II Calendar No. 317 118th CONGRESS 2d Session S. 1840 IN THE SENATE OF THE UNITED STATES June 7, 2023 Ms. Baldwin (for herself, Ms. Collins , Ms. Cortez Masto , Mrs. Capito , Ms. Klobuchar , and Ms. Murkowski ) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions February 1, 2024 Reported by Mr. Sanders , with an amendment Strike out all after the enacting clause and insert the part printed in italic A BILL To amend the Public Health Service Act to reauthorize and improve the National Breast and Cervical Cancer Early Detection Program for fiscal years 2024 through 2028, and for other purposes.

1. Short title This Act may be cited as the Screening for Communities to Receive Early and Equitable Needed Services for Cancer Act of 2023 or the SCREENS for Cancer Act of 2023 . 2. Findings Congress finds the following: (1) In 2023, there will be more than 300,590 new cases of invasive breast cancer and nearly 44,000 breast cancer deaths in the United States. (2) In 2023, there will be about 13,960 new cases of invasive cervical cancer and about 4,310 deaths from cervical cancer. (3) Black women have the highest breast, cervical, and uterine cancer death rates of all racial and ethnic groups and are more likely to be diagnosed with triple-negative breast cancer, a more aggressive form of cancer. (4) Research shows that the COVID–19 pandemic was associated with a decline of more than 3,900,000 breast cancer screenings in 2020, as compared to 2019. Similarly, cervical cancer screening utilization dropped by 90 percent in April 2020, relative to the prior year. (5) Research suggests that those postponed breast screenings appeared to disproportionately affect women of color: Non-Hispanic White women had 17 percent fewer breast cancer diagnoses, while the year-over-year decline was 53 percent for Asian women, 43 percent for Hispanic women, and 27 percent for Black women. (6) The National Cancer Institute estimates that pandemic-related disruptions or delays in breast care and screening are expected to result in an excess of 2,500 breast cancer deaths by 2030. (7) Since its creation in 1991, the National Breast and Cervical Cancer Early Detection Program (referred to in this section as the NBCCEDP ) has provided lifesaving cancer screening and diagnostic services to low-income, uninsured, or underinsured women in all 50 States, the District of Columbia, 6 territories, and 13 Tribes or Tribal organizations. (8) NBCCEDP seeks to reduce inequities in breast and cervical cancer screening and diagnosis, placing special emphasis on outreach to women who are members of racial or ethnic minority groups, and those who are geographically or culturally isolated. (9) NBCCEDP has served more than 6,100,000 people and provided more than 15,700,000 breast and cervical cancer screening examinations. (10) These screening exams have diagnosed nearly 76,000 invasive breast cancers and more than 24,000 premalignant breast lesions, as well as more than 5,100 invasive cervical cancers and 235,000 premalignant cervical lesions, of which 39 percent were high-grade. (11) The program also provides public education, outreach, patient navigation, and care coordination to increase breast and cervical cancer screening rates and reach underserved populations. (12) Reauthorizing NBCCEDP will result in expanded services, leading to more people being screened and more cancers diagnosed at earlier stages. 3. National Breast and Cervical Cancer Early Detection Program Title XV of the Public Health Service Act ( 42 U.S.C. 300k et seq. ) is amended— (1) in section 1501 ( 42 U.S.C. 300k )— (A) in subsection (a)— (i) in paragraph (2), by striking the provision of appropriate follow-up services and support services such as case management and inserting that appropriate follow-up services are provided ; (ii) in paragraph (3), by striking programs for the detection and control and inserting for the prevention, detection, and control ; (iii) in paragraph (4), by striking the detection and control and inserting the prevention, detection, and control ; (iv) in paragraph (5)— (I) by striking monitor and inserting ensure ; and (II) by striking ; and and inserting a semicolon; (v) by redesignating paragraph (6) as paragraph (9); (vi) by inserting after paragraph (5), the following: (6) to enhance appropriate support activities to increase breast and cervical cancer screening such as patient navigation, implementation of evidence-based or evidence-informed strategies proven to increase breast and cervical cancer screening in health care settings, and facilitating access to health care settings; (7) to reduce disparities in incidents of and deaths due to breast and cervical cancer in populations with higher than average rates; (8) to ensure equitable access to screening and diagnostic services and improve access for individuals who encounter additional barriers to receiving services, including due to various social determinants of health; and ; and (vii) in paragraph (9), as so redesignated, by striking through (5) and inserting through (8) ; and (B) by striking subsection (d); (2) in section 1503 ( 42 U.S.C. 300m )— (A) in subsection (a)— (i) in paragraph (1), by striking that, initially and all that follows through the semicolon and inserting that appropriate breast and cervical cancer screening and diagnostic services are provided based on national recommendations; and ; (ii) by striking paragraphs (2) and (4); (iii) by redesignating paragraph (3) as paragraph (2); and (iv) in paragraph (2), as so redesignated, by striking ; and and inserting a period; and (B) by striking subsection (d); (3) in section 1508(b) ( 42 U.S.C. 300n–4(b) )— (A) by striking 1 year after the date of the enactment of the National Breast and Cervical Cancer Early Detection Program Reauthorization of 2007, and annually thereafter, and inserting 2 years after the date of enactment of the Screening for Communities to Receive Early and Equitable Needed Services for Cancer Act of 2023 , and every 5 years thereafter, ; (B) by striking Labor and Human Resources and inserting Health, Education, Labor, and Pensions ; and (C) by striking preceding fiscal year and inserting preceding 2 fiscal years in the case of the first report after the date of enactment of the Screening for Communities to Receive Early and Equitable Needed Services for Cancer Act of 2023 and preceding 5 fiscal years for each report thereafter ; and (4) in section 1510(a) ( 42 U.S.C. 300n–5(a) )— (A) by striking and after 2011, ; and (B) by inserting , $275,000,000 for fiscal year 2024, $330,000,000 for fiscal year 2025, $385,000,000 for fiscal year 2026, $440,000,000 for fiscal year 2027, and $500,000,000 for fiscal year 2028 before the period at the end.

