II 

112TH CONGRESS 

1ST SESSION S. 752 

To establish a comprehensive interagency response to reduce lung cancer 

mortality in a timely manner. 

IN THE SENATE OF THE UNITED STATES 

APRIL 6 (legislative day, APRIL 5), 2011 

Mrs. FEINSTEIN (for herself, Mr. ISAKSON, and Mr. KERRY) introduced the 

following bill; which was read twice and referred to the Committee on 

Health, Education, Labor, and Pensions 

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: 

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

9 death for both men and women, accounting for 28 

10 percent of all cancer deaths. 


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1 (2) The National Cancer Institute estimates 

2 that in 2010, there were 222,520 new diagnosis of 

3 lung cancer and 157,300 deaths attributed to the 

4 disease. 

5 (3) According to projections published in the 

6 Journal of Clinical Oncology in 2009, between 2010 

7 and 2030, the incidence of lung cancer will increase 

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

9 The increase in the incidence of lung cancer among 

10 minority communities during that time period will 

11 range from 74 percent to 191 percent. 

12 (4) Lung cancer causes more deaths annually 

13 than the next 4 leading causes of cancer deaths, 

14 colon cancer, breast cancer, prostate cancer, and 

15 pancreatic cancer, combined. 

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

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

18 breast cancer is 89 percent, for prostate cancer 99 

19 percent, and for colon cancer 65 percent. Yet in re20 search dollars per death, lung cancer is the least 

21 funded of the major cancers. 

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

23 Group of the National Cancer Institute stated that 

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

25 levels characterized for other common malignancies 


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1 and far out of proportion to its massive health im2 pact’’ and it gave the ‘‘highest priority’’ to the cre3 ation of an integrated multidisciplinary, multi-insti4 tutional research program. No comprehensive plan 

5 has been developed. 

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

7 lung cancer, the President’s National Cancer Advi8 sory Board Report of 2010 identified radon as the 

9 second leading cause of lung cancer and listed 15 

10 other environmental contaminants strongly associa11 tion with lung cancer, and there is accumulating evi12 dence that hormonal and genetic factors may influ13 ence the onset. 

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

15 the cancers and the only cancer blamed on patients, 

16 whether they smoked or not. 

17 (9) Nearly 20 percent of lung cancer patients 

18 have never smoked. Sixty percent of individuals di19 agnosed with lung cancer are former smokers who 

20 quit, often decades ago. 

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

22 smoked is the sixth leading cause of cancer death. 

23 Of individuals diagnosed with lung cancer who have 

never smoked, 2 24 ⁄3 of are women. 


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

2 death in the overall population and in every major 

3 ethnic grouping, including White, African-American, 

4 Hispanic, Asian and Pacific Islander, American In5 dian, and Alaskan Native, with an even dispropor6 tionately higher impact on African-American males 

7 that has not been addressed. 

8 (12) Military personnel, veterans, and muni9 tions workers exposed to carcinogens such as Agent 

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

11 beryllium, and battlefield fuel emissions have in12 creased risk for lung cancer. 

13 (13) Only 16 percent of lung cancer is being di14 agnosed at an early stage and there were no targets 

15 for the early detection or treatment of lung cancer 

16 included in the Department of Health and Human 

17 Services’s ‘‘Healthy People 2010’’ or ‘‘Healthy Peo18 ple 2020’’. 

19 (14) An actuarial analysis carried out by 

20 Milliman Inc. and published in Population Health 

21 Management Journal in 2009 indicated that early 

22 detection of lung cancer could save more than 

23 70,000 lives a year in the United States. 

24 (15) A National Cancer Institute study in 2009 

25 indicated that while the value of life lost to lung canVerDate Mar 15 2010 06:19 Apr 07, 2011 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S752.IS S752

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1 cer will exceed $433,000,000,000 a year by 2020, a 

2 4 percent annual decline in lung cancer mortality 

3 would reduce that amount by more than half. 

4 (16) In 2010, the National Cancer Institute re5 leased initial results from the National Lung Screen6 ing Trial, a large-scale randomized national trial 

7 that compared the effect of low-dose helical com8 puted tomography (‘‘CT’’) and a standard chest x9 ray on lung cancer mortality. The study found 20 

10 percent fewer lung cancer deaths among study par11 ticipants screened with the CT scan. 

12 SEC. 3. SENSE OF THE SENATE CONCERNING INVESTMENT 

13 IN LUNG CANCER RESEARCH. 

14 It is the sense of the Senate that— 

15 (1) lung cancer mortality reduction should be 

16 made a national public health priority; and 

17 (2) a comprehensive mortality reduction pro18 gram coordinated by the Secretary of Health and 

19 Human Services is justified and necessary to ade20 quately address all aspects of lung cancer and re21 duce lung cancer mortality among current smokers, 

22 former smokers, and non-smokers. 


