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Let me take, as an instance, Cancer of the Breast. Dr. Janet Lane-Claypon, in a brilliant and
careful analysis of the literature of about 20,000 cases, arrives at the following conclusion with regard
to the results of early treatment: " We do not think there is any exaggeration in the statement that
if by dint of increased dissemination of knowledge and greater facilities for surgical treatment, women
suffering from Cancer of the breast could be brought to receive the best available treatment of the
present time, the average number of years of life lived by those who now die without treatment would
be increased by almost ten years."
In many cases, of course, the removal of a cancerous growth by operation has resulted in a
complete and permanent cure, the patient dying years afterwards from an entirely different cause.
The importance of early operation cannot be too strongly emphasised. As Dr. Lane-Claypon
says : " The stage of the disease at operation is seen to exercise an influence fully as great as and,
sometimes, greater than the variety of Cancer." This statement applies not only to Cancer of the
breast, but to all Cancer in an operable situation in the body.
Though our aim in every case should be the diagnosis and removal of a malignant growth in
its earliest possible stage, yet we must admit that t will be a long time before we approach such an
ideal. In the meanwhile surgical treatment can make it possible for many people to live a natural
life in comfort for a number of years and, in advanced cases, much may be done to prevent and relieve
prolonged suffering.
(ii.) Lead.—A new treatment for Cancer, which appears to give some hope of cure in certain
selected cases, has recently been described by Professor Blair Bell and his colleagues at Liverpool.
This treatment depends upon the selective lethal action found to be exercised by lead on the cells of
malignant growths. The lead is administered in a very finely divided form (collosol) by injection into
a vein and has been shewn to cause the death and coagulation or even liquefaction of the cells of
malignant growths. Of the 200 cases which had been treated up to the time of Professor Blair Bell's
announcement 50 or so were believed to be still alive and well. Such results are very encouraging,
but it is obvious from the very nature of the changes produced that the treatment is very limited in
its scope. Cases can, in fact, only be considered suitable for lead treatment when no " vital " organ
or structure is believed to be involved in the malignant change, and even then the risk of an inaccurate
diagnosis is clearly far from negligible.
(iii.) Radiation.—A word must be said here about the present position of radiation (radium or
X-rays) in the treatment of Cancer. Cancer of certain varieties and in certain situations can be treated
quite as successfully, and with far less inconvenience and risk to the patient, by radiation as by surgery.
But in the majority of cases surgical removal with or without radiation gives the only hope of permanent
cure. The attitude of investigators towards radiotherapy is now very different from what it
was a few years ago. Our ideas as to the mode of action of the rays and consequently the objects with
which we apply them are now radically changed. At first the rays were regarded in the light of a
caustic, but as such they were found to be inferior to many already in use. Later the varying radiosensibility
of cells was recognised and a selective destruction of Cancer cells was aimed at, an unattainable
goal with the comparatively crude methods in use. Lastly many radiologists have come
to regard radiation as a means of so altering the Cancer cells that they may, by acting on the patient's
normal tissues, evoke an immunity reaction by the production of a substance or substances inimical
to themselves. According to this conception the course of every case of Cancer depends upon the
degree to which these substances are formed. Unfortunately this formation of cancer-destroying
substance is almost always inadequate, but there is some hope that in the future by the more skilful
use of radiation such a production of antagonistic substances may be evoked as shall be sufficient to
hold in check and ultimately to destroy the Cancer cells.
8. What Public Authorities Have Done.—It would be out of place in this short memorandum
to give a review of the measures taken for the Control of Cancer in the different countries of the
world. But before describing what has been done in this country I think it will be useful to refer
briefly to some of the work done in the United States of America. The moving force in Cancer prevention
in that country has been the American Society for the Control of Cancer. The activities of this
influential and representative organisation include (1) Education, by means of lectures, newspaper
and magazine articles, moving pictures, radio talks, posters, circulars, handbooks, a periodical and
private correspondence ; (2) Special Campaigns, such as National Cancer Weeks ; (3) Cancer Clinics,
which are of two kinds, (i.) Temporary Clinics, formed for educational purposes in connection with
one of the Society's campaigns, or (ii.) Permanent Clinics, the object of which is to secure prompt and
efficient diagnosis and treatment for those persons who cannot afford to pay the fees which able Cancer
specialists usually receive ; (4) Statistical and Other Researches. The report of the Pennsylvania
Cancer Commission, issued in 1924, attributes considerable success to the efforts of the Society in
that State during the thirteen years, from 1910-1923. This success was shewn by:—
(i.) Patients going to doctors in increasing numbers.
(ii.) Patients applying to doctors at an earlier stage of the disease.
(iii.) An increasing desire for sound information.
The same report states that, comparing the years 1910 and 1923 the average time between
th2 discovery of the first symptoms in superficial Cancer and the first call on the doctor has been reduced
from 18 months to 14.6 months, or 20 per cent., while in cases of deep-seated Cancer the interval
has been reduced by nearly one half.