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Good Housekeeping
959 EIGHTH AVENUE. NEW YORK. NY 10019
212-649-2477
ELLEN LEVINE
EDITOR-IN-CHIEF
October 14, 1997
Bruce Reed
Assistant to President for Domestic Policy
Office of the President
The White House
1600 Pennsylvania Ave.
Washington, D.C. 20500
Dear Mr. Reed:
First of all, thank you again for the generous stretch of time
you gave us yesterday, and for assembling such an
influential group of advisors. We can't tell you how exciting
it is to know that you share our enthusiasm for a joint
Presidential-Good Housekeeping initiative sometime in the
spring.
I wanted to review where we stand. The areas that strike us
both as most viable are:
Heart disease is the number one killer of women. There
are very real inequities in diagnoses, treatment, research
and public education. As we speak, our health editor is
pulling together a report that will spell these out, as well as
information on the very newest findings. As you yourself
put it, this is an opportunity to do for women and heart
disease what has been done with breast cancer. We'll get
that off to you in a week or so. You also thought you could
share a copy of your 1998 health issues agenda.
The future of fatherhood. Here the plan would be to
stimulate discussion and ultimately spearhead social change
LIMITED WARRANTY 10 CONSUMENS
Good Housekeeping
RETURN
DEFECTIVE
A PUBLICATION OF HEARST MAGAZINES. A DIVISION OF THE HEARST CORPORATION
concerning the role of fathers. As we leave the twentieth
century, with its seismic changes in the role of women, it is
now time for men to reevaluate their involvement with
their family. The issue is very much in the air, and this is a
chance to retrieve the debate from extremists factions.
The rise in children's cancers and asthma.
Environmental pollution is suspected to be the main cause,
and focusing on this disturbing trend would mean a call to
direct research money to identifying the precise culprits,
and adjusting our environmental standards accordingly in
order to help protect generations of children.
We also discussed the issue of the quality of schools. We're
very happy to tell you that we already had in the works a
major report on the debate over teacher tenure. In fact, it
will appear in our January 1998 issue, and our discussion
with you confirmed our sense that we ought to conduct an
opinion poll to run with it. That will give us a very good start
in stimulating debate, and getting a good look at how Good
Housekeeping's 24 million readers feel about it.
In terms of national testing standards for children, we
definitely want to hear more. We'll be on the lookout for
Bruce Reed's poll results on that, which we want to study
and think through. Conceivably, another feature could be
undertaken on this subject as a follow up to our January
tenure article.
Tom Freedman also raised two interesting issues. The first
was domestic violence's impact on working women, and I've
enclosed our October issue so you can see our most recent
piece on the subject, which focused on the shortcomings of
stalking laws, and the need for more prosecutors to use
VAWA. (Before that, we covered the topic in TK, also
attached, focusing on what happens to women after they
are released from prison for killing a batterer.) We'd very
much like to have a look at whatever data he is working
with so that we can consider a feature.
Secondly, he raised the issue of a national data base for
adoptions. Our readership is passionately interested in
adoption, and we cover the subject very regularly, from
many different angles. I've attached just one recent story
about efforts to move hard to place kids out of foster care
through "adoption picnics." As you can see, we did a GH
Lobby citing the President's support. We'd be specifically
interested in knowing if there is evidence that a national
data base would raise adoption rates. We ask because we
hear from states that they have trouble getting all their
needy children adopted within the state; is there reason to
believe that recruiting parents from across state lines
would give more children homes?
Once again, let us say how pleased we are to be launching a
joint project. We're so very eager to keep the momentum
going, so that we can realize our goal by next spring.
Sincerely,
Ellen Levine
Editor- in- Chief
cc:
Ann Lewis, Director of Communications
Paul Begala, Counselor to the President
Tom Freedman, Special Assistant to the President
Jennifer Klein, Senior Policy Analyst
Jurate Kazikas, Good Housekeeping Washington
correspondent
Diane Salvatore. Good Housekeeping Deputy Editor
SEP 04 '98 10:24AM GOOD HOUSEKEEPING 212 265 3307
P.2/4
Good Housekeeping
959 EIGHTH AVENUE, NEW YORK, NY 10019 * 212-649-2200 * FAX 212-265-3307
September 4, 1998
TO: Neera Tanden
FROM: Debbie Pike
RE: Ellen Levine's remarks for colon cancer event
Today is an important day; it marks the beginning of a new public
health campaign that has the power to save thousands of lives. Good
Housekeeping believes we must start talking about colon cancer.
Women have always used their personal experiences to raise public
awareness of disease and save the lives of their families and
friends. It's really easy to forget that thirty years ago, no one talked
about breast cancer. It was embarrassing It was the C-word. But
when former First Lady Betty Ford spoke out about her breast cancer
diagnosis, other well-known people followed. Then, slowly, women
began to get mammograms, though not enough doctors were
encouraging it--despite the fact that science was beginning to show
that routine testing could save lives. Just ten years ago, only 27
percent of women age 50 and over were being tested. Today, that
number has more than doubled--at least 60 percent of women age 50
and over are getting screened. And there's been a substantial decline
in deaths from breast cancer--the largest drop since 1950. How did
this happen? In no small way, thanks to women's voices, the famous
and the not-so-famous, talking out loud about taking care of
themselves and raising our awareness of breast cancer.
-
Good Housekseping
L
#
A PUBLICATION OF HEARST COMMUNICATIONS. INC., A UNIT OF THE HEARST CORPORATION
SEP 04 '98 10:24AM GOOD HOUSEKEEPING 212 265 3307
P.3/4
Now it's time for women to speak out about colon cancer. I became
too aware of the disease. Many dear friends have been diagnosed
with it. This year, colon cancer will claim the lives of more women
than men--primarily because women aren't being screened, There are
many reasons for this: Women wrongly believe colon cancer is a
man's disease; our doctors don't insist we be tested; or we're too
afraid or embarrassed. Even I, who should know better, postponed
screening until January of this year, just because I thought it was
going to be unpleasant. That's a tragedy, because screening has been
proven to save lives.
We at Good Housekeeping want to spread the word, so we've devoted
a section of our October Issue to what women can do to protect
themselves, Experts told us over and over again that early detection
is key. At least one woman in the audience today is living proof of
that message. Last March, Elizabeth Ely, a 55-year-old interior
decorator in New York City, decided to have a colonoscopy, a test
that allows a doctor to check the entire colon for abnormalities. Her
physician had urged her to get screened because of her age. After the
test, she was shocked to learn she had a malignant rectal tumor.
Fortunately, it was an early-stage cancer, and surgery cured her. But
her experience was a real wake-up call.
In our efforts to raise awareness of colon cancer, we turned to Katie
Couric, a very brave woman and brilliant newscaster. All over
America, people tune in to the Today Show and recognize Katie as a
friend, daughter, sister or mother. And all over America, we are
SEP 04 '98 10:25AM GOOD HOUSEKEEPING 212 265 3307
P.4/4
aware that her leadership on this issue has come the hard way.
