The network TV shows which aroused citizen interest in these dread disease factors were based in large part on ACS supported research.

The National Cancer Institute has responded. Their excellent survey of the geographic occurrence of cancer has told our researchers where to concentrate their studies.

We think all this attention to data will help win advances against cancer. At the same time, we are a bit dismayed that the National Cancer Institute has been accused by some people of neglecting this area of work. On the contrary, research has called attention to problems and solutions.

It is sometimes necessary to remind people that the American Cancer Society does not want to use any power other than persuasion and the National Cancer Institute has no regulatory power.

When cancer causing substances are identified by our research it is up to FDA, EPA, and others to regulate.

Research suggests controls. We don't think the NCI should be held responsible if controls are not imposed.

Sometimes we have heard criticism that new therapies don't get to patients fast enough. It is never fast enough for the American Cancer Society.

But we work hard at it. For several years, the American Cancer Society, along with the American College of Surgeons and the National Cancer Institute, has been working with and encouraging local hospitals-more than 750 of them now have approved multidisciplinary cancer programs-all over the country, to improve cancer treatment in communities which is where the great majority of patients are and will be treated.

The huge comprehensive cancer centers have been funded as combined research and treatment centers, with outreach programs in other cities. The American Cancer Society's president-elect, Dr. R. Lee Clark, pointed out that only 9 percent of the total number of cancer patients treated in Texas received treatment at the M. D. Anderson Center. The answer then for the 900,000 Americans who are under treatment for cancer is to focus local expertise and talent on cancer, which is what we are doing.

Mr. Chairman, on my right and on my left are two of the dedicated young men who are working in the front lines of the war against cancer. First with a few facts is Dr. Jordan U. Gutterman, associate professor of medicine in the Department of Developmental Therapeutics at the University of Texas System Cancer Center, M. D. Anderson Hospital and Tumor Institute, in Houston, Tex.

Mr. PATTEN. Who is your other friend?

Dr. BYRD. Dr. Bernard Marsh, associate professor of laryngology and otology and director of Broyles Bronchoscopic Clinic at Johns Hopkins Medical School and chief of the Department of Otolarngology at the U.S. Public Health Service Hospital in Baltimore, Md. [Dr. Byrd's complete statement follows:]

NATIONAL CANCER PROGRAM, A SUCCESSFUL EXPERIMENT

Mr. Chairman, you are cosponsor of the greatest experiment in medical research administration that the world has ever known and it works.

This year the citizens' budget presented by the American Cancer Society and supported by other cancer groups is $966.8 million.

This is 7.6 percent more than we proposed last year; a modest cost-of-living increase, if you will.

It is $107 million less than the authorizing statute allows. This is the first time since there has been a specific dollar authorization that we ask less.

We ask for less because we think such a request is prudent. It is true, and we are grateful, that your committee, Mr. Chairman, helped ease the personnel problem at the National Cancer Institute last year. But several high-ranking NCI veterans have left. Some new recruits are moving very rapidly in areas unfamiliar to them. There have been a few signs of strain in this growth.

It is the judgment of the American Cancer Society that the immense dynamism of the National Cancer program is still growing. Scientists are more enthusiastic. Physicians are more hopeful. Citizen interest obviously continues strong.

PROGRESS FOR WOMEN

My testimony will not repeat the milestones of progress which the program has passed. National Cancer Institute director Frank J. Rauscher has put into the record on the House side 51 specific program advances.

Neither will I cite here the wealth of individual studies which each show re sults we seldom, if ever, saw before the National Cancer program started. Dr. Gutterman's testimony covers in depth one aspect of that.

My own part in fulfilling the American Cancer Society's role in a partnership with the National Cancer Institute in the 27-project, 25-State breast cancer detection demonstration program tells me something about the progress that is possible. In this program 77 percent of the confirmed cancers are biologically early and show no evidence of spread or of metastasis. This compares with roughly 50 percent found in usual medical practice. That 27-percent difference means much in terms of survival.

