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Ford, Betty - Cancer - Printed Material
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1489750
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Ford, Betty - Cancer - Printed Material
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Sheila R. Weidenfeld Files (Ford Administration)
Sheila Weidenfeld's General Subject Files
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President (1974-1977 : Ford). Office of the First Lady. 1974-1977
Cancer
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1976-06-30
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1976
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1974-01-01
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1974
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The original documents are located in Box 37, folder "Ford, Betty - Cancer - Printed Material" of the Sheila Weidenfeld Files at the Gerald R. Ford Presidential Library. Copyright Notice The copyright law of the United States (Title 17, United States Code) governs the making of photocopies or other reproductions of copyrighted material. Gerald Ford donated to the United States of America his copyrights in all of his unpublished writings in National Archives collections. Works prepared by U.S. Government employees as part of their official duties are in the public domain. The copyrights to materials written by other individuals or organizations are presumed to remain with them. If you think any of the information displayed in the PDF is subject to a valid copyright claim, please contact the Gerald R. Ford Presidential Library. Some items in this folder were not digitized because it contains copyrighted materials. Please contact the Gerald R. Ford Presidential Library for access to these materials. Digitized from Box 37 of the Sheila Weidenfeld Files at the Gerald R. Ford Presidential Library Cancer Resoarch Accomplishments During 1975 Prepared for use by Mrs. Betty Ford at November 1975 annual meeting of the American Cancer Society Treatment: (a) There is increasing evidence that anticancer drugs used after surgery for breast cancer can provent recurrence of that disease. The drug L-PAM (L-phenylalanine mustard) has continued to give lower recurrence rates than a placebo in reports on a growing number of women followed for two years in the study directed by Dr. Bernard Fisher, chairman of the National Surgical Adjuvant Breast Project. The approach has been supported by similar find- ings with 3 three-drug combination in a study at. the National Cancer Institute of Milan, Italy. (b) Anticancer drugs also are being shown to be effective against recurrence of osteogenic sarcoma, a cancer of the bone, in continuing studies, Results with an increasing mmber of patients followed for longer periods of time have improved on findings reported initially last year. is FORD (c) Advanced cancers of the gastrointestinal tract, recurring after surgery, have begun to respond to drug combinations in studies conducted by Dr. Charles Moerte1 and colleagues at the Mayo Clinic. In future studies, the drug combinations may be usable to prevent recurrence. (d) Adriamycin and DTIC have been approved for use against cancer in standard medical practice. 2 - Detection AM Diagenver: (a) Breast cancer continued to be dotected at an early, localized stage in a high proportion of cases discovered in the breast cancer screening demonstration program conducted jointly by the National Cancer Institute and the American Cancer Society. Nearly 80 percent of reported cases have had no evidence of spread to the axillary (ampit) lymph nodes. Women in the screening program are given annual physical examinations, X-ray manmograms, and a thormogram, and are instructed in the practice of monthly breast self-examination between the annual check-ups. (b) A computerized technique for X-ray examination had been reported to be effective in diagnosing brain cancers and other brain diseases. The technique is being modified for scanning of other parts of the body. Cause & Prevention: (a) Publication of the Atlas of Cancer Mortality for U.S. Counties: 1950-1969 has led to oxtensive work to uncover reasons for geographic.concen- trations of cancer. NCI cpidemiologists have reported unusual occurrences of bladder cancer linked with the chemical industry, and unusual occurrences of lung cancer linked with smelters that emit arsenic into the air as a byproduct of copper, lead and zinc production. (b) Scientists are exploring the role in cancer causation of viruses isolated during the past year from human cancers, normal human tissues, and disorders characterized by a weakening of the body's (continued) - 3 - imme system. Examples of such viruses Include a virus isolated from the laboratory-grown leukemic cells of a woman with acute myelogenous leukemia, a rare form of this blood cancer, by scientists at NCI and Litton Bionetics, Inc. A similar virus was isolated from laboratory-grown human embryo cells by scientists at the University of Chicago. Collaborating sciontists at NCI and the National Institute of Allergy and Infectious Diseases have reported isolation of a different type of virus from the brain tumor of a patient with an inherited immmologic disorder. (c) Dr. Peter Duesberg and coworkers at the University of California, Berkeley, have pinpointed the location of & virus gene that is responsible for the cancerous transformation of infected animal cells. The gone is part of the genetic material of the Rous Sarcoma virus, which causes tumors in chickens. Basic Research: (a) NCI scientists have identified a unique type of human white blood cell in patients with an immme defect that may make them susceptible to developing cancer. The white blood cell, called a "suppressor T cell," blocks antibody production, making the patients vulnerable to infections and other diseases. (b) Other NCI scientists have identified a type of white blood cell that they believe is the immature "stem cell" from which all blood cells develop, including red blood cells and platelets 85 well 85 the various white blood cells. 4 Is there any evidence that the mastectomies of Mrs. Ford and Mrs. Rockefeller have increased the awareness for early detection of breast lesions among American Women? Immediately after Mrs. Ford's and Mrs. Rockcfeller's mastectomies, the NCI-ACS breast cancer detoction demonstration centers were flooded with requests for appointments and, in some cases, had a patient backup for three or four months. This immediate overwhelming influx of patients was attributed to the publicity attached to Mrs. Ford and Mrs. Rockefeller. Many of the patients verified the fact that their decision to have a breast examination was influenced by the news stories on the two prominent women. The initial influx of patients has now passed, and none of the centers is backed up to a great extent. Even now, however, some of the patients coming through the centers mention Mrs, Ford and Mrs. Rockefe1ler. Elsewhere, attendance at ACS public education programs on breast cancer ALD R. FORD LIBRARY has trebled in the past year. These programs include instruction in breast self-examination, films, and information on anatomy. Although no statistical studies have been attempted on the impact of the publicity, it is evident that many women were stimulated to have a breast examination by the articles on Mrs. Ford snd Mrs. Rockefeller. Female Cancer GRUMMAN HEALTH SYSTEMS Detection Mobile Unit VM-1 FORD GREAT LIBRARY LEAD SHIELDED WALLS, PARTITION & SLIDING DOOR ENTRY EXIT CURBSIDE X-RAY TUBE WASH STEP STEP BASIN EXAMINATION TABLE "PAP SMEAR" SEAT SEAT DRESSING DISROBING AREA SLIDING CURTAINS AREA DRIVING COMPARTMENT ELECTRIC 3-AXIS SEAT ELEVATOR INTERVIEW AREA THERMOGRAPHY SENOGRAPH PHOTO SEAT TABLE FLUOROGRAPHIC MAMMOGRAPHY CAMERA SENOGRAPH COOLER INFRA-RED THERMAL PICTURE CAMERA DISPLAY UNIT UNIT PLAN VIEW SCALE IN FEET Female Cancer Detection Mobile Unit VM-1 Purpose: Provides rapid, accurate and economical system for detection of breast, cervical and lung cancer in a mobile environment, using mass screening techniques consisting of medical inter- view, mammography, clinical examination of the breast, Pap cervical smear, thermography, and chest x-ray. System Highlights: High-Density Packaging Area Components Medical Interview Area and Dressing Rooms Mammography Performed with efficient Senograph unit. Low radiation dose of 2-2.5 rads per exposure by using non-screen film Examination Table Required for clinical examination of breast Enables preparation of Pap smears from cervix and vagina for pathology Thermography Creates an instantaneous thermal image on film. Breast cancer produces increased heat in high proportion of cases Chest X-ray Provides photofluorography with an Odelca camera Mobile - quick transfer of services to area of requirement Rapid Patient Processing - estimated at 10 minutes per patient Self-contained - requires no umbilicals Special Environmental Features: Life-time all-aluminum shell (.102 aluminum sidewalls) Dual roof-mtd air conditioners - 24,000 BTU/HR total Dual doors for efficient patient flow Dual 5 KW electric power generators sets with remote start on roll-out drawers for ease of maintenance Formica walls and acoustic tile ceiling - insulated with sprayed-in-place polyurethane foam Electric heaters with individual thermostatic control Low-profile fluorescent lighting Warm decorative interior, easy-to-clean carpeting throughout GRUMMAN HEALTH SYSTEMS Customized exterior painting and lettering 534 BROAD HOLLOW ROAD MELVILLE, N. Y. 11746 Medical Special Purpose Equipment: Certified lead-lined X-ray area with lead glass viewing window TEL. 516-575-3513 Senograph Cooler specially designed to absorb Senograph-generated heat TELEX 961308 Senograph seat with three axis movement CABLE: GRUMAIR Storage cabinet for cones, film, interview cards and miscellaneous equipment General: Overall dimensions 26' 4" long, 7'7" wide, 10'2" high (headroom 6'5" floor to ceiling) Weight 12,000 pounds Power available at 220V, 115V, 60 Hz, single phase and 12VDC Chassis power steering, power brakes, automatic transmission, choice of standard chassis to 13,000 GVW Safety features in accordance with Federal Highway Safety Act 1657-71-1A What is a Breast Exam? This leaflet was prepared to help you understand and to know what to expect from an examination of your breasts, a four-part comprehensive proce- dure recommended by the American Cancer So- ciety. The Guttman Breast Diagnostic Institute provides this examination at its facilities at 200 Madison Ave, Manhattan, and in health fairs and screening programs conducted by the Society's New York City Division. Questions You May Have: Your Exam: Are mammography and thermography 1 You will have an Interview-usually by one of proven methods of cancer detection? our volunteers who will ask some general and Yes. Both methods combined with palpation, make personal health questions related to the breast. the most complete breast cancer detection test avail- able. Hundreds of thousands of women have had these 2 Each part of your breasts will then be carefully tests in the United States. felt by the examiner's hand. This is called Palpation. If you think you have any breast problems, take this opportunity to mention them Should I have mammography if I'm pregnant? to the examiner. If you're pregnant and have no symptoms you will You will be shown how to give yourself this not routinely receive the mammography test. How- examination and you'll receive a leaflet explain- ever, if you have any concern about your breasts and ing the procedure. Be sure to ask for a leaflet. wish to have the exam, please tell the technician. You should examine yourself once a month. The best time is about one week after your menstrual period, when bathing or showering while your When will I receive the results of these tests? skin is still wet and your fingers slide easily. You will be notified by mail of the results within a few weeks. If you were tested at a health fair, call the American Cancer Society if you don't hear within six 3 The Thermography test is done in an air condi- weeks. tioned room to cool your breasts. This test gives us a picture of heat patterns of your breasts. The examiner will take a picture using What if the report asks me to return for re-examination? a special camera to pickup variations in breast skin temperature which may be an important This does not mean we have found any cause for con- indicator in early cancer detection. cern. We may have to re-examine you for technical reasons-if the equipment has not functioned properly or if the photographic plates haven't reproduced well. 4 You will receive a Mammography test, a quick, painless x-ray examination using very low rad- iation. These pictures show us the inner struc- What if the tests are negative? ture of the breast and can pinpoint the location This means your breasts are healthy and that we have of even the smallest abnormality. found no condition warranting further care. (over) However, you must: 1-Continue to have your re-examination on a regular basis. We'll write to remind you. 2-Regularly examine your breasts yourself. Keep the booklet on breast self-examination handy and do the test once a month. Report any change you feel in your breast promptly either to your physician or to us. EARLY DETECTION SAVES LIVES— IT MAY SAVE YOURS! American Cancer Society New York City Division, Inc. 19 West 56th Street, New York, N.Y. 10019 586-8700 BROOKLYN UNIT: 141 Livingston Street, Brooklyn, N.Y. 11201 UL 8-8200 STATEN ISLAND UNIT: 42 Richmond Terrace, Staten Island, N.Y. 10301 Glbraltar 7-2140 Guttman Breast Diagnostic Institute 200 Madison Avenue, N.Y., N.Y. 10021 689-9797 PRACTICAL MASS SCREENING FOR EARLY BREAST CANCER PHILIP STRAX, M.D., GUTTMAN INSTITUTE, NEW YORK, N.Y. GENERO FORD GUTTMAN INSTITUTE 200 Madison Avenue New York, New York 10016 RESULTS METHOD RATIONALE Number of Examinations (1971-1974) 80,442 PROBLEM AGE-ADJUSTED MORTALITY RATES, ALL CAUSES AND Initial Exams 40,341 BREAST CANCER WOMEN AGED 25 YEARS AND OVER: Subsequent Exams 40,101 UNITED STATES, 1935-1967. ALL CAUSES BREAST CA'S PER 1,000 PER 100,000 Of 3,367 recommendations for biopsy or aspiration, 20 50 The challenge of breast cancer in American women MORTALITY 1,910 were done and 478 cancers found. has never been greater: BREAST CANCER Age < 36 36-40 41-50 51-60 61 > 40 Age distribution: % total exams 16% 15% 31% 24% 14% One of every 14 women develops breast cancer. One of every four cancers in women is in the 15 % cancer 1% 3% 29% 34% 33% breast. MORTALITY VALUE OF PERIODIC EXAMINATIONS ALL CAUSES 30 Breast cancer is the most common cause of death On initial exam, the number of prevalent cancers present is high, depending on such factors as in women aged 40 to 45. It is the most common 10 self-selection and age of women. Because cancers have been present for varying lengths of time, only cause of cancer death at any age. half of the cancers are free of nodal involvement. On subsequent exam, the number of incident 20 cancers, which have become detectable since the previous exam, is much less, but the majority have no nodal spread. Over 90% of breast cancer is detected by the woman. In the majority of instances the disease is negative axillary nodes 5 not localized at the time of diagnosis. 10 exams No. of Ca rate/1000 No. of Ca % of Ca INITIAL EXAMS 40,341 374 9.4 185 49% And there has been no change in mortality in SUBSEQUENT EXAMS 40,101 104 2.6 66 63% 40 years! 0 0 1935 1945 1955 1967 VALUE OF THE TANDEM TECHNIQUE NOTE: All rates are adjusted to the age of women 25 years of age and over in 1940. SOURCE: Annual Volumes, Vital Statistics of the United States, National Center for The tandem technique, using clinical examination, mammography and thermography gives the Health Statistics, U.S. Department of Health, Education and Welfare. highest yield of cancers because some are detectable on only one modality. Those found on one modality only have a higher percentage of negative nodes. NOTE: 1. "Interval" Cancers: of the 478 cancers found, 437 were detected on screening modalities and 41 were "interval" cancers found by the women themselves within a year of a negative examination. They are not included in the tally below. REMEDY 2. Thermography, when abnormal, alerts the physician to the possible presence of cancer in a stage not yet detectable by palpation or mammography and suggests more frequent The only promise for improvement in death rate lies in earlier detection of more cases in a localized examinations in order to localize it earlier. Since a positive thermogram alone is never the basis for biopsy, it is also not represented in the data below. stage. This goal can be achieved only through periodic examination of apparently asymptomatic 3. Negative Nodes are included in the below data only when proven. The surgical procedures women in mass screening. in 12% of the cases did not include axillary dissection, so that the true percentage of negative nodes may be higher. This concept is pointed up by the one-third today enhance the value of the x-ray and improve In 437 cancers (excluding 41 "interval" cancers) reduction in mortality achieved by the mass the yield. screening program of the Health Insurance Plan of Thermography has been highly regarded as an All Cancers Negative Axillary Nodes Greater New York involving 62,000 women-31,000 in additional means to alert the clinician to the CANCERS DETECTED BY: No. of Ca % of Ca No. of Ca % of Ca a study group with a carefully matched control group. The study group was screened periodically presence of an occult cancer, as a potential MAMMOGRAPHY ONLY over three years with mammography and clinical prescreening modality, and as an indicator of a high not palpable 75 17% 52 69% examination. In the six years of follow-up, 88 risk group. CLINICAL EXAM ONLY women died in the control group against 56 in the A 4-part tandem approach to breast cancer not on x-ray 121 28% 75 62% study group. Of 44 women whose breast cancer was detection offers the best hope for the greatest yield BOTH felt on palpation detected by mammography alone, only 1 has died. of localized, curable breast cancers in a mass and seen on mammogram 241 55% 98 41% Improved mammographic techniques available screening program. VALUE OF BREAST SELF-EXAMINATION (BSE) The GUTTMAN INSTITUTE (Stella and Charles Guttman Breast Diagnostic Institute) was formed in 1968 to develop an efficient, economical and effective examination to achieve this goal. Its Since 95% of breast cancer is first detected by the women themselves, indoctrination into BSE is vital as TANDEM TECHNIQUE consists of an interview for historical data, a clinical examination, a first step in screening. Women can be taught (and should be taught by the physician) to detect improved mammography and thermography. small lesions of 1 cm. or less in their own breasts. BSE is especially important to detect "interval" cancers. When BSE indoctrination is part of the screening process, "interval" cancers are detectable with a high degree of no nodal involvement. Of the 41 "interval" cancers, 27 or 66% had no nodal involvement. MOBILE FACILITY The Guttman Institute operates an active FIXED FACILITY "outreach" program. A significant proportion of the population lives in a low socioeconomic milieu where motivation for At its central location in Manhattan, the Guttman Institute (in cooperation with the American Cancer preventive care is poor. When a screening program Society-New York City Division) offers a complete examination consisting of: is brought into a community under the auspices of a neighborhood's organizations, peer pressure and 1 convenience increase motivation. INTERVIEW for demographic data, including menstrual, parity, breast and family A 26 foot van outfitted with a CGR Senograph for mammography and an AGA Thermovision for history. thermography makes the entire tandem technique screening process completely mobile. CLINICAL EXAMINATION under the Up to 70 women per day can be examined. 2 supervision of a physician skilled in this procedure. Details of breast structure as well as masses, ENTRANCE EXIT recommendation for treatment and follow-up are recorded. Breast self-examination is taught and LEAD strongly encouraged on an individual CURTAINS basis at this time. AGA THERMOVISION THERMOGRAPHY AND DRESS CURTAINS VERTICAL CAMERA STAND FOR X-RAY MAMMOGRAPHY performed with the CGR s 3 Senograph using improved film CGR SENOGRAPH techniques. Two views of each breast CONTROLS AND AGA THERMOVISION TECHNICIAN STATION AND TECHNICIAN are performed in six minutes time, with STATION CONTROLS low radiation dose by using non-screen film (2-2.5 rads per exposure) or by using UNDRESS PALPATION MAMMOGRAPHY rare earth screens 0.5 rad per dose). Data of breast structure and masses plus recommendations for follow-up and treatment are recorded. THERMOGRAPHY performed with the AGA Thermovision detects the infrared emanation from the breast which is visualized on 70mm film. Details of the vein patterns plus abnormalities of heat When the Guttman Institute participates in large manifestations are recorded with "health fairs" sponsored by neighborhood recommendation for follow-up. community organizations in which hundreds of women may be examined in a few days, a 70mm photomammography device is used. It is transportable, uses 110 volt current, and is capable of examining up to twenty women per hour with a radiation dose of 1-1.5 rads per exposure. This device, together with an AGA Thermovision also TANDEM TECHNIQUE 2,500 women per month receive this 4-part using 70mm film, demonstrates how great numbers examination, given in less than twenty minutes time per patient. of women can be periodically screened very 30,992 examinations were given in 1974. All modalities are done economically with the tandem technique. independently. Reports are sent to the woman's physician. No treatment is given. Advances in rare earth fluorescing screen technology, coupled with special films in vacuum cassettes, produce images with radiation dose substantially less than 0.5 rad per exposure. The photomammography device described on the next page is being optimized to produce full size mammograms of excellent quality using rare earth screen in a novel vacuum contact system. POTENTIAL As a direct result of the persisting mortality reductions achieved in the Health Insurance Plan of Greater New York study and the practical tandem technique approach to mass screening developed by the Guttman Institute, the National Cancer Institute and the American Cancer Society have jointly funded 27 demonstration projects, including the Guttman Institute, to screen over 250,000 women annually for the next 5 years. The potential from the screening programs includes: Detection of more minimal and pre-clinical cancers with a great majority free from nodal involvement. Evaluation of the contribution of each modality to the screening process. Identification of higher risk groups and optimum screening frequency. Increased motivation of women to accept periodic breast examination. Increased use of breast self-examination, taught directly at the centers. Improvement in detection techniques. The 27 projects will act as foci for disseminating knowledge about mass screening to the profession-at-large, and act as catalysts to encourage the development of other centers under private and public health auspices. CONCLUSION 1. MASS SCREENING FOR BREAST CANCER OFFERS THE ONLY PRACTICAL PROGRAM AVAILABLE TODAY TO BEGIN THE CONTROL OF BREAST CANCER. 2. MASS SCREENING CAN BE MADE A PRACTICAL, ECONOMICAL AND HIGHLY ACCEPTABLE PROCEDURE. 3. THE 4-PART TANDEM TECHNIQUE OFFERS THE BEST YIELD OF MINIMAL, CURABLE BREAST CANCERS. The female breast has intrigued mere man As a valuable, lovable, marvellous sight; As a matter of fact, from the time man began, He's found it the source of much varied delight. To all it brings life when life struggles to start, And then it delights, ever more with the years; To some it's a symbol of beauty in art, To others it's sorrow and sadness and tears. Let's take up the challenge and seek out new ways To find hidden cancer when close to its start; Let's learn the new markers that guide through the maze, To bring more success to the surgeon's art. P.S. Supported in part by N.C.I. Contract NO. 1-CN-35004 CQUDTED cancer is one of mankind's oldest enemies, laying waste since earliest times to people of all ages and stations in life. Once considered a shameful malady to be acknowledged in whispers, if at all, it has, only in the past few decades, been forced into the open and assailed with all the vigor and deter- mination science and medicine can muster. One of the first to take up the counter- attack against this widespread and dangerous foe, the Southern California Cancer Center offers hope-and the strong possibility of victory-to thousands each year who seek protection against the onslaughts of malignancies. Cancer is met and engaged on many fronts-diagnosis, therapy, research and FORD j 03.840 LIBRARY education. A complete cancer-fighting facility-one of the leading institutions of its kind in the country-the Southern California Cancer Center holds out to the cancer patient every possible chance for survival. 83 H HEARTH I detection increasing the odds More than 1.5 million Americans have been saved from cancer through early detection and treatment. An average of 200,000 are rescued each year. At least another 100,000 could be saved annually if cancer is caught in time. The Southern California Cancer Center views early diagnosis and treatment as one of its most important contributions to the conquest of malignancies. The center's precise detection machines help put time on the side of the patient. By measuring heat variations caused by tumors, the Thermograph brings a high degree of accuracy to the discovery of breast cancer. Nuclear medicine employs radioactive materials to pinpoint cells that have run amuck and is invaluable in detecting brain, thyroid and liver malignancies. To heighten the chances of life for hundreds of women each year in the Los Angeles area, a free "Pap" clinic is conducted in con- junction with the American Cancer Society. Examination of uterine smears reveals the presence of abnormal cells shed by the body in the early stages of cancer formation and gives the potential victim the edge in surviving this type of malignancy. striking back through therapy the giant machines To treat those already afflicted, a battery of mechanical giants is used to beam cancer-killing rays into affected areas of the human body to battle threatening tumors. A pioneer in the field of radiation therapy, the center was the first on the West Coast to apply this form of treatment to the control and eradication of malig- nancies. Over the years, it has added to its lineup of equipment until, today, it boasts one of the largest arsenals of cancer-combating machines to be found anywhere. In addition, radium and cesium implants are utilized to fight cancers of the tongue, uterus and cervix. Radiation therapy, however, is only one avenue for striking back at cancer. Because the Cancer Center emphasizes the team approach to the counterattack against this determined aggressor, the patient has the benefit of experience and knowledge in many areas. He is assured that the best possible therapy or combination of treatment techniques will be focused on the solution of his problem. COUNTER Left: Two-million-volt Van de Graaff Accelerator so precise that it can treat tumors around the eyes or in the lungs with complete safety effective on cancers located from one to five inches under the skin. Below: Cobalt.. one of the earliest cancer therapy machines.. still successfully engaged in turning back the inroads of malignancies. I Below: Picker Vanguard... a lower-voltage machine for tumors situated fractions of an inch below the skin... often used against skin cancer. Above: Betatron... at 18 million volts, the most powerful cancer fighter presently in existence. can zero in with pinpoint accuracy on tumors four or five inches under the skin anywhere in the body. research probing for the breakthrough The basic ingredient of life-the human cell-remains a mystery and, therefore, cancer which is a disease of the human cell exists as part of that mystery. To date, researchers have been unable to determine exactly why "good guy" cells become "bad guys" terrorizing the body and working toward its destruction. Yet they remain undaunted. The search intensifies and the frontiers of knowledge widen, however begrudgingly, keeping alive the hope of a significant breakthrough. Research in the Southern California Cancer Center is concentrated on breast cancer and leukemia. An electron micro- scope magnifies the "gangster" cells of cancer 200,000 times for investigations by scientific probers. Whirling ultra- centrifuges, generating thousands of times the force of gravity, and the ultra- microtome, which slices cells into minute sections, are enlisted in the attempt to pry open the elusive secrets of malignancies. Counterattacking through research, the Cancer Center hopes to find the Achilles' heel which will eventually spell defeat for this devastating peril to life. CA education the forward thrust of knowledge Simultaneously, continuing medical education COUNTER ЛТАСК public seminars and other educational projects. programs help doctors remain alert to new The nature of cancer, how it strikes, what can diagnostic and therapy techniques for the benefit be done about it arm the patient with infor- of the patient. Fellowships and residencies, mation that can save his life. The Southern are other means of honing the cancer knowledge California Cancer Center and California of doctors, better equipping them to aid Hospital Medical Center combine forces in cancer sufferers. follow-up the constant pursuit One of the elements brought into play by the Southern California Cancer Center in its pursuit of a victory over malignancy is the largest private Tumor Registry in California, serving as a giant knowledge bank. More than 40,000 medical histories have been recorded here since 1942, giving the patient resource to research and statistical facts which can be used for comparison and guidance in his own situation. Moreover, the Tumor Registry keeps watch over the progress of each patient through the years, issuing periodic checkup reminders so that he will be certain to receive the follow-up crucial to his survival. experience acquired impressive expertise in dealing with the power of know-how this type of problem. California Hospital Medical Center ranks as one of the largest cancer treatment facilities Some of the most widely known and highly in the state. Approximately one-third of its respected cancer specialists in the nation have patients are malignancy victims. Consequently, been affiliated with the Southern California its medical and nursing staffs are particularly Cancer Center since its inception. Treating qualified to understand the cancer patient thousands of patients annually, they have and to provide the kind of care and support he needs. When life is at stake, the insights and advantages of years of experience represent an incomparable asset to the patient. continuing the counterattack southern california cancer center a division of california hospital medical center non-profit non-sectarian Counterattacking cancer with one of the 1414 South Hope Street, Los Angeles, California 90015 (213) 748-2411 most comprehensive programs to be found anywhere in the country, the Cancer Center is grateful for the community assistance board of directors which has enabled it to score consistent chairman-emeritus advances. Orville N. Meland, M.D. president Through the generosity of its friends, it has Donald P. Loker Property Management extended the hand of help to thousands, vice-president and treasurer including many without the ability to pay. William N. Martin It stands ready to assist thousands more who Chairman of the Board: Bayly, Martin and Fay, Inc. will be struck down by the ravages of cancer vice-president William Stinehart and will want to place their chances for life Senior Vice-President: Gibraltar Savings and Loan Association on the best counter-measures available. secretary James L. Nolan Attorney: Adams, Duque and Hazeltine However, it must have continual support to assistant secretary and assistant treasurer maintain its philanthropic activities. A non- Samuel J. Tibbitts President: Lutheran Hospital Society profit organization, it offers opportunities Walter C. Alvarez, M.D. for giving which can return substantial tax Dr. W. Ballentine Henley President: United Church of Religious Science and income savings benefits to the donor. Paul H. Jernstrom, M.D. Director Emeritus John MacLeod John MacLeod Enterprises If you have been helped and wish to help J. Robert Meserve Attorney: Meserve, Mumper and Hughes others-or if you are interested in performing Robert C. Niven Fidelity and Deposit Co. of Maryland James F. Nolan, M.D. a humanitarian deed for its own sake-please Mrs. George Ponty: Civic Leader contact our Director of Development. Julian M. Sether, M.D. Sgt. Barton L. Bartel deputy sheriff "The people at SCCC know what they're doing. The service is outstanding they make you feel like they care. / have full confidence in the Cancer Center they do a great job. five who are alive The files of the Southern California Cancer Center Tumor Registry contain the names of thousands of others who are living, too. Many more thousands will live with your help. Helen Heath accountant "All / met at the SCCC were warm and caring during a very difficult time for me. / remember its staff with affection and gratitude." Pauline Cullins Walter H. Drane welder attorney COUNTER ЛТАСК "Early detection, "The SCCC regular check-ups provides all types and the kind of of vital services treatment / received for cancer victims. at the SCCC have / feel that our made it possible community is for me to still fortunate to have be alive to talk such a facility about it. " available and my relations with it have always been pleasant." Harry W. Atkinson mechanic "The best of facilities, the best of care. / owe my life to the SCCC's fine medical staff." American Cancer Society Annual Report 1974 Cancer hasn't stopped 1,500,000 Americans from living. 