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I I P.O. Box 2370 Reston, Virginia 22090 Telephone 703•620-4646 NCI GETS LONG LIST OF CONSORTIUM CENTER NEEDS. INCLUDING NEW GUIDELINES, REVIEW. MORE "GLUE" I NCi had asked for a presentation of issues, problems and needs, particularly thoee reiated to a consortium center, at the President's Cancer Panel meetingin San Atncisoolast week.Northern California ((mtinued to page 2) Jn rle .' SUSAN HUBBARD NAMED DIRECTOR OF INTERNATIONAL CANCER INFORMATION CENTER; INCLUDES ICRDB, PDD WSlIN HOBBARD, who has been chief of the 9cientific Information Branch in NCPs Office of Internatknal Affairs, has been appointed to the new position of drector of the International Cancer information Center,ltwr Masnyk, acting OIA direetor,announced.The Center Includes the lntesnational Cancer Research Data Bank Branch, which piovidesa comprehensive range of technical information services including Canoergrams and PDQ; the Computer Com munieations Branch, wh!ch operates and maintains support for the centralized scientific and medical information services of NCI; and the Putficatkms Bnmch, resporaible for editing and production of "Cancer Treatment Reports; "dournal of NCI," and "Cancer Treatment Symposia: Hubbard is acting chief of the ICRDB Branch while recruiting for a permanent chief; Robert Esterhay is acting chief of CCB while recruitment pr+oeeeds; and rearuiting has just started for a Pyblieations Braneh chtef.... HATIONAL CANCBR Advisory Board meeting Sept.24-26 will include pre9entationa on the White House and healthscienee policy, by Bernadine Bulkley, deputy director of the OfSce of Science & 9eeimolagy Pdicyand the W hite House ex officio representative on the Board; an update on new NCI funding mechanisms, by Barbara Bynum, director of the Div. of gxtra- mural Activittes; a discusgion of the NIH peer review appeals system by William Raub, NIH deputy director for eatramural research and training; and reports by Chairman Gale Katterhagen of the NCAB Committee on Cancer Control8 the Community and Chairman Ed Cailaon of the Com tnittee on Innovations in surgical oncology.... BOTil~13NCANCili9b* Oowhashadnoasmiaft withthe West Virg6da CCOP, as inoorreetly stated in 1Le Caseer Letter Aug. 25. "Moreover," writes George Omura, 8Sa chairman, "the problems which the'M-Btste CCOP (in Ckciruieti, which was not funded for the aeoond year of the program and which had SEG as one of Its research bases) has had have been local ones and in no way reflect on the activities of 8$0. We regret that the 71ri-State CCOP has not been but perhepsaomethingcan be learned from that experience byen ng what the local problems were rather " looking for explanations that are not relevant." t Vol. 10 No. 35 Sept.14,1984 ~ r ®Copvngnt 1984 The Cencer Letter inc Subscription $150 year Nortn America : $175 lroer elserMrere i House Passes Bill On New Cigarett Labels ... Pape 7 Congress Close To Approving Appropriations For FY 1985 , ... Page 8 New Publications ... Page 8

CONSORTIUM CENTERS NEED TOTALLY REVISED GUIDELINES. ROSENBERG SAYS (Continued from page 1) Cancer Program representatives complied and perhaps came up with more than NCI executives wanted to hear. Saul Rosenbe:g, eheirman of the Div. of Oncology at Stanford and NCCP director,led off the third in the Panel's series of meetings on cancer centers with this list: •Consortium cancer centers require "totally revised" core grant guidelines and "totally different" review com mitteae from those presently applied to all center core grants. "Efforts to understand consortium centers are insufficient and deficient, particularly in understanding the directa:"s authorities and respon- sibilities," Rosenberg said. "There must be an admowledgement of the strang prog<ams in member institutions " 4Core support must be available to support "m ini- institutions which are members of the center. Rosenberg was referring primarily to the Integrated Servioe Areas as develaped by NCCP.'Rt:e NCCP ISA concept is a successful one but cannot totall~y depend on local financial and volunteer support. NCCP had organized nine ISAS which would have required $125,000 support from NCI. The request was cut to $50,000, which supported four 1SAs. 71:at amount since has dropped to $30,000, resulting in only two ISAs being funded. Rosenberg said the ISAs need abart $30,000440,000 a year each for a viable operation. ISAe were developed to deal with the fact that NCCP covers the large and diversified area of Nathan Califarnia and Northern Nevada. Each serves an identilfed "catchment area" 'ihey provide local