Still speaking of breast cancer, but turning to the most difficult cases of cancer, where there is evidence of advanced, disseminated disease, the average survival after such a diagnosis was 8 months in 1971 when the National Cancer plan was being written. This survival span has more than tripled since then in our best current studies.

Those who have cancer patients surviving in their families know the tragedies sometimes entailed during these precious months of survival. Therefore, Mr. Chairman, we scientists tend increasingly to present statistics on the "diseasefree" status among patients receiving treatment.

I have served for 6 years as chairman of the Commission on Cancer of the American College of Surgeons. We recently issued a new program manual for hospital-based cancer programs. I have been especially interested in objective measures of the quality of survival. You will hear more about this as we develop better measures for evaluating this important area of human resources. Be assured our deep concern with the quality of survival continues.

PROGRESS FOR MEN

Most of the TV and newspaper comment on cancer in recent years has focused on women. Yet cancer of the prostate gland is diagnosed in more than 150 men per day in this country.

For 40 years the standard treatment of this entity has been hormones or surgery or both. Since the inception of the National Cancer program we have learned for the first time that chemotherapy furnishes a superior adjunct for surgical therapy.

Roswell Park Memorial Institute director Gerald P. Murphy, who heads the national prostate cancer project, is submitting testimony to you today.

So I will only summarize one study for the record. The prostate project has engaged in a randomized study of men with prostate cancers resistant to hormone therapy. The study began in July 1973. By June 1975, there were 125 patients in the study, this, the first national randomized study of prostate cancer. The drugs worked after relapses only in cases where there had been prior surgery. All patients entered into the study had experienced relapses after standard treatment. Nevertheless one drug was able to reduce the tumor to half-size in 29 percent of the men getting it and with another drug similar results were achieved in 31 percent of the men receiving it. Likewise in colon-rectal cancer, under the National Cancer program, a response to chemotherapy and immunotherapy has been demonstrated. This gives the surgeon an assist he has not had before.

AMERICAN CANCER SOCIETY SUPPORTS THE NATIONAL CANCER PROGRAM

Since 1913 the organization now known as the American Cancer Society has been committed to strengthening professional and lay work against categorical disease.

We firmly believe that the categorical approach is essential. Comprehensive health care is a desirable goal. The cancer community asks for no priority consideration in the comprehensive picture beyond that indicated by the prevalence, cost, and human suffering which the disease imposes.

We firmly believe, further, that a categorical, coordinated plan of research is the only way to make rapid progress in the war against cancer. We support the national cancer program enacted in Public Law 92-218 as extended.

BUDGET CONSIDERATIONS

In my capacity as president of the American Cancer Society, in my professional capacities listed in the attached curriculum vitae, and as a surgeon seeing patients practically every day, I testify that the amount authorized for funding the national cancer program is fully warranted.

Cancer costs this country at least $25 billion per year and some estimates run as high as $50 billion. Surely the authorized $1.073.5 billion can be afforded by this great Nation. We are asking only $966.8 million because we believe that amount can be spent wisely. A larger total might strain the system.

The program has grown very rapidly. Fortunately, the basic structure of research administration at the National Cancer Institute was sound at the outset.

The super structure now erected on top of that is working well. But there are several reasons for moderating expansion at this time.

NCI has lost some seasoned research leaders. Literally, several dozen loyal civil servants serve the NCI for top salaries under $39,000. This cannot compare to offers they get elsewhere in health care positions. Recently, in Atlanta a man just out of his residency training was hired at a salary rate equal to that of the director of the world's greatest biomedical program-the Director of NCI.

Under your leadership, staff strengthening was provided in fiscal 1976, but not all the new slots are filled yet. Expansion with competence takes time.

Some programs we are dealing with are highly experimental. This is an area where our country has always had difficulty-democratic, voluntary system reform, particularly health care system reform. I will refer to this again in a few moments.

