Document a4Z2p7pQaO5NRQR9m6v79bRe

American Cancer Society CANCER FACTS & FIGURES `Excluding non-matsnoma skin cancer and carcinoma in situ Based on raft Irom lha NCI SEEP Program (1973-1977) UCC 096715 1 CONTENTS AMERICAN CANCER SOCIETY.................... 19 BASIC DATA...................................................... 3 Definition, treatment, incidence, survival, mortality, prevention BLACKS AND WHITES, CANCER RATES .. .5 BUDGET ALLOCATIONS...............................27 CANCER SITES...........................................14-19 Breast............................................................... 15 Cancer in Children............................................18 Colon-Rectum.................................................. 16 Leukemia.........................................................18 Lung................................................................. 14 Oral................................................................... 17 Skin................................................................... 17 Uterus............................................................... 16 CHARTS AND TABLES................................7-13 1981 Estimated New Cases by States... . t............................ Front Cover Mortality for Leading Causes of Death: 1977 ................................................ 7 Five-year Survival Rates for Selected Sites . . .7 1981 Estimated Cancer Incidence by Site and Sex............................ :................ 7 1981 Estimated Cancer Deaths by Site and Sex................................................ 7 1981 Estimated New Cancer Cases, Deaths by Sex for all Sites...............................8 1981 Estimated New Cases, All Sites by State.............................................................9 1981 Estimated Cancer Deaths, All Sites by State............................................10 Female Cancer Death Rates by Site................ 11 Male Cancer Death Rates by Site.................... 11 25-Year Trends in Age-Adjusted Cancer Death Rates........................................11 Mortality for 5 Leading Sites by Age Group, Sex........................................12 How to Estimate Cancer Statistics Locally . .12 Cancer Around the World............................... 13 CHARTERED DIVISIONS OF THE AMERICAN CANCER SOCIETY, INC............................... Back Cover CELEBRITIES AND CANCER....................... .29 COMPREHENSIVE CANCER CENTERS. .. .31 COSTS OF CANCER....................................... 28 ENVIRONMENT........................................ 26-27 Cancer Prevention Study................................. 26 Studies of Occupational Groups.................... 26 GUIDELINES FOR CHECKUPS......................30 HOW CANCER WORKS..................................... 4 INCIDENCE AND MORTALITY STATISTICS, SOURCES.................................4 PUBLIC EDUCATION..................................... 19 PROFESSIONAL EDUCATION.................20-21 Clinical Fellowships......................................... 20 Clinical Professorships.....................................21 Unproven Methods of Cancer Management. .21 RESEARCH.................................................23-25 Kinds of Grants..............................................23 The Financial Research Picture......................24 Table of Funded and Unfunded Grants.........24 ACS-Supported Nobelists...............................25 Current Researchers....................................... 25 SERVICE AND REHABILITATION .... 21-23 Service............................................................... 21 Rehabilitation.................................................. 22 SMOKING........................................................... 14 SOURCES OF INCOME................................... 28 TRENDS IN DIAGNOSIS AND TREATMENT...................................... 5-6 WARNING SIGNALS....................................... 20 1980; American Cancer Society. Inc. All right* reterved. Including the right to reproduce thie publication or portion* thereof in any form. For written perminion, addret* American Cancer Society, 777 Third Avenue, New York, N.Y. 10017. UCc 096716 BASIC DATA What is cancer? Cancer is a large group of diseases characterized by uncontrolled growth and spread of abnormal cells. If the spread is not controlled or checked, it results in death. However, many cancers can be cured if detected and treated promptly. How is cancer treated? By surgery, X rays, radioactive substances, chem icals, hormones and immunotherapy. Has there been any progress against cancer? Yes. In the early 1900's few cancer patients had any hope of long-term survival. In the 1930's less than one in five was alive at least five years after treatment. In the 1940's it was one in four. Now the ratio is one in three. The gain from one in four to one in three currently represents about 67,000 people this year. Who gets cancer? Cancer strikes at any age. It kills more children 3 to 14 than any other disease. And cancer strikes more frequently with advancing age. How many people alive today will ever get cancer? Almost 56 million Americans now living will eventually have cancer; one in four, according to present rates. Over the years, cancer will strike in approximately two of three families. In the 70's, there were an estimated 3.5 million cancer deaths, over 6.5 million new cancer cases, and more than 10 million people under medical care for cancer. How many people alive today have ever had cancer? There are over 3 million Americans alive today who have a history of cancer, 2 million of them with diagnosis five or more years ago. Most of these 2 million can be considered cured, while others still have evidence of cancer. By "cured" is meant that a patient remains free of disease and has the same life expectancy as a person who never had cancer. The decision as to when a patient may be con sidered cured is one that must be made by the phy sician after examining the individual patient. For most forms of cancer, five years without symptoms following treatment is the accepted time. However, some patients can be considered cured after one year, others after three years, whereas some have to be followed much longer than five years. How many new cases will there be this year? In 1981 about 805,000 people will be diagnosed as having cancer.* How many people are surviving cancer? About 268,000 Americans, or about one-third of all people who get cancer this year, will be alive at least five years after treatment. However, when nor mal life expectancy is taken into consideration (fac tors such as dying of heart disease, accidents and diseases of old age), 41% of cancer patients will sur vive at least five years. Could more people be saved? Yes. About 134,000 people with cancer will probably die in 1981 who might have been saved by earlier diagnosis and prompt treatment. How many people will die? This year about 420,000 will die of the disease - 1,150 people a day, about one every 75 seconds. Of every five deaths from all causes in the U.S., one is from cancer. In 1980 an estimated 412,000 Ameri cans died of cancer. In 1979 it was 404,000. In 1978, it was 396,992. In 1977, 386,686 cancer deaths were reported by the U.S. National Center for Health Statistics. What is the national death rate? There has been a steady rise in the age-adjusted** national death rate. In 1930 the number of cancer deaths per 100,000 population was 143. In 1940 it was 152. By 1950 it had risen to 158 and in 1977 the number was 175. Except for cancer of the lung, age-adjusted cancer death rates for major sites in general are leveling off and in some cases declining. Can cancer be prevented? Some cancers, not all. Most lung cancers are caused by cigarette smoking, and most skin cancers by frequent overexposure to direct sunlight. These cancers can be prevented by avoiding their causes. Certain cancers caused by occupational/environmen tal factors can be prevented by eliminating or reduc ing contact with carcinogenic agents. Examples in clude bladder cancer among workers in the dye in dustry, and lung cancer in asbestos workers - espec ially those who are also smokers. 'These estimates of the incidence of cancer are baaed upon data from the National Cancer Institute's SEER Program (1973-1977). Non melanoma skin cancer and carcinoma in situ have not been included in the statistics. The incidence of non-melanoma skin cancer is estimated to be about 400,000. "Age-adjusted - a method used to make valid statistical comparisons by assuming the same age distribution among different groups being compared. 3 UCC 096717 SOURCES OF INCIDENCE AND MORTALITY STATISTICS INCIDENCE Cancer in most parts of the United States is not a reportable disease. Thus there is no way of knowing exactly how many new cases of cancer are diagnosed each year. In the past, estimates of cancer incidence were made by extrapolating from the experience of the few population-based cancer registries. In 1969, the National Cancer Institute embarked on a three-year survey of cancer incidence in nine major areas of the United States. It was the most comprehensive incidence survey ever carried out. Then in 1973, NCI began a new and larger program, gathering data from 11 population-based registries. It is called SEER, standing for Surveillance, Epi- demiology and End Results. Beginning with the 1979 edition of Facts & Figures, SEER incidence information has been used. The latest available information for this 1981 edi tion is from the years 1973-1977. Each time a new data base is introduced to estimate incidence, there may be sharp changes in figures due to the more accurate data. They do not indicate a cancer epidemic or new cure. Since comparisons of figures from different data bases are not valid, one can compare the 1978 Facts & Figures only with the previous editions, and the 1979 Facts & Figures only with later editions. MORTALITY There has been no change in the "data base for mortality statistics. The source is the National Center for Health Statistics, Department of Health and Human Services. The 1981 figures are estimates based on the lat est available information, which includes material through 1977. However, to increase accuracy, mortality rates per 100,000 population have been age-adjusted for the first time to the 1970 census, rather than to the 1940 census. For these population-based mortality rates alone, comparing charts and figures with those of previous years may indicate false trends. HOW CANCER WORKS Normally, the cells that make up the body re produce themselves in an orderly manner so that wom-out tissues are replaced, injuries are repaired and growth of the body proceeds. Occasionally, certain cells undergo an abnormal change and begin a process of uncontrolled growth and spread: one cell divides into two, those redivide into four, and so on. These cells may grow into masses of tissue called tumors - some benign and others malignant (cancer). The danger of cancer is that it invades and de stroys normal tissue. At the beginning, cancer cells usually remain at their original site, and the cancer is said to be localized. Later, some cancer cells may invade neighboring organs or tissue by direct exten sion of growth or they become detached and are carried through the lymph or blood systems to oth er parts of the body. This spread may be regional-confined to one region of the body-when cells are trapped by lymph nodes. If left untreated, however, the cancer is likely to spread throughout the body. This is ad vanced cancer, and usually results in death. Because with each stage a case of cancer becomes progressively more serious, it is important to detect cancer as early as possible. Aids to early detection include cancer's Seven Warning Signals and the can cer risk factors. (See Under Individual Sites.) 