer lung cancer deaths among study par15 ticipants screened with the CT scan. 

16 SEC. 3. SENSE OF THE CONGRESS CONCERNING INVEST17 MENT IN LUNG CANCER RESEARCH. 

18 It is the sense of the Congress that— 

19 (1) lung cancer mortality reduction should be 

20 made a national public health priority; and 

21 (2) a comprehensive mortality reduction pro22 gram coordinated by the Secretary of Health and 

23 Human Services is justified and necessary to ade24 quately address all aspects of lung cancer and reVerDate Mar 15 2010 04:24 Apr 08, 2011 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H1394.IH H1394

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1 duce lung cancer mortality among current smokers, 

2 former smokers, and non-smokers. 

3 SEC. 4. LUNG CANCER MORTALITY REDUCTION PROGRAM. 

4 Part P of title III of the Public Health Service Act 

5 (42 U.S.C. 280g et seq.) is amended by adding at the end 

6 the following: 

7 ‘‘SEC. 399V–6. LUNG CANCER MORTALITY REDUCTION PRO8 GRAM. 

9 ‘‘(a) IN GENERAL.—Not later than 180 days after 

10 the date of enactment of the Lung Cancer Mortality Re11 duction Act of 2011, the Secretary, in consultation with 

12 the Secretary of Defense, the Secretary of Veterans Af13 fairs, the Director of the National Institutes of Health, 

14 the Director of the Centers for Disease Control and Pre15 vention, the Commissioner of Food and Drugs, the Admin16 istrator of the Centers for Medicare & Medicaid Services, 

17 the Director of the National Center on Minority Health 

18 and Health Disparities, and other members of the Lung 

19 Cancer Advisory Board established under section 7 of the 

20 Lung Cancer Mortality Reduction Act of 2011, shall im21 plement a comprehensive program to achieve a 50-percent 

22 reduction in the mortality rate of lung cancer by 2020. 

23 ‘‘(b) REQUIREMENTS.—The program implemented 

24 under subsection (a) shall include at least the following: 


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1 ‘‘(1) With respect to the National Institutes of 

2 Health— 

3 ‘‘(A) a strategic review and prioritization 

4 by the National Cancer Institute of research 

5 grants to achieve the goal of the lung cancer 

6 mortality reduction program in reducing lung 

7 cancer mortality; 

8 ‘‘(B) the provision of funds to enable the 

9 Airway Biology and Disease Branch of the Na10 tional Heart, Lung, and Blood Institute to ex11 pand its research programs to include pre12 dispositions to lung cancer, the interrelationship 

13 between lung cancer and other pulmonary and 

14 cardiac disease, and the diagnosis and treat15 ment of these interrelationships; 

16 ‘‘(C) the provision of funds to enable the 

17 National Institute of Biomedical Imaging and 

18 Bioengineering to expedite the development of 

19 screening, diagnostic, surgical, treatment, and 

20 drug testing innovations to facilitate the poten21 tial of imaging as a biomarker and reduce lung 

22 cancer mortality, such as through expansion of 

23 the Quantum Grant Program and Image-Guid24 ed Interventions programs of the National InVerDate Mar 15 2010 04:24 Apr 08, 2011 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1394.IH H1394

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1 stitute of Biomedical Imaging and Bio2 engineering; 

3 ‘‘(D) the provision of funds to enable the 

4 National Institute of Environmental Health 

5 Sciences to implement research programs rel6 ative to lung cancer incidence; and 

7 ‘‘(E) the provision of funds to enable the 

8 National Institute on Minority Health and 

9 Health Disparities to collaborate on prevention, 

10 early detection, and disease management re11 search, and to conduct outreach programs in 

12 order to address the impact of lung cancer on 

13 minority populations. 

