program of the Forsyth County unit of the North Carolina division for banking and insurance company employees at Winston-Salem; and programs in the District of Columbia for thousands of employees of Government agencies.

Labor organizations have been very active in business and industry programs. In some unit areas joint labor-management committees supervise the programs. Labor cooperation has been highly effective in Michigan, Minnesota, and Mississippi. Unions with large numbers of women workers have been active in breast self-examination programs, especially Amalgamated Clothing and ILGWU

locals.

At military installations programs were given at Tinker Field, Okla., reaching 24,000 servicemen and at Hill Air Base, Utah, for 13,000. A breast self-examination program was conducted at Sheppard Air Base, Tex., for the wives of service personnel. Man Alive! was projected during the April crusade for 30,000 servicemen at the Great Lakes Naval Training Station, Great Lakes, Ill. The society's radio series, Music America Loves, carrying the society's message, was broadcast in full to 18,000 employees of the Brooklyn Navy Yard over the public-address system. Seventy-two sessions, involving talks or showings of films, were conducted for employees of the Marine Supply Depot at Philadelphia. The Maine and New Hampshire divisions combined in a program at the Portsmouth Navy Yard.

Many audiences, many channels

A few examples-programs on Indian reservations in Iowa and Texas; programs for the blind in Brooklyn; a crusade educational program conducted with the help of Eskimos at America's "farthest north," Point Barrow, Alaska; a "woman on horseback" who crusaded in New Jersey; a benefit concert by the Montana Prison Band; a story of a former patient who had been helped by the McKeon County unit, Pennsylvania division, won in an essay contest sponsored by the Julius Mathews Agency of New York; educational programs in 11 publichousing projects in Brooklyn; a display of cancer costumes for fashion editors in the District of Columbia-depicting surgeon, radiologist, nurse, the volunteer; a cancer warning on the marquees of drive-in theaters in southern Illinois; cancer literature distributed through comfort stations of the Seaside Oil Co., Santa Barbara, Calif.; "Welcome Wagon" cancer leaflets for new arrivals in Westchester County (N. Y.) and New Mexico.

The Cedar Rapids, Iowa, celebration

One of the outstanding educational events of the year was the Thanksgiving celebration held in April at Cedar Rapids, Iowa, sponsored by the Linn County unit. Here the 70,000 citizens of Cedar Rapids celebrated the fact that about the same number of people as their total population had been saved from cancer in the United States in the past year. Colorful ceremonies marked the event. Amongst many activities were special church services, displays in shop windows prepared by volunteers, high-school programs including an essay contest, and a municipal parade witnessed by 25,000, led by bands and 12 Cancer Crusaders clad in armor and mounted on matched Palomino horses. A dinner attended by 173 persons who had been cured of cancer climaxed the celebration. The event was carried over the Columbia Broadcasting System television network as an offering of See It Now, Edward R. Murrow's national telecast.

1952 Unit Cancer Crusade citations

Crusade citations are made not alone to honor exceptional accomplishments, but to call attention throughout the society to programs which may be advantageously developed in other areas. Besides the citation already mentioned to 15 units of the upper peninsula district of Michigan for their notable program in support of a cytology laboratory, units in Florida, Pennsylvania, and South Carolina were honored in 1952.

Allegheny County unit, Pennsylvania

The unit, with headquarters in Pittsburgh, was cited for its Survey of Public Knowledge About Cancer, conducted by volunteers in 1951 with the cooperation of the American Institute of Public Opinion (Gallup poll) and the national office staff. The survey was a combined educational and factfinding program.

The citation reads: "Volunteers used professional methods to carry out an educational project that provided guiding data for future programs. Public opinion studies are important weapons against cancer."

Duval County unit, Florida

The citation was made for a well-developed general cancer control program serving the people of Jacksonville and surrounding Duval County. Continuing year-round education is conducted through civic organizations. The film Breast Self-Examination has been widely shown to groups and in theaters. A school program has reached high school students over a 4-year period. An information center is maintained which also houses a loan closet. Articles for patients are donated by church and civic groups; dressings, made by women of church organizations. A nursing service for indigent patients is maintained through the Visiting Nurses Association; transportation, housekeeping, and child care programs conducted. In cooperation with the Duval County and

State boards of health, a hospital cancer clinic is supported, served by volunteer doctors and volunteer aides. The unit instituted in 1947 the First Annual Southeastern States Cancer Seminar for doctors and was host again in 1950 for a large group of doctors assembled for the meeting. A nursing institute was conducted in April. In the 1952 campaign the unit attained 123 percent of its goal.