4 UCC 096718 CANCER RATES IN BLACKS AND WHITES * A study of cancer rates over several decades shows that the cancer incidence rate for blacks is higher than for whites, and that blacks also have a higher death rate than whites. Male cancer incidence and mortality rates in each race increased while female rates decreased. The overall cancer incidence rate for blacks went up 8% while for whites it dropped 3%. Cancer mor tality for blacks is greater than for whites. Cancer sites where blacks had significantly higher increases in incidence and mortality rates included the lung, colon-rectum, prostate and esophagus. Esophageal cancer, long considered mainly a disease of males, declined in whites and rose rapidly in blacks of both sexes. The incidence of invasive cancer of the uterine cervix dropped in both black and white women, al though the incidence in blacks is still more than double that in whites. However, the rate for endo metrial cancer - or cancer of the body of the uterus -- for white women is double that of black women. Survival for patients diagnosed between 1967 and 1973 was compared. More whites than blaeks had cancer diagnosed in an early, localized stage when the chances of cure are best: 37 versus 28% for males, and 42 versus 31% for women. Most of the differences in black and white cancer rates were attributed to environmental and social factors rather than to inherent biological character istics. Because a higher percentage of blacks than whites are in the lower socio-economic group, risk of exposure to industrial carcinogens may be in creased. Also, limited educational opportunities may prevent early detection as the less educated are less likely to know the importance of symptoms which could lead to an early diagnosis. TRENDS IN DIAGNOSIS AND TREATMENT Cancer management today is becoming increasing ly individualized both with respect to diagnostic procedures and treatment. Early detection is follow ed by a precise staging of the disease, and the use of more than one kind of therapy, often in combi nation. The following 14 cancers a few decades ago had very poor prognoses - today they are being cured in many cases, predominantly because of chemother apy advances: acute lymphocytic leukemia, adult myelogenous leukemia, Hodgkin's disease, histio cytic lymphoma, Burkitt's lymphoma, nodular mixed lymphoma, Ewing's sarcoma, Wilms' tumor, rhabdomyosarcoma, choriocarcinoma, testicular cancer, ovarian cancer, breast cancer, osteogenic sarcoma. Other cancers are being more effectively controlled than in the past An outstanding example of progress is the im provement in the management of Hodgkin's disease (a cancer of lymph glands in predominantly young adults). Better disease staging in certain cases, more precise application of new and improved x-ray therapy and/or a combination of four cancer drugs has resulted in remarkably improved survival. In less than 10 years, the five-year survival rate for early cases rose from 68 to 90%, and from 10 to 70% for advanced cancer. The following developments indicate the direc tions of current and future research: Interferon, a natural body substance known to combat viruses, has shown promise in preliminary research on advanced human cancers of the bone, breast and lymphatic system. Retinoids, synthetic "cousins" of Vitamin A, have prevented bladder and breast cancers in mice and rats, and may also work against cancers of the lung, esophagus and pancreas in humans. About fifty drugs have been found effective against certain cancers, and others that are still being tested hold promise. Surgery now is more precise than in the past be cause of improved diagnostic equipment and laser instruments, and rehabilitation is improved through advances in plastic surgery. Experiments have been conducted with simple, inexpensive blood tests, based on unique chemical substances, to determine whether an individual has cancer and where it is. Good preliminary re sults have been obtained in selected cases by using the procedures to detect cancers of the breast, pancreas and other sites. Intense drug therapy before surgery has been suc cessful in the treatment of children with bone turnon, and is being adapted to help fight some of the more common cancers in adults. A series of chemical injections near the spine can act as a nerve block, relieving certain cancer patients of debilitating pain. 'Figures for cancer incidence are from the National Cancer Institute National Surveys, 1947 and 1969; those for cancer mortality from the National Center for Health Statistics, 1952-1977. 5 ucc 096719 Common denominator approaches to cancer pre Immunotherapy holds hope of harnessing the vention may include the study and manipula body's own disease-fighting systems to combat tion of "oncogenes" - cancer-causing genes cancer with essentially no overt toxicity. In lab which normally are dormant but which may be oratory animals, substances such as BCG can stim activated by radiation, chemicals and viruses. ulate immune mechanisms. These substances now Researchers have learned how to suppress onco are being used in humans alone or with other genes in some animals, and are determining forms of treatment, whether the same thing can be done in humans. Because environmental factors have been found A new technique makes high and potentially for virtually every major cancer, it is becoming lethal doses of the cancer drug, methotrexate, possible to "profile" individuals according to safe and effective for the treatment of some their cancer risk factors, and therefore select the cancers. most appropriate time for diagnostic tests. Hyperthermia (the superheating of body tissues) The transfusion of blood components is becoming is being used to increase the effectiveness of increasingly available and effective for cancer radiotherapy and chemotherapy. therapy. Platelets are used to prevent hemorrhag Many patients with bone cancer now are treated ing and white cells to treat infection as well as the successfully by removing and replacing a section cancer itself. of bone rather than by amputating the leg or arm. Computerized tomography uses X rays to exam Drugs and radiation therapy also are being used ine the brain and other parts of the body. Cross- effectively following surgery, resulting in dra section pictures are constructed which show a matic improvement in survival. High-frequency sound waves (ultrasound), instead tumor's shape and location more accurately than is possible with conventional x-ray techniques. of X rays, are being used to locate' tumors deep Many cancers are caused by a two-stage process in the body. For patients undergoing radiation through exposure to two different kinds of sub therapy, ultrasound may enable the therapist to stances known as initiators and promoters. Re pinpoint the tumor more precisely in order to searchers are exploring ways of interrupting the provide more accurate radiation dosage and lo process and thereby preventing the development cation of the tumor. of cancers. UCC 096720 6 MORTALITY FOR LEADING CAUSES OF DEATH UNITED STATES. 1977 Rank Cause of Death Death Number Rate of Per 100,000 Deaths Population Percent of Total Deaths All Causes 1,899,597 816.3 1 Diseases of Heart 2 Cancer 3 Stroke 4 Accidents 5 influenza & Pneumonia 6 Diabetes Melhtus 7 Cirrhosis of Liver 8 Arteriosclerosis 9 Suicide 10 Diseases of Infancy 11 Homicide 12 Emphysema 13 Congenital Anomalies 14 Nephritis & Nephrosis 15 Septicemia & Pyemia Other & Ill-defined 718,850 386.686 181,934 103,202 51,193 32.989 30,848 28.754 28,681 23,401 19.968 16,376 12.983 8,519 7.112 248,101 303.4 168.4 75.3 45.4 21.4 14.1 14.0 12.0 12.6 13,0 8.6 7.1 6.7 3.7 3.2 107,3 Source: Vital Statistics of the United States, 1977 100.0 37.8 20.4 9.6 5.4 2.7 1.7 1.6 1.5 1.5 1.2 1.1 0.9 0.7 0.5 0.4 13.1 FIVE-YEAR CANCER SURVIVAL RATES* FOR SELECTED SITES -BLADDER 27Z14%%% BREAST COLONRECTUM LARYNX LUNG lOO ORAL PROSTATE UTERUS, 78% CERVIX 41S0%% UTERUS CORPUS I LOCALIZED E53REGIONAL INVOLVEMENT DISTANT METASTASES Source: Biometry Branch, National Cancer Institute. 'Survival rate* for this chart and those discussed elsewhere in this booklet are adjusted for normal life expectancy. 1981 ESTIMATES CANCER INCIDENCE BY SITE AND SEXt SKIN LUNG COLON & RECTUM PANCREAS PROSTATE URINARY LEUKEMIA & LYMPHOMAS ALL OTHER | 7* I LEUKEMIA 4 I '79 | LYMPHOMAS ITM1 I 15% ALL OTHER tExcludmg non-melanoma skin cancer and carcinoma in situ. 7 UCC 096721 Estimated New Cancer Cases and Deaths by Sex for All Sites -- 1981* ESTIMATED NEW CASES ESTIMATED DEATHS SITE All Sites Buccal Cavity & Pharynx (Oral) Up Tongue Salivary Gland 1 JFloor of Mouth V Other & Unspecified Mouth Pharynx Digestive Organs Esophagus Stomach Small Intestine Large Intestine 1 (Colon- Rectum J Rectum) Liver & Biliary Passages Pancreas Other & Unspecified Digestive Respiratory System Larynx Lung Othar & Unspecified Respiratory Bone, Tissue and Skin Bone Connective Tissue Skin Breast Genital Organs Cervix, Invasive } Uttr(J| Corpus, Endometrium ] Ovary Prostate Testis, Other Male Genital Other & Unspecified Genital, Female Urinary Organs Bladder Kidney & Other Urinary Eye Brain & Central Nervous System Endocrine Glands Thyroid Other Endocrine Leukemia Other Blood & Lymph Tissues Hodgkin's Disease Multiple Myeloma Other Lymphomas All Other 81 Unspecified Sites BOTH SEXES male 815,000* 403,000* 26,600 4,600 4,800 18,400 4,100 3,200 9,600 5,700 7,600 5,400 194,500 8,800 23,900 2,100 83,000 37,000 13,000 24,200 2,500 99,700 6,200 14,500 1,100 38,000 20,000 6,000 12,700 1,200 135,800 ,10,700 122,000 3.100 99,000 9,000 88,000 2,000 20,900 1,900 4,700 14,300** 10,700 1,100 2,600 7,000**' 110,900 900 151,600 16,000*** 38,000 18,000 70,000 5,200 4,400 75,200 -- -- 70,000 5.200 - 54,600 37,000 17,800 38,000 27,000 11,000 1,800 900 12,100 6.700 10,800 9,900 900 3,300 2.800 500 23,400 13.000 39,500 7,100 9,400 23,000 20,900 4,100 4,800 12,000 32,500 16,300 FEMALE BOTH SEXES 412,000* 420,000 8,200 500 1,600 3,900 2,200 9,150 175 2,000 700 525 1,550 4,200 94,800 2,600 9,400 1,000 45,000 17,000 7,000 11,500 1.300 110,500 8,100 13,900 700 46,200 8,700 9,400 22,000 1,500 36,800 1,700 34.000 1,100 110,100 3,700 105,000 1,400 10,200 800 2,100 7,300** 10,050 1,750 1.600 6,700t 110,000 37,100 76,400 10,000*** 38,000 18,000 - - 4,400 46,400 7,200 3,100 11.400 22,700 1,000 1,000 16,600 10,000 6,600 18,700 10,600 8,100 900 400 5.400 10,200 7,500 7,100 400 1,500 1,050 450 10.400 15.900 18,600 3,000 4.600 11,000 21,600 1,700 6,700 13,200 16,200 28,400 MALE 227,500 6,300 150 1,400 450 400 1,000 2,900 57,600 5,800 8,400 350 21,500 4,700 4,600 11,500 750 81,000 3,100 77,000 900 5,800 1.000 800 4,000 300 23,700 -- _ -- 22,700 1,000 - 12,200 7,300 4,900 200 5,800 600 350 250 8,900 11,200 1.000 3,400 6,800 14,100 FEMALE 192,500 2,850 25 600 250 125 550 1,300 52,900 2,300 5,500 350 24,700 4,000 4,800 10,500 750 29,100 600 28,000 500 4.250 750 800 2,700 36,800 22,700 7,200 3,100 11,400 -- -- 1,000 6,500 3,300 3,200 200 4,600 900 700 200 7,000 10,400 700 3,300 6,400 14,300 Not*: Th* attimates of naw cancar cat** *r* offarad H a ough guid* tod thouId not b* ragardad H daflnitiv*. Etp*ctlly not* that yaar-to-yaar chang** may only rapraaant improvamant* th* basic data. ACS t< major tit** In botdfac* 'Carcinoma in titu and non-malanoma *kin cancart not includad in total*. Carcinoma in iltti of th* utarin* carvix account* for ovar 45,000 naw cat** annually. <on-m*lanoma ikin cancar accounts for about 400,000 now cast* annually. "Melanoma only '"Invaiiv* cancar only. tMalanoma 5,000; othar tkin 1,700 INCIDENCE ESTIMATES ARE BASED ON RATES FROM N.C.I. SEER PROGRAM 1973-1877. ucc 8 NEW CANCER CASES - 1981 Estimated New Cancer Cases for AM Sites Plus Major Sites, by State -- 1981 All Sites * Major Sites Number of Female Colon- Uterus Stats Cases Breast Rectum Lung Oral (Invasive) Prostate Stomach Pancreas Leukemia Alabama Alaska Arizona Arkansas California Colorado Connecticut el aware Dist. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming United States Puerto Rico 13,000 600 8,100 8,600 79,000 7,000 13,000 2,200 3,200 46,000 1,600 50 1,100 1,000 11,200 1,000 2,100 250 450 5,600 1,600 50 1,100 1,100 10,400 950 2,000 300 400 6,700 2,200 100 1,300 1,500 12,200 850 1,800 400 450 7,500 350 15 275 300 2,600 175 450 70 200 1,600 16,000 2,400 2,500 42,000 19,000 11,000 8,400 13,000 14,000 4,500 1,700 250 400 5,900 2,700 1,500 1,200 1,400 1,600 600 1,800 300 300 6,500 2,800 2,100 1,300 1,800 1,800 800 2,600 350 350 6,300 2,900 1,500 1,200 2,300 2,300 650 600 100 75 1,500 500 300 275 425 550 150 16,000 23,000 31,000 13,000 8,300 19,000 2,500 5,500 2,300 3,300 30,000 3,100 72,000 19,000 2,000 39,000 11,000 8,700 49,000 4,500 2,300 3,400 4,300 1,800 800 2,300 300 750 300 400 4,700 350 11,200 2,500 350 5,700 1,300 1,200 7,000 650 2,100 4,100 4,400 2,200 950 3,100 400 950 300 600 5,000 400 12,500 2,400 350 6,300 1,400 1,200 9,100 850 2,400 3,200 4,700 1,700 1,400 2,900 350 750 400 500 4,400 400 9,900 2,800 250 6,400 1,900 1,500 6,900 600 650 900 950 375 250 550 80 150 60 100 1,100 60 2,600 650 50 1,300 375 250 1,500 200 9,000 2,400 16,000 41,000 2,800 1,800 17,000 14,000 7,200 17,000 1,100 1,100 350 1,900 5,100 400 250 2,300 2,000 850 2,400 150 1,100 400 2,100 5,100 400 300 2,200 1,900 950 2,700 150 1,400 350 2,700 6,700 250 300 2,700 2,100 1,100 2,100 200 350 50 550 1,500 60 60 550 450 200 550 20 805,000 110,000 120,000 122,000 27,000 6.000 450 450 350 425 1,000 30 550 600 4,800 400 750 150 250 2,800 1,200 125 150 2,700 1,700 750 650 950 850 350 1,100 1,500 2.200 800 600 1.400 150 350 150 225 2,100 250 4,800 1,400 100 2,900 650 550 3,200 300 750 150 1,100 2,700 200 150 1,100 750 600 950 70 54,000 750 *1,100 20 750 800 6,500 550 1,100 150 275 4,400 1,500 125 250 3,400 1,400 1,200 800 1,200 1,200 400 1,400 1,900 2,700 1,500 1,100 1,900 275 500 125 275 2,300 275 5,500 1,900 300 3,200 1,000 800 3,900 400 850 300 1,400 3,500 300 200 1,500 1,300 600 1.600 80 70,000 400 325 15 175 200 2,500 175 400 50 90 1,200 400 175 70 1,400 450 300 175 275 400 150 375 850 850 500 250 500 80 175 15 70 1,100 80 2,800 400 100 1,200 275 200 1,600 175 175 80 325 1,200 80 50 400 350 200 600 20 24,000 500 425 10 250 300 2,400 250 400 50 100 1,300 400 20 225 300 2,200 250 375 40 60 1,200 450 60 80 1,200 550 350 300 375 400 150 500 70 100 1,200 500 400 300 400 350 100 400 650 850 450 300 550 80 225 60 90 900 90 2,400 500 80 1,100 325 300 1,300 100 375 600 850 475 300 550 80 225 40 100 750 70 2,000 500 70 1,200 325 300 1,300 80 300 90 475 1,200 80 50 475 400 250 500 30 250 100 475 1,300 80 60 400 450 175 500 30 24,000 23,000 100 175 'Does not include carcinoma in litu or norwnatanoma akin cancar. These estimates ara offarad at a rough guida and dtould not ba ragardad ai definitive. Thay ara calculatad according to tha dittribution of estimated 1981 cancar death* by itata. Etpacially nota that year-to-year dtangat may only represent improvamanti in tha baaic data. 9 UCC 096723 State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Diit. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wye mg United States Puerto Rico CANCER DEATHS - 1981 Estimated Cancer Deaths for All Sites plus Major Sites, by State -- 1981 All Sites Major Sites Number Death Rate of par 100,000 Female Colon- Deaths Population Breast Rectum Lung Oral Uterus Prostate Stomach Pancreas Leukemia 6,900 300 4,300 4,500 42,000 3,600 6,500 1,100 1,700 24,200 181 72 163 200 185 124 206 182 250 245 500 20 325 325 3,700 325 650 80 175 1,900 700 30 450 500 5,000 475 900 150 200 3,100 1,900 75 1,100 1,300 10,500 750 1,500 300 375 6,600 125 5 100 100 850 70 175 25 75 450 200 375 200 375 250 10 10 10 - 10 10 50 225 125 225 150 100 275 150 250 200 900 2,200 1,500 2,200 1,500 70 225 125 200 175 125 325 250 350 250 20 50 30 60 30 60 100 60 90 40 400 1,500 800 1,200 750 8,200 1,200 1,300 21,900 9,700 5,700 4,400 6,700 7,300 2,300 8,000 11,900 16,000 7,000 4,300 9,700 1,300 3,000 1,200 1,700 152 126 143 194 180 196 189 187 184 . 203 181 198 172 173 176 190 162 186 178 193 650 75 100 2,000 900 500 425 475 550 200 700 1,200 1,400 650 300 800 100 275 80 150 800 150 150 3,100 1,400 900 550 850 750 350 1,000 1,800 2,100 1.000 425 1,400 175 450 125 275 2,200 300 300 5,400 2.500 1,300 1,100 2,000 2.000 550 2,100 2,700 4,100 1,400 1,200 2,500 300 650 350 400 200 30 25 500 200 100 100 175 175 50 200 325 325 150 90 200 30 60 25 40 250 450 20 40 25 90 600 1,200 300 500 125 350 100 300 175 400 175 400 60 125 175 425 275 600 400 850 125 475 100 325 250 600 30 100 70 200 20 50 40 90 225 425 90 60 40 70 750 1,200 250 500 150 325 125 250 150 350 250 375 90 100 225 375 500 600 475 800 250 400 125 275 275 475 50 80 125 175 10 60 40 80 300 50 70 900 400 275 200 275 250 80 250 425 600 325 200 400 60 150 30 70 15,900 1,600 37,400 9.800 1,100 21,000 5,700 4,600 25,200 2,400 211 126 209 167 167 195 198 186 212 247 1,600 125 4,000 750 90 1,900 400 375 2.400 250 2,400 200 5,800 1.000 150 2,900 650 500 3,900 400 3,800 350 8,600 2.400 200 5,500 1,600 1,300 5,900 550 350 25 850 225 20 425 100 100 500 60 375 750 650 800 500 40 80 50 80 50 950 1,800 1,600 2,100 1,400 275 550 250 450 375 20 90 60 80 50 600 1,100 650 1,000 800 100 325 150 300 225 75 300 125 250 200 700 1,300 850 1,300 950 40 125 100 100 60 4,800 1,300 8,500 21,400 1,500 950 8,700 7,100 3,800 8,700 650 156 188 193 160 111 191 161 193 205 181 157 375 100 600 1,700 150 80 750 600 275 900 50 450 200 900 2,400 175 150 1,000 850 450 1,200 70 1,300 300 2,300 5,600 225 250 2,300 1,800 1,000 1,800 175 100 20 200 425 20 20 175 150 75 176 10 125 300 30 100 200 450 500 1,100 30 100 30 60 225 450 150 425 100 200 175 500 10 40 125 275 175 50 90 80 225 425 300 700 1,200 1,000 50 75 60 30 50 40 250 425 300 200 375 275 100 200 125 325 450 350 15 40 20 420,000 188 37,000 55,000 105,000 9,000 10.000 23.000 14,000 22.000 16,000 3,000 96 125 225 300 175 150 225 400 100 150 10 UCC 096724 FEMALE CANCER DEATH RATES* BY SITE UNITED STATES, 1930-1977 MALE CANCER DEATH RATES* BY SITE UNITED STATES, 30-1977 RATE P S 1 100,000 a#*u of tfw Canto*. UnM SM**- Quito rf Car** (Ji*d SUM*. 25*Year Trends in Age-Adjusted Cancer Death Rates Per 100,000 Population 1950-52 to 1975-77 All Sites All Sites Bladder Bladder Breast Brean Colon & Rectum Colon & Rectum 169 8 146.7 7.2 3.1 0.3 25.9 25.9 25.5 213.3 135.0 7.2 2.1 0.3 27.0 26.1 20.0 + 25.6 - 8.0 - 32.3 + 4.2 21.6 Esophagus Esophagus 4.7 5.4 + 14.9 1.2 1.5 Kidney Kidney 3.3 4.7 + 42.4 2.0 2.2 Leukemia Leukemia 7.7 8.8 + 14.3 5.3 4.9 - 7.5 Liver Liver 6.7 4.8 -- 38.4 7.7 3.6 - 53.2 Lung Lung Oral Oral 23.7 4.9 6.1 1.5 67.5 16.8 5.9 2.0 + 184.8 4- 238.8 Ovary 7.9 8.8 + 8.9 Pencrafts Pancreas 8.4 11.2 + 33.3 5.5 7.0 27.3 Promts Skin Skm Stomach Stomach 20.7 3.2 2.0 23.6 12.8 22.2 3.4 1.9 9.3 4.4 + 7.2 _ 60.6 * 66.6 Uterus 20.7 8.9 - 57.0 'Percent changes not lined because they ere not meaningful Steady increase mainly due to lung cancer. Slight decrease. Slight fluctuations; overall no change. Some fluctuations; noticeable decrease. Constant rate. Slight fluctuations; overall no change. Slight fluctuations; overall no change. Slight fluctuations; noticeebla decrease Some fluctuations; slitfit increase. Slight fluctuations; overall no change in females. Steady slight increase. Slight fluctuations; overall no change. Early increase, later leveling off. Slight early increase, later leveling off. Some fluctuations. Steady decrease in both taxes. Steady increase in both sexes due to cigarette smoking. Slight fluctuations; overall no change in both Mxn. Steady increase, later leveling off. Steady increase in both saxes, then leveling off. Reasons unknown. Fluctuations all through period; overall no change. Slight fluctuations; overall no change in both UXM. Steady dacraese in both sexes; reasons unknown. Steady decrease. 11 UCC 096725 Mortality for the Five Leading Cancer Sites in Major Age Groups by Sex, United States 1977 UNDER 15 MALE FEMALE Leukemia Leukemia 633 422 Brain and Brain and Nftrvous System Nervous System 414 302 Bone 58 Bona 47 Connective Tissue 50 Connective Tissue 46 Lympho-and Kidney Reticulosarcoma 49 35 15-34 MALE FEMALE Leukemia Breast 755 623 Brain end Leukemia Nervous System 474 553 Testis Brain and Nervous System 423 316 Hodgkin's Disease 352 Uterus 303 Skin 254 Hodgkin's Disease 235 35-54 MALE FEMALE Lung Breast 10,110 8,348 Colon & Rectum 2.434 Lung 4,528 Pancreas 1.307 Colon & Rectum 2,283 Brain and Uterus Nervous System 1,200 2,093 Leukemia 1,046 Ovary 2,063 55-74 75+ MALE FEMALE MALE FEMALE Lung 44,112 Breast 17,341 Lung Colon & Rectum 14,060 11,953 Colon & Lung Rectum 13,504 13,045 Prostate Breast 11,645 8,166 Prostate Colon & Rectum 8.881 12,190 Colon & Lung Rectum 8,811 4,341 Pancreas Ovary 6,378 6,000 Pancreas Pancreas 3,205 3,778 Stomach Uterus 4,852 5.573 Bladder Uterus 3,121 2,970 Source: Vital Statistics of the United Statas, 1977 How to Estimate Cancer Statistics Locally Community Population Estimated No. Who are Alive, Cured of Cancer Estimated No. Cancer Casas Under Medical Care in 1981 Estimated No. Who Will Die of Cancer In 1981 Estimated No. of New Cases in 1981 Estimated No. Who Will be Saved from Cancer In 1981 Estimated No. Who Will Eventually Develop Cancer Estimated No. Who Will Die of Cancer if Present Rates Continue 1.000 9 41 31 250 164 2,000 18 11 4 72 500 328 3,000 27 IS 5 10 3 750 492 4,000 36 20 7 13 4 1,000 656 5,000 10,000 45 90 25 9 51 18 16 5 1,250 820 33 11 2,500 1,640 25.000 225 124 45 79 28 6,250 4,100 50,000 450 248 90 158 S3 12,500 8,200 100,000 900 506 180 326 108 25,000 16,400 200,000 1,800 1,010 360 650 217 50,000 32,800 500,000 4,500 2,475 900 1,575 525 125,000 82,000 NOTE: The figures can only be the roughest approximation of actual data for you\community. It is suggested that every effort be made to obtain actual data from a Registry source. 12 UCC 096 CANCER AROUND THE WORLD, 1974-1975 Country All Sites Mala Female Age-Adjusted Death Rates Par 100,000 Population for Selected Cancer Sites for 46 Countries Orel Coton & Rectum Lung Breast Uterus Skin Stomach Mala Female Mala Pamela Mala Female Female Famala Mala Famala Mala Famala Prostata Mala Laukemia Mata Famala United States Australia Austria Belgium Bulgaria Canada * Costa Rica Chifa Czechoslovakia* Danmark Dominican Rap. England & Wales Finland* Franca* Germany, F.R. Greece Hong Kong Honduras Hungary Iceland Ireland Israel Italy* Japan Luxembourg * Mexico* Netherlands New Zealand Northern Ireland Norway Panama* Philippines* Poland Portugal Puerto Rico Romania* Scotland Singapore Spain* Sweden Switzerland Thailand Trinidad & Tobago* Uruguay * Venezuela Yugoslavia 159.4(23) 106.1(19) 163.2120) 102.0(24) 189.41101 123.41 5) 200.41 31 115.204) 124.7(37) 79.7(39) 157.6124) 109608) 127.6(33) 106.0(21) 147.0126) 121,4( 9) 213.21 n 118.0(131 165.5(18) 127.2( 41 36.7(44) 37.1(451 189.7( 91 123.21 61 182.0(121 986(301 194.51 61 98.71291 182.4(11) 121.3001 135.0(311 77.3(401 169.4(16) 9681311 29.2(46) 42.01441 196.21 4) 129.01 21 135.8(30) 115.4(15) 165.1(19) 1326( 1) 129.6(32) 118.5111) 169.2(171 100.7(27) 141.3(28) 88.0(34) 103.4( 7) 106.1(201 58.0(42) 73.6(411 193.4( 6) 113806) 174.6(14) 12181 8) 170.3(161 118.1021 136.8(291 101.8(25) 78.4(411 62.9(42) 566(43) 466143) 160.4(221 101.2126) 127.51341 86.3(36) 121.5(381 79.7(38) 125.1(36) 86.1(35) 206.01 21 128.71 3) 162.1(21) 90.2(32) 1426127) 89.0(33) 146.6(26) 112.307) 175.2(13) 103.5(22) 34.3(45) 24.9(46) 4.702) 1.6( 8) 19.109) 15.0061 51.2001 12.21 6) 22.103) 7.7(39) 26( 7) 1501) 4.304) 1.205) 21.402) 17.5001 46.7051 7.0(141 20.005) 7.2(421 5.3( 1) 2.8( 2) 4.01151 0.7(341 23.6( 6) 17.401) 51.81 91 7.005) 19.1(20) 14.2< 8) 2.103) 1.406) 3.1(23) 0.7(351 21.203) 17.1031 67.51 4) 5.6(22) 23.301) 86(30) 1.4(29) 1.0(31) 1 9(40) 0.6(411 10.5134) 8.4(34) 36.1(25) 6.607) 14.3(26) 8.4(31) 180 71 1.3(21) 3.907) 1.2061 20606) 1861 6) 46.20 7) 86011 23.6(10) 7.6(40) 18(21) 1.407) 28(26) 08(32) 4.9(41) 5.7(40) 10.3(41) 6.0(201 8.2(39) 1461 7) 0.7140) 1.2(27) 28(27) 08(301 23.8( 4) 28.41 11 176(34) 4.7(31) 10.9(33) 20.11 3) 1.1(35) 08(34) 3.709) 0.8(311 22.7( 8) 14.008) 66.41 5) 56(25) 168(24) 11.005) 2.4( 91 1600) 18(391 08(28) 22.51 9) 1781 8) 46.306) 10.300) 25.51 5) 12.7(10) 2.71 5) 2.1( 6) 1.7(411 1.0(251 22(44) 36(42) 3.7(45) 1.4(451 3.2(441 78(38) 0.4(431 0.3(43) 2.71291 1.3031 21601) 17.302) 73.7 ( 2) 14.8< 3) 27.7( O 88(27) 1.7(221 1.502) 2.3(341 1.0(231 108(311 98(30) 64.41 61 4.2(34) 16.0(25) 6.3(431 2.302) 1.4(18) 14.5( 31 1.1 (201 20.705) 138120) 33.6(261 36(39) 186(21) 9.6(23) 1.7(251 1.3(22) 26(321 0.7(36) 23.51 7) 18.1 ( 7) 476031 5.1(29) 20.4(14) 10.509) 18(201 1.3(23) 1.41441 0.7(37) 6.4(38) 8.2(37) 39.4(241 6.308) 11.2(32) 5.8(45) 1.1136) 08(351 19.31 11 7.41 1) 12.7(28) 88131) 43.4120) 2081 1) 9.0137) 8.9(26) 08(39) 05(40) 0.4(461 0.1(46) 0.1(46) 0.1(461 1.1(461 1.1 (46) 0.2146) 9.6(22) 0.0(45) 0.0(46) 6.21 9) 1.0124) 20604) 16.2041 48.202) 86112) 18609) 16.4( 6) 2.7< 6) 2.1 ( 4) 3.1124) 1.400) 106(33) 148071 17.2(361 10.71 9) 19808) 12.102) 1.3(33) 1.409) 38061 1.81 7) 236( 5) 2061 31 44.0081 14.41 4) 26.5( 31 75(41) 2.400) 2.11 5) 1.3(451 1.207) 136(26) 136(211 25.6(30) 7.2031 246( 71 5.9(44) 2.301) 1.3(24) 58( 7) 081331 166(22) 12.4(241 42.3(21) 5.2128) 18.4(221 10807) 1.4(301 08(331 1.7(421 0.7(381 108(30) 8.4(321 19.3(331 5.7(20 48(431 9.2(25) 0.7(41) 05(41) 7.0( 51 1.0(261 22.000) 13.1(22) 64.1 ( 7) 38(38) 20.0061 10.3(20) 16(261 2.0( 7) 1.5(431 06(421 26(431 3.3(431 8.9(42) 3.9(371 5.7(42) 19.01 4) 0.7(421 0.7(361 2.0(371 06(431 19.408) 15.806) 70.6( 3) 4.4(321 266< 21 8.11341 18061 1.4(201 361221 1.3041 256( 1) 24.0< 2) 48.500 1G.9( 81 24.9( 6) 881281 5.1( 2) 3.2< 11 2.4(331 1.6< 91 24.3< 3) 20.41 4) S3.0( 8) 11.0< 71 23.0021 78(371 16(27) 1.2(28) 2.7(291 1208) 15.0(231 128(23) 21.0(32) 4.3(331 18.1(23) 8.0(36) 35( 3) 2.4t 3) 2.0(38) 221 4) 56(39) 4.7(41) 106(40) 3.2(42) 6.6(40) 11803) 18(34) 0.2(44) 4.703) 3.4( 3) 38(421 2.8(44) 6.8143) 2.7(43) 6.7141) 8.4(33) 08(37) 06(39) 48001 1.1121) 10.7(32) 8.4(33) 43.9119) 56(23) 12.9129) 13.21 9) 1805) 1.503) 4801) 08129) 14.4(25) 118(27) 14.7(391 3.4(40) 138127) 10.906) 1.7123) 1.3(25) 961 41 221 5) 7.0(361 66(36) 15.81371 56(26) 10.1136) 10.7081 08138) 05142) 2.7(301 0.7(39) 6.7(37) 6.1(38) 28.8(28) 5.4(27) 10.3135) 17.7( 5) 18118) 1.2(29) 36(21) 12091 24.7( 2) 1981 5) 83.91 1) 17.1 ( 2) 2561 41 8.7(29) 2.0114) 1504) 15.2( 2) 5.0( 21 13.8(27) 106(29) 416(221 13.31 5) 1061341 10.2(21) 1.4(311 0.7(37) 381191 0.51441 11.1(29) 11.9(26) 26.81291 4.2135) 118(301 8.1 (35) 1.4(321 1.0(32) 26(361 1.1(22) 18.7(20) 13809) 23.7(31) 6.0091 20.0(171 8.4(32) 2.4( 81 1.505) 6.21 61 1.0(27) 20.0(17) 12.0(25) 46.804) 4.1 (361 23.8< 91 95(24) 3.3( 41 18( 8) 26135) 1.401) 16(451 1.2145) 46(44) 2.1(441 1.1(45) 3.6(46) 0.2(44) 0.1 (45) 7.2(42) 3.7(44) 14.50 7) 6.9< 7) 4.307) 13.1(39) 65(40) 15.502) 6.405) 4.501) 30.7 ( 9) 15.9( 9) 14.705) 6506) 4.403) 20.1121) 10.4(23) 15.800) 6.2(21) 3.9(241 29.201) 16.7( 7) 6.2(39) 6507) 4.7( 6) 12.8(40) 5.9141) 14.706) 7.0( 5) 4.209) 478( 3) 23.61 3) 88(32) 7.81 1) 4.7 ( 7) 50.21 2) 258( 2) 11.6(26) 38(36) 35(30) 33.31 8) 16.61 8) 11.2(28) 75( 3) 4.7( 8) 148136) 8.1(34) 13.4(21) 6600) 4.404) 3.8(451 16(45) 5.7(40) 1.7(44) 1.2(45) 19.7(231 9.0(30) 12.01241 5.8(22) 3.9(25) 24.708) 128119) 13.908) 5.7(24) 48( 4) 15.7(331 7.2(36) 15.403) 7.0( 61 4.502) 27.105) 14.1111) 16.0{ 9) 6509) 4.308) 14.0(37) 7.9(35) 66(37) 7.K 4) 4.405) 15.7(34) 78(37) 1.7(42) 38(37) 2.9(391 6.0(44) 5.0(42) 0.1 (46) 1.9(43) 15(441 36.41 4) 175( 4) 16.21 8) 6.503) 4.7( 91 34.21 7) 13.306) 15.1041 5.2(271 36(28) 19.9(22) 13.108) 13.3122) 6.3(181 28(40) 14.9(35) 9.8(27) 8.1(341 6.601) 561 1) 26.1061 13507) 10.71291 6.504) 4.406) 566( 1) 29.01 1) 2.4141) 4.2(341 3.1(35) 18.6(27) 9.7(291 1951 2) 28(41) 3.0(371 98(411 9.0(31) 6.3(38) 2.6142) 2.2(42) 21.4(201 9.7(281 15601) 6.602) 4.1(22) 138(381 7.0(38) 17.4( 6) 7.4( 2) 48( 5) 19.3(241 116(20) 13809) 6.3(20) 3.1 (36) 17.4(30) 98(261 18.31 41 6.7< 8) 4.2(201 15.9(32) 68(391 8.91311 3.4(391 1.5(43) 65(43) 4.7(43) 16(43) 3.0(401 2.7(41) 35.1 ( 5) 14.600) 8.0(35) 55(26) 3.7(27) 34.51 6) 17.4( 5) 126(23) 5.6(25) 4.1(21) 18.7(26) 8.9(32) 13.7(20) 4.7(301 3.9(26) 28.103) 136051 8.4(33) 46(32) 3.2(34) 19.2125) 105124) 11.4(271 4.8(29) 3,6(29) 30.200) 13.4(14) 06(44) 3.9(35) 3.0(38) 24807) 13.703) 12.0(25) 4.7(31) 3.2(321 166(311 8.3(331 21,9( 1) 6.7( 91 49( 3) 18.1(28) 10.2(25) 19.1( 3) 58(231 4.0123) 2.2(46) 1.1(461 05(45) 0.9146) 0.7(46) 104.7(391 192.91 8) 101.0(40) 127.2(351 102.9(23) 122.91 7) 100.4(28) 82.9(371 3.0(25) 5.41 8) 26(31) 3.4120) 1.4021 0.5(451 2.K 61 0.7(40) 14.7(24) 18.1(21) 5.0(401 9.2135) 11.7(26) 17.91 9) 5.8(391 76(36) 16.4(361 40.1(231 15.6(381 326(271 5.0(30) 13.0(281 28.91 1) 0.0(46) 3.2(411 24.61 8) 12.7(11) 16(28) 6.9061 86(38) 24.31 21 1.8091 5.6(241 118(31) 11.2041 1.7124) 1.1 (30) 0.7(38) 1.7( 9) 1.3(26) 17.9(29) 2850 21 27.704) 24.009) 11.7(21) 13802) 17.2( 6) 115(22) 1851. 