leadership in ad3+essing local needs and constitute bases for collaboration on NCCP's programs. •NCI must reoognise the potential conflict between arch national programs as the Community Clinical Oncology Program and the'4mique strengths of a regional cooperative group outreach progra m, such as that of the Northern California Oncology GWNOOGycrg~eI edandaponsored by NCCP,isan NCl suppsrted regional cooperative group and has had one of the contracts with NCI's Div. of Cancer Prevention and Control for a com munity outreach program. *77:e Panel and NCI should tolerate, "indeed encourage," diversity and locel progra m growth and development. "Regional conditions, needs,resourees and relationships differ nationally, even differ within the NCCP region. i am not suggesticg anarchy or lack of responsiveness and cooperation, but a balance between the direction of a centralized I The Cancer Letter Page 2 / Sept. 14,1884 I cancer program with potentially worthwhile individualized approaches." Rosenberg said that although the term "borreoMium" is used by others across the country and by NCI in vaelaus documente and caneer eenter guidelines, "there is little real appreeiation of the tn:e nature, needs and potentials of a consor- tium cancer center " NCI Director Vincent DeVita, In his opening remarks, referred to the Georgetown Univ; Howard Univ. Comprehensive Cancer in Washington D.C.and the Iilinois Cancer Cameil Comprehensive Cancer Ceater as other exam ples of consortta. Rosenberg suggested that those were not consortia centers, at least In the sense that NCCP is, particularly the one in Washington. Rosenbergsaid NCPs Cancer Control Program, which provided core support to centers for cancer controlefforts,greatly aided organisation of ISAs. He noted that NCCP's problems in supporting 1SAs became critical when NCl phased out that mechanism. NCCP's oore grant is about $500,000, approxi- mately 10 per cent of its #5-6 million annual hudget. Rosenberg estimated that NCl supported cancer research in the NCCP region totals $50 million. Among NCCP activities cited by Rosenberg ares -Operation of the SEBR (Surveillance, Spide- miologyH:d Results) registryunder contract with NCI for the five Bay Area counties ineluded in the natianal SBBR network, "a significant resource for NCCP and anyone else who would like to use it " -1lt:ecltnieal research effarts through NCOG and the Cbmmudty Outreach Pragram whicl: have entered ' about 4A00 patients on pnotooDls sinee 1977. N CCP alsos&wes as the reeeareh base for the San Joaquin Valley CCOP.Y1:ere hes been"great oooperation" on the partof eommwdty physleienawith the program r Rosenberg said. -Spidem iology studies "are beginning to take off" based on 88BR data. -More dlYifcult to arelyse is NCCP's impact on basic science. "Centerness is not seen as necessary; Rosenbeg said,hut eallabaration among seientists at the member institutions has been growing. NCCP's aims in the area of laboratory research are threefold-to foster com muadeation among scientists en~gaged in basie, applied and Ninioal cancer researehl to catalyze the creation of imwvative multidiscipainary, multi-inatitutional programs and projects; and to provide an organiza- tionsl framework to develop and adm inistratively manage multHnstitutional projertaadminisltetively -Cancer control activities initiated by NCCP have declined since the demise of the funding mechsntsm.7he eusrent NCCP anmial report states,

J r 1._, ~:I.,ai "Canoer oontrol is in a state of transition at N CCP, in part as a result of changing emphasis at the national level. TheRe efforts are moving us from a combination of service and demonstration projects to ma+e tdigoraus research into new metlrod4 of acMeving cancer oontroL More nonfederel funds are needed if we are to continue to apply proven cancer control methods in our region." Rosenberg summarized NCCP's historys "It's worked " DeVita aeimd the preemteraat ihe meaftto "be frank" in their assPSSment of NCCP anid the con- sortium eono@Pt. 'i9ie existing consortium centers seem less expensive to operate than single institution centers, DeVita said. "But if they do not get the job done, perhaps we should consider replacing them with single institution centers. If they do work, and they do cost less, maybe we should go for more of them " As he did at the Los Angeles meeting af the Panel, DeVita cited a number of cancer sites in which the incidenee and/or mortality in the NCCP region is higher than the national average. These ineLrde the overall ineidenee in whites and blacks which eaoeed the national average; the incidence among OMentals in the region exceeds that of Orientals in Hawaii, although the Incidence among Japanese and Filipinos in the region is lower than that of Hawaii. "l think we can explain those differences, and they are exploitable," DeVite said. He noted that cancer mortality In 12 ceunties covered by N CCP is higher thah the national average, despite the fact that the region has a higher percentage of physiciarrs tlren the average. "Does that mean we do better when we have fewer doctorsY" he asked, to the detightof the 150 persons who paeked the meeting room, most of them physicians. 