has a number of opportunities to seek and obtain support. He can turn to the National Cancer Institute and make application for funds there. He can turn to the Committee on Growth of the National Research Council to apply for funds, which may come through the American Cancer Society. He may turn to the Damon Runyon fund for similar support; or other private organizations, like the Jane Coffin Childs organization, the Pardee Foundation, or the Anna Fuller fund. Any of such organizations will receive his application and give it careful thought. They will seek the advice of the persons who seem best qualified to advise the donor as to the allocation of funds.

In the case of the Public Health Service there was created by lawI think in the law which was reviewed by this committee and recommended to the Congress-a National Advisory Council to the Surgeon General. We have a National Advisory Cancer Council which was created by law and which is composed of 15 persons. The individuals who review the applications on the Council also have the assistance of large panels of individual scientists whose recommendations, combined with the knowledge of the members of the Advisory Coun cil, are transmitted to the Surgeon General; and on the basis of that the Surgeon General makes awards.

I shall not attempt to go into details as to how other agencies operate, but it is very similar. As you heard this morning, the committee on growth of the National Research Council makes similar recommendations to the American Cancer Society, and it does so on the basis of recommendations of individual scientists scattered all over the country, who come together to advise the committee on growth and the American Cancer Society.

Now the research programs of the various agencies are very similar in their character, because the basic problems of cancer research fall into general areas.

As you have heard before from Dr. Cannan, there are other causes for the inciting of cancer through extrinsic or intrinsic factors. There is the problem of the nature of the tumor or the cancer and the characteristic by which it grows and multiplies; there is the problem of diagnosis, and the hope that, through biochemical means, we will find means of early diagnosis. And then there is the problem of therapy.

Rather than attempting to cover the whole field, I might point out that with the approximately $5 million which the Congress appropriated for the National Cancer Institute to dispense in research grants for cancer, there have been supported approximately 500 research projects. If you are interested in some sort of figures, you might guess that there is at least 1, and probably an average of 3 professional persons, associated with each of these research grants.

So that for just those projects which are supported with tax funds through the National Cancer Institute, there are probably in the neighborhood of 1,500 professional scientists of different degrees of development who are working on these problems.

Now, those individuals have had to get training, and one of the greatest needs in our whole research field is probably the development of new ideas in the approach to the cancer problem; new ways to explore the old problem, and consequently the fellowship program is a very important part of our training for future research.

The National Cancer Institute has been able, with the approximately $625,000 provided for fellowships, to train about 162 fellows in the field of cancer research and the allied fields that are basic to it. As Dr. Cannan pointed out, each year the American Cancer Society has a simliar fellowship program, a similar research grant programand I wish there was time; there should be time for you to have and I think you will have in the record from each of the various organizations, such as the Damon Runyon fund and other societies, a statement describing the research grants, the peoples supported by them, and the people who are being trained by them.

I think in order to save time, I should call a halt here.

The CHAIRMAN. I am very anxious to have all the information that is available from any of these organizations.

It has been my intention to call upon Mr. Teeter before this session ended today, to give information for the record concerning the Damon Runyon Foundation to which you have just referred.

As to the others, I hope you will all feel the utmost freedom in making available to me whatever information you wish placed in the record to supplement what you have testified to here today, because I realize there has been a pressure of time that has probably prevented each of you from saying all that you wanted to say-certainly prevented you from saying all you could have said.

For that reason, I want to keep the record in such shape that we will have the benefit of whatever you think ought to be in there on this subject.

Dr. HELLER. Mr. Chairman, in further extension of this control discussion which we had, control used in the narrower sense of the word— the translation of what we know and what we learn and get to the public, I should like Dr. Cameron to indicate the concepts of control and some of the applications which are observed not only in the American Cancer Society but in control generally.

Dr. CAMERON. I think this committee must be fundamentally interested in knowing whether the method of cancer control is an effective

one.

I propose in less than 5 minutes to give you some of the early theories of this 40-year program of cancer control, which, as you have heard, is based on education of the public, increased alertness of doctors and the provision of adequate facilities for detection, diagnosis and treatment.

