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9~D CoxGrmss SENATE Calendar No.239 No. 92-247 COI~QUEST OF CANCER ACT ~u~ 29 (legal day, .l~m 28), 1971.--Ordered to be printed from the Committee on Labor and Public Welfare, submitted the following REPORT [To accompany S. 1828] TOGETHER WITH INDIVIDUAL VIEWS The Committee on Labor and Public Welfare, to w!~ich was referred the bill (S. 1828) to amend the Public Health Service Act so as to promote the public health by stren~hening the national effort to con- quer cancer, having considered the same, reports favorably thereon with amendment(s) and recommends that the bill (as amended) do pass. I. Summary S. 18~8 would amend the Public Health Service Act to establish a Conquest of Cancer Agency as an independent agency withiu the National Institutes of Health under a Director reporting to the Presi- dent. The .4~gency's purpose would be to energetically conduct a na- tion~l program ~or the conquest of cancer. " The Agency would submit its budget estimates directly to the President and would obligate funds appropriated for its activities in the same manner as other independent establishments within the executive branch. • The bill would make the National Cancer I,stitute • part of the (.onquest of Cancer Agency. It would also establish a National Cancer Advisory Board to advise the Agency in the development and execu- tion of ~ts program. The Board wotdd assume the functions now per- formed by the ~ational Advisory Cancer Council, which it would supersede. The Director of the Agency would take neecssarv action, together with the Di,mctor of the National Institutes of H6alth, to maintain existing channels for the free communication of scientific knowledge between the Agency and the other health institutes, and for the coor- 4S-010 Ti55770003

di~.at.ion (through mutual program and budget review) of their respective activities. 1-L Background SE~ATZ REsm.m~o.~- 376 On March 25~ 1970~ Senate Resolution 376, calling for a compldely new study of cancer~ cancer research and the causes and cures of can- cer~ was introduced by Senator Ralph ~V. Yarborou~h. Chairman of the Committee on Labor and Public Welfare. and a b~-l~art~san ~,'oup of 53 Senate cosponsors. The inte~ut of thi~ resolution was to make the conquest of cancer a national goal of the highest priority. Behind the introduction of this Resolution: and accounti~g for the broad support accorded it, were these perceptions~ based on urgen~ advice from a number of science and medical leaders: First~ that cancer is the No. 1 health concern of the Amer- ican people. It is the disease most dreaded b~" a majority of Americans, and its incidence is increasing: Accordin~ to current statistics~ of the 200 million Americans alive today. 50 million will be aflticted by some type of cancer, and ~4 million will die of it~ i~ better methods o~ prevention and treatment are not discovered. Second, that recent advances in cancer research have brought this field to the verge, of important and exciting de- velopments in the early detection and possible control of this dread disease; and " Finally~ that as a nation, we a~e neither putting forth the effort nor deploying the resources needed to exp]oi~ the full potential of these gains against cancer. Seuate Resolution 376 authorized the Committee on Labor and Public ~Velfare to study cancer research activities. It specifically charged the Committee t~ "examine, investigate, and make a complet'e study of any and all matters pertaining to (1) the present status and exte~t of scientific research conducted by governmental and nongov- ernmental agencies to ascertain the causes and develop means for the treatment, cure, and elimination of cancer. (2) the prospect for suc- cess in such endeavors, and (3) means and measures necessa~T or desirable to facilitat~ success in such endeavors at the earliest possible time." The sum of $250~000 was authorized to be expended by the Committee in carrying out this cancer study. " On April 15, 1,070. the Senate Committee on Labor and Public ~Vel- fare unanimously reported out Senate Resolution 376 for referral to the Senate Commitee on Rules and Administration. The latter Com- mittee ordered it reported with two major pro forma amendments on .~_pril 2,3, and the Resolution passed the Senate by unanimous vote, on April 27,1970. To assist in carrying out the new cancer study required by Senate Resolution 376~ the Senate Labor and ~Velfare Committee established T|55770