1,500,000 Americans who have had can- cer are alive, well and free of the disease. This fact represents a benchmark in the progress of cancer control. But the Society's goal is to save even more lives from cancer and 2,300,000 volunteers are helping to make it possible. Concentrating on Educa- tion, Research and Service programs, the ACS works to improve cancer prevention, early detection and prompt treatment. Physicians, scientists, nurses and allied health experts, civic leaders and com- municators are united in their efforts to wipe out cancer in our lifetime. The 1974 Annual Report documents those generous gifts of time, support and energies toward the conquest of cancer. Contents: From the Chairman and President 2 From the Executive Vice President 3 Breast Cancer Detection Program 4 Service and Rehabilitation 10 Research 11 Public Education 14 Public Information 16 Smoking and Health 18 Professional Education 20 Worldwide 21 Crusade 21 Treasurer's Report 22 Financial Statements 23 Auditors' Report 26 National Officers, House of Delegates 28 Research Committees 29 FORD Divisions 32 A Legacies inside back cover From the Chairman and From the Executive the President Vice President Worldwide attention focused on breast men were visited after breast surgery by The commitment of millions of Ameri- and young investigators here and abroad. cancer this past year because of the fact ACS Reach to Recovery volunteers. cans to the conquest of cancer became a that it struck two famous women, Mrs. nationwide priority with the passage of The ACS in cooperation with Mount Gerald Ford and Mrs. Nelson Rocke- The American Cancer Society supports the National Cancer Act of 1971. The Sinai School of Medicine initiated valu- feller. Their straightforward reaction basic research and clinical research American Cancer Society pioneered in able studies on the hazards of vinyl and candor served as an inspiration bringing the knowledge of the labora- the effort to get adequate Federal re- chloride and other occupational causes of and guide to many thousands of women tory to the patient's bedside. It under- sources and funding for cancer research cancer and reported on them at a scien- confronted by breast cancer. writes the continued search for causes and control. tific symposium in New York City. and cures of cancer. Last year the ACS The American Cancer Society has in re- provided more than $26 million for can- By 1974, the great expansion of the gov- The follow-up of the massive ACS cent years concentrated its many ré- cer research. It also continued to spear- ernment's cancer control program had Cancer Prevention Study traced sources toward improving control of head the use of community resources in served to increase the need for ACS ac- George P. Rosemond, M.D. of the original 1,000,000 subjects en- Lane W. Adams breast cancer, aware that it is the major screening programs and to conduct pro- tivities. Our millions of volunteers President rolled in the Study from 25 states; new Executive Vice President cancer concern of women. A special sec- grams such as arranging for Pap tests throughout the country responded to the questionnaires were completed or death tion of this report illustrates how the on a community-wide basis through Denge P. remand MD tasks of expanding our education, serv- certificates were obtained to provide Lane W adams vital ACS programs of education, re- local health departments, industries, and ice and rehabilitation programs. data on exposure to occupational agents search and rehabilitation have contrib- organizations. suspected of causing cancer. uted to this national goal. We have wit- Volunteers and staff of the ACS have in nessed this firsthand, one of us as a sur- Another area of cancer prevention cur- many instances already become involved The ACS National Conference on geon who treats breast cancer, the other rently of deep concern to the Society is in the 17 Comprehensive Cancer Centers Childhood Cancer, held in Dallas, as a lay officer of the Society who works the link between cigarette smoking and established by the National Cancer In- brought scientists and physicians and closely with hundreds of ACS volun- lung cancer. It is estimated that 81,000 stitute around the country. These centers, allied health professionals together to teers involved in life-saving efforts. men and women will die of lung cancer currently in varying operational stages, discuss progress in treatment of leu- this year. Our Society, the government will be affiliated with a network of com- kemia and other cancers affecting chil- The Society believes early detection and and other agencies in the public health munity hospitals to provide the public dren under 15 diagnosis of cancer is the key to success- field have a grave responsibility to cut with screening programs for early detec- ful treatment and emphasizes the value down on the shocking toll produced by tion, diagnosis and treatment. Also there More than 60,000 patients were as- of breast self-examination based on the cigarette smoking. will be an outreach program to offer pro- sisted through the three major rehabili- fact that more than 95% of all breast fessional education, public education and tation programs of the Society-for cancers are first discovered by women As we review 1974, there is some cause W. Armin Willig information. Volunteers will be an ac- patients who had breast surgery through themselves. for satisfaction that one out of three Chairman tive part of this network as each center Reach for Recovery; for patients who cancer patients is being cured today. Yet, begins to service more and more com- lost their voice boxes through the ACS- The Society, along with other organiza- 111,000 cancer patients will die who Warmin munities. sponsored International Association of tions, supported research investigating might have been saved by earlier diag- Laryngectomees; for patients with bowel a combination of modalities that could nosis and treatment. This is a challenge For example, the Society's volunteers or bladder surgery through the United detect breast cancer before a lump could that makes us move into 1975 with are helping implement cancer control Ostomy Association. be felt. The ACS initiated the program renewed energy. programs like the Pap test screening of that is now jointly sponsored with the low income groups while the NCI sup- More than 50,000 public education government's National Cancer Institute, plies the funds. This joint effort will programs were conducted on uterine resulting in 27 Breast Cancer Detection make it possible to achieve the ACS ob- cancer and the Pap test. An ACS-spon- Demonstration Projects around the jective of a Pap test for every woman by sored Gallup study showed that 78% country. Early data reveal that most 1976. of all U.S. women have now had a Pap breast cancers found in this program, test. where screening includes a medical his- The American people continued to sup- tory, doctor's examination, mammogra- port ACS activities by giving $97.3 Stepped-up action programs to help phy (low-radiation X ray) and thermog- million to the Crusade through contribu- smokers quit cigarettes included com- raphy (heat scanning), are being dis- tions and legacy income. This amounted munity and school quit-clinics, special covered before the cancers have spread, to an increase in funding of 4.6% over radio and TV spots. and therefore are highly curable. the year before. The following pages report what we The ACS Reach to Recovery program Here we present a few of the year's accomplished this past year. With strong is an outstanding example of service and highlights of the Society's cancer control commitments to our ongoing programs, rehabilitation. Volunteers who have efforts: we are taking the initiative in expanding themselves undergone breast surgery, overall cancer control programs in com- visit-with the physician's consent and A record sum of more than $26 mil- munities across the nation. cooperation-breast cancer patients and lion was spent for cancer research in the provide psychological and practical help. form of 498 grants to 127 institutions During the past year alone 45,000 wo- in the U.S. and to outstanding scientists 2 3 Breast Cancer Detection monstration Projects-A amatic Attack on Breast Cancer cancer detected and treated at its stage, in situ, is practically 100% Unfortunately, most breast can- not being found that early, and is more women in this country than other form of cancer. American Cancer Society has fo- vital energies and resources on this in recent years, and late in launched an aggressive new cam- to try to save more women. The Cancer Institute joined the in establishing a nationwide net- of 27 Breast Cancer Detection nonstration Projects. These projects the best early-detection examina- available anywhere in the world at present time. The examination, for 35 and older who have no symp- of breast disease, involves four a detailed history of the patient's a clinical exam (palpation); nmography (low-radiation X rays); thermography (measuring heat pat- of the breasts). 5,000 women will be screened project the first year, another the second year; each of these women will be reexamined five years, then followed for more years. Nearly 300,000 women participate in the program. WERS FROM DATA of data from each project by versity City Science Center in Phila- ohia has already proved that these detection techniques will save more Equally important, the data could answers to some of the questions rounding this disease: Which women the greatest risk of developing it? Is a relationship between other breast and cancer, between the Pill and Which types of breast cancer be found earliest? Are these sophis- expensive techniques feasible screening? What are the full abilities of the still-experimental nique of thermography? A Dramatic Attack on Breast Cancer Teamwork between the private sector top priority in the country. The National would turn up for the exam to validate Delaware State Correctional Institute; (ACS) and government (NCI) was Cancer Act had allocated $400 million the project's effectiveness. The success of busloads of nuns arrived. Minority the key to getting a national program of in its first year for a full-scale war on New York City's Guttman Institute was, women were sought out; medical history this scope underway. Combining forces cancer. The government's National Can- after all, only one experience in one city. forms were translated into Spanish. Not provided more funds, prevented dupli- cer Institute was now in a position to To answer the skeptics and probe yet a year old, this project is a friendly, cation of effort, and brought many levels contribute funds and expertise to aug- women's real concerns about breast can- relaxed place where 25 to 30 women are of the ACS into action, including a ment the new ACS program. ACS and cer and what, if anything, they were examined each day. powerful ACS resource-volunteers. NCI would jointly establish twenty doing to help protect themselves, the ACS staff and volunteers worked closely projects, almost twice the number the ACS commissioned the Gallup Organi- How One Project Works with federal agencies, medical societies, Society could have supported alone. NCI zation to poll women across the nation. The projects differ in style and atmos- professional organizations, community would pay two-thirds of the costs; ACS, ACS education programs had long phere, depending on the communities groups, women's clubs and the media to one-third. In addition, ACS would re- stressed breast self-examination. Were they serve. Some are dynamic, bustling; get the projects set up and operating of a breast-screening study he had con- many practicing it? No one knew. the demonstration projects, not only as others operate at a more deliberate pace. quickly. ducted for Hospital Insurance Plan of early detectors, but because they would One of the earliest projects, at Virginia Greater New York (HIP). The HIP Controversy about surgical treatment teach women BSE. Mason Medical Center, Seattle, Wash- How Did This Program Begin? study showed that death rates had de- was swirling through the lay press, and ington, has achieved an outstanding ex- The growing frustration about breast creased one-third among women who the debate was spilling over into medi- BSE ON TELEVISION pertise in its 18 months of operation. cancer deaths erupted at an ACS meet- had been examined annually by palpa- cal meetings and professional journals. ing in July of 1971. The disease had tion and mammography; that one-third As a direct response to what Gallup had Were women so frightened about the reached the status of an urgent national of the cancers found in these women revealed, the Society made a film for disease and confused about the complex television called "Breast Cancer: Where problem. Society leaders decided that would have been missed without mam- issues surrounding treatment that they mography; and even more striking, that We Are." It shows a doctor teaching a action was imperative and that the So- would stay away from the projects? No woman how to examine her breasts. This ciety itself should launch the attack. of the 44 cancers detected by mammo- one knew that either. graphy alone, only one patient died in was the first attempt to teach BSE to a nationwide audience via television. A A planning committee of physicians, lay the succeeding five years. cruit the patients, and Society volunteers would be an integral part of each project. The Gallup survey found cancer to be ten-city survey several weeks later meas- volunteers and staff began mapping out a campaign. They had to devise a reliable Armed with this evidence, and hoping to the major health concern of the women ured the film's impact on audiences. It of America, and breast cancer was re- found that 83% of the women who saw system for early detection and determine broaden his screening efforts, Dr. Strax JOINT PROJECTS ANNOUNCED how early was early enough. had asked the American Cancer Society ferred to specifically most often. The the film said they would now practice The first three ACS-NCI Breast Cancer study showed that most women had BSE. to help him offer these breast exams free Detection Demonstration Projects were One approach was already being tested to the women of New York City. Divi- heard of BSE, but few were practicing it, Director Dr. Thomas Carlile is ex- announced in January 1973. Not sur- and few were receiving breast exams WOMEN RESPOND TO THE EXAM sion leadership was enthusiastic. Work- tremely enthusiastic about what is finally at the Stella and Charles Guttman prisingly, New York City's pioneering from their doctors. Many women lacked In overwhelming numbers women began Breast Diagnostic Institute, Inc., in New ing together, Dr. Strax and the Division happening in earlier breast cancer de- Guttman Institute was expanded to form confidence in their ability to do BSE calling for appointments. Medical Col- added another procedure-thermography tection around the country, and espe- York City, funded in part by the Society's one; the other two were the University -to the examination, and devised a properly. The survey singled out doctors lege of Wisconsin in Milwaukee filled cially at Virginia Mason. His deep com- New York City Division. Initiated by of Louisville Medical Center, Louisville, as the most important force for getting its first quota within 48 frantic hours; Dr. Philip Strax in 1968, Guttman Insti- method for giving the exam to large mitment is shared by his professional. Kentucky, and Emory University School numbers of women at low cost. women to practice breast self-examina- Georgetown University in Washington, staff, and by a band of devoted American tute was already giving women a breast of Medicine in cooperation with Georgia D.C., opened in June 1974, and had a Cancer Society volunteers. Dr. Carlile examination that included mammog- Baptist Hospital in Atlanta, Georgia. waiting list of 8,000 by October. emphasizes the educational opportunities raphy and thermography. At the ACS National Board Meeting in of the project-for the patient, volun- November 1971, the planning commit- By November of 1973, 17 more proj- "Our problem was not getting the first teers and staff. He believes wholeheart- Dr. Strax, a radiologist, had come to the tee made its recommendations and a ects had been approved, and by mid- 5,000 women to come; it was holding edly in the complete exam, but says, New York City Division with the results Special Task Force on Breast Cancer was 1974 the number had risen to a final back the second 5,000," says Dr. Leslie "Learning to examine her own breasts approved to carry them out. The Task 27. Detection Projects now flourish in Whitney, Project Director at the Gen- is of prime importance to each woman Force brought together a multidiscipli- Florida and Hawaii, Washington and eral Division of the Wilmington Medi- and to the goal of the program." nary group of 22 cancer experts and in Delaware, Rhode Island, Wisconsin and cal Center, Wilmington, Delaware. One February 1972, announced that twelve many states in between. Some are part of the newer centers, it serves the entire CHEERFUL ATOMSPHERE breast cancer detection projects would of large medical complexes; some are in state, plus adjoining areas of Pennsyl- At this project's small but efficient quar- be set up across the nation, each modeled small private hospitals; others in teem- vania, Maryland, Virginia and New ters, about 42 patients are examined after the Guttman Institute. ing community institutions, or newly tion. Gallup concluded that if women Jersey. "Our project caught the imagi- each day. The atmosphere is cheerful, established clinics. were convinced that early detection in- nation of the whole community," adds welcoming. ACS volunteers answer NATIONAL PRIORITY creased their chances of survival, nothing Dr. Whitney. Downstate groups or- phones quickly, appointments are made, While this plan was taking shape within WOMEN'S ATTITUDES POLLED would keep them from having breast ganized carpools to drive the 90 miles questions answered; a panicky caller is the American Cancer Society, the cam- While the projects were being planned, examinations or doing BSE. The Gallup to Wilmington; arrangements were calmed and turned over to the medical paign against all cancer had become a some experts feared not enough women findings reinforced belief in a need for made to accommodate women from the social worker. Patients are clearly the 6 7 A Dramatic Attack on Breast Cancer first priority; they move from exam to she should have a biopsy. Emotional If they have any questions, they find him exam with a minimum of delay, and support is willingly offered to anxious always ready to discuss points of differ- maximum privacy. patients by the staff. Resolving a prob- ence with them. Such interaction en- lem in terms of its human aspects makes riches the already remarkable spirit Each phase of the examination is a learn- staff and volunteers a team here, makes among those involved in this project- ing experience. The mammography and what they do so much more than just a a spirit that operates very much to the thermography technicians explain what job. They take pride in their own and benefit of its patients. they are doing while they work. The each others' achievements. patient is encouraged to ask questions. Is Cancer Being Found Earlier? A nurse clinician gives the palpation Yes, according to a report covering exam. Speaking reassuringly, she project activities through October 1974, thoroughly and carefully examines the the centers are discovering about 6 can- patient, stressing that the women be- cers per 1,000 women. In general, proj- come familiar with how her breasts look ect findings indicate that of those found and feel. She takes the patient's hand to have cancer, 77% have negative and shows her exactly how to examine nodes. That is, cancer was detected very herself, pointing out the normal ridges, early, before it had spread to the lymph muscles and bumps. The procedure is nodes. By contrast, in the general popu- gentle and unhurried; again the pa- lation, only about 45% of breast cancer tient's questions are invited-and is being found early, while the nodes are answered fully. cancer-free. Detecting breast cancer be- Special recruiting methods are used to fore it invades the nodes greatly increases If there are suspicious findings, Dr. draw in the minority women of the area. a woman's chances of survival. Carlile talks with the patient, explain- One half-day twice a week is set aside for these women who are not as likely to Reaction to the news last fall that Mrs. hear about the project through the Gerald Ford and Mrs. Nelson Rocke- media, and who need special encourage- feller had breast cancer caused thousands ment, understanding and appointment of women to contact the ACS; the de- flexibility. tection centers reported a 700% increase Each person at Viriginia Mason is en- in calls during that period. The projects couraged to grow as an individual, and had already become a part of the public expand her role. Volunteers agree to a consciousness, and were a source of help long-term commitment before being ac- and reassurance when they were needed. cepted and are given periodic training The Breast Cancer Detection Demon- sessions. They know they are vital to the ing that final diagnosis and treatment operation of the project. Some of these stration Projects epitomize the American are up to her own doctor. If she wishes, dedicated women had worked over 300 Cancer Society's threefold program of he will call her doctor and make an hours by the project's first anniversary. research, education and service. Now a appointment while she is still in his One volunteer is learning to read therm- powerful force against breast cancer is at work across the nation. office. If the patient has no doctor, the ograms; another, a nurse, has exchanged staff medical social worker arranges to her volunteer status for a full-time job find help for her. on the staff. Still another originally came to the project as a patient, but was so EMOTIONAL SUPPORT impressed that she applied and is now a Follow-up of patients with suspicious volunteer. findings is considered a major respon- sibility at Virginia Mason. Did the pa- REMARKABLE SPIRIT tient go to a doctor, as arranged? Was Staff members have visited other projects there a biopsy? If so, where was it done; to exchange ideas and experiences. The what was the outcome? If not, was it project manager took a special course in because the patient refused? Perhaps a reading the X rays; she is teaching what staff member could help persuade her. she learned to her technicians. They have Hours of counsel are sometimes needed set up a system wherein they scan X rays, to persuade a frightened woman that then listen to Dr. Carlile's taped reports. 9 Service and Rehabilitation Research Many of the specially trained volunteers speech therapy and specialized assistance The ACS research program is a forceful University is pursuing replication of gen- of the American Cancer Society's Service from the International Association of resource in the fight against cancer be- etic material and how this information and Rehabilitation program are former Laryngectomees. The IAL, sponsored by cause it has consistently awarded project is released to the cell in a usable form. cancer patients. They, along with cap- the ACS, now has some 215 member and personnel grants that encourage un- able staff, provided help last year to some clubs in the U.S. and 11 foreign countries. usual investigations in detecting, pre- The ACS has its own "in house" research 300,000 cancer patients and their fam- venting, understanding and treating project for cancer prevention which ex- ilies throughout the country. Last August the IAL held its 23rd cancer. Supporting basic research on how amines and tabulates data on where and Annual Meeting in Philadelphia, Pa., cells thrive or malfunction and how ab- when cancers appear in populations and More than 50,000 patients received spe- with more than 500 laryngectomees and normal cell growth can be corrected what potential cancer-causing hazards cialized help after breast cancer surgery, their families attending. As part of the increases knowledge vital to all health exist in our environment and our long- larynx surgery and surgery in the bowel program, instruction in esophageal programs; supporting clinical research term habits. These epidemiological or bladder area-sites of the Society's speech was offered at beginner, inter- improves current methods of saving lives studies have already demonstrated the three major rehabilitation programs. mediate and advanced levels. There was from cancer through surgery, radiation, connection between cancer and indus- also a seminar in public speaking which chemotherapy and immunotherapy. trial pollutants such as asbestos dust. The Society's Reach to Recovery pro- showed laryngectomees how to become They have confirmed the link between gram for women who have had breast effective communicators, able to conduct In 1974, the ACS received 1,613 appli- cigarette smoking and lung cancer, as cancer surgery reached fully one-half various education and rehabilitation ses- cations and supported 498 research well as cancers of the mouth, larynx, of all women in this country who had a sions in their own communities. grants with an investment of more than pancreas and bladder. mastectomy last year. $26 million-some of which was funded According to the results of an updated directly by the Society's Divisions. The ACS funded its Environmental Re- survey released at the Meeting, there are Though approved by the ACS expert search Project in 1971 to delve into the about 30,000 laryngectomees living in research committees, 903 grants multiplicity of causes and time-lapse the U.S. today and approximately one totalling $50.6 million could not be factors in cancers occurring in certain OC- out of every seven is a woman. supported because of insufficient funds. cupations. The project is co-directed by E. Cuyler Hammond, Sc.D., ACS Vice Employment discrimination, a major Many of the nation's major institutions President for Epidemiology and Statistics, threat to the total rehabilitation of re- covered cancer patients, became a top priority for the ACS last year with the formation of a National Work Study Group on the Employability and Insur- Now operating in almost every part of the ability of Recovered Cancer Patients. U.S., the program gained nationwide attention following both Mrs. Gerald The special group commissioned to in- Ford's and Mrs. Nelson Rockefeller's vestigate the extent of this problem is breast cancer surgeries in the fall of studying ways in which management 1974. Record demands were made on and industry can be re-educated about the program's 7,500 volunteers, all mas- the employability of former cancer tectomees themselves, by women want- patients. ing to know about the program. Also in have developed cancer-related research and Irving J. Selikoff, M.D., Director of 1974, the Reach to Recovery manual MGM, producers of "Medical Center," programs with ACS grants-127 uni- Environmental Sciences Laboratory of was completely revised, expanded and one of the country's most popular tele- versities and institutes were involved in Mount Sinai Hospital, in New York City. indexed. vision programs, worked closely with the recent awards. ACS Research Professor- ACS to bring this problem into the open. ships, now totalling 21, provide grants As one of its first tasks, it reactivated the Ostomates-patients who have had sur- "Tainted Lady," a one-hour episode seen to scientists at leading institutions for mass population Cancer Prevention gery in the bowel or bladder area-were last fall, dealt with this issue on CBS-TV. the duration of their active research Study of one million Americans which similarly helped to return to productive commitment. was originally organized by the ACS in and normal lives. The ACS program is a The cancer patient and his or her family 1959. With about 95% of the partici- cooperative effort with the United also needed special counseling and assist- For example, Dr. David Baltimore at pants traced, and death causes checked, Ostomy Association and local ostomy ance in coping with advanced illness. M.I.T. has added cellular immunity to the follow-up Study acts as an effective groups. Last year, the ACS organized a group of his ongoing investigation of viruses and control population group for the pro- clergy at a national level to propose bet- how they affect the cell's genetic appara- ject's ongoing occupational investiga- People who have lost their voice boxes- ter ways to deal with the social, psycho- tus. Also in the field of molecular biol- tions with cooperating unions and after larynx surgery-were offered logical and family adjustments involved. ogy, Dr. Jerard Hurwitz at Yeshiva industry, as well as providing a data 10 11 Research bank for many non-occupational epi- demiologic studies. At Mount Sinai, Dr. Selikoff's team in- volves physiologists, hygienists, field epidemiologists, mineralogists, lab and clinical technicians working to identify cancer-causing substances and those groups most likely endangered by them. Early in 1974, following the announce- ment by an industrial manufacturer that two workers in one of its vinyl chloride plants had died of angiosarcoma of the liver, a rare form of cancer, the ERCP teams set to work. Epidemiological studies were begun on a large group of vinyl chloride workers in New York State to see if other cancers might be caused by the substance. Vinyl chloride, a gas, is converted to powder form to make many plastic products. It is also used as a propellant for aerosol sprays. The ACS analyzed its Cancer Prevention Study records of 