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THE FIGHT ON CANCER lives. In some of the strains continuous observation has been practiced for more than a hundred successive generations. This is possible because one can obtain from four to five gen- erations of mice in a year. The advantage gained is obvious. Heredity and Cancer Our experiences with mice natnrally lead us to ask about .the importance of heredity in human cancer. This is far from a simple question. Pedigrees showing a very marked tendency for certaiu types of cancer to appear in various families have been recorded in medical literature over many years, It is not, how- ever, clear what tfie experieuces of these exceptional families mean for the rest of us. The influence of heredity has been easily and strikingly demonstrated iu mice. This, however, is largely dne to the close inbreeding which serves to intensify and to stabilize the role which i~eredity plays. A similar condition does not and cannot exist in man. We do not at present know of any specific hereditary factor that leads to cancer. We are certain d~at cancer as such is not passed directly from parent to offspring. Heredity does, however, seem to be related to the frequency of cancer in various parts of the body. This type of inheritance is so complex and so uncertain that it very largely can be forgotten by the individual. Iu other words, we can sum np the situation as regards heredity and human cancer by the following statement: There is evi- dence that the tendency to form cancer in man may be inherited, but the tendency is so indirect that heredity ol cancer need not be a source of worry to any person. Future research should be carried out to give us additional facts in order that any more definite hereditary tendency to form cancer may be discovered if it exists. We are still in the early stages of the problem. Tissue Cultures There are several other fields of research on cancer in which considerable progress has been made. One very im- portant one is tissue cultures. By the use of a very skillful technique devloped some THE FIGHT ON CANCER 19 years ago, it has been possible for iuvestigators to grow cul- tures of cancer cells outside of the body. Such cultures can be observed and studied uuder the microscope much more readily than one can observe condi- tions inside the living animal. Moving pictures can be easily taken and preserved as a record of the nature and extent of growth. As a result much has been learned about the activity of the caucer cell. It has been found that these cells can move in the same general way as primitive single-celled animals. This gives the cancer cell a certain power of invasion of surrounding tissues and adds one more quality to the impressive list of character- istics which it possesses. Chemical Characteristics One of the ~nost difficult fields of cancer research is that which deals with the internal chemistry of the cancer cell. A living cell is a sort of self-suffmlent unit which is able to per- form ahnost miraculous functious. It can receive throngb its surrounding envelope food material which it can then transform into substance of its own making. It can store such material until a certain point is reached, after which it begins to reorganize its own material as a dual system which later breaks apart to forln from its original substance two "daughter cells" of equal size. It can give off certain waste products which it no longer needs in order to fulfill its normal functions. To some extent all of these activities can be measured and recorded. In this way certain general differences between cancer and normal cells have been observed and are beiug studied. The future development of this phase of research will undoubtedly be great and important as more accurate methods of observation are discovered. Internal Secretions The body possesses several glands which pour secretions of a particular sort into the blood. These secretions have in them chemical substances called hormones. The importance of such hormones to the development and function of the bod~t

2O THE FIGHT ON CANCER in general and of cancer in particular cannot be overesti- mated. Among the glands of internal secretion, the sex glands of both male and female have been made the object of exten- sive study. The relation of the sex glands to cancer is already a matter of recognized importance and forms the basis for much present research. Having observed that, in mice, cancer of the breast in males is practically unknown, research workers decided to investigate further. Male mice, of a strain in which over 80 per cent of the females developed breast cancer, were operated upon and the male sex glands were removed. Still no cancer of the breast resulted. This, however, might have been due to the fact that in male mice the total ,~mount of breast tissue developed is exceedingly small, so that the opportunity to form breast cancer iu that region is not great. Another step was, therefore, necessary. This consisted of transplanting be- ueath the skin of the castrated males, one female sex gland (ovary) from a sister animal. In many cases the transplanted ovary persisted and grew as though it were still in a female body. Iu such "feminized" tnales the breast tissue developed to the same degree as that observed in virgin females. In these "feminized" animals cancer Of the breast developed in about the same proportion as that seen iu virgin females. When, however, the same experiment was tried in a stock of mice in which the normal females naturally did not have breast cancer, the feminized males did not produce breast cancer. Other glands of internal secretion, such as the pituitary, the adrenals, the thyroid, and the spleen, can be removed and the effects on cancer and on the chemical characteristics of the individual can be observed. This type of biological and che~nical research is producing extremely significant and im- portant results. Support of Research In spite of almost unlimited prospects of progress, the support of cancer research is still painfully inadequate. It may be interesting to mention some of the major organiza- tions and institutions active in this field. THE FIGHT ON CANCER There exists an American Association for Cancer search, a loosely built organization, national in scope. Its gov- erning body is a council to which one member is elected annually for a seven-year term. This Association holds an annual meeting at which papers reporting the results of scien- tific research are presented. It has strong branches in New York and other cities, and others are being organized. The United States Government has set up a National Ad- visory Cancer Council of six appointed members aud the Surgeon General of the United States Public Heahh Service as ex-oflicio chairman. This Council passes on applications for grants-in-aid for research from various parts of the country. It has at its disposal between $100,000 aml $900,000 per year. It also advises the United States Government concerning its own program of cancer research which will chiefly be housed in the new National Cancer Institute at Bethesda, Maryland. A number of research and training fellowships are also recom- mended by the Council. It also deals with the use of radium and with other clinical topics. Among state institutions, the one at Buffalo, New York, is outstanding. In addition to caring for cancer patients it has a state-wide diagnostic service, and it carries on excellent re- search in the fields of biology, physics, and chemistry. Yale University houses a very extensive and important uuit for cancer research. The chief source of funds for tiffs work is the Jane Coffin Cbilds Fund which, it is hoped, in the future will consist of a capital of some $10,000,000. The work of Columbia University's well-endowed Insti- tute of Cancer Research is also significant. Among the more active local centers for cancer research are the Roscoe B. Jackson Memorial Laboratory, Bar Har- bor, Maine; the Lankenau Hospital, Philadelphia; the Memorial Hospital, New York City; the Huntington Hospi- tal, Boston; the Barnard Free Skin and Cancer Hospital, St. Louis; and the Strong Memorial Hospital, Rochester, N. Y. These and other institutions have many problems of im- portance which, owing to the lack of adequate financial sup- port, await experimental attack. When we recall that approximately a million dollars per year have recently been given by the American public for

22 THE FIGHT ON CANCER research in infantile paralysis, a disease that kills only a tiny fraction of the death toll from cancer, we are impressed with the fact that more knowledge of the existing needs in cancer research is called for and it is hoped this will produce in- creased funds. EDUCATION THE third great subdivision of the campaign against cancer is that of education. The reason for this will be apparent to those who have read the sections of this pamphlet which deal with treatment and research. CANCER CAN BE CONTROLLED EDUCATION I ~RA~DIO I LIBRARIES EARLY SURGERY leading to TREATMENT RADIUM THE FIGHT ON CANCER At first the medical profession itself presented an obstacle to educational efforts. There was anaong the rank and file of its members a somewhat surprising and serious amount of pessimism. The ordinary general practitioner in a small or medium-sized community sees only three or four cases of cancer per year. These have usually represented advanced stages of the disease and have therefore offered little chance of permanent improvement. As a result of this situation, the profession took a somewhat fatalistic attitude towards cancer. This reaction was, in turn, communicated to the laity and reflected itself in the fear with which the ordinary man or woman viewed the menace of the disease. The task was, therefore, a double one. It was necessary to change the attitude of the doctors and to provide the layman with such information as he might need to enable him to take part intelligently in the conquest of the disease. American Society for the Control of Cancer For these purposes there was organized in New York in 1OlS a national body known as the American Society for the Control of