American Cancer Society
2006 Federal Priorities

Each year, more than 560,000 people die from cancer in the United States—one of every four deaths. But today, people are increasingly living with cancer rather than dying from it—a testament to our nation’s investment in biomedical research and cancer prevention, early detection and care. In fact, today there are more than 10 million Americans living with a history of cancer.

Since 1991, the death rate due to cancer has actually declined resulting in prevention of more than 320,000 deaths between 1991 and 2002. Just recently, the American Cancer Society announced that for the first time in the 70 years of tracking cancer data, the actual number of cancer deaths is declining.

This trend could be greatly accelerated. Cancer is one of the most preventable and increasingly curable life-threatening diseases if detected early. Most cancer suffering and death occurring today is needless. Yet despite the fact that cancer cost the nation $210 billion in 2005, we spent less than $5 billion ($16 per American) fighting a disease that affects almost half the population.

In 2005, 92 Senators and 280 Members of Congress signed a letter to the President in support of the Administration’s goal of eliminating suffering and death due to cancer by the year 2015. While this is not a goal that can be reached with certainty, our sustained historical commitment to cancer research and programs has made possible exponential gains so substantial that we now can actually talk about a time when people live with cancer rather than die from it.

The conquest of this disease is within our grasp if we adopt bold new policies and make the investments necessary to elevate prevention, early detection and survivorship, increase our commitment to research, and expand access to care.

The 2015 goal calls for truly bold action in the war against cancer; the opportunities to beat this disease demand it.

The American Cancer Society’s federal agenda for 2006 sets forth specific action items that can be taken now to put the country back on track toward this goal. In light of the cancer burden on this country and the incredible opportunities ahead, taking these steps is the minimum investment we should be making right now. The attached chart provides estimated costs.

Elevate Prevention, Detection, and Survivorship

Eliminate Medicare Co-Pays for Colorectal and Breast Cancer Screening Services

Thanks to Congress, Medicare covers colorectal and breast cancer screening services, which are essential tools in reducing deaths from these leading cancer killers. Breast cancer ranks second among cancer deaths in women, and will kill an estimated 41,000 women in 2006. Colorectal cancer is the second leading cause of cancer death overall, and will result in an estimated 55,000 deaths in 2006.

Medicare co-pays for colorectal and breast cancer screening, however, are a disincentive to preventive care and critical early detection. Eliminating these co-pays will increase significantly the number of Medicare beneficiaries receiving these life-saving screenings.

Extend the Welcome to Medicare Visit Time Limit

Extend the Welcome to Medicare visit time limit from six months to one
year to ensure effective outreach and uptake of this important benefit by new Medicare beneficiaries and physicians.

Increase Smoking Cessation for Smokers in Medicaid.

At an estimated cost of $33 per smoker, the federal government would provide $60 million annually over the next five years for cessation services to increase by 25% the number of Medicaid smokers who receive full cessation benefits. This would result in an estimated 31,000-54,000 Medicaid smokers successfully quitting annually and up to 18,000 lives saved.

Provide Grants to Activate State Comprehensive Cancer Control Programs.

The Center for Disease Control and Prevention’s (CDC) Comprehensive Cancer Control program integrates and coordinates state resources to improve prevention, early detection, treatment, rehabilitation, palliation and quality of life. Additional program funding should be provided on a demonstration basis to ensure activation of specific cancer prevention and control activities identified in current state plans.

Ensure Access to Quality Care

Reauthorize and Expand the National Breast and Cervical Cancer Early Detection Program (NBCCEDP).

Early detection and treatment are key to defeating breast cancer, which will kill 40,000 women in 2005 and ranks second among cancer deaths in women. CDC’s NBCCEDP helps low-income, uninsured and medically underserved women gain access to lifesaving breast and cervical cancer screenings and provides a gateway to treatment upon diagnosis. As currently funded, however, it reaches only one in five eligible women between ages 50 and 64 (20%). The program should be reauthorized and funded at levels sufficient to serve at least an additional 130,000 women in the first year and 450,000 women in each of the following four years to raise the total served to 60% of the eligible population.

Authorize a Colorectal Cancer Early Detection and Treatment for the Uninsured.

Colorectal cancer is the second leading cause of cancer death, resulting in about 56,000 deaths in 2005. The five-year survival rate for colon cancer caught early is 90 percent, but as low as 10 percent when the cancer is not caught until later stages. In adults 50 and older, only 18.5% with no health insurance had a recent colonoscopy or sigmoidoscopy, compared to a national average of 40.5%. Up to 80% of the cancer incidence in the age 50-64 population could be prevented if these individuals were screened. A pilot colorectal cancer outreach, screening, early detection, and treatment program should be authorized and funded at $50 million annually for five years, targeting low-income, uninsured people age 50-64. Of this population, 2.2 million individuals would benefit from this program.