76,000 deaths to see if angiosarcoma had appeared in non- occupationally exposed populations. Secondary exposure was checked by sampling dust from homes of vinyl chloride workers and examining health Commenting on the scope of the prob- watching the smokers closely in all our records of those coming in contact with lem, Dr. Selikoff said, "The discrepancy occupational exposure studies." lesser amounts of the substance during between laboratory results on animals and human incidence of cancer has to do By the end of 1974, there were 29 with time-we're seeing a 20-year hold- angiosarcoma cases related to vinyl ing period before the cancer shows up in chloride exposure throughout the world. humans. Whether somebody inhales a Of the 17 cases which occurred in the substance may make more of a difference U.S., 14 have ended in death. The aver- than if it is ingested. age exposure to vinyl chloride was 19 years. At issue now is the level of ex- posure that is tolerable. "Furthermore, the multiple factor effect makes defining high risk groups and Dr. Hammond and Dr. Selikoff have regulating exposures difficult because more than the work place has to be warned that zero exposure should be the considered. goal. "Prevention of cancer in the year 2000 is the order of the day right now." "We need to know if cigarette smoking is involved or if hobbies add another Results of research have already brought source of exposure. As a specific ex- manufacturing changes in asbestos beneficial to the workers' health. More the manufacture of vinyl chloride paints. ample, individuals exposed to asbestos such decisions are sure to come. Conclusive answers are not possible yet, who smoke cigarettes have a significantly but studies are continuing. higher incidence of lung cancer. We are 13 Public Education The 1974 Public Education program Government and industry joined the involved a nationwide effort to persuade ACS in bringing cancer education-action people to take recommended health programs to employees. Honeywell, Inc., actions such as monthly breast self- and Olin Corp. with 100,000 employees, INTERIOR OF MOBILE UNIT: PAP TEST examination, annual Pap test, regular and the U.S. Civil Service Commission health checkup or attend a quit smoking with 2.6 million Federal civilian em- clinic as safeguards against cancer. ployees, worked with ACS staff and vol- unteers in launching programs tailored The new emphasis on "action" was intro- to employee needs. duced in June as a result of special Gallup studies sponsored by the ACS which showed that a saturation point had been reached in providing information to the public. A new emphasis was needed: a commitment to follow through on health actions. By the year's end, local public education programs based on the six "target" sites (breast, lung, uterus, colon-rectum, skin, oral) reached a total of 18,732,000 peo- ple throughout the country-an increase Rather than telling young people what of nearly 300,000 over the previous health habits and attitudes to adopt, the year. The number of adult programs in- new ACS Public Education program for cluding a film showing, speaker and youth provides them with ways to make discussion expanded by 13,807 and up their own minds. The emphasis is on youth programs by 28,492. learning about cancer in order to protect themselves and how to adopt personal In order to help provide the means for health habits which may determine people to change health habits, ACS whether cancer will ever pose a serious Divisions and Units arranged BSE teach- threat to them. ins, community-wide screening projects and neighborhood health fairs. More Largely as a result of intense coopera- than 60% of all ACS Divisions now use tion between ACS Units, local public mobile units to carry cancer information health departments, and other organiza- and detection exams to inner city and tions and community facilities, a record rural populations. high of 48,000 education programs aided uterine cancer control efforts. Widespread use of a new anatomical teaching model increased audience par- According to a Gallup study, the per- ticipation and understanding of proper centage of women who had ever had a breast self-examination procedures. The Pap test rose from 53% in 1970 to 78% in 1973. Now the Uterine Cancer Task Force objective of a Pap test for every woman by 1976 is near its goal. Six new volunteer guidance handbooks and two filmstrips were produced for ACS Divisions covering youth and adult education programs. A special training filmstrip was developed on how to con- duct a "Stop Smoking Program" at the model contains simulated lumps which community level, and in addition, a women can find and feel so they become variety of new films, posters, leaflets, more aware of what to look for when and exhibits were provided as support examining their breasts. materials. 14 Public Information Cancer hasn't stopped 1,500,000 people from living. The American Cancer Society's Public month last year containing information Information program has always pro- and statistics supplied by the ACS. News- vided quick and continuous dissemina- papers requested and received resource tion of information and factual data to materials for features and frequently re- the mass media in all areas of cancer- printed sections of the ACS breast self- research, prevention, early diagnosis, examination leaflet. treatment and rehabilitation. The ACS cooperated with Barbara This capacity was extraordinarily tested Walters, who presented a second five- last year immediately following Mrs. part series on breast cancer in October, Gerald Ford's breast cancer surgery. to bring her Not For Women Only view- After the news broke, ACS physician ers up to date. ACS helped prepare a fea- members and volunteer officers were ture on The Killers series for Public Mrs. Evelyn Roll Mrs. Thelma Hinz Mr. George Schmauder Mrs. Mary Reese Mr. Podesta Mr. Paul Quadrato called upon by the media to present Broadcast Television called Cancer: The background information about breast Cell That Won't Die. After local show- ings of that segment in early March, many ACS Divisions and Units arranged for their volunteer experts to appear on panels to answer questions phoned in by the public. The ACS created a humorous, helpful film on stopping smoking for use on cancer to millions of viewers, listeners TV. Let's Call It Quits stars Tom Bosley and readers everywhere. Public concern in the role of a bedeviled heavy smoker. was heightened by the incredible coin- cidence of Mrs. Nelson Rockefeller's Mr. Homer Odums Mr Daniel Endweiss Mrs. Rose Prum Mr. Michael Cayeros Mr. Morris Gazek Mrs. Bernice Johnson similar surgery just a few weeks later. Since the fight against breast cancer had been a main ACS priority all year long, the public interest was served by spe- cialized films and informative spots already prepared. Local television sta- tions re-ran the American Cancer Soci- ety's half-hour film, "Breast Cancer: Where We Are," released early in 1974. When the entire film could not be shown, segments were used in news re- ports or to demonstrate the breast self- Volunteer communicators were vital to examination procedure, in several cases the public information effort. TV spots Mr. James Marra Mrs. Jean Mathesius Mr. Sam Kantor Mrs. Martlyn Dyson Mr. Alcibiedes Balbuena Jeffrey Sensenig for the first time in prime time on tele- and ads created by agencies N. W. Ayer vision. and Ogilvy & Mather enabled the Soci- They did it by not letting fear kill them. They did it by going to the doctor in time. They ety to channel the public's attention to did it with the help of the effective methods the hopeful side of cancer during the of treatment today-surgery, radiation, chemo- Crusade and throughout the year. therapy. They did it because of the advances made through research. More than 1,500,000 Americans are living proof The 16th annual Science Writers' Semi- cancer can be cured. The American Cancer nar brought the nation's top scientists Society needs millions to save millions more. and clinicians together to provide the Please, give more today. We want to latest data to medical writers and jour- wipe out cancer in your lifetime. nalists. In intensive sessions over a five- American Cancer Society day period, discussions followed presen- There were major magazine stories on tations on research, detection, diagnosis breast cancer appearing almost every and treatment of cancer. Mr. Donald Perry Mrs. Louise Robinson Dr. Robert Wren Mr. George Walsh Photography by Cailor/Resnick This space contributed b the publisher as public service 16 Smoking and Health Of the 52 million Americans who still Evidence of a link between smoking dur- smoke, more than half indicated they ing pregnancy, increased still-births, would like to quit, according to a Gallup increased mortality of newborns and low survey conducted for the ACS. In 1974, birth weight of babies was also reported. the ACS ran 200 "Helping Smokers Quit" clinics in communities as pilot The recent upsurge in lung cancer death programs for the new goal of 1,000 rates for women, doubling in the past clinics in 1975. ten years, can be attributed to the fact that women began to smoke in greater The ACS continued its effort to educate numbers about 35 years ago and more Americans-especially young people- are now entering the age range (55-64) about the health hazards of cigarette when lung cancer strikes most often. smoking. It expanded its antismoking campaign through a variety of special Lung cancer supplanted uterine cancer materials presented to the public as last year as having the third highest mor- posters, films, pamphlets, radio and TV tality rate for women among the five spots, and strengthened its education leading cancer sites (breast, colon-rec- program for students in primary and tum, lung, uterine, ovary). It remained secondary schools with the teacher as number one for American men. MRS. JONES example-setter. The ACS intensified action to reduce tar Examples of antismoking efforts on the and nicotine content of cigarettes. Sales local level included a don't-smoke mes- of low-tar cigarettes accounted for over sage on 250,000 milk cartons delivered half of the increased cigarette sales in daily by a New Jersey dairy to public 1973. The ACS and other health agen- schools in three counties and a statewide cies are calling on the government to set 100 DOO DOCTORS HAVE ACS-backed D-day campaign in Minne- a maximum ceiling for tar and nicotine SMOKING sota on October 7 which urged all smok- content of cigarettes. ers to stop for at least one day-476 companies distributed pledge cards en- The ACS supported federal, state and couraging individuals to make a com- local legislation limiting smoking in mitment to stop smoking. public places because it 1) discourages the smoker from smoking, 2) dissuades The increase in the number of teen-age the non-smoker and ex-smoker from girls smoking became a source of major smoking, 3) protects the non-smoker concern. By January, 1974, the percent- from harmful effects to health. Stringent age of girls between 12 and 18 who laws are being passed in many states and smoke, once much lower than that for cities-in 1974, for example, New York boys, rose to 15.3%, only slightly less City added elevators and supermarkets than boys, 15.8%. And studies have to the areas where smoking is prohibited. shown that health habits established in the teens are hardest to break. At the international level, planning be- gan for the Third World Conference on Smoking and Health, co-sponsored by the ACS and National Cancer Institute, to be held in New York City in June, 1975. Its purpose is to evaluate key research and action programs in Smok- ing and Health that have taken place throughout the world and to consider new actions necessary to counter some of the recent gains made by the cigarette industry. Already, 30 countries, includ- ing the USSR, have accepted invitations 7 to participate. 18 Professional Education Worldwide Crusade Last year, the Society's Professional Edu- Nursing Management of the Patient The Foreign Desk draws upon the The Australian Cancer Society sent its Public support expressed a confidence câtion program continued its efforts to with Cancer, and Detecting Breast resources of the ACS to channel informa- newly appointed National Director, Mr. in ACS programs that continued to grow bring the latest developments in cancer Cancer Earlier which includes the tech- tion, advice and program guidance about Giles Pickford, to observe ACS opera- last year. The investment of Americans to the medical community by presenting niques and application of thermography, cancer control to all nations of the world. tions and another representative, Mrs. in the fight against cancer paid off in another key, national-level conference, xeroradiography and conventional It collaborates with overseas volunteer Margaret Beare, to learn about "Reach more lives saved-1,500,000 Americans this one on Cancer Management. Co- mammography. health agencies, cancer societies and in- to Recovery." Mrs. Beare will imple- who had cancer were alive and well. sponsored by the American Cancer terested individuals to exchange vital ment that program in Australia as a di- Society and the National Cancer Insti- The ACS bi-monthly publication, Ca-A knowledge. rect result of the enormous success of the The American Cancer Society's Crusade tute and programmed in two parts, Part Cancer Journal for Clinicians, reached 10-country tour of cancer societies in the in fiscal 1974, despite an uneven nation- I on Treatment and Rehabilitation was over 360,000 professionals last year. In 1974, the Foreign Desk assisted in Far East undertaken by Mrs. Terese wide economic picture, reached $97.3 held in New York City in November, Cancer, the Journal of the ACS for spe- organizing and managing the first Inter- Lasser, the program's National Con- million in contributions from public 1974. Part II on Detection and Diagno- cialists in Oncology, increased its circu- national Conference on Public Educa- sultant. sources, including approximately $24 sis will be presented in May of 1975 in lation to 15,000 subscriptions, up by tion About Cancer of the International million in bequests and legacies. Denver, Colorado. 1,000 from the year before. In 1974, Union Against Cancer (UICC). Ninety The ACS fifth Postgraduate Course in other Professional Education publica- physicians, education and communica- Cancer was held in Asuncion, Paraguay. The annual Crusade did more than ask Attendance at Part I of the Conference tions reported on a wide range of medi- tions experts from 30 countries attended More than 400 physicians and medical for contributions. It brought to the peo- achieved an all-time high of 3,500 and cal topics such as Early Diagnosis of the May meeting. Panel discussions in- students attended the five-day meeting ple the most concentrated educational offered a practical updating, including Colorectal Cancer, Cancer Chemothera- cluded Motivating Physicians to Educate which was opened jointly by the Presi- message ever prepared by the ACS on overviews, specific advances and future peutic Agents, the Nurse's Role in Re- Patients, Use of Mass Media and Prob- dent of the Republic of Paraguay, Gen- the importance of early detection and prospects, for physicians and related habilitation as well as proceedings of lem Solving in Public Education. Screen- eral Stroessner, and by the then Presi- the seven warning signals. health professionals. On an invitational previous conferences. ing of films and television spots from the dent of the ACS, Dr. Justin J. Stein. basis, a special session was held for countries highlighted the different na- There were 1,989,360 residential Cru- oncologic nurses. The ongoing program of Clinical Fel- tional priorities. The Foreign Desk received about 75 saders, 107,712 independent business lowships provided training in diagnosis visitors from abroad during the year. It Crusaders and 49,082 special gifts Cru- Earlier in the year, the ACS presented and treatment of cancer for 263 physi- In October, approximately 5,000 phy- also sent information about the ACS saders. More than 2 million strong, these the first National Conference on Child- cians and dentists. The Society's Clinical sicians, researchers, public education programs and samples of our materials volunteers served under the leadership hood Cancer which brought 625 pro- Professorship program gained momen- specialists and cancer society adminis- on a semi-annual basis to a mailing list of 1974 Co-Chairmen Marvella Bayh fessionals to Dallas, Texas-an unusually tum, with five new Professors of Clinical trators gathered in Florence, Italy, for of more than 475 individuals and organ- and Peter Graves, and visited homes, large attendance for such a specialized Oncology appointed last year, bringing the UICC's XIth International Cancer izations. businesses and large industrial concerns subject. the total of Professorships to 11. The Congress-the Congress meets every four in every community. program is designed to improve cancer years. For the first time, through the The ACS-Eleanor Roosevelt Interna- teaching in medical schools at under- efforts of the ACS, a special two-day pro- tional Fellowship Grant Program allows graduate, postgraduate and continuing gram on Cancer Control was arranged so yearly exchange of researchers interested education levels. that lay cancer experts could discuss in working in the U.S. and abroad. Fi- education, fund raising and volunteer nanced by the ACS for the UICC, last Throughout the year, Divisions and recruitment in relation to scientific year's grants totaled $278,315 and en- Units conducted 45,000 topical pro- programs. abled 19 researchers to benefit from the grams, 36,500 of them with film show- international experience-12 will work ings, for 1,237,000 health professionals. The Congress provided a week of con- in the U.S., six in England and one in "Manned" exhibits were arranged for a ferences, symposia, workshops and The Netherlands. total of 988 exhibit-days for physicians advanced courses covering a wide range and medical students, 210 exhibit-days of topics such as Detection of Preclinical As part of the expanding Professional for dentists and dental students, and Cancer, Viruses and Human Cancer, Education audio-visual library, the ACS 2,313 for nurses and student nurses. A Breast Cancer: Treatment of Primary also has launched a series of audio tapes new exhibit "Control of Cancer of the Tumors; Cancer and Smoking and Re- containing highlights of ACS National Colon and Rectum" first appeared at the habilitation of the Cancer Patient. Conferences. Three of these audio tapes annual AMA meeting in June. As ad- were available by the end of 1974: juncts to various programs, Professional Last year, the ACS expanded its training Childhood Cancer, Virology and Immu- Education literature reaching physicians opportunities for cancer society repre- Inspiration for the 1975 Crusade will be nology, and Cancer Nursing. numbered 4 million pieces, dentists sentatives from abroad. Mrs. Noorini provided by Mrs. Gerald Ford as Hon- 813,000 and nurses 6.7 million. Soetadji, General Secretary of the Wis- orary Chairman, and Raquel Welch as Four new films were released for free nuwardana Cancer Society of Surabaya, Chairman of the campaign. Special Cru- loan or five-year lease to professional in- Indonesia, and Mr. H. R. Gunatilake, a sade Chairman for Education during the stitutions, organizations or individuals: member of the Board of the Sri Lanka coming year will be Edward Asner with Colon Stoma Placement, Early Cancer (Ceylon) Society studied Division ac- Marlin and Carol Perkins as Honorary Detection in the Physician's Office, tivities in various parts of the U.S. Chairmen. 20 21 American Cancer Society, Inc., National Headquarters and Chartered Divisions Combined Summary of Financial Activities for the Year Ended August 31, 1974 with Comparative Totals for 1973 Treasurer's Report Current Funds Donor Donor 1974 1973 General Restricted Endowments Total Per Cent Total Per Cent Support from the public: Contributions - These gifts include bequests of $24,116,620 and special events of $6,081,542 (net of direct expenses of $1,197,684). The cost of raising this money was $11,563,196 or 12% (Note 1) (Exhibit1) $89,338,917 $7,736,726 $193,292 $ 97,268,935 $93,013,644 Other support and revenue: Investment income- Pending actual disbursement for budgeted program expenditures, funds are invested in bank savings accounts, certificates of deposit, U.S. Government short-term securities, etc. 10,299,565 255,030 2,303 10,556,898 6,081,571 Other income, including $92,794 from U.S. Government agencies 190,673 94,882 - 285,555 373,300 For the fifth consecutive year the Amer- improvement through the cooperative grants and fellowships; 12% is for ican Cancer Society, supported by public efforts of its members among themselves National Office programs including Total support and revenue 99,829,155 8,086,638 195,595 108,111,388 99,468,515 contributions, is presenting combined and with others. technical and advisory help to Divisions financial statements, which include the in program planning and support service Awards and expenditures: National Society and its Divisions, to- Support and revenue for the fiscal year activities. Program services - gether with an unqualified report of our ending August 31, 1974 reached a record Research - To support basic scientific independent auditors. high of $108,111,388. The 1974 Cru- Funds bequeathed to the Society which studies, clinical investigations and sade saw the public contributing are not restricted by the testators for conduct programs seeking new knowl- The financial statements which follow $73,152,315 of this amount; specific program purposes are also di- edge for the cure of cancer 19,962,433 6,389,215 - 26,351,648 28.6% 25,054,410 30.7% have been prepared in conformity with $24,116,620 came from legacies and vided so that 60% is retained by Divisions Public education- Programs designed to the "Standards of Accounting and Finan- bequests, and the balance of for their programs with 40% going to inform the public about cancer cial Reporting" developed by the Na- $10,842,453 represents the amount the the National Headquarters for use prevention and symptoms and to tional Health Council and the National Society received from investments and principally in support of the research encourage periodic physical Assembly for Social Policy and Devel- other sources. Funds available are tem- program. examinations 14,999,802 35,357 - 15,035,159 16.3 13,385,603 16.4 opment. porarily invested at prevailing short- Professional education- Programs designed term interest rates from the time of The ACS, Inc. invites inquiry and will be to improve the knowledge, skills and In addition to the accounting criteria, the receipt of contributions until they are pleased to respond to requests for infor- techniques of the medical and allied ACS met organizational and operational actually needed for program purposes. mation on its program activities or finan- health professions in the detection and membership standards established by ces. The financial statements of the treatment of cancer 9,526,384 381,985 - 9,908,369 10.8 8,846,570 10.8 the National Health Council in the The Society's standard practice is to Society's National Office for the year Patient services - To provide for category of "Active Members-Voluntary budget funds based on the previous year's ended August 31, 1974, together with information, counseling, nursing and Health Agencies." income. This enables us to conduct the the report of our auditors, are also avail- homemaking services, transportation, Society's affairs in a manner which as- able on request. for S. lawron dressings, and loan closet items 11,257,955 246,133 - 11,504,088 12.5 10,483,284 12.8 Acceptance by the National Health sures advance planning and provides for Community services - To provide for Council is assurance to the public that continuity of program and support for programs in cancer detection, mass the ACS is democratically organized ongoing research projects. Substantially John S. Lawson, Treasurer screening, rehabilitation and and controlled by a volunteer Board of all of the unrestricted funds on hand at development of cancer registries 8,276,001 290,954 - 8,566,955 9.3 5,772,627 7.1 Directors including both lay and pro- August 31, 1974 were budgeted for American Cancer Society, Inc. - fessional people from throughout the fiscal 1975 programs. Combined Budget 1974-1975 Total program services 64,022,575 7,343,644 71,366,219 77.5 63,542,494 77.8 country; has no restrictions on partici- Program Services: Supporting services - pation based on race, religion, age, or Except for gifts restricted by donors for Research $28,653,000 28.7% Management and general - To direct the sex; is primarily and predominantly specific purposes, contributions received Public Education 17,139,000 17.2 overall affairs of the Society, supported by voluntary contributions; in the Annual Cancer Crusade are di- 10,579,000 10.6 accounting, personnel and office Professional Education follows ethical methods of fund raising, vided so that 60% is retained by the service activities 9,114,866 15,586 - 9,130,452 9.9 7,993,421 9.8 promotion, and reporting of fund Divisions for their programs of Public Patient Services 13,457,000 13.5 Fund raising- Activities to secure raising costs; and meets other stringent and Professional Education, Research, Community Services 8,187,000 8.2 increased support from the public for criteria for ethical and democratic Service to the cancer patient, and for $78,015,000 78.2% the needs of research, education, operation. supporting services of Fund Raising and service and overall direction 11,527,989 35,207 - 11,563,196 12.6 10,164,482 12.4 Management and General; a minimum Supporting Services: Total supporting services 20,642,855 50,793 - 20,693,648 22.5 18,157,903 22.2 The National Health Council, an or- of 25% (actually 28.6% of 1974 ex- Management & General $ 9,861,000 9.9% ganization of more than 70 national penditures by National and Divisions Fund Raising 11,885,000 11.9 Total awards and expenditures 84,665,430 7,394,437 - 92,059,867 100.0% 81,700,397 100.0% voluntary professional and govern- was for research) is for the Society's na- $21,746,000 21.8% Support and revenue in excess of awards mental agencies, together with other tionally-administered research program; Grand Total $99,761,000 100.0% and expenditures $15,163,725 $ 692,201 $195,595 $ 16,051,521 $17,768,118 groups, works for health protection and 3% is for a national program of medical The accompanying notes to combined statements and exhibit I are an integral part of this statement. 22 23 American Cancer Society, Inc., National Headquarters and Chartered Divisions Combined Balance Sheet-August 31, 1974 and 1973 American Cancer Society, Inc., National Headquarters and Chartered Divisions Combined Statement of Changes in Fund Balances for the Year Ended August 31, 1974 with Comparative Totals for 1973 Assets 1974 1973 Liabilities and Fund Balances 1974 1973 Current Funds Endowment Funds Current Funds-General Land, Cash: Research, professional education and Building and Funds Donor Equipment Donor Functioning 1974 1973 Checking accounts at National, medical project awards payable $ 24,845,805 $ 22,339,043 General Restricted Funds Endowments as Endowments Total Total 58 Divisions and their Units $ 6,293,843 $ 9,907,180 Accounts payable and accrued expenses 1,891,196 1,646,264 Balances, beginning of year $ 97,011,096 $7,788,608 $5,251,192 $3,845,856 $4,894,775 Savings accounts 6,547,348 $118,791,527 $ 99,459,287 8,355,249 Total liabilities 26,737,001 23,985,307 Support and revenue in excess 12,841,191 18,262,429 of awards and expenditures Temporary investments, at cost, which per combined summary of approximates market: Fund balances (Note 3): financial activities 15,163,725 692,201 - 195,595 - 16,051,521 17,768,118 Certificates of deposit and time deposits 96,349,165 78,046,396 Appropriated for special projects 6,876,907 6,891,359 Interfund transfers Reservation Commercial paper 6,764,178 7,737,444 Available for fiscal 1975 and 1974 of funds by action of Boards U.S. Government and other programs ($98,267,000 budgeted of Directors, net (19,951) - - - 19,951 - - for fiscal 1975 programs, securities 16,174,906 10,532,276 including $2,053,000 to be Property transactions: 119,288,249 96,316,116 financed from 1975 income) 105,107,625 90,119,737 Acquisitions Accrued interest, other receivables 111,984,532 97,011,096 Land and buildings (170,338) (224,452) 453,461 - - 58,671 2,088,160 and prepaid expenses 4,691,593 4,654,745 Office furniture and fixtures - - 971,231 - - 971,231 905,528 Educational, crusade and service Straight-line depreciation - - (969,866) - - (969,866) (762,862) materials, at cost 1,900,500 1,763,113 Sales and retirements - - (39,552) - - (39,552) (666,704) $138,721,533 $120,996,403 $138,721,533 $120,996,403 Balances, end of year $111,984,532 $8,256,357 $5,666,466 $4,041,451 $4,914,726 $134,863,532 $118,791,527 Current Funds-Donor Restricted The accompanying notes to combined financial statements are an integral part of this statement. Cash: Research awards payable $ 317,288 $ 324,028 Checking accounts $ 1,758,057 $ 1,804,543 Accounts payable and accrued expenses 13,090 7,900 Savings accounts 922,720 1,266,132 Total liabilities 330,378 331,928 2,680,777 3,070,675 Temporary investments, at cost, which American Cancer Society, Inc., National Headquarters and Chartered Divisions approximates market: Combined Statement of Awards and Expenditures by Functions for the Year Ended August 31, 1974 with Comparative Totals for 1973 Certificates of deposit and time deposits 5,259,336 3,897,507 Program Services Supporting Services U.S. Government and other Fund balances-Restricted by Public Professional Patient Community Management Fund 1974 1973 contributors for specific programs or Research Education Education Services Services and General securities 1,017,368 Raising Total Total 528,007 use within specific geographic areas 5,787,343 4,914,875 Awards and grants $23,705,900 $ 62,818 $3,599,065 $ 314,602 $3,367,673 $ - $ - $31,050,058 $27,954,663 ($1,494,000 budgeted for fiscal Accrued interest and other receivables 118,615 134,986 1975 programs) (Note 5) 8,256,357 7,788,608 Salaries 1,523,846 7,392,012 2,760,845 3,742,119 2,810,110 4,507,386 5,509,084 28,245,402 25,373,955 $ 8,586,735 $ 8,120,536 $ 8,586,735 $ 8,120,536 Employee health and retirement Land, Building and Equipment Funds benefits (Note 1) 177,724 723,175 295,088 376,219 280,529 486,248 489,397 2,828,380 2,681,519 Land ($1,339,961 and $1,148,883) 5%-91/2% mortgages payable $ 1,561,723 $ 797,384 Payroll taxes 69,285 501,082 181,018 263,622 187,918 304,417 370,730 1,878,072 1,573,304 and buildings, at cost, less Professional fees accumulated depreciation of and contract $336,304 and $342,186 (Note 1) $ 4,610,166 $ 3,455,626 services 78,011 76,892 25,025 18,220 97,184 730,735 280,187 1,306,254 1,256,049 Electronic data processing equipment, Office supplies 126,364 503,672 144,805 228,188 140,994 372,722 450,932 1,967,677 1,643,073 office furniture and fixtures, at cost, Telephone 31,621 480,593 144,045 259,530 154,965 248,901 439,312 1,758,967 1,475,176 less accumulated depreciation of $4,538,232 and $4,268,797 2,618,023 2,592,950 Fund balances (Note 1) 5,666,466 Postage and 5,251,192 shipping 48,042 556,834 237,384 228,417 139,754 224,735 593,326 2,028,492 1,739,625 $ 7,228,189 $ 6,048,576 $ 7,228,189 $ 6,048,576 Occupancy Endowment Funds and Funds Functioning as Endowments (Note 6) 88,110 962,491 375,777 537,513 321,809 675,064 629,023 3,589,787 3,055,749 Printing, visual Cash: Fund balances: Checking accounts $ 200,033 $ Donor endowments $ 4,041,451 aids, etc. 18,584 1,974,552 1,099,379 210,063 170,368 236,992 1,188,992 4,898,930 4,007,936 - $ 3,845,856 Savings accounts 142,153 105,197 Funds functioning as endowments Meetings, includ- 342,186 105,197 (by action of Boards of Directors) 4,914,726 4,894,775 ing related travel 288,884 503,144 611,483 193,587 262,219 601,437 603,838 3,064,592 2,515,722 Investments, at cost, which Travel-other 126,263 775,594 276,297 335,262 297,548 400,417 476,601 2,687,982 2,307,121 approximates market: Specific assistance Certificates of deposit and time to patients - - - 4,577,109 144,109 - - 4,721,218 4,251,128 deposits 3,854,101 4,101,778 Office furniture U.S. Government and other and equipment securities 3,193,557 2,904,611 (Note 1) 17,790 354,809 73,446 141,673 84,954 158,950 139,609 971,231 905,528 7,047,658 7,006,389 Other expenses 51,224 167,491 84,712 77,964 106,821 182,448 392,165 1,062,825 959,849 Notes Receivable 96,242 125,905 Totals $26,351,648 $15,035,159 $9,908,369 $11,504,088 $8,566,955 $9,130,452 $11,563,196 $92,059,867 $81,700,397 Deposits of marketable securities with trustee for research professor- The accompanying notes to combined financial statements are an integral part of this statement. ships (Note 4) 1,470,091 1,503,140 $ 8,956,177 $ 8,740,631 $ 8,956,177 $ 8,740,631 The accompanying notes to combined financial statements are an integral part of this balance sheet. 