Women like Katie take their responsibilities not just to their
families but to their public with a seriousness. She knows a lot
stet
more about this disease than many doctors, and she's convinced that
our ability to talk openly about colon cancer will simply save lives.
Now I'd like to introduce a woman 1 consider a good friend and one of
the great voices of our time: Katie Couric, anchor of the Today Show.
09/09/98
14:52
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Remarks by Dr. Bernard Levin
White House Event
September 10, 1998
Thank you, Secretary Shalala. Good afternoon Mrs. Clinton. Good
afternoon ladies and gentlemen. I am Dr. Bernard Levin, vice president for
cancer prevention at the University of Texas M.D. Anderson Cancer
Center, and chair of the National Colorectal Cancer Roundtable. Recently
founded by the American Cancer Society and the Centers for Disease
Control and Prevention, the Roundtable is a coalition of 25 medical
professional, consumer advocacy and voluntary organizations, many of
which are represented here this afternoon. Our mission is to reduce the
suffering and mortality from this disease by achieving screening rates for
colorectal cancer that are equivalent to those for other cancers. Currently,
for example, four out of five people are screened for breast and cervical
cancer. Colorectal cancer screening rates are nowhere near that and we
need to be.
We've all heard the old saying, "an ounce of prevention is worth a
pound of cure." As a practicing physician who specializes in colon cancer, I
09/09/98
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Levin/2
can tell you that nothing is more true of this disease. From where I sit, the
real tragedy of 50,000 deaths a year from colorectal cancer is that $0 many
of them can be prevented. I have sat by the bedsides of too many patients
with this cancer, and have sympathized with too many family members who
have lost loved ones to this disease, simply because they were not
screened.
Colorectal cancer is preventable. Moreover, colorectal cancer is
curable when detected early. In fact, if we instituted widespread screening
for the disease as a national priority, we could reduce the death rate by at
least 50 percent. There is no other disease about which we can make this
claim.
Sadly, too many people are not getting this message, even from their
physicians. The number of doctors who fail to recommend screening for
their patients over age 50 is alarming. Physicians must make screening for
colorectal cancer a routine part of their practices. General practitioners,
09/09/98
14:53
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Levin/3
family doctors, internists, gynecologists - - all must inform their patients over
50 of the benefits of screening and urge them to get tested. In fact, better
education of physicians is a primary goal of the National Colorectal Cancer
Roundtable. Medicare now reimburses the cost of screening for those over
age 65 - a wise decision by the Administration and Congress.
In addition to screening, lifestyle choices can help to prevent
colorectal cancer. Eating plenty of vegetables and high fiber foods, as well
as exercising regularly, can lower your risk. And know your family history.
People with a close relative who has had colorectal cancer are at higher
risk of developing the disease themselves, and should start screening
earlier.
In keeping with our efforts to get these messages out, I am pleased
now to unveil a new public service announcement campaign, starring the
First Lady. The National Colorectal Cancer Roundtable is grateful that Mrs.
Clinton is taking this leadership role in the fight against colorectal cancer,
09/09/98
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Levin/4
and we are honored that she serves as our Honorary Chair. We are also
very excited that NBC network has agreed to air the public service
announcement you are now about to see. Please look to the monitors on
either side of the room.
[play PSA]
I am pleased now to introduce the Editor-in-Chief of Good Housekeeping
magazine, which will publish Mrs. Clinton's print public service
announcement in its January issue. Ladies and gentlemen, Ellen Levine.
SEP.10.1998
2:02AM
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NO.932
P.2/5
jrichter
Wed Sep 9 14:40 page
1
SLUG
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TIMING LC
WHITE HOUSE REMARKS
kcouric
Wed Sep 9 14:40 1998 HOLD 3:58 120
THANK YOU ELLEN.
I WISH I COULD SAY I'M HAPPY TO BE HERE ON THIS OCCASSION, AS MANY OF YOU
KNOW THAT COULDN'T BE FURTHER FROM THE TRUTH. BUT I AM SO GRATEFUL TO MRS.
CLINTON FOR HER INTEREST AND COMMITMENT, TO ELLEN LEVINE AND THE STAFF OF
GOOD HOUSEKEEPING FOR THEIR INCREDIBLY THOROUGH COVERAGE IN THEIR UPCOMING OCT.
ISSUE AND THE TODAY SHOW PRODUCERS AND STAFF FOR WHAT I HOPE WILL BE A LIFE-
SAVING SERIES ON COLON CANCER THAT WILL AIR NEXT WEEK.
FOR THOSE OF YOU WHO HAVE HAD FIRST-HAND EXPERIENCE WITH COLON CANCER -
FOR THOSE WHO HAVE BEEN TO HELL AND BACK, OR HAVE LOVED ONES WHO WERE
TRAGICALLY UNABLE TO MAKE THE RETURN TRIP
YOU KNOW ALL TOO WELL AND TOO MUCH
ABOUT THIS DEVASTATING DISEASE.
OUR EYES SEEM TO GLAZE OVER WHEN WE HEAR CANCER STATISTICS. BUT SOMETHING
STRUCK ME RECENTLY. I WAS HEARTBROKEN AS I'M SURE YOU WERE WHEN YOU HEARD THE
NEWS ABOUT THE PASSENGERS ABOARD SWISS AIR FLIGHT 111. 229 LIVES LOST. BUT AN
EQUALLY SENSELESS TRAGEDY IS THAT IT WOULD TAKE 247 OF THOSE PLANES FULL OF
PEOPLE TO MAKE UP THE MORE THAN 56,000 WHO DIE EVERY YEAR OF COLON CANCER.
COLON CANCER KILLS MORE PEOPLE THAN BREAST AND PROSTATE CANCER COMBINED. EVERY
LIFE IS PRECIOUS, EVERY LOSS DEVASTATING. BUT CLEARLY, IT'S TIME WE PUT COLON
CANCER ON THE FRONT BURNER. WE'VE GOT TO INCREASE AWARENESS--EDUCATE THE
PUBLIC
ENCOURAGE, NO---FORCE PEOPLE TO TAKE ADVANTAGE OF THE DIAGNOSTIC TOOLS
THAT EXIST, COERCE INSURANCE COMPANIES TO PAY FOR COLON CANCER SCREENING AND
NOT JUST FOR PEOPLE WHO HAVE SYMPTOMS OR A FAMILY HISTORY OF THE DISEASE.
ANYONE WHO WANTS TO PREVENT COLON CANCER
AND YOU KNOW OF COURSE, IF IT'S
CAUGHT EARLY, THERE'S A 90 PERCENT CURE RATE
SHOULD BE ABLE TO. IT WILL SAVE
THE HEALTH CARE SYSTEM UNTOLD MILLIONS IN THE LONG RUN.