8tsdey Parry, NCCP deputy director, although not disputing Rosenbeg's call for different guidelines for core grants, pointed out that a consortium center does fit the present guidelines in many ways, including leadership, encouragement of new and imwvative research, and provision of shared resources. The role of the consortium is particu- larly important in the eoalescing of activities at the individual member institutions. NOCP memba 6alih~tiasare the American Ceneer Society Calif. Div., Bay Area Tumor Institute, California Medical Assn., California Dept. of Health, Central California Cancer Council, Claire Zellerbach Saroni Tumor Institute of Mt. Zion Hoepdtal d Medical Center, Greater Contra Costa Oanty Cancer Program, Greater Sacramento Cancer Council, Hospital Council of Northern California, KaiserPermanente Medical Care Program, Northerr Nevada Cancer Council, Palo Alto Medical Fourr dation, San Fmncisoo Regional Cancer Foundation Stanford Univ., Sutter Com munity Hospitals Univ. of California (Berkeley), Univ. of CaUfornie (Davis), Univ. of California (San Francisco) Univ.of Nevada (Reno), Veterans Administratior Hospitals Region 27, and West Coast Cancei Foundation. Donald Austin, director of the NCCP SEEA Program, said "NCCP is a unique grass roots organ- Isetion but we need a little more glue to increase our capacity to accomplish our goals. We need a wider pmpam in data analysis. Now In NCCP we can only scratch the surface. It is not sufficient to rely on ROl grants. We should spend an egual amount on analyzing data that we do on collecting it. We need wider cancer reporting and a mechanism for formal linkage of the providers of health care withthe implementers of cancereentrol and their institutions ." 9 take it you are suggesting we need more oonsortia," DeVita com mented. He asked why such a smsD amount of money was taken from the eore grant for 1SAs. "That could be the additional glue you need " Rosenberg responded with the information cited above, that funds for ISAs were out in the review. "dknow you are looking for a director," DeVita sffid,referring to the search going an since Rosen- berg decided to give up that position several months ago. "You're having difficulty getting one. Is it difficult beeause you have a different recruiting pitch to make, or that the director has no authority over the member insti:utions4" "We are close to identifying a very good one," Raeenbergsaid, but admitted that come prospects were concerned about the lack of searity. "That has been a major hangup" D3Vits,noting that NCOG putsonprotocolsabout 30 per cent of the eligible patients in the region, said that the radiotherapy protocols have been a suceess,'but not so much for chemotherapy. Thirty per cent is low " "I would have thought that 30 per cent is exeellent " Rosenberg said. "I think 30 per cent means we're doing as well as anyone, although it would be desirable to put on more." "56ER is one of the best Investments NQ has ever made," DeVita said to extended applause, with a number of SEER staff members in the audience. He aslred again why the mortality rate was higher than the average eonsidming the number of physicians in the area. "'!he cmuse of mortality varies quite a bit county by camty" Austin replied. As oqe exam ple, he said that in one county, the death rate from coronary The Cancer Lettei Vo1,10 No. 35 / PaOe ;