24 25 American Cancer Society, Inc., National Headquarters and Chartered Divisions Notes to Combined Financial Statements - August 31, 1974 American Cancer Society, Inc., National Headquarters and Chartered Divisions Exhibit I Support from the Public For the years ended August 31, 1974 and 1973 (1) Accounting policies: bequests is recorded when the Society has an (6) Lease agreements: Standards of accounting and reporting irrevocable right to the bequest and the pro- The Society's principal lease agreements for The Society follows the standards of account- ceeds are measurable. office and warehouse space expire on various ing and financial reporting for voluntary dates until December 31, 1985, with aggre- (2) Allocation of public support: health and welfare organizations developed gate minimum annual rentals as follows: Support from the public is received princi- by the National Health Council and the pally by the Chartered Divisions and is shared Year Ended August 31 National Assembly for Social Policy and with the National Headquarters. In accord- 1975 $2,207,000 Development. ance with National policy, 40% of gross 1976 1,594,000 In accordance with these standards: contributions, exclusive of approved special 1977 1,129,000 purpose gifts, is allocated to support the Na- 1978 579,000 1. Purchases of office furniture and equip- tional research program and other program 1979 386,000 ment are reflected as current General Fund activities for research (25%), medical 1980-1984 1,044,000 expenditures in the year of acquisition. grants and fellowships (3%) and other pro- 1985-1986 79,000 Major property additions are reported grams (12%). Unrestricted legacy income directly in the statement of changes in fund allocated to National (40%) is used prin- (7) Tax status: balances. Fixed assets on hand are reflected cipally in support of the research program. The Society is a nonprofit voluntary health in the Land, Building and Equipment agency, exempt from income tax under Sec- 1974 1973 1974 1973 Fund at cost, net of straight-line deprecia- (3) Available funds and budgets: tion 501(c)(3) of the U.S. Internal Revenue tion. To provide continuity of programs and per- Code, and contributions to the Society qualify mit effective budgeting, substantially all activ- 2. Donated land, buildings, equipment for the 50 per cent charitable contributions and other items are recorded at their fair ities are financed by the public support re- limitation. The Society has been classified as New York: ceived during the previous fiscal year. market value at date of receipt. an organization that is not a private founda- Alabama $ 917,574 $ 713,116 Long Island 1,214,174 1,185,617 Accordingly, substantially all of the available tion and has been designated as a "publicly Current General Funds reflected in the accom- Alaska 170,140 supported" organization. 145,209 New York City 3,583,261 5,291,382 3. Volunteers contribute their services to the Society in all aspects of its programs. panying balance sheet will be used for fiscal Arizona 709,582 792,330 New York State 3,980,337 3,843,109 Since no objective basis exists for assign- 1975 programs of education, service and Arkansas 444,798 469,127 Queens 467,182 478,396 ing values to these services, they are not related supporting activities covered by Auditors' Report California 11,360,946 10,159,764 Westchester 642,568 908,752 reflected in the accompanying financial approved budgets. To the Board of Directors of statements. Similarly, the value of space Colorado 962,858 942,211 (Total) 9,887,522 11,707,256 Amounts appropriated for special projects by and time contributed by various media for American Cancer Society, Inc.: Connecticut 4,742,186 1,598,375 North Carolina 1,252,001 1,233,996 the Boards of Directors are not expendable Society educational and fund raising ad- in the ensuing budget year but are earmarked We have examined the combined balance Delaware 326,099 352,751 North Dakota 270,869 250,682 vertisements is not subject to control or measurement and has not been reflected in for program development or expansion over sheet of American Cancer Society, Inc., District of Columbia 953,724 1,279,065 Ohio 5,637,114 5,986,244 a period not to exceed three years. the accompanying financial statements. National Headquarters and Chartered Florida 5,121,745 5,104,343 Oklahoma 626,999 589,857 Principles of combination (4) Research professorships: Divisions, as of August 31, 1974, the re- lated combined summary of financial ac- Georgia 2,348,153 2,428,911 Oregon 1,057,152 980,571 The accompanying combined financial state- Under the terms of agreements with 21 edu- tivities and the combined statements of Hawaii 922,308 1,019,104 Pennsylvania: ments include the accounts of the National cational and medical institutions, the Society is obligated to pay the annual stipends of 21 awards and expenditures by functions Idaho 302,148 204,349 Pennsylvania 4,022,663 3,865,228 Headquarters of the Society, which is a New career professorships in cancer research, each and changes in fund balances for the year York not-for-profit corporation, and its 58 Illinois 5,511,749 then ended. Our examination was made 5,164,587 Philadelphia 1,048,293 1,114,778 Chartered Divisions which are separately in- of which terminates upon the retirement of in accordance with generally accepted Indiana 1,816,022 1,425,203 (Total) 5,070,956 4,980,006 corporated under the laws of the various the approved investigator. The Society has appropriated and deposited with a Trustee auditing standards, and accordingly in- Iowa 1,447,557 1,266,899 Puerto Rico 45,518 - states and Puerto Rico. All significant intra- $1,470,091 as performance bonds. The net cluded such tests of the accounting records Kansas Society accounts and transactions have been 1,029,765 1,119,904 Rhode Island 493,056 587,596 income of each trust is paid to the Society. and such other auditing procedures as we eliminated in preparation of the combined considered necessary in the circumstances. Kentucky 788,025 696,126 South Carolina 924,855 771,174 financial statements. As of August 31, 1974, the estimated aggre- We have previously examined and re- Louisiana 601,478 2,246,555 South Dakota 236,404 196,569 Pension plan gate contingent liability over the terms of the ported on the combined financial state- Maine 404,933 462,553 Tennessee 1,357,639 1,312,929 The Society has a contributory pension plan 21 active contracts, was approximately ments for the preceding year. which covers substantially all eligible em- $8,215,000, exclusive of the liability for Maryland 2,111,152 1,861,926 Texas 4,382,942 4,075,071 In our opinion, the accompanying com- ployees. Annual payments are made to the fiscal 1975 stipends which has been recorded Massachusetts 2,539,480 bined financial statements present fairly 3,625,457 Utah 343,772 326,845 plan trustee in accordance with the Society's in the accompanying financial statements. the assets, liabilities and fund balances Michigan 3,141,809 2,942,193 Vermont 285,215 427,584 policy of funding accrued pension costs. Prior (5) Current donor restricted funds: of American Cancer Society, Inc., Na- Minnesota 1,877,987 1,434,903 Virginia 1,943,804 1,838,915 service costs are amortized over the average Current donor restricted funds were restricted tional Headquarters and Chartered Divi- future service lives of active covered em- Mississippi 694,134 424,203 Washington 1,278,351 1,213,126 by contributors for the following purposes: sions, as of August 31, 1974, and its reve- ployees. At November 5, 1974, pension fund nues, expenditures and changes in fund Missouri 2,163,934 2,074,859 West Virginia 608,694 470,115 assets approximated the actuarially computed 1974 1973 balances for the year then ended, in con- Montana 234,417 220,348 Wisconsin: value of vested benefits. The total pension formity with generally accepted account- Nebraska 671,743 678,700 Milwaukee 496,725 493,966 expense for 1974 and 1973 was $1,895,800 Research $3,735,015 $3,852,197 ing principles applied on a basis consistent and $1,751,000, respectively. Other programs 1,605,481 1,497,391 with that of the preceding year. Nevada 289,763 171,972 Wisconsin 1,209,307 940,381 For use within New Hampshire 390,139 316,936 (Total) 1,706,032 1,434,347 Outstanding legacies specific The Society is the beneficiary under various Arthur Andersen & Co. New Jersey 4,455,216 2,966,005 Wyoming 141,559 141,132 geographic wills and trust agreements, the total realiz- locations 2,915,861 2,439,020 New Mexico 251,917 181,645 Canal Zone 15,000 - able amounts of which are not presently de- terminable. The Society's share of such $8,256,357 $7,788,608 New York, N.Y. Grand Total $97,268,935 $93,013,644 December 16, 1974. 26 The accompanying notes to combined financial statements are an integral part of this exhibit. 27 NATIONAL OFFICERS Harold P. Rusch, M.D., Madison, Wis. Dale B. Flickinger, M.D., Minot, N.D. William C. Moloney, M.D., Boston, Mass.* Eldon R. Ulmer, Anchorage, Ak. COUNCIL FOR RESEARCH AND George E. Stringfellow, Arlington, Va. William J. Flynn, M.D., Youngstown, 0.* Mrs. E. Morgan Montgomery, New York, N.Y.* Thomas P. Ulmer, Jacksonville, Fla. *+ CLINICAL INVESTIGATION AWARDS Mrs. Albert D. Lasker Howard C. Taylor, Jr., M.D., New York, N. Y. G. Robert Gadberry, Wichita, Kan.* H. Don Moseley, M.D., Coeur Alene, Ida. Cecil H. Underwood, Bethany, W.Va.* Honorary Chairman of the Board of Directors Travis T. Wallace, Dallas, Tex. Van Holt Garrett, Jr., Englewood, Colo. Gerald P. Murphy, M.D., Snyder, N.Y.* Edward C. Veprovsky, M.D., Flushing, N.Y. Elizabeth Miller, Ph.D., Chrmn. McArdle Laboratory for Cancer Research, W. Armin Willig Shields Warren, M.D., Boston, Mass. Mrs. Orin G. Geesey, Kemmerer, Wyo.* Alan S. Nelson, Kennebunk, Me.* Donald T. Waggener, D.D.S., Lincoln, Neb. Univ. of Wisconsin, Madison, Wis. Chairman of the Board of Directors Lawrence Welk, Brentwood, Calif. Myron G. Gibbons, Tampa, Fla. Mrs. Walter G. Newnam, Chicago, III.* John Wallace, Needham, Mass. Elwood V. Jensen, Ph.D., Vice-Chrmn. Thomas P. Ulmer Granville Whittlesey, Jr., New York, N.Y. Jean C. Gladden, M.D., Harrison, Ark.* Mrs. Robert L. Nicks, Dickson, Tenn. D.E. Ward, Jr., M.D., Lumberton, N.C. Ben May Laboratory for Cancer Research, Vice Chairman of the Board of Directors Univ. of Chicago, Chicago, III. Francis J. Wilcox, Eau Claire, Wis. Cecil A. Gordon, Paterson, N.J. Nelson R. Niles, M.D., Portland, Ore. J. Holman Waters, Salt Lake City, Ut. George P. Rosemond, M.D. President Ashbel C. Williams, M.D., Jacksonville, Fla. Paula Green, New York, N.Y.* Spencer W. Northup, M.D., Toledo, O. Sidney Weinhouse, Ph.D., Philadelphia, Pa.* Irving Gordon, M.D. Dept. of Microbiology, School of Medicine, Benjamin F. Byrd, Jr., M.D. David A. Wood, M.D., San Francisco, Calif. William Griffiths, Ph.D., Berkeley, Calif. William F. Nowlin, M.D., Gary, Ind.* Raymond L. Weisberg, M.D., San Francisco, Calif. Univ. of Southern California, Los Angeles, Calif. Vice President and President-Elect William O. Wuester, M.D., Elizabeth, N.J. Richard F. Grise, M.D., Bowling Green, Ky. Bedford T. Otey, M.D., Flandreau, S.D. Frank H. Weitzel, Washington, D.C. Clifford W. Gurney, M.D. Justin J. Stein, M.D. Matthew Guinan, New York, N.Y.* Omar T. Pace, M.D., Springfield, Mass.* John E. Westford, Bellingham, Wash. Division of the Biological Sciences, Immediate Past President HOUSE OF DELEGATES Lewis W. Guiss, M.D., Los Angeles, Calif.* Ingolv D. Peterson, Billings, Mont.* Nathaniel Whitehorn, New York, N.Y.* Pritzker School of Medicine, Univ. of Chicago, Chicago, III. R. Lee Clark, M.D. Saul B. Gusberg, M.D., New York, N.Y. John D. Pigott, M.D., Memphis, Tenn.* Leslie W. Whitney, M.D., Wilmington, Del. Nathan O. Kaplan, Ph.D. Chairman of the Medical and Ora R. Ackerman, Ed.D., Fort Wayne, Ind. Clifford O. Hagan, Lexington, Ky.* Joseph A. Pinter, Brightwater, N.Y. Drake W. Will, M.D., Honolulu, Hawaii* Scientific Executive Committee Dept. of Chemistry, Univ. of California at W. A. D. Anderson, M.D., Miami, Fla.* George E. Hale, M.D., Anchorage, Ak.* Mrs. Barbara B. Porter, Bethany Beach, Del. Paul Whitcomb Williams, New York, N.Y.* San Diego, La Jolla, Calif. R. Wayne Rundles, M.D. Billie L. Aronoff, M.D., Dallas, Tex. *+ Chairman of the Medical and Scientific Committee Harold A. Harper, Ph.D., San Francisco, Calif. Mrs. Nancyann Raber, Santa Barbara, Calif. W. Armin Willig, Louisville, Ky. *+ Morton M. Kligerman, M.D. Harvey W. Baker, M.D., Portland, Ore.* Mrs. Barbara B. Porter John C. Hawk, Jr., M.D., Charleston, S.C. George J. Race, M.D., Dallas, Tex. John Page Wilson, M.D., Atlanta, Ga.* Cancer Research and Treatment Center, Vice President Sol R. Baker, M.D., Beverly Hills, Calif.* Univ. of New Mexico, Albuquerque, N.M. Ralph Hester, C.L.U., Jackson, Miss.* Walter H. Rath, M.D., St. Albans, Vt. Robert S. Wren, M.D., Ossining, N.Y. Hon. Joseph H. Young James D. Barger, M.D., Las Vegas, Nev.* E. Sherwood Lawrence, M.D. Larry Hilaire, Portland, Ore.* James W. Rawles, Richmond, Va. Hon. Joseph H. Young, Baltimore, Md. *+ Infectious Disease and Immunology Division, Chairman of the Executive Committee William O. Barnes, Jr., Red Bank, N.J.* Mrs. Amory Houghton, Jr., Corning, N.Y.' James E. Reid, Forest Hills, N.Y.* Mrs. Alton Zamzow, Three Rivers, Tex.* New York Univ. School of Medicine, New York, N.Y. John S. Lawson W. Cecil Bauer, Birmingham, Ala.* David Smith Hubbell, M.D., St. Petersburg, Fla. James P. Ricker, Flint, Mich. Robert P. Zanes, Jr., M.D., Madison, Conn. Treasurer Thomas T. Bednarek, M.D., Billings, Mont. Mrs. Arnold Jacobson, R.N., Crosby, N.D.* Walter A. Ricker, Jr., M.D., Zenith, Wash.* Joseph J. Zavertnik, M.D., Miami, Fla.* Walter Lawrence, Jr., M.D. Allan K. Jonas Senator Irwin Belk, Charlotte, N.C. Division of Surgical Oncology, Arthur G. James, M.D., Columbus, O.* Andrew A. Rindlaub, Portchester, N.Y. Medical College of Virginia, Secretary Práxedes Rivera Bernacet, Hato Rey, P.R. Robert W. Jamplis, M.D., Palo Alto, Calif.* A. Addison Roberts, Rosemont, Pa. Richmond, Va. PAST OFFICER DIRECTORS W. Kenneth Bonds, Oklahoma City, Okla.* Mrs. William V. Johnson, Los Angeles, Calif.* Phillip G. Rose, Reno, Nev. Choh Hao Li, Ph.D. Harold E. Bowman, M.D., Grand Rapids, Mich.* Henry P. Johnston, Birmingham, Ala.* George P. Rosemond, M.D., Philadelphia, Pa. *+ Hormone Research Laboratory, Univ. of California, San Francisco, Charles R. Ebersol, Torrington, Conn. Foster J. Boyd, M.D. Wilmington, O. Allan K. Jonas, Los Angeles, Calif.* R. Wayne Rundles, Ph.D., M.D., Durham, N.C.*+ San Francisco, Calif. Mrs. Robert W. Huff, Rome, Ga. Luther W. Brady, Jr., M.D., Philadelphia, Pa.* Bishop Robert F. Joyce, Burlington, Vt.* The Rev. Perry H. Saito, Stevens Point, Wis. Fritz Lipmann, M.D., Ph.D. A. Hamblin Letton, M.D. Atlanta, Ga. Frank E. Brennan, Kansas City, Mo. Gustave L. Juengling, III, Cincinnati, O.* Mrs. Virginia Sams, Pekin, III. Rockefeller Univ., New York, N.Y. William B. Lewis, New York, N.Y. W. Lyle Brewer, Ph.D., Rochester, N.Y.* James J. Klauer, Sioux Falls, S.D.* Edward F. Scanlon, M.D., Evanston, III.*+ Salvador E. Luria, M.D. Mrs. Gaston Oxenaar, Wallingford, Vt. Mrs. Helene G. Brown, Woodland Hills, Calif. Hon. Morgan M. Kline, Bloomfield, Conn.* Joseph C. Schabacker, Ph.D., Tempe, Ariz.* Massachusetts Institute of Technology, Cambridge, Mass. Mrs. John T. Pirie, Jr., Lake Forest, III. Robert L. Brown, M.D., Atlanta, Ga.* John A. Knebel, M.D., Buffalo, Wyo. Edward C. H. Schmidt, Ph.D., M.D., Easton, Md.* Clement Markert, Ph.D. H. Marvin Pollard, M.D., Ann Arbor, Mich. Charles J. Buesing, C.L.U., Monmouth Beach, N.J. George P. Koeck, M.D., West Orange, N.J.* Robert L. Schmitz, M.D., Chicago, III.*+ Dept. of Biology, Yale Univ., Jonathan E. Rhoads, M.D. Philadelphia, Pa. Daniel Burdick, M.D., Syracuse, N.Y.* Robert M. Kretzschmar, M.D., Iowa City, Ia.* Edward J. Schneider, San Francisco, Calif.* New Haven, Conn. Samuel M. Seegal, Brookline, Mass. Miss Mary E. Busch, Baltimore, Md. C. Roger Kurtz, M.D., Washington, D.C.* E. L. "Jack" Schuetz, Lincoln, Neb.* Henry C. Pitot, M.D., Ph.D. Benjamin F. Byrd, Jr., M.D., Nashville, Tenn. Miss Ann Landers, Chicago, III.* Robert J. Schweitzer, M.D., Oakland, Calif. Dept. of Pathology, McArdle Laboratory for Cancer Research, HONORARY LIFE MEMBERS Joshua F. B. Camblos, M.D., Asheville, N.C.* Chas. W. Lantz, Hollywood, Fla.* John K. Scott, M.D., Madison, Wis." Univ. of Wisconsin, Madison, Wis. Mrs. Henry R. Cannon, Nashville, Tenn.* William E. Larsen, M.D. Leawood, Kan. William C. Scott, M.D., Tucson, Ariz. Richmond T. Prehn, M.D. Frank E. Adair, M.D., New York, N.Y. Robert B. Caraway, Jr., M.D., Wharton, Tex." Mrs. Albert D. Lasker, New York, N.Y.* Mrs. William J. Seidel, Spartanburg, S.C.* Institute for Cancer Research, James S. Adams, New York, N.Y. David J. Carlson, M.D., Milwaukee, Wis. Dennis W. Laudon, Milwaukee, Wis. Stanley Shmishkiss, Swampscott, Mass.* Philadelphia, Pa. Elmer H. Bobst, New York, N.Y. John Mack Carter, New York, N.Y.* John S. Lawson, Bronxville, N.Y.' Joseph S. Silber, Cleveland, O.* Howard V. Rickenberg, Ph.D. Thomas Carlile, M.D., Seattle, Wash. R. Lee Clark, M.D., M.Sc., Houston, Tex. Charles J. Lee, Jr., M.D., Santurce, P.R.* Herbert R. Silverman, Red Bank, N.J. Division of Research, National Jewish Hospital and Research Center, Lowell T. Coggeshall, M.D., Foley, Ala. Robert B. Clifton, M.D., Lake Charles, La. LaSalle D. Leffall, Jr., M.D., Washington, D.C. Margaret H. Sloan, M.D., Rockville, Md.* Denver, Colo. Warren H. Cole, M.D., Asheville, N.C. Marvin C. Colton, Albuquerque, N.M. Louis A. Leone, M.D., Providence, R.I.*+ Charles R. Smart, M.D., Salt Lake City, Ut.* John Spizizen, Ph.D. Murray M. Copeland, Houston, Tex. Thomas P. Cook, Minneapolis, Minn. James B. Lepley, D.D.S., Upper Saddle River, N.J.* Clair A. Snyder, Wyomissing Hills, Pa. Dept. of Microbiology, Scripps Clinic and Research Foundation, Emerson Foote, Carmel, N.Y. Kent L. Copenhaver, Brownsville, Tex. Mrs. Jim Lewis, Austin, Tex.*+ Harry Webb Southwick, M.D., Winnetka, III. La Jolla, Calif. Mrs. W. Parmer Fuller, Jr., Hillsborough, Calif. Ray S. Crampton, M.D., Laurel Hollow, N.Y.* Edward F. Lewison, M.D., Baltimore, Md.* James Patrick Spell, M.D., Jackson, Miss. Abraham White, Ph.D. Mrs. Powell Glass, Lynchburg, Va. Jacob A. Dalm, Jr., Kalamazoo, Mich.* Charles E. Lockhart, M.D., Springfield, Mo.* Donald E. Stader, M.D., Allentown, Pa. Institute of Biological Sciences, Mrs. Roger Goodan, Los Angeles, Calif. Milton F. Darr, Jr., Oak Brook, III. Charles O. Long, M.D., East Lansing, Mich. Elvis J. Stahr, LL.D., Greenwich, Conn.* Syntex (U.S.A.), Inc., Research Division, Palo Alto, Calif. Mrs. Anna Rosenberg Hoffman, New York, N. Y. James R. Dellinger, Jr., Cartersville, Ga. Robert M. Love, Bedford, N.H. Justin J. Stein, M.D., Los Angeles, Calif. Donald E. Johnson, Flint, Mich. Albert C. Diddams, M.D., Gallup, N.M.* Walter B. Love, Jr., Monroe, N.C.* Lester G. Steppacher, M.D., Wyncote, Pa.* Walter J. Kohler, Kohler, Wis. Victor C. Diehm, Conyngham, Pa.* Alexis E. Lubchenco, M.D., Denver, Colo.* Carl H. Stetson, Jr., North Scituate, R.I. COUNCIL FOR ANALYSIS Mrs. Forrest E. Mars, The Plains, Va. Vernon E. Duckwall, M.D., Elkins, W. Va. John S. Lyle, M.D., Norwich, Vt.* Donald E. Stewart, M.D., Crookston, Minn.* AND PROJECTION Mrs. R. E. Mosiman, Seattle, Wash. William M. Dugan, Jr., M.D., Indianapolis, Ind. David E. Marcello, Jr., M.D., Brockton, Mass. C. Chester Stock, Ph.D., New York, N.Y.* Harry M. Nelson, M.D., Bloomfield Hills, Mich. John Ridgeway Durant, M.D., Birmingham, Ala. Donald A. Mayeux, Mamou, La.* Mrs. M. D. Stoddard, Coeur d'Alene, Ida. James A. Miller, Ph.D., Chrmn. Dept. of Oncology, Alton Ochsner, M.D., New Orleans, La. Mrs. Elizabeth W. Estes, Lorena, Tex. Robert E. McAfee, M.D., Portland, Me. George W. Sumner, Jr., Honolulu, Hawaii McArdle Laboratory for Cancer Research, Eugene P. Pendergrass, M.D., Philadelphia, Pa. Titus Carr Evans, Sr., Ph.D., Iowa City, Ia. Raymond A. McCormack, Jr., M.D., Trenton, N.J. Stephen William Sutherlin, Indianapolis, Ind.* Univ. of Wisconsin, Madison, Wis. Alfred M. Popma, M.D., Boise, Id. Robert C. Eyerly, M.D., Danville, Pa.* Hon. Thomas F. McGowan, Buffalo, N.Y. Charles L. Tarleton, Little Rock, Ark. Vittorio Defendi, Ph.D. J. Leonard Reinsch, Atlanta, Ga. Robert J. Faulconer, M.D., Norfolk, Va.* Frank H. McGregor, M.D., Oklahoma City, Okla. John F. Thomas, M.D., Austin, Tex.* *Denotes Member. Board of Directors Dept. of Pathology, New York Univ. Medical Center, Matthew B. Rosenhaus, New York, N. Y. Jack J. Fisher, Wooster, Robert J. McKenna, M.D., Los Angeles, Calif. Lewis Thomas, M.D., New York, N.Y.* Denotes Member. Executive Committee New York, N.Y. 28 29 Maurice R. Hilleman, Ph.D., D.Sc. Thomas E. Thompson, Ph.D. ADVISORY COMMITTEE ON CLINICAL Research Laboratories, Dept. of Biochemistry, INVESTIGATIONS I-CHEMOTHERAPY Jerome Jaffe, M.D. Lee W. Wattenberg, M.D. ADVISORY COMMITTEE ON VIROLOGY Merck, Sharp and Dohme, Univ. of Virginia, School of Medicine, AND HEMATOLOGY Columbia Univ. Neuropsychiatric Institute Univ. of Minnesota Medical School, AND CELL BIOLOGY New York, N.Y. Division of Merck and Co., Inc., Charlottesville, Va. Minneapolis, Minn. West Point, Pa. H. G. Williams-Ashman, Ph.D. Emil Frei III, M.D., Chrmn. Joseph Leighton, M.D. George Weber, M.D. Karl G. Lark, Ph.D., Chrmn. Henry S. Kaplan, M.D. Ben May Laboratory for Cancer Research, Scientific Director Elect, Dept. of Pathology, Medical College of School of Medicine, Indiana Univ., Dept. of Biology, Univ. of Utah, Dept. of Radiology, School of Medicine, Univ. of Chicago, Chicago, III. Children's Cancer Research Foundation, Pennsylvania, Philadelphia, Pa. Indianapolis, Ind. Salt Lake City, Ut. Stanford Univ., Stanford, Calif. Gerald N. Wogan, Ph.D. Boston, Mass. Stanley Levenson, M.D. Lauren A. Woods, Ph.D., M.D. Sherman Weissman, M.D., Vice-Chrmn. George Klein, M.D. Dept. of Nutrition and Food Science, John Bennett, M.D., Vice-Chrmn. Albert Einstein College of Medicine, Medical College of Virginia, Virginia School of Medicine, Yale Univ., Dept. of Tumor Biology, Karolinska Institutet, Massachusetts Institute of Technology, School of Medicine and Dentistry, Yeshiva Univ., Bronx, N.Y. Commonwealth Univ., Richmond, Va. New Haven, Conn. Stockholm, Sweden Cambridge, Mass. Univ. of Rochester Cancer Center, Brian MacMahon, M.D. Gerald Fink, M.D. George Palade, M.D. Ira G. Wool, M.D., Ph.D. Rochester, N.Y. Dept. of Epidemiology, ADVISORY COMMITTEE ON Cornell Univ., Ithaca, N.Y. Dept. of Cell Biology, Dept. of Physiology, Vincent T. DeVita, Jr., M.D. Harvard Univ. School of Public Health, PERSONNEL FOR RESEARCH Yale Univ., New Haven, Conn. Univ. of Chicago, Chicago, Ill. Chief, Medicine Branch, Boston, Mass. Guido Guidotti, Ph.D. Dept. of Biochemistry and Molecular Donald Pinkel, M.D. National Cancer Institute, Ralph M. Richart, M.D. Purnell W. Choppin, M.D., Chrmn. Biology, Harvard Univ., Dept. of Pediatrics, NIH, Bethesda, Md. ADVISORY COMMITTEE ON CLINICAL Dept. of Obstetrics and Gynecology, Rockefeller Univ., New York, N.Y. Cambridge, Mass. Milwaukee Children's Hospital, INVESTIGATIONS -IMMUNOLOGY Rose Ruth Ellison, M.D. College of Physicians and Surgeons, Milwaukee, Wis. Columbia Univ., New York, N.Y. F. E. Shideman, M.D., Ph.D., Vice-Chrmn. Janet W. Hartley, Ph.D. AND IMMUNOTHERAPHY E. J. Meyer Memorial Hospital, Dept. of Pharmacology, Univ. of Minnesota Laboratory of Viral Diseases, National Frank J. Rauscher, Jr., Ph.D. Dept. of Medicine, Benjamin F. Rush, Jr., M.D. Medical School, Minneapolis, Minn. Institute of Allergy and Infectious Diseases, Herbert F. Oettgen, M.D., Chrmn., Buffalo, N.Y. National Cancer Institute, NIH, Dept. of Surgery, Elijah Adams, M.D. NIH, Bethesda, Md. Bethesda, Md. Division of Applied Immunology, Jack Fox, Ph.D. College of Medicine and Dentistry of New Jersey -Kettering Institute for Cancer Research, Sloan-Kettering Institute for Cancer Research, Newark, N.J. Dept. of Biochemistry, School of Medicine, Leonard Hayflick, Ph.D. Edward Reich, Ph.D. Univ. of Maryland, Baltimore, Md. Dept. of Microbiology, Stanford Univ., New York, N.Y. New York, N.Y. Thomas Skillman, M.D. Dept. of Chemical Biology, Dept. of Medicine, Renato Baserga, M.D. School of Medicine, Stanford, Calif. Rockefeller Univ., New York, N.Y. D. Bernard Amos, M.D., Vice-Chrmn. Walter J. Gensler, Ph.D. Roland K. Robins, Ph.D. Dept. of Microbiology and Immunology, Dept. of Chemistry, Boston Univ., Ohio State Univ., College of Medicine, Temple Univ., Health Sciences Center, John J. Holland, Ph.D. Duke Univ. Medical Center, Durham, N.C. Boston, Mass. Columbus, Ohio Philadelphia, Pa. Dept. of Biology, Univ. of California at ICN Nucleic Acid Research Institute, Irvine, Calif. Frank L. Adler, Ph.D. Harlan J. Spjut, M.D. George J. Brewer, M.D. San Diego, La Jolla, Calif. Charles E. Mengel, M.D. Baylor College of Medicine, Dept. of Human Genetics, Univ. of Arnold Levine, Ph.D. Marvin A. Schneiderman, Ph.D. Dept. of Immunology, Dept. of Medicine, Public Health Research Institute of the Univ. of Missouri, School of Medicine, Texas Medical Center, Houston, Tex. Michigan Medical School, Ann Arbor, Mich. Princeton University, Princeton, N.J. Demography, National Cancer Institute, NIH, City of New York, New York, N.Y. Columbia, Mo. Herman D. Suit, M.D., Ph.D. George O. Clifford, M.D. Orlando J. Miller, M.D. Bethesda, Md. Dept. of Radiation Therapy, School of Medicine, Creighton Univ., College of Physicians and Surgeons, Elmer L. Becker, M.D., Ph.D. Enrico Mihich, M.D. Massachusetts General Hospital, Boston, Mass. Omaha, Neb. Columbia Univ., New York, N.Y. Dept. of Pathology, Univ. of Connecticut, Dept. of Experimental Therapeutics Farmington, Conn. Roswell Park Memorial Institute, Halvor Vermund, M.D. Pedro Cuatrecasas, M.D. Robert Bruce Nicklas, Ph.D. ADVISORY COMMITTEE ON BIOCHEMISTRY Buffalo, N.Y. Dept. of Radiology, Univ. of California at Dept. of Pharmacology and Experimental Dept. of Zoology, Duke Univ., AND CHEMICAL CARCINOGENESIS Friedrich Deinhardt, M.D. Dept, of Microbiology, Charles A. Nichol, Ph.D. Irvine, Irvine, Calif. Therapeutics, John Hopkins Univ. Durham, N.C. School of Medicine, Baltimore, Md. Presbyterian St. Luke's Medical Center, Director of Research, Joseph Wiener, M.D. Keith R. Porter, Ph.D. Chicago, III. Burroughs Wellcome Company, New York Medical College, Herman N. Eisen, M.D. Dept. of Molecular, Cellular and Research Triangle Park, N.C. Basic Science Building, Center for Cancer Research, Developmental Biology, Univ. of John L. Fahey, M.D. Valhalla, N.Y. Massachusetts Institute of Technology, Colorado, Boulder, Colo. Joseph Larner, M.D., Ph.D., Chrmn. Dept. of Microbiology and Immunology, Seymour Perry, M.D. Cambridge, Mass. Dept. of Pharmacology, Univ. of California, Los Angeles Center for Division of Cancer Treatment, Matthew D. Scharff, M.D. Univ. of Virginia, School of Medicine, Health Sciences, Los Angeles, Calif. National Cancer Institute, ADVISORY COMMITTEE ON Sidney Fleischer, Ph.D. Dept. of Cell Biology, Albert Einstein Charlottesville, Va. NIH, Bethesda, Md. INSTITUTIONAL RESEARCH GRANTS Vanderbilt Univ., Nashville, Tenn. College of Medicine, Yeshiva Univ., Evan M. Hersh, M.D. Phillips W. Robbins, Ph.D., Vice-Chrmn. Section of Immunology, Dept. of E. Peter Geiduschek, Ph.D. Bronx, N.Y. Robert Silber, M.D. Massachusetts Institute of Technology, Developmental Therapeutics, Univ. of Texas, Professor of Medicine, Erich Hirschberg, Ph.D., Chrmn. Dept. of Biology, Univ. of California at R. Walter Schlesinger, M.D. Cambridge, Mass. M.D. Anderson Hospital and Tumor Institute, School of Medicine, College of Medicine and Dentistry of New Jersey San Diego, La Jolla, Calif. Dept. of Microbiology, College of Medicine Emmanuel Farber, M.D., Ph.D. Houston, Tex. New York Univ. Medical Center, at Newark, Newark, N.J. Vincent P. Hollander, M.D., Ph.D. and Dentistry of New Jersey, Loren G. Humphrey, M.D., Ph.D. New York, N.Y. Fels Research Institute, Robert E. Parks, Jr., M.D., Vice-Chrmn. Hospital for Joint Diseases and Rutgers Medical School, Temple Univ. School of Medicine, Univ of Kansas, Medical Center, Joseph V. Simone, M.D. Dept. of Biochemical Pharmacology, Medical Center, New York, N.Y. Piscataway, N.J. Philadelphia, Pa. Kansas City, Kan. Hematology-Oncology, Division of Biological and Medical Sciences, William P. Jencks, M.D. Patricia Gail Spear, Ph.D. Harry V. Gelboin, Ph.D. St. Jude Children's Research Hospital, Brown Univ., Providence, R.I. Graduate Dept. of Biochemistry, Dept. of Microbiology, Univ. of Charles F. McKhann, M.D. Chemical Branch, National Cancer Institute, Memphis, Tenn. Dept. of Surgery, Mayo Memorial Building, Creed W. Abell, Ph.D. Brandeis Univ., Waltham, Mass. Chicago, Chicago, III. NIH, Bethesda, Md. Minneapolis, Minn. William G. Thurman, M.D. Dept. of Human Biological Chemistry and Wolfgang Joklik, Ph.D. Peter K. Vogt, Ph.D. Victor Ginsburg, Ph.D. Tulane Univ. School of Medicine, Genetics, Division of Biochemistry, The Univ. Univ. of Southern California School of Richard S. Metzgar, M.D. Dept. of Microbiology, Duke Univ., Durham, N.C. New Orleans, La. National Institute of Arthritic, of Texas Medical Branch, Galveston, Tex. Medicine, Los Angeles, Calif. Duke Univ. Medical Center, Durham, N.C. Leroy C. McLaren, Ph.D. Metabolic and Digestive Diseases, Felix Milgrom, M.D. Burton L. Baker, Ph.D. Dept. of Microbiology, School of Medicine, Frank Young, M.D., Ph.D. NIH, Bethesda, Md. Dept. of Microbiology, State Univ. of New York ADVISORY COMMITTEE ON CLINICAL Univ. of Michigan, Ann Arbor, Mich. Univ. of New Mexico, Albuquerque, N.M. Dept. of Microbiology, School of INVESTIGATIONS I-PREVENTION, Medicine and Dentistry, Univ. of Jack Gorski, Ph.D. at Buffalo, Buffalo, N.Y. DIAGNOSIS AND THERAPY Harry F. Bisel, M.D. A. Frederick Rasmussen, Jr., M.D. Rochester, Rochester, N.Y. Dept. of Biochemistry, Robert S. Schwartz, M.D. Dept. of Medicine, Mayo Clinic, School of Medicine, Center for Health Univ. of Wisconsin, Madison, Wis. Rochester, Minn. Hematology Service, Dept. of Medicine, Sciences, Univ. of California, Los Angeles, Bernard L. Horecker, Ph.D. New England Medical Center Hospital, Antolin Raventos, M.D., Chrmn. Harlyn O. Halvorson, Ph.D., Los Angeles, Calif. ADVISORY COMMITTEE ON NUCLEIC Roche Institute for Molecular Biology, Tufts Univ. School of Medicine, Boston, Mass. Dept. of Radiology, Univ. of California, Rosensteil Basic Medical Sciences Research Frank H. Ruddle, Ph.D. ACIDS AND PROTEIN SYNTHESIS Nutley, N.J. William O. Weigle, Ph.D. Davis School of Medicine, Davis, Calif. Center, Brandeis Univ., Waltham, Mass. Kline Biology Tower, Yale Univ., Ora M. Rosen, M.D. Dept. of Experimental Pathology, Scripps Clinic Thomas C. Hall, M.D., Vice-Chrmn. Harold A. Harper, Ph.D. New Haven, Conn. Robert T. Schimke, M.D., Chrmn. Dept. of Medicine and Molecular Biology, and Research Foundation, La Jolla, Calif. Los Angeles County-Univ. of Southern Graduate Division, Univ. of California, Henry P. Treffers, Ph.D. Dept. of Biological Sciences, Stanford Univ., Albert Einstein College of Medicine, Ralph C. 