On September 24, 1999, Senator Feinstein introduced legislation to require health insurance plans to cover screening tests for cancer as a way to reduce the number of cancer related deaths and increase survival rates.

The legislation requires health plans to cover screening tests that are currently available and for which there is broad consensus on their value. To address future changes in scientific knowledge and medical practice, the bill allows the Secretary of Health and Human Services to change the requirements upon the Secretary's initiative or upon petition by a private individual or group.  The measure is a companion to a bill introduced in the House of Representatives by Congresswomen Carolyn Maloney (D-New York) and Sue Kelly (R-New York).

"It is long past due for this Congress to send a strong message to insurance companies," Senator Feinstein said. "Half a million Americans will die of cancer this year -- equal to five jumbo jets crashing every day for the entire year.

Because early detection can save lives, requiring health plans to cover detection tests can decrease that number."

Screening-accessible cancers such as cancers of the breast, tongue, mouth, colon, rectum, cervix, prostate, testis, and skin account for approximately half of all new cancer cases. The five-year relative survival rate for these cancers is roughly 81 percent.

"According to the American Cancer Society, if all Americans participated in regular cancer screening, this rate could increase to more than 95 percent," Senator Feinstein said. "For example, people can have colon cancer long before they know it because they may not have any symptoms. Patients diagnosed by a colon cancer screening have a 90 percent chance of survival while patients not diagnosed until symptoms are apparent only have a 8 percent chance of survival."

The Comprehensive Cancer Screening Act of 1999 would:

(1) Require plans to cover screenings according to current guidelines. As a result, the following procedures would be covered under the legislation:

• Annual mammograms for women ages 40 and over and for women under 40 who are at high risk of developing breast cancer.

• Annual clinical breast exams for women ages 40 and over and for women between the ages of 20 and 40 who are at high risk of developing breast cancer.

• Clinical breast exams every three years for women who are between the ages of 20 and 40 and are not at high risk for developing breast cancer.

• Annual pap tests and pelvic examinations for women ages 18 and over or women who are under the age of 18 and are or have been sexually active.

• Screening procedures for men and women ages 50 and over or under age 50 and at high risk for developing colorectal cancer, including annual screening fecal-occult blood test and screening flexible sigmoidoscopy every 4 years.

• Men and women at high risk for colorectal cancer (in any age group) may receive a screening colonoscopy every 2 years.

• Annual digital rectal examination and/or annual prostate-specific blood test for men ages 50 and over or males who are at high risk.

(2) Authorize the Secretary of Health and Human Services to modify coverage requirements to reflect changes in medical practice or new scientific knowledge, based both on the Secretary's own initiative or upon petition of an individual or organization.

Finding cancers in their early states can also mean that treatment is less expensive. Treatment of breast, lung, and prostate cancers account for over half of annual medical costs, which the National Institutes of Health estimates is $37 billion annually.

Today, a colon cancer screening test costs approximately $125-$300. However, if a patient is not diagnosed with colon cancer until symptoms are apparent, care during the remaining 4-5 years of life can cost up to $100,000. Similarly, the initial average cost of treating rectal cancer that is detected early is roughly $5,7000. This is approximately 75 percent less than the estimated $30,000-$40,000 it costs to treat rectal cancer that is further along in its development.

"The cost of lost productivity due to cancer is $11 billion annually, while the cost lost productivity due to premature death is $59 billion annually. We can't afford not to screen," Senator Feinstein added.