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The American Cancer Society
A History of Saving Lives
By Irvin Fleming, Harmon Eyre, Jan Pogue, Jill Russel
American Cancer SocietyCopyright © 2010 American Cancer Society
All rights reserved.
Fighting Cancer — with Knowledge
As studies go, it was a small one only — in Pennsylvania, only covering thirteen years, only a limited sampling. Yet, to physicians across the country, it was recording a seismic shift they were experiencing in their own medical practices.
The study, prepared by the Pennsylvania State Cancer Commission and published in 1924, traced the time it took cancer patients to seek care after they noticed symptoms that might be cancer — and, subsequently, the time it took doctors to offer treatment. The study showed that in Pennsylvania in 1910, patients with established cancers waited fourteen months on average to see a doctor after the first symptoms appeared. By the time they saw doctors, their cases were often so far advanced there was no hope. Yet thirteen years later, patients were visiting their doctors after only eight months — and were asking specific, cancer-related questions.
The study showed that the doctors themselves were changing the way they were practicing medicine. Although the medical community knew that there was a small percentage of doctors who were still dilatory and inefficient — the ones they called "the backward 10 percent" — most physicians were responding to their patients' new demands with more aggressive treatments. Doctors began to offer patients surgery to remove cancers — the only truly successful method of treatment at the time — almost 70 percent faster, assertively cutting the wait time from a full year in 1910 to just under four months in 1923.
The change was having a profound rippling effect on cancer treatment in the country. A doctor from St. Louis noted "a resulting slow but steady improvement in early diagnosis." Another at the Mayo Clinic in Minnesota declared, "Many cases have been cured as a result of early treatment." Patients, said a doctor from Wheeling, West Virginia, were "almost demanding information about cancer." And an Omaha doctor noted "a noticeable increase in the number of patients seeking advice" about cancer.
What, Doctors across America Puzzled, Was Going On?
As early as 1905, the American Medical Association (AMA) appointed a committee called the Council of Health and Public Instruction to examine the increase in cancer deaths. What they found was hardly reassuring. Most people in the United States at that time, including physicians, believed a cancer diagnosis was a death sentence and any action was useless. Many doctors were uninterested or unknowledgeable about treating cancer, routinely giving patients erroneous advice to "go home and forget it" or crediting symptoms to unlikely causes: bleeding from a cancerous uterus was ascribed to "rheumatism" or a "cold in the pelvis," while a man with rectal cancer was ordered "rest and a change of scenery."
Admittedly, a few things had happened on the cancer front in the years between 1910 and 1923 to cause this shift. In 1911, Peyton Rous, a young doctor two years out of medical school, identified a transmissible tumor virus in a Plymouth Rock hen, a discovery that began the journey from tumor virus biology to tumor biology itself, and would eventually lead to Dr. Rous receiving the Nobel Prize in 1966. In 1912, the Clinical Congresses of Surgeons of North America (now the American College of Surgeons) convinced a major women's magazine to run an article on cancer. And in 1915, cancer was induced in laboratory animals for the first time by a chemical — coal tar — applied to rabbit skin at Tokyo University. The lay public was getting into the act as well. The owner of a Montreal newspaper in 1922 offered one hundred thousand dollars to any graduate or student who could find the "medicinal treatment" for cancer within five years — and received more than three thousand claims of cures from forty different nations, four hundred of them from faith healers, herbalists, and fanatics. Time magazine, established in 1923, began routinely featuring articles on cancer under titles such as "Cancer Cure?" and "The Great Enigma."
Slowly, the taboo on the discussion of cancer that had hampered both research and treatment for a hundred years in the United States began to lift. From their patients, doctors were also seeing and hearing interesting things: talk of lectures and materials where descriptions of their symptoms were matter-of-factly described, pamphlets with names like What You Should Know About Cancer and Fourteen Points About Cancer.
This activity, the doctors began to acknowledge among themselves, was a result of the work of the American Society for the Control of Cancer (ASCC). "There can be no doubt that hundreds of lives ... have been saved since the inception of the American Society for the Control of Cancer," said Dr. Frank W. Kenney of Denver in 1925. His comments, included in a slim, clothbound volume published by the Society that year to record its "objects and methods and some of the visible results of the work," were accompanied by almost two dozen others from doctors around the country. "It is apparent that both the physicians and the public at large are displaying an increased desire for information and an increased interest in the problems of cancer, for which condition I think it safe to assume the work of [the Society] is responsible," concluded Dr. Milton G. Sturgis of Seattle.
