of cancer deaths is $220,000,000 and that the annual economic loss to the families of cancer victims is $900,000,000. Thus this disease is costing us approximately 11 times as much yearly as the total amount the Government is considering spending on an all-out cancer program. During the past quarter century great strides in solving the cancer problem have been made by scattered individuals and by various organized groups. Practically none of these have had adequate financial backing and many of the advances have been made by unselfish scientists working on extremely small budgets or even without payment of any kind.

The time has come when sufficient funds must be supplied to attack the cancer problem on a far-reaching scale such as resulted in the production of the atomic bomb. The dramatic success of the Manhattan project has been a revelation in demonstrating the unlimited possibilities of adequately financed and properly coordinated research. Modern medical science has now advanced to a stage where the cancer problem can be efficiently approached in a similar manner and without further delay if sufficient funds are made available. We cannot ignore this opportunity to benefit all of mankind.

Like the development of the atomic bomb, the solution of the cancer problem is fundamentally the province of men with highly specialized abilities. Therefore the greatest intellects available should be mobilized to map a course of attack against this disease. When this group is formed it should be implemented with full authority to proceed as they see fit in accomplishing the desired purpose.

GENERAL ASPECTS OF THE CANCER PROBLEM

At the present time certain cancers can be very effectively treated with surgery, X-rays, radium, and certain chemicals. Thousands of proven cures are being recorded each year but the over-all cure rate is still considered to be less than 20 percent. This figure could be raised to 40 percent or perhaps 50 percent if all the present available knowledge was applied to each individual cancer case. For example, if the extreme importance of early diagnosis and the danger of procrastination were generally known there would be far less delay in consulting the family physician. If, then, the family physician was properly cognizant of the early signs and symptoms of cancer and the absolute urgency of immediate action, one of the greatest handicaps would be immediately overcome. The proof of this concept is shown in recent statistics of one of our largest life insurance companies which has been bombarding its policyholders with educational cancer propaganda over a period of years with the result that in the past 10 years cancer deaths in this group have diminished approximately 9 percent. There is every reason to assume that this same, or even greater, improvement may be obtained by general education-but here again the limiting factor has been insufficient funds.

Another, and perhaps even greater factor, is the lack of sufficient physicians specialized as cancer surgeons or radiation therapists. The great majority of patients are necessarily treated by doctors whose wide range of activities make it physically impossible for them to obtain superior competence in this complex and highly specialized field. It is conservatively estimated that the properly trained cancer

specialist is able to cure twice as many cases as the unspecialized physician. Thus it follows that many, if not the majority, of cancer patients are scheduled to die instead of being given a fair chance to live. Once more we run into the brick wall of inadequate funds and facilities to train these urgently needed specialists. It is appalling to consider that present authoritative figures indicate that 30,000 to 60,000 Americans are needlessly dying from cancer each year.

From these considerations we proceed logically to the fact that the finest lay and professional educational programs will be futilely wasted if the patient has no place to go in seeking aid or if the physician has not a place to work. We must answer this challenge by establishment of more cancer clinics and hospitals and we must provide aid to existing facilities which are overburdened and underfinanced. The various avenues of cancer research compose a very complicated topic which I presume will be adequately covered by various authorities during these hearings. You will hear a great deal about the chemical, biological, and physical approaches to the problem. Animal investigation will, no doubt, be discussed including the studies of heredity and genetics in mice, the role of hormones and enzymes, the influence of diet and vitamins and the actions of carcinogenic substances. These and other phases of laboratory research are tremendously important and may form the groundwork in the discovery of the ultimate causes of cancer, as well as the preventative measures. However, it is significant that some of the greatest theoretical and practical advances in this problem have resulted, not from laboratory experiments, but from "clinical" research in which cancer is considered as it affects the human patient. This phase has tended to be overshadowed by the more dramatic cancer research laboratory and merits much more attention and support than it has received in the past.

That great strides in this practical approach are possible has been proven by experiences at the Walter Reed General Hospital. This institution has been designated as the cancer center for the United States Army and under the direction of an exceptionally competent cancer specialist, serving as chief of the radiation therapy section, many significant advances and new concepts have been developed. Here extensive studies are being conducted in the mechanism whereby X-rays are able to destroy cancer cells more readily than normal cells; the effect of very high voltages on cancer with a million-volt X-ray machine; the role of genetic abnormalities in the production of germinal cancers such as occur in the male gonad. Further elaboration of such clinical problems should be encouraged and if necessary similar efforts should be subsidized in other institutions.

LOCAL PROBLEMS

At the time the writer entered military service in 1942 he was serving as the chairman of the cancer control committee of the Florida State Medical Association and as director of the tumor clinic of the Jackson Memorial Hospital in Miami. He believes that the local problems in that area may be similar to those encountered elsewhere and merit brief comment.

In 1936 the Miami area, with a population around 200,000 represented a moderately large community with a relative preponderance

of older-age groups. The city government operated a hospital of 500 beds with combined private and charity services and with a large out-patient dispensary. However, there were no facilities in the entire community for proper diagnosis and treatment of indigent cancer patients. No funds for such a purpose were available in the city treasury and it was necessary to raise money through public appeal in order to set up a small tumor clinic and to purchase X-ray machines and other essential equipment. The great need of such a clinic was quickly proven by a heavy influx of patients, numbering about 1,500 annually. The cancer death rate dropped sharply. However, the project remained a financial "orphan" for many years and is still struggling along with inadequate support-in spite of the fact that it remains to this day the only approved cancer clinic in the entire State.