5) 17.21 7) 10.1(301 6.0(36) 1.1(451 5.1(28) 3.7(38) 4.4(33) 5.1 ( 2) 4.6( 10) 3.2(33) 351311 UCC 096727 NOTE. Figure* in parentheses ere order of rank within site and sex group. *1974 only. Source of Data: World Health Statistics Annual 1977-1978. LUNQ CANCER Incidence: An estimated 122,000 new cases in 1981. Mortality: An estimated 105,000 deaths in 1981. The age-standardized lung cancer death rate for women is now approaching that of colorectal cancer, and by the mid-1980's may well surpass breast cancer to become the number one cancer killer of women. Warning Signals: A persistent cough; sputum streaked with blood; chest pain; recurring attacks of pneumonia or bronchitis. Risk Factors: Heavy cigarette smoking; history of smoking 20 or more years; exposure to certain industrial substances such as asbestos--particularly for those who smoke. Early Detection: Lung cancer is very difficult to detect early. If a smoker quits at the time of early cellular changes, the damaged bronchial lining often returns to normal. Continued smoking in many cases causes the cells to form abnormal growth patterns that lead to cancer. Diagnosis may be aided by such procedures as the chest X ray, sputum cytology test and the fiberoptic bronchoscope. Treatment: Surgery, radiation therapy and chemotherapy. Surgery is usually the treatment of choice, and with improved ventilation machinery and better antibiotics, surgical complications are infrequent. Since a third of all surgical lung cancer patients experience tumor spread, radiation therapy and chemotherapy are frequently used as well as surgery. Survival: Only about 10% of lung cancer patients live five or more years after diagnosis. Since lung cancer in women grows more slowly than that in men, women with the disease generally live longer than men. SMOKING Smoking is responsible for about 83% of lung cancer cases among men, and about 43% among women--more than 75% overall. Smoking also has been implicated in cancers of the mouth, pharynx, larynx, esophagus, pancreas and bladder. Overall, smoking accounts for about 20% of all cancers, and is linked to conditions ranging from colds and gastric ulcers to chronic bronchitis, emphysema and heart disease. These smoking-related disorders are estimated to cause some 325,000 premature deaths each year, and cost the nation about $27 billion in medical care. The 1979 U.S. Surgeon General's Report, a compendium of 22 scientific papers compiled by 12 agencies of the Department of Health, Education and Welfare, declared: "Cigarette smoking is the single most important environmental factor contributing to premature mortality in the United States." In recent years, the proportion of adult smokers in the U.S. population has been declining. From 1970 to 1978, adult male smokers declined from 43.5% of the population to 37.4%, while women smokers decreased from 31.1% to 30.4%, an average decline of 3.2% for both sexes. Teenage smoking increased significantly in the late 1960's and early 1970's, and still concerns medical authorities. However, a recent government study indicates that teenage smoking has begun to decline. The overall number of boys and girls aged 12 to 18 who smoke dropped 25% between 1974 and 1979. Per capita cigarette consumption among adults has fallen-from 4,345 in 1963 to 3,880 in 1980 reflecting a growing number of ex-smokers. How ever, the average smoker is smoking more heavily. In 1970, 23.3% of adult smokers consumed 25 or more cigarettes per day, while in 1978, the figure was 27.9%. There are now over 30 million ex-smokers in the United States, but 54 million others collectively smoke more than 620 billion cigarettes per year. The Surgeon General's Report links maternal smoking directly with a slowing of fetal growth and an increase in the risk of a child dying before, at or shortly after birth. The report also says there is evidence that children of mothers who smoke may have deficiencies in physical growth, intellectual development and/or emotional development. Industrial workers are especially susceptible to lung diseases due to the combined effects of cigarette smoking and exposure to toxic industrial substances such as fumes from rubber and fluoro carbon polymers, chlorine and dust from cotton and coal. Exposure to asbestos in combination with cigarette smoking increases an individual's cancer risk 90 times. Tobacco companies, in the face of consumer demands, have taken some steps to make cigarettes that are less hazardous, although a truly "safe" cigarette does not exist. Tar and nicotine (T/N) levels have been cut by over 50% during the past 15-20 years. Today about 40% of all cigarette sales are low T/N products. 14 UCC 096728 An American Cancer Society study showed that smokers of low T/N cigarettes had lower death rates than those who smoked brands with higher levels, although the low tar and nicotine cigarettes were clearly more dangerous than not smoking at all. Another study found that a higher proportion of low T/N smokers were able to quit than those who smoked higher level brands. Besides tar and nicotine, however, cigarette smoke contains poisonous gases--hydrogen cyanide, volatile aromatic hydrocarbons, and especially carbon monoxide--which the Surgeon General's Report cites as a possible critical factor in coronary heart disease and fetal growth retardation, among other things. Despite some reduced hazards because of the growing number of filtered cigarettes, certain filtered brands have been found to deliver more carbon monoxide than those without filters. Although per capita cigarette smoking and the percentage of smokers in the U.S. population have begun to decline, levels of lung cancer and other pulmonary diseases continue to rise. This is because these disorders usually take decades to appear. We are now seeing cancer that began back in the 1940's, 1950's and early 1960's, but if the smoking decline continues, we can look forward to a leveling off and eventually a decline in smoking-related diseases. BREAST CANCER Incidence: An estimated 111,000 new cases in 1981. About one out of 11 women will develop breast cancer at some time during their lives. Mortality: An estimated 37,100 estimated deaths in 1981. It is the foremost site of cancer deaths in women. Warning Signals: Breast changes that persist such as lumps, thickening, swelling, puckering, dimpling, skin irritation, distortion or scaliness of nipples, nipple discharge, pain or tenderness. Risk Factors: Personal or family history of breast cancer; never had children; first child after age 30. Early Detection: The ACS recommends the monthly practice of breast self-examination (BSE) by women of all ages, beginning in the high school years. Most breast lumps are not malignant, but only a physician can make a correct diagnosis. The ACS and the National Cancer Institute jointly funded 27 Breast Cancer Detection Demon stration Projects across the nation to evaluate the ability of modem technology-such as low dose mammography, a special x-ray examination-and physical examination to find breast cancers as early as possible. The cancers found through the program were localized--confined to the breast--in about 80% of the women. Outside the projects, in the usual hospital population, only about 45% of breast cancers are found before they have spread to the regional axillary lymph nodes. Mammography is recognized as a valuable diagnostic tool for all women who have symptoms that might be related to breast cancer. In addition, the Society recommends a mammogram every year for asymptomatic women over age 50, and a baseline mammogram for those between 35 and 40. Women aged 40 to 50 should consult their physician about their individual need for mammography. A professional breast examination is recommend ed every three years for women 20 to 40, and every year for those over 40. Treatment: When a curable breast cancer is found, the surgery may vary considerably : removal of the lump with some adjacent breast tissue; removal of the entire breast (simple or total mastectomy); removal of the breast and axillary lymph nodes (modified radical mastectomy); or removal of the breast, underlying muscles and axillary lymph nodes (radical mastectomy). A plastic surgeon may be consulted by the general surgeon before or after a mastectomy for possible reconstruction of the breast. Radiation therapy and/or chemotherapy may be used in combination with surgery to treat some cases of breast cancer. Newer drug combinations can sharply reduce the recurrence rate of breast cancer in selected patients after surgery. Survival: The five-year survival rate for breast cancer diagnosed while still in an early, localized stage has risen from 78% in the 1940's to 85% today. If the cancer has spread to the axillary lymph nodes, the survival rate is 56%. In spite of an increasing incidence of breast cancer, longer survival rates have helped to stabilize mortality rates over the last 50 years. 15 UCC 096729 UTERINE CANCER Incidence: An estimated 54,000 new invasive cases in 1981, including 16,000 cases of cancer of the cervix, and 38,000 cases of cancer of the endometrium--or body of the uterus. Cervical cancer incidence has steadily decreased over the years. It is most common today among low socio economic groups. Endometrial cancer afflicts mostly mature women, and diagnosis usually is made between the ages of 50 and 64. Mortality: An estimated 7,200 deaths in 1981 from cervical cancer, 3,100 from endometrial cancer. Overall, the death rate from uterine cancer has decreased more than 70% during the last 40 years, due mainly to the Pap test and regular checkups. It has the 4th highest cancer death rate in women, after breast, colon-rectum and lung. Warning Signals: Unusual bleeding or discharge. Risk Factors: For cervical cancer, early age at first intercourse, multiple sex partners. For endometrial cancer: history of infertility; failure of ovulation; estrogen therapy; late menopause; com bination of diabetes, high blood pressure and obesity. Early Detection: The Pap test, an examination under a microscope of cells from the cervix and body of the uterus, is a simple procedure which can be performed at appropriate intervals by physicians as part of every pelvic examination. A Pap test is recommended once every three years after two initial negative tests one year apart. The Pap test is highly effective in detecting early cancer of the uterine cervix; it is only 40% effective in detecting endometrial cancer. Women at high risk of developing endometrial cancer should have an endometrial tissue sample at menopause. Estrogen, which is a hormone, is given to women during and after menopause to make up for the decline in estrogens normally produced by the ovaries. Estrogen helps to control menopausal symptoms such as hot flashes or thinning of the vaginal lining causing painful sexual intercourse. For older women, there are certain risks associat ed with such treatment, including an increased risk of endometrial cancer. However, intermittent estrogen can be given under careful physician control. Treatment: Uterine cancer generally is treated by surgery or radiation, or by a combination of the two. In precancerous stages, changes in the cervix may be treated by cryotherapy, the destruction of cells by extreme cold, or by electrocoagulation, the destruction of tissue through intense heat by electric current. Precancerous endometrial changes may be treated with the hormone, progesterone. Survival: The overall Five-year survival rate for cancer of the cervix is about 60%, for cancer of the endometrium about 75%. But the five-year survival rate for cases detected in the earliest stages is 78% for cervix and 86% for endometrium. COLORECTAL CANCER Incidence: An estimated 120,000 new cases in 1981. Second only to lung cancer in the number of new cases estimated for 1980 (excluding common skin cancers). Mortality: An estimated 54,900 deaths in 1981. Warning Signals: Unusual bleeding, change in bowel habits. Risk Factors: Personal or family history of colorectal cancer; personal or family history of polyps in the colon or rectum; ulcerative colitis. There is evidence that bowel cancer may be linked to environmental factors, such as dietary patterns. Some scientists believe that a diet high in beef and/or deficient in fiber content may be a significant causative factor. Ongoing research in this area may reveal important answers. Early Detection: The ACS recommends three tests as valuable aids in detecting colorectal cancer early. The digital rectal examination is performed by a physician during an office visit. The ACS recom mends one every year after age 40. The stool guaiac slide test, done by the patient at home, is a simple method of testing the feces for hidden blood. The ACS recommends the test every year after age 50. Proctosigmoidoscopy, known as the "procto," is an examination in which a physician inspects the colorectal area with a hollow lighted tube 25 cm long. About 40% of all colorectal cancers are within reach of this instrument. A newer, flexible sigmoidoscope under development will be able to inspect 55-60 cm of the rectum and lower colon, making it possible to find 60% of all colorectal cancers. The ACS recommends a procto every 3 to 5 years after the age 50, following two annual exams with negative results. If any of these tests reveals possible problems, a physician may recommend more extensive studies. Colonoscopy is a technique for viewing the entire 16 ucc colon with a flexible, lighted tube. The colonoscope can also biopsy suspicious tissue. Treatment: Surgery is the most effective method of treating colorectal cancer, but radiation and chemotherapy are being used in combination with surgery in some cases. When surgery is extensive and the two ends of the bowel cannot be connected again, an opening called a stoma is made in the abdominal wall for the elimination