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Wyoming Division, Inc. 1001 South MacDill Avenue 535 Broad Hollow Road 1118 Logan Avenue Tampa, Florida 33609 Melville, New York 11746 Cheyenne, Wyoming 82001 Georgia Division, Inc. New York City Division, Inc. 2025 Peachtree Road, N.E. 19 West 56th St. Atlanta, Georgia 30309 New York, New York 10019 Hawaii Division, Inc. Queens Division, Inc. 200 North Vineyard Boulevard 111-15 Queens Boulevard Honolulu, Hawaii 96817 Forest Hills, New York 11375 Idaho Division, Inc. Westchester Division, Inc. NATIONAL HEADQUARTERS: 1609 Abbs Street 107 Lake Avenue AMERICAN CANCER SOCIETY, INC., Boise, Idaho 83705 Tuckahoe, New York 10707 219 E. 42nd ST., NEW YORK, N.Y. 10017 32 Cancer's Seven Warning Signals 1 Change in bowel or bladder habits. 2 A sore that does not heal. 3 Unusual bleeding or discharge. 4 Thickening or lump in breast or elsewhere. 5 Indigestion or difficulty in swallowing. 6 Obvious change in wart or mole. 7 Nagging cough or hoarseness. If you have a warning signal, see your doctor. 74-120M-2/75-No.1508.74 75 CANCER FACTS & FIGURES AMERICAN CANCER SOCIETY ® 11,000 2,100 2,800 2,000 1,600 3,700 6,900 12,000 2,100 2,300 14,000 21,000 800 27,000 70,000 3,700 10,000 1,400 5,300 9,800 43,000 26,000 35,000 2,100 37,000 1,700 16,000 63,000 5,400 6,300 12,000 7,400 17,000 13,000 3,100 11,000 14,000 5,000 8,500 12,000 2,300 6,600 6,500 6,600 10,000 12,000 32,000 11,000 28,000 estimated cancer incidence ALASKA in 1975 by states HAWAII 300 1,700 total: 665,000* (Excluding Puerto Rico) PUERTO RICO 6,000 "Excluding superficial skin cancers and carcinoma-in-situ of the uterine cervix. Based on rates from the NCI Third National Cancer Survey. CONTENTS BASIC DATA Page Page What Is Cancer? THE ACS INCIDENCE What It Is 30 1975 Estimates, by States front cover Cancer is a disease characterized by abnormal growth and spread of cells. If this malignant process is Income Sources 29 By Sex & Site .4, 10 not controlled or checked, the patient will die. However, many cancers can be cured if detected early Funds Allocations 29 For Major Sites-1975 5 in their development and treated promptly. The 58 Divisions back cover By Site, By State 9 BREAST CANCER 14 Leading Sites- 1975 11 LARYNGECTOMEE ASSN. 23 How Treated? CANCER What It Is 3 LEUKEMIA 20 3 LOCALIZING STATISTICS 13 By surgery, X-rays, radioactive substances, and various drugs, chemicals and hormones. How Treated Can It Be Prevented? 4 LUNG CANCER 18 Who Will Get It? 3 ORAL CANCER 18 How Many Are Being Saved? How Many Will Get It? 3 OSTOMY PROGRAM 23 How Many Have It? 3 PROFESSIONAL EDUCATION 21 About 222,000 Americans will be saved from cancer this year. This means that about one-third of all New Cases Annually 3 PUBLIC EDUCATION 20 people who get cancer will be saved. CELEBRITIES AND CANCER 31 REACH TO RECOVERY 22 CLINICAL FELLOWSHIPS 22 RESEARCH How Many More Could Be Saved? COLON-RECTUM CANCER 17 Summary of Grants 24 COSTS OF CANCER 28 Background Narrative 23 Another 111,000 cancer patients will probably die in 1975 who might have been saved by earlier and ACS Aided Research 26 DEATHS better treatment. How Many Will Die? 4 SERVICE & REHABILITATION 22 National Death Rate 4 SEVEN SAFEGUARDS 2 Survival Rate Is One-In-Three By Sex & Site 4, 10 SKIN CANCER 18 For Major Sites-1975 5 SURVIVAL RATES In the early 1900's few cancer patients had any hope of long-term survival. In the 1930's fewer By Site, By State 8 Now One-In-Three 3 than one-in-five was being saved - that is, alive five years after first being treated. In the 1950's Worldwide 12 How Many Actually Saved? 3 13 How Many More Could Be Saved? 3 one-in-four was being saved. Now the ratio is one-in-three. The gain from 1-4 to 1-3 currently By Age Groups & Sex Leading Causes 13 Cured of Cancer: 1.5 Million 4 amounts to some 55,000 lives each year. Of every six persons who get cancer today (exclusive of Trends in Death Rate 11 Five-Year Chart 5 superficial skin cancer and carcinoma-in-situ of uterine cervix), two will be saved and four will EARLY DETECTION IS VITAL 5 SWORD OF HOPE 30 die. Numbers 1 and 2 will be saved. Number 3 will die but might have been saved with early diag- ENVIRONMENTAL RESEARCH PROJECTS TRENDS IN CANCER-1975 6 nosis and prompt treatment. Numbers 4, 5 and 6 will die of cancer which cannot yet be con- Cancer Prevention Study 27 UNPROVEN METHODS 23 16 trolled; only the results of research can save these patients. This means that about half of those Occupational Group Studies 28 UTERINE CANCER WARNING SIGNALS 2 who get cancer could and should be saved. Thus, the immediate goal of cancer control in this country is saving 333,000 lives, or half of those who get cancer (other than superficial skin cancer and carcinoma-in-situ of the uterine cervix) each year. Who Will Get Cancer? CANCER'S 7 WARNING SIGNALS THE 7 SAFEGUARDS URGED BY ACS Cancer strikes at any age. It affects children as well as adults, but it strikes with increasing frequency with advancing age. Change in bowel or bladder habits Lung: Reduction and ultimate elimination of cigarette smoking. Asore that does not heal How Many Will Get Cancer? Colon-Rectum: Proctoscopic exam as routine in About 53 million Americans now living will eventually have cancer; one-in-four persons according to Unusual bleeding or discharge annual checkup for those over 40. present rates. Cancer will strike over the years in approximately two of three families. In the 70's, there will be an estimated 3.5 million cancer deaths, 6.5 million new cancer cases, and more than Thickening or lump in breast or elsewhere Breast: Self-examination as monthly female practice. 10 million under medical care for cancer. Indigestion or difficulty in swallowing Uterus: Pap test for all adult and high-risk women. How Many With Cancer? Obvious change in wart or mole Skin: Avoidance of excessive sun. This year more than 1 million Americans will be under medical care for cancer. Nagging cough or hoarseness Oral: Wider practice of early detection measures. New Cases Annually If YOU have a warning signal, see your doctor! Basic: Regular physical examination for all adults. There will be about 665,000 new cancer cases (diagnosed for the first time) in 1975. (This does not include superficial skin cancer or carcinoma-in-situ of the uterine cervix, which have been included in past years.) These estimates of the incidence of cancer are based upon data from the National Cancer Insti- tute's Third National Cancer Survey (1969-71). The incidence of superficial skin cancer is shown 2 3 ©1974, American Cancer Society, Inc. ESTIMATED NEW CASES AND DEATHS FIVE YEAR CANCER SURVIVAL RATES* to have been substantially under-reported; the annual number of new cases may vary from FOR MAJOR SITES OF CANCER - 1975* FOR SELECTED SITES 300,000 to 600,000 or more. Carcinoma-in-situ of the cervix is first diagnosed in over 40,000 cases annually. Site No. of Cases Deaths 0 20 40 60 80 100 BLADDER 71% How Many Will Die? 21% Lung 91,000 81,000 This year about 365,000 will die of the disease; that is about 1,000 persons a day; one every one-and- BREAST 84% Colon- one-half minutes. Of every six deaths from all causes in the U.S., one is from cancer. In 1974 an esti- 99,000 49,000 56% Rectum mated 358,000 Americans died of cancer, and in 1973 it was 351,000. In 1972 it was 344,000. In COLON 71% RECTUM 43% 1971, 337,398 cancer deaths were reported by the U.S. National Center for Health Statistics. Breast 89,000 33,000 LARYNX 79% Uterus 38% 46,000** 11,000 National Death Rate LUNG 33% Oral 23,000 8,000 10% There was a steady rise in the (age-adjusted*) national death rate until 1950. Since 1950 it has been Skin 9,000* 5,000 ORAL 67% flattening out. In 1930 the number of cancer deaths per 100,000 population (age-adjusted) was 112; 30% in 1940 it was 120; by 1950 it had risen to 125; and in 1971 the number was 131. Except for cancers Leukemia 21,000 15,000 PROSTATE 68% of the lung, ovary, and pancreas, age-adjusted cancer death rates in general are leveling and in some 57% cases dropping off. *Figures rounded to the nearest 1000. UTERUS 82% **If carcinoma-in-situ included, cases total over 86,000. 44% LOCALIZED REGIONAL INVOLVEMENT Can It Be Prevented? Estimates widely, from 300,000-600,000 or more, *ADJUSTED FOR NORMAL LIFE EXPECTANCY for superficial skin cancer. SOURCE: END RESULTS GROUP, NATIONAL CANCER INSTITUTE Some cancers; not all. Most lung cancers are caused by cigarette smoking, and most skin cancers by INCIDENCE RATES ARE BASED ON RATES FROM N.C.I. THIRD NATIONAL CANCER SURVEY frequent overexposure to direct sunlight. These can be prevented by avoiding their causes. Also, certain cancers caused by occupational factors - particularly bladder cancer in thedye industry - have been prevented by eliminating the causative agents. WHY EARLY DETECTION IS VITAL About half of all cancers could be detected early enough to be curable. For unknown reasons, some About One and One-Half Million Now Living - Cured cancers grow and spread slowly while others grow and spread rapidly. Some types spread with such There are now 1,500,000 Americans, alive today, who have been cured of cancer. By "cured" it is rapidity that they are incurable at the present time. meant they are without evidence of the disease at least five years after diagnosis and treatment. The Cancer typically begins as a "localized" disease. At the start, just one cell (or perhaps a few) under- decision as to when a patient may be considered cured, in the sense of being free of the disease, is one goes an abnormal change it becomes a malignant cell, cancer. The cancer cell reproduces itself by that must be made by the individual physician. For most forms of cancer, five years is the accepted dividing into two cells, which in turn redivide and so on. All of the descendants of the original cancer time. However, some patients can be discharged as free of the disease after one year; others after three cell are themselves cancer cells - thus the cancer grows. years, while some may be followed much longer than five years. Most cancers originate on the surface of some tissues such as the skin, the surface of the uterus, the lining of the mouth, stomach, intestines, bladder or a bronchial tube, or the lining of a duct in the *Age-adjusted-a method used to make valid statistical comparisons by assuming the same age distribution among different groups breast, prostate gland or elsewhere. For a time, such cancers typically remain in the lining or on the being compared. surface at the site of origin ("in situ") and are visible only under a microscope. After a while, some of the cancer cells penetrate beyond the surface and "invade" the underlying tissues. This is "invasive cancer." After invading, the cancer continues to grow, though, for a time, the CANCER INCIDENCE BY SITE AND SEX* CANCER DEATHS BY SITE AND SEX cancer cells may remain as an intact mass which may be visible to the naked eye. As long as all the living cancer cells remain where the disease started, it is said to be "localized." 1% 1% SKIN 1% SKIN SKIN SKIN 1% The more dangerous phases of cancer are the later ones. Some of the cancer cells eventually become 2% ORAL 1% ORAL detached and are carried through the lymph channels or blood vessels to other parts of the body. This ORAL 5% ORAL 3% process is known as "metastasis." But the body has a protective mechanism. The detached cancer cells 27% BREAST 20% BREAST LUNG 22% LUNG 33% may be trapped in a lymph node in the region of the original organ. This retards the spread for a time. 6% LUNG 11% LUNG This stage of the disease is known as "regional involvement." COLON & COLON & RECTUM 14% RECTUM 12% 15% COLON & 15% COLON & If left untreated the cancer cells eventually spread to other parts of the body. This is "advanced RECTUM RECTUM OTHER OTHER cancer." Death is almost inevitable. 15% DIGESTIVE 12% OTHER DIGESTIVE 14% OTHER 9% DIGESTIVE DIGESTIVE The problem therefore is to detect cancer before it has spread so that it can be removed by surgery PROSTATE 17% PROSTATE 9% 14% UTERUS 7% UTERUS or destroyed by radiation and/or chemotherapy. URINARY 9% URINARY 6% 4% URINARY 3% URINARY Early Detection and High Risk Groups LEUKEMIA & LEUKEMIA & LEUKEMIA & LEUKEMIA & 8% LYMPHOMAS 7% 9% 9% LYMPHOMAS LYMPHOMAS LYMPHOMAS The key to saving three-out-of-six persons who get cancer, rather than the present two-out-of-six, is ALL OTHER 12% 15% ALL OTHER ALL OTHER 12% 19% ALL OTHER earlier detection of the disease. Present treatment knowledge is adequate for this goal but timely detection and diagnosis lag behind. *Excluding superficial skin cancer and carcinoma-in-situ of uterine cervix. 4 5 One important way of improving treatment yield is selective, earlier detection - determining popu- The death rate for men since 1930 has risen by over 40%, due mainly to a 2,000% increase for lung lation groups more likely to have cancer and providing frequent and inexpensive checkups for them. cancer, a highly preventable disease. Short of a universal screening test that would disclose the presence or absence of cancer, identifying Since 1949, more men than women have been dying from cancer each year; in 1975 about high risk groups can be a most effective step in saving more lives. 55 to 45. The following are the major cancer sites for which some high risk categories have been identified. Better 3-year survival rates were reported among white Americans since the 1940's for cancers of Lung Cancer: It is estimated that cigarette smoking causes at least 80% of lung cancer. The highest the bladder, brain, breast, cervix, body of the uterus, larynx, thyroid, prostate, chronic and childhood number of male lung cancers occurs in age group 60-69, in men who have smoked two or more packs a leukemias, Hodgkin's disease, melanoma and multiple myeloma at the 7th National Cancer day for 20 years and who started smoking before age 15. A male in this group has a 15 to 20 times Conference, co-sponsored by the ACS-NCI in September, 1972. greater chance of dying from lung cancer than his counterpart who never smoked. He also has a signifi- The same report noted "little or no improvement in life expectancy" for patients with lung and cantly higher risk of getting cancer of the larynx, bladder and oral cavity. pancreas cancer. The largest number of female lung cancers occur in age group 55-64, in women who have smoked Deaths by age groupings show more than half of all mortality among persons over 65. one or more packs of cigarettes a day for at least 20 years, inhale smoke deeply and begin smoking Cancer is the leading cause of death among women age 30 to 54. before age 20. A woman in this group has a risk of dying of lung cancer 5 to 10 times that of a female In 1975, cancer will take the lives of about 3,500 children under 15 and about half of them will who never smoked. die of acute leukemia, a cancer of the blood-forming tissues - a notable reduction from the maximum Breast Cancer: High risks in the U.S. are: 1) women over age 35 - risk increases with age; 2) a deaths (4,615) recorded in this age group in 1965. woman who has never had a child; 3) a woman who bore her first child after age 25; 4) women whose More school children die of cancer than from any other disease. mothers or sisters had breast cancer; 5) women who experienced early menarche and/or late menopause. The overall incidence of cancer among men is increasing, but among black men the incidence is Gastric Cancer: A recent study of Japanese (who have a very high incidence of stomach cancer) substantially higher. The cancer mortality rate per 100,000 population has increased by 50% for black gives some interesting clues to high risk. The elevated incidence of gastric cancer continues for men against 16% for white men. In black women, the mortality rate has been declining, but by 3% Japanese who migrate to Hawaii but does not persist among their offspring. Diet is a likely causative while it declined by 9% among white women. factor and evidence for a higher incidence of gastric cancer was observed among frequent consumers of The increase among men is attributed to higher incidence of prostate cancer as well as lung, and to pickled vegetables and dried salted fish, but not for consumers of raw fish and unprocessed vegetables. a lesser increase in colon cancer. The decrease among women is attributed to a drop in cancers of the Diet has been suggested as the causative factor in all countries with a high incidence of gastric stomach and rectum, as well as cervix. cancer. Colon-Rectum Cancer: The familial tendency for polyps has been observed and a high incidence of Trends in Individual Sites colon-rectum cancer in patients with a history of familial polyposis is documented. Lung cancer: The male mortality rate has increased more than 20 times in 45 years and is going Cancer of the Uterine Cervix: The high risk female for this cancer is of low income background, up steadily in women. Incidence has doubled in both men and women, both black and white. It is who never has had a Pap test or regular checkups, has borne children, has a history of early sexual second in incidence only to colon-rectum cancer overall and first in incidence in men. intercourse with multiple partners. Colon-rectum cancer: Excluding skin cancer, it is the site of the greatest number of new cases Cancer of the Endometrium: Most cases of this cancer occur in women between the ages of 50 and estimated for 1975. Slight, if any, recent change in incidence or death rates. 64, women with late menopause, postmenopausal bleeding, obesity, a tendency toward high blood Breast cancer: It is the leading cause of cancer incidence and death among women today. Leading pressure, and a history of diabetes. cause of all deaths among women 40-44 years of age and second leading cause of death for other Other cancers: There is evidence of a relationship between cancer and certain industries, such as age groups. No great reduction in mortality rate in the past 35 years. Survival is 85%-90% when asbestos, typography and roofing, plastics - vinyl chloride and arsenic processing. (See page 28). found early. Uterine cancer: Deaths continue steady decline, now are one-third of rate 35 years ago. Two Practical Controls factors contribute - better programs of education for women and wider use of Pap test for cancer of The ACS sometimes in cooperation with the NCI, is initiating practical control measures toward the uterine cervix. improving early case finding. Examples are: the Society's Uterine Cancer Task Force program of Pancreas cancer: Highly fatal, with incidence up 65% in past generation, 200% in the past 40 having a Pap test for every woman in the country and the Breast Cancer Task Force program, which years. No known reason. has already established 27 centers where mammography, thermography, xeroradiography and clinical Larynx cancer: Strikes few women, survival rate among men improved into the '60s but has since examinations are being tested. leveled off. Stomach cancer: Steady decrease, both sexes; about half the death rate of 20 years ago. Reasons TRENDS IN CANCER unknown. Cancers of the bladder, kidney, brain, lip-tongue-mouth: Improvement in survival through the The overall age-adjusted cancer death rate for American women has been declining slowly but '40s, a plateau since early '50s. steadily since 1936. The total drop has been about 13%, largely due to a sharp reduction in mortality Prostate and thyroid cancers, Hodgkin's disease: All show some improvement in recent survival from cancer of the uterine cervix, a readily detectable disease. information. Leukemia: No great change in survival data of chronic forms but acute leukemias show continuing dramatic improvement. 6 7 Estimated New Cancer Cases for All Sites, Estimated Cancer Deaths for All Sites, Plus Major Sites, by State - 1975 Plus Major Sites, by State - 1975 All Sites* Major Sites All Sites Major Sites Number Number Death Rate of Colon- Uterus Leu- of per 100,000 Colon- Leu- State Cases Breast Rectum Lung Oral (Invasive) Prostate Stomach Pancreas kemia State Deaths Population Breast Rectum Lung Oral Uterus Prostate Stomach Pancreas kemia Alabama 10,000 1,100 1,100 1,400 350 1,000 1,000 300 400 300 Alabama 5,600 155 425 550 1,300 125 250 350 175 375 200 Alaska 300 50 50 60 15 20 20 15 10 20 Arizona 5,000 600 800 Alaska 200 60 15 20 50 5 10 10 10 10 10 600 150 350 450 150 200 150 151 225 300 700 70 50 150 100 150 125 Arkansas 6,600 600 800 1,000 200 500 800 200 250 300 Arizona 3,000 Arkansas 225 400 900 75 100 275 125 250 200 California 3,700 183 63,000 8,700 8,700 8,700 2,300 3,900 4,700 2,300 2,100 2,000 7,700 1,400 1,800 1,400 Colorado 5,400 750 800 650 150 350 550 150 200 200 California 34,500 161 3,200 4,300 750 1,000 1,600 Colorado 3,000 128 275 400 600 60 70 175 100 175 150 Connecticut 10,000 1,400 1,700 1,300 450 550 750 400 350 350 Delaware 1,700 200 300 250 70 100 100 50 Connecticut 5,500 171 500 800 1,100 175 125 250 250 325 250 50 40 Delaware 950 163 70 125 225 25 20 40 30 50 30 Dist. of Columbia 3,100 450 400 350 200 250 250 90 80 60 28,000 3,300 3,900 Dist. of Columbia 1,600. 213 175 200 325 60 60 90 60 80 40 Florida 5,000 1,100 1,600 2,700 1,000 1,000 700 Florida 16,600 236 1,200 2,100 4,400 350 400 900 600 950 500 Georgia 12,000 1,500 1,400 1,800 450 1,100 1,100 400 350 400 Georgia 6,600 136 550 650 1,600 150 275 375 250 350 275 Hawaii 1,700 100 200 200 80 80 60 150 60 70 90 60 50 Idaho 2,100 250 250 250 50 100 250 70 70 100 Hawaii 900 104 60 90 150 30 20 30 Idaho 1,100 145 90 125 200 20 25 80 40 70 70 Illinois 37,000 5,100 5,800 4,800 1,300 2,700 3,000 1,400 1,200 1,200 Indiana 16,000 2,200 2,700 2,300 450 1,300 1,400 Illinois 20,100 171 1,900 2,900 4,300 450 700 1,000 850 1,100 900 400 500 500 Indiana 8,800 160 800 1,300 2,100 175 325 450 250 500 350 Iowa 9,800 1,300 1,800 1,300 300 650 1,100 300 300 400 7,400 950 lowa 5,400 183 500 900 1,100 100 125 350 175 250 275 Kansas 1,100 1,000 250 650 800 150 250 300 550 850 90 125 275 100 225 200 Kentucky 11,000 1,200 1,400 1,600 400 900 900 250 350 400 Kansas 4,100 172 375 Kentucky 5,800 175 425 800 1,400 150 200 300 150 325 275 Louisiana 11,000 1,300 1,200 1,800 450 850 950 400 350 350 300 250 Maine 3,700 500 600 500 125 250 400 150 150 100 Louisiana 6,000 154 475 600 1,600 150 200 325 250 Maine 2,200 211 175 300 475 40 60 125 90 100 80 Maryland 12,000 1,600 1,800 1,900 500 900 950 350 400 300 Massachusetts 21,000 3,200 3,500 2,500 850 Maryland 6,600 159 600 900 1,700 175 200 325 200 325 200 1,200 1,500 850 600 550 Massachusetts 11,400 189 1,200 1,700 2,300 300 300 500 525 600 400 Michigan 27,000 3,700 3,900 3,600 900 1,800 2,300 850 800 750 12,000 Michigan 14,500 153 1,400 1,900 3,200 300 425 800 525 700 550 Minnesota 1,600 2,000 1,300 350 600 1,300 500 450 400 1,100 125 125 450 300 375 275 Mississippi 6,600 750 800 950 200 700 750 250 250 Minnesota 6,600 163 600 950 300 Mississippi 3,600 153 275 400 850 70 125 250 150 225 200 Missouri 17,000 2,100 2,500 2,400 500 1,200 1,700 450 550 550 475 Montana 2,100 250 300 250 70 150 200 80 80 Missouri 9,200 190 800 1,200 2,100 175 275 550 275 400 80 Montana 1,300 177 100 150 250 25 30 70 50 80 60 Nebraska 5,300 700 900 550 150 300 500 150 200 200 Nevada 1,400 150 150 250 50 Nebraska 2,800 180 250 425 500 60 70 175 100 175 150 60 90 15 50 40 Nevada 800 153 60 80 200 15 20 25 10 60 30 New Hampshire 2,800 350 500 400 100 200 250 70 80 100 New Hampshire 1,500 193 150 250 350 30 50 80 40 80 70 New Jersey 26,000 3,800 4,500 3,400 850 1,600 1,700 1,100 900 700 300 400 600 650 800 500 New Mexico 2,300 250 250 300 60 150 200 80 70 70 New Jersey 14,300 189 1,400 2,200 3,000 New Mexico 1,300 116 100 125 250 20 30 60 50 70 50 New York 70,000 10,700 12,000 8,500 2,400 4,300 4,700 2,800 2,300 2,000 North Carolina 14,000 1,600 1,400 1,900 500 1,200 1,200 350 450 500 New York 37,700 194 4,000 5,800 7,800 800 1,000 1,600 1,700 2,100 1,400 North Carolina 7,300 137 600 800 1,700 175 300 400 225 425 350 North Dakota 2,000 200 300 200 50 80 200 100 80 70 Ohio 35,000 4,800 5,600 4,800 North Dakota 1,100 167 90 150 175 15 25 70 60 80 50 1,200 2,500 2,700 1,200 1,000 1,000 19,100 170 1,800 4,200 425 650 900 700 900 750 Oklahoma 8,500 950 1,100 1,300 250 600 2,700 900 250 300 300 Ohio 177 80 125 300 150 275 200 Oregon 6,900 900 1,000 950 4,700 350 550 200 500 1,100 650 200 250 300 Oklahoma 80 225 125 200 200 Pennsylvania 43,000 6,300 7,400 5,400 1,400 2,800 3,400 1,600 1,300 1,300 Oregon 3,900 179 325 500 850 100 4,800 750 950 1,200 950 Rhode Island 3,700 550 500 700 1,200 500 200 200 Pennsylvania 23,500 3,600 300 150 193 2,300 90 80 Rhode Island 2,000 200 200 350 450 60 50 90 100 90 60 South Carolina 6,500 800 750 950 250 700 650 150 250 200 South Carolina 3,600 131 300 375 800 80 150 225 100 250 150 South Dakota 2,300 250 350 250 50 150 300 80 90 100 Tennessee 12,000 1,500 1,600 South Dakota 1,200 170 80 175 200 20 40 100 50 90 80 1,800 450 1,000 1,100 300 450 400 Tennessee 161 550 750 1,600 150 225 400 200 400 275 Texas 32,000 3,800 3,700 6,600 5,000 1,000 2,300 2,700 1,100 1,200 1,200 150 2,000 4,500 375 600 900 650 1,100 900 Utah 2,100 300 300 200 50 Texas 18,000 1,400 200 250 80 60 80 80 50 50 60 Vermont 1,600 200 300 200 60 100 200 50 50 60 Utah 1,100 95 100 150 175 20 30 Vermont 850 181 70 150 175 20 30 60 30 50 40 Virginia 13,000 1,800 1,700 2,000 500 1,000 1,100 350 450 400 Washington 11,000 1,400 1,500 1,600 350 700 950 350 Virginia 7,200 147 650 900 1,800 175 250 375 225 425 275 350 400 Washington 5,800 162 500 700 1,500 125 150 350 225 325 275 West Virginia 6,300 650 800 1,000 200 600 600 200 200 150 14,000 2,200 2,500 West Virginia 3,500 195 250 400 900 70 125 200 125 200 125 Wisconsin 1,500 450 850 1,300 600 450 450 Wisconsin 7,800 167 800 1,200 1,300 175 200 450 350 400 325 Wyoming 800 100 100 90 20 60 80 20 30 30 Wyoming 500 142 40 60 100 10 10 40 15 30 20 United States 665,000 89,000 99,000 91,000 23,000 46,000 56,000 23,000 22,000 21,000 United States 365,000 170 33,000 49,000 81,000 8,000 11,000 19,000 14,000 20,000 15,000 Puerto Rico 6,000 350 275 300 425 700 300 500 100 125 Puerto Rico 3,000 105 125 175 250 175 200 175 425 100 125 Does not include carcinoma-in-situ of the uterine cervix or superficial skin cancers. These estimates are offered as a rough guide and should not be regarded as definitive. They are calculated according to the distribution of estimated 1975 cancer deaths by state. Especially note that year to year changes may only represent improvements in the basic data. 8 9 Reference Chart: Leading Cancer Sites, 1975* Estimated Cancer Deaths and New Cases by Sex for All Sites - 1975 ESTIMATED ESTIMATED WARNING SIGNAL NEW CASES DEATHS IF YOU HAVE ONE, ESTIMATED DEATHS ESTIMATED NEW CASES SITE 1975 1975 SEE YOUR DOCTOR SAFEGUARDS COMMENT BREAST 89,000 33,000 LUMP OR THICKENING IN THE ANNUAL CHECKUP. THE LEADING CAUSE OF CANCER DEATH IN WOMEN. SITE TOTAL MALE FEMALE TOTAL MALE FEMALE BREAST. MONTHLY BREAST SELF EXAM. 665,000* 334,000* 331,000* COLON 99,000 49,000 CHANGE IN BOWEL HABITS; ANNUAL CHECKUP INCLUD- CONSIDERED A HIGHLY CURABLE DISEASE WHEN All Sites* 365,000 199,000 166,000 AND BLEEDING ING PROCTOSCOPY, ESPECIAL- DIGITAL AND PROCTOSCOPIC EXAMINATIONS ARE Buccal Cavity & Pharynx (Oral) 8,200 5,900 2,300 23,300 16,600 6,700 RECTUM LY FOR THOSE OVER 40. INCLUDED IN ROUTINE CHECKUPS. Lip 225 200 25 4,000 3,700 300 LUNG 91,000 81,000 PERSISTENT COUGH, OR PREVENTION: HEED FACTS THE LEADING CAUSE OF CANCER DEATH AMONG 1,950 1,400 550 4,500 3,100 1,400 LINGERING RESPIRATORY ABOUT SMOKING, ANNUAL MEN, THIS FORM OF CANCER IS LARGELY Tongue AILMENT. CHECKUP. CHEST X-RAY PREVENTABLE. Salivary Gland 650 400 250 Floor of Mouth 525 400 125 8,400 5,000 3,400 ORAL 24,000 8,000 SORE THAT DOES NOT HEAL. ANNUAL CHECKUP. MANY MORE LIVES SHOULD BE SAVED BECAUSE (INCLUDING DIFFICULTY IN SWALLOWING. THE MOUTH IS EASILY ACCESSIBLE TO VISUAL Other & Unspecified Mouth 1,250 800 450 PHARYNX) EXAMINATION BY PHYSICIANS AND DENTISTS. Pharynx 3,600 2,700 900 6,400 4,800 1,600 SKIN 9,000*** 5,000 SORE THAT DOES NOT HEAL, ANNUAL CHECKUP, AVOIDANCE SKIN CANCER IS READILY DETECTED BY OBSER- Digestive Organs 101,700 53,800 47,900 167,800 87,800 80,000 OR CHANGE IN WART OR MOLE. OF OVEREXPOSURE TO SUN. VATION, AND DIAGNOSED BY SIMPLE BIOPSY. Esophagus 6,500 4,700 1,800 7,400 5,500 1,900 UTERUS 46,000** 11,000 UNUSUAL BLEEDING OR ANNUAL CHECKUP, INCLUD- UTERINE CANCER MORTALITY HAS DECLINED 65% Stomach 14,400 8,500 5,900 22,900 14,000 8,900 DISCHARGE ING PELVIC EXAMINATION DURING THE LAST 35 YEARS. WITH WIDER APPLI- WITH PAP TEST. CATION OF THE PAP TEST, MANY MORE LIVES CAN Small Intestine 700 350 350 2,200 1,200 1,000 BE SAVED, ESPECIALLY FROM CERVICAL CANCER. Large Intestine (Colon- 38,600 17,900 20,700 69,000 31,000 38,000 KIDNEY 43,000 17,000 URINARY DIFFICULTY. ANNUAL CHECKUP WITH PROTECTIVE MEASURES FOR WORKERS IN HIGH-RISK Rectum) 10,600 5,900 4,700 30,000 17,000 13,000 AND BLEEDING IN WHICH CASE URINALYSIS. INDUSTRIES ARE HELPING TO ELIMINATE ONE OF Liver 9,800 4,800 5,000 11,500 5,700 5,800 BLADDER CONSULT DOCTOR AT ONCE. THE IMPORTANT CAUSES OF THESE CANCERS. Pancreas 19,500 10,900 8,600 21,500 12,000 9,500 LARYNX 9,000 3,000 HOARSENESS DIFFICULTY ANNUAL CHECKUP, INCLUD- READILY CURABLE IF CAUGHT EARLY. Other & Unspecified Digestive 1,600 750 850 3,300 1,400 1,900 IN SWALLOWING ING MIRROR LARYNGOSCOPY. Respiratory System 85,700 67,150 18,550 102,600 81,600 21,000 PROSTATE 56,000 19,000 URINARY DIFFICULTY. ANNUAL CHECKUP, OCCURS MAINLY IN MEN OVER 60, THE DIS INCLUDING PALPATION. EASE CAN BE DETECTED BY PALPATION AND Larynx 3,250 2,800 450 9,100 8,000 1,100 URINALYSIS AT ANNUAL CHECKUP. Lung 81,100 63,500 17,600 91,000 72,000 19,000 STOMACH 23,000 14,000 INDIGESTION. ANNUAL CHECKUP. A 40% DECLINE IN MORTALITY IN 20 YEARS, Other & Unspecified Respirator 1,350 850 500 2,500 1,600 900 FOR REASONS YET UNKNOWN. Bone, Tissue and Skin 8,600 4,900 3,700 15,300 7,800 7,500 LEUKEMIA 21,000 15,000 LEUKEMIA IS A CANCER OF BLOOD-FORMING TISSUES AND IS CHARACTERIZED BY THE ABNORMAL Bone 1,900 1,100 800 1,900 1,100 800 PRODUCTION OF IMMATURE WHITE BLOOD CELLS. ACUTE LEUKEMIA STRIKES MAINLY CHILDREN AND IS TREATED BY DRUGS WHICH HAVE EXTENDED LIFE FROM A FEW MONTHS TO AS MUCH AS Connective Tissue 1,700 900 800 4,400 2,400 2,000 TEN YEARS. CHRONIC LEUKEMIA STRIKES USUALLY AFTER AGE 25 AND PROGRESSES LESS RAPIDLY. Skin (Melanoma) 5,000 2,900 2,100 9,000* 4,300* 4,700* IF DRUGS OR VACCINES ARE FOUND WHICH CAN CURE OR PREVENT ANY CANCERS THEY Breast 32,900 300 32,600 88,700 700 88,000 PROBABLY WILL BE SUCCESSFUL FIRST FOR LEUKEMIA AND THE LYMPHOMAS. LYMPHOMAS 29,000 19,000 THESE DISEASES ARISE IN THE LYMPH SYSTEM AND INCLUDE HODGKIN'S AND LYMPHOSARCOMA. Genital Organs 42,700 19,800 22,900 127,900 60,300 67,600 SOME PATIENTS WITH LYMPHATIC CANCERS CAN LEAD NORMAL LIVES FOR MANY YEARS. Cervix, Invasive 7,800 - 7,800 19,000* - 19,000* Uterus Corpus Uteri 3,300 - 3,300 27,000 - 27,000 *All figures rounded to nearest 1,000. If carcinoma-in-situ is included, cases total over 86,000. Ovary 10,800 - 10,800 17,000 - 17,000 Estimates vary widely, from 300,000 to 600,000 or more, for superficial skin cancer. Other Female Genital 1,000 - 1,000 4,600 - 4,600 INCIDENCE ESTIMATES ARE BASED ON RATES FROM N.C.I. THIRD NATIONAL CANCER SURVEY Prostate 18,700 18,700 - 56,000 56,000 - Other Male Genital 1,100 1,100 - 4,300 4,300 - Urinary Organs 16,500 11,000 5,500 43,200 30,000 13,200 Trends in Age-Adjusted Cancer Death Rates Per 100,000 Population 1949-51 to 1969-71 Bladder 9,400 6,500 2,900 28,700 21,000 7,700 Percent Kidney & Other Urinary 7,100 4,500 2,600 9,000 5,500 Sex Site 1949-51 1969-71 Comments 14,500 Changes 20 Steady increase mainly due to lung cancer. Eye 400 200 200 1,700 800 900 Male All Sites 129.8 156.1 Female All Sites 119.8 107.8 10 Slight decrease. Brain & Central Nervous Male Breast 0.3 0.3 Constant rate. System 8,500 4,800 3,700 10,700 5,900 4,800 Female Breast 22.0 22.8 + 4 Slight fluctuations: Overall no change. 19.6 18.9 4 Endocrine Glands 1,650 650 1,000 9,000 2,600 6,400 Male Colon & Rectum Thyroid 1,150 350 800 5,800 Female Colon & Rectum 19.1 15.3 20 Slight decrease in both sexes. 