Fund the Patient Navigator Program.

The American Cancer Society thanks Congress for enacting the Patient Navigator Act to help place trained “navigators” in health facilities to help break down the barriers that prevent medically underserved populations from getting the quality care they need. Navigators are trained individuals who are skilled in assessing community and patient needs and helping patients overcome barriers in the complex health care system. The President signed the Patient Navigator Act into law in July 2005. Total funding of $25 million over 5 years, as currently authorized, should be provided.

Expand, Rather than Curtail, Cancer Screening and Treatment Protections.

The American Cancer Society recognizes the enormous difficulties that small businesses and their employees face in the health insurance market. Expanding the number of people with meaningful insurance coverage is an important goal, but we must not sacrifice quality coverage in the process. We strongly oppose legislative proposals to allow business associations or any other insurers to bypass state guarantees of access to critical benefits, including life-saving screenings for breast, colon, and prostate cancer, access to cancer specialists, evidence-based off-label prescription drug use, groundbreaking clinical trials, and proven smoking cessation services. Continued success in the war against cancer requires that we expand, not reduce, the number of people with access to these vital benefits.

Accelerate Discovery

Our investment in research through the National Cancer Institute (NCI) has produced remarkable advances and built a powerful research infrastructure. The American Cancer Society urges Congress to continue building this infrastructure and sustain this progress by

Funding key research areas.

The Director of NCI reports that an increase of $240 million (5%) is needed just to maintain NCI’s current programmatic agenda, and that an increase of $1.1 billion (23%) is required to actually meet current needs and opportunities. (The Nation’s Investment in Cancer Research: A Plan and Budget Proposal for Fiscal Year 2007.)

The American Cancer Society urges Congress to provide sufficient funding increases for NCI to meet needs and opportunities in key areas:

1. Expand survivorship services, geographic distribution and reach of the NCI-designated Cancer Centers, increasing from 61 existing centers to 75. These centers are hubs for cutting-edge research, cancer care, and outreach and education for healthcare providers and patients.
   
   
2. Modernize clinical trials infrastructure. Deploy a modern, integrated clinical trials infrastructure that would reach new populations and expand access to state-of-the-art care. NCI currently supports clinical trials at the NIH clinical center and at nearly 3,000 other sites across the US, conducting over 1,500 trials annually and involving more than 12,000 investigators. Several hundred anti-cancer drugs may be in clinical trials at any given time, and in recent years, more than 25,000 cancer patients have enrolled annually in NCI treatment trials.
   
   
3. Improve interventions. Develop more effective and tailored strategies for cancer prevention and control, early detection, diagnosis, treatment, as well as follow-up care for survivors, with particular emphasis on survivorship research and addressing those cancers that remain deadly. For example, ovarian cancer will be diagnosed in an estimated 22,220 women in 2005. An ovarian cancer early detection test that finds it at the localized stage would yield a five year survival rate of 94%. But the reality is that only 19% of all cases are detected at this stage, so the current five year survival rate for all stages is only 44%.
   
   
4. Enhance bioinformatics. Build our bioinformatics infrastructure, develop and apply advanced imaging technologies, and support proteomics, nanotechnology, and other promising initiatives. Technology is revolutionizing our ability to understand and intervene in the cancer disease process. We now have a portfolio replete with opportunities to make cancer diagnosis and treatment more accurate and less invasive with fewer adverse side effects. This new era of molecular oncology will deliver medical advances that improve both quality of life and length of survival for cancer patients.
   
   
5. Address disparities. Determine the causes and extent of cancer health disparities, develop effective interventions to reduce those disparities, and facilitate intervention delivery. Cancer risks and rates may be influenced by social and economic inequities, cultural factors, genetic factors, and geographic disparities in quality of care that result in disproportionate cancer burden for certain populations. For example, prostate cancer incidence and death rates are significantly higher in African American men than in white men. Opportunities for research to reduce cancer disparities exist across the entire disease spectrum, from primary prevention to screening and treatment.

Protecting and Strengthening the Authorities of the NCI.

America’s investment in biomedical research has brought us to the threshold of unimagined progress against cancer and other diseases. We now know how to prevent many cancers, and we are also developing technologies to detect some cancers earlier and treat them more effectively. Our nation’s biomedical research enterprise, led by the National Institutes of Health, is a critical cornerstone in these efforts.

We look forward to working with Congress during the reauthorization of NIH to help ensure better coordination and efficiency in our national research system as well as appropriate accountability. At the same time, we urge Congress to preserve the authorities and autonomy of the National Cancer Institute that have served the nation so well in the decades since President Nixon declared war on cancer.