(Automatic transcript - may present inaccuracies)

>>Dr. Leonna Baumgartner: I should like to thank, first of all, the New York City Cancer Committee, and the Academy of Medicine for the opportunity before the Department of Health, to present this series of cancer alerts to the medical profession. An introduction to these brief messages and a backward glance together with a summary of present day knowledge, might perhaps help orient us to the total picture. Some of you may recall a dramatic event surrounding the diagnosis and treatment of a president of the United States some 50 years ago. I refer to President McKinley who, after the diagnosis of cancer of the jaw had been made, was operated upon under the greatest secrecy on a boat, believe it or not, drifting in the East River. The physicians and attendants were sworn to secrecy. No information was given to the press, no bulletins were issued. Contrast this attitude to the recent fatal illnesses from cancer of several outstanding figures in our government in which diagnoses were fully mentioned in the press. And on the radio and where bulletins on the conditions on the distinguished patients were issued several times a day. This change in attitude and the part of the medical profession and the acceptance of the facts of lay profession, reflects graphically the progress made in one important element in the total cancer problem. Namely, information and education. Now, at the turn of the century, cancer occupied 8th place in the leading causes of death. At the mid century in 1950, cancer had moved up to occupy 7th place next to heart disease. In 1900, 2,291 deaths from cancer were reported in New York City with accrued rate of 66 per 100,000. In 1950, 15,509 deaths from cancer were reported. Accrued rate of 196 per 100,000. Sixty six per 100,000 in 1900, 196 per 100,000 in 1950. Cancer, of course, is both a personal problem and a public health problem. It may be expected to take a toll of over a quarter of a million of American lives this year. Despite continued progress and cancer research and medical care, it is possible with our aging population the problem will grow in magnitude in future years. Over the past half century in the United States, the cancer death rate has more than doubled from 64 cases per each 100,000, general population in 1900 to 135 in 1915. The same lies nationally as we saw here in the city. Cancer has come to the forefront as a cause of death for several reasons. Among these, of course, are better diagnosis and more accurate reporting of the causes of death. But another and more important reason, of course, is the communicable diseases that a generation ago have largely been brought under control. With the decline of these infections which formerly took a heavy toll of persons in the earlier years, the majority of Americans now survivor until the middle and the later years of life. It is in these years, of course, that cancer is most likely to occur. In 1900, 2.8 percent of the population of New York City was over 65 years of age. In 1950, this proportion of our senior citizens had risen to 7.7 percent. Looking out of another way of the turn of the century, 15 percent of the city's population was over 45. In 1950, this proportion had more than doubled to 32 percent. The disconcerting rise in cancer mortality, of course, represents the challenge to the entire medical profession is a problem to patients and their families. But particularly to the family doctor is it a challenge. Because in most cases, he is the one who sees the patient at the time when early symptoms or no symptoms are present. And at the time when the cure, possibility of cure, is most favorable. While there are many factors which contribute to earlier diagnosis and more effective treatment, the most important one is generally recognized to be the awareness and the interest of the family physician. One question people may ask is, is there really an increase in cancer? Is the increase real? Dr. Dublin, the well known statistician, stated that the marked rise in the death rate probably does not reflect the true cancer situation. The proportion of the population surviving to old age has been growing steadily. Persons saved from premature death, as we said before, can now live to an age at which cancer takes its toll. And the great improvements in the diagnosis of cancer in the last 50 years have also added to a false imprecision of the trend of cancer mortality. Has any real progress, therefore, been made in the cancer field in the past 50 years? This is a common question. It is true that the basic cause or causes of cancer have not yet been found, nevertheless, in the areas of detection, diagnosis and treatment, enormous advances have been made. It becomes, therefore, the possibility of the practitioner to be familiar with these new techniques so that his patients may benefit by them. The average general practitioner it is estimated may see about 2 or 3 new cases of cancer annually. Because of this, there rises the need for keeping physicians alerted to cancer and abreast of the very latest developments in the diagnosis of the disease. Here in New York City, the county medical societies, the Academy of Medicine, the New York City Cancer Committee, the Department of Health. All cooperate in bringing up to date information on the chemical aspects of cancer diagnosis in treatment to the profession. Since diagnosis starts in the doctor's office, it is necessary, of course, to encourage the public to seek medical attention through a widespread educational program. Which outlines the nature and the significance of initial symptoms of the disease which might indicate cancer. And stresses the importance of immediate, physical examination. Public health education, that is widespread education of the public as to the nature and significance of cancer as a prerequisite of cancer control today. The American Cancer Society and its local affiliates in this area assist the Department of health with this major job of bringing the basic information on cancer to the public. Physicians practicing in New York City have able almost comprehensive array of medical services to aid them in their efforts of cancer control. Skilled specialists and consultants are available in their private offices. As well as in large medical centers, university hospitals, and other leading institutions where the most modern methods of diagnosis and treatment can be found. Diagnostic [inaudible], together with a physician's diagnostic service center operated by the health department over on 9th Avenue, constitute another resource in our attack on cancer. A number of cancer detection centers, some of which are subsidized by the New York City Cancer Committee, also aid in training the public for cancer. And then, of course, again, through the cooperation of the New York City Cancer Committee, there's an exfoliate psychological service for [inaudible] patients. Which has been organized and is working in Manhattan and the Bronx so that doctors can make papanicolaou smears in their own offices and have expert psychologists [phonetic] examine the slides. This is a service that more doctors should know and use. While we await the discovery, of course, of the basic causes of cancer, the most important aspect of increasing the cure rate, it lies in this earliest of detection. The very earlier detection. And then control and treatment. This can best we illustrated by mentioning, perhaps, a few examples. Connection at the various sites of cancer. The first, 1 out of 5 cancer deaths is due to breast cancer. Many of these deaths can be and are being prevented through community wide educational programs which instruct women in breast self examination. And encourages them to carry out such an examination procedure at monthly intervals. The women, of course, are told to go to their doctor when they find anything suspicious. Second example, cancer of the lung is today on the increase. Periodic chest x rays of persons over 40 should be encouraged for the earliest detection. Not only of tuberculosis, but of cancer of any change in the thorax. A third example. Repeated examination of cellular materials from the cervix and in the uterus constitute an effective screen for cancer of the cervix. And this connection, incidentally, in the Department of the Health, we have a pilot project in which we're experimenting with self obtained vaginal secretions. Which we hope to talk more about in the future. The last example, encouragement of periodic physical examinations by the family doctor. Stressing the so called accessible sites of cancer, the skin, the oral cavity, the breast, the rectum, the uterus, and the prostate. These examinations are all not for the purpose of instilling into the patient but getting the patient to seek medical care in an intelligent way. Advances in fundamental knowledge. Improvements in diagnostic and therapeutic techniques. Increase in hospitals, clinics, and other facilities for diagnosis and treatment. All these elements of progress against cancer bring maximum advantage only if the individual who assumes personal responsibility. Therefore, persons of cancer bearing age should not fail to take the precaution of regular and thorough medical examinations. Thus the control of cancer is truly a significant public health problem which requires mass action as well as action on the part of the individual doctor. For this reason, public health agencies are interested in bringing together all the groups. The agencies and the professional disciplines and the people all widely concerned with the cancer problem. It seems that only in this way, will we be able to make substantial headway in controlling the disease.