7,900 2,100 Other Endocrine 500 300 200 1,100 500 600 Male Lung 18.2 47.1 158 Steady increase in both sexes due to cigarette Female Lung 3.9 9.5 144 smoking. Leukemia 15,200 8,500 6,700 21,200 12,000 9,200 Male Oral 4.8 4.9 Slight fluctuations: Overall no change in 28,800 15,700 13,100 Female Oral 1.2 1.5 both sexes. Lymphomas 18,600 10,000 8,600 Lymphosarcoma & Male Skin 2.4 2.4 Slight fluctuations: Overall no change in 3,600 10,200 5,500 4,700 Female Skin 1.6 1.5 both sexes. Reticulosarcoma 7,800 4,200 Hodgkin's Disease 3,500 2,100 1,400 7,100 4,200 2,900 Female Uterus 19.0 9.4 51 Steady decrease attributed in part to widening Multiple Myeloma 5,100 2,700 2,400 7,800 4,000 3,800 acceptance of regular checkup with "Pap Test". Other Lymphomas 2,200 1,000 1,200 3,700 2,000 1,700 Male Esophagus 3.7 3.9 Slight fluctuations: Overall no change in Female Esophagus 0.9 1.1 both sexes. All Other & Male Stomach 18.4 8.2 55 Unspecified Sites 24,350 12,000 12,350 24,800 12,200 12,600 Female Stomach 9.8 3.9 60 Steady decrease in both sexes: Reasons unknown. Male Pancreas Note: The estimates of new cancer cases are offered as a rough guide and should not be regarded as definitive. Especially note that year 6.4 8.6 34 Female Pancreas 4.1 5.1 + 24 Steady increase in both sexes: Reasons unknown. to year changes may only represent improvements in the basic data. ACS six major sites in boldface. Male Prostate 13.2 13.2 I Fluctuations all through period: Overall no change. *Carcinoma-in-situ of the uterine cervix and superficial skin cancers not included in totals. Female Ovary 6.9 7.6 + 10 Steady increase. INCIDENCE ESTIMATES ARE BASED ON RATES FROM N.C.I. THIRD NATIONAL CANCER SURVEY. Male Kidney 2.7 3.6 + 33 Steady slight increase. Female Kidney 1.6 1.7 * Slight fluctuations: Overall no change. Male Leukemia 6.3 7.2 + 14 Early increase, later leveling off. Female Leukemia 4.4 4.5 + 2 Slight early increase, later leveling off. *Percent changes not listed because they are not meaningful. 10 11 Mortality for the Five Leading Cancer Sites by Age, Sex and Site, U.S. - 1971 (15) (39) (19) TOTAL UNDER 15 15-34 35-54 55-74 75+ LEUKEMIA MALE FEMALE 7.41 3) 4.74 (10) 5.85 (20) (18) 4,97 (25) 1.38 (38) (27) 3.75 4.21 (30) 3.32 (29) 5) (11) 3.96 (20) 5.83 2) 4.46 (19) 4.43 2) 8) 3.48 2.75 (33) 4.01 (31) 1) 3.80 7.29 4) 5.45 3) 6.91 9) 7) 3.81 (33) (31) 3.95 (21) 4.71 (26) 3.64 1.54 (39) 0.91 (40) 1.98 (37) 7.18 6) 4.99 5) 4.93 6) 6.37 (14) 3.05 (30) 1) 5,00( 4) (37) (36) 5.01 (24) 3.61 (25) 5,01 (23) 4.16 (17) 4.61 (28) (28) 5.35 (22) 3.55 (26) 3,93 (32) (34) 7.05 7) 4.75 9) 3.68 (34) 2.84 (32) 3.52 (27) MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE 7.05 8) Lung Breast Leukemia Leukemia Leukemia Breast Lung Breast Lung Breast Lung Colon & Rectum 54,931 29,969 923 707 722 495 9,364 8,509 35,258 14,487 10,098 9,880 2) Colon & Colon & Brain, Brain, Leukemia Colon & Lung Colon & Colon & Prostate Breast PROSTATE MALE 13.66 (12) 15.25 8) 14.46(10) 16.01 4) 15.37 6.51 (31) 13.50(14) 10.05(24) 0.83(40) 12.88(15) 3.68 (35) 11.90(18) 11.82(21) 15.45( 5) 13.52 13.52(13) 5.79 (32) 3.97 (34) 12.83(16) 11.87 (20) (20) 9.92 (25) 2.05(38) 14.66( 9) 9.22 (26) 2.19(37) 4.43(33) Hodgkin's 7.18(29) 15,38 6) 14.12(11) 12.66(17) 16.50( 3) 8.07 (27) (27) 8.00(28) 11,45 (23) (23) 3.13(36) 17.98 = 11.52 (22) 6.85 (30) Rectum Rectum etc. etc. Disease Rectum Rectum Rectum 22,410 23,924 489 364 484 475 2,403 3,503 12,049 11,251 9,807 6,473 Prostate Lung Lympho- Bone Testis, Uterus Pancreas Uterus Prostate Lung Colon & Pancreas FEMALE (39) 8) (38) sarcoma, etc. Rectum 4.31 4) 20.62( 5) 12.70(18) 21.18( 3) 2) 35,62( 10.62 17.87 8.71 (33) 10.08 36.95 5) 13.63(14 9.82 15.79 1) 34.39( 2) (23) 12.16 9.23(30) 5.92 (37) 15.74 7.03(35) 11.67 (23) 3) 18.81 6) etc. 15.87 113 74 235 1,417 7,625 7,388 25.55 12.92 31.47 18.78( 7) 15.89 22.88 (19) 11.99 (21) 35.11 6) 17.20( 9) 13,686 (28) 10.09 (18) 12.33(19) 8) 21,12( 4) 17,772 344 3,104 7,737 2,940 STOMACH 22.80 (20) 11.71 Pancreas Uterus Bone Kidney Brain, (33) Brain, Brain, Colon & Pancreas Uterus (34) Stomach (38) Uterus MALE 8.68 15.01 33,83( 9) 16.11 (31) etc. etc. etc. Rectum 15.01 9.89 9,967 12,216 81 67 429 321 1,242 2,628 5,773 5,999 3,295 2,766 Source: World Health Statistics Annual 1968-1969. Stomach Ovary Soft Lympho- Lympho- Hodgkin's Stomach Ovary Stomach Ovary Pancreas Stomach Age-Adjusted Death Rates Per 100,000 Population for Selected Cancer Sites for 40 Countries - 1968-1969 (39) (40) Tissue sarcoma, sarcoma, Disease SKIN MALE FEMALE 2.35 8) 1.42 (13) 4.67 1) 2.47 2) 1.68 9) 0.87 (32) (31) 1.65 (21) 1.09 (25) 1.53 1,23 1.38 2.60( 4) 5) 2,48( 7) 1,83 ( 6) (15) 1.41 0.33 2,64 ( 3) 2.27 3) (28) (35) 0.73 (19) 1.66 (20) 1.28 (19) 4.44 2) 2,49 1) 2.59 5) 1.74( 8) 1,75 ( 71 1.99 1.57 (12) 1.52 (25) 1.32 (17) 1.11 (30) (26) 1.68 (18) 1.67 (10) 2.35 9) (29) 2.11 (12) 1.41 (14) 9,421 9,978 62 51 254 1,147 2,477 4,918 5,333 2,714 2,730 2,48 ( 6) 1.59 2.20 1,99 4) etc. etc. 296 0.81 0.77 (35) Source: Vital Statistics of the United States, 1971 1.33 UTERUS FEMALE 9,67 (27) 7.89 (35) 28,79 ( 2) 11.01 7,15 (36) 14.33( 9) 14.24(10) 15.64 8.17 (33) 9.77 (26) 88.56( 10.55(22) 12.21 6.19(37) (31) 9.07 (31) 16.51 8,07 (34) 5.85 (38) 12.20(15) 14.21 (11) 10.76(21) 18.92 4) 18.04 6) 8,29 (32) 9.44 (29) 9,12 (30) 5.31 (39) 5.31 (39) 1.59 1.59 (40) 12.51 18,73 5) 9.81 (25) 12.07 12.07 (16) 10.02 (24) 11.11(18) 26.87 3) Mortality for Leading Causes of Death: United States, 1971 CANCER AROUND THE WORLD 6) Death Percent Death Percent BREAST FEMALE 22.18 (12) 23.54( 9) 11.49(26) 3.70 (39) 3.06 (40) 25.34( 3) 14.22 (24) 16.99(22) 18.79(18) 9.83(31) 8.61 (34) 23.57 8) 23.73( 7) 25.06 4) 16.79 (23) 20.93(15) 21.78(14) 4.87 (36) 4.15 (37) 26.51 1) 23,35 (10) 24,54( 5) 19,17 (17) 5.28 (35) 11.23(27) 12.03(25) 9,19 (32) 26.36( 2) 11.15(28) 18.62(19) 23,04 (11) 9.08 (33) Number Rate of Number Rate of of Per 100,000 Total of Per 100,000 Total Rank Cause of Death Deaths Population Deaths Rank Cause of Death Deaths Population Deaths 8) (35) = 5) 6) FEMALE 4.98 6.25 3,57 (34) 5.45(17) 7.66( 9) 3,95 (28) (12) 3,57 (33) 3,73 (29) 3.58 (32) 9) 7) MALE 7.59 (37) 72.08 2) 4) 5.81 (16) 8,80 ( 7) 1,41 (40) (37) (36) 9,08( 8,90 ( 3.61 LUNG 6) 4.40 2.24 (38) 4.96 (22) 26.42 (25) 5,27 31.37 (23) 11,75( 3) All Causes 1,927,542 932.2 100.0 3) 8) 80.02 1) 12,89( 2) 1 Diseases of Heart 743,138 359.5 38,6 9 Arteriosclerosis (40) (28) 31,521 15,2 1,6 29.27 (24) 34.17 (20) 59.57 5) 60.76 4) 11.55 (35) 2 Cancer 337,398 163.2 17.5 10 Suicide 24,092 11.7 1.2 40.26 34.59 16.81 3.77 43.15 13.87 36.62 11.96 6.98 33.08 13.95 24.44 3 Stroke 209,092 101.1 10.8 11 Emphysema 22,539 10.9 1.2 4 Accidents 113,439 54.9 5.9 12 Homicide 18,787 9,1 1.0 5) 15,957 7.7 FEMALE 16.92 9) (39) 0.8 13.97 (15) 2.30 (40) (34) 5 Influenza & Pneumonia 3.0 4.16(37) 57,194 27.7 13 Congenital Anomalies 22.38 3) 18,39 7) 8.01 (30) 6.41 (33) 21.49 9) 18.71 6) 11.92 10.11 (23) 5.53(35) (37) 3.28 (38) 18,50 (16) 16.83 (11) 22.30( 4) 20.25 3) 22.26 5) 21.09 1) 6.82 (31) 11.74 (24) 10.97 (20) 6.33 5,58 (35) 25,18 2) 21.06 2) 13.01 (22) 8.77 (24) 5.06 (37) (32) 2.0 COLON & RECTUM 10.58 (25) 8.72 (25) 19,29 MALE 7.14(31) 22,10 21.69 7) 17.68 8) 10.04 (22) 6 Certain Diseases of Infancy 38,494 18.6 14 Nephritis and Nephrosis 8,443 4.1 0,4 20.84 15.22 21,63 8) 18.75 21.24 16.85 7 Diabetes Mellitus 15.52 8.43 13,92 (21) 10.76 14.99 11.46 25.54 1) 16.28 8.99 (27) 8.26 12.79 16.46 12.94 20.03 (12) 12,28 38,256 18.5 2.0 15 Hypertension 7,837 3.8 0,4 8 Cirrhosis of Liver 31,808 15.4 1.7 6) Other & III-Defined 229,547 110.8 11.9 18.94 6.66 5.30 2.57 (40) 2.85 (39) 8,50 (29) Source: Vital Statistics of the United States, 1971 Prepared by: Research Department, American Cancer Society, July, 1974 FEMALE 4.84 7) (10) 1,28 (14) (32) 0.32 (40) 0.67 (32) 2.23 0.66 (34) 1.21 (15) 0.92 (27) (39) ORAL 3.26 0.80 6.00( 4) 2.64 6) 1,20 1,31 0.77 (31) (22) 1.38 (27) 1.29 MALE 11.08 3) 0.93 1.96 0.61 (37) 20.70 1) 7.71 1) 4.72 8) 2.06 8) 1.71 (36) 0.94 (25) 5.71 5) 0.96 (23) 0.66 (35) 1.39 4.53 9) 2.67 5) 1.81 (34) 1.01 (22) (40) 0,57 (38) 1.80 (35) 0.62 (36) 2.60 1.18 3.28 2.29 7) 2.94 (23) 1.09 (21) 4.01 (12) 2.78 3) 3.50 (15) 0.87 (29) 4.11 1.11 (20) 2,78 (24) 0.90 (28) 3.39 9) 15.17 2) 5.49 2) 2.27 (28) 1.12 (19) 5.55 6) 0.95 (24) 3.37 3.69 2.71 0.66 NOTE: Figures in parentheses are order of rank within site and sex group. Applying Cancer Statistics Locally Estimated No. Estimated No. Estimated No. Estimated No. Estimated No. Cancer Cases Estimated No. Estimated No. Who Will be Who Will Who Will Die Who are Alive, Under Who Will Die of Saved from Eventually of Cancer if FEMALE 106.7 (18) (27) Community Cured of Medical Care of Cancer New Cases Cancer Develop ALL SITES 191,2 3) 5) 127.6 (28) 104.1 (21) 186.9 5) (12) 132.7 84,1 (32) 149.9 109.9 (15) 138.5 1) 70.5 159.2 131.6 2) 35.5 (40) 35.9 (40) 190.2 4) 103.9 (22) 9) (26) 177.2 125.4 6) 130.9 3) Present Rates 147.8 121.5 7) 117.8 142.1 (23) (29) 204.6 2) 118.1 9) 86.5 77.3(37) 62.0 (38) 51.1 (38) (37) 184.7 7) 121.1 8) 163.7 (13) 118.1 (10) 205.1 1) 130,5 4) 168.0 107.9 (17) 111.6 (34) 112.7 (14) Population Cancer 73.9 in 1975 in 1975 in 1975 in 1975 Cancer Continue 186.61 (9 182.7 8) 101.7 157.1 (16) 109.7 133.9 (24) 105.0 123.3(30) 168.8 98.2 129.8 (26) 106.4 1,000 7 4 1 3 1 250 150 2,000 15 9 3 6 2 500 300 MALE 3,000 22 13 4 8 3 750 450 100,3 125.4 114.0 45.4 147.1 (22) 103.2 112.4 4,000 30 18 6 11 4 1,000 600 5,000 37 21 7 14 5 1,250 750 10,000 74 43 15 28 9 2,500 1,500 70 United States Australia Belgium China (Taiwan) Dominican Rep. England & Wales 185 Germany F.R. 25,000 107 37 6,250 Bulgaria Denmark Hong Kong Luxembourg Malta Gozo Mauritius Netherlands New Zealand Northern Ireland 23 3,750 Philippines Portugal Romania Scotland Singapore Switzerland Venezuela Yugoslavia 50,000 370 215 75 140 47 Barbados 12,500 7,500 Austria Canada Chile Finland France Greece Iceland Ireland Israel Italy Japan Mexico Norway Poland Sweden 100,000 740 430 150 280 93 25,000 15,000 200,000 1,480 860 300 560 186 50,000 30,000 500,000 3,700 2,150 750 1,400 465 125,000 75,000 NOTE: The figures can only be the roughest approximation of actual data for your community. It is suggested that every effort be made to obtain actual data from a Registry source. 12 13 Cancer Research Center Oklahoma Medical Research Foundation BREAST CANCER Rhode Island Hospital Business Loop 70th & Garth Avenue 800 N.E. 8th Street Rhode Island Department of Health Columbia, Mo. 65201 Oklahoma City, Okla. 73190 Eddy Street 314-443-2216 405-235-8331 ext. 241 Providence, R.I. 02908 Breast Cancer Detection Demonstration Projects 401-831-6970 College of Medicine and Dentistry Breast Cancer Screening Project of New Jersey 2222 N.W. Lovejoy Vanderbilt University School The American Cancer Society and the National Cancer Institute have funded 27 detection projects 15 S. 9th Street Portland, Ore. 97210 of Medicine Newark, N.J. 07107 503-229-7292 Nashville, Tenn. 37322 across the nation in a joint effort to demonstrate the value of better diagnostic technology in achieving 201-484-9221 615-322-2501 Temple University earlier case-finding to reduce the shocking mortality from breast cancer, the foremost cancer killer of Guttman Institute 3401 No. Broad Street St. Joseph's Hospital 200 Madison Avenue (at 35th Street) Philadelphia, Pa. 19140 American women. 1919 La Branch New York, N.Y. 10016 215-221-3832 Houston, Texas 77002 At each center a comprehensive breast examination will be available to women 35 and over who 212-689-9797 and 713-225-3131 ext. 301 Albert Einstein Medical Center have no present or past indications of breast disease. The restriction was imposed because this is a test Duke University Medical Center York & Tabor Roads Virginia Mason Medical Center 3040 Erwin Road Philadelphia, Pa. 19141 911 Seneca Street program designed to develop techniques which eventually will make it feasible for community medical Durham, N.C. 27705 215-567-0559 Seattle, Wash. 98101 919-286-7943 or 383-1060 206-624-1144 facilities to offer early detection to women everywhere. All project centers were operational by late University of Pittsburgh School of University of Cincinnati Medical Center Medicine/The Falk Clinic 3601 Fifth Avenue Medical College of Wisconsin 1974, with fair geographic distribution and adequate service potential as prime considerations in site Eden & Bethesda Avenues 8700 W. Wisconsin Avenue Cincinnati, Ohio 45229 Pittsburgh, Pa. 15213 selection. Milwaukee, Wis. 53236 513-872-5331 412-624-3336 414-257-5200 The examination has been standardized as a four-part procedure which can detect breast cancer in its earliest stages when it is most curable: 1) Interview (general and personal health questions related to the breast); 2) Palpation (each breast felt by examiner for lumps or other abnormalities); 3) Mammog- The ACS Approach raphy (painless, low-radiation X-ray examination to expose the inner structure of each breast, and pinpoint small abnormalities); 4) Thermography (a camera picture of the heat patterns in the breast). With about 89,000 new cases and 33,600 deaths expected in 1975, breast cancer remains the foremost To get these tests, qualified women in the areas served by the 27 projects need only contact their site of cancer incidence and death in American women. local ACS Unit where a Society volunteer will set up an appointment. Women with symptoms will be Although this disease is found most often among women of middle age and over - who are the referred to their own physicians or to a radiologist, hospital or clinic. main educational target - the ACS has in recent years been encouraging girls of high school age to Women tested at the centers will also be taught how to do breast self-examination (BSE), a simple learn breast self-examination as a future health habit. At present rates, one of every 15 American procedure. The ACS recommends that every woman practice BSE monthly. Statistics show that 95% women will develop breast cancer at some time. Early detection through self-examination and periodic of all breast cancers are discovered by women themselves. health checkups are of primary importance in control of breast cancer. The demonstration project idea was initiated by the ACS in 1971 because complete breast screening The current methods of therapy are highly effective (85% survivals at five years) when diagnosis and had been obtainable at relatively few medical centers in the U.S. The Society allocated $2-million to treatment are achieved at an early stage. At the present time, about 95% of patients discover their launch the program. cancers themselves through breast self-examination but, by that time, 60% of them have cancers that In 1972, the NCI joined and helped expand the effort by providing additional financial backing. have spread to the axillary lymph nodes, a stage when the five-year survival rate is only 40-45%. How- The two agencies allocated $5.4-million to support all 27 centers for the first year, with NCI contrib- ever, the percentage of those with localized cancers has increased since the 1940s, as a result of wider uting nearly $4-million and the ACS nearly $1.5-million. public education, and a more alert medical profession. Most lumps in the breast are not malignant - Some of the institutions will use their funds (around $200,000 each) to expand ongoing programs. 65-80% of breast biopsies are benign. Most will use the money to set up new facilities. Each funded institution must screen at least 5,000 Studies on the various techniques of treatment of primary operable breast cancer are now underway women during the first year and an additional 5,000 in the second year. Each of these 10,000 women in a number of U.S. institutions. will be reexamined through five years and then followed up for another five years. ACS volunteers will The American Cancer Society recommends that any woman suspecting that she may have breast help motivate women - many of them from low-income families - to have the free examinations. The cancer should consult a physician who is knowledgeable in this field, seek and rely on the physician's program will be evaluated through national tabulation of findings by the University City Science advice and judgment in the selection of treatment for her individual medical situation. All American Center, Philadelphia. women should be well informed SO that they may intelligently discuss important considerations with their physicians.* BREAST CANCER DETECTION DEMONSTRATION PROJECTS-SCREENING CENTERS (Listed alphabetically by states) Women's Attitudes, Beliefs, Habits University of Arizona Georgetown University Medical School Mountain States Tumor Institute Arizona Medical Center 3800 Reservoir Road. N.W. 215 Avenue B Cancer is the number one disease concern of American women and breast cancer figures prominently Tucson, Ariz. 85724 Washington, D.C. 20007 Boise, Idaho 83702 602-882-7401 or 7402 202-625-2183 208-345-3590 in this concern, according to the Gallup survey conducted for the ACS in late 1973 on "Women's Atti- Los Angeles County, University St. Vincent's Medical Center Iowa Lutheran Hospital tudes Regarding Breast Cancer." of Southern California/John Barrs Street & St. Johns Avenue University at Penn Wesley Hospital Jacksonville, Fla. 32204 Des Moines, Iowa 50316 Despite the high degree of concern, few women have their breasts examined regularly by their physi- Los Angeles, Calif. 90033 904-389-7751 ext. 8491 or 8492 515-283-5678 213-748-5379 cian or engage in monthly breast self-examination, though they are aware that early discovery Georgia Baptist Hospital University of Kansas Medical Center improves chances of cure. In fact, results of interviews with more than 1,000 women 18 and over Samuel Merritt Hospital/Breast 340 Boulevard N.E. Rainbow Boulevard at 39th Street Screening Center Atlanta, Georgia 30312 Kasnas City, Kan. 66103 showed that wider and better education is needed on this subject because too many women hold too 384 34th Street 404-525-7861 913-342-1338 Oakland, Calif. 94609 and many mistaken beliefs about the disease. 415-658-8525 Emory University University of Louisville School Atlanta, Georgia 30322 of Medicine For example, there is widespread belief that most breast lumps are cancerous - only about Wilmington General Hospital 404-355-4940 601 S. Floyd Street 20-35% are. Chestnut & Broom Streets Louisville, Ky. 40402 Wilmington, Del. 19899 Pacific Health Research Institute, Inc. 502-583-2894 302-428-4815 Alexander Young Building, Suite 545 A majority (62%) of women mistakenly believe that a blow or injury to the breast can cause breast Hotel & Bishop Streets University of Michigan Medical Center Honolulu, Hawaii 96813 396 W. Washington Street 808-524-4337 Ann Arbor, Mich. 48103 *For a copy of the American Cancer Society Policy Statement on the Surgical Treatment of Breast Cancer, contact your local ACS 313-763-0056 Unit or Division, 14 15 cancer. On the other hand, only 41% knew that if there is a family history of breast cancer, there is checkups regularly compared with 29% for whites; 45% of the white women reported having had more likelihood of developing the disease. specific tests to detect cancer compared with 28% for nonwhites; and 52% of the whites had had a Pap Other observations: about one half of women surveyed incorrectly believe that use of birth control test, compared to 22% of nonwhites. A later study showed that while 59% of women in a family pills increases the chances of developing breast cancer; 25% believe breast feeding decreases chances of income bracket above $7,000 had had a Pap test, only 32% of those with incomes under $3,000 had. developing breast cancer - it doesn't. A Gallup study for the ACS, released in 1974, showed that almost nine in 10 women (87%) were The Gallup survey pointed out that one half of the adult female population does not have annual aware of the Pap test as a means to detect cancer. Since 1963, there has been substantial increase in breast examinations by a physician --- lack of examination is more prevalent among older women, the the proportion of those who reported ever having had the test - 48% to 78%. Those who reported poorly educated, low-income women, and blacks. having had it within the past year rose from 23% to 52%. Among women asked why they first had the Only one out of every four women who have heard of breast self-examination has ever practiced it, test, 29% said it was part of a routine physical examination; 23% said their physicians suggested it; and three out of four of these aware women do not practice it monthly. only 11% specifically mentioned personal safety as the paramount reason. Thus it seems a woman According to the survey, there are three factors accounting for the failure of women who know usually has her first Pap test through her doctor's influence. about BSE to practice it: 1) Ignorance of the importance of frequent breast examination; 2) Fear and anxiety (46% of all women said they feel doing monthly BSE would make them worry needlessly); and 3) Lack of knowledge about breast self-examination and confidence in how to do it. ACS Recommendations The survey further showed that the physician plays a key role in convincing women to practice BSE The ACS recommends that the "cervical scrape method (Pap test) by the physician be used where on a regular and continuing basis. Of women who had received personal instruction from a physician possible, and that the irrigation smear technique useful for many women who cannot or will not about BSE, 92% continue to practice it. come to the doctor, and requiring special training for the cytotechnologist, should not be undertaken Women's confidence in their physicians also determines to a large degree whether or not they con- unless personnel trained in the preparation and interpretation of the slides are available." This may be sent, prior to exploratory surgery, for immediate removal of the breast provided tests showed the however the only way of involving a "hard-to-reach" group. lump to be cancerous. Concerning the removal of a breast, 92% of the women think that a normal life The five-year survival rate among patients with localized uterine cancer is 82%; this drops to 44% if pattern can probably be maintained or re-established after a mastectomy, but there is less confidence the cancer has spread beyond its site of origin before treatment. However, the U.S. death rate for among single and young women, and among those of lower socio-economic status. uterine cancer shows a steady decline; it is one-third the rate of 45 years ago. Two factors contribute to this progress: the unremitting programs of education for women, and improvement in detection and UTERINE CANCER treatment. The educational campaign has paralleled a gradual but steady drop in death rates. In 1930, the age-adjusted death rate per 100,000 females was 27.9. By 1945, this had declined to 23.5. By Uterine cancer could be dramatically reduced as a cause of death - if every adult woman had a Pap 1971, the long-term effects of the program had helped bring the figure to 9.2. test with the annual checkup and if postmenopausal women and those approaching menopause had The Pap test is based on the study of cells which are shed normally or scraped from living tissue. any abnormal bleeding checked by their doctor. The Pap test is so simple, important and effective, it is The technique is named for Dr. George N. Papanicolaou, who developed it with financial support from routinely given to adult women on admission to many U.S. hospitals. This early detection technique Cornell University, the Commonwealth Fund and the National Cancer Institute. The American Cancer can detect not only cancers of the cervix, but precancerous conditions, and permits diagnosis at this Society also invested about $1-million in research and in winning acceptance for this method of cancer site before symptoms appear. Cancer of the corpus (body) of the uterus can be diagnosed before detection, termed cytologic examination. When cell samples are studied by qualified laboratory cyto- symptoms if women at high risk (see Early Detection and High Risk Groups, page 5) are checked technologists, the results are 95% accurate (confirmed by tissue diagnosis) in cervical cancer detection, regularly. There will be 46,000 new cases of uterine cancer, both fundal and cervical (excluding and about 60% accurate in detection of cancer of the body of the uterus. The Pap test of cells carcinoma-in-situ) in 1975, and 11,000 deaths. obtained from the cervix has made it possible to detect carcinoma-in-situ sufficiently early to make In 1972 the Society activated a National Task Force on Uterine Cancer Control to provide new treatment almost 100% successful. direction for a major ACS program of a Pap test for every woman 20 years or older to whom the test is applicable, and for those under 20 at risk. The latter term refers to the younger woman who has COLON-RECTUM CANCER begun to make sex a part of her life; data indicate a causal relationship between cervical cancer and early sexual activity. Key objective of the task force is to assist in mobilizing health resources at Cancer of the colon and rectum will strike 99,000 Americans this year, claiming more victims than any national, state and community levels in a coordinated plan of action designed to persuade every other type except superficial skin cancer. It occurs about equally in men and women. Over 49,000 die American woman to have a Pap test by 1976. of it annually - though almost three out of four patients might be saved by early diagnosis and Cancer of the corpus of the uterus is primarily a disease of the mature woman. Most cases of endo- prompt treatment. Key to early diagnosis is the proctoscopy as part of the health checkup. This is an metrial carcinoma are diagnosed in the 50 to 60 age group. According to the 1970 census, there are examination with a lighted tube passed into the rectum and lower colon by which the physician can about 45 million women 35 years of age or older. Of these, an estimated 700,000 will eventually inspect the wall visually. Undergone regularly by all over 40, this exam might help save more lives develop this type of cancer. Many older women have not had a checkup since childbearing years. The from cancer than any other step in the health checkup. Another detection technique is the guaiac test need is to persuade older women to have regular examinations and get them to seek prompt medical for occult blood in stool specimens which involves preparing three samples at home over three consec- attention for the warning signal of abnormal bleeding. utive days on special resin-treated paper and having a physician check them. In conjunction with There has been a decrease in deaths from uterine cancer among American women. It now ranks professional education aimed against cancer of this site, the chief public education tools are materials fourth highest, with breast cancer first, colon-rectum cancer second and lung cancer third. Among low- stressing the importance of the proctoscopic examination, and stressing the hopeful aspects if income groups, the incidence of cancer of the uterine cervix is higher. Puerto Rican immigrant women treated early. have about four times as much cervical cancer as the average American female population and the rate is 90 blacks to 50 whites. One study may have thrown light on this by showing that 22% of nonwhite women had health 16 17 ORAL CANCER The recent upsurge in the lung cancer death rate for women can be attributed to the fact that women began to smoke in much greater numbers about 30 years ago and the trend has been increasing Cancers of the mouth area afflict some 23,000 Americans annually and kill about 8,000. So many steadily since then, partly as a result of advertising and promotion. deaths arising from a site so easily observable underline the need for a more intensive program of Smoking habits are established in the teens, and in the great majority of cases, teen-age girl smokers education. To achieve this, the Society has accelerated its efforts to make dentists, physicians, nurses will become adult women smokers. Teen-age girls, who never smoked to the extent teen-age boys did, and the general public more aware of the potentials for closer control at this site. It is accomplished through professional and public education programs and materials, together with community-wide have now caught up. In 1968, only about half as many teen-age girls smoked as boys - 8.4% of girls screening projects. between 12 and 18 were smokers compared to 14.7% of the boys. But, by January 1974, 15.3% of the girls between 12 and 18 were smoking, only a fraction of a point below the boys' 15.8%. This means SKIN CANCER that in about another 10 years or less, there should be as many adult female smokers as there are adult male smokers, with a commensurate increase in lung cancer deaths for women. More than 9,000 new cases of skin cancer are reported in the U.S. each year (excluding superficial Recently, some vital information has been disclosed concerning women and smoking. There is cases). Superficial skin cancer, which ranges in incidence from 300,000 to 600,000 cases a year, is a evidence of a link between smoking by pregnant women and (1) stillbirths, (2) increased mortality form of cancer that is preventable through avoidance of overexposure to the sun. Early detection is among newborns, and (3) low birth weight of babies. Lower-than-normal birth weight is associated achievable through the annual physical examination and knowledge of the Warning Signals. The ACS with a child's poor physical and emotional development. estimates that about 95% of skin cancer could be cured if sores which do not heal were reported Smoking mothers set the example for children. Statistics show that youngsters whose parents smoke promptly to a physician. Deaths run about 5,000 a year and are caused mainly by melanoma. are more likely to adopt the habit than the children of non-smoking parents. ACS Policies and Programs LUNG CANCER The major thrust of the ACS effort is to educate Americans - particularly young people - regarding Today over 100,000 American men and women are suffering from lung cancer. In 1975, another the personal health hazards of cigarette smoking. To help disseminate the facts to the broadest pos- 91,000 will be stricken with this disease. During the same year, 81,000 will die of lung cancer-or sible public audience the Society makes available a wide variety of materials and activities. Basic to the approximately 225 a day. Society's policy is the conviction that adult individuals must make up their own minds about smoking, This is largely a preventable disease, since most lung cancer is caused by cigarette smoking. Unfor- but this requires that individuals know the facts. tunately, it is difficult to diagnose in time for cure. Only about 10% of all cases are being saved. The ACS believes there have been a number of developments which are cause for concern, vigilance Though the general trend of smoking has been upward in the past 25 years, there were a number of and action: per capita consumption on the rise again; gross consumption 584.7-billion cigarettes in years during which there was a sharp decline - 1965-71 - due to the impact of educational anti- '73) up over '72, some 52-million smokers still numbered among the population, no genuine abate- smoking campaigns. In 1965, nearly 43% of the total adult population was smoking; by 1971, ment of advertising on the part of manufacturers. this had dropped to 36%, or about 1 in every 3 adult Americans was a smoker, with 29-million The ACS, therefore, has reaffirmed its decision to expand and intensify the fight against smoking ex-smokers. along the following general lines: 1) Support Federal action to reduce tars and nicotine in cigarettes, While no national survey has been taken since 1971, there are indications that the total percentage to require disclosure of these figures on packages and in advertising, and to require a stronger warning of smokers in the adult population is beginning to increase again. label; 2) Seek elimination of cigarette advertising in all media, hopefully by