3 in .lune 19'70, a Panel of Consult~nt~ on the Conquest of Cancer~ com- posed of 13 eminent laymen and 1.3 eminent scientists, chai'red by Mr. Benno C. Schmidt. Managing Partner of J. If. Whitney and Com- pany. New York City, 'and with Dr. Sidney Farber~ Founder and Scientific Director. C~ildren~s Cancer Research Foundation, Boston~ as Co-Chalrma~. Other members of the Pgnb] were : ,~Ir. L W. Abel, president. United Steelworke~ of America~ Mr. William McC, Blair~ o]'r, general director, the John F. ~Kennedy- Center for the Performing Arts, . " ~ ~Ir. Elmer Bobst. chairman of board. Warner Lambert Pharmaceu- tical Co ..... '.. I)r. Joseph Burchenal, vice president, Sloan-Ketterin'g Institute for Cancer Research. Dr. Paul B. Cornely, president, American Public I-Iealth Association~ ~fr. Emerson Foote, Mr. G. Keith Funston, chairnmn of board, Olin Corp., Dr. Solomon Garb, scientific director: American Medical Center at Denver. Mrs. Anna Rosenberg I-Ioffman, Dr. James F. Holland, chief of medicine A: Roswell Park ~Iemorial Institute for Cancer Research, Dr. William B. Hutchinson: president. Pacific Northwest Research Foundation, Dr. I-leafy S. Kaplan~ chairman, Department. of Radiology. Stanford Univer:~ity Medical Center, ~ " Dr. h[athilde Krim, Sloan-Kettering Instithte for Cancer Research~ 3h's. Maze: Wells Lawrence~ ~,Vells, Rich & Green Advertising Agency~ Dr. Josh~a Lederberg, pro~essor of genetics, Stanford University School of Medicine, ~Ir. Emil ~[azey~ secretary-treasurer~ United ~kutomobile Workers~ ~Ir. Mike O'Neill, managing editor, New York Daily News, ~fr. Jubal R. Parten~ member of board, Fund for the Republic~ .~[r. Laurance S. Rockefeller, chairman~ Rockefeller Brothers, Inc.~ Dr. Jo~nathan E. Rhoads~ chairman, department of surgeL~', Univer- sit)" of Pennsy]vanla School of ~fedicine, I)r. Harold P. Rusch. professor of cancer research, McArdle Labora- tory. University of Wisconsin, Dr. ~Vende]l G. Scott, clinical "professor o~ radic#]ogy: Washington University~ Mr. Lew Wasserman~ president~ Music Corp. of America, Inc, Ihe Panel which met for the first time on June ~9, 19~0, ~'as asked to submit its report and recommendations at the earliest practicable date, but not later than December 15~ 1970. HOUSE CO-~CURREXT RESOLUTION 675 As the Panel began its deliberations, a £-urther Resolution from the Co,~gress l~}derlined the importance 6f the study undertaken: On July 15. 19 #0, the House o~f Representatives passed Concurrent Reso- luti'on 675, later passed by the Senate, expressing ~he unanimou~ ss~me of the Coheiress that "the Conquest Of Cancer ~s a na~iona! crusade" and that "the Congress should appropriate the necessa~- fuuds so that TI55770005

4 the citizens of this land and all other.lands may be delivered from the g~eatest lnedical scourge in history.." " :. I~PORT OF THE PAI~r~L. OF CONSULT~NTS The Report of the Panel of Consultants~ entitled "A National Program for the Conquest of Cancer" was transmitted to the Com- mitte~ on Labor.~ and Public Welfare on November 25, 1970. The R~l~ox¢ .(Report No. 91-140B~ 91st Congress~ 2nd Session) was ordered to b~ printed on December 4~ 1970. On April 14~ 1971~ it was ordered to be re-printed with. illustrations~ as Senate Document No. 92-9. Par~ I o~ the Panel's P~por~ provides a brlef summary of the cancer problem~ identifies areas of special promise which offer unusual oppor- tmdties ~or intensh%d effort, and states the recommendations o~ the Committee. The second part o~ the Report sets ~orth the scientific and medical background in more detail The principal fi~ dings and r~commendatio~s o~ the Panel were as follows: 1. Cancer ~s~ the No. 1 health .concern o~ the American people. poll conducted in 1966 showed that 62 percent of the public feared cancer more than any other disease. O~ the B00 million Americans alive today~ 50 million will develop cancer at present rates of dence~ and 84 m~llion will d~e of th~s pahfful and often ugly disease: i~ better methods o~ prevention nnd treatment are not discovered. About one-half of cancer deaths occur before the age o~ 65, and cancer causes more deaths among children under ~ge 15 than any other dis- ease. Over 16 percent o~ all deaths in the United States are caused b.v cancer~ malting ~t by a wide margin our second greatest ]tiller (after cardiovascular diseases). Cancer often strikes as harshly at human di~dty as at human li~e, and more o~ten than not ~t represents finan- cial catastrophe for the family in which ~t strikes. 