the members of the committee, the press, and those in the audience who would like to have them. At this time I would like to have these statements officially entered in the record of the hearing.

(The statements referred to appear at appropriate points throughout the testimony.)

The CHAIRMAN. The committee has prepared a broad agenda covering cancer, as a guide to our discussion. Copies of this agenda are available to the participants in the hearing, and they have indicated their willingness to discuss the various subjects covered by it. At this time I wish to have the agenda and the list of witnesses entered in the record.

(The information is as follows:)

AGENDA FOR THE HEARING ON CANCER-HOUSE COMMITTEE ON INTERSTATE AND FOREIGN AFFAIRS

I. Introductory remarks by the committee chairman.

II. Why cancer is a major public health problem in this country.

A. What it is, the nature of this family of diseases.

B. Who gets cancer? How many people are under treatment for it now? How many new cases this year? How many people will die of cancer in 1953? The rise of the cancer death toll during recent years? The outlook for 1965 or 1975?

C. What are the most frequent types of cancer in men, women, and children?

D. What is the cost of cancer illness to the Nation in loss of productive manpower, to communities in financial aid to families and provision of hospital care to families?

III. What is available today in the way of treatment, diagnosis, and prevention?

Are many cancers

A. What are the accepted methods of treatment? cured by them? Are there any wonder drugs that can be used against cancer? Or any products of atomic-energy research? Where do we stand with regard to X-ray, radium, surgery, drugs, synthetic hormones? In availability of cancer clinics?

B. What can doctors do now to detect cancer early? How good are present methods? Is there a reliable blood test for cancer? Where do we stand in

The detection of cancer by physical examinations, X-ray, specific tests, radioactive isotopes.

The development of blood or chemical diagnostic tests.

The use of detection centers.

Educating the public and the doctors, dentists, and nurses to the importance of early diagnosis and prompt treatment of cancer.

C. What can be done now to prevent cancers? In industries where workmen may be exposed to cancer-causing hazards? By adequate handling of precancerous lesions?

IV. What resources of skilled personnel, facilities, and funds are being devoted to the nationwide attack on cancer? What are the cooperative relationships among the various groups working in the cancer field? How are the different activities coordinated?

A. By private and voluntary organizations at the community, State, and national levels (American Cancer Society, Damon Runyon Fund, American College of Surgeons, American Medical Association, medical schools, hospitals).

B. By governmental agencies at the community, State, and national levels (State health departments, the National Cancer Institute, Atomic Energy Commission, Veterans' Administration, Department of Defense).

V. As a whole, what are the interested groups and agencies doing to improve treatment, diagnosis, and prevention of cancer?

A. In fundamental research on the cause and development of cancer? On the role of heredity, viruses, diet, various factors in the human environment? B. In clinical and basic studies to improve the treatment of cancer by the different kinds of radiation, by surgery, and by anticancer drugs and hormones?

C. In learning more about preventing cancers through studies of materials used in certain industrial processes, experimental production of cancer inanimals, and of the relationships between human cancers and factors such as race, marital customs, age, and sex?

D. Through provision of skilled scientists needed to carry on research and physicians with special training to treat cancer patients?

E. To provide hospitals, clinics, or centers properly equipped to treat cancer patients and to do the necessary diagnostic procedures?

VI. What are the recommendations for strengthening the attack on cancer? A. In research, both laboratory and clinical?

B. In maintaining an adequate supply of scientists and physicians?

C. In education of physicians and members of allied professions? In public education?

D. In State and community programs?

E. In improved medical practice and medical facilities?

PARTICIPANTS

Dr. John R. Heller, Director, National Cancer Institute, Bethesda, Md.

Dr. Charles Cameron, medical and scientific director, American Cancer Society, New York, N. Y.

Dr. Cornelius P. Rhoads, scientific director, Memorial Center for Cancer and Allied Diseases, New York, N. Y.

Mefford R. Runyon, executive vice president of the American Cancer Society, New York, N. Y.

Dr. Paul L. Wermer, secretary, committee on research, American Medical Association, Chicago, Ill.

Dr. Sidney Farber, scientific director, Children's Cancer Research Foundation, Boston, Mass.

Dr. R. Keith Cannan, Chairman, Division of Medical Sciences, National Research Council, Washington, D. C.

Dr. G. Burroughs Mider, Associate Director in Charge of Research at the National Cancer Institute, Bethesda, Md.

Dr. Ralph G. Meader, Chief, Research Grants Branch, National Cancer Institute, Bethesda, Md.