of body wastes. The procedure, known as a colostomy, may be either temporary or permanent. The Society has a special program to help patients adjust to the surgery. Survival: When colorectal cancer is detected and treated in an early, localized stage, the .five-year survival rate is 71%. This compares with less than 50% when the cancer has spread to regional lymph nodes. SKIN CANCER Incidence: An estimated 400,000 cases a year, the vast majority of which are highly curable basal or squamous cell cancers. More common at latitudes near the equator. The most serious skin cancer is malignant melanoma, which strikes about 14,000 men and women each year. Mortality: An estimated 6,700 deaths a year, 5,000 from malignant melanoma, and 1,700 due to other skin cancers. Warning Signals: Any unusual skin condition, especially a change in the size or color of a mole or other darkly pigmented growth or spot. Risk Factors: Excessive exposure to the sun; fair complexion; occupational exposure to coal tar, pitch, creosote, arsenic compounds and radium. Prevention & Early Detection: Most skin cancer is caused by the ultraviolet rays of the sun, through overexposure such as excessive suntan and sunburn. You can help protect yourself by avoiding the sun between 10:00 a.m. and 3 p.m. when ultraviolet rays are strongest, and by using protective clothing. When you do plan to be in the sun, use one of the growing number of sunscreen preparations, especial ly those containing such ingredients as PABA (para-aminobenzoic acid). They come in varying strengths, ranging from those that permit gradual tanning to those allowing practically no tanning at all. They work most effectively if applied about 45 minutes before exposure, and most brands should be reapplied after swimming or perspiring. Basal and squamous cell skin cancers often take the form of a pale, waxlike, pearly nodule, or a red, scaly, sharply outlined patch. Melanomas are usually distinguished by a dark brown or black pigmentation. They start as small, mole-like growths that increase in size, change color, become ulcerated and bleed easily from a slight injury. Treatment: There are four methods of treat ment-surgery, radiation therapy, electrodesiccation (tissue destruction by heat), or cryosurgery (tissue destruction by freezing). In some cases a combina tion of therapies may be employed. For malignant melanoma, wide and deep surgical excision and removal of nearby lymph nodes are often required. Survival: For basal cell and squamous cell cancers, cure is virtually assured with early detection and treatment. Malignant melanoma, however, metastasizes quickly. This fact accounts for the lower 5-year survival rate for patients with this disease-63% compared with 95% for patients with other kinds of skin cancer. ORAL CANCER Incidence: An estimated 27,000 new cases in 1981. Incidence is more than twice as high in males as in females, and is most frequent in men over age 40. Cancer can affect any part of the oral cavity, from lip to tongue to mouth and throat. Mortality: An estimated 9,150 deaths in 1981. Warning Signals: A sore that bleeds easily and doesn't heal; a lump or thickening; a reddish or whitish patch that persists; difficulty in chewing, swallowing or moving tongue or jaws. Risk Factors: Heavy smoking and drinking, use of chewing tobacco. Early Detection: Dentists have the opportunity, through regular checkups, to see abnormal tissue changes and to detect cancer at an early and curable stage. Treatment: Principal methods are surgery and radiation therapy. Survival: Five-year survival rates vary substantial ly depending on the site of an oral cancer, from 23% for cancer of the pharynx to 88% for men with lip cancer. Overall, the five-year survival rate for oral cancer patients is more than 50%. 17 UCC 096731 LEUKEMIA Incidence: An estimated 23,000 new cases in 1981, about half of them acute leukemia, and half of them chronic leukemia. Although it is often thought of as primarily a childhood disease, leukemia strikes many more adults (20,500 cases per year compared with 2,500 in children). Acute lymphocytic leukemia accounts for about 1,800 of the cases of leukemia among children, whereas in adults the most common types are acute granulocytic (about 6,600 cases annually), and chronic lymphocytic (7,400 cases annually). Mortality: An estimated 15,900 deaths in 1981. Warning Signals: Acute leukemia in children appears suddenly, with symptoms similar to those of a cold, and progresses rapidly. Lymph nodes, spleen and liver become enlarged with white blood cells that accumulate in those organs. Early signs may include fatigue, paleness, weight loss, repeated infections, easy bruising, nose bleeds or other hemorrhages. Symptoms of advanced leukemia include extreme fatigue, massive hemorrhages, pain, swelling of gums and various skin disorders. Chronic leukemia progresses slowly and without warning signs. Symptoms, similar to those of acute leukemia, may not appear for years. Risk Factors: Leukemia, a cancer of the bloodforming tissues, strikes both sexes and all ages. Causes of most cases are unknown. There is some evidence of inherited susceptibility, although not for direct transmission from parent to child. Individuals with Down's syndrome (mongolism) and certain other hereditary abnormalities have higher than normal incidence of leukemia. It has also been linked to excessive exposure to radiation and certain chemicals such as benzene. Early Detection: Leukemia may be difficult to detect early because symptoms often appear to be those of other less serious conditions. When a physician does suspect leukemia, a diagnosis can be made through blood tests and a biopsy of bone marrow. Treatment: Chemotherapy is by far the most effective method of treating leukemia patients. Today, continuing research in 80 U.S. medical centers is yielding new and better drugs for treating leukemia patients. A variety of anticancer drugs are used singly or in combinations. All blood-forming tissues release millions of each type of cells daily into one of the body's two circulatory systems-the blood vessel system and the lymph system. When leukemia strikes, millions of abnormal, immature white blood cells called leukocytes are released into these circulatory systems. Because these cells are immature, they cannot carry out their basic function of fighting infection. In advanced leukemia, the uncontrolled multiplica tion of abnormal cells results in crowding out the production of normal white cells to fight infection, of platelets to control hemorrhaging and of red blood cells to prevent anemia. Blood transfusions and antibiotics are used as supportive treatment. Survival: Overall five-year survival rate is 14%. Chronic leukemia has a rate of 32%, in contrast to 3% for acute leukemia. Nevertheless, there has been great improvement in the treatment of acute lymphocytic leukemia in children. As recently as 1960, five-year remissions were extremely rare, but now with optimum treatment, between 50 and 75% of the patients with this predominantly childhood leukemia are living five years or longer. CANCER IN CHILDREN Incidence: An estimated 6,200 new cases in 1981, making it rare as a childhood disease. Cancers in children, however, tend to develop more quickly than adult cancers because body tissues are growing rapidly and the cancer grows right along with them. Common childhood cancer sites include the blood, bone, brain, nervous system and kidneys. Mortality: An estimated 2,300 deaths in 1981, about half of them from leukemia. Despite its rarity, cancer is still the chief cause of death by disease in children between the ages of 3 and 14. Early Detection-General: Cancers in children often are difficult to recognize since they may seem like trivial disorders at fust. Parents should see that their children have regular medical checkups, and be alert to any unusual symptoms that persist. Such conditions include nausea, swelling, double vision, stumbling, nosebleeds, drowsiness and listlessness. Main Childhood Cancers: Leukemia (See section above). Osteogenic Sarcoma is a bone cancer which develops most often in the forearm or lower leg. There is usually no pain at first, but eventually swelling and difficulty in using the arm or leg occur. Cancers of the- Nervous System, known as neuroblastomas, can appear anywhere but usually in the abdomen, where a swelling occurs. Brain Cancers in early stages may cause blurred or 18 uCC 096132 double vision, dizziness, difficulty in walking or handling objects, and nausea. Lymphomas are cancers that attack the lymph nodes, bone marrow and various organs throughout the body. They may cause swelling of lymph nodes in the neck, armpit, or groin. Other symptoms may include general weakness and possibly fever. Eye Cancers usually occur in children under the age of four. When detected early, cure is possible with appropriate treatment. Cancer of the Kidney, or Wilms' Tumor, may be recognized by a swelling or lump in the abdomen. Treatment: Childhood cancers are frequently treated by a combination of therapies, coordinated by a team of experts. They include medical special ists, pediatric nurses, social workers and psycholo gists who work with the child and his or her family. Survival: The five-year survival rate of childhood cancers ranges from practically nil to 84%. However, in some medical centers, the five-year survival rate for acute lymphocytic leukemia--the most common childhood type-is SO to 75%. THE AMERICAN CANCER SOCIETY The American Cancer Society, Inc., is a national voluntary health organization of 2V4 million Americans united to conquer cancer through balanced programs of research, education and patient service and rehabilitation. Its symbol is the Sword of Hope - a double-edged blade with twin serpent caduceus to emphasize the medical and scientific aspects of the Society's program; it appears on all ACS materials and is displayed at meetings, lectures, exhibits and film showings. Organization: The American Cancer Society, Inc., is composed of a National Society, with 58 charter ed Divisions and 3,072 local Units. The National Society: A 194-member House of Delegates provides a basic representation from the 58 Divisions and additional representation on the basis of population. It elects and is governed by a Board of Directors of 116 voting members, approxi mately half of whom are members of the medical or scientific professions. The National Society is responsible for overall planning and coordination, and provides technical help and materials to Divisions and Units. The National Society admin isters programs of research, medical grants and clinical fellowships, and is charged with carrying out public and professional education on the national level. The 58 Divisions: These are governed by 3,849 members of Divisional Boards of Directors, both medical and lay, in all the states plus six metro politan areas, the District of Columbia and Puerto Rico. The Units: These are organized to cover the 3,130 counties in the U.S. There are more than 75,700 community leaden who direct the Society's pro grams at this level. The basic strength of the Society lies in the loyal ranks of volunteen fighting cancer in their communities. The Programs: The ACS maintains its priorities and goals through activities developed by the depart ments of Research, Professional Education, Public Education, Public Information, Epidemiology and Statistics, Service and Rehabilitation, and Crusade. PUBLIC EDUCATION The Society's Public Education program helps save lives by demonstrating simple ways to prevent some cancers and detect others early, when the chance of cure is greatest. The program also focuses on six priority sites: lung, colon-rectum, breast, uterus, oral cavity and skin. Public Education stresses that individuals can help protect themselves against cancer by adopting positive health habits. They include monthly breast self-examination (BSE), avoiding smoking, having regular health checkups, and taking good care of one's body in general. Special emphasis is placed on programs involving person-to-person contact--a proven educational method-with opportunities for discussion built-in. The Society's volunteer force is strengthened by the use of specialized volunteers, who range from ex-smokers with group work experience who lead quit smoking clinics, to nurses who teach BSE to women's groups, and other professionals who develop colorectal cancer education programs in the community. Although cancer occurs mainly in adults, good health habits and a familiarity with major diseases such as cancer should begin early. The Society conducts a variety of youth programs on health and science topics, and produces youth-oriented films, filmstrips, posters and pamphlets. Last year, local Public Education programs in volving two-way communication reached more than 27 million people throughout the country. There were 470,000 youth programs and 371,000 for 19 UCC 096733 adults. The ACS in conjunction with business and industry developed employee cancer education pro grams reaching hundreds of thousands of workers across the United States. In addition to the Society's intensive, person-toperson educational outreach, broader ACS programs blanket the nation with lifesaving messages. During the annual ACS Cancer Crusade, volun teers make personal home visits, urging individuals to protect themselves against cancer. More than 78 million educational leaflets are distributed each 'year, and important cancer educa tional messages reach nearly every U.S. household through TV, radio and print media. CANCER'S 7 WARNING SIGNALS Change