Cancer Registries Amendment Act
PL 102-515 (S.3312), enacted 10/24/1992

106 STAT. 3372 
PUBLIC LAW 102-515—OCT. 24, 1992 
Public Law 102-515 
102d Congress 
Oct. 24, 1992 
[S. 3312] 
Cfuicer 
Registries 
Amendment 
Act. 
Diseases. 
Health and 
health care. 
42 u s e 201 note. 
42 use 280e 
note. 
42 use 280e. 
An Act 
Entitled the "Cancer Registries Amendment Act". 
Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the "Cancer Registries Amendment 
Act". 
SEC. 2. FINDINGS AND PURPOSE. 
(a) FINDINGS.—Congress finds that— 
(1) cancer control efforts, including prevention and early 
detection, are best addressed locally by State health depart-
ments that can identify unique needs; 
(2) cancer control programs and existing statewide popu-
lation-based cancer registries have identified cancer incidence 
and CEincer mortality rates that indicate the burden of cancer 
for Americans is substantial and varies widely by geographic 
location and by ethnicity; 
(3) statewide cancer incidence and cancer mortality data, 
can be used to identify cancer trends, patterns, and variation 
for directing cancer control intervention; 
(4) the American Association of Central Cancer Registries 
(AACCR) cites that of the 50 States, approximately 38 have 
established cancer registries, many are not statewide and 10 
have no cancer registry; and 
(5) AACCR also cites that of the 50 States, 39 collect 
data on less than 100 percent of their population, and less 
than half have adequate resources for insuring minimum stand-
ards for quahty and for completeness of case information. 
(b) PURPOSE.—It is the purpose of this Act to establish a 
national program of cancer registries. 
SEC. 3. NATIONAL PROGRAM OF CANCER REGISTRIES. 
Title III of the Public Health Service Act (42 U.S.C. 241 et 
seq.) is amended by adding at the end the following new part: 
"PART M—NATIONAL PROGRAM OF CANCER REGISTRIES 
"SEC. 399H. NATIONAL PROGRAM OF CANCER REGISTRIES. 
"(a) IN GENERAL.—^The Secretary, acting through the Director 
of the Centers for Disease Control, may make grsuits to States, 
or may make grants or enter into contracts with academic or 
nonprofit organizations designated by the State to operate the 
State's cancer registry in lieu of making a grant directly to the 
State, to support the operation of population-based, statewide cancer 
registries in order to collect, for each form of in-situ and invasive 
cancer (with the exception of basal cell and squamous cell carcinoma 
of the skin), data concerning— 
PUBLIC LAW 102-515—OCT. 24, 1992 
106 STAT. 3373 
"(1) demographic iikformation about each case of cancer; 
"(2) information on the industrial or occupational history 
of the individuals with the cancers, to the extent such informa-
tion is available from the same record; 
"(3) administrative information, including date of diagnosis 
and source of information; 
"(4) pathological data characterizing the cancer, including 
the cancer site, stage of disease (pursuant to Staging Guide), 
incidence, and type of treatment; and 
"(5) other elements determined appropriate by the Sec-
retary. 
"(b) MATCHING FUNDS.— 
"(1) IN GENERAL.—^The Secretary may make a grant under 
subsection (a) only if the State, or the academic or nonprofit 
private organization designated by the State to operate the 
cancer registry of the State, involved agrees, with respect to 
the costs of the program, to make available (directly or through 
donations from pubhc or private entities) non-Federal con-
tributions toward such costs in an amount that is not less 
than 25 percent of such costs or $1 for every $3 of Federal 
funds provided in the grant. 
"(2) 
DETERMINATION OP AMOUNT OF NON-FEDERAL CON-
TRIBUTION; MAINTENANCE OF EFFORT.— 
"(A) Non-Federal contributions required in paragraph 
(1) may be in cash or in kind, fairly evaluated, including 
plant, equipment, or services. Amounts provided by the 
Federal (Jovemment, or services assisted or subsidized to 
any significant extent by the Federal (Jovemment, may 
not be included in determining the amount of such non-
Federal contributions. 
"(B) With respect to a State in which the purpose 
described in subsection (a) is to be carried out, the Sec-
retary, in making a determination of the amount of non-
Federal contributions provided imder paragraph (1), may 
include only such contributions as are in excess of the 
amount of such contributions made by the State toward 
the collection of data on cancer for the fiscal year preceding 
the first year for which a grant under subsection (a) is 
made with respect to the State. The Secretary may decrease 
the amount of non-Federal contributions that otherwise 
would have been required by this subsection in those cases 
in which the State can demonstrate that decreasing such 
amount is appropriate because of financial hardship. 
"(c) ELIGIBILITY FOR GRANTS.— 
"(1) IN GENERAL.—^No grant shall be made by the Secretary 
under subsection (a) unless an application has been submitted 
to, and approved by, the Secretary. Such application shall be 
in such form, submitted in such a manner, and be accompanied 
by such information, as the Secretary may specify. No such 
application may be approved luiless it contains assurances that 
the applicant will use the funds provided only for the purposes 
specified in the approved appUcation and in accordance with 
the requirements of this section, that the appHcation will estab-
Ush such fiscal control and fund accounting procedures as may 
be necessary to assure proper disbursement and accounting 
of Federal funds paid to the applicant under subsection (a) 
106 STAT. 3374 
PUBLIC LAW 102-515—OCT. 24, 1992 
of this section, and that the applicant will comply with the 
peer review requirements under sections 491 and 492. 
"(2) ASSURANCES.—Each applicant, prior to receiving Fed-
eral funds under subsection (a), shall provide assurances satis-
factory to the Secretary that the applicant will— 
"(A) provide for the estabhshment of a registry in 
accordance with subsection (a); 
"(B) comply with appropriate standards of complete-
ness, timeliness, and qusdity of population-based cancer 
registry data; 
"(C) provide for the annual publication of reports of 
cancer data under subsection (a); and 
"(D) provide for the authorization under State law 
of the statewide cancer registry, including promulgation 
of regulations providing— 
"(i) a meguis to assure complete reporting of cancer 
cases (as described in subsection (a)) to the statewide 
cancer registry by hospitals or other facilities providing 
screening, diagnostic or therapeutic services to patients 
with respect to cancer; 
"(ii) a means to assure the complete reporting of 
cancer cases (as defined in subsection (a)) to the state-
wide cancer registry by physicians, surgeons, and all 
other health care practitioners diagnosing or providing 
treatment for cancer patients, except for cases directly 
referred to or previously admitted to a hospital or 
other facility providing screening, diagnostic or thera-
peutic services to patients in that State and reported 
by those facilities; 
"(iii) a means for the statewide cancer registry 
to access all records of physicians and surgeons, hos-
pitals, outpatient clinics, nursing homes, and all other 
faciUties, individuals, or agencies providing such serv-
ices to patients which would identify cases of cancer 
or would establish characteristics of the cancer, treat-
ment of the cancer, or medical status of any identified 
patient; 
"(iv) for the reporting of cancer case data to the 
statewide cancer registry in such a format, with such 
data elements, and in accordance with such standards 
of quality timeliness and completeness, as may be 
established by the Secretary; 
"(v) for the protection of the confidentiality of all 
cancer case data reported to the statewide cancer reg-
istry, including a prohibition on disclosure to any per-
son of information reported to the statewide cancer 
registry that identifies, or could lead to the identifica-
tion of, an individual cancer patient, except for disclo-
sure to other State cancer registries and local and 
State health officers; 
"(vi) for a means by which confidential case data 
may in accordance with State law be disclosed to cancer 
researchers for the purposes of cancer prevention, con-
trol and research; 
"(vii) for the authorization or the conduct, by the 
statewide cancer registry or other persons 
and 
organizations, of studies utilizing statewide cancer reg-
PUBLIC LAW 102-515—OCT. 24, 1992 
106 STAT. 3375 
istry data, including studies of the sources and causes 
of cancer, evaluations of the cost, quality, efficacy, and 
appropriateness of diagnostic, therapeutic, rehabilita-
tive, and preventative services and programs relating 
to cancer, and any other cUnical, epidemiological, or 
other cancer research; and 
"(viii) for protection for individuals complying with 
the law, including provisions specifying that no person 
shall be held Uable in any civil action with respect 
to a cancer case report provided to the statewide cancer 
registry, or with respect to access to cancer case 
information provided to the statewide cancer registry. 
"(d) RELATIONSHIP TO CERTAIN PROGRAMS.— 
"(1) IN GENERAL.—^This section may not be construed to 
act as a replacement for or diminishment of the program carried 
out by the Director of the National Cancer Institute and des-
ignated by such Director as the Surveillance, Epidemiology, 
and End Results Program (SEER). 
"(2) SUPPLANTING OF ACTIVITIES.—In areas where both such 
programs exist, the Secretary shall ensure that SEER support 
is not supplanted and that any additional activities are consist-
ent with the guidelines provided for in subsection (c)(2) (C) 
and (D) £uid are appropriately coordinated with the existing 
SEER program. 
"(3) TRANSFER OF RESPONSIBILITY.—The Secretary may not 
transfer administration responsibiUty for such SEER program 
from such Director. 
"(4) COORDINATION.—^To encourage the greatest possible 
efficiency and effectiveness of Federally supported efforts with 
respect to the activities described in this subsection, the Sec-
retary shall take steps to assure the appropriate coordination 
of programs supported under this part with existing Federally 
supported cancer registry programs. 
"(e) REQUIREMENT REGARDING CERTAIN STUDY ON BREAST CAN-
CER.—In the case of a grant under subsection (a) to any State 
specified in section 399K(ib), the Secretary may establish such condi-
tions regarding the receipt of the grant as the Secretary determines 
are necessary to facilitate the collection of data for the study carried 
out imder section 399C. 
"SEC. 3991. PLANNING GRANTS REGARDING REGISTRIES. 
42 USC 280e-l. 
"(a) IN GENERAL.— 
"(1) STATES.—^The Secretary, acting through the Director 
of the Centers for Disease Control, may make grsuits to States 
for the purpose of developing plans that meet the assurances 
required by the Secretary under section 399B(c)(2). 
"(2) OTHER ENTITIES.—For the purpose described in para-
graph (1), the Secretary may make grants to public entities 
other than States and to nonprofit private entities. Such a 
grant may be made to an entity only if the State in which 
the purpose is to be carried out has certified that the State 
approves the entity as qualified to carry out the purpose, 
"(b) APPLICATION.—^The Secretary may make a grant under 
subsection (a) onlv if an application for the grant is submitted 
to the Secretary, the application contains the certification required 
in subsection (a)(2) (if the appUcation is for a grant imder such 
subsection), and the application is in such form, is made in such 
106 STAT. 3376 
PUBLIC LAW 102-515—OCT. 24,1992 
manner, and contains such agreements, assurances, and informa-
tion as the Secretary determines to be necessary to carry out 
this section. 
42 use 280e-2. 
<nSEC. 399J. TECHNICAL ASSISTANCE IN OPERATIONS OF STATEWIDE 
CANCER REGISTRIES. 
"The Secretary, acting through the Director of the Centers 
for Disease Control, may, directly or through grants and contracts, 
or both, provide technical assistance to the States in the estabUsh-
ment and operation of statewide registries, including assistance 
in the development of model legislation for statewide cancer reg-
istries and assistance in establishing a computerized reporting and 
data processing system. 
42 use 280e-3. 
"SEC. 399K. STUDY IN CERTAIN STATES TO DETERMINE THE FACTORS 
CONTRIBUTING TO THE ELEVATED BREAST CANCER 
MORTALITY RATES. 
"(a) IN GENERAL.—Subject to subsections (c) and (d), the Sec-
retary, acting through the Director of the National Cancer Institute, 
shall conduct a study for the purpose of determining the factors 
contributing to the fact that breast cancer mortality rates in the 
States specified in subsection (b) are elevated compared to rates 
in other States. 
"(b) RELEVANT STATES.—^The States referred to in subsection 
(a) are Connecticut, Delaware, Maryland, Massachusetts, New 
Hampshire, New Jersey, New York, Rhode Island, Vermont, and 
the District of Columbia. 
"(c) COOPERATION OF STATE.—The Secretary may conduct the 
study required in subsection (a) in a State only if the State agrees 
to cooperate with the Secretary in the conduct of the study, includ-
ing providing information from any registry operated by the State 
pursuant to section 399H(a). 
"(d) PLANNING, COMMENCEMENT, AND DURATION.—The Sec-
retary shall, during each of the fiscal years 1993 and 1994, develop 
a plan for conducting the study required in subsection (a). The 
study shall be initiated by the Secretary not later than fiscal year 
1994, and the collection of data under the study may continue 
through fiscal year 1998. 
"(e) REPORT.—Not later than September 30, 1999, the Secretary 
shall complete the study required in subsection (a) and submit 
to the Committee on Energy and Commerce of the House of Rep-
resentatives, and to the Committee on Labor and Human Resources 
of the Senate, a report describing the findings and recommendations 
made as a result of the study. 
42USe280e-4. 
"SEC. 399L. AUTHORIZATION OF APPROPRIATIONS. 
"(a) REGISTRIES.—^For the purpose of carrying out this part, 
the Secretary may use $30,000,000 for each of the fiscal years 
1993 through 1997. Out of any amounts used for any such fiscal 
year, the Secretary may obligate not more than 25 percent for 
carrying out section 3991, and not more than 10 percent may 
be expended for assessing the accuracy, completeness and quahty 
of data collected, £uid not more than 10 percent of which is to 
be expended imder subsection 399J. 
PUBUC LAW 102-515—OCT. 24, 1992 
106 STAT. 3377 
"(b) BREAST CANCER STUDY.—Of the amounts appropriated for 
the National Cancer Institute under subpari; 1 of part C of title 
IV for any fiscal year in which the study required in section 399K 
is being carried out, the Secretary shall expend not less than 
$1,000,000 for the study.". 
Approved October 24,1992. 
LEGISLATIVE HISTORY—S. 3312: 
CONGRESSIONAL RECORD, Vol. 138 (1992): 
Oct. 2, considered and passed Senate. 
Oct. 5, considered and passed House, amended. 
Oct. 7, Senate concurred in House amendment. 
59-194 OT-93 
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