At Issue; 27; Outlook on Cancer

At issue of cancer, composite, take one. The laboratory of Dr. Albert St. Georges, a Nobel Prize winning scientist, deeply committed to cancer research. I expect that these substances will help us to understand cancer better. They actually have opened the way to an entirely new attack on cancer.

Being a medical doctor myself, I also hope that these substances will be eventually useful as new weapons against human suffering. National Educational Television presents, at issue, a commentary on events and people in the news. At issue this week, cancer, the outlook for finding a control and a cure. With Inved Marvellous Mechanism called the Human Body, life is sustained by cells which divide normally in an orderly progressive fashion. But sometimes, for reasons no one completely understands, cells do not stop in their growth and division. They continue multiplying without regard for the needs of the tissues,

growing wildly on a mad course of aimless unlimited development. The result is the formation of a growth, a disease we call cancer. To understand why the cell system goes wrong and having gone wrong, how to control and cure it, and perhaps one day to prevent it from ever going wrong, is the urgent work of cancer researchers throughout the country. Philadelphia, the Albert Einstein Medical Center, area of research, better means of diagnosing and treating breast cancer. The scientist is Dr. J. Gershon Cohen, Director of the Center's Department of Radiology. He speaks with Leonard's Wig. In the United States this year we expect at least 64,000 women to have cancer the breast, to discover cancer the breast for the first time. Unfortunately, 50% of these women don't have a chance of living beyond five years. And the reason for this is that in this group,

the cancer has spread to the lymph nodes in the armpit, and once that situation arises, the surgeon has an operation to do, which is not successful. Not so successful as when the cancer is still localized to the breast itself. You know, women discover as a lump accidentally and by the way, about 95% of all cancers are discovered by the woman herself, usually accidentally, usually doing baby. And when that happens, the woman usually is overtaken by fear. And this fear often engenders inertia, and she finds herself under a considerable strength before she can find herself in a position to a solid doctor. And this delay sometimes is unfortunate, but those women who consult a doctor right away, they put themselves in the best position for her effective treatment. The extra examination of the breast discloses the size and the shape of a new growth with great precision.

Usually when a patient reports to a doctor with a lump, he usually can feel a lump. And he makes a decision as to whether or not he should do a diopsy as to the nature of the lump as he feels it under his fingers. But unfortunately, in about 20% of all cancers, there is no lump that the surgeon can palpate. And these patients usually report to the doctor merely with a symptom such as a drawing sensation or a burning sensation or some kind of a pain, but one palpation no lump can be found. But the extra examination of these breasts and 20% of them discloses a cancer unknown to the patient and unknown to the surgeon, but easily discovered and shown in x-ray films. Will you explain what that means? I'll be glad to show you some examples of this. Here we have examples of two patients.

For instance, in the first case, we have a large breast and inside almost in the middle of the breast is a small cancer. This cancer was not palpable by the physician, but shall is very distinctly in the x-ray film. In the second case, again, we have that of a patient with a very large breast with a tumor almost in a central portion. And again, when this patient reported for examination, she herself thought she felt a lump. Doctors thought that she was right, but they thought that the lump was not significant, and they didn't know whether or not a surgical operation was necessary. But when the x-ray examination came through and showed the nature of this lump with its extension into the surrounding tissues, its obvious malignant character was evident on these x-ray films. Now, the presence of a tumor in the breast is not significant to the surgeon, unless it is what he calls a dominant tumor,

because many patients have cysts and other changes in her breast, which to the palpate and hem are not significant. But if among these various little tumors in the average female breast, one tumor stands out predominantly, then this is significant to the surgeon and is on this basis that he decides to operate. Now, in both these cases, the situation did not pertain. Neither of these tumors was what he would call a dominant lump. Yet on the x-ray film, there's no question about the malignant character of these two tumors. Doctor, is this what we would call a foolproof system of the use-section of a cancer on the breast? No, by no means. This is not a foolproof system. We make errors and diagnosis, and sometimes there are an excess of 10%. But when this examination is added to the findings of a clinical examination, the accuracy of diagnosing these conditions reaches almost 100%. Is it a safe system?

