a famed actress, a wise philanthropist, dies of cancer. Approximately 1 in 7 still must go this way-many, far too soon, leaving tasks unfinished.

Certainly, no body of people can be more conscious of the painfully slow progress we appear to be making in the control of cancer than the hundreds of thousands-doctors, scientists, and lay persons together--who give their time or money to the work of the American Cancer Society. For they, most of them, know cancer at first hand and all of them have accepted the challenge which this disease lays down to the human spirit and to their energies. There is meaning, therefore, in the fact that such people today, in some measure are heartened.

It is proper, therefore, in these opening pages of the society's annual report for 1952 to state the facts which give courage to so many. As progress is slow, measured year by year, perspective is needed for the true picture. The society is today in its 39th year, but its present national program, including the now widespread program of research into the basic nature of cancer, dates only from 1945. Progress there was and no lack of determination before that time, but the full will of Americans to strike back at cancer required the historical opportunity which came, in due course, with a revival of concern for health problems at home and the reorganization of the society upon a wide national basis at the close of the World War period. Before 1945, our powers of attack had not been summoned in full strength. That so much has been done in so short a time, when it is known the struggle must be long, promises well for the future.

The collective "we" of the statement is employed unreservedly, for the accomplishment speaks for all and not those alone who are most concerned, as donors or workers, with the society's progress. We have good reason, all of us, to be encouraged by these achievements:

A powerful volunteer striking force: We have created under voluntary auspices in the American Cancer Society an instrument of the determination of the American people to strike back at cancer. It combines the knowledge of the physician, the scientist, the health educator, the social scientist, and the publichealth official, with the active concern of the private citizen. A program of action has been developed which each year becomes stronger, sharper, more accurately directed to the ultimate defeat of the disease. More people than ever before engaged in educational and service activities of the society in 1952. More people than ever before contributed to the financial support of the society in 1952-enabling the society for the second year in succession to exceed its announced goal and to maintain its attack with undiminished vigor.

A national research attack: The attack includes in its scope, and has included in the past 7 years, the major scientific institutions of the country, the accredited schools of medicine and research hospitals, and many hundreds of individual research scientists, physicians, and research technicians. A primary focus on cancer as a disease entity has been created from studies which in the past were dispersed a concentration of effort which is resulting in a slowly but surely growing body of specific information on the nature of cancer in man. The society bears a large share of the responsibility for the aroused spirit of scientific inquiry concerning cancer which exists today.

Increased interest by physicians: With the warm cooperation of medical societies of all kinds and schools of medicine and nursing, we have encouraged members of the medical profession in all parts of the country to take a greater interest in cancer as a curable disease. Through the society we have supplied and are continuing to supply doctors with the latest and best information on approved treatment procedures, including diagnostic and detection techniques not commonly available a few years ago. The cancer patient today in many parts of the country has a far better chance of receiving adequate and prompt treatment for his disease than in past years.

Cancer can be discussed now: Strongly supported by educators of all kinds, by the press, radio, television, and other means for communication with great numbers of people, we have lifted-largely through the work of the societycancer from a position of blind and unreasoning dread in the minds of many people to the point, at last, where the disease can be openly faced, accurately reported, and boldly examined for all its consequences-economic, medical, and social-to the American public.

Health habits formed without unreasoning fear: Through continued stress on the curability of many forms of early cancer, and wide dissemination to the public of the bodily signs which may mean early cancer, we have made it possible for a very large number of people to adopt without unreasoning fear the sensible health habit of regular physical examinations by a physician. Undoubtedly, many lives have been saved from cancer by this practice, strongly encouraged

by the society in the past 7 years. Cancer is properly feared-it is unreasoning fear that is dangerous. In the same process, we have diminished the hold of the cancer “quack" on those who fear but lack real knowledge of cancer.

Service program begun: We have laid the foundations for service to persons suffering from cancer and to members of their families. Primary emphasis is given to early detection of the disease and prompt and more positive treatment, but aid is also extended to patients in need in later stages of the disease in areas where that activity seems necessary and desirable. In acceptance of the fact that cancer in later stages often means financial disaster for the patient and his family, the society has encouraged more effective measures in public assistance.

