A2240

CONGRESSIONAL RECORD — APPENDIX

The Conquer Uterine Cancer Program

 

EXTENSION OF REMARKS
o

HON. JOHN E. FOGARTY

OF RHODE ISLAND .
IN THE HOUSE OF REPRESENTATIVES
Wednesday, March 14, 1962
Mr. FOGARTY. Mr. Speaker, under

leave to extend my remarks, I include
an address which I delivered to the
1962

Rhode Island Federation of Women’s
Club, at Providence, R.I., on December
7,1961:

THE CONQUER UTERINE CANCER PROGRAM

It is a real pleasure for me to have been
asked to address you on this occasion, on
the anniversary of Pearl Harbor Day. be-
cause I believe there is some significance in
the campaign you have undertaken which
coincides with the singlemindedness of the
American people in the task of overcoming
our adversary after that sneak attack. This
same spirit I find in your expressed desire
to face an enemy far more formidable than
the one that was faced and defeated after
Pearl Harbor. The lives of American women
are at stake. Your task is to prevent these
deaths by education and persuasion.

The partnership between the General
Federation of Women’s Clubs and the
American Cancer Society in the promotion
of health education spans the entire modern
era of cancer research and control. That era
began in 1937 with the adoption of the
National Cancer Institute Act and the
launching of the society’s first nationwide
educational campaign, It was from this part-
nership that the Women’s Field Army
emerged to provide a continuous program of
education, to dispel ignorance and mystery,
and bring about the control of cancer. Be-
cause of your efforts to promote the early de-
tection of cancer of the uterus, you are cred-
ited with being a major factor in the
50-percent decrease in the death rate from
that disease between 1936 and 1959 in spite
of a steady rise in the national death rate
for cancer as a whole. Much more remains
to be done, however, for the sheer magnitude
of the problem staggers the imagination.

Since 1945, this dread disease has taken
the lives of well over 344, million Americans,
nearly 10 times as many as were lost during
World War II. And each year, without
respite and without mercy, it tags another
quarter of a million human victims for de-
struction. Nevertheless, the campaign we
have waged for so long a period against
this disease is beginning to achieve results.

Although cancer today continues to be
the second leading cause of death, there has
been a steady increase over the past 25 years
in the proportion of patients who survive
& years or longer without evidence
of disease. These are the people who may be
regarded as cured. A study of this trend
which the National Cancer Institute made
in cooperation with the Connecticut. State
Health Department several years ago led to
the conclusion that the credit goes mostly
to better treatment, although early detection
is, of course, extremely important. These
improvements have been made not only in
surgery and radiation, but also in the new
fleld of drug treatment, or chemotherapy.

The discovery that viruses cause cancer in
animals was more over 50 years ago.
During more recent years research in this
field has shown that many different kinds of
cancer in animals are caused by viruses.
This has led scientists to assume that it is
probably only a matter of time until it can
be demonstrated that at least some forms
of cancer in man are likewise caused by vi-
ruses. Some scientists are strongly of the
opinion that now is the time to advance re-
search in this field with vigor, and many
investigators are currently engaged in study-

ing human cancers with the methods already”

so successfully used in work with animals.

In this connection I can say with confi-
dence that we are getting very close to sci-
entific proof that leukemia in human beings
is a virus-caused disease. Very recently two
investigators at the National Cancer Insti-
tute reported that they had extracted viruses
from the blood of leukemic rats. When in-
jected into other rats, these viruses caused
leukemia sooner and in a higher percentage
of animals than viruses recovered from other

CONGRESSIONAL RECORD — APPENDIX

tissues. The scientists are now using the
same technique to see if they can find vi-
ruses in the blood of human leukemia vic-
tims. If they do, it will be one of the most
important findings in the entire history of
cancer research.

The implications of studying viruses in
relation to human cancer are, I am told, very
broad. For one thing, these investigations
will greatly help medical science to under-
stand the whole problem of the cause of
cancer. For another thing, they are likely
to lead to the prevention of at least some
types of human cancer through some kind
of immunization. In fact, some of the im-
munization methods recently developed have
already made it possible to prevent some
tumors in animals.