You will first notice that in charts 11, 12, and 13 there have been three different studies of the factor of delay. There has been a constant decline during the period of measurement in the interval between the onset of cancer symptoms and the time the patient consults his doctor. If this is of value in the control of cancer, it should be reflected in increasing survivorship rates, and those I am going to run through quickly.

Dr. Rhoads has alluded to their study-the Vermont study. In the year of 1937 of all patients with cancer admitted to Vermont hospitals, only 20 percent had localized disease and were considered candidates for cures and treatment. In their study covering a period of 10 years, the proportion of patients with cancer admitted to State hospitals with localized disease had risen to 58 percent. Of all patients with breast cancer seen at the Mayo Clinic between the years 1910 and 1919, 63 percent already had extensions of the disease from

the breast to the glands in the armpits, with relatively unfavorable setting for cure.

Of the patients sent to the clinic during the year 1945, only 45 percent had cancer of the breast in that unfavorable state.

This improved outlook, of course, is reflected in the survivorship rates both at the Mayo Clinic and in our own hospital. Of the number of patients suffering with breast cancer which could be operated upon in 1936, 47.5 percent were living 5 years later, but of the group seen in 1942, there were 60 percent living 5 years later without any significant change in the treatment technique and Dublin has shown among the female policyholders of the Metropolitan Life Insurance Co. a very substantial drop. There has been 11 percent decline in the death rate of cancer during a 10-year period, and in the age group from 55 to 64, when cancer is most common, there has been a 15-percent decline in the death rate.

The State with a respectable registry of cancer-a statewide cancer registry-is Connecticut and I will cite the figures from there briefly. Of the patients with cancer-and they know of 95 percent of all patients with cancer in the State so far as it is possible to determine of all patients with cancer who were registered in the Connecticut Tumor Registry as having had cancer in the year 1935, there were 18 percent living 5 years later of the males, and of the cancer-registered patients in 1941, there were 25 percent living 5 years later, Among females in the State of Connecticut, 25 percent were alive 5 years after they were registered in 1935. But, of the group regis tered 6 years later-in 1941-there were 40 percent living at the end of 5 years for males and females.

This improvement, from 22 percent at the end of 5 years for the 1935 registered group, to 33.5 percent survivorship 5 years later based on the 1941 group, is significant.

If you will look at the table of the trends in cancer between the years 1933 and 1946, which are before you, you will see that cancer of the pancreas, of the prostate, of the intestinal tract, of the ovary, and of the larnyx is increasing, but at rates which are of doubtful statistical significance.

There is no question whatever about the significance of the increase in cancer of the lung, but cancer of the skin, of the kidney, of the bladder, stomach, rectum, breast, uterus, the esophagus, tongue and lip, are either not increasing or are decreasing. These are figures covering a 13-year study period. I think these are heartening records and I think they indicate that the mechanism for cancer control may well exist.

Dr. HELLER. Thank you, Dr. Cameron.

The CHAIRMAN. Are there any questions?

Mr. CARRIGG. May I inquire if that same kind of survey as conducted by the New England States has been carried out on a nationwide basis?

Dr. CAMERON. No, it has not.

Mr. CARRIGG. Those are merely technical spot checks?

Dr. CAMERON. Yes, sir.

The CHAIRMAN. Is that information which you have just given in any of these documents that have been previously handed to me? Dr. CAMERON. Yes, sir; it is, sir.

The CHAIRMAN. Are there any further questions, gentlemen?

Dr. HELLER. Mr. Chairman, I should like to call upon Dr. Wermer of the American Medical Association to complete any remarks or information he may have for us apropos of the Research Foundation of the American Medical Association, or their relationship to the control activities.

Dr. WERMER. Mr. Chairman and members of the committee, the American Medical Association, since it is an association representing most of the physicians practicing in the United States, would be most interested in the treatment measures that could be applied by most physicians without any special skills in the treatment of cancer.

As you realize after hearing the description of method or treatment outlined by Dr. Farber and Dr. Rhoads, rather skillful people must administer some of the treatments outlined.