Third, it is clear that scientific judgment and many expressions from informed laymen coincide in calling for a marked departure in program emphasis. As the national cancer plan has evolved we have become completely convinced that most cancer is effected by something we eat, breathe, smoke, or otherwise ingest. Since we cannot quickly change national patterns of eating, smoking, fuel consumption, and other activities contributing cancer-associated chemicals to our environment we must necessarily keep up the medical conquest of cancer. People get cancer. Some are cured. Officially, 11 types of cancer are now considered curable. Unfortunately, these 11 types account for only a fraction of all cancers. There is progress. It must be continued.

Nevertheless, a much more effective element of environmental carcinogenesis research is needed in the NCI. On that there is a consensus. The new division of work will require careful adjustments and monitoring to avoid waste. This is another general reason for moderation in overall program growth. The specific budget considerations I wish to address are:

1. Tobacco.

2. Clinical trials.

3. Cancer cause and prevention.

4. Cancer control.

5. Research planning.

Tobacco

The American Cancer Society has seldom mentioned tobacco at appropriations hearings. The years of evidence continue to march, and the end of the road is always that smoking is more certainly a culprit associated more with cancer than any other single influence we know.

It is a national anomaly of the worst order that Federal budgeting support for tobacco runs at least $60 million per year. We say at least because there may be more. The support is split at least nine ways in the agriculture budget. Mr. Chairman, everyone on your subcommittee holds an important post on the full Senate Appropriations Committee. We urge you to use your powerful influence and your vote to reduce Federal spending on tobacco. Appended to this testimony are the official support figures.

Later this year the American Cancer Society will make further recommendations on this subject.

Clinical trials

The 51 excellent milestones of progress Dr. Rauscher has been able to report to you have come mainly from clinical trials.

Fully half of the NCI research dollars are invested in grants. About half of those dollars go into basic research and this is a ratio the American Cancer Society endorses. We hope that the basic, new insights will some day elucidate the entiology, the actual cause of cancer in its various forms.

Meanwhile, the person-years of lives saved is running tens of thousands per year over the national experience before the impact of our national cancer program.

These include many years of happiness. These include enough years of economic livelihood so that we think your appropriations are actually profiting the U.S. Treasury.

Cause and prevention

There is great pressure on all authorities-public and private-to clean up the environment. For the ACS this is more than a fad. The American Cancer Society has directly supported the original research identifying the culprit chemical vinyl chloride, the widely used industrial material, asbestos, and other chemical carcinogens.

It is ironic, to say the least, that the very agencies which discovered the importance of these carcinogens and have initiated the prime steps to locate and reduce the centers of impact produced by these substances have come under attack for not doing enough about the environment.

The attack has been vicious. It has on occasion come from some of the scientists in this country and, I regret to say, sometimes from Capitol Hill.

The truth of the matter is that science can do a great deal about the major chemical offenders, the ones that the excellent national cancer surveys with county-by-county incidence data have identified. Where we can pinpoint heavy environmental presence of these chemicals, we can take action and action is being taken.

The American Cancer Society is proud to have paid for the research which with nationwide visibility via several network television shows, has built public awareness of these killers. We are proud that we have led the fight on this new front in the war against cancer.

But we must caution this committee that there are some things which science cannot now do. We cannot establish with a high degree of confidence exactly what is a safe dose or a tolerable exposure to certain chemical carcinogens. We know quite definitely these chemicals are invariably associated with cancer in heavy dosages. Yet some, such as a number of insecticides, save many human lives in many countries. The right decision on their use is not simple. The cancer cause and prevention budget for the National Cancer Institute as proposed in the citizens' budget shows a considerable increase over that item for 1976. We think this is as it should be. Having built the awareness of the danger, the American Cancer Society believes there should be followthrough. The American Cancer Society's own position paper on this important topic is appended to my statement.

We don't think it is appropriate for the NCI budget to be turned around, so to speak. We don't have the technology to do it. There is one good test for the dangers of low dosage chemicals, long-term exposure to chemicals, but it is far from the battery of tests we ultimately hope to develop.

