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Testimony'Of. LaSALIiE', D. LEFFP:LL, JR'.,, M.D. President-Elect, American Cancer Society Before The Health Subcommittee of the Senate Human Resources Conmittee SENATOR EDWARD M. KENNEDY. CHAIRMAN May 25, 1978 Washington, D.C.

C C 5~ .~ some of the recommendations of the commission, which, held hearings in several cities:to get expert testimony on the smoking problem. For instance, a subcommittee of our new Public Issues Committee has already recommended for Society endorsement a differential tax on cigarettes according,to their tar and nicotine content; has recommended end'orsement of stronger death and' disease warnings on.cigarette packages and' in cigarette advertising. Our full Public Issues Committee will consider these recommendations the second week,in June. There is: no question in my mind that the Amirican Cancer Society will in a number of ways join with this Subcommittee in seeking to strengthen the preventive medical measures that have been proven effective in tests or demonstrations and which should now be - proliferated. t. We commend you on your approach to these,problems.,

2. related'.to their genetic make-up. Rather something is happening, to U.S. blacks which,is not happening to U.S. whites to produce a cancer effect greater in the blacks. Specifically, measurement of all cancers in the U.S. on a sample basis during the years 1950 to 19'b9~shows that the death rate.from cancer amongg white males was 174.04 but nonwhite males: suffered a death rate from cancer of 184.28,, or 5.97% higher. Among nonwhite females:the excessive cancer death rate was 7.07.'. Some the the big problem areas are in prostate cancer.where the nonwhite death.rate exceeds the white by 53.57. In stomach cancer the nonwhite males sufber a 57.9% 4K. In pancreatic cancer the excess is 5'..6% among males and 5.82 among females. excessive cancer death rate and the women suffer a 38.82' higher cancer death rate than white wtfinen. In . cancer of ther bladder and.other urinary organs: the black.males suffer a 34.2% excessive death.rate and females 27.67.,

Now that we have definite data that, at least in cancer sites studied so far, the excess deaths among blacks is not geneticallg based, it is clear resarch is needed to find the cause , so~that preventive medicine can be used to salvage these lives in,the future that are.tragically lost now. One area where work among, all ethnic groups is needed, where preventive medicine is needed, is certainly in cigarette smoking. As this Health Subcommittee knows, lung cancer is the.most obvious cancer corollary of smoking, but,bladder and other 3. cancers are related to smoking as well in statistical degrees that.leave practically no room for doubt. In lung cancer the white and non-white death rates are very closely similar, the excessive white rate for men being 3'.677 and for women 0'.37. S But.it is clear that special efforts on smoking, must be made.among black.groups. The American, Health Foundatinn in 1976 ~, published data showing.that.about,24Z of white males were non-smokers, but only about 177 . of the blacks. About 267 of the white males were

C ex-smokers, but only about 167 of the blacks. And non-filter cigarette smokers nutnbered about 12 percent of the white males compared,to 247,' of the blacks. So you can see the real excessive hazard among blacks.. (Data from one study; not necessarily accurate for the entire nation.) The American Cancer Society has scheduled for next -FGVrutRy . . J&wiwewy a conference on the subject of cancer and black Americans. At that have new insights on the problem.of cigarette related cancer among . blacks. I'Seanwhile, we see in busses, in magazi'_zes and newspapers cigarette advertising explicitly directed by content or medium to the black community. The data already cited represent strong time we think we will learn a great deal more than.we now know about the disease's impact on minorities, and about the perceptions of minori.ties with regard to cancer cause and, prevention. We will no doubt evidence that this advertising is effective. E1 Mr. Chairman, our Society has just recently received a report from a special commission headed by a former kTEW assistant secretary for health on the subject of cigarette smoking. With,study of tbat report, committees of our Society have already begun.adopting,

Mr.. Chairman, a clear need for preventive medicine is shown in official statistics on cancer death rates. Among patients diagnosediduring the years,1950 through 1959' and includ'ed in the National Cancer Institute's end results study, white five-year, survival was 397.,, but black was only 29%. The same thing showed'up with patients diagnosed , '' during the years 1960 through 1966: White five-year survival was 40% and black was 287. I includ'e,the table here,, but will not orally quote, ~ .,. Relative Survival /--------Year Of Diagnosis----------/ Rate 1950-59 1960-66 1'967-73' White 1-year 60 3-year . . 44 5-year 39. Bli ack 1-year 51; 3-year 345-year 29_ ="'Relative takes into account that some patients would have died from various causes even if they didn't have cancer. ~ ~ Incomplete Source: National Cancer Institute Mr. Chairman, I personally happen.to have been involved in a study comparing patients here and in Africa which sho:ws that these excess black deaths. are, in fact, not.racial, that is not