in bowel or bladder habits A sore that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion or difficulty in swallowing Obvious change in wart or mole Nagging cough or hoarseness If YOU have a warning signal, tea your doctorI PROFESSIONAL EDUCATION ACS Professional Education programs bring the latest developments in cancer to the medical community: members and students of the medical, dental, nursing and allied health professions. National conferences, clinical fellowships, Divi sion- and Unit-level meetings, workshops and schol arships provide information and training in the pre vention and early detection of cancer, and the treat ment and rehabilitation of cancer patients. Films, audio tapes, speakers, publications and ex hibits are available to other organizations for Profes sional Education programs. The ACS publishes Ca-A Cancer Journal for Clinicians, which is direct ed particularly to the primary physician and has a total circulation of more than 400,000. The Society supports the publication of the journal Cancer, which is directed to those specializing in the care of the ca :er patient. The Society maintains a library of Professional Education motion pictures, available in 16mm and 8mm cartridge formats, as well as in 3/4-inch video cassettes. All are distributed through ACS Divisions and Units on a free loan or five-year lease basis. ACS national conferences in 1980 included one on cancer prevention and detection in April, and an other on gynecologic cancer in October. The pro ceedings of these conferences are published and highlights are recorded on tape cassettes. CLINICAL FELLOWSHIPS The ACS National Clinical Fellowship program since 1948 has invested more than $28 million for the training of approximately 5,500 physicians and dentists in the diagnosis and treatment of cancer. Training is provided on two levels at approved teach ing centers and hospitals. The regular Clinical Fellowship program, for hos- pital residents, is designed to improve the manage ment of the patient with cancer by supporting clin ical oncology training for young physicians and dentists. The Junior Faculty Clinical Fellowship program, for postresident physicians and dentists, is intended to strengthen cancer teaching programs by support 20 UCC 096734 ing outstanding young clinicians in academic careers, upon completion of their specialty training. Fellows put their special skills and knowledge to work through their professional societies, teaching activities, participation in hospital cancer programs and in their private practices. Many new depart- ments and divisions of oncology in hospitals and medical schools in the nation are now headed by former ACS Fellows. During 1980-1981, training will be supported for approximately 450 Regular Clinical Fellows, and 140 Junior Faculty Clinical Fellows. CLINICAL PROFESSORSHIPS The ACS supports a program for Professors of Clinical Oncology which is designed to improve cancer teaching in medical schools. Each grant pays a portion of the yearly salary of an oncologist, who sets up a cancer teaching program in his or her med ical school. The professorship is aimed both at strengthening an institution's cancer curriculum and increasing its staff. UNPROVEN METHODS OF CANCER MANAGEMENT The American Cancer Society maintains an extensive reference center for the collection and dissemination of data on unproven methods of cancer management. This information is available on request to physicians, science writers, editors and the general public, to assist in evaluating claims made for unproven methods of cancer prevention, detection, diagnosis and treatment. ACS Divisions are actively involved in encourag ing passage of state legislation to curb the use of un proven methods of fighting cancer. One well-known example of unproven methods is laetrile, a substance extracted from apricot pits. After exhaustive and repeated tests by many clinical and research institutions, the American Cancer Society, the U.S. Food and Drug Administration and most major medical institutions concluded that laetrile was not effective in the prevention or treat ment of cancer in humans. Presently, however, the National Cancer Institute is conducting a clinical trial of the compound. Until such time as objective evidence is obtained to show that laetrile is of any value in the treatment of cancer, the Society will continue to advise against its use. Many other unproven methods of cancer manage ment also are being followed closely. Those the Society feels do not conform to established medical, scientific, ethical or legal standards are reviewed reg ularly for any change in their status. Occasionally new evidence shows some of these methods to have some benefit against cancer, and the ACS position on them is revised accordingly. The Society always welcomes new developments which have been proven scientifically effective and safe in the prevention, detection, diagnosis or treat ment of cancer. SERVICE AND REHABILITATION As part of its comprehensive attack on cancer, the their families. In 1980, more than 400,000 patients American Cancer Society conducts extensive Service were reached through various ACS Service and Re and Rehabilitation programs to assist patients and habilitation programs. SERVICE The Units conduct a basic service program which includes: 1) information and guidance for the cancer patient and family by helping them make the best use of ACS services, community health services and other resources; 2) loans of sickroom supplies and special comfort items to assist in caring for the homebound patient, such as hospital beds and wheelchairs; 3) surgical dressings prepared by vol unteers; 4) transportation to and from a doctor's office, clinic or hospital for treatment. Depending on local policies and resources, programs may be expanded to include more extensive services. These may include; Home Health Care - Home health care is an im portant alternative for cancer patients who need long-term assistance of some sort and yet are neither financially nor psychologically prepared for an extended stay in a hospital or nursing home. The 21 UCC 096735 Society provides services by its own volunteers whenever possible, and also coordinates other available community services. Blood Program - ACS Divisions are establishing close ties with existing blood collecting and pro cessing facilities in each area, determining needs not now being met and assisting in the recruitment of blood donors. The ACS blood effort also is designed to keep treatment facilities informed on the latest uses of blood and blood components in cancer therapy. Childhood Cancer -- The Society has established a National Advisory Committee on Childhood Cancer, and similar committees in about two dozen ACS Divisions across the country. Committee members include pediatric oncologists, psychiatrists, nurses, social workers* and teachers as well as parents and others. Growing out of these committees are coun seling and education programs to help meet the needs of families with children who have cancer. There is also a close relationship between the Society and the Candlelighters, a self-help group of parents who have or had children with cancer. REHABILITATION The major ACS rehabilitation programs are pri marily directed toward the new laryngectomy, mas tectomy or ostomy patient, offering psychological and physiological assistance to improve the quality of survival. Over 80,000 patients were assisted in 1980. Thousands of individuals who have experienced similar surgery assist patients on a one-to-one basis. With approval by the attending physician, these carefully selected and trained volunteers provide in valuable help - someone for the patient to see and talk to who has successfully coped with the same treatment. Confidentiality is respected in all cases. Educational materials, including audiovisual aids directed at cancer patients and their families, are available from ACS Units and Divisions. Laryngectomee Rehabilitation Program - Patients who have had their larynx (voice box) removed be cause of cancer are faced with the inability to speak, as well as with the trauma of cancer. Members of the International Association of Laryngectomees (IAL) who have mastered esoph ageal speech - a technique of forming words with swallowed air - give new patients practical informa tion and psychological support. Both preoperative and postoperative visits are made. In addition, a host of new surgical methods and the acceptance of electronic or pneumatic devices as a method of communication have brought new hope and flexibility to laryngectomees. Since the formation of the IAL in 1953, the American Cancer Society has been the sole sponsor of the national IAL office. Today, most affiliated clubs are sponsored to some degree by local Units of the Society. The national IAL sponsors training of esophageal speech therapists. A list of speech teachers is avail able upon request from ACS Units or Divisions as well as from local IAL clubs. In 1980, there were 295 affiliated clubs represent ing 48 states and 16 foreign countries registered with the national IAL. Mastectomee Rehabilitation Program - Women who have had breast surgery are under psychological as well as physical strain. Reach to Recovery volunteers, women who have adjusted successfully to the same operation, visit breast cancer patients with their physician's consent, shortly after the mastectomy. They serve as living proof that women after breast surgery can look at tractive and return to active, normal lives. These volunteers also bring practical information on exercises, clothing, swimwear and breast forms that will help make adjustment easier. They do not offer medical advice, but they can provide tips on coping with everyday problems. Ostomee Rehabilitation Program - Some patients with intestinal or urinary cancers must have abdom inal stomas-surgically-constructed openings for the elimination of wastes. Volunteers who have adjusted successfully to these altered body functions, as well as allied health professionals known as enterostomal therapists (ET's) are working closely with new patients to help them lead productive lives free of complications and embarrassment. The Society encourages its Divisions to train new ET's to meet patient needs, and also assists ET schools financially. Most ACS visitor-training programs are coordi nated with those of the United Ostomy Association. Self-Help Groups - A number of other ACS pro grams that draw heavily on the talents and man power of patients and other volunteers have been developed to meet specific needs. Among them are: 1 Can Cope, a program that helps patients under stand cancer as a disease, team the proper nutrition and exercise, and handle problems of stress and self-image. 22 UCC 096736 CanSurmount, a one-to-one visitation program of successfully rehabilitated patients helping other patients through sympathy and caring. The Cancer Adjustment Program, a counseling program for such groups as parents of children with cancer, spouses of cancer patients, and adults with parents who have had cancer. RESEARCH The American Cancer Society is one of the largest sources of cancer research funds in the United States, second only to the National Cancer Institute, the agency of the federal government. The Society's overall investment in research each year has grown steadily from $1 million in 1946 to more than $47 million* today. This sum represents nearly a third of the total ACS budget. To date, the Society has invested more than half a billion dollars in cancer research. The focus of the program is on individually developed projects, rather than directed research on a contract basis. With the exception of epidemiol ogical work, the ACS neither hires staff researchers nor operates its own laboratories. This gives the Society the freedom to place its grants wherever the most innovative and promising work is being done. A key factor in the role of the Society in cancer research is the value of providing qualified scientists with alternative sources for research funds. The Society believes it can make most effective use of its research funds by supporting scientists working in established medical institutions across the country. In this way there is a minimum of overhead and a maximum of flexibility to make sure that research money yields results. Applications for ACS grants are carefully evaluated by scientific review commit tees and by the Board of Directors. KINDS OF GRANTS The Society makes five types of grants to support research: (1) "Research and Clinical Investigation Grants" to finance investigator-initiated research; (2) "Institutional Research Grants" to universities, institutes and hospitals to support pilot studies and the work of young investigators in the cancer field; (3) "Research Personnel Grants" to outstanding scientists and students specializing or planning to specialize in cancer research; (4) "Research Develop ment Program Grants" to provide rapid funding for priority projects; and (5) "Special Institutional Grants for Cancer Cause and Prevention Research" to provide longer-term funding. Research Professorships - This Research Person nel Grant program, unique in the field, has been in existence since 1957. The Society invests about $550,000 in it each year to support 21 of the nation's most gifted scientists. These are people devoting their life's work to cancer research. Freed of major administrative responsibilities and other restrictions, they can concentrate on their chosen fields of scientific investigation. Research Development Program - This was established to identify and provide rapid funding for high priority projects. Approved applications can be funded in less than three months from the date submitted. This compares with the 10 to 18 months required by the federal government before a new approved application can be funded. More than $ 10 million have been appropriated so far for the program, over half of which have been for interferon research. The kinds of research projects eligible under the Research Development Program include: (I) unique research opportunities which cannot wait for the normal lengthy funding procedures; (2) unanticipat ed needs relating to research already under way; (3) program coordination, especially that involving clinical trials and the dissemination of research results to community hospitals; and (4) program integration between the American Cancer Society and other health organizations. All applications are evaluated for--among other considerations-merit, qualifications and produc tivity of the investigator, relevance, need for rapid funding, and probability of the project's eventual contribution to cancer control. Interferon Research - Interferon, a natural body protein with low toxicity, was discovered in 1957 as an antiviral agent and later found to have anticancer activity. The growth of certain human cancers has been at least temporarily halted. Until very recently, interferon for humans could be produced only from human sources such as fresh blood, making it extremely scarce and expensive. But promising results led the American Cancer Society in 1978 to invest an unprecedented $2 million in interferon research through its Research Development Program, so that meaningful clinical cancer trials could be done. 