I i disease is high because that is how the coroner signs out all nursing home deaths. DeVita asked if the advent of CCOPs has damaged NCCP's clinical research efforts, with the two CCOPs In the region competing for patients which might otherwise go onto NCOG protocols. Rasenbetg said that the CCOPs use NCCP but "we have to be careful. They could drain off patients fiom the potentiSIly weaker NCOG outreach pt+agram " On whether there should be more consortium centers, Rosenberg said "It would take an unusual relationship. We deal with hospitals, institutions, and individuais. But it should be tried elsewhere " DeVita suggested that Southern California, with seven cancer centers, might be a prospect for another consortium. Rosenberg said that NCCP meets regularly with repressentativesof the Southern California centers. Amolg the items being dLseussed is whether to ejqxmd NCOG into a statewide group. Peter Greenwald, director of NCI's Div. of CanoerPrevention & C9ntrol,commented on the need expressed by Rosenberg and others for greater core support for ISAs. "A problem in cancer control is an absence of a good, critical data set demonstrating the needs. How can we get that information to help us base our decisions on expenditures?" Parry responded that cancer control and cancer control research needs should be evaluated as rescxa•oes. "iSAs should be evaluated as resources. We should expand SEER, to obtain more data and analysis " Greenwald told The Cancer Letter after the rmeeting that NCI mightcoanider changing the core grant guidelines to permit award of more money for consortia to support ISAs and similar activities.'Ihat could be among the items being discussed at the Cancer Center P1anh:nQ Com- mittee meetings this week. Jerome Yates, who heads the Centers & Com munr ity Oneokgy Program in DCPC, said that'pert of the reason the core grant has done so well Is that it is tied to the ROl and P01 base. We have to look at excellence. Do you have any idea how an ob jective, fair review should be done, tied to exdstitg ROl-P01 support as we have now? It sounds as if the cancer control effort here has been very sueeessful. That Is not true everywhere else. Should we go back to entitlement?" '7 woukt not tie core sapport to ROls and POls in the institutions or to those in the consortium Itself," Rosenberg re4ponded, "Both would be wron~. There should be somewhere in between. You oan t answer that simply. It would help if individuals doing the review had some appreciation of eonsortia and how they work, and of the opportunities they offer." DeVita pointed out that the National Cancer The Cancer Letter Page 4/ Sept. 14, 1984 Advisory Board has approved revision of core grant guidelines to permit basing some core grants on cancer control research, not necessarily ROIs and POls. Comments by others atteading the meeting, ioeluditg members of three dis~.~ussion panels, and responses follow: Donald Lyman, head of public health in Cali- fasnia-A decentralized approach as represented by NCCP is needed to help achieve NCI's goal of reducing cancer mortality 50 per cent by the year 2000. in each of the great public health accomplish- ments which has eradicated a dlease, it was accom- plished by local people with a consortium to coordinate the various efforts. Some consensus is needed by the academic eom munity and elsewhere, Including NCI, that a project is doable. We do not need hard and fast documentation to move, but a ooraensus by the professional oan munity that it can be done. Finally, we need marketing tools-infor- mation devices and the paraphernalia to sell prevention efforts. Part of the marketing effort is the glue that has been talked about here. I encourage you (the Panel and NCD to provide it. You may say, "California is a rich state. W hy ean't you do it yourself?" To a large extent, we have. Some other states cannot do it themselves. Victor Levin, associate director for laboratory sciences of NCCP and professor of of netav-anoology at UCSF-NCCP has achieved the formidable goal of iringing togethersMentists from different institu- tions, creating a dialogue, learning each other's terminology, undesstanding each other's problems, preventing eoln mon frustration. Many informal oontacts mwhn+ed by NCCP have lad to new research efforts. Those include oollaborative drug development efforts and sueeesslVl competition for oneof the new National Drug Disoovery Group awards from NCI's Div.of Canaer'Ireatment. The current oaa'e grant guidelines were established with single institutions in mind. It would be helpful if they were modified for consortia. We need flexible support for new programs. Edwin Cadman, director of the UCSF Cancer ResearehTnstitute-NC00 works. The excitement generated 10 years ago when it was organized persists. Joseph Castro, director of the Radotherapy Dept. at Laweence Berkeley Laboratories-7tie strength of NCOa is Important. Further efforts to promote interaction between basic and clinical scientists Is critical. We must inerease the participation of surgeons. There is a growing number of surgical oneologists in the region, but we need the support and participation of com munity surgeons. We need to reevaluate the guidelines foreansortium centers.

