Cancer Control. Proceedings of the 12th International Cancer Congress, Buenos Aires, 1978

292 Pages·1979·6.47 MB·English

by  A. R. Smith and C. A. Alvarez (Eds.)

ADVANCES IN MEDICAL ONCOLOGY, RESEARCH AND EDUCATION
Proceedings of the 12th International Cancer Congress,
Buenos Aires, 1978
General Editors: A. CANONICO, O. ESTEVEZ, R. CHACON and S. BARG, Buenos Aires
Volumes and Editors:
I - CARCINOGENESIS. Editor: G. P. Margison
II - CANCER CONTROL. Editors: A. Smith and C. Alvarez
III - EPIDEMIOLOGY. Editor: Jillian M. Birch
IV - BIOLOGICAL BASIS FOR CANCER DIAGNOSIS. Editor: Margaret Fox
V - BASIS FOR CANCER THERAPY 1. Editor: B. W. Fox
VI - BASIS FOR CANCER THERAPY 2. Editor: M. Moore
VII - LEUKEMIA AND NON-HODGKIN LYMPHOMA. Editor: D. G. Crowther
VIII - GYNECOLOGICAL CANCER. Editor: N. Thatcher
IX - DIGESTIVE CANCER. Editor: N. Thatcher
X - CLINICAL CANCER - PRINCIPAL SITES 1. Editor: S. Kumar
XI - CLINICAL CANCER - PRINCIPAL SITES 2. Editor: P. M. Wilkinson
XII - ABSTRACTS
[Each voiume is available separateJy.J
Pergamon Journals of Related Interest
ADVANCES IN ENZYME REGULATION
COMPUTERIZED TOMOGRAPHY
EUROPEAN JOURNAL OF CANCER
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY, BIOLOGY, PHYSICS
LEUKEMIA RESEARCH
ADVANCES IN
MEDICAL ONCOLOGY, RESEARCH
AND EDUCATION
Proceedings of the 12th International Cancer Congress,
Buenos Aires, 1978
Volume II
CANCER CONTROL
Editors:
A. SMITH
Department of Epidemiology and Socio! Research
Christie Hospital and Holt Radium institute, Manchester
and
C. A. ALVAREZ
Department of Clinical Oncology
School of Medicine of "del Salvador" University, Buenos Aires
PERGAMON PRESS
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First edition 1979
British Library Cataloguing in Publication Data
International Cancer Congress, 12th, Buenos Aires,
1978
Advances in medical oncology, research and
education.
Vol. 2: Cancer control
1. Cancer - Congresses
I. Title II. Smith, A III. Alvarez, C A
616.9'94 RC261.A1 79-40704
ISBN 0 08 0 2 4 3 8 5 1
ISBN 0-08-023777-0 Set of 12 vols.
In order to make this volume available as economical-
ly and as rapidly as possible the authors' typescripts
have been reproduced in their original forms. This
method un/brtunately has its typographical limita-
tions but it is hoped that they in no way distract the
reader.
Printed and bound in Great Britain at
William Clowes & Sons Limited, Beccles and London
Foreword
This book contains papers from the main meetings of the Scientific Programme
presented during the 12th International Cancer Congress, which took place in Buenos
Aires, Argentina, from 5 to 11 October 1978, and was sponsored by the International
Union against Cancer (UICC).
This organisation, with headquarters in Geneva, gathers together from more than a
hundred countries 250 medical associations which fight against Cancer and organizes
every four years an International Congress which gives maximum coverage to oncological
activity throughout the world.
The 11th Congress was held in Florence in 1974, where the General Assembly unani-
mously decided that Argentina would be the site of the 12th Congress. Argentina
was chosen not only because of the beauty of its landscapes and the cordiality of
its inhabitants, but also because of the high scientific level of its researchers
and practitioners in the field of oncology.
From this Assembly a distinguished International Committee was appointed which under-
took the preparation and execution of the Scientific Programme of the Congress.
The Programme was designed to be profitable for those professionals who wished to
have a general view of the problem of Cancer, as well as those who were specifically
orientated to an oncological subspeciality. It was also conceived as trying to
cover the different subjects related to this discipline, emphasizing those with an
actual and future gravitation on cancerology.
The scientific activity began every morning with a Special Lecture (5 in all), summa-
rizing some of the subjects of prevailing interest in Oncology, such as Environmental
Cancer, Immunology, Sub-clinical Cancer, Modern Cancer Therapy Concepts and Viral
Oncogenesis. Within the 26 Symposia, new acquisitions in the technological area
were incorporated; such acquisitions had not been exposed in previous Congresses.