'Subject to audit. Include! J2 million in committee and operating expenaei for evaluating and proceuing research applications. 23 UCC 096737 The first tests are being performed on carefully selected patients in 10 institutions, and will include more than 150 patients in all. Four cancers are involved-multiple myeloma, melanoma, breast cancer and lymphoma. Between 30% and 50% of the patients so far have shown some response to the interferon, ranging from those whose steady downhill course was stabilized, to those whose tumors disappeared entirely. It is still too early to tell what the ultimate effect will be on the patients' length of survival and well-being. Inconclusive though they are, these preliminary results are highly encouraging, and the Society now has allocated an additional $4.3 million for inter feron research. The 10 institutions conducting interferon re search are: University of Texas M.D. Anderson Hospital and Tumor Institute, Houston, Texas--Dr. Jordan Gutterman. Memorial Sloan-Kettering Cancer Center, New York, New York-Dr. Herbert Oettgen. * Stanford University Medical Center, Palo Alto, California-Dr. Thomas C. Merigan, Jr. Roswell Park Memorial Institute, Buffalo, New York-Dr. Thomas L. Dao. Johns Hopkins Medical Center, Baltimore, Maryland-Dr. Albert H. Owens, Jr. College of Physicians and Surgeons, Columbia University, New York, New York-Dr. Elliott Osserman. University of California, Los Angeles, CalifomiaDr. Donald L. Morton. Yale University Medical Center, New Haven, Connecticut--Dr. Joseph Bertino. University of Wisconsin Hospital, Madison, Wisconsin--Dr. Ernest C. Borden. Mount Sinai Medical Center, New York, New York-Dr. James F. Holland. Future directions in this promising search for a new and effective weapon against cancer include attempts to produce a purer form of the protein, increased doses of interferon for patients in the trials, a widening of the tests to include other kinds of cancer, and refinement of a newly developed technique for producing interferon synthetically, which will make it more plentiful and less costly. Besides the American Cancer Society, sponsors of interferon research include such bodies as the National Cancer Institute and the National Institute of Allergy and Infectious Diseases. THE FINANCIAL RESEARCH PICTURE In fiscal 1980 (as of July 31, 1980), the ACS made more than 700 grants to major institutions in this country and to scientists working both here and abroad. The total amount, subject to audit, was over $42 million. This does not include some $3 million granted directly by ACS Divisions. The following table-covering the years 1974 to 1980 inclusive-lists the total number of grant applications received, total grants funded annually by the ACS's National Office, and the dollar amount and number of applications approved but not funded. The ACS allocates its funds based on a three-pronged attack against cancer involving Research, Education, Service and Rehabilitation. Our commitment to continuing and expanding these programs in all three areas has resulted in a number of scientifically qualified research proposals not being funded. Year 1974 1975 1976 1977 1978 1979 1980 REQUESTED Number Amount 1,613 1,456 1,572 1,696 1,912 1,940 1,931 105,095,040 106,069,802 117,059,144 138,887,083 162,535,560 171,999,099 188,032,301 FUNDED Number 477 475 542 630 641 715 712 Amount! 21,557,695 22,320,799 26,903,873 34,263,941 33,193,448 42,875,610 42,474,595* APPROVED BUT NOT FUNDED Number Amount 903 746 776 750 1,115 1,103 1,080 50,643,280 44,522,925 53,298,055 56,940,343 87,578,200 88,283,042 96,594,696 f For the yean 1974-80 ACS chartered Divisions spent an additional average of S3,000,000 per year for research. Subject to audit. 24 UCC 096*738 ACS-SUPPORTED NOBELISTS Dr. Daniel Nathans and Dr. Hamilton 0. Smith, Johns Hopkins microbiologists who have received ACS grants over the years, shared the 1978 Nobel Prize in Medicine with Swiss scientist Dr. Werner Arber. Nathans and Smith made possible the decod ing of a cancer-causing virus, SV40, yielding the largest genetic message yet decoded. It may shed more light on how the cancer process starts and stops. Arber discovered a class of enzymes called endonucleases, Smith later found a specific kind of endonuclease, and Nathans applied endonuclease to genetic decoding. Two ACS Research Professors, Dr. David Baltimore and Dr. Howard M. Temin, shared the 1975 Nobel Prize for Medicine with Dr, Renato Dulbecco for their work in viruses and genetics. Among other things, it led to the discovery that DNA is not always the "master molecule" and may be produced by RNA. Temin's recent work has revealed the origin of at least one class of viruses and how they might interact with a cell's hereditary factors to produce cancer. Dr. Robert W. Holley (ACS Research Professor) received the Nobel Prize in 1968 along-with two other Americans for discovering the process by which enzymes determine a cell's function in genetic development. Dr. Charles Huggins ('66) was the first to demon strate the importance of hormones in the develop ment and treatment of cancer of the prostate and breast. Dr. Peyton Rous ('66) demonstrated that viruses are a cause of cancer in animals. Dr. James Watson ('62), with his colleagues, discovered the "architecture" of DNA. Dr. Severo Ochoa ('59) and his associates disclosed how the DNA molecule is synthesized. Drs. George W. Beadle and Edward Tatum ('58) uncovered the mechanism by which genes transmit hereditary traits and functions. CURRENT RESEARCHERS There are many eminent scientists now working antigen systems which can be used to characterize under ACS grants: Dr. Elliot F. Osserman is a tumor cells as well as some normal cells. Dr. Stanley pioneer in the study and treatment of multiple Cohen discovered the epidermal growth factor myeloma and some forms of leukemia. He is now (EGF), contributing significantly to our understand investigating the possible treatment of multiple ing of cellular growth in animal tissues. Dr. Oliver H. myeloma patients with interferon. Dr. Joseph Lowry is widely known for his research in cellular Bertino has been studying how interferon might metabolism and his development of microanalytical help patients with malignant melanoma. He is also techniques. This work has contributed to much of known for his research in enzyme protection and the current understanding of the malignant process. how to increase the tolerance of patients to metho Dr. Edward Reich has pioneered in research involv trexate--a valuable but toxic drug. He has discovered ing the relationship between cancer and the blood what appears to be a general mechanism by which clotting protein, plasminogen. This research may certain cancer cells resist drugs such as methotrex lead to a screening technique for human cancer. Dr. ate. Dr. Bernard Fisher is studying alternatives to Alexander Rich recently discovered a new biological radical breast cancer surgery, including postopera form of DNA whose structure may make it a useful tive chemotherapy. Dr. Elwood V. Jensen is testing model for studying chemical carcinogens. Dr. S. J. the growth of hormone-dependent tissues for use in Singer developed a now-widely recognized theory breast cancer therapy. Dr, Bernard Roizman is in for the molecular structure of biological membranes. volved in a long-term investigation of herpesviruses, Known as the "fluid mosaic model," it serves as the which may have practical relationships to the pre framework for understanding how cell membranes vention and treatment of human malignancies. Dr. work, and in turn may help in learning more about G. Barry Pierce, a leader in cancer biology, has been exploitable differences between normal and cancer studying cell differentiation in various cancers. Dr. ous cells. Dr. Sidney P. Colowick is studying how Earle C. Gregg is developing radiological methods cancer cells metabolize sugars faster than normal for detecting soft-tissue tumors. Dr. Vincent G. cells, a process that might lead to cancer treatment Allfrey, a pioneer investigator of chromosomal pro by depriving cells of sugar. Dr. Fred Rapp pioneered teins, is continuing to study their role in gene acti in demonstrating that human herpes simplex viruses vation. Dr. Paul Berg has done DNA research result sometimes transform human cells in tissue culture. ing in new approaches to analyzing the structure of In certain cases these cells cause cancerous growths viral chromosomes, and has furthered the under when injected into laboratory animals. This is the standing of cell growth and division in higher organ most convincing evidence yet that viruses might isms. Dr. Edward A. Boyse discovered a series of cause cancers in humans. 25 UCC 096739 CANCER AND THE ENVIRONMENT Most cancer cases in the United States are be lieved to be environmentally related, that is, asso ciated in some way with our physical surroundings, personal habits or lifestyles. Occupational hazards, although associated with only a small percentage of cancers, are under close surveillance. Virtually every suspected major chem ical hazard discussed by the news media is under investigation. Each study, however, can require years and hundreds of thousands of dollars to com plete, since many cancers take decades to develop. Some environmental causes of cancer are wellknown. About 20% of all cancers are directly re- lated to the use of tobacco, either alone or in con junction with excessive consumption of alcohol. Other causes, are more difficult to pin down. One suspected influence is diet, which some experts have associated with major cancer sites. So far, however, the evidence has been indirect and inconclusive. To help identify environmental factors in human cancer, the American Cancer Society in 1971 em barked on an extensive Environmental Cancer Re search Project, involving: (1) a resumption of the Society's Cancer Prevention Study, and (2) studies of groups exposed to industrial substances sus pected of causing cancer. CANCER PREVENTION STUDY The Society realized more than two decades ago the potential for saving lives from cancer through prevention. From this concept developed the ACS Cancer Prevention Study, the largest human biolog ical study of life and death ever undertaken. Some 68,000 volunteers were mobilized to enroll more than a million Americans in the study. More than 450 million pieces of computerized information were collected. This data provided overwhelming evidence that cigarette smoking is the major cause of lung cancer, and an important factor in other cancers. It also yielded vital informa tion about heart disease and other serious illnesses. Originally the Cancer Prevention Study was a sixyear undertaking begun in 1959, but in 1971 it was resumed to: (1) analyze some of the factors involv ing less common sites of cancer; (2) determine if the reduction of tar and nicotine in cigarettes resulted in lower cancer death rates (see page 14); and (3) pro vide data on cancer death rates among persons not exposed to suspected occupational cancer-causing agents, to serve as control data for occupational studies. One result of the resumption of the Cancer Pre vention Study was an analysis showing that obesity is clearly linked to rising mortality rates from heart disease, cancer and other diseases. For individuals who are 40% or more over weight, cancer mortality is 33% above normal for men, and 55% for women. Among the cancers most involved were colorectal (men), and breast, uterus and ovary (women). The Cancer Prevention Study continues today in the examination of long-lived survivors of the orig inal million persons enrolled. Learning why some people do not get cancer can be as important as learning why others do. The influence of heredity, lifestyle and other factors are considered. The Society is now charting a new dimension in cancer prevention by initiating a series of Special Institutional Grants for Cancer Cause and