14 ‘‘(2) With respect to the Food and Drug Ad15 ministration, the provision of funds to enable the 

16 Center for Devices and Radiologic Health to— 

17 ‘‘(A) establish quality standards and guide18 lines for hospitals, outpatient departments, clin19 ics, radiology practices, mobile units, physician 

20 offices, or other facilities that conduct com21 puted tomography screening for lung cancer; 

22 ‘‘(B) provide for the expedited revision of 

23 standards and guidelines, as required to accom24 modate technological advances in imaging; and 


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1 ‘‘(C) conduct an annual random sample 

2 survey to review compliance and evaluate dose 

3 and accuracy performance. 

4 ‘‘(3) With respect to the Centers for Disease 

5 Control and Prevention— 

6 ‘‘(A) the provision of funds to establish a 

7 Lung Cancer Early Detection Program that 

8 provides low-income, uninsured, and under9 served populations that are at high risk for 

10 lung cancer access to early detection services; 

11 ‘‘(B) the provision of funds to enable the 

12 National Institute for Occupational Safety and 

13 Health to conduct research on environmental 

14 contaminants strongly associated with lung can15 cer in the workplace and implement measures 

16 to reduce lung cancer risk and provide for an 

17 early detection program; and 

18 ‘‘(C) a requirement that State, tribal, and 

19 territorial plans developed under the National 

20 Comprehensive Cancer Control Program include 

21 lung cancer mortality reduction measures com22 mensurate with the public health impact of lung 

23 cancer. 

24 ‘‘(4) With respect to the Agency for Healthcare 

25 Research and Quality, the annual review of lung 


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1 cancer early detection methods, diagnostic and treat2 ment protocols, and the issuance of updated guide3 lines. 

4 ‘‘(5) The cooperation and coordination of all 

5 programs for women, minorities, and health dispari6 ties within the Department of Health and Human 

7 Services to ensure that all aspects of the Lung Can8 cer Mortality Reduction Program adequately address 

9 the burden of lung cancer on women and minority, 

10 rural, and underserved populations. 

11 ‘‘(6) The cooperation and coordination of all to12 bacco control and cessation programs within agen13 cies of the Department of Health and Human Serv14 ices to achieve the goals of the Lung Cancer Mor15 tality Reduction Program with particular emphasis 

16 on the coordination of drug and other cessation 

17 treatments with early detection protocols.’’. 

18 SEC. 5. DEPARTMENT OF DEFENSE AND THE DEPARTMENT 

19 OF VETERANS AFFAIRS. 

20 The Secretary of Defense and the Secretary of Vet21 erans Affairs shall coordinate with the Secretary of Health 

22 and Human Services— 

23 (1) in developing the Lung Cancer Mortality 

24 Reduction Program under section 399V–6 of the 

25 Public Health Service Act, as added by section 4; 


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1 (2) in implementing the demonstration project 

2 under section 6 within the Department of Defense 

3 and the Department of Veterans Affairs with respect 

4 to military personnel and veterans whose smoking 

5 history and exposure to carcinogens during active 

6 duty service has increased their risk for lung cancer; 

7 and 

8 (3) in implementing coordinated care programs 

9 for military personnel and veterans diagnosed with 

10 lung cancer. 

11 SEC. 6. LUNG CANCER SCREENING DEMONSTRATION 

12 PROJECT. 

13 (a) SENSE OF THE CONGRESS.—It is the sense of the 

14 Congress that a national computed tomography lung can15 cer screening demonstration project should be carried out 

16 expeditiously in order to assess the public health infra17 structure needs and to develop the most effective, safe, 

18 equitable, and efficient process that will maximize the pub19 lic health benefits of screening. 

20 (b) DEMONSTRATION PROJECT IN GENERAL.—Not 

21 later than 1 year after the date of enactment of this Act, 

22 the Secretary of Health and Human Services (referred to 

23 in this Act as the ‘‘Secretary’’), in consultation with the 

24 Secretary of Defense, the Secretary of Veterans Affairs, 

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1 rector of the Centers for Disease Control and Prevention, 

2 the Commissioner of Food and Drugs, the Administrator 

3 of the Centers for Medicare & Medicaid Services, and the 

4 other members of the Lung Cancer Advisory Board estab5 lished under section 7 of the Lung Cancer Mortality Re6 duction Act of 2011, shall establish a demonstration 

7 project, to be known as the Lung Cancer Computed To8 mography Screening and Treatment Demonstration 

9 Project (referred to in this section as the ‘‘demonstration 

10 project’’). 