Is perfectly safe. The amount of x-ray exposure connected with this type of examination as well within safe limits. Thermography. A new method of measuring the body's surface temperature through photographic heat impressions is another tool in Dr. Gershon Cohen's work. Let me explain to you the difference between ordinary photograph and a photograph. On this side, we have two individuals who are sitting in, and actually you can see four legs. This is the ordinary photograph. Now, on this side of the picture, we have the same two individuals, a photograph, but take notice that between them we can only see two legs. The reason for this is the fact that each of them has a wooden leg, and the wooden leg is cold and doesn't show in the thermogram, while their natural leg, of course, has heated it and shows up very clearly in the thermogram. Instead of using a normal thermometer which merely registers the temperature of the mouth, this instrument measures the surface temperature over the part of the body that we are examining.

The machine operates very much like a ordinary camera. The patient is stripped. The infrared rays coming from the body are allowed to go into the camera. The camera has mechanisms inside of it which convert these infrared rays into rays in a visible portion of the spectrum, which then make it possible for us to expose ordinary photographic film. And so the film that we get is a portrait of the surface temperature. And by inspecting this thermogram and looking at the light spots and the dark spots, we know immediately where there might be disease because disease, whether it be due to an inflammation or whether it be due to cancer or whether it be due to some metabolic disturbance, will show itself by increased heat radiation from that area. And when that occurs on the thermogram, we have a light area that immediately portrays the location of this abnormal process. Any woman who discovers a lump at her breast or any woman who discovers that she has a annoying sensation or a pain or any symptom in her breast, which lasts for more than a few days,

that woman ought to report to her doctor and he in turn ought to be sure to include an extra examination as a part of the total examination. How often should a woman have the right to take it? Well, now with women who have no symptoms and who are above 35 years of age, it would be a good screening method if we were to employ this type of examination. For instance, if every woman over 35 years of age or to have an examination of a light that's done once a year, this would be pretty good insurance for detecting the tumor when it would be operated on with complete safety and with a good chance of permanent cure. Now, a woman between the ages say of 45 and 60 might resort to this examination every six months instead of once a year, but otherwise those women between 35 and upwards once a year probably would be sufficient. The University of Chicago School of Medicine, area of research, lung cancer. The scientist, Dr. Charles E. Huggins, director of the Ben May Laboratory for Cancer Research.

Dr. Huggins is working toward the day, when as he puts it, smokers can take a protective pill and smoke their heads off without worrying about lung cancer. It is Dr. Huggins' contention that it is not cigarette tobacco that contains any cancer causing substances, but the smoke itself. These carcinogens and cigarette smoke are aromatic hydrocarbons, the most deadly of them, a substance called DMBA. He has reported that a single feeding or injection of DMBA in reds causes fatal cancer 100% of the time. Dr. Huggins has found, however, that very small doses of DMBA itself and of other related aromatic hydrocarbons are able to protect laboratory animals from cancer and death caused by the carcinogens in tobacco smoke. The problem now, says Dr. Huggins, is to find the most potent protectors. When found, they will become ingredients in a pill for smokers.

How soon for such proof? Perhaps 20 or 30 years away, says the doctor. Woods Hole, Massachusetts, the Institute for Muscle Research at the Marine Biological Laboratory. The laboratory is devoted to finding and applying substances in nature which may inhibit cancer. How is it going, Andy? Oh, very nice. Does it separate? Does it separate well? Yes, one can look. Dr. Albert St. Georgie, a biochemist who won the Nobel Prize in 1937 for isolating hydrogen sea. A precipitate? Yes, sir. Have you got any other proofs that, in the control, we have an average of 2.5 grams. Oh, that's true. How big is it?

This study has led us to the unexpected discovery that the animal tissues contain two very potent substances, one which promotes growth, which we call tromein, and one which retards growth, which we call retine. The two substances in a normal cell hold each other in balance. This is why an extract of tissues seem to have no effect at all. But once you separate retine from pomeene, you see very remarkable actions. What we do in our experiment is to inoculate mice with cancer, let the tumor grow, and then after a while we begin to treat it with our retine preparations, while in a number of animals we let the tumor grow. In the very end, we kill the animal and compare the tumors of those animals, which have been treated with the tumor of those, which have not been treated.

