have many forms of solid tumors also. We are now faced with the grim choice of deciding virtually whether this patient shall live or that one shall die, if we have a limited amount of platelets or haven't enough platelets to go around.

Mr. DUNCAN. This isn't produced as the Red Cross produces blood

or serum?

Dr. FARBER. It can't be produced enough without additional funds. The Red Cross has entered this field and has been very helpful. We have programs in five different institutions now. We want to start at least 10 more as quickly as possible. We are able to take donors and by using a special technique we can bleed them as much as three times a week. What we do is take 1 pint of blood and then spin out the red cells and white cells and plasma leaving the platelets. We then return everything to the donor within 45 minutes, except the blood platelets and the donor doesn't miss them because he can regenerate those quickly.

We take a second pint of blood and this is done with professional donors as often as three times a week for a period of weeks and then we give them a period of rest.

In this way we are able to give even a child as many of the platelets from, let us say, 10- to 15-pint equivalents of blood or more within a very short period of time and stop the massive hemorrhage which otherwise would destroy the child.

This program is one of the many which is in jeopardy. It is inadequately supported at the present time and certainly will not be adequately supported next year with the proposed budget.

There are new and old programs which require additional support. In the field of cell biology, which your committee commented on particularly, there are inadequate funds for grant support. There are inadequate funds to support the ongoing programs of cell biology in the regular program, not to speak of the support of new ones.

In the chemistry and biology of steroids, with particular reference to cancer of the breast and with reference to a number of other forms of cancer, we have great needs and this will be dealt with by Dr. Pincus. Under the term "special grants" in the citizens' budget, you will find a number of items which we include and which I would like to put into my testimony. The first is an increase in clinical cancer research centers. We have some 20 in operation. This has been a magnificent program, but it is costly and we would like to recommend that at least 5 more such centers be set up this year and an additional 10 new clinical research centers set up in those parts of the country where they are planning to have regional centers for the heartcancer-stroke program.

These centers are designed to bring concentrations of great strength in research, in the basic sciences, as well as in the clinical portion of research in one place so scientists and doctors working together can produce the kind of new knowledge which is necessary to move ahead more rapidly in behalf of the patient with cancer.

Included here in these special grants are also funds for at least five centers of radiotherapy. We speak of five as the beginning, but we should point to the fact that we are going to need many more.

One of the greatest surprises to those interested in cancer research comes from learning that there is a grave deficit in the field of radiotherapy in this country. The cobalt bomb did not answer everything.

What is needed is a concentration of very expensive hardware of highly specialized nature in a place where there is a sufficient number of leaders in radiotherapy in an environment of cancer strength who can give not only the best care to patients with cancer, but also train badly needed radiotherapists for the country as a whole.

We are very disappointed to report that the training programs in radiotherapy have moved very slowly. I think they will move much more rapidly if adequate facilities in such radiation therapy centers could be provided and if the leaders in such locations could be assured of the proper support for their enterprises.

The next item I would like to talk about concerns the establishment of new task forces.

You have had testimony given to you by the Cancer Institute Administration and by citizen witnesses last year of the success of the leukemia task force. This is a great enterprise. We defined the task force last year in terms of the bringing together of a number of scientists and doctors from many parts of the country who agree to work together on directions of research which are decided on after study and discussion and common agreement.

This brings together a critical mass of knowledge and of scientific workers so that far greater progress can be made in a shorter period of time than by any other technique. This implies that basic knowledge must be available or must be gained in sufficient amounts in order to mount such a task force.

The National Cancer Institute has worked hard to create a reorganization of the leukemia task force and of the old Cancer Chemotherapy National Service Center. They have mounted a perfectly splendid program in the field of virology of leukemia. Unfortunately, all of the funds which are available under the heading of "Direct Operations Collaborative Research" (contract funds) are used mainly in this field of leukemia, and to a smaller amount in the field of carcinogenesis.

Leukemia, lymphoma, and Hodgkins disease are closely related and they account for perhaps 10 percent of all of the cases of cancer in the country. This leaves us 90 percent of the cancers which we deal with, from which people die, without any specific task force backing and without the contract funds or the grant funds to make really meaningful attacks on these programs, or these forms of cancer.

What I am talking about, Mr. Chairman, and gentlemen, is, first, cancer of the lung. There were 52,000 cases in 1965, and more than 40,000 of those patients died in 1965. There is no task force on cancer of the lung.