I SUFFERED A VERY PERSONAL LOSS, ONE THAT I DEAL WITH EVERY MINUTE OF
EVERY DAY. JAY WAS A GIFTED, HIGHLY INTELLIGENT MAN OF COMPASSION AND
INTEGRITY
WITH EVERYTHING TO LIVE FOR, INCLUDING TWO ADORED AND ADORING
SEP.10.1998
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NO.932
P.3/5
jrichter
Wed Sep 9 14:40 page
2
DAUGHTERS. ONE OF THE TRULY GOOD GUYS. AND FRANKLY, I'M STILL IN THE ANGER
STAGE. I'M MAD AS HELL THAT THE FIRST LINE CHEMOTHERAPY FOR COLON CANCER, WHICH
IS ONLY MODESTLY SUCCESSFUL, HAS BEEN AROUND SINCE THE 1950'S. I'M MAD AS HELL
THAT DESPITE THE FACT THAT 13,000. PEOPLE UNDER 50 ARE DIAGNOSED WITH THIS
DISEASE EVERY YEAR, MANY DOCTORS DON'T EVEN CONSIDER IT A POSSIBILITY, AND EVEN
DISMISS SYMPTOMS AS HEMMORHOIDS
UNTIL IT'S TOO LATE.
I'M MAD AS HELL THAT NO MEDICAL SOCIETY RECOMMENDS SCREENING FOR PEOPLE
UNDER FIFTY UNLESS THERE'S A FAMILY HISTORY AND THAT MEDICARE DOESN'T PAY FOR
COLONOSCOPIES FOR PEOPLE WITH AN AVERAGE RISK FOR THE DISEASE. I'M MAD AS HELL
THAT NO ONE HAS COME UP WITH A LESS EXPENSIVE, LESS INVASIVE PROCEDURE OR BLOOD
TEST TO DETECT THE DISEASE.
AND WHILE I'M RAILING, I'M MAD AS HELL THAT ONE CENT OF EVERY TEN DOLLARS
COLLECTED IN TAXES GOES TO CANCER RESEARCH AND THAT THREE-OUT-OF-FOUR FEDERALLY
APPROVED CANCER RESEARCH GRANTS GO UNFUNDED.
MALCOLM X ONCE SAID "USUALLY WHEN PEOPLE ARE SAD, THEY DON'T DO
ANYTHING. THEY JUST CRY OVER THEIR CONDITION. BUT WHEN THEY GET ANGRY, THEY
BRING ABOUT A CHANGE."
THIS WILL BE MY ONLY SOLACE.
I HAVE GOT TO DO SOMETHING FOR ALL THE OTHER 42-YEAR-OLDS LIKE MY HUSBAND,
49-YEAR-OLDS LIKE KEN HAWKHOUSER, 28-YEAR-OLDS LIKE LISA SHERER
WHOSE
FAMILIES ARE HERE TODAY. WE ALL DO. I KNOW I'M SINGING TO THE CHOIR HERE, BUT
WE'VE GOT TO CONVERT THE NON-BELIEVERS. AND IT CAN'T END WITH ONE ISSUE OF
GOOD HOUSEKEEPING, A WEEK-LONG SERIES ON THE TODAY SHOW OR EVEN AN EVENT AT
THE WHITE HOUSE. WE'VE GOT TO MAKE COLONOSCOPY AS MUCH A PART OF THE LEXICON AS
MAMMOGRAM. MY ANGER MAY DIMINISH, BUT MY RESOLVE WILL NOT. TO ALL YOU MEDICAL
PROFESSIONALS OUT THERE, TO PARAPHRASE JERRY MCGUIRE, HELP ME HELP YOU GET THE
MESSAGE OUT. AND TO ALL OF YOU WITHOUT THE M.D. AFTER YOUR NAMES, PLEASE SPREAD
THE WORD
IF WE CAN KEEP OTHER HEARTS FROM BREAKING AS A RESULT OF THIS VILE
DISEASE THEN WE CAN ALL PROUDLY SAY, WE HAVE MADE A DIFFERENCE.
IT'S MY PLEASURE TO INTRODUCE SOMEONE WHO CARES DEEPLY ABOUT HEALTH CARE,
SEP. 10.1998 2:03AM NBC TODAYS SHOW
NO.932 P.4/5
jrichter
Wed Sep 9 14:40 page
3
PREVENTION, AND MOST OF ALL PEOPLE. FIRST LADY HILLARY RODHAM CLINTON.
09/02/98 WED 19:09 FAX 202 690 7318
DHHS/ASPA
002
Thank you Mrs. Clinton. Ms. Couric, Ms. Levine, Dr. Levin [pronounced
Levine], distinguished guests.
Yesterday, in his speech to schoolchildren in Orlando, the President made an
interesting observation about the new king of swing, Mark McGwire.
He said that although McGwire has made home-run history, he's not going to quit
baseball or take walks.
He's going to keep suiting up, staring pitchers down, and swinging for the fences.
Because that's what heroes do, no matter what their walk of life.
And that's what we need to do in the battle against Cancer
Many of my heroes are in this room - physicians, researchers, foundation leaders
who helped build a cancer detection and prevention strategy.
And they join other heroes in the fight against cancer: the President and First
Lady; scientists at NIH, FDA,CDC and research institutes and universities around the
world; Congress that appropriated funds, and, of course, patients and their families.
Together, these heroes have helped win many victories.
09/09/98 WED 19:09 FAX 202 690 7318
DHHS/ASPA
003
2
Overall cancer rates are down.
New drugs are coming on the market that prevent some breast cancers.
Public awareness about the importance of cancer prevention is on the rise.
But just as Mark McGwire won't start taking walks, we won't walk away from
this fight. And that's why we're here today - to strike out colorectal cancer.
Although many Americans don't know it, colorectal cancer is one of our nation's
biggest killers.
It often strikes in the prime of life - and hits men and women almost equally.
And most important, although it tends to run in families, no one is immune.
This is a seemingly bleak story. But turn the page because behind it is a story of
discovery, change and hope.
Today, the death rate from colorectal cancer is dropping.
We know that a high-fiber, low-fat diet cuts the risk of this terrible disease.
09/09/98 WED 19:10 FAX 202 690 7318
DHHS/ASPA
004
3
And we've discovered a genetic marker that make critical early detection easier.
Research proves that a special test for colorectal cancer - - just once a year -
reduces the chance of death in people 50 to 80.
And the examinations are getting easier as new diagnostic equipment makes
screenings quicker and less painful.
So our message is unmistakable. Eat smart. Know your family history. And get
a regular screening after age 50.
That's a message that the National Colorectal Cancer Roundtable - with major
help from the CDC - is bringing to homes across America.
