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an explanation. When we come to a country such as Switzerland that is considered to be progressive from the standpoint of advancement in medical science, or Sweden, in the latter, the cancer rate is 136.2 and the total rate is 1,088. In the United States the cancer rate is 120 as against the total rate of 1,074. No; I was using Norway figures at that point instead of Sweden, but the Swedish figures are practically the same.
I was wondering if that difference in the cancer rate between 120 and 136 in Norway and 135 in Sweden would be due to what Mr. Dolliver has said? Is there any difference in the diagnosis or treatment of it-public or private-in the United States as compared to Norway or Sweden?
Dr. CAMERON. I would be inclined to answer that one by the other factor which I mentioned and which would be applicable for the year 1940 on which, or around which, most of these figures are based and we are here talking about record keeping and recording the causes of death and correlating this information. This has been done with much greater effectiveness and for a longer period by these two Scandinavian countries than we have been able to do in the registration area of the United States. We think we have about caught up with them now.
The CHAIRMAN. Well, of course, I asked the question not from the standpoint of any sense of obligation or responsibility to these other countries but in the effort to ascertain whether there are any different methods pursued there that would enable them to get better returns than we do here.
We were speaking a moment ago about the number of beds. What would you say is the major problem of availability of beds in general hospitals?
Dr. CAMERON. I would say the major problem is the disposition of those beds. Is that an intelligent answer to your question?
The CHAIRMAN. Well, partially so; that does touch on a very important element, if you have in mind by disposition the same thing that I do. Do you have in mind the disposition so far as the locality is concerned?
Dr. CAMERON. Partly. I also have in mind disposition so far as ability to pay for hospital services is concerned.
The CHAIRMAN. That subject will be one that this committee will give considerable attention to as these hearings draw toward a close. It is very apparent with respect to hospitalization and general medical care that the very poor are able to get attention and the very rich, but today the great number of people that lie between the poor and the rich are up against a pretty stiff proposition when it comes to cancer, for instance.
I have an illustration of that in my own family that I know of and in that instance I know it has been difficult to carry on under the circumstances.
That will be given attention by this committee, but this question that I asked was with reference-not that you are a specialist in that any more than any other doctor, whether it be heart or rheumatism or whaever it might be-to what in the general picture it is that you would consider is the real problem or the major problem of providing availability of beds in general hospitals.
Dr. CAMERON. I do not think I could amplify my answer.
The CHAIRMAN. This committee has recognized that problem to the extent that we passed legislation that provides for a construction program of hospitals among the several States, based upon a certain formula, and it was adopted with the idea of providing additional hospitals to communities that seemed to be unable to have them under the present construction cost.
If any other members of the committee have any questions, I wish you would take advantage of this opportunity to ask them.
Would you answer this question: Is there more cancer now than there was 40 or 50 years ago?
Dr. CAMERON. Yes, sir.
The CHAIRMAN. What is that due to? A better knowledge of what is cancer or a better keeping of statistics, or is the growth of the disease greater?
Dr. CAMERON. I think it is due to the three factors I pointed out. No. 1, it is due to the fact we have more old people and cancer is mainly a disease of older people, so we stand to have more cancer. No. 2, it is due to more accurate diagnosis and better record keeping, and No. 3, it is due to an indeterminate degree to an increase in cancer itself.
Mr. DOLLIVER. The chairman has asked some questions with respect to the number of beds available for the treatment of cancer. As I understood you, you said there were about 1,800 beds devoted exclusively to cancer, but the number available for cancer was limited only by the incidence of the disease and the local availability of hospital
Is it the confirmed opinion of the medical profession that cancer is not a communicable disease or what is the status of the learning of the profession on that particular phase of the problem?
Dr. CAMERON. I think the widely held view is that human cancer is not communicable.
Mr. DOLLIVER. Does the medical profession generally believe that the disease is hereditary in any aspect?
Dr. CAMERON. There are evidences of certain hereditary relationships for certain kinds of cancer.
Mr. DOLLIVER. Could you specify those? I do not mean to get into any technical details if that is not proper, but I think it would be informative perhaps to the committee and to the public generally.