Preven tion Research. They will be unique in that they pro vide substantial, flexible and long-term support to institutions studying various environmental cancer links. The first of these grants has been awarded to the Environmental Sciences Laboratory at Mount Sinai School of Medicine in New York City. Its director is Dr. Irving J. Selikoff, a longtime collaborator with the Society in epidemiological research. STUDIES OF OCCUPATIONAL GROUPS With the cooperation of industry and labor unions, a number of studies of union workers ex posed to various agents have been undertaken. For example, it has been found that asbestos workers have a high risk of lung cancer, gastrointestinal cancer and other conditions, and that even short term exposure carries an extra lung cancer risk. One important asbestos study concerns possible health hazards to persons who lived within a halfmile radius of an asbestos manufacturing plant more than 35 years ago. They were exposed to asbestos dust from chimneys and open windows of the plant. Their death rates, both from cancer and all causes, were found to be no higher than those of other 26 XjCC 096140 socioeconomic levels who were living in the same city, but were not exposed to asbestos from the plant. We are now studying the mortality of family members of asbestos workers to determine if they have an extra risk of lung cancer and other asbestos- associated risks. A study of roofers exposed to benzo(a)-pyrene showed that after 20 years of exposure, this kind of worker had elevated death rates from cancer of the lung and several other sites. A study of anesthesiologists, however, showed no increase in mortality rates, and a report on cotton textile workers found no elevated incidence of lung cancer, despite other respiratory problems. Occupa tional groups under continuing investigation include vinyl chloride workers, painters, rubber plant em ployees, those who work with polychlorinated bi phenyls (PCB's), photo-engravers and shipyard workers. ALLOCATION OF ACS FUNDS BASED ON TOTAL 1979-1980 BUDGET --SI64,188.000* Program services - Research - to support basic scientific studies, clinical investigations and conduct programs seeking new knowledge for the cure of cancer Public education - programs designed to inform the public about cancer prevention and symptoms and to encourage periodic physical examinations Professional education - programs designed to improve the knowledge, skills and techniques of the medical and allied health professions in the detection and treatment of cancer Patient services - to provide for information, counseling, nursing and homemaking services, transportation, dressings, and loan closet items 34% Community services - to provide for programs in cancer detection, mass screening, rehabilitation and development of cancer registries Supporting services - Fund raising - activities to secure increased support from the public for the needs of research, education, service and overall direction Management and general - to direct the overall affairs of the Society, accounting, personnel and office service activities Figures taken from 1979 Annual Report 27 UCC 096741 COSTS OF CANCER Because of a lack of data in many areas, the real costs of cancer are very difficult to estimate. Based on recent studies,* direct cancer costs in the United States have been estimated at $9.1 billion for the year 1977. Included in this figure are hospital and outpatient expenses, physicians' fees, nursing ser vices, home care and drugs. Indirect economic costs, including lost wages and the forced liquidation of tangible assets, have been estimated at between $13.7 and $17.1 billion for the year 1975. These figures are only the most general of esti mates: many costs are not reported, and escalating inflation renders figures obsolete by the time they are published. Estimates have been based on fees received, and do not reflect how much is paid by health insurance and how much by the individual. Nor is there any accounting of fees which are never paid, and which must be absorbed by hospitals and physicians. One study indicated that about 20 percent ofthe average hospital bill for cancer patients must be written off. The average cost to individual cancer patients is even more difficult to estimate. It can vary enor mously depending on how advanced the cancer is when a diagnosis is made. A 1978 Consumer Reports study said that the average hospital visit for a cancer patient is 15 days. At $200.00 a day, the hospital bill alone (excluding surgery and other treatment) would be $3,000. Consumer Reports estimated the average cost for individual direct medical services for cancer to be $20,000. The figure has undoubtedly increased since then. Studies by T.A. Hodgson of the National Center for Health Statistics, J. Cromwell and L.C. Paringer. SOURCES OF NCOME Financial support of the American Cancer Society in fiscal 1980 is estimated to exceed $146 million from public sources. The Cancer Crusade raised about $111 million. National Headquarters and chartered Divisions received some $35 million from bequests and legacies. The public has given generous and growing support to the Crusade over the years. In 1944, for example, the Society raised $800,000. Thirty years later, in 1974, that figure had soared to more than $96 million. Legacies--in which the Society becomes bene ficiary of willed funds--are an increasingly important source of ACS income. Income from legacies indi cates confidence in the leadership of the Society and a determination by many Americans to continue the fight against cancer even after their lifetime. Legacy income in relation to Crusade receipts is shown below. Year 1970 1971 1972 1973 1974 Crusade 50,147,609 56,427,471 62,044,243 67,784,862 72,152,315 Legacies 15,099,088 13,636,651 16,774,295 25,228,782 24,116,620 Year 1975 1976 1977 1978 1979 Crusade 78,788,160 84,882,450 90,120,508 95,927,848 102,778,011 Legacies 31,056,259 33,968,066 24,605,566 30,178,722 39,360,721 28 UCC 096 CELEBRITIES AND CANCER Cancer has struck many persons of world and national fame. Such personalities as Bess Myerson and Van Johnson have had cancer; other well-known people are: Betty Ford, Happy Rockefeller, Shirley Temple Black and Senator Frank Church; tele vision's Virginia Graham, Betty Rollin, Arthur Godfrey and Amanda Blake; pro football's Jack Pardee and golfs Gene Littler. Most people in public life are reluctant to talk about their personal involvement with this or any disease, so actual records are sparse. Even among those lost to cancer the death cause is not always accurate. The toll of world figures with each passing year is a dramatic reminder of the full dimensions of cancer's human devastation. Past victims in various fields include: Entertainment Bud Abbott Tallulah Bankhead Jack Benny Humphrey Bogart George M. Cohan Gary Cooper Andy Devine Duke Ellington Susan Hayward Alfred Lunt Ted Mack Frederic March Ozzie Nelson Lily Pons Minnie Riperton Rosalind Russell Vivian Vance John Wayne Science Marie Curie Tom Dooley Charles A. Lindbergh Margaret Mead Peyton Rous Literature Rachel Carson T.S. Eliot Edna Ferber Erie Stanley Gardner Lonaine Hansberry Damon Runyon Cornelius Ryan Gertrude Stein Jacqueline Susann Communicetioni Stewart Alsop Chet Huntley Frank McGee Walter Winchell Sport* Ty Cobb . Walter Hagen Fred Hutchinson Vincent Lombardi Babe Ruth Casey Stengel Babe Didrikson Zaharias Politici Marvella Bayh Chou En-lai Sen. Hubert H. Humphrey Golda Meir U Thant Busin-- J. Paul Getty Charles H. Revson Toots Shot Died of Lung Cancer Jacques Brel Nat "King" Cole Wait Disney King George VI of England Betty Grabte Buster Keaton Edward R. Murrow Jesse Owens Boris Pasternak Robert Ryan William Talman Robert Taylor 29 UCC 096743 1 GUIDELINES F r the early detect! n f an r in people with utsympt ms TALK WITH YOUR DOCTOR Ask how these guidelines relate to you. AGE 20-40 CANCER-RELATED CHECKUP EVERY 3 YEARS Should include the procedures listed below plus health counseling (such as tips on quitting cigarettes) and examinations for cancers of the thyroid, testes, prostate, mouth, ovaries, skin and lymph nodes. Some people are at higher risk for certain cancers and may need to have tests more frequently. BREAST e Exam by doctor every 3 years e Self-exam every month e One baseline breast X-ray between ages 35-40. Higher Risk for Breast Cancer: Personal or family history of breast cancer, never had children, first child after 30 UTERUS e Pelvic exam every 3 years Cervix e Pap test--after 2 Initial negative teats 1 year apart--at feast every 3 years, includes women under 20 if sexually active. Higher Risk for Cervical Cancer: Early age at first intercourse, multiple sex partners AGE 40 & OVER CANCER-RELATED CHECKUP EVERY YEAR Should include the procedures listed below plus health counseling (such as tips on quitting cigarettes) and examinations for cancers of the thyroid, testes, prostate, mouth, ovaries, skin and lymph nodes. Some people are at higher risk for certain cancers and may need to have tests more frequently. BREAST Exam by doctor every year Self-exam every month Breast X-ray every year after 50 (between ages 40-50, ask your doctor) Higher Risk for Breast Cancer: Personal or family history of breast cancer, never had children, first child after 30 UTERUS e Pelvic exam every year Cervix Pap test--after 2 initial negative tests 1 year apart--at laast every 3 years Higher Risk for Cervical Cancer: Early age at first intercourse, multiple sex partners Endometrium Endometrial tissue sample at menopause if at risk Higher Risk for Endometrial Cancer: Infertility, obesity, failure of ovulation, abnormal uterine bleeding, estrogen therapy COLON & RECTUM e Digital rectal exam every year e Guaiac slide test every year after 50 e Procto exam--after 2 initial negative tests 1 year apart--every 3 to 5 years after 50 Higher Risk for Colorectal Cancer: Personal or family history of colon or rectal cancer, personal or family history of polyps in the colon or rectum, ulcerative colitis Remember, these guidelines are not rules and only apply to people without symptoms. If you have any of the 7 Warning Signals i your doctor or go to your clinic without delay. Pamphlat: Guldaiina* for Canear-R.latad Chackupa, 1980 30 UCc 096744 COMPREHENSIVE CANCER CENTERS Alabama Comprehensive Cancer Center University of Alabama in Birmingham University Station Birmingham, Alabama 35294 Phone: (205) 934-5077 California Los Angeles County-University of Southern California Comprehensive Cancer Center 2025 Zonal Avenue Los Angeles, California 90033 Phone: (213) 226-2008 UCLA Comprehensive Cancer Center UCLA School of Medicine 924 Westwood Boulevard, Suite 650 Los Angeles, California 90024 Phone: (213)825-1532 (213) 825-5268 Connecticut Yale University Comprehensive Cancer Center 333 Cedar Street New Haven, Connecticut 06510 Phone: (203) 432-4122 District of Columbia Georgetown University/Howard University Comprehensive Cancer Center Vincent T. Lombardi Cancer Research Center Georgetown University Medical Center 3800 Reservoir Road, N.W. Washington, D.C, 20007 Phone: (2021 625-7066 Howard University Cancer Research Center College of Medicine Washington, D.C. 20059 Phone: (202) 745-1406 Florida Comprehensive Cancer Center for the State of Florida University of Miami School of Medicine/ Jackson Memorial Medical School P.Q, Box 016960 Miami, Florida 33101 Phone: 1305) 547-6758 Illinois Illinois Cancer Council 36 S. Wabash Avenue, Suite 700 Chicago, Illinois 60603 Phone: (312) 346-9813 Maryland Johns Hopkins Oncology Center 601 North Broadway Baltimore, Maryland 21205 Phone: (301) 955-8822 Massachusetts Sidney Farber Cancer Institute 44 Binnay Street Boston, Massachusetts 02115 Phone: (617) 732-3555 Michigan Comprehensive Cancer Center of Metropolitan Detroit 110 East Warren Avenue Detroit, Michigan 48201 Phone: (313)833-0710 Minnesota Mayo Comprehensive Cancer Center 200 First Street, S.W. Rochester, Minnesota 55901 Phone: (507) 282-2511 New York Cancer Centar/lnstituta of Cancer Research Columbia University 701 W. 168th Street New York. New York 10032 Phone: (212) 694-3807 Memorial Sloan-Kettaring Cancer Center 1275 York Avenue New York, New York 10021 Phone: (212) 794-7585 Roswell Park Memorial Institute 666 Elm Street Buffalo, New York 14263 Phone: (716) 845-5770 North Carolina Comprehensive Cancer Center Duke University Medical Canter P.O. Box 3814 Durham, North Carolina 27710 Phone: (919) 684-2282 Ohio Ohio State University Comprehensive Cancer Center 357 McCampbell Drive Columbus, Ohio 43210 Phone: (614) 422-5022 Pennsylvania Fox Chase/University of Pennsylvania Comprehensive Cancer Center The Fox Chase Cancer Center 7701 Burholme Avenue Philadelphia, Pennsylvania 19111 Phone: (215) 342-1000 University of Pennsylvania Cancer Center 578 Maloney Building 3400 Spruce Street Philadelphia, Pennsylvania 19104 Phone: (215) 662-3910 Texas The University of Texas System Cancer Center M.D. Anderson Hospital and Tumor Institute 6723 Bertner Avenue Houston, Texas 77030 Phone: (713) 792-3000 Washington Fred Hutchinson Cancer Research Center 1124 Columbia Street Seattle, Washington 98104 Phone: (206) 292-2930 Wisconsin The University of Wisconsin Clinical Cancer Center 1300 University Avenue Madison, Wisconsin 53706 Phone: (6081 263-2553 31 UCC 096745 CHARTERED DIVISIONS OF THE AMERICAN CANCER SOCIETY, INC Alabama Division, Inc. 2926 Central Avenue Birmingham, Alabama 35209 (205) 879-2242 Alaaka Division, Inc. 1343 G Street Anchorage, Alaska 99501 (907) 277-8696 Arizona Division, Inc. 634 West Indian School Road PO. 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