Cancer. This today is the one great national organ- ization primarily engaged in cancer education. Its central oflice is at 350 Madison Avenue, New York City. For a number of years the Society attempted to organize local branches in various states, but soon found that such branches would be ineffective until the organized medical profession was more active in assuming responsibility. In order to bring this about it was necessary to convince state and county medical societies that early cancer was curable in most cases. Intensive educational campaigns on cancer of the breast and of the uterus were held on successive years. Literature, films, exhibits, and speakers were provided for many state and county societies. Slowly at first, but with increasing mo- mentum, the profession responded. It abandoned its former pessimism and began to take a new interest in fighting cancer. Cancer committees of state and county societies began to ~ome into being and continued the educational work among medical men. Through all of this development several medi- cal field r.epresentatives of the American Society for the Con-

THE FIGHT ON CANCER trol of Cancer were moving about the country stimulating and directing the local interests and activity wherever it was desired. The importance of the cancer committees of the state medical societies cannot be overestimated. In several states excellent booklets dealing with cancer have been prepared by them and have had wide distribution among the profes, sion. These booklets have not only provided the doctors with the latest information on the diagnosis and treatment of cancer but have, by so doing, helped to change their attitude towards the disease. American College of Surgeons Perhaps the greatest factor in producing a more coopera- tive point of view among the medical profession has been the American College of Surgeons. This national organization, with its central office in Chicago, has had a tremendous infln- ence on the establishment of high standards for the per- sonnel and equipment of cancer clinics throughout the coun- try. A few years ago there was only a handful of such clinicS. Today there are more than three hundred. The College in- spects them at intervals and places its seal of approval only on those which ~naintain the standards which it has established. The educational effect of this has been very great. Intelli- gent people today demand much more adequate examination and diagnosis in cases of suspected cancer than they did before they had been in contact with well-equipped clinics. Lay Educational Efforts Recently, the American Society for the Control of Cancer, having surveyed carefully the development of medical educa- tion, believed that the time had arrived for launching a permanent national program for the education of the public on cancer. The relative increase in the number of older persons in our population has made the control of cancer increasingly more important. A growing general interest in public health, augmented by the Government's brilliant attack on the THE FIGHT ON CANCER 25 venereal diseases and by the well-organized "Birthday Balls" in the fight against infantile paralysis, also was of assistance in setting the stage for such a campaign. Cancer, however, presents certain unique characteristics which affect the type of educational campaign which must be undertaken. Fear is a very important element. Its presence makes necessary an impersonal type of presentation of facts which in themselves are of a highly personal character. Con- fidence must be created and maintained by giving only accu- rate information and by rigidly discouraging speculation and rumors, which upset the public and arouse false hopes. The balanced relationship between surgery and radiology must be tmderstood aud used in order to preveut over-eu- tbusiastic expouents of either from attempting to monopolize the clinical lieid. The need of careful and accurate physical examination and the ineffectiveness of superficial diagnosis is a delicate matter which requires an intelligent lay opinion to spnr the profession to its best efforts. A set of rules for such examinations, prepared by Dr. Frank E. Adair of the Memorial Hospital in New York,* has proved to be of great value in summarizing tfie necessary steps. These are as follows: 1. Examine the lips, tongne, cheeks, tonsils, and pharynx persistent ulcerations, the larynx for hoarseness, and the lungs for persistent coughing. 2. Examine the skin oI the /ace, body, and extremities Ior scaly, bleeding warts, black moles, and unhealed sears. 3. Examine every woman's breasts for lumps or bleeding nipples. 4. Examine the subcutaneous tissue for lumps on the arms, legs, or body. B. Investigate any symptoms of persistent indigestion or diffa'- culty in swallowing. Palpate the abdomen. 6. Examine the lymphoid system [or enlargement of the nodes of the neck, armpit, or groin. 7. Examine the uterus for enlargement, lacerations, bleeding, or new growth. Make a bimanual examination to deter- mine the condition of the ovaries. # In Southern Medicine and Surgery.