Roundtables are like great baseball teams. Everyone is necessary, but there will
always be a Mark McGwire - or a King Arthur- - leading the charge.
The head of the National Colorectal Cancer Roundtable has that kind of
extraordinary leader of vision and courage..
So I'm proud to introduce a knight in shining armor for every American fighting
colorectal cancer, Dr. Bernard Levin. Bernard
WHSO Layout FINAL
a/o 9/8/98; L. Schwartz
THE COLON CANCER PREVENTION EVENT
Thursday, September 10, 1998
East Room
Event
Grand Foyer
Reception
EV Gate Opens:
2:30 p.m.
Invite Time:
3:00 p.m.
Principal Time:
3:00 p.m.
Brief
Elevator, State Floor
3:05 p.m.
Meet
Red Room
3:15 p.m.
Meet
Blue Room
3:25 p.m.
Event East Room
Approx. 180/Open Press/Business Attire
10 Social Aides
SET UP NOTES GROUND FLOOR: coat check in family theater; 2 tables in booksellers
with cloths and flowers with photo cards and pens.
BOOK SELLERS: two tables with cloth and flowers for photo cards and pens; also for
distribution of Good Housekeeping October issue distribution on departures.
GRAND FOYER/STATE FLOOR: string combo with piano in Grand Foyer; 1 easel in
Grand Foyer for Good Housekeeping cover - 30x40
EAST ROOM/EVENT: 10x16 stage at gold curtain; Toast lectern in East Room; WHCA
Announce from Blue Room; water at podium; 2 Press risers on both sides of cross hall doors;
2 50inch monitors placed on floor on both sides of stage in East Room for play of psa during
event; lights provided by residence electricians; programs on chairs.
BLUE ROOM MEET/RECEIVING LINE: furniture removed from Blue Room for meet and
greet; WHCA announce for program; social aide announce position with microphone and
monitor.
GRAND FOYER: stand up reception - tea and pastries; string combo will play for reception.
WEDNESDAY, September 9
2:00 p.m.
Future View Video monitor and WHCA set up for event.
THURSDAY, September 10
12:00 p.m.
Future View, WHCA return for video check/final set up.
2:15 p.m.
IN PLACE TIME
2:30 p.m.
East Visitors Gate opens and guests proceed to the State Floor and are
seated in the East Room.
3:00 p.m.
THE FIRST LADY arrives at the elevator on the State Floor and is
briefed.
Contact: Jennifer Klein/Neera Tanden
3:05 p.m.
THE FIRST LADY proceeds to the Red Room for a private meet with
Katie Couric and family.
Red Room Participants
Katie Couric
Katie's parents, Mr. and Mrs. John Couric
Katie's brother and sister-in-law, John and Marilyn Couric
Jay Monahan's sisters, Claire Myers, Barbara Monahan and Sally Monahan
3:15 p.m.
THE FIRST LADY proceeds to the Blue Room to meet event
participants and corporate commitment representatives (see attached).
Note: THE FIRST LADY will be presented with an award from Dr. Gerald
Woollam president-elect of the American Cancer Society on behalf of the
American Cancer Society.
Blue Room Participants
Event Participants:
Secretary Shalala
Ellen Levine, Editor-In-Chief of Good Housekeeping Magazine
Katie Couric, NBC Today Show Anchor
Dr. Bernard Levin, Chairman of the Colon Cancer Roundtable
Corporate Representatives:
Nestor Kowalsky, Central Regional Medical Director, American Airlines
Deborah Dingell, General Motors Industry
Karen Kafer, Director, Communications, Kellogg USA
Janine Nessit, Better Health Foundation (on behalf of Bristol Myers Squibb Oncology)
Louis Costentio, Vice President, Endoscope Division Manager, Olympus America
James Schlicht, Vice President, Government Relations, Zeneca Pharmaceuticals
William Pelzer, Jr, President, SmithKline Diagnostics, Beckman Coulter, Inc.
Gregory Larkin, MD, Director, Corporate Health Services, Eli Lily
Deborah Hohit, Director, Public Affairs, Eli Lily
Phillip Schnieder, National Association of Chain Drug Stores
Jill Froula, American Greeting
Amy Manela, Program Director, American Digestive Health Foundation
Gerald L. Woollam, MD, American Cancer Society
Colon Cancer Roundtable:
Carole Anikis
Amy Minella
Colon Cancer Survivor:
Barbara Barrie, Actress
3:25 p.m.
THE FIRST LADY is announced into the East Room accompanied by
Secretary Donna Shalala, Good Housekeeping Editor-In-Chief Ellen
Levine, NBC Today Show Anchor Katie Couric and Chairman of the
Colon Cancer Roundtable Dr. Bernard Levin.
PROGRAM BEGINS
Note: The event will be available live on the America Cancer Society's
and Colon Cancer Roundtable's websites.
THE FIRST LADY briefly welcomes guests to the White House and
introduces Secretary Shalala.
Secretary Shalala makes remarks and introduces Dr. Bernard Levin.
Dr. Bernard Levin makes remarks, introduces the PSA and Ellen Levine.
Ellen Levine makes remarks and introduces Katie Couric.
Katie Couric makes remarks and introduces THE FIRST LADY.
THE FIRST LADY returns to the podium to make substantive remarks.
4:00ish p.m. The program concludes and THE FIRST LADY invites guests to a reception in
the Grand Foyer and proceeds to Blue Room for receiving line.
NOTE: Guests move from the East Room, through the Green, into the Blue
and out the Red and into a reception in the Grand Foyer.
Following the receiving line, THE FIRST LADY has the option to proceed to the
Grand Foyer or depart to the Residence.
Following the tea, guests depart East Gate.
Seating
9 pink reserved - survivors
(11 on chairs)
17 blue reserved - blue room guests
(20 on chairs)
7 red reserved - Couric family
(8 on chairs)
MOC cards
Rep. Ben Cardin (D-MD)
Rep. Alcee Hastings (D-FL)
Rep. John Lewis (D-GA)
Rep. Nita Lowey (D-NY) *tentative
Rep. Jim McDermott (D-WA)
Rep. Darlene Hooley (D-OR)
Rep. Jay Johnson (D-WI)
16
1:25:01 AM
Record Type:
Record
To:
Jennifer L. Klein/OPD/EOP
CC:
Subject: First Lady Colon Cancer event UPDATE
Forwarded by Neera Tanden/WHO/EOP on 09/10/98 11:33 AM
Marty J. Hoffmann
09/10/98 10:52:42 AM
Record Type:
Record
To:
See the distribution list at the bottom of this message
cc:
Laura D. Schwartz/WHO/EOP, Bronson J. Frick/WHO/EOP, Sharon K. Gill/WHO/EOP, Neera
Tanden/WHO/EOP
Subject: First Lady Colon Cancer event UPDATE
EVENT:
First Lady Event - Announcing the Colon Cancer Prevention
Initiative
DATE:
Thursday, September 10th
TIME:3:30 pm (Members arriving at 3:10 PM).