2. The amount spent on cancer research is grossly inadequate today. For every man~ woman~ and child in the United States. we spent 1969:$410 on national defense; $125 on the war in Yie~nam: $19 on the space program; $19 on foreign a~d and only $0.8~ on calmer r~- search. C~neer deaths l~st year ~ere 8 thnes the number o~ lives lost in 6 years in Vietuam~ 5~ t~m~ the number killed ~n automobile acc~- dents~ and grea~er than the number o~ America~ k~ll~ in battle in all 4 years o~ World ~ar II. Given ~e seriousn~s of the ~n~r prob- lem to the health and morale o~ our society, th~s a~locat~on of priorities seems o~n to serious qu~on. In addition ~ the poignancy o~ the dis~se~ ~d the de~h and sugerh~g that ~ ~uses. the economic 1o~ is stagger~g~ w~th ~at~ o~ i~ ~s~ ~ ~e Nation ~g as high ~s $15 billion per year~ o~ which some ~ to $5 billion represents direc~ care and treatment cost~ and the be]ance is loss o~ earning power and productivity. 3. The incidence of cancer is increasing. T~s is partly due to fac~ tha~ a grea~r num~r of our elti~ns are reaching mo~ vaned a=es, ~here c~n~r stMkes more ~u~lv~ but it is also due to th~ sharp increas~ ~ lung cancer~ undou~l~at~but~l~ a~r po~u~on ~ ~r~a~n ~vlro~en~ and ~f~r~y t~ ~. sel~-po~u~on o~ th~ who smoke ci~tt~. 1~ is ~imated that T!55770006

5 the American people stopped smoldng eir.o~rettes this alone would eliminate about 15 percent of all cancer deaths.. • 4. '£he uature o~ cancer ~s not yet fully known. We know tha¢ human cancers are caused by certain chemidals', by certain types of radiation, ,nd pro.bably by vir~ses. The precise n{ec~mnisms b~ which these car- cinogemc a~ents cause~ or interact to cause, cancer is ~ot known~ antl very little i~ known about the rmtur,~J de'ease mechanisms that pre- vent cancer in some cases and not in others: ~ great deal more must be learned about chemical carcinogens, radiation: and'viruses, and how they work. ~lre must also learn more about what takes place at the cellular level when cancer occurs. The~e is very strong suggestive evi- dence that viruses cause some human cancers:'but which w~ruses, how they are transmitted, and how they operate are unknown. It is errone- ous~ to think of canc~.r as a single disease with a. single cause that will be subject to ~t single form of immunization (as in the case of polio) or a single cure. Cancer comprises many diseases and results from a variet.y ~ ca.u~s that will have to be dealt with in a variety of was's. ~-Iowever, as our knowledge is expanded, more and more c~ncers s~':ill become preventable or curable. 5. The cure rate for cancer is gradually improving. In 1980 we were "~ble to cure only about one case in five; today we cure one case in three; and it is estimated that the cure rate cothd be brought close to one in two by a better application of knowledg~ whicl~ e~ists todav~ i.e. detection'at an earlier stage through the more widespread use ~f existing techniques (such as the Papanicolaou test for women and mammography)~ coupled with an extension to all citizens of the same quality of diagnosis ~nd treatment now available ut the best treatment centers. There are three methods for curing cancer today.; surgery~ radiation therapy~ and chemotherapy. Often t~'o or eveh three of these methods are used in combination. Some types of c~ncer are far more curable than others. For example, early breast c~ncer treated by sur- gery, cancer of the cervix l~y r,~diation or surgery~ and choriocarci- nomh and Burkitt~s tumor by chemotherapy~ are ~mong those most susceptible to cure today. Treatment techm~ques a~e improving mark- edit-, particularly in ra~liat.ion therapy and chemotherap:~', and more ~vit'i~spread avai~abillty of the best quality detection a~'d treatment will We us more and'more cures. However~ it is still true that those cancers which disseminate rapidly are seldom curable toda'¢~ and thi~ represents a major gap in our existing knowledge. VCher~ ave stand today in our knowledge of the causes~ nature~ prevention, diagnosis, treatment~ and control of cancer is set forth in detail in part II of this report. 6. There have been major advances in the fundamental knowledge of cancer in the past decade, and these advances in knowledge have opened up far more promising areas for intensive investigation thau have ever heretofore existed. These areas of special promi~ must be explored with vigor~ if we are to exploit the gt~at opportunities that lie before us. They are examined in detail in part II of this report. Among the areas of special promise which must be aggressively pursued are: (a) The identification and study of the chemical, physical, and other environmental factors that cause cancer (food additive.% air Ti55770007