26 THE FIGHT ON CANCER 8. Examine the rectum, and determine the cause of an), bleeding or pain. 9, Examine the urine microscopically for blood. 10. Examine the bones and obtain an X ray diagnosis of an), bone which is the seat of a boring pain, worse at night. The effect of inadeqnate examination is often tragic. In large hospitals scarcely a week goes by without the record of advanced cancer cases, the early detection of which was missed by hasty or superficial examination leading to a false sense of security and, therefore, to delayed action. Cancer education must also be tactful. In many types of the disease the danger signals are matters of .the greatest intimacy. Only the prospective paticnt can rccognizc thcse danger signals and must, ~here[ore, be the person to report them. In several sites, such as the breast and the uterus, a sense of false modesty may prove to be an ally of death. There is also a need for repeated or, in [act, of continu- ons contact with educational nmterial. New groups of indi- viduals are constan,tly reaching the age at which the danger of cancer increases. For these as well :~s for those already in the more dangerous age groups, eternal vigilance is the price of freedom from unnecessary risk. Patience and attention to what may seem to be unimportant details are necessary for successful cancer education. For all ,these reasons it seemed that women, who are the chief snfferers from cancer, should be the leaders of a continu- ing educational campaign. The A~nerican Society for the Control of Cancer, in re- viewing possible national organizations of women which might be used for this purpose, found several that were promising. The General Federation of Women's Clubs was the largest and most prominent, but the American Association of University Wo~nen, the National Federation of Business and Professional Women's Clnhs, the nursing organizations, the medical auxiliaries, the various religions groups and others were also important. All of these have been interested and enlisted in the fight to cu,t the death rate from cancer. In addition to discovering .the origin and nature of differ- THE FIGHT ON CANCER 27 ent types of cancer and preventing their occurrence, these groups are working to obtain the best treatment available for every c~ncer patient. This must be achieved regardless of the patient's means or .the stage and nature of the cancer. It can be attained only by the organized cooperation of public and private agencies, both individual and organized. The Women's Field Army The active interest of existing organizations, althongh of great value, was not enough to insure the development of a sufficiently comprehensive and versatile campaign against cancer. Some particular organization was very definitely needed. For that purpose the American Society for the Con- trol of Cancer created, as a part of its activity, a national body of women known as the Women's Field Army Against Cancer. The main objective of this group is the education of lay persons, especially women, concerning the danger signals of cancer; what to do about them and what the outcome of prompt action may be. In order to accomplish this result most .successfully an enlistment campaign is conducted annually m April. During this campaign as many persons as possible are asked to join the Field Army. Membership is a dollar, of which seventy cents are retained by the state in which the enlistment was made, to be expended there under a budget prepared and administered by the state unit of the Women's Field Army. The other thirty cents come to the National Society to be used by it in the planning and preparation of educational ~naterial, the conduct of national publicity concerning the Field Army, and the salaries and ex- penses of its field representatives who largely are engaged in Field Army activities. April was pickcd as the bcst time for the enlistment drive after conferences with leaders in the caucer control movement all over the conntry. It was felt that the spirit of sacrifice and of newly aronscd hope attendant upon the Easter scason hath- rally lent itself to the devclopment of the proper attitude of the pnblic towards the cancer problem. The value of April as the focal point of the ca~npaign was materially strengthened and established by the action of Con- gress which definitely designated that month of each year as

