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LaSALLE D. LEFFALL, JR., M.D. President-E1!ect, American Cancer Society Before The Health Subcommittee of the Senate Human Resources Committge SENATOR EDWARD M. KENNEDY, CHAIRMAN ! May 25, 1978 Washington, D.C.

Now that we have definite data that, at least in cancer sites studied!so far, the excess deaths among blacks is not genetically based, it is clear resarch~ is needed to f ind 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 neededi, where preventive medicine is needed',, is certainly in cigarette smoking. As this Health Subcommiittee knows, lung cancer is the!most obvious cancer corollary of smoking, but bladder and other cancers are related to smoking as well in statistical degrees that le'ave practically no room for doubt. Irr lung cancer the white and non-white death rates are very closely similar, the excessive white rate for men being 3.6% and for women ©.3I. 1, But it is clear that special efforts onismoking must be made, among black groups. The American Health Foundatinni in 1976 C,} published data showirig that about 24% of white males were non-smokers, but onZy~ about 17~7. ~ of~ the blacks~«~ About 26% of the ~ white~~ males~~ were~ - k.-::;:•..., , ; .

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 I950 to 196'9' shows that the death rate from cancer among white males was 174.04 but nonwhite males suffered a death rate from cancer of 184.2'8, or 5.9% higher. Among nonwhite females the excessive cancer death rate was 7.0%'. Some the the big,probLem areas are i;n prostate In pancreatic cancer the excess i:s 5I.67 among cancer where the nonwhite death rate exceeds the white by 53.5%. the~ black males~~ suffer~ a 34.2~T~ excessive death rate andi fe~.^iales~ 27'.~6'L~ In stomach, cancer the nonwhite. males suffieT a 57.,9% excessive cancer death rate and the women suffer a,38,8% higher cancer death rate than white women. In. cancer of the bladder and other urinary organs males and 5.8% among females. ~

Mr. Chairman, alclear need for preventive medicine is shown in official statistics on cancer death rates. Among patients diagnosed'during the years 195&through 1959 and included in the National Cancer Institute's end results study, and black was 28%. I' include the table here, but will not orally quote The same thing showed up with patients diagnosed during the years 1960 through 1966: White five-year survival was 40% white five-year survival was 39%, but black was only 29%. - Relative Survival~' /-------- Year Of Diagnosis----------/' Rate 1950-59 1960-66 19'67-73' l-ye ar 60 61 64 , 3-ye ar 44 45 47, 5-year 39 40 . 41 White Black 1-year 51 3'-ye ar 34 5-year 2'9' 50 54 33' . 3',7': .,,, 2 8 32 ~ *"'Relative takes into account that some~ patients would have died trom various causes even if they didn't have cancer. Incomplete Source: National Cancer Institute Mr. C'hairman, I personally happen to have~ been involved inia study comparing patients here and in Africa which shows that these excess black deathsiare, in fact, not racial, that is not

4. ex-smokers, but only about 16%' of the blacks. And non-filter cigarette .smokers numbered about 12 percent of the white males compared'to 24% of the blacks. So you can see the real excessive hazard' anong,blacics. (Data from one study; not necessarily accurate for the entire nation.)The American Cancer Society has scheduled for next ~Uo~u~fiy _ 3aaAiawy a conference on the subject of cancer and black Americans. At that minorities with regard to cancer cause and prevention. We will no doubtt have new insights on the problemlof cigarette related cancer among time we think we will learn a great deal more than we now know about the d'isease''s impact on minorities, and about the perceptions of medium to the black community. The data already cited!represent strong bl'acks. Meanwhile, we seelin busses, in magazi_les and' newspapers cigarette adve,tising explicitly directed by content or evidence that this advertising is effective. t,. Mr. Chairman, our Society has just recently received' of that report, committees of our Society have already'begun adopting a report from a special commission headed by a former .~~IEW assistant secretary for health on the subject of cigarette smoking,. With study'

white five-year survival was 39%, but black was only 2'9%', is shown in official statistics on cancer death rates. Mr. Chairman, a clear need for preventive medicine Among patients diagnosed'during the years 1950~through. 1959 and included in the National Cancer Institute's end results study, and black was 28%. 1 include the table here, but will not orally quote The same thing showed up with patients diagnosed during the years 1960 through 1966: White five-year survivall was 407. ~. Relative~Survival~~ /--------Year Of Diagnosis----------/ R'ate 1950-59 1960-66 1967-73 White, 1-ye ar 60 3,year 44 5-year 39 B1ack 1-year 51. 3-year 34 5-year 29 t from !A"Relative takes into account that some patients would have died various causes even if they didn't have cancer. Incomplete Sourcel: National Cancer Institute involved in a study comparing patients here and in Africa which shows that these excess black deaths are, in fact, not racial, that is not Mr. Chairman, I personally happen to have been

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 endbrsement a differential tax on cigarettes according to their tar and nicotine content; has recommended endorsement of stronger death and disease warnings on cigarette packages and in cigarette adNertising. Our full Public Issues Commiittee will consider these recommendations the second week in June. There is no question in my mindithat the Ami.rican 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 andi which should now be proliferated. We commend you on your approach to these problems., C4. Q9:-: