The United States' National Cancer Policy Legislative History

1937

National Cancer Institute Act of 1937 passed (P.L. 244)

  • Established NCI within Public Health Service
  • Directs Surgeon General to promote research
  • Established National Advisory Cancer Council

1971

National Cancer Act of 1971 passed (P.L. 92-218)

  • Established that NCI Director would be Presidentially-appointed and that NCI Director would prepare and submit Bypass Budget directly to the President
  • Established the President's Cancer Panel and the National Cancer Advisory Board
  • Directed NCI Director to expand and develop a coordinated cancer research program
  • Authorized the first cancer centers
  • Established the International Cancer Research Data Bank (ICRDB)

1974

National Cancer Amendments of 1974 passed (P.L. 93-352)

  • Authorized awards of construction grants for new construction/alteration/renovation of basic research laboratory facilities
  • Authorized expanded information dissemination activities for scientists, health professionals, and the general public

1978

Community Mental Health Center Extension Act of 1978 and Biomedical Research and Research Training Amendments of 1978 passed (P.L. 95-622)

  • Recodified 1971 Act, consolidating and reorganizing duties and functions of the NCI Director
  • Mandated an expanded research program for prevention of cancer caused by occupational or environmental exposure to carcinogens
  • Reduced minimum number of President's Cancer panel meetings from 12 to 4 per year
  • Expanded the mission of cancer centers to include basic research and prevention
  • Added several ex-officio members to the NCAB, and required that five of appointed members be knowledgeable in environmental carcinogenesis

1985

Health Research Extension Act passed (P.L. 99-158)

  • Established position of Associate Director for Prevention
  • Added to NCI's mission research on continuing care of cancer patients and their families

1988

Health Omnibus Programs Extension of 1988 passed (P.L. 100-607)

  • Added Rehabilitation Research to the umbrella of NCI's mission
  • Expanded NCI's information dissemination programs
    *As of this date, purpose of the National Cancer Institute, including all amendments is as follows:
    "The general purpose of the National Cancer Institute is the conduct and support of research, training, health information dissemination, and other programs with respect to cause, diagnosis, prevention, and treatment of cancer, rehabilitation from cancer, and the continuing care of cancer patients and the families of cancer patients." (42 USC 285)

1990

Breast and Cervical Cancer Mortality Prevention Act passed (P.L. 101-354)

  • Provides grants to states (via CDC) for the purpose of carrying out programs to: screen women for breast and cervical cancer as a preventive measure, provide referrals for follow up, improve training of health professionals in detection and control, provide for quality and accountability, and establish appropriate surveillance programs
  • Provides that priority will be given to low-income patients
  • Provided as base for CDC's development of the National Breast and Cervical Cancer Early Detection program

1992

Mammography Quality Standards Act passed (P.L. 102-539)

  • Regulates mammography screening facilities, providers and equipment

Cancer Registries Amendment Act passed (P.L. 102-515)

  • Purpose of Act is to establish a national program of cancer registries, but in Findings section states that cancer control efforts are best addressed locally by State health departments that can identify unique needs
  • Directs Secretary, acting through the Director of the Centers for Disease Control, to make grants to States for operation of state cancer registries
  • Directs Secretary to provide technical assistance to the States in their operation of statewide registries

1993

The NIH Revitalization Amendments of 1993 passed (P.L. 103-43)

  • Called for expanded research programs in both women's cancers and prostate cancer
  • Mandates a set-aside of NCI's appropriation for cancer control activities
  • Requires studies of potential environmental risk factors, specifically a case control study of elevated breast cancer rates on Long Island

1997

Balanced Budget Act of 1997 passed (Subtitle B: Prevention Initiatives)

