Sec. 4 of the RECA amendments gives an explicit requirement for screening. The HRSA administrator must make competitive grants available “for the purpose of carrying out programs to screen individuals described under section 4(a)(1)(A)(i) or 5(a)(1)(A) of the Radiation Exposure Compensation Act (42 U.S.C. 2210 note) for cancer as a preventative health measure” (PL 106-245 Sec. 417C(b)(1)) (emphasis added). In other words, RECA, as amended, does require cancer screening as a preventive health intervention for the purpose of early detection (CFR, Vol. 67, No. 83, page 21256).
To carry out that mandate, HRSA created RESEP and announced the first fiscal-year competitive application cycle on April 30, 2000, in the Federal Register. In its announcement, HRSA described the legislation as providing the authority for competitive grants for “individual cancer screening” (CFR, Vol. 67, No. 83, page 21257). Although the amended legislation might be read as linking screening to cancer, this CFR section provides for the “availability of $3.0 million to eligible entities for the purpose of carrying out programs to screen eligible individuals for cancer and other radiogenic diseases” (ibid) (emphasis added). Because RECA legislation covers both nonmalignant and malignant radiogenic diseases, RESEP is consistent with the overall intent of the amended RECA in not limiting screening to cancer.
HRSA charges its Bureau of Primary Health Care with administering the RESEP grant program. On May 2, 2002, and June 5, 2003, HRSA published a program information notice providing guidance to potential grantees about the RESEP competitive process. This guidance includes eligibility requirements, program expectations, review criteria, and award factors for the grants.
RESEP grantees are expected to pursue multiple core activities: education, screening and early detection, referrals for medical treatment, eligibility assistance, quality assurance, staffing, data collection, finance, performance reports, and outreach. We examine only the screening and early detection component here.
HRSA treats screening and early detection as a single activity. The notice did distinguish between nonmalignant and malignant radiogenic diseases. RESEP identifies basic screening protocols and differentiates basic screening and an array of steps collectively considered referrals for medical treatment (advanced testing, diagnosis, evaluation, and treatment), as follows:
Screening and early detection:
Basic screening protocols.
Referrals for medical treatment: