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And for the National Cancer Institute budget, $750 million for 1975, $830 million for 1976, and $985 million for 1977.

This, of course, is far short of the $1 billion which was contemplated for fiscal 1976 by the Panel of Consultants to the U.S. Senate for the Conquest of Cancer. It is also a far cry from NASA's budget of $3 billion in a year when NASA is supposedly curtailing its activities. NASA has spent $54 billion so far.

The 1971 law is not specific concerning the amount of overhead in the limitation of $35,000 in grants in section 410(b) (1) and (2). We would urge that the law be changed to read so that the $35,000 includes only direct costs.

The reason here revolves around the uncertainty of the costs, which vary widely from one institution to another, and the size of the indirect costs, which often leave a sum too small for practical use.

Indirect costs are not controlled by the National Cancer Institute. Rather, they are negotiated by the institution and higher levels of Government and then applied to any grants from the Government to the individual institution. So far as the National Cancer Institute is concerned, there is no opportunity for either waste or economizing with regard to the negotiated indirect cost rate applicable to any given grant.

For instance, institutions of higher education operated last year at indirect costs of 64 percent, 52 percent, and 59 percent, among other rates applicable in that geographic area. A noneducational institution in the same area received grants on which a 53-percent indirect cost rate applied.

Scientists reviewing $35,000-maximum projects face uncertainty, in these circumstances, of the proposal's feasibility.

The authority for construction is not specific in the 1971 law. This should be more specific, applying to new building as well as that which is specified in the 1971 law: "... To acquire, construct, improve, repair, operate, and maintain cancer centers, laboratories, research, and other necessary facilities and equipment, and related accommodations ..." in section 410(2). This has been interpreted to bar new construction of basic cancer research facilities.

However, new construction is explicitly needed. One important use for this building is the control of biohazards. The virus work is one of the most important new frontiers. It requires particular care for isolation, atmospheric control, positive waste disposal, cleansing, and personnel traffic.

Occupationally acquired cancer among researchers is a distinct possibility. The consequences of laboratory exposure to experimental carcinogens may not be demonstrated for many years. Prevention now is imperative to reduce hazards to a minimum.

The 1971 cancer law authorized 15 new clinical centers. As of today we have not met that goal, though we expect that the National Cancer Institute will be able to designate the full number by June 30 of this year when the present law expires. .

The Institute has designated three world-recognized comprehensive cancer centers as fitting the law's intent, but only nine "new" centers have been designated as such since the law went into effect.

I am submitting for the record a list of these centers. We need

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The outreach of designated centers simply cannot be extensive
enough to serve the whole country. Such major cities as San Fran-
cisco, Atlanta, Kansas City, Chicago, New Orleans, Memphis, Pitts-
burgh, and many others are without comprehensive centers.

This means unavoidable delays in putting into the mainstream of
medical advances those new discoveries, new treatments, that ema-
nate from the conquest of cancer program. And it means that pa-
tients needing highly specialized treatment available only at such
centers must often travel hundreds of miles from their families for
that care. We have enclosed a map designating the locations of the
approved centers.
The 15-center limit in the law should be removed.

Personally, I want to add that all the American Cancer Society
volunteers are grateful to you and to this committee for your consist-
ent and dedicated support of the Cancer Act and its program. We
are confident that the program has advanced our fight against cancer
in the last few years.

The effects of such a program are not always easy to see unless one is engaged in patient care, but we who are in the practice of medicine are confident that the ideas and improvements brought forth are going to prove very valuable as we view the cure rate of cancer in the years to come. We must push this fight with vigor through renewal of the cancer law.

Historically, the American Cancer Society has been extremely interested the work of the National Cancer Institute. The National Cancer Institute was established in 1937 by the Congress, largely as a result of interest and efforts of the American Cancer Society,

Through the years the Institute and the Society have cooperated. However, the independence of the National Cancer Institute, as authorized by the National Cancer Act of 1971, has brought this into a never-before-realized cooperative partnership with the American Cancer Society.

This legislation has produced a unique form of Federal-private cooperation. In the area of cancer control, the American Cancer Society and the National Cancer Institute are actively sharing funding, planning, and administration of several cancer control projects as part of the national cancer program.

This represents a first in the Government-private sector relationship, the benefactors of which are the American people, both in the service rendered, and in the savings to them because of the volunteers of the American Cancer Society

Were the Government required to pay for all of these man-hours of labor, the cost would be astronomical. The American Cancer Society with its over 2.5 million volunteers, including the professional expertise of over 50,000 doctors, has provided this involvement without cost to these projects.

I would like to describe one example of this cooperation, and I refer to the joint American Cancer Society/National Cancer Institute breast cancer detection demonstration program.

The object of these project units is to demonstrate to the practitioners and to the public the effectiveness of early detection of breast cancer, to better define the high-risk groups and to develop better


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screening methods—see attached list of leaders and locations of project units.

Breast cancer mortality rates have remained constant at about 25 per 100,000 for the last 40 years. The incidence, however, has increased from 65 to 72 per 100,000. Therefore, we are curing more

We lost 8.5 times as many women during the years of the Vietnam war than we lost servicemen in Vietnam. In a 10-year period the number of women in the United States having breast cancer would outnumber the population of Boston, Mass., man, woman, and child.