Union County unit, South Carolina

The Union County unit citation honors a notable all-round program. The unit serves a medium-sized county of the State, with a largely rural population of 31,529. Educational data reaches every home in the county. Breast SelfExamination has been widely shown to women. All women are urged to have regular examinations—a large percentage regularly visit the detection clinic or are examined by their own physicians. A chest X-ray program in cooperation with the State board of health has been started. A speakers' bureau of volunteer doctors and nurses is maintained. From One Cell and The Traitor Within have been shown in each of the high schools. Newspapers and radio stations cooperate vigorously. Each year an exhibit is presented at the Union County Fair, staffed by unit volunteers. Indigent patients are helped with a service program which includes nursing care, transportation, the provision of drugs, loan closet supplies, dressings made by local groups of women. Thus the people of Union County have become "cancer conscious" and generously support the cancer crusade with their contributions. In 1952, Union County contributions were 220.7 percent of quota, supporting an even stronger program in 1953.

RESEARCH

Again, in 1952, the society assigned a far greater proportion of its resources to research than any other major voluntary health organization. Since 1945 the society has allocated nearly $25 million of the funds contributed by the public to research, and to train the manpower needed to sustain research in the years ahead. What has been accomplished?

The ultimate research goal is to discover the basic nature of cancer in manto establish means for preventing cancer, or for curing it readily if it strikes. Progress has been slow but steady. Each year has seen a broadening accretion of basic facts about the growth process, normal and abnormal.

We know this ultimate goal still lies ahead-just how far is impossible to say. But we ask the practical question, a question that can be answered specifically. What can be done today for the cancer victim that could not be done before the national research attack on cancer was launched? Recent authoritative statements given in testimony before congressional committees during the year and in papers at the society's annual meeting point to some of the answers. Surgery, radiation—still the only cures

Surgery and irradiation are still the only recognized cures for cancer. But cure rates of certain types of cancer treated by surgery have been significantly improved through advances in cancer surgery techniques. Cancer surgery has become bolder, more extensive. Besides removing malignant tissues and adjacent lymph nodes, surgeons today often find it possible to the great advantage of the patient to remove adjoining organs and tissues that are frequent sites of extension. Inhibition of tumor growth, through alteration of hormone balance by surgical removal of endocrine glands, is another example of useful cancer surgery. Cancer can often actually be prevented surgically by the removal of certain benign growths, such as intestinal polyps, which may become malignant in time.

Important new methods in surgery have raised some cancer cure rates. Control of hemorrhage, control of secondary infection by antibiotics, better anaes

thesia, control of body chemistry and other advances in surgical techniques have considerably raised the probability of favorable outcome for cancer operations. In radiation treatment of cancer, the development of new and more powerful radiation sources, through advances in physics and engineering, have vastly enhanced its effectiveness. Supervoltage X-ray generators operate in therapy at several million volts with promising results. The betatron and other particle accelerators provide new types of radiation at voltages as high as 350 millionssoon to reach a billion volts. In addition to more powerful irradiation, ingenious improvements have been made in methods for applying radiation. For example, rotational therapy, in which the patient is fastened in a chair and slowly rotated underneath an X-ray beam, makes it possible to pin the radiation on the cancer with minimal harm to neighboring tissues.

Radioactive isotopes, widely available only since research on atomic energy has reached its full stride, have now made it possible to apply radiation therapy with particular advantage to certain malignant conditions formerly difficult of approach. Radioactive iodine is valuable against cancer of the thyroid gland. Radioctive phosphorus is useful gainst chronic leukemia, and against another malignant condition of the blood stream called polycythemia. It has been possible, indeed, to keep polycythemia patients alive and vigorous for their normal life span through treatment with radioactive phosphorus and sodium. Both radioactive iodine and radioactive phosphorus have practical value also in the localization of brain tumors and make possible their removal with improved precision.

Skillful and resourceful combinations of surgery and radiation are today making possible cures of cancers that could not in the past have been effectively treated by either method alone.

Chemotherapy of cancer

Although the use of chemicals against cancer-so-called cancer chemotherapyis not established as a cancer cure, certain chemicals have been found to have ancillary value when used with irradiation. Perhaps even more important, certain chemicals have proved value in the palliation of incurable cancers, permitting the victims of some types of cancer to survive for extended periods in comfort and with sufficient vigor to lead productive lives.

