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J ¢" • ?>; i,~:~¸¸' National i~s~ltU~es o[ Health N, IriOnal Cancer in~ti~ufe D'HEW I~ublicali~ 1Vo. (~hff) 7s.4;~ t~

(7 In accordance with provisions of the National Cancer Act of 1971, the Natioaal Caacer Advisory ~a~ submits the foIlo~ving repot[ on cancer research and e~er control program~ under the Nationa[ Cancer Program in 197g. This report is to be con- s~ered in conjunction with cor~ responding reports of Dr. Frank J. Rau~cher, it., Director ef the National Cancer Program and the National Cancer Insfftute, and of Mr. Benno C. 5chmidt, Chairman of the President's Cancer Pane]. • The Board commends Dr. Radscher and the ¸entire staff of the NC! for another year of in- tensG and productive activity. Although f~nds f~r the program ha~'e i~creased tlvo and a half times sin Le Io71, there has been " an increase o~ only 28 percent in staff positions. The 8oard wishe~ again to emphasize ~at ~is Serious inadequacy in ~,taff positions has creaced, and will Cl~r/gi~lue tO cfeat~', mdjor obsta- cles to accompfishmem of the Program's objeelives. In 1973 nine of 15 cancer cen- ters called for in Section 40g ~f the Act have been established. Four to six more centers are in an advanced state of plaa~ing and should be established as colllprehensive canc~f centers in 197,1. A fargo number of additionaI lastitutmn~ have received pian~ nin8 grants tO asses~ their ac- tivities and develop plans ~or coordinating their cancer pro- grams• Many of these insfi rations will request suppo~e to estabfish comprehensive programs as de- scribed in the Act; olhers will request support for specialized center centers which will allow effective use of their particular resources and specialized staff expertise. NCI initiated ~he cancer centers program in 1.962, and there are now 66 of these centers, both comprehensive and specialized. It is already possible to assess the positive results of this effort. Substantial amounts of time continue ~o be required for plan- nlng, preliminary organization, application, review, approeal, fund raising for matching dol- lars, bidding, construction and equipping. Nevertheless the cen- ters program i~ ongoing and productive as a whole, During 1973 sabstamial ad- vances were made in knowledge of the distribution and action of • ~'lvironmental carcinogens. A new carcinogen givmg rise to hemangiosarcomas in Ihe liver 'of exposed workers was identi- fied. The compound, vinyl ch!~r- ide, is used widely to make the polymer polyvinvI chloride but is also employed as such in celtain aero~oI ~prays ;rod may be eluted from ~omc fond c~n- rashers. It is 1o be hoped that this hazard will he controlled. The ~sso¢iation of inhahd as- bestos with occupational cancer in man IS well known--the oo- tential bc, zard arising from the presence of these hbres in cer- tain drinking water supplies is now uader study" Hard scientific evidence that ea~'Iier diagno~_is and treatment ,sl

( x~suhs in improved survival xerom cancer is steadily acerui~tg ~J.lh colnrnon cancer5 st~cb as ~east and uterine cervix and with rarer forms of cancer such Hodgkln's disease and certaln lyrnphomas. Indeed, even with advanced stages of Ibese latter ~orfns of cancer ,is well as aeute lymphocytic leukemia in chil- dren, tremendous strides have been made this year alone. Many patients who would have died within months a decade ago can Ilo',v e×pEct five-ye,ir disease free survivals, and perhaps cures, if they receive the latest treatments such as are available tt~ clcrtaill cancer certters. Advances continue to be made tnrarlydiu;no,ll,;,T~venty .,eve n dtull¢~ll ,H ili~l/i ct, nier~ tl~r e,lrly beea~l cancer d~le¢lion tech- nique~ including mammography, xeroradiography and thermog- raphy will screen nearly 300,000 women, These een~ers, estab- lished