Nor is there in the fields of cancer of the colon and rectum. There were 73,000 Americans in 1965 with this form of cancer; 43,000 died. These are the two greatest causes of death with patients with cancer. In cancer of the uterus there were 44,000 new cases and 14,000 died. As you know from your hearings on this subject, if the Papaniculau Smear technique diagnosis were put into effect throughout the country, this form of cancer of the uterus could be literally wiped out today. This calls for something which is not possible with present resources. Cancer of the prostate; 33,000 cases in 1965. Fifty percent of the patients with cancer of the prostate live for 5 years if the tumor is discovered before there has been spread. Thirty percent live 5 years or

longer if regional involvement has taken place at the time the tumor is first discovered.

I would like to emphasize cancer of the prostate today because I have been planning to since the last appropriation hearing. I have brought with me a copy of a letter from Dr. Reuben Flocks, the professor of urological surgery at Iowa University, sent to you, Mr. Chairman. With your permission I would like to put his letter in the record.

Mr. FOGARTY. We will put it in the record. (The letter referred to follows:)

Hon. JOHN FOGARTY,

Chairman, Committee on Appropriations,
U.S. Congress, Washington, D.C.

MARCH 19, 1966.

DEAR MR. FOGARTY: As you know. I have been giving a good deal of thought to our cancer programs over the past several years, and have been particularly interested in the work of the National Cancer Institute over the past year. I want to give you some reflections on this subject as it is related to the many patients with genitourinary cancer that I see daily. During the past decade the Cancer Institute has achieved a tremendous amount, through the work done intramurally, but more appreciably through the extramural research grant and contract mechanisms several very important capabilities have been achieved.

(1) Laboratories and individuals capable of important advances in the field of cell biology have been developed ;

(2) Laboratories and individuals in virology and immunology as related to cancer have been developed :

(3) Very excellent capability in carcinogenesis and in other aspects of cancer etiology have been developed :

(4) A very excellent capability in the various aspects related to cancer chemotherapy has been developed.

It is of great importance that our investment in the production of these capabilities in the laboratories over the country, and in their scientific and technical personnel not be allowed to lie fallow because of inadequate support. Their support is a must. The important work must be continued at this critical time when they are beginning to flower. Lack of support would not only decrease the chance of significant discovery but may cause trained personnel to wander into other fields and lose them from cancer research at this very critical time. There is another area that has remained relatively unsupported up to this time, but which is in great need of development at this stage of our attack on cancer. This is the training of clinical researchers and clinicians to work in the hospitals relating the new developments in basic research to the patients with cancer, and feeding back the results of such clinical research to the scientific personnel carrying out basic research.

Task forces, like the one in acute leukemia, can and must be formed for the more common types of solid tumors of the breast, the prostate, the lung, urinary tract, bladder, and uterus. As you know, the leukemia task force has achieved significant advances in the survival of these patients, as results of team research, particularly in the area of chemotherapy. In order to obtain similar results in solid tumors intensive support is needed for clinical training and clinical research training, above the residency level, in our large teaching hospitals. These individuals would really be career cancer scientists clinicians. Such trainees would then form an important cadre and be important cogs in the task forces.

An example of the problem is illustrated in our own institution where we see 200 new patients with prostate cancers each year; and 1.000 return cases of patients with prostatic cancers; 75 new cases of cancer of the bladder, with 300 return cases of cancer of the bladder each year. The resident doing the routine work is carrying out a very favorable job in the basic clinical area but the need of superior scientists, clinicians, and far more specifically trained clinical researchers in this field, whose total mission would be in the first as part of a task force, or a team with basic research workers interested in these forms of cancer is great. These areas urgently need support. They are qualitatively different and much more likely to obtain significance than training at the student or medical intern level. They also, of course, would be much more costly but results, in my opinion, would be worth the investment.

From a study in our own institution to mount a beginning for a national program in the solid tumors, would necessitate a budget of at least $10 million, which would probably double in the ensuing 2 years.

