II 

108TH CONGRESS 

1ST SESSION S. 1899

To improve data collection and dissemination, treatment, and research relating 

to cancer, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

NOVEMBER 20, 2003

Mr. BROWNBACK (for himself and Mr. GREGG) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL

To improve data collection and dissemination, treatment, and 

research relating to cancer, and for other purposes.

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 ‘‘National Cancer Act 

5 of 2003’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 

8 (1) In 2003, an estimated 1,334,100 Americans 

9 will be diagnosed with some form of cancer. 
2

•S 1899 IS 

1 (2) In 2003, an estimated 556,500 Americans 

2 will die of cancer. In the United States, 1 in every 

3 4 deaths results from cancer. 

4 (3) In 2002, the National Institutes of Health 

5 estimated the overall cost of cancer at 

6 $171,600,000,000. 

7 (4) In 2003, an estimated 211,300 American 

8 women and 1,300 men will be diagnosed with breast 

9 cancer, and 40,200 will die of the disease. A mam10 mogram every 1–2 years can reduce the risk of 

11 dying by about 16 percent for women 40 years of 

12 age and older. 

13 (5) In 2003, an estimated 40,100 women will 

14 be newly diagnosed with cancer of the uterine corpus 

15 and 6,800 women will die of the disease. 

16 (6) In 2003, an estimated 147,500 Americans 

17 will be diagnosed with colorectal cancer and 57,100 

18 will die of the disease. 

19 (7) Incidence rates of colorectal cancer sta20 bilized between 1995 and 1999. Research suggests 

21 that declines may be in part due to increased screen22 ing and polyp removal. 

23 (8) The Chronic Disease Prevention Depart24 ment found that screening for colorectal cancer can 

25 reduce the number of deaths by at least 30 percent. 
3

•S 1899 IS 

1 (9) Regular screening examinations by a health 

2 care professional can result in early detection of can3 cers of the breast, colon, rectum, prostate, testis, 

4 oral cavity, and skin. If all these cancers were diag5 nosed at a localized stage through regular examina6 tions, the 5-year survival rate would increase from 

7 82 percent to 95 percent. 

8 (10) Cancers of the lung, mouth, larynx, blad9 der, kidney, cervix, esophagus, and pancreas are re10 lated to tobacco use. The American Cancer Society 

11 estimates that in 2003 more than 180,000 cancer 

12 deaths will be caused by tobacco use. Smoking alone 

causes 1 13 ⁄3 of all cancer deaths. 

14 (11) More than 1,000,000 skin cancers ex15 pected to be diagnosed in 2003 could have been pre16 vented by protection from the sun’s rays. 

17 (12) An estimated 9,000 new cases of childhood 

18 cancer are expected to occur in 2003. 

19 (13) Cancer is the chief cause of death by dis20 ease in children between the ages of 1 and 14. 

21 (14) The American Cancer Society estimates 

that approximately 1 22 ⁄3 of the 556,500 cancer deaths 

23 expected in 2003 will be related to nutrition, phys24 ical inactivity, obesity, and other lifestyle factors 

25 that could be prevented. 
4

•S 1899 IS 

1 (15) About 77 percent of all cancers are diag2 nosed at age 55 and older. In order to ensure high 

3 quality cancer care for American seniors, medicare 

4 reimbursements must reflect the true cost of treat5 ment in every treatment setting and medicare pay6 ments should accurately reflect the cost of drug and 

7 biologics as well as the cost of administering drugs 

8 and supportive care therapies. 

9 (16) Despite an aging population, death rates 

10 for the most common cancers, lung, colorectal, 

11 breast, and prostate continue to drop at an average 

12 of 1.7 percent per year. 

13 (17) In May 2001, Gleevec, the first in what is 

14 expected to be a number of cancer treatments, was 

15 approved for use by the Food and Drug Administra16 tion as it appeared to be effective in stopping the 

17 growth of deadly Chronic Myeloid Leukemia cells 

18 within 3 months of use. In 2002, Gleevec showed 

19 ability to stop growth of gastrointestinal stromal tu20 mors. 