C It is time for a change In our name. There is oonfision about what a Narthern California Cancer Program is. Northern California Cancer Center, perhaps. Qarol D'Onoftio, NCCP vice chairman who Is with the Sclrool of Public Health at UCB-If we sueeeed in reducing mortality 50 per cent by 2000 AD we need more effort in rehabilitation. We can't talk about saving lives without doing something about the quality of life. 7lat is not unrelated to mortality reduction. People will seek treatment and undergo screening earlier if they are confident they will maintain their quality of life. We need evaluation. Cancer control programs in the past were specifically marked not for research, then were criticized for not having evaluation. W e need money far program development. We have the capadt:y to do many more sophfisticated innovations, but it takes ttme,orgsniration,andghie.Weneed more room to experiment with different forms of organizations, such as ISAs. We need tp learn how to develop local flmds to help a44;ort them. We need research on the peocess of organizing the com munity, developing programs and implementing them. We need general overall efforts to help communities develop programs in primary prevention. DeVita-You are absolutely right. In the early 1970s, a lot of people did not know what cancer cancer is. It was a major mistake not to permit research. But those things have changed. Some of the things you suggest are happening. C>9dman-1Ihe CCOP idea is a good one, but we could accrue more patients if the power were given to the consortium center. DeVita--One of the reasons for CCOP was that community physicians did not like relating with centers. They do not like going to centers to be rewarded. CCOP gives the eom munity physicians ineentives and some contral. l do not feel we should force all of them to go to NCOG. Castro-I'm all for strengthening ISAs. Their ooniribution has been great. It seems to me the CCOP approaeh is whatisneeded to inereese the number of patients on clinical trials. Roger Miercort, chairman of the Radiation 'Itrerepy Dept.at Washoe Medical Center In Reno- ISAs are a unique concept. Our ISA is the main repository for all publications on cancer care in our area. It coordinates all NCCP programs in our area. We initiated training oncology nurses and psrepatessionals.'ltu+orrgh NC00, we have placed 150 patients onp+otacols. We need a stable and adequate source of funds, from $50-60,000 for each ISA. Rcbwrt Carlsmr, NCOG exmutive officer and head 01 the NCCPOam maffdty Qrbeadr Pn$tam-ihe ounert outreach program is drastically underfunded. Communitypartieipants in N000 outreach are full members of the group, and equal partners. It is i rich resource with a broad range for eancei prevention, cartrol and research activities. Fundini eontirares to be the single most significant problem Lrcreased reparting resquire m ents for phase 1 and S studies is a problem. The high cost of living ir California is not reflected in the awards. The NG review ptvicem (of protocols) sometimes takes sir months. The review of each arm of our Kaposi'i protocol took longer than the trial. It is difficull for NCOG to respond to a serious local healti problem.NCCP and NCOG function very well, with e spirit of cooperation instead of competition Current and anticipated problems are surmountable with the joint efforts of NCCP and NCI. Phyllis Mowry,prkrcipal investigator for the Sar Joayuin Valley CCOP headquartered in Fresna-Kerr Cbmtyhas just been added to our CCOP. Cooperatior between NCOG and our physicians has been excellent How can NCI help us put more patients on protocol? We need to educate the public on the benefits. We need more support for data collection and analysis, We are in a good position to do cancer control research,'lhere is a high content of seleniu m in thE soil in our area; and we are talking with Dr (William) DeWys `director of DCPC's Preventior Program) about a selenium project. We are aoreidering responding to the RFA farstudies of loM fat diets for breast cancer patients. We could test for the anticancer effects of betacarotene. We car consider such ambitious projects because of the outstandingseseMists affiliat.ed with NCCP. We neet toproteet cur programs against the ravages of the DRG system. Jonas Richmond, of the UCB Dept.of Nutrition- The Fut Bay (Oakland, Herkeley) death rate from prostate cancer among blacks is twice that oi whites. We need to look at dietary and other factors in the environment. Gaald Hanks, director of radiation therapy at the Rsdation Onoology Center in Saeramento-Eighty per cent funding of group trials Is an existing policy Mt must be changed if you want to retain private sector patients. In a few years, they will disappear unlessyoupay more of the costs. We need im mediate funding of carefully screened initial involvement private groups, at a cost of i10-15,000 each to bring in more private facWties. If they are screened carefully, three quarters of them will be long term producers. There is a vast untapped reaoriree of patients in community private practice. The level of government funding will play an important role in tapping this resource. DeVita, to Mowry-I liked everything you said, particularly prevention trials by CCOPs. We have felt that CCOPs, once set up, could be a nidus for implementing prevention trials. How would you mct The Cenoer Latta Vol. 10 No. 36 / Page i