The National Cancer Institute and the American Cancer Society have established 27 projects throughout the United States in the breast cancer detection program. The response of the public and the profession has been overwhelming.

Each project will examine 5,000 women each year. In my own project we are now booked up into next fall with women clamoring for this examination.

This is a wonderful example of the public's realization that somebody cares about them and is doing something for them—it is wonderful public relations for the National Cancer Institute, for the Congress, and for the President.

We do not yet have the figures from all of the projects, but in my own, in Atlanta, in the first 1,300 women we screened, we found 8 cancers, only 1 of which was large enough to be felt clinically and only 1 of which had any evidence of spread.

The results of this cooperative effort will result in a highly significant reduction in the death rate from cancer of the breast, which is the number one killer of women in the United States.

Mr. Chairman, we have made great progress in the first 3 years under the National Cancer Act. The Congress is dedicated, the President is dedicated, the American Cancer Society remains dedicated as a committed partner. This is an unbeatable team.

We, therefore, urge the renewal of this legislation for the sake of the survival of the untold thousands of men, women, and children, the future victims of cancer. May this act preserve them, that they may enjoy this great country of ours in the years to come.

Mr. Chairman, this is a great country, yet, there are many things we could do better, but it is the greatest country on this earth.

Last year I met with health educators behind the Iron Curtain in Krakow, Poland. In discussing cancer education among medical students, Dr. Glazer, who is professor of surgery at Leipzig University in East Germany, said that they had difficulty in teaching cancer education, because the government demanded that 25 percent of the time of the curriculum in medical school be dedicated to the teaching of Leninism and Marxism.

We are fortunate in the United States that we have been able to keep politics and medicine separate. The cooperative efforts of the Government and the private sector, as is demonstrated by the National Cancer Institute/American Cancer Society partnership can only survive in such a society free of politics, free to answer the needs of our people: the need to give and the need to receive.

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Thank you.

Senator KENNEDY. Thank you very much. That is a splendid statement. We are interested in your comments about the budget and personnel in the independent centers, and these are very helpful comments for us to have.

You are in support of the program!

Dr. LETTON. It is in accord with the bill as I see you have suggested.

Senator KENNEDY. Is the figure of 25 per 100,000 or more?

Dr. LETTON. Twenty-five per 100,000 is the number of deaths of cancer of the breast among women for the last 40 years.

However, the incidence has risen, and these are the figures, from 55 per 100,000 to 72 per 100,000 is the incidence of cancer

of the breast. We are curing more women, but our mortality rate has remained at this 25 per 100,000.

Senator KENNEDY. Is that because people are living longer?

Dr. LETTO This one of the reasons that we have people in the older age group coming in now.

There seems to be an increase in the number of cancers of the breast.

Senator KENNEDY. Why is that?

Dr. LETTON. We do not know at the present moment. I wish we did, Mr. Chairman.

Senator KENNEDY. We want to thank you very much. .

At this point I order printed the statements of those who could not attend and other pertinent material submitted for the record.

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Albert Einstein Medical Cntr.

Temple U. Hospital

Philadelphia, Pa. College of Medicine and Dentistry

of New Jersey

Newark, New Jersey Guttman Institute

New York, New York Rhode Island Hospital

Philip Strax, M. D.

18 April 73

t.bir. #


! 2 people in the

Herbert P. Constantine,
Bernard Fisher, M.D.
Leslie W. Whitney, M, D.

Richard G. Lester,
R. Waldo Powell, M. D.
A. Hamblin Letton, M. D.
Margaret Abernathy,
M. D.
Marvin A. McClow,
M. D.
Condict Moore, M.D.
John R. Amberg, M.D.

William L. Donegan,
Donald C. Young, M.D.

James E. Youker, M.D.

Myron Moskowitz, M. D.
Loren J. Humphrey,
M. D.
Walter M. Whitehouse,

Providence, Rhode Island
U. of Pittsburgh School of Med.
Wilmington Med. Cntr.

u.n. *
1 Jan 74

ancers of the


1. n.

t. I wish

9 May 73

4. n.

Fo could not ord.

Duke University Med. Cntr.

Durham, N. C.
Emory U. --Georgia Baptist Hosp.

Atlanta, Georgia
Georgetown U. Med, School

Washington, D. C.
St. Vincent's Med. Cntr.

Jacksonville, Florida
U. of Louisville School of Med.
Vanderbilt U. School of Med.

Nashville, Tennessee

6 June 73

17 April 73 t.b.r.


t. b.r.

u. n.

18 June 73

Ellis Fischel State Cancer Hosp.

Columbia, Missouri
lowa Lutheran Hospital

Des Moines, Iowa
Medical College of Wisconsin

Milwaukee, Wisconsin
U. of Cincinnati Med. Cntr.
U. of Kansas Med, Cntr.

Kansas City, Kansas
V. of Michigan Med. Cntr.

Ann Arbor, Michigan

28 June 73 19 June 73

น. .

*u, n. --under negotiation
#t. b. r. --to be reviewed Feb. 1974 by ACS, then by NCI; to receive
award in FY 1974 if NCI money is available.

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