With appreciation for your own great accomplishments in health research, I remain,

Sincerely yours,

REUBEN FLOCKS, M.D., Professor, University of Iowa. Dr. FARBER. He has 200 new cases of prostate cancer each year. He follows at any time 1,000 patients with cancer of the prostate. I bring this up for a second reason, even though this was on our program for the past year, because one of the great men of the Congress has recently died because of cancer of the prostate. He announced himself at a hearing when I was present, concerning the Veterans' Administration, that he had that form of cancer, and you will find this in the record. And so I do not hesitate to mention the name of this great man, Mr. Albert Thomas, a dear friend of those of you who served with him in Congress and a dear friend of citizen witnesses who had the pleasure of appearing before him in behalf of the Veterans' Administration. His life was prolonged 8 years by devoted and skillful care and by the use of new chemicals and hormones, from the time of the onset of his tumor and 4 years after he had evidence of metastisis or spread to other parts of the body.

I want to emphasize that here is a tumor which is still incurable once it has spread, but here is a tumor which has responded to hormones and to some chemicals in such a manner as to give great hope that a unified effort, a task force in this field, would yield results far greater than those we could ever expect if we went our several ways alone in the many institutions of the country.

This is one of the greatest causes of death among the kinds of cancer which afflict men. We will hear more about it from Dr. Gregory Pincus.

In 1965, there were 62,000 new cases of cancer of the breast and 26,300 deaths from cancer of the breast.

One year ago, Mr. Chairman, you and your colleagues directed the National Cancer Institute to form a task force in breast cancer. They have had meetings. They have been proceeding slowly because of a number of reasons. We hope that soon this task force will be underway. It will not function as it should without adequate support, to have a truly professional attack on this problem.

I would like to mention brain tumors. We have been negligent in this country in attacking a problem which is again difficult, but within our reach, too. The amount of study in the chemotherapy of brain tumors has been extremely small because there have not been institutions which could get sufficient support to mount the kind of program that we need.

The last tumor I will mention is cancer of the skin. There were 80,000 new cases in 1965. I mention this because it is not generally realized by the laity that there were 4,000 deaths from cancer of the skin in 1965. This is a tumor that is accessible, that is easily seen, that can be treated in a number of ways. My colleague, Dr. Moore, will speak to this point later, with particular reference to splendid new work by Dr. Edmund Klein in clinic therapy.

I would like to finish this portion of the presentation, Mr. Chairman, and gentlemen, with a little reference to the regional center

61-753-66-pt. 5—5

program. We are all very much heartened by the great enthusiasm with which the President's Commission Report on Heart, Cancer, and Stroke was greeted, by the President, by the Congress, and by the people as a whole. I want to emphasize that plans are being made in a number of parts of the country today. A council has been set up and my colleague, Dr. Moore, is a member of that.

But the present definition of a regional center for cancer is not entirely what was envisioned by the President's Commission. We must have a facility where we can translate very quickly the results from the research laboratory for the benefit of the patient. We must have a facility where everything that is known today can be passed to the practitioner. But in addition we must have a facility where clinical investigation and basic research can go on hand in hand, as a large enterprise. In this country there should be at least 20 centers of the kind that we have in Buffalo at Roswell Park or Houston in the M. D. Anderson or in New York at the Memorial. I cannot mention more than three of this kind. No one of these three is complete as the talents of their leadership would dictate. No one of these is as complete as it should be to fulfill the promise of the leaders in these cancer institutes, because of the lack of support, for such large enterprises. Both Dr. Shannon and Dr. Endicott have emphasized repeatedly both publicly and in discussion with the Cancer Council their belief that there should be at least 20 large enterprises, similar to the effort at the National Cancer Institute in Bethesda. In these centers, these are true cancer institute centers, there can be the kind of activity of professional nature which cancer progress requires.

It cannot be done unless there is a critical mass of professional strength in one place, that is, all devoted toward the acquisition of new knowledge. The reason that we have recommended here today for the Citizens Committee, under special grants, these clinical research centers and new centers and so on, is that we can do this today while the regional center program is achieving maturity and shape and form, which it will.

But we do not have to wait to do this all at one time. It can be done by adding sizable centers wherever there is the proper leadership and the proper environment. We are not lacking în either in many parts of this country.

Mr. Chairman, with your permission I would like to include a table in the record of 5-year survival rates, for selected kinds of cancer. I do this to show you some degree of optimism, which some of us have in what can be done today in some forms of cancer, in the saving of life for 5 years or longer. But I show it to you also to point out very clearly the distance that we must travel between what we know today and what we must know in order to handle the cancer problem in a completely satisfactory manner.

(The chart referred to follows:)