28 THE FIGHT ON CAHCER Cancer Control Month aud authorized the President to issue a proclamation to that effect. There have been three annual enlistment drives of the Women's Field Army. Each has shown an encouraging growth and extension of activity and interest. There are today ap- proximately 135,000 women actively interested in this work. Forty-six states and the District of Columbia have divi- sions of the Field Army under volunteer leadership of public- spirited and able women who have seen~and accepted the opportunity and responsibility which the situation offers. The form of a military organization adopted by the Field Army has been enthusiastically accepted by the vast majority of those contacted. It has been possible to show .that the active fight against such a great menace as cancer requires the same qualities as those needed in any great war with a powerful enemy. The American Society for the Control o[ Cancer as the parent organization is studying carefully the various problems presented in different parts of the country, and is attempting to develop a consistent aud well-integrated plan of attack. It has recently consulted the commanders of state divisions and the medical chairmen of executive committees, under the direction of which each unit operates, to find out the attitude of state units ou the following lines of activity: 1. Adult education. It is urged in every state that the program of adult education be continued and extended. The press, radio, motion pictures, meetings, and individual contacts can all be used to advantage. Steps must be taken not only to introduce the topic to interested individuals, but to maintain interest. 2. Education in schools. A program of talk~ on cancer in the junior and senior high schools as well as in colleges is ex- tremely important. High school students can receive cancer information logically and impersonally, perhaps as a part of a general course on science or biology. Special emphasis is ~placed on the natural incidence of cancer and its biologi- cal nature as a growth process. An indirect effect of in- forming students is that their parents at home receive valuable educational material. 3. Following ttp hospital cases after treatment for cancer to determine what becomes of them is an important function, THE FIGHT ON CANCER 29 at present largely neglected but which can be fullilled by members of the Women's Field Army. 4. Preparaffon and financial support oJ educational exhibit~ with models, charts, and illustrations to be placed in high schools, colleges, museums, and large hospitals. ~. Cured cancer clubs. The organization and maintenance of clubs made up of persons who can present adequate evi- dence that they have been treated for and have subse- quently remained free from cancer for at least a five-year period is an important educational adjunct to the other work, 6. Periodic health examinaHons. The encouragement of peri- odic health examinations and the building up of organiza- tions to make such examinations more general among women is a splendid objective for Wmnen's Field Army units. Many tlmusands of precancerous conditions and of cancer cases might be promptly detected and receive early treatment should this objective be attempted. 7. Educational motion pictures. Assistance in preparing ma- terial for and in creatiug educational motion pictures deal- ing with research, treatment, and education in cancer control is an important need and can be greatly facilitated by cooperation of Women's Field Army units. 8. Recognition. Adequate recognition by some type of deco- ration in the case of women who by their activity have educated and so saved the lives o[ others is encouraged. In addition .to these objectives there is, in some states, very definite pressure to make the ~nembers of the Women's Field Army units take np some practical and definite work in con- nection with the aid of indigent cancer patients. Wherever this is encouraged, care is taken to make sure that the State Medical Society favors not only the general project, but the detailed way in which it is being carried out. In no case is such activity allowed if it is contrary to the expressed agree- meat of the medical profession. The following objectives have been found to be of inter- est in this connection: 1. To make available funds for the transportation or care of indigent cancer patients nnder the direction of the medical profession. 2. To pnrchase surgical or radiological equipmeut or snpplies for hospitals or clinics approved by the American College of Surgeons.