The Cancer Crusade had begun.
"Too damn clear"
The Society made it clear from its beginnings at the Harvard Club in New York City in May 1913 that it intended to fight cancer with information. Physicians estimated that seventy-five thousand people were dying every year in America from cancer, and the numbers of deaths were skyrocketing in the early years of the twentieth century, as nearly a million immigrants arrived in the country annually.
In 1913, cancer was an enigma — seemingly resistant to the kinds of efforts that had begun to successfully control tuberculosis and pneumonia. Although physicians still believed it was spread by contagion, cancer didn't respond to sanitation or any of the methods commonly employed against infectious diseases. There seemed to be no drug or serum that could prevent or cure it. Dissemination of even the rudimentary information known was difficult, and treatment sometimes impossible.
The typical American medical school curriculum did not emphasize cancer diagnosis and treatment. Consequently, physicians graduated with little knowledge of the disease. As one early ASCC leader put it, "The cancer patient's fate was in the hands of the first physician they encountered," and those doctors all too often were neither knowledgeable nor eager to handle cancer patients.
In addition, physicians who practiced outside major metropolitan areas like New York City were frequently isolated and without access to the latest medical knowledge. Small-town doctors worked without diagnostic x-ray and laboratory studies, lacked modern pharmaceutical agents, often had no close colleagues with whom to exchange opinions, and were sometimes far away from hospitals.
Patients themselves didn't seek care until they were desperate. They often treated themselves and alternately revered or feared their doctors and the medical treatments they prescribed. When patients did acknowledge their illnesses, the sick were often driven by desperation and ignorance to seek help outside accepted medical practices — giving strength to quacks and charlatans offering surefire "cures."
Yet there had already been hints for years of at least some surgical successes, if cancer cases were diagnosed early enough. A physician named William Stewart Halsted performed the first radical mastectomy in 1882 and stated in his accompanying paper that "more women could be cured with early diagnosis and treatment." In the same publication he posited that "both patients and referring physicians delayed referral out of a sense of hopelessness about curing the disease."
Two decades later, some European gynecologists were encouraging education of the public after successes with surgery in early-stage cervical cancer, and a few American doctors took note. As evidence mounted in the early 1900s, the rumblings to push public education grew louder from a few progressive surgeons and gynecologists. The AMA's 1905 cancer committee was the first attempt at this; this committee was joined in May 1912 by the American Gynecological Society (AGS), which devoted the entire third day of its annual meeting to a series of papers on the surgical treatment of cervical cancer. Each presentation pointed out the critical need for public education, and a committee of three physicians was named to gather suggestions and report their recommendations the following year to both the AGS and the AMA.
These efforts were all beginning to converge when a professor of gynecology at Johns Hopkins sat at his desk one October day in 1912, analyzing results of his cervical cancer cases to see how many patients were well after five years. Dr. Thomas S. Cullen found that only 23 percent of his patients were apparently still healthy. "I felt very blue about the situation," he wrote years later. "It was perfectly evident to me that if we were to get better results, it would be necessary to educate people as to the early symptoms of cancer."
Cullen wrote to the editor of a major medical publication about his concerns and was advised to bring up the issue at a meeting of surgeons in Brooklyn, New York, a month later. The idea of educating the public was readily adopted by the surgeons, many of whom knew of the AMA's own recommendations for more education, and a committee was formed to work on the issue, with Cullen as the chair. Cullen and his committee decided the best approach was to reach out to women. Not only was cancer still considered by many in the public to be a "woman's disease," but, as Cullen wrote, "it seemed wise to educate women ... because, after all is said and done it is the wife, the mother, or the sister, who insists on a man going to the physician."
Cullen wrote a short article describing the signs and symptoms of uterine cancer and stressing the importance of early diagnosis and treatment. He hand-delivered it to the editor of the Ladies' Home Journal, one of the most popular women's magazines of the day. The editor, Karl Harriman, sat with a long black cigar while he read the article, puffing and scowling. Looking up from the paper, he finally told Cullen the article was "too damn clear; half our women readers would grab their hats and rush for the closest doctor." Instead, the editors at the Journal suggested a layperson should write the article — specifically, Samuel Hopkins Adams.