PLACE:
EAST ROOM, WHITE HOUSE
YES (8)
Sen. Barbara Boxer (D-CA)
Sen. Arlen Specter (R-PA)
Rep. Ben Cardin (D-MD)
Rep. Alcee Hastings (D-FL)
Rep. John Lewis (D-GA)
Rep. Nita Lowey (D-NY) *tentative
Rep. Jim McDermott (D-WA)
Rep. John Tierney (D-MA) *tentative
PENDING (3)
Sen. Ron Wyden (D-OR)
Rep. John Porter (R-IL)
Rep. Norman Sisisky (D-VA) * tentative
NO (36)
Sen. John Breaux (D-LA)
Sen. John Chafee (R-RI)
Sen. Tom Daschle (D-SD)
Sen. Chris Dodd (D-CT)
Sen. Russell Feingold (D-WI)
Sen. Dianie Feinstein (D-CA)
Sen. Slade Gorton (R-WA)
Sen. Bob Graham (D-FL)
Sen. Tom Harkin (D-IA)
Sen. Ernest Hollings (SC)
Sen. Daniel Inouye (D-HI)
Sen. James Jeffords (R-VT)
Sen. Edward Kennedy (D-MA)
Sen. Patrick Leahy (D-VT)
Sen. Connie Mack (R-FL)
Sen. Barbara Mikulski (D-MD)
Sen. Patty Murray (D-WA)
Sen. Harry Reid (D-NV)
Rep. Bill Archer (R-TX)
Rep. Michael Bilirakis (R-FL)
Rep. Thomas Bliley (R-VA)
Rep. Leonard Boswell (D-IA)
Rep. Sharrod Brown (D-OH)
Rep. Robert Cramer (D-AL)
Rep. John Dingell (D-MI)
Rep. Lane Evans (D-IL)
Rep. Darlene Hooley (D-OR)
Rep. Jay Johnson (D-WI)
Rep. Ron Kind (D-WI)
Rep. David Obey (D-WI)
Rep. Earl Pomeroy (D-ND)
Rep. Louise Slaughter (D-NY)
Rep. Adam Smith (D-WA)
Rep. Pete Stark (D-CA)
Rep. Charles Stenholm (D-TX)
Rep. Bill Thomas (R-CA)
Message Sent To:
Sharon K. Gill
09/09/98 06:39:41 PM
Record Type:
Record
To:
See the distribution list at the bottom of this message
cc:
Laura D. Schwartz/WHO/EOP
Subject: Colon Cancer / Press accepts
FYI, Matt Lauer (NBC), David Bloom (NBC), Tamara Jones (Wash Post) and Babara Harrison
(WRC/DC) have accepted. Russert and Shipman have regretted.
Message Sent To:
Capricia P. Marshall/WHO/EOP
Marsha E. Berry/WHO/EOP
Neera Tanden/WHO/EOP
Jennifer L. Klein/OPD/EOP
Toby C. Graff/WHO/EOP
Jen-
shecura aouble wl Marty putting
Marty J. Hoffmann
09/02/98 07:33:38 PM
they Dem
Record Type:
Record
even one cirtical $1
list t
To:
Bronson J. Frick/WHO/EOP
CC:
Neera Tanden/WHO/EOP
the there
Subject: colon cancer MOC
whites
*Here is our list of invites, however, we do not expect the RSVP to be more than 10
x,
members. WE ADDED THE FOLLOWING INVITES IN BOLD.
the
it
First Lady Event - "Announcing the Colon Cancer Prevention Intitiative":
September 10, 1998, 3:30 PM
does way bolded
SENATORS (21)
Sen. Barbara Boxer (D-CA)
Sen. John Breaux (D-LA)
Sen. John Chafee (R-RI)
are tus. to
Sen. Tom Daschle (D-SD)
Sen. Chris Dodd (D-CT)
Sen. Russell Feingold (D-WI)
Sen. Dianie Feinstein (D-CA)
Sen. Slade Gorton (R-WA)
I'm 1 im call gous will univir
Sen. Bob Graham (D-FL)
Sen. Tom Harkin (D-IA)
Sen. Ernest Hollings (SC)
sayds
Sen. Daniel Inouye (D-HI)
&
Sen. James Jeffords (R-VT)
of
w/
Sen. Edward Kennedy (D-MA)
Sen. Patrick Leahy (D-VT)
Approp.
ok
not
Sen. Connie Mack (R-FL)
I
Sen. Barbara Mikulski (D-MD)
Sen. Patty Murray (D-WA)
Sen. Harry Reid (D-NV)
Sen. Arlen Specter (R-PA)
fnix we to Just are make
Sen. Ron Wyden (D-OR)
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HOUSE (27)
Rep. Bill Archer (R-TX)
Rep. Michael Bilirakis (R-FL)
Rep. Thomas Bliley (R-VA)
Appoys.
Rep. Leonard Boswell (D-IA)
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Rep. Sharrod Brown (D-OH)
Rep. Ben Cardin (D-MD)
Rep. Robert Cramer (D-AL)
Rep. John Dingell (D-MI)
Rep. Lane Evans (D-IL)
Rep. Alcee Hastings (D-FL)
Rep. Darlene Hooley (D-OR)
Rep. Jay Johnson (D-WI)
Rep. Ron Kind (D-WI)
Rep. John Lewis (D-GA)
Rep. Nita Lowey (D-NY)
Rep. Jim McDermott (D-WA)
Rep. Eleanor Holmes Norton (D-DC)
Rep. David Obey (D-WI)
Rep. Earl Pomeroy (D-ND)
Rep. John Porter (R-IL)
Rep. Norman Sisisky (D-VA)
Rep. Louise Slaughter (D-NY)
Rep. Adam Smith (D-WA)
Rep. Pete Stark (D-CA)
Rep. Charles Stenholm (D-TX)
Rep. John Tierney (D-MA)
Rep. Bill Thomas (R-CA)
house wpd
Page 1
WHSO Layout Draft 4
a/o 9/8/98; L. Schwartz
GOOD HOUSEKEEPING COLON CANCER PREVENTION EVENT
Thursday, September 10, 1998
East Room
Event
State Dining Room
Reception
EV Gate Opens:
2:30 p.m.
Invite Time:
3:00 p.m.
Principal Time:
3:00 p.m.
Brief
Elevator, State Floor
3:05 p.m.
Meet
Red Room
3:15 p.m.
Meet
Blue Room
3:25 p.m.