  • Screening mammography (sec. 4101): provides coverage for annual screening mammograms for all women 40 and over, and waives the Part B deductible for screening mammography. Effective Jan 1, 1998
  • Screening pap smear and pelvic exams (sec. 4102): provides coverage every 3 years for a screening pap smear and pelvic exam, or annual coverage for women (1) at high risk for cervical or vaginal cancer, or (2) of childbearing age who have had a pap smear during the preceding three years indicating the presence of cervical or vaginal cancer or other abnormality. Waives the Part B deductible for screening pap smears and pelvic exams. Effective Jan 1, 1998.
  • Prostate cancer screening tests (sec. 4103): provides coverage for annual prostate screening for men over age 50. Effective Jan 1, 2000.
  • Coverage of colorectal screening (sec. 4104): Provides coverage for colorectal cancer screening procedures as the Secretary determines appropriate. Effective Jan 1, 1998 (except for a few rules effective Jan 1, 1999)

Sense of the Senate Concerning Need for Guidelines for Breast Cancer Screening passed (S. Res. 47)

  • NIH reviewed findings but did not mandate reissue of guidelines
  • Resolved that: (1) need for more studies to determine benefits of mammography for women in their forties; (2) House urges NCI Advisory Panel to consider reissuing guidelines rescinded in 1993 for mammography for women between 40-49; (3) House directs the public to consider guidelines issued by other organizations

National Tobacco Policy and Youth Smoking Reduction Act introduced, not passed (S. 1415)

  • Directs Secretary to take all actions necessary to ensure that reductions in underage tobacco usage are achieved, including legal action, allowance of block grants to states as incentives, and requiring random checks by states
  • Establishes the National Smoking Cessation Program
  • Requires revision of the warning labels on domestic cigarettes and smokeless tobacco
  • Mandates regulations requiring testing, reporting and disclosure of tobacco smoke constituents
  • Provides for the Women's Health and Cancer Rights Act of 1998, which requires minimum coverage of reconstruction after mastectomies (this provision appears to be the one tucked into the Omnibus funding bill passed by the 105th Congress)

1998

Mammography Quality Standards Reauthorization Act of 1998 passed (P.L. 105-248)

  • Mammography facilities to operate under high standards and appropriate federal guidelines
  • Patients to be notified of mammogram results and informed of whether they should seek follow-up care

Women's Health Research and Prevention Amendments of 1998 passed (P.L. 105-340)

  • Reauthorized national program of cancer registries through 2003
  • Reauthorized the National Breast and Cervical Cancer Early Detection Program, and mandated inclusion of case management as a program component

Breast and Cervical Cancer Treatment Act of 1998 introduced, not passed (H.R. 3779)

  • Provided for State Medicaid plans to provide coverage for breast or cervical cancer-related treatment services during a presumptive eligibility period

Sense of the House Regarding Importance of Mammograms and Biopsies in Fight Against Cancer passed (H.Res. 565)

  • Included some compelling statistics regarding breast cancer incidence and mortality
  • Resolved that (1) all American women should perform self-examination and see physicians regularly; (2) the role played by community organizations and providers should be recognized; (3) the Federal government has a responsibility to raise awareness, continue to fund research and to make mammograms and biopsies more widely available

1999

Patients' Bill of Rights Plus Act (S.1344)

  • Sec. 201: "Women's Health and Cancer Rights Act of 1999"
  • Sec. 715: Coverage for minimum hospital stay for lumpectomies, lymph node dissections, and coverage for secondary consultations
  • Sec. 730: Coverage for individuals participating in approved cancer clinical trials

The Breast and Cervical Treatment Act of 1999 (introduced 3/11 in House and 3/18 in Senate)

  • Bill to provide an optional state Medicaid benefit for the coverage of certain women who were screened and diagnosed with breast or cervical cancer under the CDC National Breast and Cervical Cancer Early Detection program (introduced by Sen. Chafee and Reps Eshoo, Lazio, Capps, and Ros-Lehtinen)
  • As of 10/29/99: Senate: in Finance Committee. House: bill reported favorably out of Commerce Committee.