21 (18) In early 2003, researchers used gene chips 

22 to accurately predict whether or not breast cancer 

23 tumors would spread in the future. If the findings 

24 are validated, doctors will be able to determine which 

25 patients are likely to relapse and need chemo-
5

•S 1899 IS 

1 therapy, while sparing those with a favorable prog2 nosis from additional treatment. 

3 (19) The Lance Armstrong Foundation, a lead4 ing national organization providing services and sup5 port for cancer survivors, defines cancer survivorship 

6 as living with, through, and beyond cancer. 

7 (20) In 2001, there were 9,600,000 cancer sur8 vivors in the United States. 

9 (21) Sixty percent of adults diagnosed with can10 cer survive at least 5 years. 

11 (22) While nearly every childhood cancer diag12 nosis 20 years ago was fatal, today more than 80 

13 percent of children diagnosed with cancer survive at 

14 least 5 years. 

15 SEC. 3. SENSE OF THE SENATE. 

16 It is the sense of the Senate that the United States 

17 is at a point in history in which we must take the proper 

18 steps to reach the goal of making cancer survivorship the 

19 rule and cancer deaths rare by the year 2015. 

20 TITLE I—PUBLIC HEALTH 

21 PROVISIONS 

22 SEC. 101. NATIONAL PROGRAM OF CANCER REGISTRIES. 

23 Part M of title III of the Public Health Service Act 

24 (42 U.S.C. 280e et seq.) is amended by inserting after 

25 section 399B the following: 
6

•S 1899 IS 

1 ‘‘SEC. 399B–1. ENHANCING CANCER REGISTRIES AND PRE2 PARING FOR THE FUTURE. 

3 ‘‘(a) STRATEGIC PLAN.—Not later than 1 year after 

4 the date of enactment of the National Cancer Act of 2003 

5 the Secretary shall develop a plan and submit a report 

6 to Congress that outlines strategies by which the State 

7 cancer registries funded with grants under section 399B 

8 and the Surveillance, Epidemiology, and End Results pro9 gram of the National Cancer Institute (in this section re10 ferred to as the ‘SEER program’) can share information 

11 to ensure more comprehensive cancer data. The report 

12 shall include ways in which the Secretary will—

13 ‘‘(1) standardize data between State cancer reg14 istries and the SEER program; 

15 ‘‘(2) increase the portability and usability of 

16 data files from each registry for researchers and 

17 public health planners; 

18 ‘‘(3) ensure data collection from the greatest 

19 number of health care facilities possible; 

20 ‘‘(4) maximize the use of State registry data 

21 and data from the SEER program in State and re22 gional public health planning processes; and 

23 ‘‘(5) promote the use of data to—

24 ‘‘(A) improve the health status of cancer 

25 survivors; and
7

•S 1899 IS 

1 ‘‘(B) research quality of cancer care and 

2 access to that care.’’. 

3 SEC. 102. ENHANCING EXISTING SCREENING EFFORTS. 

4 (a) GRANT AND CONTRACT AUTHORITY OF

5 STATES.—Section 1501(b)(2) of the Public Health Service 

6 Act (42 U.S.C. 300k(b)(2)) is amended to read as follows: 

7 ‘‘(2) CERTAIN APPLICATIONS.—

8 ‘‘(A) STRATEGIES FOR COLORECTAL CAN9 CER SCREENING.—If any entity submits an ap10 plication to a State to receive an award of a 

11 grant or contract pursuant to paragraph (1) 

12 that includes strategies for colorectal cancer 

13 screening and outreach, the State may give pri14 ority to the application submitted by that entity 

15 in any case in which the State determines that 

16 the quality of such application is equivalent to 

17 the quality of the application submitted by the 

18 other entities. 