Here in this refrigerator, we keep the result of the very last experiment. You see here in one tree, am I assistant, has kept the tumors of animals which have not been treated. They are enormously big, in a big time they go to an enormous size. In the other tree, you see the tumors of the animals which have been treated with a moderate amount of retine for a little while, and you see they are quite small as compared to the control experiment. I have no doubt that, had we given more retine and for a longer time, the tumor had disappeared altogether and we had cured the mice. See, so this is what we actually do in our experiment. I really cannot see why human cancer should be different. All you could object that human cancer comes spontaneously and we have inoculated our mice, but we tried these experiments also on spontaneous cancers of mice and it exists the same.

So I see the reason why we shouldn't have a similar result in human patients. The difficulty of this problem of practical application is that there is enormous need for a substance which could cure cancer. The number of cancer patients and the suffering which is caused by cancer is just enormous. So tons of such a substance would be needed and retine and for me are present in the tissues only in very small quantities and it's very difficult to get them out in pure condition. Naturally, for such a study, I need myself a little factory which allows me to work up thousands of pounds of different tissues or gallons of extracts and I have fortunately all these heavy machines, big stills, big centrifuges, big mincing machines and all that what is needed for this very cool work.

Now, once we have these substances entirely separated which we do by dividing them between two different fluids and the ones we send it to separation columns and all that, then we hope to get them out in crystals and if these crystals are quite pure then we will be able to find out what they are chemically and be able to synthesize them and produce them by the thumb to get even with this awful enemy of mankind. To achieve this goal, I need the freedom which I have now. I have a perfect freedom and to do what I please and if I wouldn't have it I could get nowhere in my research which changes the action very often. So the only bottleneck of this whole research is above my neck in my brain that I can do nothing about that.

Very unfortunately I know from my own experience how awful the suffering is caused by this cancer and I want to get even with this awful disease. So and once a biochemist starts on this line and sees any hope, it is his moral obligation to go to the bitter end. I see a chance that within a fairly short period we may have something left in it. How far we are, I do not know. Research is always slower than one expects and if one would know in advance how slow it is or wouldn't start at all, but sometimes developments are very fast. But it may be a few years. I do not know. I am just hoping that I can come to the help of those many suffering people.

I am glad to say, hey, in full, I have no disturbance. My chief company apart from my research fellows and associates and friends are the sea-gulls and they don't disturb me. They are a very pleasant company and the fishes which I try to catch which are equally pleasant and they don't talk too much, as you know. Nildred Spencer, science writer of the Buffalo evening news. The three scientists whose work you have just seen are among many thousands who are engaged in an all-out war against cancer, one of mankind's oldest and most devastating diseases. They described their findings at a recent meeting sponsored by the American Cancer Society for scientists and science writers in Palm Beach Shores, Florida.

Here with us today are three other scientists who also described new findings at that meeting. Dr. Ruth Sager, the Department of Zoology, Columbia University. Dr. Martin L. Levin of Razzel Park Memorial Institute, Buffalo. And Dr. Stephen O. Schwartz of Cook County Hospital, Chicago. One of the big problems that has been discussed, a great deal in recent months, particularly since a case here in New York, is the question of the human volunteer, the person who deals, who offers to serve as a research subject. We all know that the time comes when scientists can't do research on animals anymore and they have to find out more about cancer in humans by working with humans. And there has been some criticism of the way human volunteers have been used or have participated in these studies. There's been some feeling that they are not told as much about the studies as they should be. How do you feel about that, Dr. Sager?

Well, this was a subject of some debate at the American Cancer Society meeting. I feel quite strongly about it that there is one thing to treat a patient who has a disease for which the cure is not known in the best manner possible. And very often a kind of experimentation becomes necessary simply because there is no backlog of information about how to treat that patient. But it's quite something else to use either healthy people or patients who have a different disease as experimental organisms with respect to a general problem, which is not their particular problem. Now, this is what was done in this unfortunate case, which was described, which occurred sometime ago in Brooklyn. And I think that there is no justification for this. A volunteer is very clearly to be distinguished as a person who has freely and of his own volition agreed to operate as an experimental organism for reasons which are not directly related to his disease. And should be given the very fullest information.