jointly by NCI and the /G"aertean Cancer Society, wi[I provide a realistic test of how many patients with early stages of breast cancer can be ~aved by presently available treatment methods if thelr disease is de- tected earlier. In one center, five ea¢Iy eases of breast eance¢ wet'e detected in the first month of operation. The centers will also deI~onslrate the latest dEtEction techniques to community physi- cians and other health profes- sinnals. The introdue~inn o~ the colono- ~¢ope for accurate diagnosis of early large bowel tumors has been proceeding rapidly. More physicians and surgeons are acquiring skill in the use of these instraments, t~,hiEh should result in a reduction in mortality from cancer in that area. The same may be true of the fiberopfic bronch0scope which in combination with programs of ~putum ¢ytolog'¢ in high risk groups of smokers permlt5 ear- lier diagnosis of many lung cancers. It remains to be dem- onstrated whether lung caxxcer can be detected enoogh esther to have a large impacl on the mortality statistics. Combined therapy using sur- gel'y, radiation and chemicals is providing improved surwvM in Wilms' tumor and other child- hood cancers which would apt have been believed posstblea few years ago The comblaed approach is also being utilized laa ~umber of other cancers with encouraging results. Mounting evidence of the importance of host resistance to cancer is leading to changing concepts of the role of surgery-- which remains the mainstay of cancer treatment, The tradltiona] surgical concept is to remove a locaIized tumor before i~as spread [f the tumor has already spread, surgery frequently is not considered worthwhile There is taow reason to believe that many 5re,all tumors have been growing for months or years and may have already spread. Neverthe- less, surgical removat ot these primary tumors, may tip lhe balance between tumor and host resistance in favor of the host;

(" =ad reduction of the tumor bur- ~lt~ ~lone may he of therapeutic val=e. Ar, ima~ experiments have shown deaHy that surgical re~ moral of the primary t~mor plus chemotherapy ta~ 5ave many a~iraals which would die with either form of therapy alone One of many objectives of the National Ginee r Plan has been to identify groups at high risk to e~mcer La the popuIation, The re~mt observation that the in. du¢ihility of the enzyme Aryl Hydrocarbon Hydroxylase in patients v*ho smoke is as~eda~ed with a much higher occurrence oE lurtg cancer than m the aver- age smoker, is potentially very important. Ci~¢~ette smoking remains th~ most remediable cause of cancer deaths in the United States-- and the one which seems hard- est to change. Even with overt cis=rette adveriisL, ag banned Srora television, the immense advertising hudget~ of the to- hacco companies, the immediate ecor~omic betx¢ fRs t~ the t~hacco growers, the cigarette m~mufac- turers, and ~ndeed to govern- ments through taxation, have helped to lead host~ of young Americans down the long road that leads to death for some 74,000 persons per year In thi~ ctaJntry. vghi[e there is at present no way to declare any cigarette gale, it should be possible to deny tho~e cigaretles which are obviously high in ~icotine and tar access. to interstate commerce and thereby discourage their mantx- fatVare. At pte~ent ~either the FOA, nor the Environmental I~rotection Aget~cy hat jurisdic~ lim't. "l~e FDA ~axd the EPA ate spec~czlly denied this authority. Appropriate regu~ator~ powers *hould be ertacted by the Con- gresl. Lihewiser the advertisin8 of cigarettes could be harmed. W~e thee m~asures wouId no~ e~ninate the dgarei'te habit, they would reduce the dose of noxious materials it~spired and provide a medium in which educational programs might k~ve for mo:~ impact. The NCAB has held four meet- ings of three days each. In