19 ‘‘(B) WOMEN DIAGNOSED WITH CANCER.—

20 If any entity submits an application to a State 

21 to receive an award of a grant or contract pur22 suant to paragraph (1) that includes strategies 

23 for the provision of treatment for uninsured 

24 women diagnosed with cancer discovered in the 

25 course of the screening, the State may give pri-
8

•S 1899 IS 

1 ority to the application submitted by that entity 

2 in any case in which the State determines that 

3 the quality of such application is equivalent to 

4 the quality of the application submitted by the 

5 other entities.’’. 

6 (b) REQUIREMENTS WITH RESPECT TO TYPE AND

7 QUALITY OF SERVICES.—Section 1503 of the Public 

8 Health Service Act (42 U.S.C. 300m) is amended by add9 ing at the end the following: 

10 ‘‘(d) WAIVER OF DIRECT SERVICES REQUIRE11 MENT.—The Secretary may waive the requirement under 

12 subsection (a)(1) if—

13 ‘‘(1) the State involved will use the grant under 

14 this section for a demonstration project that will le15 verage private funds to supplement program efforts; 

16 or 

17 ‘‘(2) such requirement would cause a barrier to 

18 the enrollment of qualifying women.’’. 

19 (c) AUTHORIZATION OF APPROPRIATIONS.—Section 

20 1510(a) of the Public Health Service Act (42 U.S.C. 

21 300n–5(a)) is amended by striking ‘‘$50,000,000’’ and all 

22 that follows and inserting ‘‘such sums as may be necessary 

23 for each of fiscal years 2004 through 2008.’’. 

24 (d) REPORT ON THE COMPREHENSIVE COLORECTAL

25 CANCER INITIATIVE.—Not later than 6 months after the 
9

•S 1899 IS 

1 date of enactment of this Act, the Director of the Centers 

2 for Disease Control and Prevention shall submit to the 

3 appropriate committees of Congress a report containing 

4 an assessment of the success of the Comprehensive 

5 Colorectal Cancer Initiative (within the Centers for Dis6 ease Control and Prevention) in—

7 (1) increasing public awareness of colorectal 

8 cancer; 

9 (2) increasing awareness of screening guidelines 

10 among health care providers; 

11 (3) monitoring national colorectal cancer 

12 screening rates; 

13 (4) promoting increased patient-provider com14 munication about colorectal cancer screening; 

15 (5) supporting quantitative and qualitative re16 search efforts; and 

17 (6) providing funding to State programs to im18 plement colorectal cancer priorities. 

19 SEC. 103. ENHANCED PATIENT EDUCATION. 

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

21 (42 U.S.C. 280g et seq.) is amended by adding at the end 

22 the following: 
10

•S 1899 IS 

1 ‘‘SEC. 399O. ENHANCED PATIENT EDUCATION. 

2 ‘‘(a) GRANTS AUTHORIZED.—The Secretary is au3 thorized to award grants to eligible entities to implement 

4 programs to educate patients and their families about—

5 ‘‘(1) the availability and options of effective 

6 medical techniques and pain management technology 

7 therapies to reduce and prevent pain and suffering 

8 for those with cancer upon diagnosis; 

9 ‘‘(2) the unique health challenges associated 

10 with cancer survivorship, including—

11 ‘‘(A) the role of followup care and moni12 toring to support and improve the long-term 

13 quality of life for cancer survivors; 

14 ‘‘(B) physical activity and healthy life15 styles; and 

16 ‘‘(C) the availability of peer and mentor 

17 support programs; and 

18 ‘‘(3) community resources available to increase 

19 access to quality cancer care. 

20 ‘‘(b) APPLICATION.—An eligible entity desiring a 

21 grant under this section shall submit to the Secretary an 

22 application at such time, in such manner, and containing 

23 such information as the Secretary may require. 

24 ‘‘(c) AUTHORIZATION OF APPROPRIATIONS.—There 

25 are authorized to be appropriated to carry out this section 

26 such sums as may be necessary.’’. 
11

•S 1899 IS 

1 SEC. 104. PRACTITIONER EDUCATION PROGRAM. 

2 Section 414 of the Public Health Service Act (42 

3 U.S.C. 285a–3) is amended by adding at the end the fol4 lowing: 

5 ‘‘(d) In order to receive funding under this section, 

6 a center described under subsection (a) shall maintain a 

7 program for disseminating to patients and research par8 ticipants, as well as their caregivers, the latest information 

9 about—

10 ‘‘(1) pain and symptom management and pallia11 tive care; and 

12 ‘‘(2) the unique clinical and research challenges 

13 associated with cancer survivorship. 

