[Congressional Record (Bound Edition), Volume 145 (1999), Part 19]
[Senate]
[Pages 28147-28148]
[From the U.S. Government Publishing Office, www.gpo.gov]



              THE CITY OF BOSTON'S CRUSADE AGAINST CANCER

 Mr. KENNEDY. Mr. President, I welcome this opportunity to 
commend the city of Boston's Crusade Against Cancer and I commend our 
outstanding Mayor, Thomas M. Menino, for his leadership on this 
excellent program. Donald Gudaitis, the chief executive officer of the 
American Cancer Society's New England Division, has called the Crusade 
Against Cancer, ``the most visionary public health initiative ever 
undertaken in any city around the prevention and early detection of 
cancer.''
  Through innovative measures such as giving city employees time off 
for cancer screenings, Boston's Crusade Against Cancer uses a small 
public investment to create a large public health payoff. It may well 
serve as a model for communities throughout the nation.
  Boston's program provides essential preventive care to the city's low 
income and minority communities, who are hit disproportionately hard by 
the ravages of cancer. Many members of these communities are neglected 
by HMOs and private insurers and might otherwise never receive a cancer 
screening.
  Nearly a quarter of the women using the program's mobile mammography 
van were receiving a mammogram for the very first time. Since early 
detection is a critical factor in the successful treatment of cancer, 
these preventive screenings are literally a lifesaver for many 
Bostonians. Boston's program has gained nationwide attention and was 
described in a recent article in the New York Times. I believe the 
article will be of great interest to all of us in Congress and I ask 
that it be printed in the Record.
  The article follows:

                [From the New York Times, Nov. 2, 1999]

             Boston Battles Cancer With a Citywide Mailing

                          (By Carey Goldberg)

       Boston, Nov. 2--Cities often undertake campaigns to fight 
     crime or litter.
       This city is fighting what health officials call its No. 1 
     killer: cancer.
       Over the last few days, every household in Boston, in 
     theory, has been mailed a brochure describing how to prevent 
     cancer and to detect it early if it develop.
       The quarter-million English-and-Spanish brochures, Boston's 
     largest public health mailing ever, are the flashiest element 
     of the city's ``crusade against cancer,'' but they are only 
     one of many.
       Boston's municipal employees are allowed to take four hours 
     off each year for cancer screening--a rule that city 
     officials say was the only one of its kind until Springfield, 
     Mass, adopted a similar rule last week.
       Over the last several months, about 1,600 chemotherapy 
     patients have been given free rides to and from their 
     sessions, thanks to hospitals and taxis participating in the 
     city's crusade.
       Other cities and states run anti-cancer programs as does 
     the federal government. But overall, said Donald J. Gudaitis, 
     chief executive officer of the American Cancer Society's New 
     England division. ``This is the most visionary public health 
     initiative ever undertaken in any city around prevention and 
     early detection of cancer.''
       Such a campaign may seem logical at a time when the death 
     rate from heart disease has been dropping and cancer, the 
     nation's No. 2 cause of death, kills more than half a million 
     Americans every year.
       But Mr. Gudaitis attributed the anticancer campaign in 
     Boston to a particular asset: a personally interested mayor.
       Mayor Thomas M. Menino's father died of prostate cancer, 
     and the mayor, who does not normally play up his personal 
     life, said in a telephone interview that he saw his father 
     ``go from a big brawny guy to 70 pounds.''
       ``And you ask yourself, why?'' Mayor Menino added. ``I want 
     to try to help other people out.''
       In particular, it seems, he wants to help the poor. Boston, 
     like many other cities, has found that cancer death rates are 
     especially high in poor and minority neighborhoods. Patchy 
     health care makes poor people less likely to have checkups 
     for cancer and thus more likely to die from it.
       More than a year ago, Mayor Menino convened a panel of 
     medical experts and cancer survivors to help decide what to 
     do. The process, which led to the crusade against cancer, is 
     continuing, said John Rich, medical director of the Boston 
     Public Health Commission. But the panel established three 
     initial goals: that all Boston households, receive 
     information on cancer prevention, that all Bostonians receive 
     appropriate screenings and that all cancer patients have 
     transportation to and from treatment sessions.
       Transportation may seem minor compared with the first two 
     goals but not to chemotherapy patients, said Maureen 
     Sullivan, vice president of the Massachusetts Bay region of 
     the American Cancer Society who is a cancer survivor. It 
     might not be bad getting to chemotherapy sessions, but, Ms. 
     Sullivan added, ``Let me tell you, coming home can be really 
     awful, and not only for you but for everyone else on that bus 
     with you.''
       Boston has introduced other help on wheels, a mobile 
     mammography van that has been booked solid since it began six 
     months ago. Officials say the city is fighting cancer in 
     small ways as well--supplying sunscreen to its outdoor 
     workers, for example--and in bigger ones: Mayor Menino 
     supported a ban on smoking in Boston restaurants, despite 
     heavy opposition from restaurateurs. The program includes 
     television advertising and a new city agency, the Office of 
     Cancer Prevention.
       The campaign costs little, Mr. Menino said, perhaps, 
     $100,000 for the mammography van, about $250,000 for the 
     brochures and nothing for the transportation and time off.
       Asked why Boston is undertaking an anticancer campaign now, 
     when the disease has killed millions for decades, those 
     involved cited two factors: the accumulation of research 
     finding on cancer prevention and widespread disillusionment 
     with the prevention promise offered by health maintenance 
     organizations.
       ``If we look at the actual synthesis and explosion, if you 
     will, of information on the relationship between life-style 
     factors and cancer in the last 20 years, it really has moved