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1 SEC. 4. LUNG CANCER MORTALITY REDUCTION PROGRAM. 

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

3 (42 U.S.C. 280g et seq.) is amended by adding at the end 

4 the following: 

5 ‘‘SEC. 399V–6. LUNG CANCER MORTALITY REDUCTION PRO6 GRAM. 

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

8 the date of enactment of the Lung Cancer Mortality Re9 duction Act of 2011, the Secretary, in consultation with 

10 the Secretary of Defense, the Secretary of Veterans Af11 fairs, the Director of the National Institutes of Health, 

12 the Director of the Centers for Disease Control and Pre13 vention, the Commissioner of Food and Drugs, the Admin14 istrator of the Centers for Medicare & Medicaid Services, 

15 the Director of the National Center on Minority Health 

16 and Health Disparities, and other members of the Lung 

17 Cancer Advisory Board established under section 7 of the 

18 Lung Cancer Mortality Reduction Act of 2011, shall im19 plement a comprehensive program to achieve a 50 percent 

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

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

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

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

24 Health— 

25 ‘‘(A) a strategic review and prioritization 

26 by the National Cancer Institute of research 


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1 grants to achieve the goal of the lung cancer 

2 mortality reduction program in reducing lung 

3 cancer mortality; 

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

5 Airway Biology and Disease Branch of the Na6 tional Heart, Lung, and Blood Institute to ex7 pand its research programs to include pre8 dispositions to lung cancer, the interrelationship 

9 between lung cancer and other pulmonary and 

10 cardiac disease, and the diagnosis and treat11 ment of these interrelationships; 

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

13 National Institute of Biomedical Imaging and 

14 Bioengineering to expedite the development of 

15 screening, diagnostic, surgical, treatment, and 

16 drug testing innovations to facilitate the poten17 tial of imaging as a biomarker and reduce lung 

18 cancer mortality, such as through expansion of 

19 the Quantum Grant Program and Image-Guid20 ed Interventions programs of the National In21 stitute of Biomedical Imaging and Bio22 engineering; 

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

24 National Institute of Environmental Health 


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1 Sciences to implement research programs rel2 ative to lung cancer incidence; and 

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

4 National Institute on Minority Health and 

5 Health Disparities to collaborate on prevention, 

6 early detection, and disease management re7 search, and to conduct outreach programs in 

8 order to address the impact of lung cancer on 

9 minority populations. 

10 ‘‘(2) With respect to the Food and Drug Ad11 ministration, the provision of funds to enable the 

12 Center for Devices and Radiologic Health to— 

13 ‘‘(A) establish quality standards and guide14 lines for hospitals, outpatient departments, clin15 ics, radiology practices, mobile units, physician 

16 offices, or other facilities that conduct com17 puted tomography screening for lung cancer; 

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

19 standards and guidelines, as required to accom20 modate technological advances in imaging; and 

21 ‘‘(C) conduct an annual random sample 

22 survey to review compliance and evaluate dose 

23 and accuracy performance. 

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

25 Control and Prevention— 


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

2 Lung Cancer Early Detection Program that 

3 provides low-income, uninsured, and under4 served populations that are at high risk for 

5 lung cancer access to early detection services; 

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

7 National Institute for Occupational Safety and 

8 Health to conduct research on environmental 

9 contaminants strongly associated with lung can10 cer in the workplace and implement measures 

11 to reduce lung cancer risk and provide for an 

12 early detection program; and 

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

14 territorial plans developed under the National 

15 Comprehensive Cancer Control Program include 

16 lung cancer mortality reduction measures com17 mensurate with the public health impact of lung 

18 cancer. 

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

20 Research and Quality, the annual review of lung 

21 cancer early detection methods, diagnostic and treat22 ment protocols, and the issuance of updated guide23 lines. 

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

25 programs for women, minorities, and health dispariVerDate Mar 15 2010 06:19 Apr 07, 2011 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S752.IS S752

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1 ties within the Department of Health and Human 

2 Services to ensure that all aspects of the Lung Can3 cer Mortality Reduction Program adequately address 

4 the burden of lung cancer on women and minority, 

5 rural, and underserved populations. 

6 ‘‘(6) The cooperation and coordination of all to7 bacco control and cessation programs within agen8 cies of the Department of Health and Human Serv9 ices to achieve the goals of the Lung Cancer Mor10 tality Reduction Program with particular emphasis 

11 on the coordination of drug and other cessation 

12 treatments with early detection protocols.’’. 