15 Multidisciplinary Panels were held studying the more frequent sites in Cancer,
with an approach to the problem that included biological and clinical aspects, and
concentrating on the following areas: aetiology, epidemiology, pathology, prevention,
early detection, education, treatment and results. Proferred Papers were presented
as Workshops instead of the classical reading, as in this way they could be discussed
fully by the participants. 66 Workshops were held, this being the first time that
free communications were presented in this way in a UICC Congress.
ix
χ Foreword
The Programme also included 22 "Meet the Experts", 7 Informal Meetings and more
than a hundred films.
METHODOLOGY
The methodology used for the development of the Meeting and to make the scientific
works profitable, had some original features that we would like to mention.
The methodology used in Lectures, Panels and Symposia was the usual one utilized
in previous Congresses and functions satisfactorily. Lectures lasted one hour each.
Panels were seven hours long divided into two sessions, one in the morning and one
in the afternoon. They had a Chairman and two Vice-chairmen (one for each session).
Symposia were three hours long. They had a Chairman, a Vice-chairman and a Secretary.
Of the 8164 registered members, many sent proferred papers of which over 2000 were
presented. They were grouped in numbers of 20 or 25, according to the subject, and
discussed in Workshops. The International Scientific Committee studied the abstracts
of all the papers, and those which were finally approved were sent to the Chairman
of the corresponding Workshop who, during the Workshop gave an introduction and
commented on the more outstanding works. This was the first time such a method had
been used in an UICC Cancer Congress.
"Meet the Experts" were two hours long, and facilitated the approach of young profes-
sionals to the most outstanding specialists. The congress was also the ideal place
for an exchange of information between the specialists of different countries during
the Informal Meetings. Also more than a hundred scientific films were shown.
The size of the task carried out in organising this Congress is reflected in some
statistical data: More than 18,000 letters were sent to participants throughout the
world; more than 2000 abstracts were published in the Proceedings of the Congress;
more than 800 scientists were active participants of the various meetings.
There were 2246 papers presented at the Congress by 4620 authors from 80 countries.
The Programme lasted a total of 450 hours, and was divided into 170 scientific
meetings where nearly all the subjects related to Oncology were discussed.
All the material gathered for the publication of these Proceedings has been taken
from the original papers submitted by each author. The material has been arranged
in 12 volumes, in various homogenous sections, which facilitates the reading of the
most interesting individual chapters. Volume XII deals only with the abstracts of
proffered papers submitted for Workshops and Special Meetings. The titles of each
volume offer a clear view of the extended and multidisciplinary contents of this
collection which we are sure will be frequently consulted in the scientific libraries.
We are grateful to the individual authors for their valuable collaboration as they
have enabled the publication of these Proceedings, and we are sure Pergamon Press
was a perfect choice as the Publisher due to its responsibility and efficiency.
Argentina Dr Abel Canonico
March 1979 Dr Roberto Estevez
Dr Reinaldo Chacon
Dr Solomon Barg
General Editors
Introduction
The concept of disease control embraces the co-ordinated and purposive mobilisation
of a community's resources with a view to reducing the total unfavourable impact of
a disease on that community. It involves the setting of realisable objectives
relating to preventive, curative and alleviative measures: it involves the systematic
implementation of plans designed to achieve those objectives; and it involves the
necessity for continuous monitoring of progress as a mechanism for the maintenance
of the momentum and direction of the control programme.
Control of cancer involves educational, political and administrative measures as
well as preventive, curative and palliative techniques.
A. SMITH
March 1979
xi
Cancer Education in the United States
Since 1948
Margaret H. Edwards
National Cancer institute, Bethesda, Maryland 20014
ABSTRACT
The National Cancer Institute initiated a support program for cancer education in
1948. Its goals were to coordinate cancer teaching in medical and dental schools
and to improve its quality. Changes in this program over a 30-year period as well
as its present status are described.
Medical education has undergone many changes during the same period such as an
increase in elective time. Similarly, knowledge concerning cancer has expanded,
and more must be taught so that physicians are able to provide optimum care to
their patients. Chemotherapy is an example of such new knowledge.
Significant improvements in medical and dental education have been noted in insti-
tutions which are the recipients of the National Cancer Institute's support grants.
These include a wide variety of educational offerings and opportunities for periods
of intensive study. There is still a need, however, for more emphasis on certain
neglected areas of cancer teaching, such as radiation therapy and the psychosocial
aspects of cancer.
Graduate education in the clinical specialties varies in cancer content, and
examination of these programs is underway to learn the optimum amount of cancer
experiences desirable in each specialty training program. Training in the clinical
subspecialties pertaining to cancer has grown rapidly but some types of oncologists,
notably radiation therapists, are still in short supply. A new specialty in dental
oncology is emerging.
Continuing education of medical and dental practitioners is not carried out system-
atically in the United States, but a wide variety of courses and other offerings are
available. The medical specialties all require periodic re-examinations for main-
tenance of certification.
Cancer education has evolved as medical knowledge has advanced, and therefore future
changes and improvements may be anticipated.
KEY WORDS
Cancer Education Clinical Medical Dental
3
4 Μ. Η. Edwards
INTRODUCTION
Education regarding cancer has been provided to physicians and dentists in the
United States by governmental and voluntary agencies since 1938, as well as by
private sources.
The National Cancer Institute, a governmental agency, has supported clinical
training since its founding in 1938 (1,2), when clinical traineeships as well as
research fellowships were initiated. The clinical traineeships were transferred
to the Division of Chronic Disease Control in the Bureau of Health Services in
1948, where they remained active until that Division was phased out in 1968. In
1948, the National Cancer Institute, at the direction of the National Advisory
Cancer Council, initiated a program to promote coordination of cancer education
for undergraduate students within schools of medicine and dentistry, known as the
Undergraduate Cancer Training grants (3). These grants supported institutional
activities such as tumor boards, seminars, conferences, guest speakers, and
stipends for students working on cancer projects during vacation periods. A
national Cancer Achievement Test was developed and administered in all institu-
tions having these grants; by 1950 these included virtually all of the nation's
medical, osteopathic, and dental schools. Grants to medical schools were limited
to $25,000 per institution, and those to dental schools to $5,000 per institution.
In 1963, the National Advisory Cancer Council, after a review and evaluation of
the Undergraduate Training Grant Program and consultation with cancer educators,
decided to phase out this program and replace it with one which would 1) be
competitive, 2) expand the scope of activities to include graduate and continuing
education, and 3) place no ceiling on the funding of individual grants. In 1966,
73 Clinical Cancer Training grants were awarded, and by 1972, 104 institutions were
funded for a total of $7,257,000.
Graduate post-resident trainees were supported on these grants from the outset in
a variety of clinical specialties. In 1966, the only officially recognized onco-
logic specialty was radiation therapy, but the largest proportions of graduate
trainees on Clinical Cancer Training grants were in medical oncology, followed by
surgical oncology, pediatric oncology, radiation therapy, gynecologic oncology,
and pathology. Since that time, national subspecialty boards have been estab-
lished for medical oncology, pediatric hematology-oncology, and gynecologic
oncology. The majority of the trainees on Clinical Cancer Training grants,
however, have always been undergraduate medical and dental students working during
vacation periods on cancer projects (65 to 75 percent). The annual numbers of
graduate trainees have ranged from 55 to 205.
In 1974, the Clinical Cancer Education grants were established to replace the
Clinical Cancer Training grants. These grants have similar objectives and guide-
lines (4) for both undergraduate, graduate, and continuing education as the
earlier grants, but do not carry stipends for trainees. However, individuals can
be funded for periods of graduate post-resident instruction coupled with teaching
responsibilities for periods up to one year; such individuals are classified as
"clinical associates," and no more than $12,000 of the salary for each individual
may be charged to the grant. Undergraduate medical and dental students may still
be supported during vacation periods to work on cancer projects. As in the past,
the numbers of undergraduate students receiving support exceed those of the grad-
uate students.
The amount of support for this program in the past ten years has ranged from
$5.0 million to $9.5 million, and the number of institutions supported annually
has ranged from 51 to 113. Presently, 53 of our country's 114 medical schools,
Cancer education in the United States 5
20 of its 59 dental schools, and 13 larger teaching hospitals receive support from
the National Cancer Institute in grants totaling $9.5 million. Two hundred ninety
undergraduate and 221 graduate students received support this year for engaging
in special periods of study related to cancer. A total of 5,847 such individuals
have received such support since the program was initiated in 1948.