voluntary self-regulation; In 1971, the anti-smoking educational campaign was weakened when the number of anti-smoking 3) Oppose cigarette company sponsorship of indirect advertising via televised sports events, which has spots on television was markedly reduced. This occurred when Congress outlawed cigarette advertising become a new promotional device since explicit TV advertising became illegal in 1971; 4) Urge TV on broadcasting and the stations applied public service standards for usage to the anti-smoking mes- personalities and entertainers to refrain from smoking during their broadcasts because of their influ- sages. Prior to this, stations were acting on a ruling from the Federal Communications Commission to ence on the young; 5) Support restrictions on smoking in places of public assembly, such as theaters, give the spots significant air time. As a result, during the past 4 years, there has been an upturn in the restaurants, offices, hospitals, and in trains, planes, buses, elevators and other places of common trans- per capita rate of smoking, although it is still below the peak of 10 years ago. port; 6) Involve physicians, dentists and nurses more deeply in local programs and educational efforts; During the past 20 years, as a result of pressure brought by the ACS and other anti-smoking forces, 7) Expand educational programs for primary and secondary school students with new emphasis on the cigarette companies have reduced the tar content of cigarettes. It is important because the ingre- teacher involvement and teachers as exemplars, while maintaining the position that smoking areas dients of tobacco tars are regarded as the factors which cause lung cancer as well as other cancers. The should not be provided on school grounds or in school buildings; 8) Extend anti-smoking information tar content of the average cigarette today is 50% lower than it was 20 years ago and 30% lower than it through films, television, radio, magazine and newspaper articles, posters, brochures. was 10 years ago. An important factor in the reduction of tar content is the addition of filters which The Society also reiterates its strong support of research into the health hazards of smoking, the strain out a good deal of the tar. Today, 85% of all cigarettes smoked have filters. A generation ago, carcinogenic components of cigarette smoke, the development of less dangerous cigarettes, the nature only 3.5% of all cigarettes were filter-tipped. The tar content of cigarettes is also reduced by adding to of addiction and the motivations for smoking, the effects of smoke on the non-smoker, the most effec- the tobacco synthetic products which have very little tar; also by "puffing up" the tobacco, resulting tive methods for persuading and helping people quit the habit. in greater bulk, and therefore less actual tobacco per cigarette. One way is through "helping smokers quit" clinics. Approximately 200 ACS antismoking clinics were in operation in 1974. The National ACS goal for 1975 is to conduct 1,000 clinics at the com- Women and Smoking munity level. The average percentage of people quitting cigarettes through clinics is 35-40%. ACS cessation programs are run in industry, hospitals, health centers, schools and colleges. Company incen- Though women used to feel safe from lung cancer because the death rate was low for women com- tive programs are encouraged and aided. Hoped-for goal is at least one clinic in each community. pared with that for men, this picture is beginning to change alarmingly. The female lung cancer death rate has doubled in the past ten years. While female death rates from lung cancer were once as low Help for Nonsmokers as 1/6 the death rate for men, they are now only 1/4 the death rate for men and are threatening to Ex-smokers in the U.S. number some 30 million. Increasingly, these nonsmokers are making their own catch up. feelings about smoking felt in various ways. They are being aided by Federal and state and local 18 19 tion level has been reached in information dissemination, but that behavioral changes in the American authorities in many instances. In March, '74, an Interstate Commerce Committee order restricting population have lagged behind. smoking on interstate buses to a rear smoking section limited to 20% of seating capacity was upheld The traditional ACS education program has emphasized three ways for individuals to protect them- by court order and put into effect nationally. In July, 1973, the CAB regulation establishing com- selves against cancer: 1) adopt preventive habits - avoid cigarette smoking, overexposure to sunlight pulsory separate smoking sections for all classes of airline service became effective. and other known causes of cancer; 2) have medical checkups regularly, no matter how well they feel; A number of bills in state legislatures favoring nonsmokers have won support and this is expected to 3) learn cancer's Warning Signals and go to their doctor or clinic if one should occur. spur action by other states. Since Arizona passed a bill banning smoking in elevators, buses and cul- The new public education effort now will sharpen its focus on: new audiences (high risk groups, and tural centers such as museums, theaters, libraries, Nebraska has passed one similar to it, and legislation those who have been missed in the past); expansion of participatory education to stimulate greater of the same kind was introduced in the New York State Legislature. Minnesota is considering a bill audience involvement; aid in the provision of services and resources so that necessary action can be restricting smoking in all public gathering places, and nonsmoking legislation is under scrutiny in Con- taken. necticut and Maine. Miami, Florida prohibits smoking in stores, buses, elevators. Such bills, ordi- Cancers of six sites - breast, colon-rectum, lung, oral cavity, skin, uterus - offer the greatest oppor- nances and restrictions are indicative of a wave of action beginning to take form nationally. tunity for saving lives, either by prevention or through early diagnosis and treatment. They add up to Nonsmokers are receiving consideration in other quarters too. The Marriott hotel chain has set aside more than 60% of all cancer cases and over 50% of deaths. The ACS continues to emphasize these sites entire floors for nonsmokers. Since certain studies have shown smokers about twice as likely to have in a massive effort to help save thousands of additional lives each year through intensification of its auto accidents, several insurance firms offer discounts to nonsmokers. The Department of Defense educational and service efforts. made it known in 1973 that cigarettes would no longer be included in "C" rations. Public education activities are programmed at two age levels, one for adults and another for young people. Many ACS Units maintain separate volunteer subcommittees for each SO that one aspect of the LEUKEMIA total program will not overshadow the other. Generally, the adult program stresses early detection, while the youth program emphasizes prevention in ways young people will find acceptable. Leukemia is cancer of the blood-forming tissues. Long considered primarily a disease of children, it Adult education helps save lives by stressing the importance of early detection and of prevention actually strikes many more adults and at a rapidly increasing rate. There is no prevention or cure as where applicable (lung, skin, etc.). The message is spread as widely as possible through meetings, films, yet, but some cancer experts believe the latter may be imminent. The first temporary remissions in person-to-person activities, leaflets and mass media. The program attempts to reach people where they acute leukemia were achieved by chemotherapy in 1947. Today, in some medical centers, survival live, where they work and where they meet - to persuade them to consult their physicians at the early times are improving dramatically and patients have longer symptom-free periods with near-normal recognition of a Warning Signal, and to have the regular health checkups which can lead to earlier diag- blood pictures. Some drugs, in combinations, have prolonged the life of leukemia patients for well nosis and treatment and therefore more cures. over 10 years. In some medical centers, remissions are being achieved in up to 90% of so-called child- The opportunity exists in the '70s to save almost one million Americans who, at present rates, will hood, or acute leucocytic leukemia. probably die of cancer during the decade but who could have been saved by earlier detection and treat- Many of the drugs, still experimental, are restricted to certain research institutions. Meanwhile, re- ment. This would entail the enlistment and training of more volunteers to give talks, lead discussions, search continues to seek better chemicals to treat the disease and better ways of using them. New show films, etc. It would mean greater efforts to reach more adults, plus expansion of the Society's drugs and combinations of drugs are constantly under trial in 80 U.S. medical centers. As treatment programs aimed at young people. improves, the rate of remissions in acute leukemia nears 100% and the remission time grows longer. In 1960, only a few patients could be expected to live five years, while under today's optimum treatment PROFESSIONAL EDUCATION regimen, almost 25% are expected to live that long. The ACS conducts a nationwide service program which attempts to meet the often extraordinary The Society's professional education program reaches physicians, medical students, dentists, nurses requirements of leukemia patients and their families. The Society endeavors to help those so afflicted and members of related professions with the latest information about cancer. Special seminars, con- solve the multiple aspects of the total problem through all available local funds and resources. If leu- ferences, courses, fellowships and scholarships provide training in the detection, diagnosis, treatment kemia strikes, families in need are directed to consult the nearest ACS Unit to find out what help is and rehabilitation of cancer patients. Speakers and materials are made available to professional soci- available from the Society and other local agencies. eties for their programs. Journals, other publications and exhibits offer the newest findings on the In 1975, there will be 21,000 new victims of leukemia and 15,000 deaths. It strikes both sexes as management of cancer. well as all ages. The disease constitutes approximately half the cancer deaths of American children Last year, four major national conferences covered a broad range of cancer-related topics, including between ages 3-14, where cancer is the leading disease-death cause. cancer nursing, cancer of the colon and rectum, virology and immunology and childhood cancer. Two The ACS has long been in the forefront of the leukemia fight and has supported much research major conferences on advances in cancer management and a regional conference on cancer for medical directly or indirectly in the field over the years, with close to 100 grants in effect last year alone. This students are being planned for the 1974-75 year. program embraces the continuing search for more effective drugs for treating the disease, plus studies In 1974 several hundred thousand members of the medical professions were reached with ACS relating to radiation, viruses, basic leukemic cell structure and function, and other problem areas. materials and programs designed and conducted for the various specialties concerned with cancer. Pro- gram activities dealt with the major sites of cancer, i.e.: lung, colon-rectum, breast, uterus, skin, oral. PUBLIC EDUCATION The Society maintains a library of films for professional education which are available in 16mm and 8mm cartridge formats and in video cassettes. These are available through Divisions and Units, on loan American Cancer Society public education activities will take on an added dimension in 1975 focusing or on five-year lease to qualified professional institutions, agencies or individuals. Over the last nine on action-oriented programs - programs which motivate people to discuss facts about cancer, commit years 39 new Professional Education films have been produced and circulated, 4 of them in the last themselves to get a Pap test and other cancer detection exams or to take advantage of a specific service fiscal year. Most are for physicians and medical students. Films have also been produced for dentists, provided, i.e., free instruction in breast self-examination, "helping smokers quit" clinic, etc. nurses and nursing students, pharmacists and speech therapists. This new focus is in direct response to Gallup studies done for the Society which show that a satura- Eight Professional Education films will be in production and six are expected to be released during 1974-75. Two others have been approved for production but await funding. An expanding library of audio and video tapes is under continuing development. 20 21 Clinical Fellowships tional Units of the ACS adopting it almost daily. Carefully selected and trained volunteers assist the physician and surgeon in providing specialized assistance without interfering in any way with the The ACS National Clinical Fellowship program has, since 1948, invested approximately $18-million doctor-patient relationship. The high quality of this effort is assured by uniform training practices for the training of more than 3700 physicians and dentists in the diagnosis and treatment of cancer. under the direction of a qualified medical advisor at the Division and Unit level. The patient sees and Training is provided on two levels at approved teaching centers and hospitals. The regular Clinical talks to another woman who had the same surgery - intimate proof that it will be possible for her to Fellowship program, for hospital residents, is designed to provide specialized training in scope and look normal and return to normal activities. She receives practical help on how to go about it and depth beyond that which would ordinarily be received in residency training programs. The Junior medical personnel are relieved of time-consuming activities not primarily medical in nature. There Faculty Clinical Fellowship program, for postresident physicians and dentists, is intended to strength- were 32,000 such visits during 1973. A film, Recovery After Mastectomy, can be shown at the pa- en cancer teaching programs by supporting outstanding young clinicians in academic careers upon tient's bedside. completion of their specialty training. Fellows put their special skills and knowledge to work through 2) Volunteers of the ACS, in many instances working with volunteers of the various ostomy groups their professional societies, teaching activities, participation in hospital cancer programs and in their throughout the country, are mobilizing to provide psychological reassurance for patients with private practices. Many new departments and divisions of oncology in hospitals and medical schools in ostomies. The volunteer in the ostomy visitor program, himself an ostomate, can provide the assur- the nation are now headed by ACS former Fellows. During 1973-74, 190 Clinical Fellows and 45 ances that a patient can gain in no other way. Again, careful selection of volunteers and high standards Junior Faculty Clinical Fellows received training in 117 institutions in 39 states, Puerto Rico and of training under medical supervision will provide valuable assistance to the surgeons and enterostomal Washington, D.C. therapists in the medical team who face the problem of rehabilitation of the ostomy patient. Enteros- tomal therapists are being sponsored for training by ACS Divisions and training facilities are receiving Clinical Professorships ACS support. Bedside film is People With Colostomies. In 1971, the Society established a new program and category of support: American Cancer Society 3) The International Association of Laryngectomees, which assists those who have lost their voices Professors of Clinical Oncology. The purpose of the Professorships, awarded to medical schools, is to to cancer, is sponsored by the American Cancer Society. It is composed of 213 member clubs in 45 improve cancer teaching at the undergraduate, postgraduate and continuing education levels, to stimu- states of the United States, in Canada, England, Israel, Australia, Japan, New Zealand, Belgium, India, late clinical investigation of cancer and to coordinate all cancer-related activities - educational, service South Africa, Jamaica and Venezuela. Stated purpose is to promote and support the total rehabilita- and research - in the medical school. Nine Clinical Professors have been appointed and at least five tion of laryngectomized persons by the exchange and dissemination of ideas and information to the others are being proposed. clubs and to the public; to facilitate the formation of new clubs; to foster improvement in the teaching of postlaryngectomy speech. Programs of the IAL include: 1) seminars and institutes for prospective SERVICE AND REHABILITATION teachers; 2) public and professional education in first aid and artificial respiration required for laryn- gectomees; 3) registry of postlaryngectomy speech instructors; 4) international annual meetings; 5) The prime objectives of the Society's service and rehabilitation program are to support physicians' encouragement of the new patient with helpful literature; 6) Film: To Speak Again. efforts in early detection, to bring greater comfort to cancer patients, to ease the burden on their fami- lies, and to improve the quality of survival by assisting patients in their physiological and psychological UNPROVEN METHODS OF CANCER MANAGEMENT rehabilitation. The ACS provides information to physicians and the public on unfounded claims concerning unproven Service methods of cancer management, and aids in the creation or strengthening of state laws to control the use of worthless cancer remedies and tests. An active file of information on such unproven methods The Society expects all of its organized Units to conduct a minimum service program which: 1) in- is maintained. cludes information and counseling regarding existing facilities and services related to cancer within the community; 2) provides assistance to the cancer patient and family with the help of community re- RESEARCH sources (medical and social), with loan of sick room equipment and with transportation service to and from treatment facilities. The ACS entered the field of cancer research in 1946, putting close to a million dollars into grants. Depending on local needs and financial resources available, the program may be expanded by Units Since then, the Society has been a major independent source of research support along with the from a minimum program to a total program which includes: medication, nursing service, homemaker National Cancer Institute, the National Science Foundation, and other agencies. The Society's research services and rehabilitation. Community projects having the endorsement of state and local medical program has grown because the demand has grown. In 1950, the average project grant was $6,600 per societies may be supported to include cancer detection in physicians' and dentists' offices, diagnostic year. In 1973, the average allocation was $35,500. services, and community programs including support of cancer registries and hospital cancer clinics for The year the Society got into the research business, the NCI program was just getting off the limited periods. ground. Together, they opened up the field. Millions of dollars were plowed into universities, medical In 1973, 270,759 cancer patients received all types of ACS services. (A tabulation of services pro- schools, hospitals and institutes to set up research programs where none existed. Hundreds of scientists vided to these patients shows: 35,439 equipment loans, 38,188 gift items, 31,827 transportation ser- were attracted to this new area. Once established, many moved on to other centers, setting up new vices, 50,876 rehabilitation services, 166,764 information and referral activities.) programs, and attracting additional hundreds (later, thousands) of scientists. Each new wave of expan- sion created a new demand for support. Both the ACS and NCI responded with increased research Rehabilitation budgets. Some scientists applied to the ACS, others to the NCI, some to both. The American Cancer Society conducts rehabilitation programs for mastectomy, ostomy and laryn- In fiscal year 1974 (Sept. 1, 1973 through Aug. 31, 1974), the ACS made 498 grants to 127 major gectomy patients: institutions in this country and to scientists working both here and abroad. The total amount, subject 1) The Reach to Recovery program, first step of an organized and comprehensive plan for the re- to audit, was $27,316,950 which includes some $3,000,000 granted directly by ACS divisions. Refund habilitation of the mastectomy patient, is now in operation in most parts of the country with addi- of unexpended balance of some $900,000 from prior year awards, left a net total of $26,416,950. 22 23 181,376.00 88,835.00 78,797.00 642,668.00 65,229.00 107,838.00 146,508.00 28,015.00 193,113.00 98,441.00 452,533.00 55,000.00 61,025.00 222,538.00 57,334.00 284,062.00 8,751.00 42,200.00 75,899.00 37,852.00 57,905.00 20,702.00 324,582.00 590,376.00 8,335.00 135,000.00 701,857.00 75,490.00 814,171.00 769,443.00 70,000.00 375,000.00 8,645.00 37,500.00 30,000.00 1,170,010.00 787,156.00 3,000,000.00 $27,316,950.00 (900,000.00) $26,416,950.00 The number of ACS grants applied for and approved by its expert research committees, but which were not supported because of insufficient funds, has increased at a phenomenal pace in recent years - from 60 grants of about $1.5-million unfunded in 1964, to 903 grants totaling over $50-million in $ 1974. These figures apply to National Office grants only and are illustrated in the following table: Approved SUMMARY OF RESEARCH GRANTS & FELLOWSHIPS AWARDED BY ACS (NATIONAL SOCIETY & DIVISIONS) DURING FISCAL YEAR ENDED AUGUST 31, 1974 Southern California, University of, Los Angeles, Calif. (4) State University of New York at Stony Brook, Stony Brook, N.Y. (4) 206,737.00 Wistar Institute of Anatomy and Biology, Philadelphia, Pa. (2) Eleanor Roosevelt-ACS International Cancer Fellowships (1) Funded But Not Funded Southern Research Institute, Birmingham, Ala. (2) St. Jude Childrens Research Hospital, Memphis, Tenn. (2) Requested Stanford University, Stanford, Calif. (14) State University of New York at Albany, N.Y. (1) State University of New York, Brooklyn, N.Y. (2) State University of New York, Buffalo, N.Y. (2) Switzerland, University of, Geneva, Switzerland (2) Temple University, Philadelphia, Pa. (5) Tennessee, University of, Memphis, Tenn. (3) Fiscal Texas, University of, Houston, Tex. (11) Thomas Jefferson University, Philadelphia, Pa. (1) Trudeau Institute Inc., Saranac Lake, N. Y. (1) Tufts University, Medford, Mass. (5) Universities Assoc. for Res. & Educ. in Pathology, Inc., Utah, University of, Salt Lake City, Utah (6) Utrecht, University of, Utrecht, Netherlands (1) No. of No. of Vanderbilt University, Nashville, Tenn. (2) Vermont, University of, State Agricultural College, Veterans Administration Hospital, Minneapolis, Minn. (1) Virginia, University of, Charlottesville, Va. (3) Walter and Eliza Hall Inst. of Medical Research, Washington, University of, Seattle, Wash. (7) No. of Washington University, St. Louis, Mo. (10) Wayne State University, Detroit, Mich. (1) Wesleyan University, Middletown, Conn. (1) Wisconsin, University of, Madison, Wis. (17) To Support Journal "Cancer Research" (1) Committee and Operating Expenses in Evaluating and Total Awarded (496) Amount Grants Amount Yale University, New Haven, Conn. (21) Yeshiva University, Bronx, N. Y. (18) Professional Programs of the UICC (2) Processing Research Applications (1) Total Grants Amount National Epidemiological Studies (1) Refund of Unexpended Balances of Prior Year Awards Note: Numbers in parentheses indicate number of grants per institution for the year ending August 31, 1974; totals are subject to audit. Year Requests (2) 1965 $23,829,008 $13,088,622 $ 4,046,015 25,042,749 384 11,013,667 106 4,955,328 Bethesda, Md. (1) Melbourne, Australia (2) 482 157 756 Burlington, Vt. Tobacco Habituation (1) Nutrition and Cancer (1) Division Research Grants (1) 1966 611 1967 932 40,338,782 528 16,884,962 103 4,393,132 1968 986 43,498,174 489 17,174,670 200 7,603,796 1969 1,254 63,995,580 534 19,652,785 375 15,713,333 1970 1,252 67,607,098 507 19,125,420 460 21,318,199 1971 1,126 58,378,944 642 22,692,927 325 14,183,963 60,082.00 235,754.00 172,038.00 881,685.00 40,000.00 42,162.00 67,500.00 152,430.00 321,361.00 38,440.00 302,301.00 17,000.00 16,275.00 8,000.00 1,500.00 112,935.00 40,760.00 25,000.00 40,650.00 7,947.00 293,023.00 110,000.00 112,500.00 110,217.00 88,450.00 80,668.00 62,041.00 78,818.00 41,590.00 293,583.00 118,203.00 8,850.00 170,744.00 3,000.00 259,879.00 21,676,069 650 34,914,342 40,000.00 40,740.00 67,750.00 259,221.00 327,156.00 50,875.00 289,042.00 269,521.00 35,000.00 34,156.00 58,070.00 1972 1,361 82,416,461 516 1973 1,260 75,849,496 525 23,052,737 527 27,092,335 1974 1,613 105,095,040 498 27,316,950 903 50,643,280 A summary of all project and personnel grant applications reviewed in fiscal '73 by anatomical sites (1) shows this breakdown: Head and Neck - 12 applications (1% of all applications reviewed), 4 funded (33%) for $227,000 Mallory Institute of Pathology, Boston, Mass. (1) with 4 unfunded (33%) for $151,400 and 4 unapproved (33%); Digestive Organs 113 applications Maryland, University of, Baltimore, Md. (2) Massachusetts General Hospital, Boston, Mass. (5) Massachusetts Institute of Technology, Cambridge, Mass. (17) Mayo Foundation, Rochester, Minn. (1) Medical College of South Carolina, Charleston, S. C. (1) Miami, University of, Coral Gables, Fla. (2) Michigan, University of, Ann Arbor, Mich. (5) Minnesota, University of, Minneapolis, Minn. (6) Missouri, University of, Columbia, Mo. (1) Mount Sinal School of Medicine, New York, N. Y. (3) National Academy of Sciences, Washington, D. C. (1) NCI-Viral Leukemia and Lymphoma Branch, Bethesda, Md. (1) National Institute of Arthritis and Metabolic Diseases, Bethesda, Md. (1) National Society for Medical Research, Washington, D. C. (1) Nebraska, University of Omaha, Neb. (3) New England Medical Center Hospital, Boston, Mass. (1) New Jersey, College of Medicine and Dentistry, New Brunswick, N. J. (1) New Mexico, University of, Albuquerque, N. M. (1) New Mexico State University, Las Cruces, N. M. (1) New York University, New York, N. Y. (5) North Carolina, University of, Chapel Hill, N. C. (2) Northeastern University, Boston, Mass. (1) Northwestern University, Chicago, III. (4) Oak Ridge National Laboratory, Oak Ridge, Tenn. (2) Ohio State University, Columbus, Ohio (2) Oregon State College, Corvallis, Ore. (1) Oregon, University of, Eugene, Ore. (4) Papanicolaou Cancer Research Institute, Miami, Fla. (1) Pennsylvania State University, University Park, Pa. (1) Pennsylvania, University of, Philadelphia, Pa. (8) Pittsburgh, University of, Pa. (4) Polytechnic Institute, Brooklyn, N.Y. (1) Portsmouth Polytechnic, Portsmouth England Princeton University, Princeton, N.J. (4) Public Health Research Institute, New York, N.Y. (2) Rhode Island, University of, Kingston, R.I. (1) Rochester, University of, Rochester, N.Y. (6) Roger Williams General Hospital, Providence, R.I. (1) Roswell Park Memorial Institute, Buffalo, N.Y. (5) Salk Institute for Biological Studies, San Diego, Calif, (6) Scripps Clinic Research Foundation, La Jolla, Calif. (6) South Carolina, University of, Columbia, S.C. (1) reviewed (10% of all), 33 funded (29%) for $1,469,000 with 61 unfunded (54%) for $3,798,500 and Rockefeller University, New York, N.Y. (5) Sinai Hospital of Baltimore, Baltimore, Md. (1) Sloan-Kettering Institute for Cancer Research, New York, N.Y. (11) 513,206.00 South Alabama, University of, Mobile, Ala. (1) 19 unapproved (17%); Respiratory Organs 39 applications reviewed (3% of all), 14 funded (36%) for $742,200 with 19 unfunded (49%) for $1,187,000 and 6 unapproved (15%); Female Genital Organs 96 applications reviewed (8% of all), 38 funded (40%) for $1,876,300 with 43 not funded (45%) for $2,764,600 and 15 unapproved (15%); Urinary Organs - 21 applications reviewed (2% of all), 10 funded (48%) for $536,300 with 7 not funded (33%) for $421,200 and 4 unapproved (19%); Lym- phomas and Leukemia - 165 applications reviewed (14% of all), 69 funded (42%) for $3,306,000 with 82 not funded (50%) for $6,129,900 and 14 unapproved (8%); Other Sites, including eye, skin, central nervous system, thyroid, bone 202 applications reviewed (17% of all), 62 funded (31%) for $3,259,400 with 100 not funded (50%) for $6,483,900 and 40 unapproved (20%). $ 190,704.00 32,170.00 125,000.00 70,475.00 9,915.00 401,817.00 114,687.00 1,457.00 165,957.00 116,764.00 42,795.00 2,133,307.00 35,096.00 248,484.00 9,705.00 531,062.00 207,922.00 55,000.00 30,720.00 22,188.00 8,500.00 591,129.00 176,767.00 30,976.00 132,531.00 256,012.00 99,365.00 134,750.00 316,065.00 50,000.00 182,083.00 137,500.00 65,685.00 19,585.00 204,937.00 477,308.00 180,168.00 65,288.00 207,250.00 17,501.00 74.097.00 69,975.00 84,653.00 408,078.00 100,000.00 17,536.00 51,350.00 62,590.00 30,000.00 Of a total 1,260 applications reviewed by the ACS in 1973, 40% were funded for $23,052,737 with 46% not funded for $33,835,600 and 14% unapproved. These represent sum totals and not just those $ involving anatomical sites. Applications for these grants are carefully screened by scientific review committees. A small percentage are approved and funded. Another group consists of approved grants for which no funds are available. The third is made up of applications which were not approved or funded. Albany Medical College of Union University, Albany, (1) The Society makes three types of grants to support research: 1) "Research Project Grants" to fi- Alabama, University of, Tuscaloosa, Ala. (4) American Health Foundation, New York, N. Y. (2) Arizona University, Tucson, Ariz. (3) Basel, University of, Switzerland (1) Baylor College of Medicine, Houston, Tex. (8) Beth Israel Hospital, Boston, Mass. (2) Boston University, Boston, Mass. (1) Brandeis University, Waltham, Mass, (5) Brown University, Providence, R. I. (3) California Institute of Technology, Pasadena, Calif. (3) California, University of, California (state system) (44) Carnegie-Mellon University, Pittsburgh, Pa. (1) Case Western Reserve University, Cleveland, Ohio (6) Cedars of Lebanon Hospital, Los Angeles, Calif. (1) Children's Cancer Research Foundation, Boston, Mass, (3) Children's Hospital Research Foundation, Cincinnati, Ohio (1) Cold Spring Harbor Laboratory of Quantitative Biology, N. Y. (1) Community Blood Council of Greater New York, N. Y. (1) German Cancer Research Center, Heidelberg, Germany (1) Grumman Aerospace Corporation, Bethpage, N. Y. (1) support of pilot studies and of young investigators in the cancer field; 3) "Research Personnel Grants" Chicago, University of, Chicago, III. (10) Children's Hospital of Los Angeles, Calif. (1) Cincinnati, University of, Cincinnati, Ohio (1) Colorado, University of, Boulder, Colo. (15) Columbia University, New York, N. Y. (6) Connecticut, University of, Storrs, Conn. (3) to outstanding scientists and students specializing, or planning to specialize, in cancer research; these Cornell University, Ithaca, N. Y. (4) Cornell University, New York, N. Y. (2) Dartmouth College, Hanover, N. H. (1) Duke University, Durham, N. C. (4) Emory University, Atlanta, Ga. (1) Florida, University of, Gainesville, Fla. (3) George Washington University, Washington, D. C. (2) Georgetown University, Washington, D.C. (1) Harvard University, Boston, Mass. (15) Institute for Cancer Research, Philadelphia, Pa. (3) nance individual work; 2) "Institutional Research Grants" to universities, institutes and hospitals for Illinois, University of, Urbana, 111. (5) Indiana, University of, Bloomington,' Ind. (2) Institute for Medical Research, N. J. (1) lowa, State University of, Iowa City, lowa (2) Jackson Laboratory, Bar Harbor, Me. (2) Jewish Hospital of St. Louis, Mo. (2) Johns Hopkins University, Baltimore, Md. (7) Kansas, University of, Lawrence, Kan. (1) Karolinska Institutet, Stockholm, Sweden (1) Los Alamos Scientific Laboratory, Albuquerque, N. M. (1) Louisiana State University, Baton Rouge, La. (1) Louisville, University of, Louisville, Ky. (1) cover many levels of academic and professional training, starting with fellowships and scholarships for recent M.D. and Ph.D. graduates and ranging to research professorships. 