pollutants~ industrial hazardss radiations and okher carchlogens) ; (b) Viruses causing cancer (what viruses cause cancer, how are they transmitted~ and]aow do th.e,y act) (c) Cell and tumm- biology (including cell surface phenomena, molecular functions~ differentiation and genic expressions controls of cell divisions mechanisms of metastasis, nutritional require- ments and other biological factors) (el) Immunology (host resistance against cancers its natures causes and ther.a!~eutic use) ; (e) F, pidemimogy (the variables in cancer incidence and types ste~nming from geographic, socials economics nutritional, occuua- t~ nal~ and constltutmnal differences~ ; (f) Cancer prevention (more effective utilization of existing knowledge and intensified research on preventive measures) ; (g) Diagnosis (the development of new and improved diag- ~ostic techniques) ; (h) Chemotherapy (the development o~ new and better dru~o~ and improvement in ~heir uses) ; (~) Radiotherapy (development of new and better techniques and apparatus for radiation therapy) ; (~) Surgery (the best techniques in cancer surger]- coupled with earlier diagnosis must be made generally available in-order to further increase the cure of cancer. Better rehabilitation tech- niques must be further developed and utilized to return the cancer patient to an active and full life) (k) Combinations of treatment modalities (improvement treatment results by better combinations of surgery~ radiotherapy. chemotherapy~ and immunotherapy). " 7. A national program for the conquest of cancer is now essential if we are to exploit effectively the great opportunities which are pre- sented as a result of recent advances in our knowledge. However, such a program will require three major ingredienfs that are not present today: Firsts effective administration with clearly defined authority and responsibility; Second, the development of a comprehensive national plan for a coherent and systematic attack on the vastly complex problems of cancer. Such a plan would include not only programmatic research where that is appropriate, but also major segments of much more loosely coordinated research where plans cannot be definitively laid out nor long-range objectives clearly s~ecified- and "11 ~rds the necessary financml resources. At the present time there is no coordinated national program or program plan. The National Cancer Institute has done excellent work itsei~f and has supported grants and contracts in the scientific com- munity which have resulted in much outstanding work, but the orer- all research effort is fragmented and, for the most part, uncoordinated. The effort in cancer should now be expanded and intensified under an effective administration charged with developing and executing a com- prehensive national plan for the conquest of cancer at the-earliest possible time. The three foregoing elements are considered separately m more detail in the succeeding paragraphs 8, 9, and 10. TI55770008

7 8. Ad~nlnistrat~o~---[An effective major assault on cancer requires an administrative setup which can efficiently administer the coherent program that is requii:ed in this formidable and complex scientific field. Such a setup will not be easy to achieve within the Federal Gov- ernment. The effective implementation of such a program will require a simplification of organization arrangements and a drastic reduc- tion in the number of people invol~'ed in administrative decisions. This type of straight-line organizational efficiency does not. exist today in the National Cancer Institute, the l~'ational Institutes of ttealth, or the Department of I-Iealth~ Education~ and Welfare. Obviously, from many standpoints it can be argued that any cancer program should be in the Department of Health, Education~ and Welfare and indeed that it should be in the National Institutes of Health. However, there is real doubt whether the kind of organization that is required for this program can in 2act be achieved within the l~ational Institutes of Health or within the Department of Health, Education, and ~Vel- fare. Apart from the question of whether it can be done~ there is also the question of whether it would be wise to require the Secretary of Health~ Education, and Welfare to attempt, to give cancer the priority necessary to carry out the congressional mandate in a department charged with the multiple health and other responsibilities of that Depart]neut. In the past when the Federal Government has desired to give top priority to a major scientific project of the magaaitude of that involved in the ~'onquest of cancer, it has on occasiom with considerable success~ ,.iven the responsibility for the project to an independent agency. Such an agency provides a" degree of independence in management, plan- ning. budget presentatiom and assessment of progress which is difficult if uot imi3ossible to achieve in a large government department. Ac- cordingly, if the Congress and the administration are truly committed to making the conquest of cancer a ~national crusade", as expressed in the concurrent resolution of the Congress. it is the view of the Com- mitte,~ that a National Cancer Authority should be established whose mission is defined by statute to be the conquest of cancer at the earliest possible time. ,kll t]~e functions, personnel, facilities, appropriations. programs, and authorities of the National Cancer Institute should be transferred to the Natioual Cancer Authority. The Authority should be headed by an Administrator appointed b~" the President with the advice and donscnt of the Senate. and he sho{fld report directly to the President and present his budgets and programs to the Cong~'ess. In cousidering the feasibility of a~ independent a;g~ncy, it should be borne in mi~l that we are talking about a major scientific program and. as pointed out in subsequent phragraphs, not the delivery of patient care ~,enerallv in cancer cases. The only patient care involved in this pro- gram will be that associated with'clinical research and teaching and tim development and demonstration of improved methods in the live~T of patient care undertaken as a part of the comprehensive program plan. The po~vers of such a National Cancer Authority should be very broadly defined in order to accomplish a mission o~ this complexit.~'. It wo~ld not be useful to attempt to enumerate here all the powers that such an Authority should have and in the writing of the imple- TI55770009

8 menting legislation~ the Committee believes that the powers should be broadly defined and not enumerated. However: the following are illustrative of the kinds of powers which the National Cancer .~uthor- ity will have to be able to- exercise in order to catty out a comprehen- sive program of the type envisaged: (a) The power to enter into prime contracts with authority in the prime contractor to enter into subcontracts; _ (b) The power to commit available funds until expended rather than on a year-to-year basis; " (c) The power to authorize exceptions to existing regulations~ where necessary, to permit t}m use of experimental drugs~ bio- logieals, and devices in cancer research; (d) The power to establish or support the large-scale produc- tion o~ specialized biological materials for cancer resear~a~ such as viruses~ cell cultures~ animals, and the like. as welt as the power to set standards o~ safety and care for those ~sing such materials; (e) The power to support research outside the~'nited States by highly qualified foreign nationals~ collaborative research involv- ing American and foreign participants, and training of American scientists abroad and foreign scientists iu the United S~ates. to the extent that such activities will promote the accomplishmen~ o~ the mission. The Committee believes that cancer research offers a particularly fruitful field for collaboration with other nations, in- eluding those nations with whom present cooperation is limited bu~ with whom greater collaboration is desired; (~) The power to fund by loan, grant, contract~ or otherwise any facilities or programs~ or to take-such other actions, as may be required for the accomplishment of the mission. 