Adams was a crusading journalist whose articles often made a huge impact on the public. In 1905, he had written a series of eleven articles for Collier's Weekly, analyzing some of the country's most popular medicines, a series that led to the passing of the first Pure Food and Drugs Act the next year. Cullen invited Adams to Baltimore for a dinner with some of the state's outstanding health leaders. They pumped Adams full of information about cancer, then sent him off to talk to doctors in Chicago and at the Mayo Clinic.
The two-page article Adams wrote, titled "What Can We Do About Cancer?" appeared in May 1913. Graphic and dramatic, much of the information the article provided was erroneous and primitive by today's knowledge, and it was accompanied by an endorsement from Cullen, as chair of the surgeons' cancer committee. Adams's reporting was picked up by other magazines and newspapers all over the country, with a combined estimated readership of eleven million. Cullen related that shortly after the article appeared, he met a surgeon from the South headed to an AMA meeting who told him, "Cullen, as a result of the Ladies' Home Journal article, I have had six early cases of cancer in a little over a week."
On May 22, 1913, after a year of discussions and with the blessing and participation of more than two dozen medical groups, Dr. Clement Cleveland, nine other doctors, and five laypeople officially formed the American Society for the Control of Cancer. The organization was formed with two main goals: to gather information about cancer and to use that information to educate health care professionals and the public.
The Society's slogan was "Fight cancer with knowledge."
It was an incredible effort to undertake. The Society had no money and no structure. Medical professionals harbored a tremendous amount of skepticism that words — and words alone, since the first efforts of the Society did not include medical research of any sort, a path it did not veer from until 1946 — could make any difference. And although it had been formed by doctors, the Society would rely heavily on both the generosity and leadership of laypeople — its first president was a New York stockbroker. The combination of laypeople and medical professionals was unprecedented and would both cause friction and instigate change for the Society.
"The particular objects for which the corporation is to be formed are as follows: To collect, collate and disseminate information concerning the symptoms, diagnosis, treatment and prevention of cancer; to investigate the conditions under which cancer is found; and to compile statistics in regard thereto."
— Quote of the mission spelled out in the first certificate of incorporation, passed in 1922
For the Society, information was the key — to everything. Its objectives were both epidemiologic and educational. It wanted to act as a clearinghouse for the most modern medical information about cancer to be shared with both doctors and the public. On the medical front, the Society began to create a systematic and uniform record of cancer cases in hospitals and dispensaries in order to provide data on the value of surgical treatments — a forerunner of today's facts and figures about cancer. This approach in itself was revolutionary: no one kept statistics on cancer, because patients routinely begged their doctors to hide the diagnosis out of fear their families would be ostracized and because doctors often were either ignorant or uncertain about a cancer diagnosis.
Raising Funds, Fueling Progress
The first lay leaders of the ASCC were all outstanding businesspeople from New York, and the first medical leaders were primarily from East Coast cities with established medical centers. One of the challenges of the Society was to reach beyond the large cities into more midsized and even smaller communities throughout the country. To make the Society a truly national effort, however, physicians from many universities and hospitals across the country were included on the first board, executive committee, and advisory council. Physicians were named as regional and state chairmen to represent the Society. The ASCC in some cases still depended on its founding core to be these chairpeople; among those first physician chairmen was Thomas Cullen, who cochaired the Maryland committee with Joseph C. Bloodgood. (The two men, both of Johns Hopkins Hospital, led the way toward origination and acceptance of the frozen section technique of surgical pathology.) But the Society also sought out doctors in Montana, Alabama, Idaho, Arkansas, Wyoming — anywhere that progressive doctors thought the work of the ASCC would make a difference.
In addition to complex organizational challenges, there was an immediate need to raise money to support the educational programs of the new Society. The original plan was to offer several categories of ASCC membership, depending on the level of donation. Elsie Mead, a Society founder and daughter of Dr. Clement Cleveland, was named temporary head of the Ways and Means Committee, and she convinced five New York business leaders to guarantee one thousand dollars each toward the expenses for the first year. Mead then set about raising money from other sources. She interested a number of women of means in giving money to the Society and was interested a number of women of means in giving money to the Society and was so successful that she did not need to ask the original guarantors for their one thousand dollars.
Excerpted from The American Cancer Society by Irvin Fleming, Harmon Eyre, Jan Pogue, Jill Russel. Copyright © 2010 American Cancer Society. Excerpted by permission of American Cancer Society.
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