13 SEC. 5. DEPARTMENT OF DEFENSE AND THE DEPARTMENT 

14 OF VETERANS AFFAIRS. 

15 The Secretary of Defense and the Secretary of Vet16 erans Affairs shall coordinate with the Secretary of Health 

17 and Human Services— 

18 (1) in developing the Lung Cancer Mortality 

19 Reduction Program under section 399V–6 of the 

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

21 (2) in implementing the demonstration project 

22 under section 6 within the Department of Defense 

23 and the Department of Veterans Affairs with respect 

24 to military personnel and veterans whose smoking 

25 history and exposure to carcinogens during active 


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1 duty service has increased their risk for lung cancer; 

2 and 

3 (3) in implementing coordinated care programs 

4 for military personnel and veterans diagnosed with 

5 lung cancer. 

6 SEC. 6. LUNG CANCER SCREENING DEMONSTRATION 

7 PROJECT. 

8 (a) SENSE OF THE SENATE.—It is the sense of the 

9 Senate that a national computed tomography lung cancer 

10 screening demonstration project should be carried out ex11 peditiously in order to assess the public health infrastruc12 ture needs and to develop the most effective, safe, equi13 table, and efficient process that will maximize the public 

14 health benefits of screening. 

15 (b) DEMONSTRATION PROJECT IN GENERAL.—Not 

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

17 the Secretary of Health and Human Services (referred to 

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

19 Secretary of Defense, the Secretary of Veterans Affairs, 

20 the Director of the National Institutes of Health, the Di21 rector of the Centers for Disease Control and Prevention, 

22 the Commissioner of Food and Drugs, the Administrator 

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

24 other members of the Lung Cancer Advisory Board estab25 lished under section 7 of the Lung Cancer Mortality ReVerDate Mar 15 2010 06:19 Apr 07, 2011 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S752.IS S752

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1 duction Act of 2011, shall establish a demonstration 

2 project, to be known as the Lung Cancer Computed To3 mography Screening and Treatment Demonstration 

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

5 project’’). 

6 (c) PROGRAM REQUIREMENTS.—The Secretary shall 

7 ensure that the demonstration project— 

8 (1) identifies the optimal risk populations that 

9 would benefit from screening; 

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

11 and cost-efficient process for screening and early 

12 disease management; 

13 (3) allows for continuous improvements in qual14 ity controls for the process; and 

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

16 health information technology and the concept of a 

17 rapid learning into the health care system. 

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

19 less than 5 National Cancer Institute Centers, 5 Depart20 ment of Defense Medical Treatment Centers, 5 sites with21 in the Veterans Affairs Healthcare Network, 5 Inter22 national Early Lung Cancer Action Program sites, 10 

23 community health centers for minority and underserved 

24 populations, and additional sites as the Secretary deterVerDate Mar 15 2010 06:19 Apr 07, 2011 Jkt 099200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S752.IS S752

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1 mines appropriate, as sites to carry out the demonstration 

2 project described under this section. 

3 (e) QUALITY STANDARDS AND GUIDELINES FOR LI4 CENSING OF TOMOGRAPHY SCREENING FACILITIES.—The 

5 Secretary shall establish quality standards and guidelines 

6 for the licensing of hospitals, outpatient departments, clin7 ics, radiology practices, mobile units, physician offices, or 

8 other facilities that conduct computed tomography screen9 ing for lung cancer through the demonstration project, 

10 that will require the establishment and maintenance of a 

11 quality assurance and quality control program at each 

12 such facility that is adequate and appropriate to ensure 

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

14 interpretation of the screening scan and set appropriate 

15 standards to control the levels of radiation dose. 

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

17 demonstration project under this section for a 5-year pe18 riod. 

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

20 of enactment of this Act, the Secretary shall submit a re21 port to Congress on the projected cost of the demonstra22 tion project, and shall submit annual reports to Congress 

23 thereafter on the progress of the demonstration project 

24 and preliminary findings. 


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1 SEC. 7. LUNG CANCER ADVISORY BOARD. 

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

3 Human Services shall establish a Lung Cancer Advisory 

4 Board (referred to in this section as the ‘‘Board’’) to mon5 itor the programs established under this Act (and the 

6 amendments made by this Act), and provide annual re7 ports to Congress concerning benchmarks, expenditures, 

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

9 programs. 

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

11 of— 

12 (1) the Secretary of Health and Human Serv13 ices; 

14 (2) the Secretary of Defense; 

15 (3) the Secretary of Veterans Affairs; 

16 (4) the Director of the Occupational Safety and 

17 Health Administration; 

18 (5) the Director of the National Institute of 

19 Standards and Technology; and 

20 (6) one representative each from the fields of 

21 clinical medicine focused on lung cancer, lung cancer 

22 research, radiology, imaging research, drug develop23 ment, minority health advocacy, veterans service or24 ganizations, lung cancer advocacy, and occupational 

25 medicine to be appointed by the Secretary of Health 

26 and Human Services. 


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1 SEC. 8. AUTHORIZATION OF APPROPRIATIONS. 

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

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

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

5 through 2016. 

Æ 


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