Treatment facilities established: We have made possible the establishment of formally organized cancer diagnostic and treatment clinics within many general hospitals. Here physicians can bring to bear on a particular cancer case the force of their collective medical experiences and medical skills. Patients in many parts of the country, formerly without such services, receive the highest medical consideration available to their communities. The society has given much attention, many voluntary services, and large sums of money to the establishment and support of these clinics. There is a need for many more of them. Manpower has been trained: We have encouraged, with fellowships and scholarships in leading scientific institutions, many hundreds of younger scientists and physicians of promise to make life careers of the study and treatment of cancer. This has added weight to the contemporary attack upon the disease and at the same time has begun to provide for the scientific and medical manpower which will be needed to sustain the attack in future years. By such means, consistently employed by the society and the National Cancer Institute of the United States Public Health Service, the number of talented younger men and women who are devoting their lives to the defeat of cancer grows larger year by year. Plant equipment: Through the construction program of the National Cancer Institute and by substantial private philanthropies, plant equipment has been increased significantly for the research attack upon cancer. Under the Institute's building program, new laboratories and other facilities exclusively devoted to cancer studies have been added to the equipment of 49 medical and scientific institutions in 27 States. Since the war over 15 major cancer hospital and research institutions have received large private gifts for building purposes. Fellowships and studies financed by the society are today often housed in these new research facilities.

Cancer registries and records: We have improved our recordkeeping of the prevalence and mortality of cancer in many States, local communities, and individual hospitals to the point where we begin to see more clearly the true dimensions of the formidable enemy we face. Cancer registries keep patients during and after treatment in closer touch with their doctors and provide the medical profession as a whole with more accurate and more complete information on the value, as proved in time, of treatment procedures. The society has had an active role in this useful epidemiological development.

An integrated national cancer control program: Besides the educational, research, and service programs of the society, the national attack includes complementary control and research activities by the Federal and State Governments. The society consistently supports and participates in these programs and has played a significant part in testimonies to congressional committees and other activities in obtaining for the National Cancer Institute of the United States Public Healh Service annual appropriations of reasonable adequacy for the task at hand.

The American Cancer Society strives to be hopeful but realistic, conservative but open-minded, constantly self-critical, ready for change when change will lead on to better things. It holds to the classic American belief that responsibility for one's self and one's fellow citizens may never in entirety be delegated to others, and that in the case of cancer, in particular, this doctrine must hold especially true because the individual is at all times personally and directly threatened by the disease. Oneself--you and I-must take the early symptom to a doctor.

For this reason-of a personal responsibility in the control of cancer-the society believes it can serve the American public most effectively through combining its educational efforts with its own fund-raising activities. We learn through the educational effects of giving to care for ourselves, our neighbors, and what must be done perhaps for many years to come, to defeat cancer. In most cases the sharpness of the educational effect is diminished where the cancer crusade is combined with other appeals, no matter how worthy-lives may be unnecessarily sacrificed.

Though the society thus strongly supports the voluntary spirit in all its affairs. it believes this admirable readiness to serve, and to learn, must be strengthened and guided everywhere by the best technical advice. It is needed, for one thing, to engage the full interest of the intelligent voluntary worker. For such reasons, the society makes wide use of expert technical advisory committees-in education, in the social services, in medicine, and the basic sciences-and it insists upon the employment of persons in salaried staff positions of the highest professional competence for their daily tasks. The Committee on Growth of the National Research Council is a notable example of the expert voluntary advisory services made use of by the society in its program.

The following three sections of the report discuss the activities of the society during 1952 under headings representing its principal structural parts-the National Society, the State, Territorial, and metropolitan divisions, and the community units. Other sections are devoted to research, fund-raising, and finances of the society.

The reader should bear in mind the need for perspective in considering cancer. The road has been and will be, probably for many years to come, a hard one. The gains are measured in inches, not miles. The great achievement of the present is the mobilization of the attack-the organized willingness to striveeverywhere evident in 1952 activities. Nevertheless, time, work, thought, training, organization, money, are still basic requirements of ultimate success. Bear in mind also

Every day over 600 Americans die of cancer.

Out of every 7 deaths last year, 1 was caused by cancer.

Cancer strikes 1 in every 2 families.

About 220,000 Americans died of cancer in 1952.

