Cancer Census

The complex of diseases known as cancer is not only the most feared of human maladies, it is also the most baffling. Man's counterattack against it has produced victories of a sort: 40 years ago, less than one-fifth of all known victims survived five years after diagnosis; now one-third live at least that long. Yet a basic understanding of cancer's causes and cure is still elusive--and the casualty list is growing. This year the death count will amount to 339,000 in the U.S. In 1972, according to the National Cancer Institute and the American Cancer Society, the figure will rise to 345,000.

The NCI bases its report on a new study that covered areas with a combined population of 20 million.* The survey is the most complete ever undertaken, and will analyze statistics from at least one more state and Puerto Rico before it is completed in 1973. Meanwhile, the preliminary findings, which include the projection that more than 600,000 new cancers will be diagnosed in the coming year, point to changing patterns. Items:

P:In women, the overall incidence of cancer is decreasing. Since 1947, the rate has dropped from 294 per 100,000 to 256. Fatalities among women have also declined dramatically, largely because of earlier detection of uterine cancer, which is almost always curable if treated promptly. In 1940, uterine cancer caused the death of 27.9 out of every 100,000 women. By 1968, the figure had fallen to 10.6. Breast cancer, however, remains a constant threat.

P:For men, the peril is rising. Since 1947, the male cancer rate has climbed from 280 per 100,000 to 304, while the death rate has risen by nearly 40%. Tumors of the prostate and colon account for part of the increase, but lung cancer is the biggest factor in the upsurge. The lung-cancer death rate among American men is three times greater than in 1947; next year the disease is expected to kill 56,000. Women are also suffering from lung cancer in growing numbers.

P:Blacks are proportionately more vulnerable than whites. Black men are 65% more likely to suffer from cancer of the prostate than whites, 250% more susceptible to cancer of the esophagus. Black women are 25% less likely to develop cancers of the breast or uterus than whites, but 115% more likely to get cancer of the cervix.

These and other statistical trends have not yet been fully analyzed, but some theories are emerging. The National Cancer Institute's assistant director, Dr. Anthony Bruno, believes that women are more likely than men to seek medical help as soon as symptoms appear. Together with improved treatment methods for certain types of cancer, this attitude would account for the decrease of fatalities among women. But there is no explanation of why incidence of the disease is falling for one sex while rising for the other. Nor is there any evidence in the NCI survey to suggest that the difference between the races is based on genetics. Diet, environment, access to medical treatment, work patterns--all these may be involved. But Bruno stresses that much more research will be necessary before firm conclusions can be drawn from the cancer census.

There may soon be a large increase in that research. Congress has been debating new federal approaches to cancer since last winter. At that time Senator Edward Kennedy proposed the creation of a separate cancer agency outside the National Institutes of Health. The Nixon Administration responded with a plan of its own for an expanded NCI within NIH, then was forced into a surrender disguised as a compromise (TIME, July 5). The Senate subsequently passed a bill, 79 to 1, creating an ambitiously named Conquest of Cancer Agency. It would be administratively and financially independent of NIH, though nominally part of the agency. The theory behind both plans is that medicine knows enough about the disease to adopt a crash-program approach comparable to the Manhattan Project during World War II.

Overkill. But many scientists argue that not enough has yet been done in basic cancer research. They fear, rightly or wrongly, that an organizational change would enmesh the cancer budget in politics and divert too much money from science efforts to clinical approaches. This fall they picked up an ally in the person of Florida Congressman Paul Rogers, chairman of the House Public Health and Welfare Subcommittee. Rogers drafted a bill to expand cancer research in the NCI within the present NIH-NCI framework. Before the House bill could be reported out, however, some proponents of the Senate bill counterattacked. They bought space in 22 newspapers serving the home districts of each House subcommittee member. The ad supported an independent cancer agency and urged readers to write to their Congressmen.

The campaign proved to be a case of overkill. Most subcommittee members resented what they considered an attempt at intimidation; one argued that the money spent on the ads could have been better spent on cancer research. All the subcommittee members ultimately went along with Rogers and cleared his bill, which increases the number of NCI research centers from eight to 23, speeds up the process of awarding study grants, and takes backers of the Administration's bill off the hook by creating a presidential watchdog commission to oversee an expanded NCI. Scheduled to reach the floor of the House later this month, the bill is expected to pass. Some tough House-Senate bargaining is likely to extend into the politicking of 1972. The chances are good that some form of the legislation will be enacted before the presidential election and all factions will doubtless claim credit. The extra funds and facilities should accelerate many programs, stimulate new ones and buy more of the sophisticated laboratory equipment researchers require. But the history of cancer research suggests that the enemy will continue to yield its secrets with excruciating slowness.

* Iowa, plus Detroit, Minneapolis-St. Paul, Pittsburgh, Atlanta, Birmingham, Dallas-Fort Worth, Denver and San Francisco-Oakland.

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