In fact, there is in the works at this moment a possibly better test than the most popular one now in use. By next year we fully expect to be able to tell you whether the new test is a true improvement.

In any case we need to develop more tests, different tests, and, ultimately, a battery of tests on which citizens can rely, on which regulatory agencies can rely, the kinds of tests which will lend confidence to public and private deci

sions on the hazards or the safety of widely used chemicals or chemicals proposed for wide use.

We do not have that confidence now in some instances.

As you know, saccharine produces cancer when administered directly in enormous doses to the bladders of some test animals. At this date a new regulatory action is under discussion, as you've noted from new stories, and it would be inappropriate for me to say what action science should recommend. I will say flatly, however, that no scientist known to the American Cancer Society can with full confidence, and with full supporting proof, say definitely what the precise danger is to ingestion of ordinary amounts of saccharine over a human lifetime.

Mr. Chairman, we know that the $70 million increase in the citizens' budget for this purpose is not precise. Frankly, we've been struggling with what to recommend on this one.

We have settled on the budgeted figure after some thought. But we pledge to you that the American Cancer Society will stay in close touch with this program over fiscal year 1977 and will come back to you with a lower recommendation next year if it is warranted.

We have disciplined ourselves to call for an overall budget figure lower than the authorization this year. We are taxpayers. We'll lower this figure if we think it is not being spent wisely.

Thousands of new chemicals enter commerce every year. The NCI has the budget, the manpower, and laboratory capacity to test for long-term carcinogenicity only about 150 new ones per year. At any one moment about 450 are in one stage or another of trial. One reason our manpower budget is suggested for a hefty increase is that we need more epidemiologists, more chemical carcinogenesis experts, more oncologists to keep up with an expanding test program.

At present only those chemicals whose molecular make-up is similar to known carcinogens are worthy of test in our over-burdened laboratories and, among those, only the ones in rather wide use. We simply cannot waste resources on pure random testing, or on testing on the sole criterion that a chemical is widely used.

We have not looked into each detail of this line item. But we have found some facts which make me think that possibly a good bit more money should be invested in this work. For instance, work in conjunction with the Veterans' Administration on follow-up of persons exposed to industrial chemicals which we know are associated with bladder cancer-one of the most sensational pieces of news about cancer in recent years-this work is taking at present only $40,000 a year. Obviously that cannot buy much research.

Some salient facts on diet have come out of international studies. Iran has high esophageal cancer; Hong Kong a great amount of nasal cancer; Japanese migrants to Hawaii, as you've heard often, have different cancer rate with adaptation to a typical U.S. diet, and don't experience different rates from Japanese residents if they stick to their old diet. These and other similar studies are only costing about $150,000 per year. We might be able to learn much more with expanded studies.

We should certainly explore more carefully why cancer rates are notably lower in the state of Utah than elsewhere in the United States.

We had a case last year of cattle feed treated with a flame retardant. The results were highly carcinogenetic. The entire incident cost about $300,000 to trace out. How many other incidents need checking we don't know for sure, for we have not been as alert to these mishaps as we are learning to be. The asbestos trouble in Tyler, Tex., cost some $400,000 to investigate. These are just a scattering of studies which took place because of very early information of the type science is now beginning to handle. What is needed is a better planned approach to anticipate likely trouble spots.

Dr. Irving Selikoff, the foremost scientist in this field, the man who has been supported practically from the outset of his work, and who has done more than any other to explore chemical carcinogenesis hazards, has recommended to the American Cancer Society that the scientists in his field can significantly increase funds and this is reflected in the citizens' budget. We certainly think his judgment is unlikely to be contradicted by his peers. Everyone in the field knows that it would be a very great mistake to try to expand the chemical carcinogenesis program at breakneck speed just in order to meet the critics of NCI program balance in this regard, and NCI does have its critics on this.