It would be unfortunate indeed if other communities should be forced into similar painful experiences which could so easily be obviated by Federal or State aid.

The need for long-term and "all out" research in the causes and prevention of cancer is obvious and unquestioned. In the meanwhile, however, we must not penalize the cancer victim of today by denying him the benefits of our present knowledge.

In my statement I have included some of the generally known facts that have already been brought out here, and I will not take any further time to go through the statistics and the recommendations as to coordinating effort and that sort of thing. I agree perfectly with the comments that have been made as to the great necessity and importance of studies in the basic sciences.

I would like to take this opportunity to express my opinion, more or less as a middleman, however.

I see that most of the witnesses that have appeared here are distinguished scientists and national figures, and you might be interested in having the reaction of an individual like myself who sees cancer patients.

Up until 48 hours ago I was lieutenant colonel in the United States Army. Now I am a private citizen and can speak freely.

At the time I entered the service in 1942, I was acting as chairman of the cancer control committee of Florida State Medical Association and served as chairman of a tumor clinic in the city hospital in Miami. I disagree with Dr. Failla in his statement that none of this money should be spent for the cancer patient.

Senator PEPPER. I understand that. What is the next point? Dr. LEVIN. I know, and everyone in the cancer problem knows, that not all the patients that are suffering from cancer today are being cured, simply because of lack of facilities and lack of attention. It is generally agreed that 30,000 to 60,000 Americans are dying just because of lack of facilities, and that is needless. In spite of the fact that all this money is needed for research, I do not think we are fair in denying the cancer patient today the chance to live. I think that there should be enough of this money available to help existing clinics and to create more clinics. We have got to help train the so-called cancer specialists, because we have already shown that the cancer specialist has almost twice as much chance to cure an individual cancer patient as the general practitioner. We cannot neglect that.

We have got to encourage what we call clinical research as well as. laboratory research. There are certain cancers that cannot be reproduced in laboratory experiments.

At Walter Reed Hospital-I served there on my last assignment in the Army-we saw 300 cases of testicular tumors in young males. That was a wonderful opportunity, and it was not neglected, and just by carefully studying these cases and seeing the effect of X-ray on the cancer cells, as compared with the normal, a great deal has been learned.

I simply want to urge that along with all the experimental experts there should be some clinicians incorporated in this bill-men who have seen cancer as it occurs in the patient and can advise as to how best to approach that end of the problem.

The only other thing I want to add is that in a local community like Miami, where we have a quarter of a million people, just 10 years ago there was not a single facility for treating an indigent cancer patient. We had to go out and beg money from the race tracks and from independent citizens to get a few thousand dollars to set up a tumor clinic for the benefit of indigents in that community. To this day we have to go out and get help; and, incidentally, it is still the only approved cancer clinic in Florida.

I have nothing further to add, no suggestion as to the organization, but I would like to urge that the cancer victim of today be not neglected.

Senator PEPPER. In other words, you do think that some of the money that might be appropriated under this bill should be made available for the application of the knowledge that we have? Dr. LEVIN. Yes; very heartily.

Senator PEPPER. Thank

you very much.

The hearing will be resumed at 10 o'clock tomorrow morning in this room. There will also be a hearing on Wednesday on this bill.

(Whereupon, at 11:45 a. m., the subcommittee adjourned until tomorrow, Tuesday, July 2, 1946, at 10 a. m.)

CANCER RESEARCH

TUESDAY, JULY 2, 1946

UNITED STATES SENATE,

A SUBCOMMITTEE OF THE COMMITTEE ON FOREIGN RELATIONS,

Washington, DC.

The hearing was resumed, pursuant to adjournment, at 10 a. m., in room 424-B of the Senate Office Building, Senator Claude Pepper (chairman) presiding.

Present: Senator Pepper (chairman).

Also present: Representative Matthew M. Neely, of West Virginia. Senator PEPPER (chairman of subcommittee). The hearing will be resumed on the cancer-research bill.

We are fortunate to have with us this morning Hon. Fiorello H. LaGuardia.

STATEMENT OF FIORELLO H. LaGUARDIA, DIRECTOR GENERAL, UNRRA, NEW YORK, N. Y.

Senator PEPPER. I do not know what title you prefer, Mr. Mayor. Whatever your title, you are your own inimitable and distinguished.

self.

Mr. LAGUARDIA. In the last few days they have been calling me all sorts of things on the Hill.

Senator PEPPER. You are one of those who are complimented when they are called names.

Would you give us your views on either this legislation or legislation on this subject which you would recommend?

Mr. LAGUARDIA. Mr. Chairman, S. 1875 I consider one of the most important bills before the American Congress. The subject should receive full and complete discussion.

Cancer is something that has been "hush, hush" for so long that I think these hearings will serve a most useful purpose. I speak from my experience of 12 years as mayor of the city of New York, when this subject was constantly before me, and I can say without any fear of contradiction that there is not a city or State in this country that can afford to provide proper and sufficient treatment for people suffering from cancer. There is not a country in the world that can afford the cost of creating a world study of this subject, except the United States. Perhaps Canada or some other country might afford the money, but they would not have the material for the clinical studies. Fortunately, we have both.

As a conservative estimate, we lose in our country about 200,000 people from cancer. Mark you, these are the recorded cases. I would add that an equal number of people die who have not had proper or accurate diagnosis. That is true of the smaller cities and in the rural

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