addi- tion, many of the members have been Involved in subcommittee m~tth~;s or have partic~ated in sit~ visits. The Board has par- ticipate4 In the developraettt o£ budgets by recommending guiddines, areas of interest, a~d amounts, It advised the Director to tnahe greatee use of the grant thechani~m, believit~g that this wa~ better adapted to tI~e needs ~t~ more of ottx" Investig~ttors, and went on record at the June m~tLr~g tha~: ~p~oxtm~e[y go percent of th~ 1975 budget ch~d b~ recluested fo~ graters. The Cancer Cofitrol Program w~ich was e~tire~y on ~ contact ha~is in its inJ tial years, is now conducted in part by grants. At ~ts O~ab*~ r,~zetiog, the Board conducted a wide-rangL~g re',dew oi: new scio~ti~¢ dev~- opments. Inve~tig~tor~ from the Nation.~l Cancer ]~stltu~e ant~ h'om Iaboratories tl~roa~hout t~e U.~. gave reports including: 'Discovery o~ prmc~v~c enz'cmc~ m$~o¢ialed with ¢a[teet c~l[s; Appllcat~on O~ h~;~ I~n,:ar energy Iransfcr radiation i~l radiotherapy; O ¢o

( ,Uses of m~lecul~r biolo~oy and blo- • physlcs In cancer d¢lecfion end treatment; Rel~ion of immu nosuppresslon to Racial differences ~n ¢~ncer incl. dence a~ d~th rates; ~tectlon and a¢~Jv~tlo~ oF can¢~F- Causing chemicals: 1E~idenc¢ ~ viT~ in|~rma~ion in ~l.tm~ cam'er c41Bs; Role of polypept~de hormones and fetal pmlelns in c~ncer diagnosis; • r, ocalizat~on of lung ¢~ncer by ~beropllc tJroac]~oscopy; ~esearch [ea~ing to~v~r~ combined I!nodal~tp therapies ~ot" ¢.tnce~ of ~e ~ea~, he~d and neck; Can.~er t~'e.ltment .,.~i~h d~ug.~ Bt~uL~n QI~ the ~mm~ne swtem In the hope o~ er~h~n¢~ host [4~sis~.~ to ~fgcer; ~ro~e~uces lo pro~ect sdenllsts ~tnd O~her ~-~arch F~:~onne[ from potentially canccr-c~u~ing ¢~emica~s and vlruse~; Cancer research in the ~ovlet Union indudln~ i~int ~l~nica] trl~ls • ~ith certain U.S. and Soviet cancer drugs; F~gre~s ir~ ~e~Tch ~ir e~te~, t~- ward th~ p~eve~t~D~, diagnosis a.~ Substantial impto!'e~ents in treat- Blenls for certain ~dv~nced ~:an¢~r~ [nc~ttd~ ovarian carcinoma, Hodgkln'~ disease, cert=in no~- Hodgkln~ lymp~¢~a~, .~¢u !e ]y~- ot~er ch]ldhoo~ c~cers. At ~he O~ob~ meetin~ ~he ~r~t,l~., [ir~ b.~v~[, br~.,I and [un~;, Similar progr~m~ for p~l~- he~d and ~'¢~: arc u~der study and/or d~w[~pn~t. ~e ~'o- grams are tBe subi~t o~ study Jnd review by a special Board commit~e~. At the NovemBer meeting the Board beg~r~ it~ revie~v of the report o[ a ¢or~mit~ec chaired by Dr. Norton Zinde~, which wa~ ap~it~ted to study the • Vir~s Cancer [~rogram. The report emphasized the need for modi[i~ations in the r~ethods o~ reviewing ~ppllc~ian~ for ~an~ zation~[ ¢hange~ aimed at ~el~- raBng rn~nageti~J functions from scientific ~u~ctions to ~ greater extent, better rnethaJ5 R~r ~e]ect- research ~0o1~ su~ ~5 m~ss- produced viruses or viru~ c~e~iv- atives, and greater f~eedom o~ action ~or ~on~ract~r~ havin~ resear~'n co~tra¢l~ a5 opposed pr~cur~merlt contracts. Tl~e Director ~a~ r~ad~ rna~y of the indicated change~ ~n~ wiI1 ~cek advice from ~ ~ubcor~rnhtee o~ t~e Board regarding ~ele~t~ve impIe~ent~tior~ of other~. The Board ha~ reviewed the cerl~er~; progr~r:~ repeatedly and ~a~ u~ stlic~er comp]iance with the g~i~eliaes for com~re- B~r~ has also re~r~mended that [~ Lhe I~)7~ renewal o~ Ihe of comprehensive ~er~!ers ~hau]d n~tbe Iimi~rd to a ~i~ed r~,mbe~ It h~s sludied c~r~f~ r~or!~ on the demography ~f ¢~acer i:~ ~he Uaited States ~vhich ~ve been a major con~der~i~n in the award of ~l~te~s ,~:l.~ co:l~t~'~c~ tiong~ants The~o~rdin~°73 ;t~i~m~d t~e rc~or~ o~ it~ eo~~ ~ ~i~~[ t~ ~viel~ o~?r~- O