Research has given us some of the neces-
sary weapons for our arsenal in the battle
against cancer. A few of these weapons are
imperfect as yet, and only serve to stun the
enemy temporarily and postpone the ultimate
fate of his victims. Other weapons, how-
ever, are potentially able to provide almost
total victory. against certain forms of the
disease.

One such weapon is the “pap” smear.

’ This is an examination, through the micro-

scope, of fluid taken from the body, for the
detection of cancer cells among the cells
shed naturally by the uterus, or womb. The
observance of abnormal cells warns the doc-
tor that cancer may be present. Although
cytologic examination cannot be used for
the detection of cancer in general, it is the
most powerful and most perfect weapon yet
developed for conquering uterine cancer
which takes the lives of 14,000 American
women a year. .

The “pap” smear, developed by Dr. George
N. Papanicolaou who received generous sup-
port for his work from the American Cancer
Society, can detect uterine cancer months,
and even years, before ordinary symptoms
appear. The significance of this lies in the
fact that cervical cancer in this preinvasive
stage is practically 100 percent curable.

Widespread availability of the “pap” smear
test is due largely to the fact that National
Cancer Institute scientists spent many years
of research to demonstrate its reliability as
® practical means of detecting early uterine
cancer. This research began with the estab-
lishment of a study at Hot Springs, Ark.,
to evaluate the technique as an aid to di-
agnosis. In 1951 the project was moved to
Memphis, Tenn., to learn whether the method
was practical as a case-finding procedure in
large populations.

Shortly thereafter, research projects were
established in 10 other cities throughout
the country, some of them administered di-
rectly by the Institute and others. operated
through grants to universities and medical
schools. In each of these situations, the
Institute cooperated directly with local
health and medical groups and with indi-
vidual physicians and pathologists.

Results of the Memphis project were fully
satisfactory, from the standpoints both of
public cooperation and the results obtained
from the test. Among the first 108,000
women given the test there were some 800
cases of cancer detected and subsequently
diagnosed microscopically.
these proved to be intraepithelial carcinoma
in situ which has a cure rate approaching
100 percent, and fully 90 percent of them
were totally unsuspected. The other 400
cases. were invasive cancers in different

stages, 830 percent of which were also unsus-

pected.

About a year later, 33,000 of these 108,000
women received a second cytologic examina-
tion. In this group another 83 cases. of

cancer were detected, of which 72 were pre-.

invasive and 11 invasive. Thus, in terms of
rate per thousand, there was a slight de-
crease for preinvasive cancer, from 3.6 de-

About half of -

A2241

tected on the first examination to 2.2 on the
second examination. For invasive cancer,
however, there was a sharp drop, from 3.4 on
the first examination to 0.3 on the second.
In other words, the invasive cancer rate on
the second screening was only one-tenth as
high as on the first screening.

The National Cancer Institute’s vigorous
research program in this area has also been
aimed at investigating other promising ap-
plications of the cytologic technique. For
example, Institute scientists, together with
the scientists of cooperating non-Govern-
ment institutions, have been studying the
possibility of employing cell examination to
Getect cancer in other parts of the body such
as the lung, the stomach, the large intestine
and the urinary tract. In these studies, one
of the most promising leads at the present
time appears to be from examination of the
urine for celis that might indicate the pres-
ence of cancer of the bladder.

I have also been informed that one group
of Institute scientists has discovered a tech-
nique for preparing human whole blood so
that it can be examined for cancer cells,
The technique appears to promise the possi-
bility for detecting certain kinds of cancer
which eluded discovery by other means. It
may also be valuable for followups after a
cancer operation to reveal whether metasta-
sis, or the spread of cancer to other parts of
the body, has occurred.

Methods of enlisting the cooperation of
the medical and health professions, ,and
winning public acceptance of the idea, were
pursued slong with research on the tech-
nique itself. Both the American Cancer
Society and the Public Health Service have
been working hard—and are still working—to
introduce the “pap” smear technique in com-
munities throughout the country. Your ef-
forts in this campaign are a part of this
whole effort which has been advanced to the
point where more than 5 million women are
expected to receive the examination this .
year. But the job is by no means finished.
It has hardly gotten a good start.