14 ‘‘(e) The Secretary may provide additional amounts 

15 to fund centers under subsection (a) that develop innova16 tive relationships with community cancer centers, commu17 nity health centers, rural hospitals, and other community18 based health care providers who target medically under19 served populations for the purpose of increasing access to 

20 quality cancer care.’’. 
12

•S 1899 IS 

1 SEC. 105. ELEVATING THE IMPORTANCE OF PAIN MANAGE2 MENT AND CANCER SURVIVORSHIP 

3 THROUGHOUT THE NATION’S CANCER PRO4 GRAMS. 

5 (a) NATIONAL CANCER PROGRAM.—Section 411 of 

6 the Public Health Service Act (42 U.S.C. 285a) is amend7 ed to read as follows: 

8 ‘‘SEC. 411. The National Cancer Program shall con9 sist of—

10 ‘‘(1) an expanded, intensified, and coordinated 

11 cancer research program encompassing the research 

12 programs conducted and supported by the Institute 

13 and the related research programs of the other na14 tional research institutes, including research pro15 grams for—

16 ‘‘(A) pain and symptom management; 

17 ‘‘(B) survivorship; and 

18 ‘‘(C) the prevention of cancer caused by 

19 occupational or environmental exposure to car20 cinogens; and 

21 ‘‘(2) the other programs and activities of the 

22 Institute, including research on populations with 

23 both uniquely diverse genetic variation and geo24 graphic isolation.’’.
13

•S 1899 IS 

1 (b) CANCER CONTROL PROGRAMS.—Section 412(2) 

2 of the Public Health Service Act (42 U.S.C. 285a–1(2)) 

3 is amended—

4 (1) in subparagraph (A), by striking ‘‘, and’’ 

5 and inserting a semicolon; and 

6 (2) by adding at the end the following: 

7 ‘‘(C) appropriate methods of pain and 

8 symptom management for individuals with can9 cer, including end-of-life care and cancer survi10 vorship; and’’. 

11 (c) SPECIAL AUTHORITIES OF THE DIRECTOR.—Sec12 tion 413(a)(2) of the Public Health Service Act (42 U.S.C. 

13 285a–2(a)(2)) is amended—

14 (1) in subparagraph (D), by striking ‘‘and’’ at 

15 the end; 

16 (2) in subparagraph (E), by striking the period 

17 and inserting ‘‘; and’’; and 

18 (3) by adding at the end the following: 

19 ‘‘(F) assess and improve pain and symptom 

20 management of cancer throughout the course of 

21 treatment and cancer survivorship.’’. 

22 (d) BREAST AND GYNECOLOGICAL CANCERS.—Sec23 tion 417 of the Public Health Service Act (42 U.S.C. 

24 285a–6) is amended—

25 (1) in subsection (c)(1)—
14

•S 1899 IS 

1 (A) in subparagraph (D), by striking 

2 ‘‘and’’ at the end; 

3 (B) in subparagraph (E), by striking the 

4 period and inserting ‘‘; and’’; and 

5 (C) by inserting after subparagraph (E) 

6 the following: 

7 ‘‘(F) basic, clinical, and applied research 

8 concerning pain and symptom management and 

9 cancer survivorship.’’; and 

10 (2) in subsection (d)—

11 (A) in paragraph (4), by striking ‘‘and’’ at 

12 the end; 

13 (B) in paragraph (5), by striking the pe14 riod and inserting ‘‘; and’’; and 

15 (C) by adding at the end the following: 

16 ‘‘(6) basic, clinical, and applied research con17 cerning pain and symptom management and cancer 

18 survivorship.’’. 