Dr. CAMERON. Cancer of the breast, cancer of the intestine-let us say cancer of the digestive system-and probably cancer of the female generative organs appear to occur slightly more frequently in familial lines than would be accountable for on a pure random basis.
I wish other members of this panel would amplify that if it needs it, or correct it.
Dr. HELLER. Mr. Chairman and Mr. Dolliver, there is a report in the literature apropos of breast cancer incidence which states that women whose mothers had cancer of the breast are 3 to 5 times more likely to acquire cancer of the breast than do women whose maternal ancestry did not have the disease. That has been reported in literature from reputable sources, but it has not been completely documented or supported in detail as to that exact increase, but it does suggest, as Dr. Cameron pointed out, that the tendency is toward familial hereditary traits to be involved in cancer.
Mr. DOLLIVER. Has a study been made with reference to the familial characteristics with reference to the incidence of cancer as a dominant or special characteristic in the line of descent?
Dr. HELLER. Mr. Dolliver, to answer your question directly, studies of extensive nature have been made in animals, but studies in human beings have not been possible because the human race is essentially not one of inbred people except in extraordinary situations.
I wonder if I might call upon Dr. Mider and ask if he would care to illuminate us on that subject.
Dr. Mider, have you any comments?
Dr. MIDER. The experience has already been recounted to you by Dr. Cameron and Dr. Heller with reference to mammary cancer and we are in accord on the facts. It is interesting that some trace of familial influence has been observed in the Scandinavian countries and Great Britain, and a recently published study from the United States a very brief study from New York-indicates that in a high proportion of mothers and daughters who both develop cancer of the breast, the daughter develops it at a considerably younger age than does the mother.
It has long been known that there are some familial instances of cancer in human experience, and in a very few instances families have been recorded in which the specific type of cancer has appeared in successive generations.
I would reemphasize that this is a truly exceptional phenomenon, and was studied extensively by the late Dr. Whorton, of the University of Michigan. Many physicians have within their own experience observed what they choose to call cancer families in which an apparently inordinate proportion of the family has acquired or died of cancer. Mr. DOLLIVER. Both male and female?
Dr. MIDER. Both male and female. These instances of cancer, however, have not been of any one or even a very few specific anatomical types. They have been more or less at random and have not necessarily affected successive generations.
When we go to the laboratory and use the laboratory mice and breed them together, brother and sister, in successive generations, we are able to develop strains of mice in which a specific anatomical type of cancer is readily predictable. Furthermore, it is possible to tell at about what age these standardized animals will develop their tumors. It seems, therefore, that there is from laboratory investigation strong evidence of hereditary factors playing an important role in the development of cancer. But, to obtain similar evidence by a similar type of study in man seems now impossible because of moral and ethical questions.
The CHAIRMAN. Are there any further questions, gentlemen?
May I ask just what is cancer? Can you give us some kind of a definition? What is it? We talk about it as if it was the most familiar thing in the world. What is cancer?
Dr. HELLER. Mr. Chairman, the proposition of what is cancer from an abstract scientific viewpoint is one of the most difficult things in the world. Cancer is a situation in which the cell loses its ability to grow in a normal manner. In other words, there is a removal-if I may be permitted this latitude-there is a removal of the inhibiting factor which makes a cell or a group of cells stop growing after they
form a toenail or a nose or a finger. Someone has described it as cells gone crazy or cells gone berserk. That is an oversimplification scientifically, and I think perhaps some of my colleagues could supply a more precise definition.
I wonder if Dr. Rhoads would care to comment on that?
Dr. RHOADS. I think one must oversimplify to make clear the biological problem which we term cancer. If one chooses to oversimplify one must recall that the body is composed of a number of individual tiny units or cells. Each one of these units has the power to reproduce itself. Each one of these units is in a constant state of repairing and renewing, growing old, and dying. So, large biological units, such as our bodies, are simply a composite of an enormous number of individual tiny units that we call cells.
We have felt it proper to use the example of grass and weeds. We believe that the cancer cell can be compared to the growth of weeds in a lawn of grass, the cancer cell being more aggressive and more competent under the particular environmental circumstances in which it finds itself than are the normal cells. You see in cancer as a process in the body under the microscope what you have seen many times when weeds have invaded your lawn.