9. Program 'flan.--A comprehensive national plan for the conquest of cancer should be developed as promptly as possible. The develop- ment o~ a coherent overall program plau s~ould include the following features : (a} The present research activities now being carried "forward under the National Cancer Institute should iu no way be impeded or inter- rupted while plans are being made for the expansion, intensificatiom and coordination of the cancer research program; (5) Existing research facilities and manpower should be used as promptly as possible for the accelerated exploitation of the opportuni- ties in the areas of special promise. There is substantial unused capac- ity in this country today that should be utilized in order to attract and retain the manpower that is needed. It is a myth that we could not spend effectivel on cancer very much more than is now bein~ spent. The fact that ~eY~eral suppor~ for c~ncer research has leveled ~ sb~ce 1967 and that, due to inflation, the actual amount of work done has decreasexl~ has created a serious gap between what we are doing now and what we could and should be doing in cancer research. It is esti- mated that current expenditures could be doubled within the frame- work of the existing facilities and manpower potential of this country today~ exclusive of {hegreat industrial research capability in this whi'ch should be brought to bear on an appreciable scale [n high prior- itv m~as to which this type of capabili@ is particularly suited. T15677001,

(c) Existing cancer centers should be Strengthened andadditional caner centers in different parts of the country should be created. The solution of the cancer problem lends itself to a multidisciphnary effort~ where teams of highly qu£1ii~ed specialists are available to interact on problerns of research, ~oth clinical and nonclinical, teaching, diag- nosis, preventive programs~ and the development of improved methods in the delivery of patient care~ includ~g rehabilitation. Among those who work in the cancer field, there is great emphusis on the advantage~_ of critic~.l mass~a critical mass of scientists and physicians committed to the cooperative solution of the cancer problem, of research facilities~ of patient~, and of financial and other resources. This is simply another way of sayi/~g that the comprehensive cancer center offdrs the best organizationaI structure for.tt~e expanded attack on cancer. In addition to the few compreheaisive cancer centers that exist in the.United States today, there are a number of other institutions @hich combine all or most of the capabilities for a multidisciplinary effort in cancer. These could serve as a base for the creation of additional centers. The new cente~ should have appropriate geographic distribution and should. whez~ver possible, be created where a nucleus of scientific, professional and managerial personnel already exists and preferably where a uni- versity or a medical school affiliation exists otis planned. In the creation of new cancer centers, manpower limitations should be taken into account, ~nd new centers should not be created where there would be a dilution in the effectiveness'of existing centers which would offset any gain from t~e new center. There shouId be a realistic operating plan for each ne~x center which ~ssu.res the' scientific and managerial commitment and:ability necessary to the creation ~nd op- eration of a successful center." ..... . • " It should" be emphasized that the strengthening of existing cancer centers and the creation of new cancer centers does not mean that under tMs program general responsibility should be undertaken fo~ the care of the Nation's cancer patients. Tt~e dellve~T of patient care in cancer cases is a part of.the gener~.l problem of the delivery "of patient care and shouldbe so dealt with. However, this inhibition must not prevent the cal~cer centers from including such patient care facilities as are necessary for clinical research arid teaching and for the development and demonstration, of the best methods o~ treatment in cancer cases. (d) The cance~ centers ~l~oulcl also sexwe as administratiw coordina- tom of those programs which require regional coordination. Such cen- ters should support and assist clinics end community medical centers in their own geogrupl~c are~ in :order to assure the .widespread use of the best available methods fbr early detection and treatment of cancer. They shoulc~ a~so serve to collect data useful in the pre~rention and.cure of cancer, including..p~tent follow-up information, and be responsible for the dissemination of information, both at the lay and professional levels, that-is useful in the prevention~ diagnosis aridcure of cancer. The effective .d~semination and utilization of such infor- mation is a most importgnt par~.ef any national plan to conquer cancer. (v) .4~ national plan of the-type envisaged must take uccount of the manpower re~tniremonts for this effort.. Them is a critical need for tra~ing ~nd career oppoi~unities for young scientists, phyalcians~ and other l~rsonnel in this program. We mus~ reaffirm to young investiga- S. l~ep~. 92-247~2 TI5577001"

10 tors our confidence in the future of American science and in our na- tional dedication ~o success in the conquest Of cancer. A manpower program in this field should include training stipends,predoctoral fel- lowships for particularly promising candiaates~ post~Ioctoral fellow- ships for brilliant investigators, and career positions where appro- priate through career L~tiktion awards, career development awards~ and senior career awards. (f) A national plan for the conquest of cancer should provide for the generous use of grants as well as contracts and other methods of funding. There should be increased emphasis on the grants mechanism in order to stimulate continued independent exploration, particularly in those areas where knowledge is not sufficiently mature for a c~- ordinated program aimed at reaching defined objectives. (~) A comprehensive national ~rozram requires ontimum commu- nication and centralized banks of l~nfo~mation: There ~nust be an accu- rate and prompt information flow in both directions. This will call ~or integrated data processing, storage~ and retrieval in order to rationalize the decision-making and to make information available when and where needed. As indicated above~ the centers can be impor- tant loci in both th~ collection and dissemination o~ this information. (h) A coordi_nated national program plan should~ to the greatest possible extent, be generated by the voluntary productive interaction and joint planning of the scientists who will be responsible for doing the work. Theprogram should not he the result of the happenstance of a multitude o~random decisions independently arrived at. An inte- grated and coherent plan resulting from the joint effort o~ representa- tive scientists who will be responsible ~or its execution is fundamentally differen~ from the hierarchical imposition or direction of a research program from above, ttowever~ the effective use of collective plannin~ does not mean that centralized administration or management of re- sources should be sacrificed. 10. F~nd~ng.~The Committee estimates that a coordinated national progrard aimed at the conquest of cancer at the earliest possible time~ as envisaged by the concurrent resolution of the Congress, would re- quire an appropriation in fiscal 1972 of approximately $400 million. Thereafter~ the cost of the program would increase at'the rate of ap- proximately $1,00. ~o $150 million per year~ reaching a level of .$800 million to $1 billion in 1976. These sums are hot large in terms o~ our national ~esources or of the humafi suffering and economic loss attrib- utable to cancer. A program o~ the type herein recommended is so im- portant to the American ~eople and to the world that we feel that the a.mounts called for should be provided ~ven i~ this necessitates the raising o~ additional revenues. It is of utmost importance that the fi.nancing o~ this program not result in cutbacks in other health programs. 11. ~Vat~rnn:l ~a~cer AdvCs~3/. Boa~.--Both the_ ~ublie ~tnd the sci: entific communi .~y must be effectlvhly r~presented in this ef~ort~ and mus~. hav~ a part in its plahning as well ~ its e~ecutisn. To this end. a lCational Cancer .~dvisory Bo~rd should be created with 18 members. nine o~ ~vhom are distin~U_isbed scientists knd doctors in the field of cancer, and nine o~ wh0~ are distin~uishdd laymen. The members should serv~ ~or a term o~ 6 .~ears with the terms of one-third o~ the members expiring every 2 years..-~fembers of the Board should be appointed by the President of the United States ~th the advice and TI557700