Materials now effectively used in the chemical treatment of cancer-either alone or in combination with other treatments—include hormones, nitrogen mustard, triethylenemelanine (TEM), triethylenephosphoramide and folic acid antagonists. Cancerous conditions that have been benefited with such chemicals, although not cured, include Hodgkin's disease, chronic leukemia, acute leukemia in children, lymphosarcoma, neuroblastomas, embryoma of the kidney, certain brain tumors, some cancers of the breast, of the lung, of the bladder, and of the prostate gland.

Before 1947 a child who fell prey to acute leukemia usually survived less than a year. There is still no cure. But today, with skilled application of the folic acid antagonists, 30-50 percent of children with acute leukemia enjoy almost complete remission of symptoms for worthwhile periods of time. Treatment by such means of one group of almost 400 children produced relief and increase in the survival period of approximately two-thirds. One child lived almost 4 years after the onset of acute leukemia, and another is alive today after more than 3 years.

Chemotherapy survey

Chemotherapy has been so effective against other diseases, and results in cancer treatment so promising, that the society in 1952 visited the leading investigators and laboratories in the field to see how the chemotherapy research program might be enlarged and made more effective. Pharmaceutical concerns were approached and gave assurances of their wholehearted cooperation. Industrial concerns of America have helped to fight cancer-many of the compounds tested for effectiveness against cancer are of industrial origin. A report on the survey, received in December 1952, indicates several promising courses of action for the society to follow in 1953.

Fighting for small percentages

Perspective on the avenues of progress in cancer research was provided by Dr. Paul E. Steiner, president of the American Association for Cancer Research, in his presidential address at the 1952 annual meeting of the association in New York in April, Dr. Steiner said: "Progress in the past has been slow in human cancer, as in tuberculosis and some other diseases, but it has been steady. Decade by decade things get better. Progress has consisted of eroding away

a few percent from the mortality of one kind of tumor this year and a few percent from another type at a later time. The sum of these small victories adds up to the impressive figures totaled for some cancers. Progress of this type can be expected to continue. It is slower than we would like, but it is acceptable, since it could eventually infiltrate and eliminate the mortality problem. This solid progress in no way precludes the possibility of sudden, dramatic advances.

****To the initiate, progress in terms of a few percent is apparent; to the others it is not. We are fighting for small percentages in each type of cancer and are grateful for the sum of numerous small conquests. Decade by decade they add up to perceptible, if not entirely satisfactory sums."

Growth in cancer research support

The specific steps of laboratory progress, while important, do not give the complete picture of the massive growth in cancer research of the postwar years. Development has been in two areas: First, there has been a vast expansion of laboratory facilities across the country, aided by the training of hundreds of scientists to man them; and second, a more intangible change, there has been a shift in viewpoint among researchers from pessimism to a reasoned optimism. Since its reorganization in 1945, the society has assumed a leading position in supporting and stimulating cancer research in this country. Up to that time too little had been done to give scientists the tools, the encouragement, and the financial support they needed to launch into cancer research. Before the war, the number of determined senior investigators in the cancer field was severely limited-they were numbered in dozens, not hundreds. Great work had been done by brilliant and resourceful men and women, but among scientists in general the attitude toward cancer was gloomy and young men were reluctant to enter a field that seemed to offer so little promise. Scientists used to say with a bitter smile that cancer laboratories ought to have a sign reading "Abandon hope all you who enter here."

TABLE 1.—Summary of the society's research program—1945–52

The society's research program has three major parts:

(a) Grants-in-aid.-Awarded to universities and scientific institutions for specific_research projects under designated investigators.

(b) Institutional research grants.-Awarded to research institutions for coordinated programs conducted by groups of investigators.

(c) Research fellowships and scholar grants.-Fellowships are awarded to specific individuals undergoing training in designated institutions-scholar grants are awarded to institutions for advanced training of designated individuals. The research funds have been allocated to these categories, as follows:

(a) Grants-in-aid__

(b) Institutional research grants_.
(c) Fellowships and scholar grants____

Total 1945-52---

$12, 204. 887. 72

10, 312, 715. 16 2,056, 991. 55

24, 574, 594. 43

Informal studies indicate that not more than a million dollars a year was available from all sources for cancer research before 1941. Today the figure ranges above $15 million annually. Approximately 1,800 first-rate scientists are now devoting much of their time and thought to cancer research. A good share of their work is in new laboratories, constructed since 1945.