The happy history of cooperation that has
marked the relationship between the Ameri-
can Cancer Society and the General Federa-
tion of Women’s Clubs made it logical that
this partnership should be the instrument
chosen to conduct a nationwide drive against
uterine cancer. The program was officially
launched on April 10 at a reception held
at the Federation headquarters in Wash-
ington, D.C. On this occasion stimulating
addresses were made by Mrs. Ozbirn and the
ranking officers of the American Cancer So-
ciety. The effort got off to a solid start.

The new conquer uterine cancer program
constitutes an extension of the Society’s
basic 10-point cytology program which was
launched some 3 years ago. Since then, in
close cooperation with the medical. profes-
sion, great progress has been made in en-
courage “pap” smears as part of regular
checkups for women. Medical cooperation
has also insured a suitable balance between
medical: resources and laboratory. facilities
and the increasing demands made upon them
as the result. of the program. .

The main objective of the uterine cancer
program is, of course, to induce more wom-
en to have “pap” smears regularly. A sur-
vey made for the society by the Gallup or-
ganization showed that 40 percent of the
adult female population—some 23 million
women—still did not know about this life-
saving examination. Of women 65 and over—
a group. that accounts for 20 percent of
new cases and 41 percent of the deaths
each year—only 81 percent have even heard
of the examination, as compared to 71 per-
cent of women aged 35 to 50. This situa-
tion would seem particularly pertinent to
the suggestion by Dr. John W. Cline, im-
mediate past president of the American
Cancer Society, that such federated club
member try to persuade another woman,
A2242 |

preferably a nonmember, to have a physica:
and a “pap’’ smear. .

The conquer uterine cancer program with
the General Federation of Women’s Clubs
is regarded as a 1-year pilot phase of a con-
tinuing program to be expanded and ex-
tended in future years with other women’s
groups, and with women not in clubs. A
distinguishing feature of the pilot program
is that it introduces an element of incentive
or even competition on. a broad scale in an
organized way. For federated clubs, the
goal or incentive is to have all or as many
members as possible go.for a “pap” smear
and checkup within the period of a year—
as the first step toward a lifelong habit.
Clubs with outstanding participation by
members will receive certificates of award
from the American Cancer Soctety.

I would like to point out that the coming
year is a most appropriate time to bear
down on your efforts in this life-saving cam-
paign. Nineteen hundred and sixty-two will
mark the 25th annivesary of one of the
most important pieces of legislation ever
enacted by the Congress. I have reference,
of course, to the National Cancer Institute
Act of 1937, which was signed into law by
President Franklin D. Roosevelt on August
5 of that year. . ;

Several months ago I suggested in a pub~
lic address that steps be taken, both with-
in and outside the Government, to observe
this anniversary in an appropriate manner.

.I suggested that due note be taken of the

progress made against cancer during this
quarter-century, and of the task remaining
before us for the conquest of this dread
disease. I urged that we rededicate our-
selves to the furtherance of this unfinished
task by all possible means.

Iam happy to say that the National Cancer
Institute and the American Cancer Society,

are cooperating to arrange a number of —

activities by which 1962 will be observed as
cancer progress year. These activities are
designed to encourage the scientific com-
munity in its research efforts, to give the
public complete information about progress
against cancer and the problems still to be
resolved, and to emphasize the importance
of each individual's participation in the to-
tal effort for the control of cancer.