25 24 In the research professorship category, the Society will invest $566,000 to support 21 of the na- the importance of hormones in the development and treatment of cancer of the prostate and breast. tion's most gifted scientists, men devoting their life's work to cancer research. These professorships at Dr. Peyton Rous ('66), who first demonstrated that viruses are a cause of cancer in animals, and leading universities and research institutes have been guaranteed financially by the Society for the Dr. Wendell Stanley ('46), who was the first to extract viruses in solid form. Dr. James Watson ('62), duration of their scientific lifetimes provided that they continue to be productive. The commitment who, with his colleagues, discovered the "architecture" of DNA, and Dr. Severo Ochoa ('59), who, with for the professorships averages $400,000 and in some cases exceeds $700,000. Freed of major adminis- his associates, disclosed how this molecule is synthesized. Drs. George W. Beadle and Edward Tatum trative responsibilities and other restrictions, these scientists can devote their talents to their chosen ('58), who uncovered the mechanism by which the gene transmits a hereditary trait or function. fields of research. Some other eminent scientists who have received ACS grants are: Dr. David Baltimore, who simul- Basic research proceeds generally in two directions: 1) to discover why and how the cellular machin- taneously with Dr. Howard Temin, made the startling discovery that DNA is not always the "master ery goes wrong and triggers the disease process, and 2) to develop means of correcting or controlling molecule" and that it may be produced by RNA. Dr. Jonathan Beckwith, who was the first to isolate abnormal cell growth. We already have some answers, but not enough. and photograph a gene. Dr. Joseph Burchenal, pioneer and eminent researcher in cancer chemotherapy Surgery, radiotherapy, chemotherapy - all these methods of saving lives have been improved and director of many team efforts in basic and clinical research. Dr. Robert Good, who is a leading through research, most notably in the field of chemotherapy. Here, the hope remains high that new investigator in cancer immunology and was one of the three men making up the President's panel to and ever more potent drugs to control specific cancers will be developed. Combinations of compounds supervise the Federal cancer program. Dr. Ludwik Gross, one of the original and most prolific contrib- have been found dramatically useful in treating children with acute leukemia, more than a hundred of utors to knowledge about viral causation of animal cancers. Dr. James Holland, whose clinical research whom have now survived ten years and more, and one rare type of cancer (choriocarcinoma) has been with acute lymphocytic leukemia has lengthened the average survival rate for children with this disease cured by chemicals alone. to four years or better. Dr. Henry Kaplan, whose work with radiation and chemotherapy took Hodg- At certain specialized cancer centers, drugs have become a really potent factor in the treatment of a kin's disease out of the "hopeless" column and opened the way toward achieving 80 to 90% five-year dozen or so human cancers and are achieving astonishing long-term survival in some "incurable" can- cures. Dr. Choh H. Li, who was the first to synthesize the incredibly complex growth hormone. cers. The drugs are used alone, or in series, or in combination with such standard therapy as surgery Dr. Andre Nahmias, whose work has produced all but conclusive proof that cancer of the cervix is and radiation. All these drugs, being highly toxic, require exactness in both timing and dosages because caused by a common type of virus (herpes) and that it is very likely transmitted sexually. Dr. George they can be so very damaging to the patient's normal tissue. There exist over 40 of such useful drugs M. Papanicolaou, whose Pap test has saved the lives of tens of thousands of women from cervical and of every one of these there are many thousands of compounds which have been tested and cancer. Dr. Howard Skipper, whose work with "total cell kill" in animal leukemia led the way to great rejected. advances in the treatment of leukemia in humans through combination chemotherapy. Dr. Chester Developments in the area of immunology and its relation to cancer have generated rapidly increas- Southam, pioneer in cancer immunotherapy, on whose original work much of the current immuno- ing research in this field. The human immune system is being explored as a means of both diagnosing therapy research is based. cancer and treating it. Research currently involves identifying the antigens produced by cancer and ENVIRONMENTAL CANCER RESEARCH PROJECT stimulating the immune system to combat cancer with BCG (a vaccine for TB), cancer cells, etc. Major Research Aided by ACS The purpose of this study, begun in late 1971, is to identify factors in the human environment which To date, the Society has spent some $350-million for the support of projects, institutions and person- play a role in the occurrence of cancer in man. The project is being co-directed by E. Cuyler Ham- nel involved in every important area of cancer research and clinical investigation. mond, Sc.D., Vice President for Epidemiological and Statistical Research of the ACS, and Irving J. Many of the nation's major cancer research programs were developed with the aid of ACS grants. Selikoff, M.D., Director of the Environmental Sciences Laboratory of Mt. Sinai Hospital, New York Among them are those now in operation at Sloan-Kettering (New York), M.D. Anderson (Houston), City. It consists of two major parts: 1) a resumption of the Society's Cancer Prevention Study; 2) Southern Research Institute (Birmingham), McArdle Laboratories (Wisconsin University), Institute of studies of occupational groups exposed to industrial products which are suspected of causing cancer. Cancer Research (Philadelphia), University of California in San Francisco, University of Chicago, Yale (New Haven), Emory (Atlanta), University of Michigan, University of Minnesota, Washington Univer- Cancer Prevention Study sity (St. Louis), Tufts (Mass.), Princeton (N.J.) and others. Originally, this was a six-year follow-up study begun in 1959 in which 68,000 volunteers of the ACS in The ACS Research Professorship Program, unique in the field, has been in existence since 1957. 25 states enrolled more than 1,000,000 subjects and asked them to complete questionnaires about Every ACS Research Professor stands at the top of his field. Several are world-renowned: their habits, exposures, heredity, history of disease, etc. Each year's follow-up reported whether or not Dr. Charles Heidelberger, who synthesized the drug 5-fluorouracil (5-FU), one of the major agents for the persons enrolled were alive or dead. If dead, copies of the death certificates were obtained and treatment of skin cancer, breast cancer and cancer of the gastrointestinal tract. Dr. Dan H. Moore, who analyses were made of death rates from cancer and other diseases in relation to these factors. The was one of the first to detect and study the presence of virus particles in breast cancer; he is now a study was highly successful - about 30 papers were published, including important information on leading investigator in that field. Dr. Elliot F. Osserman, who is a pioneer in the study of multiple smoking, air pollution, and risk factors in relation to cancer and other diseases. myeloma and some forms of leukemia; he has made major contributions toward the detection and The study was resumed in 1971 in order to 1) be able to make analyses of some of the factors in- treatment of these diseases. volving the less common sites of cancer, and 2) determine if general reduction of tar and nicotine con- Dr. Robert W. Holley, another ACS Lifetime Professor, is a Nobel Prize winner in medicine; he and tent in cigarettes in the last 19 years as a result of ACS studies is reflected in a lowering of cancer two other Americans were honored (1968) for their discovery of the process by which enzymes, con- death rates, and 3) provide data on cancer death rates for persons not exposed to occupational agents sisting of a sequence of amino acids, determine a cell's function in genetic development. Other Nobel suspected of causing cancers as a control for the studies of occupational groups. laureates among ACS grantees have been: Dr. Charles Huggins ('66), who was the first to demonstrate The 1971 follow-up was remarkably successful. Volunteers were able to trace (dead or alive) 94.6% of the subjects. Nearly 90,000 deaths were reported and death certificates for most of these persons have been obtained. In the 1972 follow-up the surviving subjects were traced again and requested to complete a short supplementary questionnaire on diseases, hospitalization, and habits. Data are now being prepared for analyses. 27 26 Studies of Occupational Groups SOURCES OF INCOME With the cooperation of industry and labor unions, a number of studies of union workers exposed to Financial support of the American Cancer Society in fiscal 1974 reached about $97 million from pub- various agents have been started. For example, it has been found that asbestos workers have a high risk lic sources. The Cancer Crusade raised approximately $73 million. National Headquarters and char- of lung cancer, gastrointestinal cancer and other conditions; thus studies of a number of groups of tered Divisions received $24 million from bequests and legacies. The public has given generous asbestos workers are underway. Analysis of death rates from lung cancer and other diseases in these and growing support to the Crusade. In 1944, the Society raised $800,000; in 1956, the figure was groups was published in 1974. Printing pressmen are exposed to carbon black, various dyes, talc con- $27,234,906; in 1973, more than $93 million. taining asbestos and various other substances; thus, in cooperation with the Printers Union and the Legacies - in which the Society becomes beneficiary of willed funds - are an increasingly impor- Printers Guild, a study of death rates of long-time members of this trade is being conducted. tant source of ACS income. Income from legacies indicates confidence in the leadership of the Society Cancer death rates among typographers, cotton mill workers, vinyl chloride workers and other occu- and a determination by many to continue the fight against cancer even after their lifetime. Legacy pational groups are under study. A survey of roofers was recently completed and is being prepared for income in relation to Crusade receipts is shown below. publication. Year Crusade Legacies Year Crusade Legacies THE COSTS OF CANCER After the cardiovascular diseases, cancer is the most devastating in terms of lives lost but may be more 1958 29,796,676 2,894,239 1966 38,590,502 11,673,973 costly in over-all implication because it can continue for years and become as chronic in its financial 1959 30,372,944 4,237,179 1967 41,070,771 9,996,188 as in the medical aspects. Economic specifics are limited as they relate to cancer but they can be 1960 28,356,626 5,372,115 1968 43,410,932 11,810,927 1961 30,791,708 6,151,247 1969 46,605,435 14,407,712 measured somewhat in the light of total health cost. In 1971, the nation's spending for all medical care reached $75-billion and accounted for 7.4% of 1962 33,313,773 5,758,100 1970 50,147,609 15,099,088 the gross national product; in 1950, the figure was $12.1-billion. Of the $75-billion total, $65-billion, 1963 33,151,138 7,608,928 1971 56,427,471 13,636,651 or 87%, was for personal health care - meaning for health services of direct benefit to individuals. 1964 34,093,865 9,681,476 1972 62,044,243 16,774,295 Of this $65-billion, 27% was spent by or on behalf of the aged. This group comprises only 10% of 1965 36,920,999 8,887,755 1973 67,784,862 25,228,782 the population but their higher costs reflect these facts: 1) average over-65s have more and costlier illnesses than younger age groups; 2) they are twice as likely to have chronic conditions (such as can- cer); 3) they enter hospitals more often and stay longer; 4) they use physician services to a far greater extent. In 1971, the personal health care bill for the average American was $311, but for the average aged HOW ACS FUNDS ARE ALLOCATED person (over 65) it was $861. Per capita hospital-care expenditures for the aged was $410 and for (BASED ON TOTAL 1973-74 BUDGET $89,633,000) physicians' services $144. In 1971, 37% of every personal health care dollar was a direct patient outlay with the remaining 63 cents paid by government (Federal, state, local), private health insurance, phi- lanthropy and industry. Direct Cost Estimate The nearest approximation of the direct costs of cancer was arrived at some years ago by the Presi- dent's Commission on Heart Disease, Cancer and Stroke. Personal services, such as hospital and nursing Research $26,028,400 400 home care, physicians' and nurses' services and drugs, were put at a $920.7 7-million total, with non- personal services, such as research, training, construction, insurance, health services, etc., adding an- other $326.8-million. That comes to nearly $1.25-billion, and the year was 1962. At the ACS National Conference on Human Values and Cancer, at Atlanta in June '72, an American Hospital Association director put that figure at $3-billion, an increase of 150% in 10 years. Public Education $15,457,100 The 1962 report cited cancer illness among those under 65 as costing 72,000 man-years of produc- tivity among the labor force; 44,000 man-years among those keeping house, and 52,000 man-years among those unable to work. Among women, cancer far exceeds any other disease as a cause of "working years lost"; among men, it is third after accidents and heart disease. Cancer also costs American business and industry the Professional Education Patient $9,387,000,1,425,700 Services Community Services $8,316,900,Sing $10,389,000 Management and General $8,628,200 loss of valuable executives at the peak of their efficiency and of trained workers at the height of their productivity. Lung cancer, the greatest cancer killer among men and continuing to rise at an alarming rate, becomes a major cause of disability among the country's work force. Lung cancer and emphy- sema, another chronic lung disease caused mainly by cigarette smoking, may be the prime disablers of 29.0% 17.2% 10.5% 12.7% 9.3% 11.7% 9.6% workmen between 40 and 65. Emphysema now ranks second to heart disease in that respect, and as a killer it increased its U.S. death toll 700% between 1950 and 1965. 28 29 CELEBRITIES AND CANCER THE AMERICAN CANCER SOCIETY Cancer has struck many personalities of world and na- Blackmer, Catherine Drinker Bowen, Betty Bruce, Nor- WHAT THE ACS IS: The American Cancer Society, Inc., is a voluntary organization of about 2.3- tional fame. Such greats of stage and screen as John man Chandler, Eddie Condon, Martha Deane, Duke El- million Americans united to conquer cancer. It is a national organization fighting cancer through bal- Wayne, William Powell, Glynis Johns and Van Johnson lington, John Ford, Laurence Harvey, Chet Huntley, Al- have all had cancer but are alive today - cured of the len Jenkins, Gene Krupa, Charles A. Lindbergh, Anna anced programs of research, education and patient service and rehabilitation. disease. Other famous names on the cured list include: Magnani, Frank McGee, Nancy Mitford, Marcel Pagnol, Senator Maureen Neuberger, the NAACP's Roy Wilkins, Georges Pompidou, Arthur W. Radford, Diana Sands, HOW ORGANIZED: The American Cancer Society, Inc., is composed of a National Society, with 58 theatre's Richard Rodgers and William Gargan, televi- David Siqueiros, Lewis L. Strauss, Del E. Webb, William chartered Divisions, and 2,758 local Units. sion's Virginia Graham and Arthur Godfrey, pro-foot- L. White. ball's Jack Pardee. In 1972-73, these: Leo G. Carroll, Robert Casadesus, Most people in public life are reluctant to talk about, Dave Chasen, Sir Francis Chichester, Walter Van Tilburg THE NATIONAL SOCIETY: A 190-member "House of Delegates" provides a basic representation or perhaps ever think about, their personal involvement Clark, Richard Crooks, Edward-Duke of Windsor, Har- from the 58 Divisions and additional representation on the basis of population. It elects and is gov- with this or any disease, so the actual records are sparse. vey Firestone Jr., Jack Hawkins, Fay Holden, Tim Holt, Even among those lost to cancer, the death cause is not Elena Krushchev, Elmer Layden, Frank Leahy, Jose erned by a Board of Directors of 114 voting members - approximately half members of the medical always accurately specific, but the toll of world figures Limon, Matthew McCloskey, Neil McElroy, Katina Paxi- or scientific professions and half laymen. The National Society is responsible for over-all planning and with each passing year is a dramatic reminder of the full nou, Lester Pearson, Edward G. Robinson, Winthrop A. coordination, and provides technical help and materials to Divisions and Units. The National Society dimensions of cancer's human devastation. Rockefeller, Aline Saarinen, Ellen B. Stevenson, Admiral In 1973-74, these well-known people died of cancer: Felix Stump, Margaret Webster, Marie Wilson. administers programs of research, medical grants and clinical fellowships, and is charged with carrying Stewart Alsop, Bud Abbott, Bernt Balchen, Sidney Among other past victims in various fields: out public and professional education on the national level. Entertainment Literature Music THE 58 DIVISIONS: These are governed by 4,794 members of Divisional Boards of Directors, again Tallulah Bankhead Charlotte Armstrong Sidney Bechet Richard Barthelmess Hamilton Basso Eddy Duchin medical men and laymen, in all the states plus six metropolitan areas, the District of Columbia, Puerto Mimi Benzell Ludwig Bemelmans Amelita Galli-Curci Rico. Physicians and dentists also serve as regular volunteers. Humphrey Bogart Van Wyck Brooks Percy Grainger Spring Byington Thornton W. Burgess Glen Gray Jack Carson Henry Seidel Canby Oscar Hammerstein II THE UNITS: These are organized to cover the 3,130 counties in the U.S. There are over 66,850 com- George M. Cohan Rachel Carson Spike Jones munity leaders who direct the Society's programs at this level. The basic strength of the Society lies in Gary Cooper T.S. Eliot Franz Lehar DIED OF the loyal ranks of volunteers fighting cancer in their communities. Brian Donlevy Edna Ferber Frank Loesser LUNG CANCER Dan Duryea Lewis S. Gannett Malcolm Sargent Fernandel Erle Stanley Gardner Alec Templeton Creighton W. Abrams THE BRANCHES: An organizational development of growing importance whereby the ACS reaches Cedric Hardwicke John Gunther John Charles Thomas Michael Arlen more people at the "grass roots" action level by involving more people in its programs. A Branch is the Sonja Henie Lorraine Hansberry Gene Austin organizational element next below the Unit, and is established on the basis of géographic subdivision Jean Hersholt Mark Hellinger Sports William Baziotes Judy Holliday James Hilton Tommy Armour Joseph Drexel Biddle of Unit areas. These are permanent (year-round) organizations that are involved with program activi- Edward Everett Horton Aldous Huxley Ty Cobb Elizabeth Bowen ties as well as Crusade. Charles Laughton Oliver LaFarge Ernie Davis Frank Buck Gertrude Lawrence Harold Lamb Hank Gowdy Bruce Cabot Gypsy Rose Lee Howard Lindsay Willie Hoppe Clair L. Chennault Harold Lloyd Gavin Maxwell Walter Hagen Nat "King" Cole Paul Lukas Clifford Odets Fred Hutchinson Bill Corum Dennis O'Keefe Edward Arlington Red Rolfe Bebe Daniels THE SWORD OF HOPE: Zasu Pitts Robinson Barney Ross Walt Disney Dick Powell Damon Runyon Babe Ruth Glenda Farrell This is the registered trademark and insignia of the American Cancer Society. The double-edged blade Charles Ruggles Lillian Smith Horton Smith King George VI of England Ann Sheridan Gertrude Stein Dick Tiger Betty Grable with twin serpent caduceus forming the hilt emphasizes the medical and scientific aspects of the Soci- Zachary Scott Jacqueline Susann Paul "Dizzy" Trout Buster Keaton ety's programs. The Sword of Hope appears on all ACS Crusade materials, literature, posters, ads, Ed Sullivan James Ramsey "Pop" Warner Josef Krips films, etc., and is shown at meetings, lectures, exhibits and film showings. Lee Tracy Ullman Babe Didrikson Zaharias Sean Lemass, P.M., Eire Sophie Tucker Robert Carl Zuppke Hal March Ed Wynn Edward R. Murrow Communications Boris Pasternak Arthur "Bugs" Baer Hubbell Robinson John Chapman Robert Ryan Science Government Bill Cunningham Robert A. Taft Marie Curie William C. Bullitt Rube Goldberg William Talman Tom Dooley Harry F. Byrd Dan Parker Robert Taylor Enrico Fermi Grenville Clark Quentin Reynolds Jennie Tourel J.B.S. Haldane John Foster Dulles Joe Williams Franchot Tone Irene Joliot-Curie Herbert Hoover, Jr. Walter Winchell Martin Whitaker William Menninger Adam Clayton John von Neumann Powell, Jr. Peyton Rous Sam Rayburn Richard E. Shope Lurleen Wallace 30 31 CHARTERED DIVISIONS OF THE AMERICAN CANCER SOCIETY, INC. Alabama Division, Inc. Indiana Division, Inc. New Hampshire Division, Inc. Philadelphia Division, Inc. 2926 Central Avenue 2702 East 55th Place 22 Bridge Street 21 South 12th Street Homewood, Alabama 35209 Indianapolis, Indiana 46220 Manchester, New Hampshire 03101 Philadelphia, Pennsylvania 19107 (205) 879-2242 (317) 257-5326 (603) 669-3270 (215) 567-0559 Alaska Division, Inc. lowa Division, Inc. New Jersey Division, Inc. 1343 G Street P.O. Box 980 Puerto Rico Division, Inc. 2700 Route 22, P.O. Box 1220 Avenue Domenech 257-Alto Anchorage, Alaska 99501 Mason City, lowa 50401 Union, New Jersey 07083 (515) 423-0712 Hato Rey, Puerto Rico 00918 (907) 277-8696 (201) 687-2100 (809) 764-2295 Arizona Division, Inc. Kansas Division, Inc. 4700 North 12th Street 3003 Van Buren New Mexico Division, Inc. Rhode Island Division, Inc. 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Box 9863 270 Amity Road Towson, Maryland 21204 111-15 Queens Boulevard Austin, Texas 78766 Woodbridge, Connecticut 06525 (301) 828-8890 Forest Hills, New York 11375 (512) 345-4560 (203) 389-4571 (212) 263-2224 Massachusetts Division, Inc. Utah Division, Inc. Delaware Division, Inc. 138 Newbury Street Academy of Medicine Bldg. Westchester Division, Inc. 610 East South Temple Boston, Massachusetts 02116 1925 Lovering Avenue (617) 267-2650 107 Lake Avenue Salt Lake City, Utah 84102 Tuckahoe, New York 10707 (801) 322-0431 Wilmington, Delaware 19806 (302) 654-6267 Michigan Division, Inc. (914) 793-3100 1205 East Saginaw Street Vermont Division, Inc. District of Columbia Division, Inc. Lansing, Michigan 48906 North Carolina Division, Inc. Drawer C, 13 Loomis Street Universal Building, South (517) 371-2920 P.O. Box 27624 Montpelier, Vermont 05602 1825 Connecticut Avenue, N.W. 222 North Person Street (802) 223-2348 Washington, D.C. 20009 Minnesota Division, Inc. 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(216) 771-6700 (304) 344-3611 Community Services Center Bldg. 200 North Vineyard Boulevard Montana Division, Inc. 2115 Second Avenue North Oklahoma Division, Inc. Wisconsin Division, Inc. Honolulu, Hawaii 96817 Billings, Montana 59101 1312 Northwest 24th Street P.O. Box 1626 (531) 1662-3-4-5 (406) 252-7111 Oklahoma City, Oklahoma 73106 Madison, Wisconsin 53701 (405) 525-3515 (608) 249-0487 Idaho Division, Inc. Nebraska Division, Inc. P.O. Box 5386 6910 Pacific Street, Suite 210 Oregon Division, Inc. Milwaukee Division, Inc. 1609 Abbs Street Omaha, Nebraska 68106 1530 S.W. Taylor Street 6401 West Capitol Drive Boise, Idaho 83705 (402) 551-2422 Portland, Oregon 97205 Milwaukee, Wisconsin 53216 (208) 343-4609 (503) 228-8331 (414) 461-1100 Nevada Division, Inc. Illinois Division, Inc. 4220 Maryland Parkway Pennsylvania Division, Inc. Wyoming Division, Inc. 37 South Wabash Avenue Suite 105 P.O. Box 4175 1118 Logan Avenue Chicago, Illinois 60603 Las Vegas, Nevada 89109 Harrisburg, Pennsylvania 17111 Cheyenne, Wyoming 82001 (312) 372-0472 (702) 736-2999 (717) 545-4215 (307) 638-3331 NATIONAL HEADQUARTERS: AMERICAN CANCER SOCIETY, INC., 219 E. 42nd ST., NEW YORK, N.Y. 10017 74-400M-10/74-No. 5008-LE The Shaky Link Between CANCER AND CHARACTER Nobody has proved a cause-and-effect relationship between cancer and despair, loneliness, or loss of loved ones. The clearest causes are environmental carcinogens, not the victim's personality. by Mary G. Marcus MOST PHYSICIANS AND PSYCHOLOGISTS ease more painful emotionally than it that if type-A people loosen up enough accept the idea that psychological fac- already is. Although it may eventually to alter their personalities, they can de- tors play an important role in the de- be shown that emotional factors play crease the risk of heart attacks. velopment of a variety of illnesses some role, the research thus far does not Interest in the psychological aspects including asthma, tuberculosis, colitis, allow us to draw such conclusions. of cancer revived in the 1950s, when hypertension, arthritis and heart at- Situation and Personality. According to Lawrence LeShan spotted a common tacks. Cancer has usually not been in- earlier reports, psychological factors pattern among cancer patients he was cluded among these illnesses. But supposedly trigger particular diseases in treating in psychotherapy. As children, reports that personality plays a role in people who, because of genetic, con- most of his patients had gone through the development of the disease now ap- stitutional or environmental factors, experiences that weakened their ability pear regularly, and cancer patients are are predisposed to the disease. These to form emotional relationships. They beginning to wonder if their emotions psychological factors fall into two cate- had lost a parent, brother, or sister, and are somehow responsible for their gories: situation and personality. had come to associate emotional rela- misfortune. Among the situational factors influenc- tionships with pain and loneliness. In ancient Greece, the physician ing disease are life events such as birth, Later, as adolescents or young adults, Galen theorized that melancholy marriage, death, loss of job, or change of many of these patients had developed women were more likely than sanguine home. Personality factors include de- either a close, happy personal relation- women to develop cancer. Today's the- pression, rigidity and dependency. ship or a satisfying job, only to have orists claim that cancer tends to de- Psychiatrist Thomas Holmes be- the relationship or employment end velop in inner-directed families; that lieves that constant stress weakens the abruptly. LeShan's patients said that expressing our emotions may help us re- body's resistance, allowing the onset of this loss left them without hope, believ- sist cancer; that cancer victims have illness. In one study, Holmes and his ing that they were forever doomed to placid, gentle, nonaggressive disposi- colleague Richard Rahe found that over loneliness. LeShan found that his pa- tions, and as children lacked closeness 79 percent of those who had undergone tients first developed symptoms of can- to their parents; and that cancer may re- major life changes developed some kind cer anywhere from six months to eight sult from hopelessness following the of illness within two years of the years after rupture of the relationship. loss of a loved one. changes, while only 37 percent of those Distortion of Emotions. LeShan's early These reports of emotional causes of who experienced minor life changes de- work identified two of the most fre- cancer bring hope to some and anguish veloped such illnesses. quently suggested psychological fore- to others. The optimistic see the pos- The role of stress in development of runners to cancer: hopelessness and sibility of changing their personalities, illness has long been noted by Canada's loss. LeShan's studies, however, are thereby avoiding the disease; the pessi- Hans Selye. He argues that illnesses ap- beset with problems that make one mistic see the new reports as a death pear when the body reacts to long-term skeptical of his conclusion. His evi- sentence against which it is pointless to stress by prolonged excessive produc- dence is retrospective; he studied peo- struggle. Instead of asking, "Why me?," tion of various hormones. ple who had already developed cancer. some cancer victims, convinced of the The relationship of personality to Since retrospective studies compare link, assume that it is their own fault heart attacks has also been widely pub- people with cancer with those who do that they have developed cancer. Some licized. Meyer Friedman and Ray not have it, the personality differences fall back on the old notion that they are Rosenman found that type-A people, that appear may be caused by the can- sick because of their sins. classified as competitive and driven, are cer. For example, LeShan states that a Cancer is a horror in itself, and hasty much more likely to develop heart at- feeling of utter despair was present in 43 generalizations from inconclusive re- tacks than type-B people, who are easy- out of 45 cancer patients as compared Mark Kozlowski search could make the course of the dis- going. Friedman and Rosenman suggest with only one out of 30 who did not 52 PSYCHOLOGY TODAY June 1976 PHILIP STRAX, M.D. Foreword by MARVELLA BAYH (Mrs. Birch Bayh) EARLY DETECTION BREAST CANCER IS CURABLE EARLY DETECTION Breast Cancer Curable STRAX JOAN BOOK EARLY DETECTION Breast Cancer Is Curable PHILIP STRAX, M.D. HARPER & ROW, PUBLISHERS New York / Evanston / San Francisco / London THIS BOOK IS DEDICATED to the two and a half million volunteers of the American Cancer Society who give of themselves toward the prevention, early detection and ade- quate treatment of cancer as well as to the rehabilitation of the cancer patient. This book is also dedicated to the many who are doing the same in other organizations on a national level, such as the United Order of True Sisters, as well as to organiza- tions operating on the local scene, such as the Stella and Charles Guttman Breast Diagnostic Institute in New York City. These inspired and dedicated volunteers have learned that the greatest benefit in doing for others accrues to themselves. They echo the call: we must all strive to- EARLY DETECTION: BREAST CANCER IS CURABLE. Copyright © 1974 by gether to conquer cancer in our lifetime! Philip Strax. All rights reserved. Printed in the United States of America. No part of this book may be used or reproduced in any manner whatso- ever without written permission except in the case of brief quotations embodied in critical articles and reviews. For information address Harper & Row, Publishers, Inc., 10 East 53rd Street, New York, N.Y. 10022. Published simultaneously in Canada by Fitzhenry & Whiteside Limited, Toronto. FIRST EDITION ISBN: 0-06-014151-4 LIBRARY OF CONGRESS CATALOG CARD NUMBER: 74-4856 Designed by Gwendolyn O. England Contents Foreword, by Marvella Bayh ix Acknowledgments xi Introduction xiii 1 Don't Be Afraid of Breast Cancer 1 2 Alertness Could Save Your Life 11 3 Who Is Most Likely to Develop Breast Cancer 21 4 What We Know About the Breast 32 5 What We Know About Breast Cancer 45 6 What Constitutes a Breast Examination 50 7 How Breast Cancer Is Treated 70 8 What Else Physicians Could Do 79 9 What Else You Can Do: Ten Precepts for Protection 85 10 Do You Have a Question? 87 Glossary 99