11 (c) PROGRAM REQUIREMENTS.—The Secretary shall 

12 ensure that the demonstration project— 

13 (1) identifies the optimal risk populations that 

14 would benefit from screening; 

15 (2) develops the most effective, safe, equitable 

16 and cost-efficient process for screening and early 

17 disease management; 

18 (3) allows for continuous improvements in qual19 ity controls for the process; and 

20 (4) serves as a model for the integration of 

21 health information technology and the concept of a 

22 rapid learning into the health care system. 

23 (d) PARTICIPATION.—The Secretary shall select not 

24 less than 5 National Cancer Institute Centers, 5 Depart25 ment of Defense Medical Treatment Centers, 5 sites withVerDate Mar 15 2010 04:24 Apr 08, 2011 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H1394.IH H1394

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1 in the Veterans Affairs Healthcare Network, 5 Inter2 national Early Lung Cancer Action Program sites, 10 

3 community health centers for minority and underserved 

4 populations, and additional sites as the Secretary deter5 mines appropriate, as sites to carry out the demonstration 

6 project described under this section. 

7 (e) QUALITY STANDARDS AND GUIDELINES FOR LI8 CENSING OF TOMOGRAPHY SCREENING FACILITIES.—The 

9 Secretary shall establish quality standards and guidelines 

10 for the licensing of hospitals, outpatient departments, clin11 ics, radiology practices, mobile units, physician offices, or 

12 other facilities that conduct computed tomography screen13 ing for lung cancer through the demonstration project, 

14 that will require the establishment and maintenance of a 

15 quality assurance and quality control program at each 

16 such facility that is adequate and appropriate to ensure 

17 the reliability, clarity, and accuracy of the equipment and 

18 interpretation of the screening scan and set appropriate 

19 standards to control the levels of radiation dose. 

20 (f) TIMEFRAME.—The Secretary shall conduct the 

21 demonstration project under this section for a 5-year pe22 riod. 

23 (g) REPORT.—Not later than 180 days after the date 

24 of enactment of this Act, the Secretary shall submit a re25 port to Congress on the projected cost of the demonstraVerDate Mar 15 2010 04:24 Apr 08, 2011 Jkt 099200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H1394.IH H1394

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1 tion project, and shall submit annual reports to Congress 

2 thereafter on the progress of the demonstration project 

3 and preliminary findings. 

4 SEC. 7. LUNG CANCER ADVISORY BOARD. 

5 (a) IN GENERAL.—The Secretary of Health and 

6 Human Services shall establish a Lung Cancer Advisory 

7 Board (referred to in this section as the ‘‘Board’’) to mon8 itor the programs established under this Act (and the 

9 amendments made by this Act), and provide annual re10 ports to Congress concerning benchmarks, expenditures, 

11 lung cancer statistics, and the public health impact of such 

12 programs. 

13 (b) COMPOSITION.—The Board shall be composed 

14 of— 

15 (1) the Secretary of Health and Human Serv16 ices; 

17 (2) the Secretary of Defense; 

18 (3) the Secretary of Veterans Affairs; 

19 (4) the Director of the Occupational Safety and 

20 Health Administration; 

21 (5) the Director of the National Institute of 

22 Standards and Technology; and 

23 (6) one representative each from the fields of 

24 clinical medicine focused on lung cancer, lung cancer 

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1 ment, minority health advocacy, veterans service or2 ganizations, lung cancer advocacy, and occupational 

3 medicine to be appointed by the Secretary of Health 

4 and Human Services. 

5 SEC. 8. AUTHORIZATION OF APPROPRIATIONS. 

6 To carry out this Act (and the amendments made by 

7 this Act), there are authorized to be appropriated such 

8 sums as may be necessary for each of fiscal years 2012 

9 through 2016. 

Æ 


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