( tional programs at the Frederick Cancer Research Center. A "major recommondation of the committee was the rccrn~mcnt of an outslanding individual to establish a unique center of excellence in cancer biology at the Frederick Center. The search for that indlvidua[ is now under- way. Another commtttee of the Board reviewed the revised National Cancer Plan ~,'hkh is prepared by the staff with broad input from the scientific community. Recommendations TVhile the Board is generally pleased with the progress of the overall program and most en- thusiastic about the future, it would call attention to the need for increased funding. A level higher than $600 millin r, will be needed in FY I975; the Board's recommendation for "1.975 is $750 mflIion. This is based on the high qualiW of approved research applications which cannot be ftmded--only 30 to 35 percent of those ap- proved can be paid; there is an even greater discrepancy be- tween the need for construction and the funds available• There also have been significant in- creases in the general costs of all of the programs. We direct attenHon particularly to NCI's need for more man- power and higher salary ceilings, A 2S percent increase in per- sonnel positions is inconsistent with and damaging to a program which has expanded 250 per- cent• The Institute rn'ust compete for manpower among scientists, 'physlclans and admlnistratol~ who can command much higher salaries in the privale sector of thc ¢'co/~omy. I~tx,tuq~. of pre';erlt salary trill,g,, gO individua[~ at NCI earn approximately the same salary as the Director of the In$1itute. The Board has gone oa record repeatedly in favor of fnnds for the education and training of new investigators in cancer. The predoctoral training programs of the NIGM5 have been most important for the NCI and for the country as a whole. The NCI program is now focused nn post-doctoral fenow~hips which draw many of the best minds at the height of their acuity to concentrate on the problems of cancer. We look upon such awards no~ as training expendi- 'cures but rather as the employ- ment of first-rate scientific talent at very modest rates. We are pleased that the Iatter program has been largely restored in the FY 1975 budget as proposed by the administration and we con- tlnue to urge fulI restoration of the training programs at the predoctoral level. Appendix A summary of resolutions as adopted by the National Cancer Advisory Board in I973 is as " follows: Resolutions Recognizing the continuing tragedy o~ lung cancer caused by cigarette smoking the Board adopted two resolutions on smoking and heahh during 1973 At its March meeting, the

( ) Board voted that the Congress be urged to tak© step~ to require that tar and nicc~ti~e lewis be labeled on cigarette p0ckages. in November, the Board re~om- mended unanimously that the Governmeclt take all v~gorous steps possible to reduce ciga- rette smoking Further, the 8oard recommended ~hat the Federal Goverrtment I~ahe the fullest po~Mble ~se of its regula- tory authoritic~ for the protec- tion of h'~man health to reduce the hclhh hazard from ~;nlokiB~g At its March mce~ing, tb~ Board that the President's Cancer ~an~ seek a p~rso~a~ a~dle~c~ with the President to bring the Beard's ~ave cr~nc~r~ about ~b.~ t~rrainati~n ~ the trai~ing pro- grams ~o b~ ~e~io~. TF.~ Board I~a~sed a resQlution r~commcnding to the Director of the N~tiona[ Canter |~stitute a $0 ~,ercent al]oc~io~ to grants in the fi~cal y~ar I975 budget. Further, the Board recommended an ~fforl to fund tb~ gran~s program as fully as possible in the 1974 budset. Because'the authorizations of the ~laliona/Cancer A~ ~xI~ir¢ o~ June 30, 1974, the Board appoin~e~ a subcor~raillee ~o determine whether or ~ot legis- |alive changes are needed ~o facilitate the conduct of the ~"]ationa~ Canter Pr~grar~. ~ i~s November m~et~ng, the ~oard ( dcceptcd ~hl? !iuI~k~llnlniH~,e's report, whkh r¢c~mmcfxdcd a number of modifications in the National Cancer Act of 7.971 ta make it appropriate to the anticipated needs of the Nat/on in FY 1975,1976, 1977. The Board adopted a resolution at i~s June meetlng expressing its profound sorrow on the death, of one of its outstandlng members, Dr. Sidney Father. Dr. Father brought to ~he Board a devotion to the cancer patient and a wise understanding oE fruitful d{recfions for ca~cer research. He was the original co-chalrman of the Senate's Advisory PanEl of Consultants on the Conquest of Cancer and did much to shape the National Car~¢er Act of 1971. Respect ftd/y submitted~ Chairman