About 15 million Americans will die of cancer in the next 50 years if present trends continue.

In 1953 there will be about 525,000 new cancer cases in the United States. In 1953 about 700,000 persons will be under treatment for cancer in the United States.

In 1952 about 70,000 Americans were saved from dying of cancer.

The number of cancer patients saved in 1952 could have been doubled if every cancer case had been treated early and by the most effective methods.

We still do not have a readily applied test for cancer or a means for cure effective at any stage of the disease.

THE NATIONAL SOCIETY FIGHTS CANCER

The war against cancer has been only fairly begun. Though the end of the beginning may be in sight, the beginning of the end is still far distant. The enemy is still implacable, still deeply entrenched in the pits of our ignorance, its threat still growing through the growth in our population and in the numbers of older people who make it up. Cancer strikes the older person far more often than the young.

It is one of the purposes of the national organization of the society to hold the gains which have been made. That in itself is no small task. But an even more important purpose is leadership in the attack-through direct action in public and professional education, service to the patient, and research into the nature of cancer; and through indirect actions, designed to enlist in the national undertaking other national agencies, official and private, which can be helpfully employed in the struggle. There are but few agencies which may not be so employed.

A duty of the national society, moreover, is to provide guidance and assistance to the combat troops of the society-the divisions-in the carrying out of programs within each of the 61 divisional areas-in every State, the Territories of Alaska and Puerto Rico, the District of Columbia and 10 metropolitan areas. The leadership role

The world cancer picture is today in a state of great change, much of it due to knowledge of the disease and of means for its control gained in postwar years-much of it resulting from the society's work. Some of the advance in our knowledge is medical and scientific in its nature; some can be called "social," as betokening advances in other health and welfare activities; some is educational, involving newer methods for influencing the actions of people; some is administrative, in the sense that experience with any problem increases the

ability to deal with the problem. It is the duty of the national society to relate these advances in knowledge to each other, to study and judge them, and, when deemed practical in saving lives from cancer, to translate them into positive programs speedily and effectively in one or more departments of the society's work. Complex and difficult decisions are often involved.

A number of examples of the principle here at work as expressed in actions of the national society in recent years are of interest. How early is early enough for the best chance of cure in the treatment of certain forms of cancer? Much attention has been given in medical and scientific literature to refinements in the general concept of early treatment as offering the best hope of cure. In general, the earlier the better remains still the basic rule for all forms of cancer: The 7 danger signals (page 14) which may mean cancer are still the signs to take one to a doctor at the earliest possible moment. But we are beginning to learn that if the right social and medical actions are taken, some forms of cancer may be discovered even before signs of disease can be obvious to the layman. If a woman will learn to examine her breasts at regular monthly intervals, the lump or other sign which may mean cancer can be discovered earlier than if discovery is left to chance, even though the woman is well informed on the basic importance of early treatment. Similarly, cancer of the uterine cervix, which takes the lives of nearly as many women every year as breast cancer, can be detected by the effective "smear test" long before obvious signs of disease occur. If women will present themselves periodically for smear examinations for cancer of the cervix, more than twice as many could be saved from this form of the disease as are saved at present. Lung cancer is on the increase out of all proportion to other forms of the disease, particularly in men above fifty. Precisely why is not known, though in another exercise of the national society's leadership function a study was initiated over a year ago to see if there is any relationship to smoking (page 29). If a cause can be learned, better means for control will follow. What is known about lung cancer today is that in far too many cases it is found too late for much hope of cure and that its earlier detection through semiannual chest X-rays, especially for men over 45, could raise the present cure rate for this form of the disease from less than 4 percent of all cases up to 50 percent.

Such approaches to the control of cancer are new and have been named "precision" attacks. They are based on methods we could not have sponsored a few years ago. It will be seen that all three possibilities involve social as well as medical actions, that all three call for education to induce people in the mass to take the necessary steps in advance of the medical detection of the disease, and that in each case special equipment or a tactical method is a requirement. In launching such programs it is the national society's responsibility to point the way, to forge or help forge the special weapons which may be needed, and to reenforce the attack by actions taken with other national groups. Comment will be made on these activities in following pages of this report.