To explain the change in the climate of opinion that surrounds a vital research problem, such as cancer, is never easy; but it does seem clear that the society has been a major factor in the development of a more positive and hopeful approach. Today the difficulty is to decide what research to select for support from the many who apply for grants and fellowships; there is not now nearly enough money to meet the requests. A few years ago-in 1946 and even in 1947-the problem was different. Then, the society had to persuade institutions and scientists to undertake cancer research; interest had to be aroused in students; assurance had to be given that financial support would not in a year or two wither away. Of fundamental importance were the annual crusades of the society, fund

raising and educational, which provided money for research, stirred public interest, gave direction and hope to the entire attack on cancer.

When it was clear that voluntary contributions would not be enough to underwrite the total research attack, the society joined others in urging larger appropriations for the National Cancer Institute. Although not all that was needed has been voted, the Congress has shown a remarkable and constantly increasing understanding of the cancer problem.

Today cancer research is supported principally from four sources: Private funds, the Government, public contributions, and by funds of universities, hospitals, and other institutions conducting cancer research. In the total picture, the society has played a major role, both in the research that the society itself supports and in its influence on the programs of other agencies. Table I shows that since the society's reorganization in 1945 it has allocated nearly $25 million for research. This table also explains the types of research grants made by the society. Table II shows in detail the society's 1952-53 research program. The committee on growth

The society's scientific adviser on research, the committee on growth, was established in 1945 as an operating unit of the National Research Council through contract between the society and the National Academy of Sciences. The committee maintains a small, highly competent full-time staff at National Research Council headquarters in Washington, D. C. The heart of the operation, however, is the committee itself and its advisory panels, comprising over 100 of the country's leading scientists. These scientists contribute their knowledge to the society; they receive no compensation. In 1952 the committee and its panels had to consider in detail 337 applications, comprising 2,246 pages of typewritten text. Nor are services of the committee limited to consideration of written applications, for often committee or panel members, or staff personnel, pay visits to institutions applying for or having society research grants.

It will be seen that deliberations of the committee and its panels concerning applications for research grants provide the society with a machinery for the constant evaluation of research progress. As projects and fields of inquiry are reviewed and studied year by year, decisions of the committee give impetus and encouragement to those of the greatest scientific promise. Thus the program as a whole is kept in step with broad advances in scientific knowledge, and its many parts related to each other in a coherent, carefully judged manner.

The entire research training program of the society-fellowships and scholar grants-is based upon committee on growth recommendations. Such training is one of the society's basic contributions to research; for through it new ideas, and the vigor of new investigators, are constantly added to the cancer fieldand future generations of cancer scientists provided. These fellowships are in addition to the society's medical fellowships, referred to earlier. In 1952, upon recommendation of the committee, the society awarded 73 research fellowships and research scholar grants, totaling $272,600. Since the start in 1946 of the society's research fellowships program, 376 fellowships and scholar grants have been awarded, totaling $2,056,992.

The grants-in-aid approach

In table II, those sections of the society's research program awarded under recommendation of the committee on growth are shown in the columns indicating grants-in-aid, research fellowships, and research scholar grants. This program represents about half of the research dollars annually granted by the society. Although administratively each grant-in-aid is handled as a separate project, the individual studies as a rule are parts of substantial cancer-research programs carried on within the various institutions. In 1952, the society awarded 262 grants-in-aid to 101 institutions, totaling $1,713,363. Since the start of the program in 1946, 1,455 grants have been made totaling $12,204,888.

Following are typical examples, from various sections of the country, of cancer research made possible by the society's grants-in-aid program:

Skin cancer: At the University of Oregon, in Portland, four different research groups are pursuing cancer studies, under grants from the society and other agencies. One of the Oregon scientists for over 5 years has been studying melanomas-pigmented cancers that occur in human beings and animals. He has found that the pituitary gland regulates activity of the pigment-producing cells that give rise to melanomas. The scientist and his coworkers have identified a specific hormone in human pituitary glands that stimulates the pigment cells. The Oregon group is now engaged in purifying the hormone. so that its precise role in normal and abnormal functioning of the pigment cells may be clarified.

39087-53-pt. 1-17