In 1946 there was reported a form of treatment of cancer of the breast which had spread beyond the breast and had become inoperable and not available to treatment by any one form but use of sex hormones-male sex hormones. That report initially in the United States came from Dr. Rhoads' institution, and shortly thereafter Dr. Nathanson, of Boston, who is present, made a report on the use of estrogen-that is the female sex hormone-in the treatment of cancer. The subcommittee on steroid and hormones of the Committee on Research was then formed and both these men-Dr. Adair of the memorial group and Dr. Nathanson took part as investigators. You will find an outline of that experimental program on page 3 of the formal statement which I presented to the committee, and to save time I believe that would be the best information.

I think at this time, with your permission, I would like to introduce the other problem that we feel so strongly about.

You have heard today outlined the efforts of the many, many disciplines that are necessary to give us a basic understanding of the cancer problem, and I think that all of us here appreciate the enormity of this problem. It is unfortunate that all the problems in regard to cancer are not on the positive side-that is imposed by the disease itself. There are some venal negative portions of this problem which are manmade, and are created by those who seek commercial dividends by_foisting false hope of cure on the cancer patient, and his family. For over 50 years the American Medical Association has shown bold leadership in opposing these forces. During this time we have maintained an agency for the collection and dissemination of information on nostrums and quackery. We feel this task to be a public duty in order to protect the laity and to furnish physicians with objective evidence as to the lack of value and the identity of the secret nostrums proposed as cures.

In this endeavor, the association, through its bureau of investigation, has cooperated closely with the various Federal and State agencies charged with the enforcement of laws regulating the drug industry. The Food and Drug Administration is one of those agencies. The Federal Trade Commission is another. We have also cooperated with the State agencies which have jurisdiction over the licensing of individuals who seek to follow either the practice of medicine or the other healing arts. This has not been an easy task, gentlemen, in turning the searchlight of truth upon the quack; we have frequently become the defendant in a court of law. Thus, the association has

been obligated to spend large sums of money in the defense of such legal actions. It is significant, however, to note that although we have been sued for more than $40 million over the years, we have been obliged to pay but 1 judgment and that, in the nominal sum of 1 penny. This is a constant battle in which we have chosen to remain in the forefront. Even now several nostrums are being promoted to the public either on representation that cures are obtainable or that the proponents are experimenting clinically for something new and valuable in the management of cancer patients, particularly those beyond the conventional methods of treatment used by medicine.

In our efforts to educate and evaluate-I notice there was an error here in our statement-that next word should be "evaluate"-We have been joined by the American Cancer Society, the National Cancer Institute, the Damon Runyon Foundation, and the Food and Drug Administration in sponsoring the National Research Council's Committee on Cancer Diagnosis and Therapy. Inasmuch as I hope the work of this committee will be described by one other witness, I will not go into details on it, but we believe that it gives the Nation a sound method of evaluating proposed cancer cures and diagnostic aids. It is the intention of our association to encourage and further every honest attempt to increase our knowledge about cancer, to continue our earnest efforts in the quick dissemination of such knowledge to our physician members and to foster the type of cooperative research program previously outlined.

This concludes my formal statement.

Dr. HELLER. Mr. Chairman, our final panelist has the information which follows very closely Dr. Wermer's presentation. So, with your permission, at this time I will ask him to proceed, and then the committee may have questions.

We have a very distinguished physician from Boston-Harvard University-Dr. Ira T. Nathanson, who is the chairman of the committee to which Dr. Wermer and Dr. Cameron referred earlier, namely, the Committee on Diagnosis and Therapy of the National Research Council.

The CHAIRMAN. We are very pleased to have the doctor testify. I assume he will give the committee some information as to the makeup of the Council.

Dr. HELLER. Yes; he will.

STATEMENT OF DR. IRA T. NATHANSON, CHAIRMAN, COMMITTEE ON CANCER DIAGNOSIS AND THERAPY, NATIONAL RESEARCH COUNCIL

Dr. NATHANSON. Mr. Chairman and members of the committee and others. You have heard very briefly some of the reasons for the institution of this type of care, which is unique in many ways in medical annals. Many of the agencies that sponsored the committee and other organizations have received various proposals for control of cancer either on the basis which was described this morning where temporary relief may be obtained, or on a permanent cure basis.

I would like to reemphasize that there are still two methods of orthodoxy in cancer therapy-the methods of surgery and radiation, as you know and have heard from the testimony, and the method of