Event East Room
Approx. 170-180?/Open Press/Business Attire
10 Social Aides
SET UP NOTES GROUND FLOOR: coat check in family theater
GRAND FOYER/STATE FLOOR: string combo with piano in Grand Foyer; 1 easel
in Grand Foyer for Good Housekeeping cover - 30x40
EAST ROOM/EVENT: 10x16 stage at gold curtain; Toast lectern in East Room;
WHCA Announce from Blue Room; water at podium; 2 Press risers on both sides
of cross hall doors; 2 50inch monitors placed on floor on both sides of stage in
East Room for play of psa during event; lights provided by residence electricians;
programs on chairs.
BLUE ROOM MEET: furniture removed from Blue Room for meet and greet;
WHCA announce for program.
GRAND FOYER: stand up reception - tea and pastries; string combo will play for
reception.
BOOK SELLERS: one table with cloth and flowers for distribution of Good
Housekeeping October issue distribution on departures.
WEDNESDAY, September 9
2:00 p.m.
Future View Video monitor and WHCA set up for event.
THURSDAY, September 10
12:00 p.m.
Future View, WHCA return for video check/final set up.
2:15 p.m.
IN PLACE TIME
house wpd
Page 2
2:30 p.m.
East Visitors Gate opens and guests proceed to the State Floor
and are seated in the East Room.
3:00 p.m.
THE FIRST LADY arrives elevator on State Floor and is briefed.
Contact: Jennifer Klein/Neera Tanden
3:05 p.m.
THE FIRST LADY proceeds to the Red Room for a private meet
with Katie Couric and family.
3:15 p.m.
THE FIRST LADY proceeds to the Blue Room to meet other
event participants and corporate commitment representatives (approx.
20 total).
3:25 p.m.
THE FIRST LADY is announced into the East Room accompanied
by Secretary Donna Shalala, Good Housekeeping Editor Ellen Levine,
NBC Today Show host Katie Couric and Dr. Bernard Levin.
PROGRAM BEGINS
THE FIRST LADY briefly welcomes guests to the White House
and introduces Secretary Shalala.
Secretary Shalala makes remarks and introduces Ellen Levine.
Ellen Levine makes remarks and introduces Katie Couric.
Katie Couric makes remarks and introduces Dr. Bernard Levin.
Dr. Levin makes remarks, introduces the PSA and THE FIRST
LADY.
THE FIRST LADY returns to the podium to make substantive
remarks.
4:00ish p.m.
The program concludes and THE FIRST LADY invites guests into
the Grand Foyer for tea and pastries.
NOTE: Optional receiving line following event. The flow would
be as follows: Guests move from the East Room, through the
Green, into the Blue and out the Red and into a reception in the
Grand Foyer.
THE FIRST LADY has the option to proceed to the Grand Foyer
house wpd
Page 3
or depart to the Residence.
Following the tea, guests depart East Gate.
colen.wpd
Page 1
WHSO Layout Draft 2
a/o 9/2/98; L. Schwartz
GOOD HOUSEKEEPING COLON CANCER PREVENTION EVENT
Thursday, September 10, 1998
East Room
Event
State Dining Room
Reception
EV Gate Opens:
2:30 p.m.
Invite Time:
3:00 p.m.
Principal Time:
3:00 p.m.
Brief
Elevator, State Floor
3:05 p.m.
Meet
Red Room
3:15 p.m.
Meet
Blue Room
3:25 p.m.
Event East Room
Approx. 180/Open Press/Business Attire
10 Social Aides
SET UP NOTES GROUND FLOOR: coat check in family theater
GRAND FOYER/STATE FLOOR: string combo with piano in Grand Foyer; 1 easel
in Grand Foyer for Good Housekeeping cover - 30x40
EAST ROOM/EVENT: 10x16 stage at gold curtain; Toast lectern in East Room;
WHCA Announce from Blue Room; water at podium; 2 Press risers on both sides
of cross hall doors; 2 50inch monitors placed on floor on both sides of stage in
East Room for play of psa during event; lights provided by residence electricians;
programs on chairs.
BLUE ROOM MEET: furniture removed from Blue Room for meet and greet;
WHCA announce for program.
STATE DINIG ROOM: stand up reception - tea and pastries; string combo will
play for reception.
BOOK SELLERS: one table with cloth and flowers for distribution of Good
Housekeeping October issue distribution on departures.
WEDNESDAY, September 9
2:00 p.m.
Future View Video monitor set up for event.
THURSDAY, September 10
12:00 p.m.
Future View returns for video check/final set up.
2:15 p.m.
IN PLACE TIME
colon kwpd
Page 2
2:30 p.m.
East Visitors Gate opens and guests proceed to the State Floor
and are seated in the East Room.
3:00 p.m.
THE FIRST LADY arrives elevator on State Floor and is briefed.
Contact: Jennifer Klein/Neera Tanden
3:05 p.m.
THE FIRST LADY proceeds to the Red Room for a private meet
with Katie Couric and family.
3:15 p.m.
THE FIRST LADY proceeds to the Blue Room to meet other
event participants and corporate commitment representatives (approx.
20 total).
3:25 p.m.
THE FIRST LADY is announced into the East Room accompanied
by Secretary Donna Shalala, Good Housekeeping Editor Ellen Levine,
NBC Today Show host Katie Couric and Dr. Bernard Levin.
PROGRAM BEGINS
THE FIRST LADY briefly welcomes guests to the White House
and introduces Secretary Shalala.
Secretary Shalala makes remarks and introduces Ellen Levine.
Ellen Levine makes remarks and introduces Katie Couric.
Katie Couric makes remarks and introduces Dr. Bernard Levin.
Dr. Levin makes remarks, introduces the PSA and THE FIRST
LADY.
THE FIRST LADY returns to the podium to make substantive
remarks.
4:00ish p.m.
The program concludes and THE FIRST LADY invites guests into
the State Dining Room for tea and pastries.
THE FIRST LADY has the option to proceed to the State Dining
Room or depart to the Residence.
Following the tea, guests depart East Gate.
Sharon K. Gill
08/21/98 05:58:24 PM
Record Type:
Record
To:
Jennifer L. Klein/OPD/EOP, Marsha E. Berry/WHO/EOP
CC:
Kim B. Widdess/WHO/EOP
Subject: Colon Cancer
welcome back. By the time you read this, I will be on vacation. Kim will follow-up with you all for
the event. Outstanding issues:
- invitation / this event is more like a message event for POTUS where we do not do mailed
invitations - but phone calls. Neera and I played with language and were not able to come with
anything that felt right. Thoughts -
1. Not do a mailed invitations, but phone invites and a handout program at the event. What do you
think? Would Colon Cancer Roundtable, Good Housekeeping and Today Show be OK with this
format? In addition, we could mail a special letter from HRC to guests - explaining the event better
- after the phone invite has been extended. We are most concerned that Katie Couric is confortable
with format -- Marsha have you been able to get a sense of her expectations?
