What was the state of cancer in mid twentieth century America? There was no "cure," nor was there a consensus on causation; but in the mind of the American public, with its almost unwavering faith in science and medicine, cancer had shifted from being a death sentence, whispered about as the "c" word, to an often treatable disease. The mantra from public officials became "many cancers are treatable if caught early enough."

When Dr. Leona Baumgartner, the new NYC Health Commissioner, stepped on the podium at the New York Academy of Medicine on October 26, 1954, cancer had moved up to the second leading cause of death in New York City and nationally. Death rates due to cancer had more than tripled in 50 years, but Dr. Baumgartner, expertly threading the line between reassurance and concern, assures the audience (including WNYC listeners) that the statistics provide a somewhat false impression of cancer mortality. She explains that the numerical rise is attributable to three factors: (1) better diagnosis, (2) more accurate reporting of the causes of death and (3) the conquest of most communicable diseases, which allowed a much larger proportion of the population to live into late middle age and old age —precisely the age at which many cancers strike.

By the time of this speech, cancer awareness and education were not new, having formally begun before World War I; the Second World War and the subsequent Cold War led to significant investment by the federal government in scientific and medical research (as well as a concern about the effects of radiation, but that's another story). The best defense, it seemed, was an early offense, so public cancer control strategies focused on early detection and mass screenings. Commissioner Baumgartner saw cancer control as a four-part program: her speech focuses on the interdependency of (1) the Department of Health, (2) voluntary agencies, (3) private practice physicians and (4) educated New Yorkers. Thus it would be through mass and individual action —through agencies, professionals and people— that the dread disease could be tamed.

Widespread education was seen as a prerequisite of cancer control, so the Department of Health's role in this respect was threefold. It tried to educate the public, individuals and family doctors about possible cancer symptoms; to encourage individuals to get in the habit of seeing the family physician annually; and to make the family doctor aware of his important role in the process of early detection. The Department also ran three cancer detection centers: the first opened in 1947 and two more were added in 1951. Admission was restricted to women 30 years and over and men 35 years and over, who had no cancer symptoms.

Of equal importance was the support provided by voluntary agencies, particularly the New York City Cancer Committee. This organization, founded in 1926 as a local branch of the American Society for the Control of Cancer (later the American Cancer Society), focused on early detection. The Cancer Committee funded a cytological service for indigent patients in Manhattan and the Bronx. Doctors could take a Papanicolaou smear (the pap smear) in their offices and send it for analysis free of charge. The Cancer Committee funded some of the Department’s cancer detection centers as well.

Because the detection centers could only serve a fraction of the population needing annual examinations, the private practitioner’s role in cancer detection was paramount. In her speech Dr. Baumgartner reminds family physicians that they are in the best position to examine what she calls "accessible sites" —the skin, oral cavity, breast, rectum, prostate and uterus— during routine visits. "Every Doctor's Office a Detection Clinic" was the goal of the New York City Department of Health's cancer control program.

The final component to a successful plan of early detection, control and treatment was the patient. Dr. Baumgartner believed the plan would only work if individuals were equipped to take the first step. She did not believe in fear as a tactic but wanted to encourage all New Yorkers to take advantage of the health care resources of their city. This started with an annual visit to the family doctor's office. An educated patient would be aware of potential symptoms related to cancer and would report them to the doctor, who, in turn, would start the process of initial testing to reach a diagnosis. According to Dr. Baumgartner, the "individual must assume personal responsibility" for his or her health and "seek care in an intelligent way." In this regard the Health Department, in conjunction with the Cancer Committee, taught women the correct method by which to examine their own breasts monthly using films and leaflets. And long before the women’s health movement of the 1970s, the Department initiated a pilot program, in which women would prepare their own slide for a pap smear and send it to a laboratory for analysis. It was called S.O.S. - self-obtained smear. Dr. Baumgartner was clear that this was not a substitute for a visit to the doctor but may have served as an incentive to get women to make a visit. Finally, the Department also provided free kits for all interested physicians in Manhattan and the Bronx and the Cancer Committee funded the analysis of the smears at New York University - Bellevue College of Medicine and at Harlem Hospital.

Where does that leave us today in terms of cancer control? Cancer deaths are still the number two cause of death in New York City, but the death rate has declined. Perhaps more interestingly, data on cancer incidence vs. mortality show that Leona Baumgartner and other public health leaders were correct: when caught in time, the most common forms of cancer are quite treatable. Moreover, the same four prongs of cancer control are still as essential today as they were in 1954. Public health campaigns must remind us of potential symptoms; voluntary health agencies still remind us to be ever vigilant (pink is everywhere); primary care physicians, who are the only contact with the medical profession for many Americans, need to be on the lookout for these symptoms and must make recommendations for further testing and treatment when appropriate; and we, as individuals, must absorb all of this information and have a duty to ourselves to act on it.

The Baumgartner speech also provides us with a glimpse of the time when a tidal shift occurred in the focus of many health departments, from the containment of contagious diseases to the control of chronic diseases, like cancer, heart disease and diabetes. This shift has prevailed until today.

New York City, 2007-2011, rate per 100,000 people

(https://www.health.ny.gov/statistics/cancer/registry/vol1/v1rnyc.htm)