to the suggestion that ya use only NCOG protocols? IMowry-Ihaven't thought about it.I suppose that if there were good reasons presented, we would consider it. I don't see why that would be necessary. I think we enjoy our participation with NSABP and RTOG (in addition to NCOG). DeYrta-You made an important point on educating the public about clinical trials. NCI has to play a major iole in getting the public to understand that clinical trials are the best way to get standard treatment plus something that may be better. DeVita to CarlmrAre N COG protoaols reslistic and are the prime protocols at the base Inst,i tions? Are standard protocols used by N CarJson-Protocols are identified at imiversities and in the com munities. ProtocoWbr earlystudies with toxicity problems are donftnly at the institutions, although I would feel comfor- table with many physiciens in eom munities perform- ing those protocols. If anything, com munity physiciensdo a better job following protocols than university physicians. DeVita-On funding at the 80 per cent level, I agree. We never like to fund less than recom m ended. We are no loWgoing to do that, depending on how generous Congress is. (DeVita earlier had stated that NCI grants in the 1984 fiscal year would be funded in the 1984 fiscal year at or close to reco m m ended levels. N CI will pay 35 per cent of approved eom peting grants, to a priority score of 175. NCI intends to fund centers and oooperative groups at full recom m ended levels In FY 1985). Carl9oo--We expect,on the best time schedule possible, for protocols to be reviewed by NCI in five to six weeks. We have found it can take six months,evar whanonly mmimal clsugesare made.7he problem seems to be that relatively junior staff people at NCI are doing the review of protocols written by senior investigators. The junior people don't always understand them, and the problem has to be straightened out with discussions (Carlson admitted that with the Kaposi's protocol, NCI review was completed in three months, while the NCOG review required twice as 1ong1. DeVita-7tie average tim e of review (by N CI) is two months. I have told our Cancer Therapy Evaluation Program people that if they don't approve a protocol in two months, I'11 opprove it myself without further review. The Kaposi's protocol had serious problems.It took five months to come back to us after our eom m ents. W e,would rather do this than FDA.1 assure you it Is faster this way. It is a seriaug cancern, but the delays usually are not at NCI. Heii®,cncompetitionbetween groups-When we got involved with N COG, it was not very interested in The Caneer Letter Page 8/ Sept. 14. 1984 tadiotherapy qusstions. We were (and therefore most patients entered into trials from his center were enrolled in RTOG studies). My impression is that thet+e has been a significant change. There are now a fair number, of joint trials with both groups doing the studies. Csrl9am-NO0G has foifted NSABP to work jpintly on a nu mber of protocols, specifically not to dilute the number of patients. Sidney Saltsstein, president of the ACS California Div. and professor of surgical pathology at Univ. of California (San Diego), on DRG rei m- ment-'Ib restdet payment for care to a mean determined in the past is unrealistic. It imposes a burden on institutions that is not justified. Wan+en Winkelstein, professor in the School of PdblEe Health at UCB-7hechergetousat NCCP is to increase our efforts in education, partieulary on lifestyle. If we are to be effective at the local level, we must end this silly policy of a mule with two heads. It has been known for 20 years that cigarettes may eause death from ceneer in men, and now we know thatit al,o kills women. Government must present a consistent and rational policy and cease the subsidizing of tobacco growing. It is encouraging that In the last 10 years, there has bean a 20 per cent decline in cancer among men wider age 50. The decrease Is small, but it is just a beginning. You in Washington have to be more out- spoken, even If it costs you your jobs as it did Secretary Califano(when he implemented a strong antismokirgcampaign while HEW secretary in the Carter Administration). DeVita--Is that director's job still open paaghter).Icouldn't agree more. We'll do the best we can. It is up to Congress (to halt tobacco sub- sidies, increase cigarette taxes, control advertising. See following article).I'm encouraged. Antismoking campaigns are poppingup everywhere., Smoking is an the decline. One of our goals for the year 2000 is to decrease smoking 50 per cent by 1990. I have been encouraged by the reaction to prevention efforts. People do want information. They are enttaaviastic.'ltie food industry is taking up the aulKel. It is planning a large advertising program and Is seeldng ways to modifyproduets to make them less likely to cause cancer.'I'he reception is not uniformly negative, except for the cigarette tndustry. I have not heard from them any svggestlons for redue3ng smoking. 7b the contrary, the industry Is making an effort to attract children by making diewing tobaeoo look like bubblee gum.'Riey are doing this beoause their older customers are dying of lung eanew and heart disease, and they need yang people as replacements. g we reduce tobacco subsidies, It could make eigaretRes cheaper, and we should not permit that.7te difference ahould be made up for by I