Dr. Ira T. Nathanson, Chairman, Committee on Cancer Diagnosis and Therapy, National Research Council, Boston, Mass.

Mr. John Teeter, Damon Runyon Foundation, New York, N. Y.

Dr. Antonio Rottino, director of laboratories, St. Vincent's Hospital, New York, N. Y.

The CHAIRMAN. Because much of what we will hear today will be of a technical nature, the discussion can better be led by one of our experts than by the committee. I understand that Dr. John R. Heller, Director of the National Cancer Institute of the United States Public Health Service, will act as discussion leader for this hearing. Dr. Heller, I wish that you would kindly proceed to outline for us in more detail the plan of our discussions, and introduce those who are going to participate. I hope that you will feel free to direct the course of these discussions in such a way as to bring out the maximum amount of information within the limited time at our disposal. Members of the committee will, of course, have questions to ask from time to time. Dr. Heller, we would like you to take over at this time; and I would like those who are here to participate with you in this discussion this morning to realize that the committee greatly appreciates your presence, the thought and the attention that you have given to this matter, and your willingness to be present to assist the committee in what it considers this very important work that it is seeking to do with respect to the diseases that are common to our people and leading particularly and finally to how it will be possible through congressional action or otherwise to be helpful in the general progress of the work that is being done to relieve our people from this great disease.

We thank you for your presence. We know it has been a great inconvenience to your folks to come. All of you are busy individuals. For that reason we appreciate all the more the fact that you are here and willing to give of your knowledge, study, and experience to this committee in this important matter. Dr. Heller.

STATEMENT OF DR. JOHN R. HELLER, DIRECTOR, NATIONAL CANCER INSTITUTE, BETHESDA, MD.

Dr. HELLER. Mr. Chairman and members of the committee, participants and gentlemen, this group represents the people who are charged with the responsibility for administration and execution of programs of cancer control and cancer research.

I should like to introduce the members of the panel and I should like each to rise, state his name, his official position, his activity with the organization with which he is connected, and any other pertinent data which the committee might find helpful.

I should like to start on my left with Dr. Rottino.

The CHAIRMAN. Will you give the name in full, please.

Dr. ROTTINO. Antonio Rottino. I am the director of laboratories and pathologist for the St. Vincent's Hospital in New York City. I am also director of Hodgkin's research at that institution. I come as one of the representatives for the Damon Runyon Foundation, being a member of the advisory committee.

Dr. HELLER. Dr. Charles S. Cameron.

Dr. CAMERON. I am medical and scientific director of the American Cancer Society and am clinical assistant surgeon at the Memorial Hospital and the James Ewing Hospital in New York City.

Dr. HELLER. Dr. Keith Cannan.

Dr. CANNAN. I am Chairman of the Division of Medical Sciences of the National Research Council. As such, the National Research Councils holds a general watching brief on research in general, and the Division of Medical Sciences on research in the medical field. We represent the major scientific societies of the country. We have a particular interest in cancer because we are adviser to the American Cancer Society on its program of research.

Dr. HELLER. Dr. G. B. Mider.

Dr. MIDER. I am Associate Director in Charge of Research at the National Cancer Institute. With the key members of the staff I am responsible for the program of intramural research within the organization.

Dr. HELLER. Dr. Cornelius P. Rhoads.

Dr. RHOADS. I am the scientific director of the Memorial Center for the Treatment of Cancer and Allied Diseases in New York City; director of the Sloan Kettering Institute for Cancer Research, the research division of that hospital; and professor of pathology at Cornell University College of Medicine.

Dr. HELLER. Mr. Mefford Runyon.

Mr. RUNYON. I am the executive vice president of the American Cancer Society; the only layman, I believe, who so far has been introduced.

Dr. HELLER. Dr. Sidney Farber.

Dr. FARBER. I am scientific director of the Children's Cancer Research Foundation in Boston, responsible there for the care of children with cancer and for a research program designed to find new methods of treatment for children with cancer. I am also professor of pathologoy at Harvard Medical School, stationed at the Children's Hospital; and am a member of the National Advisory Cancer Council. Dr. HELLER. Dr. Ralph Meader.

Mr. MEADER. I am Chief of the Cancer Research Grants Branch of the National Cancer Institute; and as such under the general guidance of Dr. Heller carry out the administration of the research grants funds appropriated by the Congress. In this effort the National Cancer Institute, Public Health Service, is advised by the National Advisory Cancer Council, a group of appointed officials, nongovernmental employees, of which Dr. Farber is a member.