For almost 40 years the American Cancer Society has provided support for a variety
of professional educational activities. The Society has, since 1948, awarded more
than 4500 one-year Clinical Fellowships to institutions with the appropriate quali-
fications, to provide advanced training relative to cancer in seven medical and
four dental specialties. These include internal medicine, gynecologic oncology,
pathology, pediatrics, diagnostic radiology, radiation therapy, nuclear medicine,
surgery, oral pathology, oral surgery, orthodontics, and prosthodontics. Junior
Faculty Clinical Fellowships are also offered by the Society in Diagnostic Radi-
ology, Radiation Therapy, Pathology, Surgery, Internal Medicine, Pediatric Onco-
logy, Gynecologic Oncology, and four dental specialties. This year, 140 of these
are Junior Faculty Fellowships. In addition, occasional grants for fellowships
are made to institutions by local Divisions of the Society. Currently $2.49
million is budgeted by the Society to support 435 fellows in both clinical fellow-
ship programs. Of these, 142 are in medicine, 82 in surgery, 77 in radiology, 41
in pediatrics, and 28 in gynecologic oncology. Reviews (5) of the program have
shown that it is producing a rich harvest of highly talented and well-trained
cancer teachers and investigators.
The Leukemia Society (6) also provides fellowships to 117 individuals annually
at a cost of $1,750,000. A few of these are physicians engaged in clinical
research relative to leukemia. The Damon Runyon - Walter Winchell Cancer Fund
likewise supports postdoctoral research fellowships, approximately 125 annually,
of which a small number are awarded to M.D.'s (7).
Hospitals and medical centers use funds from other sources to support interns,
residents, and advanced trainees. The Council of Teaching Hospitals of the Asso-
ciation of American Medical Colleges (8) reports that in 1976, 169 non-federal
and 20 federal hospitals supported Clinical Fellows, the support for which was
derived from patient revenue (44 percent), National Institutes of Health (23
percent), Veterans Administration and other Federal sources (14 percent), private
foundations (ten percent), state and local governments (six percent), medical
school sources (one percent) and other sources (two percent). Sixty-one percent
of the funds for Clinical Fellows was expended by hospitals in 11 northeastern
states. The proportion of these fellows in cancer-related training programs is
undetermined.
CANCER EDUCATION
Medical education has undergone many changes in the United States since 1948.
The increase in research conducted in medical and dental schools, a "systems"
approach to teaching in the basic and clinical sciences, reduction in the time
devoted to laboratory work, the use of computers and sophisticated audiovisual
aids, increasing input on curricular structure from students, a shift in the
proportion of required courses with the rise of student electives, and growing
emphasis on the production of family physicians (general practitioners) are
examples of such changes.
Similarly, our knowledge concerning cancer has increased dramatically since 1948,
and has changed the instruction provided to all students of the health profes-
sions. Improvements in radiation therapy, developments in the use of chemo-
6
Μ. Η, Edwards
therapy, advances in immunotherapy, in support capabilities during the course of
any therapeutic modality, uses of multimodal therapy, and advances in diagnostic
capabilities have altered the content of cancer instruction.
Significant improvements in medical and dental education relating to cancer, which
have been noted in the United States in recent years and which are carried out in
many of the institutions supported by National Cancer Institute education grants
include:
a required core of cancer content in the curriculum
for all students
comprehensive cancer syllabi as required reading for
all students
self-instructional teaching aids regarding cancer
curricular reviews and analyses regarding cancer
development of educational objectives regarding cancer
systematic evaluation of cancer teaching activities
a variety of cancer electives
rotations on cancer units or in cancer hospitals
summer (free-period) cancer projects
use of other health professionals in educational roles:
cancer nurse specialist
pharmacist
medical librarian
medical social worker.
There is still a need, however, for more emphasis in the curricula of medical and
dental schools on the following areas:
the epidemiology of cancer
cancer prevention
early diagnosis and screening for cancer
carcinogenesis (especially environmental)
psychosocial aspects of cancer
role of radiation therapy
nutritional aspects of cancer
systematic evaluation of therapeutic modalities
(cooperative studies)
uses of a tumor registry
evaluation of student responses to educational methods.
Graduate education in the medical and dental specialties is variable in its cancer
content among the many hospitals in the United States which provide such residency
programs. There is a need to determine guidelines for the optimum amount of cancer
experiences to be furnished during residency training, and the skills to be devel-
oped. A beginning has been made to do this for the specialty of gastroenterology;
other specialty groups need to provide similar guidelines.
Graduate education in the cancer subspecialties of medical oncology, gynecologic
oncology, pediatric hematology-oncology, and radiation therapy is provided by many
institutions, but specific standards and guidelines for such programs have been
developed only for radiation therapy. A series of workshops has been held with the
medical, surgical, and pediatric oncologists to develop such standards. The grants
for clinical education from the National Cancer Institute presently support grad-
uate students in these subspecialties related to cancer.