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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.
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. Education, 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
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 advertisements 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
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.
Motion and still pictures tell the cancer story clearly and quickly. Many hundreds of still pictures showing research and other cancer activities were taken during the year. Especially noteworthy was the release of the society's color motion picture, Man Alive, produced by UPA, creators of Gerald McBoing-Boing and Mr. Magoo, employing clever psychological characterization to stir men from a dangerous apathy concerning the threat of cancer to them.
Life magazine, with about 13 million readers, devoted 4 full pages to a highly favorable review of Man Alive, saying "grim but funny." The Saturday Review of Literature, in a roundup of comment on meritorious educational films, said "local and State cancer groups have done remarkably well in having their films brought to the public eye ** Man Alive makes a lively and sensible addition to any kind of adult film program." By the end of the year, the picture was being widely shown in commercial theaters in divisional areas, as well as to many smaller gatherings. Six hundred and thirty 16 mm. prints were in use by the divisions at the year's end.
Breast self-examination, the effective 10-minute movie jointly produced by the society and the National Cancer Institute to lead the precision attack against breast cancer, continued to be widely shown in 1952. About 2 million women have seen the picture since its release 2 years ago. But nowhere near enough women have yet seen the film or learned the wholesome health practice it teaches. In radio and television the national society was greatly aided in 1952 in the educational work of the April appeal by a skilled advisory committee for radio and television on which 30 advertising agencies were represented. In result, the usual support of the radio and television networks during April was more generous than ever.
The national office produced and distributed through the divisions in 1952 for local radio stations 450 sets of a new series of transcribed dramatic programs on cancer, But Where Today? Well received, also, by local stations was a new series of musical transcriptions, Songs for America, each with a 3-minute cautionary message from the society-715 sets were employed by the divisions. Slides and other visual materials for television were also provided in large numbers.
Cancer News, the national society's popular magazine, was given a new format in 1952 and a new appeal for the general reader in illustration and content. It reached with timely articles on developments in the cancer control movement 70,000 readers every quarter. The ACS Bulletin, a fortnightly for operational personnel, continued its aid on "how-to-do-it" for volunteers, division and unit staff people. Circulation is 13,000.
Service to divisional educational activities required the production and shipment on order of the divisions of 12,888,390 pamphlets, 168,705 posters, 1,648 films, 6,871 cardboard-display units, 1,326 sets of radio transcriptions, and 169 sets of TV films and slides. The count does not include educational materials prepared by the national office for divisional use in the April appeal-in all, some 40 million additional pieces.
An important technical service of the year to the divisions was the completion of a new Handbook for the Public Education Chairman of a Unit of the American Cancer Society. The handbook reflects experience in community educational activities of postwar years. In it, permanent programs are outlined under five main heads-mass media, business and industry, organized groups, schools and colleges, and neighborhood programs. The divisions aided in the preparation of the booklet, indeed it was their hard work which formed it. It should go far to strengthen community educational activities in coming years. Divisional and unit educational programs owe much to local leaders in health and adult education. For this reason, the national society participated in 1952 in national conventions of the American Public Health Association, and the National Association for Adult Education. It joined in meetings of the American Library Association, the National Conference of Social Work, the National Science Teachers Association, the National Conference for Cooperation in Health Education, the Society of Associated Industrial Editors, and for the second year, in a joint conference of the Industrial Medical Association, American Association of Industrial Nurses, and the American Association of Industrial Dentists. It continued its effective liaison with the United States Public Health Service, the Extension Service of the United States Department of Agriculture, the United States Office of Education.
The doctor's office is the key. Will people, in the mass, go to it in time? Will the doctor-and he has seen too much late cancer-be able when people come to him to detect the beginnings of the actual disease? It will be fatal if not treated early. Shall we wait for the sure, quick, cheap test-the certain cure or shail we try it now, the hard way?
All the doctor's instincts, and actions of his official associations as represented everywhere in society councils, say try now-the hard way. The society's professional educational program is based on that decision. The effort is idle if the doctor has not made the decision himself.
What doctors want, they say in the aggregate, is help for the average practicing physician in his fight with the disease as he must meet it in his office, in his round of calls. The society's professional educational program is designed to give him every help. The program emphasizes earlier detection and diagnosis. It seeks to take to the doctor in all parts of the country tests for cancer such as the effective smear test and to encourage, as routine, better-known procedures such as chest X-rays for lung cancer. It seeks to back up this information with established information on treatment procedures, so that when the diagnosis is made treatment will be positive, prompt, the best available.