- Lists - have you guys approved/vetted. I have the following lists:
OPL
103 names (OPL is about 30 names over)
Good Housekeeping -
57
Today Show-
57 (I know Julie is trying to talk to Kassie about the list)
Kim will hold on inviting until you guys can let her know the status. Thanks so much for your help
and see you in September!
I
Barbara Barry
516-583-7743
I
5/28
file Sept
mecanne -
marsha -
Jen K. -
meera -
at last shed mtg, HRC indicated
she wanted to do a public
awareness event on colonrectal
cancer. attached you nice find
letter from Rep. Louise slaughter
I called Cindy 225-3615 Pellegrini in Slaughter's
of tood her someone from gen Klein's
shop world call to follow up for
possible sept/oct went. HRC wanted
coordinated effert w/ Good House-
keeping, Katei Courie, slaughter
FHI- Dave
a
RULES
week of 9/14 2347
RAYBURN HOUSE OFFICE BUILDING
WASHINGTON, D.C.
DISCOMMITTE
202/226
AND ORGANIZATION
OF THE HOUSE
DISTRICT OFFICE
UCUS FOR WOMEN'S ISSUES
3120 FEDERAL BUILDING
CONGRESS OF THE UNITED STATES
100 STATE STREET
ROCHESTER, MY 14614-1308
CONGRESSIONAL ORGANIZATION
LOUISE M. SLAUGHTER
716/232-4650
FOR THE ARTS
TTY 716/454-4606
CHAIR
28TH DISTRICT, NEW YORK
8-mail: [email protected]
DEMOCRATIC LEADERSHIP
web:
VICE CHAIR: RESEARCH
WHIP-AT-LARGE
Fax from the Washington, D.C. Office of
Congresswoman Louise M. Slaughter, 28th District of New York
Please Deliver To: Diase Dewhirst
Organization:
Fax Number:
From Cindy pellegani
Total Pages Including Cover Sheet: 3
Date:
5/14
Time:
Comments:
Here is the letter, per our conversation, pws
the letter we received back yesterday. look forward
to working with you on this!
(If you did not receive all pages, please call 202-225-3615. Thank you.)
PRINTED ON 100% RECYCLED PAPER
"
2247 RAYBURN HOUSE OFFICE BUILDING
ON RULES
WASHINGTON. O.C. 20616-3228
COMMITTEE
202/225-3615
ORGANIZATION
THE HOUSE
DISTRICT OFFICE:
3120 FEDERAL BUILDING
CUS FOR WOMEN'S ISSUES
CONGRESS OF THE UNITED STATES
100 STATE STREET
ROCHESTER, NY 14614-1209
CONGRESSIONAL ORGANIZATION
LOUISE M. SLAUGHTER
716/232-4860
FOR THE ART$
TTY 716/454-4905
CHAIR
28TH DISTRICT, NEW YORK
E-mail: [email protected]
DEMOCRATIC LEADERSHIP
web: http://www.hause.gov/slaughter/
VICE CHAIR: RESEARCH
WHIP-AT-LARGE
April 21, 1998
Ms. Melanne Verveer
Chief of Staff
Office of The First Lady
Old Executive Office Building, Room 100
Washington, D.C. 20500-0005
Dear Melanne,
I am writing to follow up on the First Lady's expressed interest in an event to educate men
and women about colorectal cancer.
Understand that, in a recent conversation with Linda Tarr-Whelan, the First Lady
expressed an interest in participating in an awareness-raising event on colorectal cancer. As you
may know, colorectal cancer is the number two cancer killer of all Americans and the third leading
cancer killer among women, yet it receives virtually no attention. As a result, more than 55,000
Americans die each year of a disease that is highly preventable, readily detectable and often
curable. Linda and I are commited to bringing new public attention to colorectal cancer
prevention, detection, and treatment.
The First Lady has been an outstanding leader on a range of health issues over the past six
years. Her participation in a colorectal cancer event would be a tremendous asset and a great
service to the American people. We would be happy to plan the event around her busy schedule
and are therefore interested in dates over the coming months when Mrs. Clinton would be
available. If you would like to discuss this matter further, please do not hesitate to contact me or
Cindy Pellegrini of my staff at 225-3615.
Thank you for your time and consideration. I look forward to working with the White
House to educate our nation about colorectal cancer.
Sincerely,
Leuise Louise M. Slaughter
Member of Congress
CC: Diane Dewhirst
PRINTED ON 100% RECYCLED PAPER
"
21
202 225 7822
CONG SLAUGHTER
003/003
THE WHITE HOUSE
WASHINGTON
May 11, 1998
The Honorable Louise Slaughter
U.S. House of Representatives
Washington, D.C. 20515
Dear Representative Slaughter:
Thank you for your kind letter inviting Mrs. Clinton
to participate in an event about colorectal cancer. She greatly
appreciates your hard work and dedication to your constituents.
Since it is difficult to know what the First Lady's upcoming
official schedule will be, I am unable to make a commitment for
her at this time. While it is unlikely Mrs. Clinton will be able
to accept your invitation, please be assured that we will keep it
in mind and contact you if we can accommodate your request.
Mrs. Clinton appreciates your thoughtfulness and sends her
best wishes.
Sincerely,
Patti Salis Doyle
Special Assistant to the President
Director of Scheduling
for the First Lady
TO:
Jen Klein, Neera Tanden
FROM:
Fiona Rose
DATE:
June 17, 1998
RE:
Colorectal cancer screening procedures
In recent years, colorectal cancer (CRC) incidence rates have declined from 53 per 100,000 in 1985 to 45 per
100,000 in 1993. Research suggests that this decline may be due to more widespread use of screening
procedures. There are four tests currently employed: fecal occult blood test (FOBT), flexible sigmoidoscopy,
and two more-invasive measures, the barium enema and the colonoscopy. Until the early 1990s, there was
disagreement within the medical community as to which screening programs were best for at-risk patients.
But, according to Dr. Gabriel Feldman (ACS), enough research has now been done to conclude that the above
tests are just as effective for detecting early-onset CRC as mammograms are for detecting breast cancer.
The 1997 ACS Guidelines for Screening and Surveillance for Early Detection of Colorectal Polyps and
Cancer suggests a program of testing procedures, which is outlined on the attached page. These guidelines
are almost identical to those of two other widely-respected healthorganizations, the US Preventive Services
Task Force (USPSTF) and the Agency for Health Care Policy Research (AHCPR). There are no major
dissenters in the medical community concerning these guidelines. Further, the ACS's recommendations are
supported by every major American gastroenterological society.
A 1995 Centers for Disease Control and Prevention (CDC) survey found that 38% of American adults 50
years and older reported ever having a colon exam; 29% had had one within the past 5 years. The American
Digestive Health Foundation (ADHF) suggests that as many as 25,000 - 30,000 lives could be saved each
year if all men and women 50 years and older were screened annually for CRC.