19 (e) PROSTATE CANCER.—Section 417A(c)(1) of the 

20 Public Health Service Act (42 U.S.C. 285a–7(c)(1)) is 

21 amended—

22 (1) in subparagraph (F), by striking ‘‘and’’ at 

23 the end; 

24 (2) in subparagraph (G), by striking the period 

25 and inserting ‘‘; and’’; and 
15

•S 1899 IS 

1 (3) by inserting after subparagraph (G) the fol2 lowing: 

3 ‘‘(H) basic and clinical research concerning 

4 pain and symptom management and cancer sur5 vivorship.’’. 

6 SEC. 106. SURVIVORSHIP RESEARCH PROGRAM. 

7 Subpart 1 of part C of title IV of the Public Health 

8 Service Act (42 U.S.C. 285 et seq.) is amended by adding 

9 at the end the following: 

10 ‘‘SEC. 417D. SURVIVORSHIP RESEARCH PROGRAM. 

11 ‘‘(a) ESTABLISHMENT.—There is established, within 

12 the Institute, an Office on Cancer Survivorship (in this 

13 section referred to as the ‘Office’), which may be headed 

14 by an Associate Director, to implement and direct the ex15 pansion and coordination of the activities of the Institute 

16 with respect to cancer survivorship research. 

17 ‘‘(b) COLLABORATION AMONG AGENCIES.—In car18 rying out the activities described in subsection (a), the Of19 fice shall collaborate with other institutes, centers, and of20 fices within the National Institutes of Health that are de21 termined appropriate by the Office. 

22 ‘‘(c) REPORT.—Not later than 1 year after the date 

23 of enactment of this section, the Secretary shall prepare 

24 and submit to the appropriate committees of Congress a 
16

•S 1899 IS 

1 report providing a description of the survivorship activities 

2 of the Office and strategies for future activities.’’. 

3 TITLE II—RESEARCH 

4 PROVISIONS 

5 SEC. 201. NATIONAL CANCER INSTITUTE. 

6 (a) OTHER TRANSACTIONS AUTHORITY.—Subpart 1 

7 of part C of title IV of the Public Health Service Act (42 

8 U.S.C. 285 et seq.), as amended by section 106, is further 

9 amended by adding at the end the following: 

10 ‘‘SEC. 417E. OTHER TRANSACTIONS AUTHORITY. 

11 ‘‘Notwithstanding any other provision of this subpart, 

12 the Director of the National Cancer Institute may cofund 

13 grant projects with private entities for any purpose de14 scribed in this subpart.’’. 

15 (b) SENSE OF THE SENATE ON A CENTRAL INSTITU16 TIONAL REVIEW BOARD.—It is the sense of the Senate 

17 that—

18 (1) the current procedure of sending 1 clinical 

19 trial through multiple local institutional review 

20 boards may not be the most efficient method for the 

21 protection of patients enrolled in the trial and may 

22 delay the process of bringing lifesaving treatment to 

23 cancer patients; 
17

•S 1899 IS 

1 (2) the National Cancer Institute should be 

2 commended for its work in centralizing the institu3 tional review board process; and 

4 (3) the research community should continue to 

5 streamline the institutional review board process in 

6 order to bring lifesaving treatments to patients as 

7 quickly as possible. 

8 (c) PATIENT AND PROVIDER OUTREACH OPPORTUNI9 TIES WITH EXPERIMENTAL THERAPIES.—For the pur10 pose of enhancing patient access to experimental thera11 pies, the National Cancer Institute shall conduct the fol12 lowing activities: 

13 (1) Integrate, to the maximum extent prac14 ticable, trials being conducted by private manufac15 turers into the National Cancer Institute’s clinical 

16 trials online database. Such integration may require 

17 specific awareness-raising and outreach activities by 

18 the National Cancer Institute to private industry. 

19 (2) Establish an education program which pro20 vides patients and providers with—

21 (A) information about how to access and 

22 use the National Cancer Institute clinical trials 

23 database online; and 
18

•S 1899 IS 

1 (B) information about the Food and Drug 

2 Administration process for approving the use of 

3 drugs and biologics for a single patient.

Æ