Dr. HELLER. Dr. Paul Wermer.

Dr. WERMER. I am Paul L. Wermer, of Chicago. I am secretary of the committee on research of the council on pharmacy and chemistry of the American Medical Association. I am here as a representative of that association to outline our activities in the clinical research and education in cancer.

Dr. HELLER. Dr. Ira Nathanson.

Dr. NATHANSON. My name is Dr. Ira T. Nathanson. I am associate clinical professor of surgery at Harvard Medical School; the director of the Massachusetts division of the American Cancer Society; I am a member of the staff of Huntington Laboratories; which are the laboratories of the Harvard cancer committee; and I am chairman. of the National Research Council's Committee on Cancer Diagnosis and Therapy.

Dr. HELLER. Dr. Gordon Granger.

Dr. GRANGER. Dr. G. A. Granger, Acting Medical Director of the Food and Drug Administration. We are involved in enforcing the Food, Drug, and Cosmetic Act.

Dr. HELLER. Have I overlooked any witnesses in the audience not known to me?

I believe, Mr. Chairman, that constitutes the group of witnesses. The CHAIRMAN. Now that you have introduced your associates, will you introduce yourself and give your background.

Dr. HELLER. I am Dr. John R. Heller, Director of the National Cancer Institute, a Federal activity charged by the Congress with the responsibility for the study of the causes, diagnosis, treatment, and prevention of cancer; a very broad charge which the Congress established in 1937 and implemented with the appropriate funds. And since that time there has been a very marked expansion of activity in the Federal program. This has received the support of the people, as evidenced by the interest of the Congress.

The CHAIRMAN. With reference to your mentioning the fact that this was a Federal agency, it is always gratifying to members of this committee to realize that it was this committee which established the several national institutes that have performed so well; and our only regret is that probably there has not always been sufficient appropriations to have accomplished all you would have liked to have done. We are hopeful, however, that by hearings such as these and acquainting the general public with the situation that exists, both with

respect to the number of people incapacitated by these diseases and also by the work that can be done in the way of research, there will be a more general support given to the efforts to make all of these institutes more effectual in carrying out the will of Congress by providing appropriations that will enable them to do so.

Now you may proceed, Dr. Heller.

Dr. HELLER. Thank you, Mr. Chairman. Members of the panel, the chairman desires that we discuss the several broad aspects relating to causes, diagnosis, treatment, and prevention of cancer, with especial emphasis toward the magnitude of the problem, the economic impact upon our socity, the accomplishments of research, the accomplishments of the translation of research into those elements which lead to control of the disease in the population, and the most important element of research-to find and establish and develop those elements which can lead ultimately to the control of cancer.

I should like to establish in as broad terms as I can, Mr. Chairman, some of the facets which we see as residing in the framework of this very complex question of cancer control; cancer control being used in the broad sense, embracing research in all of its facets.

To begin with, cancer is not only an extraordinarily complex disease but it is one in which the cause is not established. There being no known definitive cause of cancer in the medical sense, the diagnosis of the disease has been hampered by this very fact of being unable to establish a cause or causes.

I should like to establish, also, the fact that cancer is not considered usually as one disease. It is considered as many diseases. It is likely, therefore, that there may be various causes involved rather than one

cause.

By the same token, there will probably be a number of treatments instead of one treatment for cancer.

We are confronted, then, with a situation in which research, while aimed at the general problem of cancer, nevertheless has to consider these several complicating variables.

Cancer, as most of you know, is a disease which has grown not only in importance-it has always been important to our society-but has grown because we are an aging population in the sense that each year more of us are entering the older age brackets, since medical science has been successful in eliminating those communicable diseases especially which previously were major causes of death. We find that since 1900, cancer has come from eighth place in cause of death to second place at this time. While it is primarily a disease of the older age groups it must be remembered that better than 15 percent of the deaths from cancer occur in individuals under the age of 45.

It is estimated that this year, 1953, there will be about 224,000 deaths from cancer. There are coming to medical attention each year about 530,000 cases of cancer. It is estimated that at the rate at which we are acquiring cancer 50 million of the present population of the United States probably will acquire cancer and about 25 million of them will die from that disease.

I would not like to leave in the minds of the committee a grim or gruesome picture because of the statistics which I have related. There is cause for optimism. This optimism will be developed by the several members of the panel. I think that the evidence which you will hear will indicate to you that advances have been made and