~ ~- ~ JFI~Ji G~JJ~ Increasing cigarette taxes and making sure that all that money goes to eanoar ~eseeeeh and prevention. Rose Kushner, member of the National Cancer Advisory Board-There are 25,000 physicians in Northern l7alifaria and 10 m illion people. There Is intense competition fcr medkml do11ar8. How many of the 25,000 actively participate In protocols? What challenge is there to encourage patients to get attentlan Immediately? Radiotherapists must have a machine, whereas any physician with a pad can treat a cancer patient until he is untreatable. Do you have that here? Carlsan--We have no figures on participation. I aspect that is from 300 to 500. NCOG doesn't have any doatments to tell physdcians how to adm inister state of the art treatment outside of a research setting. NCOG has no funds to support education programs. Suslner-11he prchiem Is that oom munity physicians do not refer patients to specialists until the disease is advanced. Carlson-I don't know about that. But we're impressed by the yuelityof eare in the eom munities. Isuspeat that many cancer patients are treated by primary care physicians. Itaymand Weibag,deirnenof the Cancer Plannirg Cflalition•-It isstandard practice in San Francisco to refer cancer patients to oncologists. DeVita, responding to a statement from the audience, that if he really believes primary pre- vention will account for half of the 50 per eent reduction in mortality by 2000, "you will allocate yaurr,eaoaurees accordingly, and put your money where your mouth td"-About one third of the DCCP budget goea into primary prevention. We're frequently asloed, it 80 per cent of cancer is environmentally caused, why not put 80 per cent of the budget in that areP 7he answer is, we'll put every nickel we can in prevention when good studies are propoead. Plmel Ohehman Armard Ham mer said the tWl hatse turnout for the meeting "is vary encauraging: Referring to the year 2000 goal, he said that even if It is met, "five million people wW die of cancer from now until then, at a cost of $16 billion.lfiat is Intolerable. We should aim higher, for greater reduction, and sooner. Even when you hcrease survival to 95 per cent, for the other five per cent, It Is 100 per cent fatal " '1Me Panel's next meeting will be Oct. 1 in lbattle, at Fred Hutchinson Cancer Research Center, Stuart Auditorium. Robert Day, director of the center, will be the host. 7he final meeting of the Panel's weatern swing in its review of cancer centers Is scheduled for Nov. 9 in Honoluiu. lawrence Piette, director of the Cancer Center of Hawaii, will be the host. HOUSE PASSES COMPROMISE Bi LL ON NEW CIGARETI' LABELING; SENATE IN DOUBT A compromise bill acceptable both to hft ~ graupsand the tobacco industry-that in itself amazing feat-lassed the House of Representatih this week, a measme that would e eplace the 13 ye oldhealth warning on cigarette packages. The p wendngs o~sist of faur alternating messages abc the dangers of cigarette smoking. 11m bill was passed unanimously by voice vol with only a handUof members present.Its fate now up to the Senate, where it may have been act upon by the end of this week unless blocked tobacco state senators. The warning which would be replaced stat aimply,"Wendrg: The Surgeon Geneat hes determin that cigarette smoking is dangeroas to the healtl Zhenew wamira each begin with the statemer "Surgeon General's 9Yarning," followed withi "Smoking causes lung cancer, heart diseas emphysema, and may complicate pregnaney, ""Quitting smoking now greatly reduces serio risks to your health." a5moking by pregnnnt women may result In fet injury, premature birth and low birth weight "Cigarette smoking contains miton monoxide 0, v - non Henry Waxmin, chairman of the Hou Health 9abeom mittee and chief sponsor of the bil said the "anTent warning label hasn't been revisi in over 13 years and does not adequately reflect tt extent of adverse health effeets caused by smoking 7heircp®ed new wamings would be about 50 per ce~ larger than the old. 7he compromise was worked out last spring t Cbngreesman Aibert Gore (D.-71snn,)andother Hcee members with representativefs of the Tobace Institute and the Coalition on Smoking or Healti which represents the American Cancer Societj AmwkmHeart Asan.and American IAung Assn.,amoe other groups. 7110 compromiae maintained the concept of nea more specific warnings advocated by the healt glaps, but was made more acceptable to the industr by omitting references to addiction, death an miserrlege that raised product liability fears. Th labels also will be less visible than originall, proposed. H0150HVI,q dc Glxnmeroe ObmmttEee Chatrmemloh Dingell said he had assurances from Sen. Orrii Hatch, long a champion of the bill, as well as fron 8en. Jesse Helms, who had been blocking its con sideration, that the bill would be acted upoi swiftly by the Senate. However, Sen. Paul'IMble o; Virginia and others had placed a hold on it Congress is due to ad journ early In October, anc failure to act on the bill by then would kill it The Cancer Let:ti Vol. 10 No. 35 / Pagi I