The tendency of biological units of any type, whether they be bacteria or body cells, is not only to reproduce themselves exactly, but also to inherit characteristics indicated by what we call sport or mutation and confer upon the progeny aggressive types of competence not possessed by the brothers and sisters or by the parents. They continue to grow uncontrolled and destroy bodily structures.
The CHAIRMAN. What causes this abnormal growth that is frequently spoken of as sometimes resulting from a blow? If that is the case all of these prizefighters ought to be dead with cancer or dying fast, according to the blows they get. Does that have anything to do with it, injuries?
Dr. RHOADS. It is very hard to escape the conclusion, though_still very difficult to document in court, that injury can play a role in the development of cancer, providing the tissue injured is already inclined to be cancerous.
The CHAIRMAN. I assumed when I asked the question that, of course, you could answer that you would have the cure for it.
Dr. RHOADS. No, sir; that does not necessarily follow unless we could not only define the cause, but also remove or neutralize this
The CHAIRMAN. I think finding the cause, you might be able to conquer it in the way you have just explained here.
Dr. RHOADS. Yes, sir; we would be very happy indeed, and we do now know a number of causes of cancer. Cancer can be caused
in men and animals by X-rays or the rays from radium, and as you know that is one of our great fears in the case of atomic attack and indeed there is evidence that the incidence of certain forms of cancer has increased in Japan following the injury from the bomb, still very slight evidence, but quite suggestive.
We can cause cancer in man and animals by certain chemicals which have been prepared by the chemist in his laboratory and tested. We do have in our bodies chemicals that cause cancer in experimental animals. There is also the hazard resulting from X-rays and certair chemicals encountered in industry.
The CHAIRMAN. Does the question of diet have any effect on cancer? Dr. RHOADS. There is unequivocal evidence that restriction of caloric intake and dietary restriction in experimental animals will reduce the rate of occurrence of the cancer to which these animals are liable spontaneously and will reduce the tendency of these animals to acquire cancer after exposure to sunlight, X-rays, and cancer-producing chemicals. The lessened functioning of the glands of internal secretion which follows this dietary restriction is presumed to lead to the result of reducing the incidence of cancer.
The CHAIRMAN. Does the American Cancer Society or any other agency that is interested in the question of cancer indicate the kind of a diet that would be helpful in preventing cancer or making it less likely, or that would promote it?
Dr. RHOADS. May I refer this back to the Director of the National Cancer Institute?
Dr. HELLER. I am not sure that that could be answered to your satisfaction because it has not been established scientifically, to my knowledge. I wonder if Dr. Mider has any elucidation on that. Dr. MIDER. This is a very complex problem.
The work that Dr. Rhoads referred to involved the quantitative restriction of an adequate diet. The animals were given less diet than they would have chosen had they had the choice. A dietary essential was restricted, and it resulted in a marked decrease in the number of cancers of the breast that followed.
There is cancer of the liver which can be readily produced with a particular dye, but this dye produces cancer only when the diet is restricted in a very important vitamin. If animals can eat all they want to, if they eat a highly nutritious diet they develop comparatively little cancer of the liver. If, however, the riboflavin content is reduced they develop a lot.
It is interesting, however, that studies of certain segments of the human population purport to show that cancer occurs more frequently among those who are considered to be overweight.
The CHAIRMAN. I hope that does not apply to any of the committee. Is there a tendency for cancer to be more pronounced in some countries than others, having in mind the different diets that are used in different countries?
Dr. MIDER. I am afraid, Mr. Chairman, that I cannot answer that categorically, although I believe some members of this panel might submit suggestions.
Cancer of the liver occurs more commonly in Africa than in the United States, which might have something to do with dietary considerations.
The CHAIRMAN. Have you found in your studies, or experiments, that animals, dogs, mice, or whatever it is that you wish to use as an illustration, develop cancer without it having been inoculated into them? In other words, is there a natural cancerous growth in any animals that you know of, that is, either domestic or wild animals? Dr. MIDER. Yes, sir; almost all of the animals that have been studied have some incidence of cancer, including those which are wild, when they are incarcerated in captivity. It is a problem which is not limited to man or even to mammalia. The loss to chicken breeders from various forms of cancer is not inconsiderable.