Well, I think we have to remember that all advances, either in the prevention of disease in humans or in the treatment depend on essentially some type of experimentation. In other words, given all the laboratory data possible, you still have to try it out in some form in humans. And you should be done under all safeguards, but I don't think that the question of experimentation in humans is even a matter of that issue. This is essential. You didn't suggest that you were against human experimentation. No, what I would suggest is that there is a need for a code that there has never been a formal code, a legal code, or any sort of understanding, which has been clearly formulated about the problem of human experimentation in medical research, although, of course, this has been going on for a long time. And I think that it has now come to the public eye because of this case in Brooklyn, and that it simply highlights what is a real need, namely that the things should be aired and that there should be some kind of a formal understanding of the conditions under which this can be carried out. Do you find, Dr. Schwartz, that you have any problem in getting patients to volunteer for studies that you are making or in getting non-patients that is healthy people, perhaps medical students, other people to participate in these studies?

We have limited ourselves entirely to healthy individuals who are in strict sense volunteers who are fully informed of what we are going to do, what the risks are, what the possibilities of harm are. This, any real progress is practically impossible because we can do all the animal work and the basic research in the world, unless we can apply it to man, it's really meaningless, so that I feel very strong. This is something that shouldn't hinder us from continuing to do human experiments with full knowledge of the participants of code. But would you agree that some sort of a formal code or a legal code of, in any way, a generally recognized code of the conducting, the manner of conducting of these experiments, that it's really time that something of this sort was on the books? Well, I don't think there is a code that came out of the Nuremberg trials, but it's never been really formalized, but I think this is something that we've been very much aware of and we've been very careful about because there are very real legal risks entailed in any of these experiments.

That's, of course, moral and ethical risks, which we have to face, and so each of us has laid down very strict rules for itself about these things. Actually, it's interesting that in cancer, most of what we know about the causes of cancer in humans have come from experiments, not delivered experiments, but natural experiments, which people have inflicted on themselves by exposure to various chemicals and radiations. And this is where most of the clues have come from. The Trinity Suite Cancer in 1776. Now, there's another question I'd like to ask each of you before we get through with our discussion here. If I could wave a magic wand and give each of you what you would most like for your cancer research, what would be most helpful to you?

What is most needed today in the field of cancer research? Is it money? Is it to public understanding? Is it to more intelligence, more researchers, Dr. Stager? Well, I would say more brains and some better ideas. I think that the challenge of all sorts of medical research, particularly the challenge of cancer, is one which I would think would have tremendous appeal to teenagers and to people who are now growing up and trying to decide what will be their profession, because the profession of medical research scientist is one which is extremely rewarding, particularly if you really solve some problems. I would think that that is the area that I would hope would, that's what I would ask for, more bright people to come into the field. Dr. Levin? Well, I think a number of things could be asked for, but one of the things which strike me is first the need for more intensive and more extensive study of environmental factors in humans.

Secondly, a great understanding on a part of the public, and especially on a part of public agencies, asked to the significance of research and the prevention of cancer, because it is now evident to two significant sources of environmental chemicals, many of which probably have cancer effects or probable cancer effects, one of which is tobacco and the other is the general chemical industry. We are entering into our environmental exposure, either through food, water, smoking or the air, but that there is considerable resistance to the use of this information, even resistance to considering it on a part of the industry concern, and this is turning out to be an important public factor. Dr. Schwartz, what would you like from my magic wand? Well, I agree with Dr. Sager, I think what we need is more talent, but of course this means money to buy this talent, to make it attractive for these people to come into the field, to give them the tools with which to work, to give them the laboratories in which to work, but ultimately it reduces itself to brain power. I don't think that buildings are going to do it, I don't think that money is going to do it, it's ultimately going to be good people really applying themselves to the problem.

Thank you all very much ladies and gentlemen for the discussion. What is the outlook on finding a control and cure for cancer? The outlook is good, if measured in no other terms than the quality of those men who are researching ways of understanding and coping with this disease. Scientists are a pragmatic lot, more disposed to research than rhetoric, yet if they are asked when, how soon, many answer that the cure for our last elusive sickness will happen in this age of mankind, perhaps in the next few years. This is the first time I've ever seen a cure for cancer, I've never seen a cure for cancer, I've never seen a cure for cancer, I've never seen a cure for cancer. I've never seen a cure for cancer, I've never seen a cure for cancer.

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