1. Short title This Act may be cited as the Screening for Communities to Receive Early and Equitable Needed Services for Cancer Act of 2023 or the SCREENS for Cancer Act of 2023 . 2. National Breast and Cervical Cancer Early Detection Program Title XV of the Public Health Service Act ( 42 U.S.C. 300k et seq. ) is amended— (1) in section 1501 ( 42 U.S.C. 300k )— (A) in subsection (a)— (i) in paragraph (2), by striking the provision of appropriate follow-up services and support services such as case management and inserting that appropriate follow-up services are provided ; (ii) in paragraph (3), by striking programs for the detection and control and inserting for the prevention, detection, and control ; (iii) in paragraph (4), by striking the detection and control and inserting the prevention, detection, and control ; (iv) in paragraph (5)— (I) by striking monitor and inserting ensure ; and (II) by striking ; and and inserting a semicolon; (v) by redesignating paragraph (6) as paragraph (9); (vi) by inserting after paragraph (5) the following: (6) to enhance appropriate support activities to increase breast and cervical cancer screenings, such as navigation of health care services, implementation of evidence-based or evidence-informed strategies to increase breast and cervical cancer screening in health care settings, and facilitation of access to health care settings; (7) to reduce disparities in breast and cervical cancer incidence, morbidity, and mortality, including in populations with higher than average rates; (8) to improve access to breast and cervical cancer screening and diagnostic services and reduce related barriers, including factors that relate to negative health outcomes; and ; and (vii) in paragraph (9), as so redesignated, by striking through (5) and inserting through (8) ; and (B) by striking subsection (d); (2) in section 1503 ( 42 U.S.C. 300m )— (A) in subsection (a)— (i) in paragraph (1), by striking that, initially and all that follows through the semicolon and inserting that appropriate breast and cervical cancer screening and diagnostic services are provided consistent with relevant evidence-based recommendations; and ; (ii) by striking paragraphs (2) and (4); (iii) by redesignating paragraph (3) as paragraph (2); and (iv) in paragraph (2), as so redesignated, by striking ; and and inserting a period; and (B) by striking subsection (d); (3) in section 1508(b) ( 42 U.S.C. 300n–4(b) )— (A) by striking 1 year after the date of the enactment of the National Breast and Cervical Cancer Early Detection Program Reauthorization of 2007, and annually thereafter, and inserting 2 years after the date of enactment of the Screening for Communities to Receive Early and Equitable Needed Services for Cancer Act of 2023 , and every 5 years thereafter, ; (B) by striking Labor and Human Resources and inserting Health, Education, Labor, and Pensions ; and (C) by striking preceding fiscal year and inserting preceding 2 fiscal years in the case of the first report after the date of enactment of the Screening for Communities to Receive Early and Equitable Needed Services for Cancer Act of 2023 and preceding 5 fiscal years for each report thereafter ; and (4) in section 1510(a) ( 42 U.S.C. 300n–5(a) )— (A) by striking 2011, and and inserting 2011, ; and (B) by inserting , and $275,000,000 for each of fiscal years 2024 through 2028 before the period at the end. 3. GAO study Not later than September 30, 2027, the Comptroller General of the United States shall report to the Committee on Health, Education, Labor, and Pensions of the Senate and the Committee on Energy and Commerce of the House of Representatives on the work of the National Breast and Cervical Cancer Early Detection Program, including— (1) an estimate of the number of individuals eligible for services provided under such program; (2) a summary of trends in the number of individuals served through such program; and (3) an assessment of any factors that may be driving the trends identified under paragraph (2), including any barriers to accessing breast and cervical cancer screenings provided by such program.

February 1, 2024 Reported with an amendment