Increased awareness of screening options is important to combating CRC. Dr. Feldman suggests working
with HMOs to pressure doctors, through a system of incentives and disincentives, to encourage patients to
undergo CRC tests. The HEDIS index (Health Employer Data Information Statistics) is a comprehensive
measure of how each American HMO is doing in preventing and treating patients' diseases. If CRC
screenings were added to the HEDIS index, medical employers would be able to monitor how consistently
their employees (the physicians) were employing CRC screenings.
Most insurance companies reimburse patients for FOBTs, but less often for the other three tests. Kaiser
Permanente Medical Care Program of Northern California and Puget Sound of Oregon are major
"preventive" insurance companies, covering the full range of CRC screenings. Costs for CRC tests range
from $4.00 for each FOBT and $80 for a sigmoidoscopy, to $400 for a diagnostic colposcopy (+ associated
clinical costs) and $1,000 for a double-contrast barium enema. In comparison, a mammogram costs about
$200 (+ associated clinical costs).
In 1997, the National Institutes of Health (NIH) spent $103 million on CRC research, and expects to spend
$109 million in 1998. Most of the NIH money is used towards scientific research, while the CDC is
launching a $2.5 million CRC education campaign. Funds for CRC still lag far behind the funds allocated
to breast cancer ($477.9 million). This discrepancy can be attributed both to constituents' focus on other
cancers, and on scientists' lack of CRC research proposals.
American Cancer Society Guidelines for
Screening and Surveillance for Early Detection of
Colorectal Polyps and Cancer:
Update 1997
-- PEOPLE AT AVERAGE RISK --
"Approximately 70 to 80% of all colorectal cancers occur among people at 'average risk. Average risk
is defined by exclusion as anyone who is not otherwise defined as being at increased risk. (1997 ACS
Guidelines, p. 4.)
Everyone should begin colorectal cancer screening by age 50 with either an annual FOBT (plus a
sigmoidoscopy every 5 years); or with a total colon examination by colonoscopy (every 10 years) or by
double-contrast barium enema (every 5 to 10 years).
-- PEOPLE AT MODERATE RISK --
"Approximately 15 to 20% of colorectal cancers occur among people at moderate risk. People with
adenomatous polyps of any size, or with a family history of colorectal cancer, are considered to be at
moderate risk. (1997 ACS Guidelines, pp. 4-5.)
Moderate-risk patients diagnosed with adenomatous polyps should have them removed via colonoscopy,
followed by a total colon examination in 3 years. If polyps have not recurred at the time of the 3-year
procedure, surveillance of the colon can be reduced to a total colon exam (colonoscopy or double-
contrast barium enema) every 5 years.
-- PEOPLE AT HIGH RISK --
"Approximately 5 to 10% of all colorectal cancers occur among people at high risk. Most of those
defined as being at high risk for colorectal cancer have one of two hereditary syndromes or inflammatory
bowel disease. (ACS Guidelines, p. 6.)
With the discovery of a familial colorectal cancer gene, doctors are now able to identify high-risk
individuals at a younger age. Genetic counseling, plus early surveillance (as young as puberty) with
endoscopy and colonoscopy are recommended for those in the high-risk category.
These guidelines have been endorsed by the following organizations:
American College of Gastroenterology
American College of Physicians
American College of Radiology
American Digestive Health Foundation (ADHF)
American Gastroenterological Association
American Society of Colon and Rectal Surgeons
American Society for Gastrointestinal Endoscopy
National Caucus and Center on Black Aged, Inc.
National Center for Chronic Disease Prevention and Health Promotion, CDC
TO:
The First Lady
FROM:
Neera Tanden
DATE:
April 9, 1998
RE:
Colorectal Cancer
Colorectal cancer is the second leading cause of cancer-related death in the United States.
Approximately 130,000 new cases of colorectal cancer are diagnosed each year, with roughly
55,000 ending in death. For both men and women, it is the third most common cancer in
frequency.
Survival of colorectal cancer depends heavily on early detection. When diagnosed at the localized
(early) stage, only 8% of those patients will die within 5 years. However, only 37% of all
colorectal cancer cases are diagnosed at this stage. When the disease is diagnosed at an advanced
stage the death rate is a staggering 93% within 5 years.
The risk of developing colorectal cancer increases greatly after the age of 40. Men are more
likely than women to develop the disease, as are African Americans over other racial groups.
Major risk factors include having inflammatory bowel disease, a family history of colorectal
cancer, and certain hereditary syndromes. A growing number of studies suggest that diet is also a
major risk factor in the development of colorectal cancer: high fat and low fiber diets seems to
promote a high rate of polyps and cancer.
The statistics mentioned above indicate how critical early detection is to survival, yet the nature of
the cancer makes it especially difficult to detect. Most colorectal cancers are "silent" tumors; they
grow slowly and often do not produce any noticeable symptoms until they reach a large size. The
earliest sign of colon cancer is usually bleeding. Fortunately, two currently available tests have
been shown to be beneficial in screening for colorectal cancer. First, fecal occult blood testing
(FOBT) is a chemical test for blood in the stool sample. A positive test can indicate bleeding
from a precancerous growth or from colorectal cancer. Studies have found that colorectal cancer
screening by FOBT is effective, reducing colorectal cancer mortality by 33% in those who
underwent annual screening by FOBT in one study. The other popular screening method is
flexible sigmoidoscopy, which uses a hollow, lighted tube to visually inspect the wall of the
rectum and lower sections of the colon. The 60-centimeter flexible scope can detect about 65%-
75% of polyps and 40-65% of colorectal cancers. Recent studies show that removing polyps can
reduce a person's risk of colon cancer by as much as 90%. The CDC recommends an increase in
screening for colorectal cancers, especially for those individuals over the age of 50.
Under the 1997 Balanced Budget Act the President signed, Medicare covers Fecal Occult Blood
Tests, flexible sigmoidoscopy and screening colonoscopy for high-risk individuals. The Secretary
of HHS was also given authority to allow Medicare coverage of other screening tests/procedures,
or modifications thereof as they become available. Nevertheless, screening for colorectal cancer
lags far behind screening for other cancers, perhaps because the effectiveness of colorectal
screening has only recently been documented. Another possibility is that screenings have been
unaffordable for many without the Medicare coverage. Given the fact that less than half of the
adult population over 50 has ever had an FOBT, and only 38% have had a sigmoidoscopy,
increased awareness is crucial.
According to the National Cancer Institute and the Center For Disease Control and Prevention,
the federal government appropriated roughly $99 million for colorectal cancer research and $2.5
million for prevention in 1997. In comparison, the government allocated $332.9 million on breast
cancer research and $145 million on breast cancer prevention and $123.3 million on lung cancer
research in 1997.
Two institutions that deal specifically with colorectal cancer are the David J. Jagelman Foundation
in Cleveland and the National Institute of Diabetes, Digestive and Kidney Diseases, which is part
of the National Institute of Health.