3O THE FIGHT ON CANCER 3. To raise funds for the support of clinics, hospitals, or other cancer control units. What You Can Do If the brief summary of facts on cancer control which this pamphlet contains has aroused sufficient interest so that you wish to do your part in the conquest of this disease, there are certain very definite steps which you can take without delay. First, write to the American Society for the Control of Cancer, 350 Madison Avenue, New York City, and free litera- ture will be sent to you. Second, get in touch with the division of the Women's Field Army nearest to where you live, familiarize yourself with its program and participate in it. Third, learn the signs and symptoms that may mean cancer and the suggested rules of hygiene which, if followed, diminish the likelihood of its appearance. Act on both of these and spread information concerning them to others. Fourth, establish the habit of obt,~ining regular periodic physical examinations at intervals of one year or less. Fifth, organizations doing research i~ the field of cancer and institutions offering ,~pproved types of treatment deserve your support. If you join the Americ,~n Society for the Control of Cancer you will receive its monthly Bulletin which will keep you up to date. Remember above all that whatever effort you ~nake may save not only the lile o] someone dear to you, but your own. FOR FURTHER READING Books Curie, Eve, Madame Curie. New York, Doubleday, Doran g: Company, Inc., 1938 Editors of Fortune Magzzine, Cancer: The Great Darkness. New York, Doubleday, Doran g: Company, Inc., 1937 Little, C. C., Sc.D., Civilization Against Cancer. New York, Farrar & Rinehart, Inc., 1939 Tobey, James A., P.H., Cancer: What Everyone Should Know About It. New York, Alfred A. Knopf, 1932 THE FIGHT ON CANCER .-11 Articles Fergusou, Russell S., M.D., "When Cancer Is Not Guilty." The Reader's Digest. New York, October, 1939 Marcosson, Isaac F., "The Cured Cancer Club." The Reader's Digest. New York, September, 1939 The two articles in The Reader's Digest have been re- printed together and may be secured from the Ameri- can Society Ior the Control of Cancer. Ratcliff, J. D., "War On Cancer." McCall's. New York, July, 1939 "The Truth About Cancer." Look Magazine. New York, April 11, 1939 Pamphlets The following pamphlets just issued or revised in 1939 by the American Society for the Control of Cancer are suggested: (Single copies free. Prices on quantity orders upon request) What Everyone Should Know About Cancer. A com- prehensive summary of essential facts, 22 pages. Answers to the Public's Questions on Cancer. Replies to 76 questions most frequently asked by laymen, 12 pages. Cancer And lts Care. Handbook for nurses, revised iu '1939, suitable for those desiring clear, technical informa- tion, 48 pages. Cancer Periodicals Quarterly Review of the New York City Cancer Committee of the American Society for the Control of Cancer. New York City Cancer Committee, 130 East 66th Street. $1.00 a year. Articles for the lay reader. National Bulletin of the American Society for the Control of 'Cancer, 350 Madison Avenue, New York, New York. $1.00 a year. Articles for lay and medical readers on recent progress in cancer control.

THIS pamphlet is the 38th of a series published by the Public Affairs Committee. The other titles available are listed on the back cover. A million and a half of these pamphlets have been sold. Busy men and .women are finding them valuable time-savers in keeping up with important questions of the day. You may subscribe to the pamphlet series, as you would to any magazine. For $3 you may have 36 issues, and for $2 any 24 consecutive issues. Those that have been published will be sent immediately, and the balance as they appear monthly. The publication of the Public Affairs Pamphlets is one of the activities of the Public Affairs Committee, whose purpose as expressed in its Constitution is "to make available in summary and inexpensive form the results of research on economic and social problems to aid in the understanding and development of American policy. The sole purpose of the Committee is educa- tional. It has no economic or social program of its own to pro- mote." The members serve in a personal capacity and not as representatives of their respective organizations. Publication of a pamphlet does nat necessarily imply the Committee's ap- proval of the statements or views contained in it. The Committee Robert P Lone, Chairman Lyman Bryson, Vice Chairman S. M. Keeny, Secretary Luther Gulick, Treasurer Raymond Leslie Buell Frederick V. Field William F. Foster Harry D. Gideonse Francis P. Miller Felix Morley George Soule Ordway Tead Maxwell S. Stewart, Editor of the Pamphlet Series Caroline C. Rounds, Assistant Secretary Marion Humble, Educational Publicity All rights reserved. No part of this pamphlet may be reproduced without permission, except short passages of no more than 500 words in length, which may be quoted by a reviewer or commentator, with full credit to the Committee. For permission to use longer excerpts, write to lhe Public Affairs Committeer Incorporated, .~0 Rockefeller Plaza, New York, N. Y. First Printing, December, 1939 Printed in the United Slates of America