The significance of Cancer Progress Year,
and of the role of the American Cancer
Society and the National Cancer Institute
in promoting its observance, is recognized in
@ proposed joint resolution which I had the
pleasure of introducing in the House of
Representatives in the closing days of the
last session. The House readily adopted the
resolution, which requests the President to
issue proclamations inviting the participa-
tion of the people of the United States, Gov-
ernment and private agencies, and all media
of communication, in this important cancer
information and education effort. This reso-
lution will be introduced in the Senate when
the new congressional session begins in
January, and I am certain that it will be
adopted as an expression of the continued
support in the Congress of this vital move-
ment, :

My purpose in mentioning Cancer Progress
Year is twofold: First, I want to call your
attention to the magnitude and importance
of the contribution to medical research, and
to the health and welfare of the people of
this Nation and the world over, which was
made by the Congress in adopting the
National Cancer Institute Act of 1937. This
legislation, which inaugurated the modern
era of medical research, is indeed a milestone
on the highroad of human progress. Second,
I wish to emphasize the urgency of the chal-
lenge that still confronts us for the ultimate
conquest of cancer.

4s we approach the anniversary of this
important act, I hope that the American peo-

: CONGRESSIONAL RECORD — APPENDIX

ple fully appreciate the wisdom and fore-
sight shown by the Congress in establishing
the National Cancer. Institute in the late
thirties. It was around that time that in-
fectious diseases were being brought under
better control and it was becoming obvious
that the chronic and degenerative diseases
were going to be the big problem of the
future. Even in 1937 heart and circulatory
diseases were the leading cause of death in
this country, and it was only a year later that
cancer moved into second place ahead of in-
fluenza and pneumonia. From then on, with
the aid of sulfa drugs and later the anti-
biotics, deaths from infectious diseases stead-
ily declined, and the proportion of our popu-
lation liable to the threat of chronic diseases
in later life began to grow.

The National Cancer Institute was the first
unit of our medical research center at the
National Institutes of Health in Bethesda,
Md. It was therefore the nucleus of a whole
new concept of responsibility for the con-
duct and support of medical research on a
scale far beyond the resources of private
philanthropy or commercial enterprise.
These activities include not only research
itself, but also the construction and equip-
ping of laboratory buildings and hospitals,
the training of scientists, and the develop-
ment of public health programs for the con-
trol. of our major killing and crippling
diseases.

In taking special note, then, of the anni-
versary of the National Cancer Institute Act
of 1987, we are really recognizing the inau-
guration of a whole new approach to medical
research. As this new pattern has developed
over the years, it has mobilized research
manpower and facilities throughout this
country, and even abroad, for the most
thorough and comprehensive attack ever
made on the diseases that afflict mankind.

Those who work professionally in the can~
cer field are confident that the knowledge we
possess today, if fully appHed to the control
of cancer, could quickly improve the ratio
of lives saved from 1 in 3 to 1 in 2. But
the point here is that right now, the best
we can possibly do is to save only half of
the people who get cancer, and I am sure
we all agree that that is not enough.

What about the other half? What is going
to be their fate?. The answer can come only
from continued research and prompt appli-
cation of new knowledge gained through
research.

In the cell examination test for uterine
cancer—the “pap” smear research has given
us a very effective weapon against one form
of cancer. It is a form of cancer that takes
the lives of many women in their most pro-
ductive years and at a time they are most
needed by their families. Thus, the 14,000
fatal cases of uterine cancer a year not only
cause suffering and loss of life to the vic-
tims themselves, but strike a serious blow
to families and communities the country
over.

The American Cancer Society and the Gen-
eral Federation of Women’s Clubs have
undertaken a huge and important task.
This is a pilot project, which means that
the success achieved with it will greatly in-
fluence the pattern of future educational
campaigns enlisting the cooperation of other
national organizations to carry this vital
health message to women throughout the
country. There is much at stake here apart
from the lifesaving character of the effort
itself. There is an opportunity for both the
society and the federation to show the
country how effectively a project like this
can be carried out.

Here in Rhode Island we want to pick
up our end of the load and make one of
the best showings of any State. We know
how to do these things and we do them well.
More than that, of course, we are no less

March 22.

concerned with the health and welfare of
our people than any other region of the
United States. .

As:I said, there is much at stake here.
But there is nothing to risk, and nothing to
lose. There is only the opportunity to work
hard for an undisputed cause, and to enjoy
the rewards of a well-directed effort to stamp
out one of the greatest threats to women
everywhere—the threat of uterine cancer.

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