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(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;