w-• CONGRESS CLOSE TO PASSING FY 1985 MONEY BILL: AUTHORIZATION DOUBTFUL Cagress is cloae to passing the 1985 fiseal year appropriations bill for the Dept. of Health A Human Services, which includes NCI's funding. But rauthoeiaation of the National Qaneer Act appears farther away then evet, with prospects of approval belcreadjoununait next monthgrowingdunmerby the day. 'Ole Hcuse has passed its version of the HH&Iebor Bducatian appropriations bill, calling for $1.084.9 billion for N C1 in the fiscal year which starts Oct. 1.'Ilds amount does not include money for cancer control, construction, or research training. Those activities were specifically authorized in the National Cancer Act of 1971 and its subsequent renewals and are not mentioned in Secticn 301 of the Public Health Service Act, the blanket authority for Ni}I.'Itrle Senate t>Iorad the fact that reauthoriza- tion had not yet been completed, since when si m ilar situations have come up in recent years, authority for specific programs has been extended by continuing resolutions. Mle Hase Appropriatians Com mittee decided not to include those items, primarily because of some eonoern about the construction is9ue. For one thing, there is no consistency at NIH, with some institutes, ineluding NCI, having authority to award construction grants, while others do not. The Senate bill, as approved by its Apprapriatkxis Committee, would give NCI $1.188 biiHon next year, approximately $13 million more than the House would have been with control, conshuction and training including, depending on the final figures for those categories. Action by the full Seaate is im minent. Now the differences will be resolved, considering the authorization issue, remains to be seen. . That problem could be resolved if the Senate would pass its version of the authorization bill. That is not likely to happen, despite the smooth mwe by Harty Wawnan, chairman of the Hane Health 9beommtttee, to oiroumvent the roadblodc thrown up in the Senate by fetal research issue. So aalled pro-life senators have prevented Sen. Orrin Hatch's reauthoeipetion bill from reaching the floor, but they permitted the Senate to pass another Hatch bill authorizing a new National Arthritis Hmitute. When that bill came to the Hame, Waxman moved to substitute his biomedical reeearch autlroei~tion bill, which had been approved by the House, for the Senate measure.7tle House oonmuted, wtich meeiu that the differelow could be wottced out In aonfeelenoe and a revtsed ventlcn presented to the &nate. Hor<tlever, Hatch ltles not appointed the Smte oonfeteesand Is not likely to unless an agreement can be reached with the pro-life senators. Meanwhile, Hatch's committee has 11 other conferences lined up with the House, and time Is running out. , HHSattonneys feel that a ease can be made that cancer control, at least, is authorized under Sertian 301. If House conferees on the appropria- tiana bill can be convinced of that, cancer control ilmds could be included without a new authoriza- tion. In any case, a continuing resolution will be approved to keep construction, research trahaing and, if necessary, cancer control going. NEW PUBL1CATiONS The following publications are available from Raven Praw,1140 Avenue of the America, New %k 10036,phone 212-575-0335: "Gene Transfer and Cancer," edited by Mark Pearson and Nat Sternberg, $58. "Mechanisms of Neoplastie Zrar>`s[ormation at the Cellular Level," edited by George Klein, $79. "Bonnrrrssard Chncer 2s Proeeedhoof the Seocxlld International Congress," edited by Francesco Breaciani, Roger King, Marr Lippman, Moise Nam er, and Jean-Pierre Raynaud, $95. "Zoosarwidsand Cancer; edited by Helene'It>Ie1er- Dao, Andre Crastesde Paulet,and Rodolfo Paoletti, $48.' "Markersof Colanic Call Differentiation," edited by Sandra Wolman and Anthony Mastfomarino,,$58. "Interpretation of Breast Biopsies; by Darryl Carter, $37.50. "Auoolops Hane Marrow 71anslentation and Solid 'lbmcrs,"edited by Gcxdat MoVie,OtNa Dalet3o,and Jan Smith, $52. "Role of Medroxyprogesterione in Endocrine Related'IUmaW edited by A.Pellegrini, Ci. Robus- telli Della Cuna, F. Pannuti, P. Pouillart, and W. Jonat, $35. NCI CONTRACT AWARDS Title: Cancer ihformation Processing for the PDQ Information 8ystem Contractore Technical Resources Inc,, $251,891 Title: Monographs on Chemopreventive Agents Contractor: SRI International, $179,335 7heCanoeP Letl41` _Editor Jerry D. Boyd Published forty-eWht times a yeer bV The Ganeer Letter. lna, P.O. aox 2370. Reston, Virginia 22090. Also pubusher of The Clinical Cancer Letter. All rights reservetl. None of the eontent o1 this publication nl,y be ropronuced, stored in e retrieval ,y6tem, or transrmtted in eny form or by any means (eleetronie, mechanltel, Dhotot'opyhq. recording or othenvhel without the prior written permisslon of the publisher Vbleton risk Qiminel peneltle, arr! E50A00tlem,pss0 I