The national society's pioneering institutional grants which make possible large research programs following several lines of inquiry at once and reenforcing the more general research attack of independent projects (p. 47), is a further illustration of the leadership role exercised by the national society. Another example is the attention given to the society's accounts, operating budgets, and annual financial statements (pp. 56-64). Still other illustrations are the use made in public and professional education of new techniques in films, radio, and television, pamphlets, discussion-group practices.

Make-up of the National Society

The national society-legally, American Cancer Society, Inc., a membership corporation of the State of New York-is headed by a national board of directors of 56 members; one-half are lay persons, one-half representatives of the medical and scientific professions. To preserve continuity, membership is staggered in 2-year periods. All are democratically elected.

The national board is composed exclusively of volunteers. The president of the society is always a physician or a scientist, the chairman of the board a layman. Women's interests are represented by a vice presidency which can be held only by a woman. For coordination, the Director of the National Cancer Institute, the Federal agency responsible for the Government's program in cancer control, is a member of the national board.

Much of the work of the board is conducted by committees of board members and technical advisers who may not be board members. Principal standing committees of the board are the medical and scientific committee (composed

of all medical and scientific members), research committee, committee on field organization, and finance committee. Aiding the society with technical advice are the professional education committee, clinical fellowships committee, service committee, statistics committee, nursing advisory committee, medical social work advisory committee, the institutional grants advisory committee and, outstandingly, the committee on growth.

Public education

Of the 220,000 people who died of cancer in 1952, 70,000 could have been saved if they had received treatment in time. We must keep everlastingly at it. Elucation, thought, care, are of the essence. With present knowledge alone, and use of precision methods, if people would see their doctors upon the first appearance of a sign which may mean cancer about twice as many people could be saved from the disease as are being saved at present. The signs which may mean cancer

are:

1. Any sore which does not heal.

2. A lump or thickening, in the breast or elsewhere.

3. Unusual bleeding or discharge.

4. Any change in a wart or mole.

5. Persistent hoarseness or cough.

6. Persistent indigestion or difficulty in swallowing.

7. Any change in normal bowel habits.

But knowing the signs is not enough. People should know that if untreated the disease will spread and once that happens there is little hope of cure. They should know the examinations which may be made at home or by the doctor to help detect certain forms of the disease, as breast cancer, cancer of the cervix. and lung cancer. They should know that only surgery, X-ray, and radium can actually cure cancer and only when treatment is early-that quack treatments cost lives. Moreover, people are persistently interested in research: What have we learned about cancer that we did not know a few years ago? Has a new and certain test for cancer been discovered? A new cure?

In 1952, the national society continued to supply in great volume, to national media of communication-newspapers, magazines, radio, and television-reliable information on the curability of many forms of cancer when treatment is early, on the fatal character of the disease when untreated, on our hopes for research. It worked with other national organizations so as to encourage their interest in cancer. And it provided the divisions with counsel and educational materials in broad range-films, radio, and TV features, exhibits, posters, pamphlets.

Notable was a tour sponsored by the society in March and April of 12 nationally known science writers to research centers in 9 principal cities. Over 200 research workers were interviewed, all phases of the research outlook reviewed. Probably never before has the American public been given so much solid, well-reported information on cancer research as through the clearly written articles which appeared in hundreds of newspapers and magazines in all parts of the country. During 1953 it is planned to round out this national report with visits to other research centers.

During the year the national society continued its series of educational advertisements which are published, free of cost to the society, in space generously contributed as a public service by national magazines. In 1952 a series of adver tisements was issued urging people to protect themselves from cancer through knowledge of the disease, and a second extensive series urged support for the April appeal for funds. The advertisements appeared in magazines totaling in circulation more than 182 million readers.

A valuable service of the national office is to writers preparing articles on cancer. Readership studies have demonstrated the great interest in the disease. But articles must be accurate and well judged so as not to cause either fear or false hopes. It was gratifying that in 1952 more and more writers and editors made use of the national office for review purposes and for sound information

on cancer.

A constructive development has been the increased willingness of many newspapers to list cancer as a cause of death in obituary columns. This is by no means a routine procedure but a few newspapers throughout the country have made a practice, where families permit it, of mentioning cancer in death notices Time magazine follows this custom. In 1952 the deaths of a number of prominent persons were rather widely reported as due to cancer.