LETTER OF TRANSMITTAL Hon. JOHN L. MCCLELLAN, U.S. SENATE, Chairman, Senate Committee on Government Operations, July 13, 1959. MY DEAR MR. CHAIRMAN: The subcommittee submits for your consideration the attached summary of information on the worldwide incidence of cancer. This is the fifth in the series of committee prints presenting data pursuant to Senate Resolution 347, 85th Congress, and Senate Resolution 42, 86th Congress. These resolutions provided— for a complete study *** of any and all matters pertaining to international health research, rehabilitation and assistance programs *** and *** the coordination of programs related to international bealth. Committee Print No. 1 (S. Rept. 160, 85th Cong.) was entitled, "International Medical Research A Compilation of Background Materials." It set forth highlights of international research contributions in most of the major fields of disease, in addition to fulfilling other background purposes. Committee Print No. 2 was entitled, "Statutory Authority for Medical and Other Health-Related Research in the U.S. Government-The Basis for International Cooperation." It contained the texts of the legal authority for medical research efforts by diverse. agencies of the U.S. Government. Committee Print No. 3 (S. Rept. 161, 86th Cong.) was entitled, "The Status of World Health-In Outline Text and Chart." Within it were presented charts on the incidence of certain major diseases. throughout the world. It included one chart devoted to the differential rates in the incidence of malignant tumors in various countries of the world. Committee Print No. 4 was entitled, "The United States and the World Health Organization-Teamwork for Mankind's Well-Being." It represented my personal report on WHO, based upon my conferences with its officials and other authorities in Europe and on subsequent review. One of its phases was a consideration of WHO's role in worldwide cancer research. The present print constitutes therefore a logical extension in this series, concentrating, as it does, on this disease of deep worldwide significance. It is a disease whose ultimate conquest will undoubtedly involve an unparalleled effort of worldwide biomedical research-the topic which is a prime focus of this subcommittee. Additional publications in this series will be submitted for your consideration in the period ahead. With kindest wishes, I am Sincerely yours, HUBERT H. HUMPHREY, Chairman, Subcommittee on Reorganization and International Organizations. FOREWORD By Hon. Hubert H. Humphrey, Chairman, Subcommittee on This publication summarizes facts on a disease which is the No. 2 killer in the United States. Only cardiovascular disease causes more deaths here and elsewhere among the population of the Western World. Throughout the entire globe, with its population of 2.7 billion, reasonable estimates indicate that over 2 million people die of cancer each year. This figure is on the rise, paradoxically, as less developed regions approach the health standards and longer lifespans of the Western countries. What is the nature of this disease? "Cancer" means crab in Latin. It is an apt word picture for a mysterious transformation which changes disciplined body cells into a malevolent, devouring growth. THE INCREASING THREAT Cancer is a disease found in all races and all ages of man, and in all animal species. It was known and described in the earliest medical records. In the modern world, mankind has fortunately gained increasing control over certain diseases, notably the pestilential infections. By curbing these infectious diseases, mankind has achieved impressive results in prolonging the average lifespan. With the resultant change in the age-distribution of populations and, perhaps, with the onset of factors coinciding with industrialization, cancer has gained ascendancy as man's mortal enemy. THE PRESENT TOLL OF CANCER Cancer occurs more frequently at older ages, but no age is free of the disease. In the United States, more children under 5 now die from leukemia and other types of cancer than from all infectious diseases combined. The economic cost of cancer in the United States has been estimated at $12 billion a year. This financial figure cannot fully portray the human tragedy of a lingering disease. At most, only one-half of those afflicted can be salvaged by the maximum utilization of present medical knowledge. At birth, the chances of an American developing cancer in a lifetime are one in five for men and one in four for women. (See question 5.) The evidence is clear that cancer is a world problem, best solved by research on a world basis. The combined efforts of scientists throughout the world should be applied to developing and exploiting leads wherever they occur. 81 QUESTIONS AND ANSWERS Some of the possible leads are indicated in the pages which follow. The reader will find herein 31 questions and answers providing highlights of information on cancer within the United States and foreign countries. In each instance of text, table, and chart the expert sources for the data are documented. THE SUBCOMMITTEE'S FIVEFOLD APPROACH In its continuing quest for judgment on the overall cancer problem, this subcommittee's approach has been fivefold. It has consisted of: 1. Correspondence and visits with leading American experts, particularly with authorities in the U.S. Government, including Dr. John R. Heller, Director of the National Cancer Institute, and with officers and staff of the Institute. Similarly, the committee has been in touch with cancer specialists, representing the broad spectrum of public and private cancer research centers throughout the United States. This includes, in the latter instance, such renowned institutions as the Sloan-Kettering Institute for Cancer Research. 2. Conferences in Europe with cancer experts, including Prof. Leiv Kreyberg, of the Riks Hospital of Oslo, and Prof. Nicholas Blochin, Director, Institute of Experimental Pathology and Therapy of Cancer, of Moscow. 3. Contacts with other leading members of the International Union Against Cancer, as such. This is the esteemed professional organization which has contributed so much to the worldwide effort against cancer. (See question 30.) Its activities will be described in a later publication by this subcommittee. These contacts with the UICC (as it is known by the initials of its name in French) have included correspondence with individual cancer experts in many nations. 4. Contacts with a wide variety of leaders in the American voluntary organization concerned with the cancer problem, the American Cancer Society. (See question 29.) 5. Contacts with specialized cancer organizations such as professional groups concerned with cytology, surgery, radiation, chemotherapy, and other phases. LACK OF ESSENTIAL DATA FOR RESEARCHERS The subcommittee clearly perceives that solution of the problem must come from intensified scientific research. The subcommittee is encouraged by the scientific assault which is being mounted. Indispensable in that assault is the availability of facts defining the extent of the problem. But, as cancer experts have reported with regret to the subcommittee, medical science to date has available for its mapping of the fight against cancer only the most sketchy information. Death registry figures which can be considered as adequate by modern standards are published for cancer in only some 20 countries of the Western World. Adequate continuing statistics on the incidence of cancer (that is, the occurrence of new cases per year based on a population figure) are available in but a few smaller European countries, in one State of the United States, Connecticut, and one province of Canada. Yet our best possibilities for the control of cancer and the understanding of its causes lie in studying the distribution of cancer in different populations, and the relations of its occurrence to place, occupation, habits, and other human and environmental traits. More exact information of the distribution of cancer in the world, therefore, is urgently needed. Accumulation of facts about cancer in human populations is not an easy task. Large numbers of persons must be observed for prolonged periods. Standards for diagnosis must be comparable and firmly based on the laboratory findings of the pathologist. The statistical and medical observations have to be correlated with laboratory observations. In order to define the problem as closely as the presently available data will permit, the National Cancer Institute was asked by our subcommittee to gather information and charts on the occurrence of cancer in the world and the present status of organized research efforts. BASIC SOURCES OF DATA For this purpose, three major sources of data were used: the mortality statistics reported by the National Office of Vital Statistics for this country and by the World Health Organization for other countries; cancer morbidity surveys conducted by the National Cancer Institute, and the State cancer register maintained by the Connecticut State Department of Health. Some of these facts were previously gathered for professional workers in cancer and published by the Department of Health, Education, and Welfare in 1958 under the title of "The Extent of Cancer Illness in the United States." Information on current_developments and studies at an international level are given in the Transactions of the International Society of Geographic Pathology. INTENDED FOR LAYMEN This committee print is designed primarily for laymen. To fit our needs it was necessarily assembled rapidly. As indicated above, it does not purport to present new scientific information so far as professional workers are concerned. But it does conveniently bring together, it is hoped, in readable and graphic form certain fundamental data not heretofore generally available to the Congress and to interested laymen. EXPERT FINDINGS BY OTHER COMMITTEES The information may provide, therefore a helpful supplement to the comprehensive body of knowledge previously assembled by other congressional committees. In the instance of the U.S. Senate, these expert groups are the Committee on Labor and Public Welfare and the Subcommittee for the Department of Health, Education, and Welfare, of the Committee on Appropriations. Senator Lister Hill is the distinguished chairman of both of these groups. Interested readers are invited to review the broad varieties of information published in this and previous years by these committees and by authoritative sources in the House of Representatives which have jurisdiction in this field. |