Once again, in 1952, the national society made wise use of publications in professional education. It continued to publish and distribute through the divisions to 54,240 readers, CA-a Bulletin of Cancer Progress, the society's effective bimonthly digest of cancer information for the general practitioner. It continued its support for Cancer, the distinguished bimonthly for physicians and scientists specializing in the cancer field. It continued in Cancer Current Literature, to issue the only monthly index of world cancer literature, widely consulted and made use of in medical libraries, schools of medicine, research and medical institutions.
The national society released during the year the seventh and eighth of the Cancer Monograph Series on early diagnosis for general practitioners. The new titles are "Cancer of the Esophagus and Stomach" by Dr. Owen H. Wangensteen, and the "Value of Early Diagnosis of Malignant Lymphomas and Leukemias" by Dr. Lloyd F. Craver. The monographs were distributed in 1952 to 190,000 practicing doctors, hospital residents, and internes.
Late in 1951 the medical teaching film Uterine Cancer; the Problem of Early Diagnosis, was introduced to the profession at the interim session of the American Medical Association at Los Angeles. The fourth in a series jointly sponsored by the society and the National Cancer Institute, the film emphasizes the detection of cancer of the uterine cervix in the noninvasive stage when cure rates of 75 to 100 percent are possible. The precision detection technique of vaginal smears is demonstrated in the picture. In its review the Journal of the American Medical Association said "highly recommended for the general practitioner, the advanced medical student, and hospital staff meetings."
Since the start of the professional film series 5 years ago, 922 prints of the four films produced have been distributed: 352 to divisions, 192 to State health departments, 136 to medical schools, 119 to foreign countries, 193 to the Department of State, Armed Forces Medical Services, and other agencies.
The national society expanded the services of its professional film library during the year; the 622 requests accommodated nearly doubled those of any previous year. One hundred and eighty-eight sets of the society's kodachrome slide library of 482 slides of lesions of early cancer were in use by medical lecturers in 1952.
Several new exhibits were made available for medical meetings during the year. A comprehensive exhibit on cancer of the uterus was first shown at the June convention of the American Medical Association. An exhibit on lung cancer was introduced at the annual meeting of the National Tuberculosis Association in Boston in May. A new exhibit for nurses had its initial showing at the 1952 biennial nursing convention in Atlantic City in June.
Clinical fellowships program
The national society's fellowship program for younger physicians has become the most comprehensive medical fellowships entrprise undertaken by any organization-voluntary, governmental, or private. Since its beginning in 1948 through June 30, 1952, 202 younger physicians of promise have received advanced training in medical specialties bearing on cancer, such as surgery, radiology, internal medicine, pathology, and gynecology. At the end of the academic year on June 30, 70 physicians were in training in 35 institutions. At the beginning of the
new training period on July 1, the number was increased to 75 physicians in 36 institutions. In addition, the society gave financial support in 1952 aiding the training of 43 younger physicians in the 4-year training system of the Memorial Cancer Center in New York. What is more, medical institutions approved for graduate training have been informed the society's fellowship program will be expanded, effective July 1, 1953, to allow the advanced training of 88 physicians in that year.
In 1952, additional fellowships in exfoliative cytology were awarded to 8 pathologists, bringing to 38 the number receiving training since 1948 in this vital diagnostic technique.
This sustained training activity is saving lives today, in every State through the influence of these specially trained physicians. It is carried as a regular portion of the budget of the national society; $330,840 was devoted to the program in 1952-$900,195 since 1948.
National cancer meetings
The exchange of knowledge between physicians and research workers is of the highest importance in the fight against a disease so complex, varied, and little understood as cancer. In cooperation with medical and scientific groups, the society supports these meetings in many forms-refresher courses, seminars, teaching days, clinics-national, within the divisions, in cities and counties of the units.
At the national level, the society and the National Cancer Institute sponsored the first national cancer conference, held at Memphis in 1949, attended by over600 doctors and scientists. In 1952, the society joined with the Institute and the American Association for Cancer Research in support of the second national cancer conference, held in Cincinnati in March. At Cincinnati, more than 1,400 physicians and scientists from all parts of the United States and several foreign countries heard 325 presentations summarizing recent clinical and research findings on cancer. Proceedings of the conference are being published by the society.
Scientific sessions of the annual meeting of the society in October brought together another group of over 1,000 physicians for a 3-day discussion of radiation versus cancer; a critical evaluation. Published proceedings of the sessions will be made available to the profession in the near future. A smaller meeting of medical leaders sponsored by the national society in 1952 was the lung cancer conference, held at Chocorua, N. H., in September.
The grants are made upon recommendation of the medical and sicentific committee to support nonresearch undertakings which further the control program. In 1952, the American College of Surgeons, the World Medical Association,