( National Cancer Advisory Board Dtt. JonA';Hat¢ E, RROADS. M.D., Chairman Professor of Surgery. School of Medicine University of Pennsylvania Philadelphia, Pennsylvania HASOtD A~tos, Ph.D. Professor, Department of Microbiology and Molecular Gertelics Harvard Medical School Bosto~t, Massachusetts EL.~t~ H Bo0sr Consultant Warner-Lambert Company New York, New York AR~OtD L. BROWX, M.O. Chairman, Department of Pathology and Anatomy Mayo Clinic Rochester. Minnesota IrRA~K J'. Dixon, MD. Chairman, Biomedical Research Depaltt~ents Scripps Clinic and Rescarch Foundation La Julia, California STONEY FA~r~, MD* Prcsident and D~rcctor of Research The Chddrcn's Cancer Research Foundation Boston, NTas~achusetts JAMES 5. GXLMO~t, JR President Gilmore Broadcasting Corporation Kalamazoo, Michigan JoH~ R Hoc~ss, M.D. President Institute of Medlciae National Academy of Sciences Washington, DO, Don^tD E. JOHNSON President, Adver risers Press, ~nc. Flint, Michigan KENNETH L. KRABBENHOFY, M.D, Professor and Chairman Department of Radiology Wayne State Unlversity Detroit, Michigan Mss. MARY LasKrR President - Albert and Mary Lasker Foundation New York, New York Isvl~c M. LONOON, M.D. Director Harvard-MIT Program in Health Sciences and Technology Cambridge, Massachusetts G[RALI~ P, MURrHY, M.D. Institute Director Ros~.'eil Park MemoriaI institute Buffalo, New York Ios~rH H Ocur, A, M.D. Professor and Head Department of Otolarvngology School of Medicine Washit~gton University St. Louis, Missouri LAtrRANCZ: S. ROCKEFELLER Chairman of the Board Memorial S[oan-Kettering Cancer Center New York, New York HAt, arc, P. Ruscm MD., Ph.D. Chairman of the Board Wisconsin Cbnica[ Cancer Center Madison, Wisconsin FRtDt~IC~: S~ITZ, PhD. President RockeFeller Unlver it\' New York, New York WILLIAM ~] SIII~*GI £TON, MD. professor and Chief Division of General 5ur~zcrv Duke University Medical Center Durham, North Carolina " I'd ¢4

P.xu~p~ SMUBIK, PI~.D. Director, The Eppley Institute for Research in Cancer University of Nebraska Omaha, Nebraska How^Ru E SKtrv~¢, Ph.D. Vice President and Director Kettering-Meyer Laboratories Southern Research Institute Birmingham, Alabama SOL SPI~GEkMXr~, Ph.D. Director Institute of Cancer Reseacch College of Physician5 and Surgeons Columbia University New York, New York Jx~Es D. Watson, Ph.D. Director Cold Spring Harbor Laboratory Cold Spring Harbor, New York W. CLARKE WESCo~, M D. Vice Chairman Sterling Drug, Inc. New York, New York 'Deceased (3/~0173) Ex Officio Members ['IONO~A~LE CASPAR W, WI.INI~ERG~R Secretary of Health, Education, and Welfare Washington, D.C. EDWarD E. DAy*v, IR., S¢.D. (Replaced by Dr. Brevet, July 1973) Office of Science and Technology Washinglon, D.C. H. Gw~roRo SilveR, FED. Director National 5dence Foundation Washington, D.C. Marc J, MUSsE~, M.D. Chief Medical Director D~partmcat of Medicine and Surgery Ve%erans Administration Washington, DC, ~LTI~R~AT~; L'~NDOS E. LE~, Jt~., M.D. AsMstant Chief Medical Director ~or Professional Service Department of Medicine and Surgery Veteran~ Admir~is~ration Washington, D.C. Ro~ar B. BTONE, MD. " Director Nalional Institutes of Health, PHB 8eth~da, Maryland RICrt~RD S. WILBUR, M.D Assistant Secretary of Defertse (Health and B~vlror~ment) Departmet~t of Defense Washington, D.C. ALTEICNAT~: Associate Dir¢~Ir)r o~ Re~earc~ Armed Forces lnstilu~e o~ Pathology Washin~tu~, DC,