[[Page 28148]]

     beyond just smoking as a major cause,'' said Dr. Graham 
     Colditz, director of education at the Harvard Center for 
     Cancer Prevention, which is participating in the campaign.
       Dr. Colditz said the center had determined that at least 50 
     percent of cancer cases could be prevented through behavioral 
     changes alone. The screenings could also prevent deaths among 
     those whose cancer would be detected early, he said.
       The brochure advises people to eat a healthy diet, to get 
     at least 30 minutes of physical activity every day, to keep 
     their weight down, to drink less alcohol, to avoid smoking, 
     to avoid sexually transmitted diseases and to protect 
     themselves from the sun.
       None of that was news to Mary Caulfield, a 58-year-old 
     retired resident of the Dorchester section of Boston. But, 
     Ms. Caulfield said, ``I think a lot of newcomers, foreigners, 
     probably don't understand even things like immunizations.''
       The Boston anticancer program is impressive, Sandra Mullin, 
     spokeswoman for the New York City Department of Health, said 
     upon hearing it described. New York does not give municipal 
     employees time off for screenings, Ms. Mullin said, though it 
     periodically includes reminders of the need for screenings in 
     employees' paychecks, and it has a program to encourage 
     exercise at lunch.
       While New York has done no blanket mailing and is not as 
     involved in cancer screening, it does provide cancer 
     information through mobile health vans, Ms. Mullin said. The 
     city focuses some of its other anticancer efforts on 
     antismoking programs and on making sure that managed care 
     plans screen Medicaid patients for cancer.
       What the Boston campaign will try next remains under 
     discussion. Among some ideas mentioned: persuading private 
     employers to give employees four hours off for cancer 
     screening, making it easier for Bostonians to bicycle or job 
     to work and making programs that help smokers quit available 
     to anyone who wants them.
       As for immediate results, Mayor Menino said that the four 
     hours off for screening had already led to the early 
     detection of some cancer and that nearly 5 percent of the 
     women who used the mammography van had found suspicious 
     lumps. Nearly one-fourth of those who used the van said the 
     mammogram was their first, the mayor added.
       For the most part, the campaign is expected to yield only 
     gradual results. Certainly, the immediate effect of the 
     brochure mailing seemed a bit underwhelming: Of more than a 
     dozen people interviewed on the streets of Dorchester, most 
     said they had paid little if any attention to the brochure, 
     although some said they had set it aside to read later.
       ``Sometimes I'm just too tired to read,'' said Esther 
     Ellis, 72, who nonetheless was having her annual mammogram at 
     a local health center. ``I just leave it to God. God respects 
     my body.''
       Jose Navarro, a flea market vendor, said he did not recall 
     getting the brochure. But when he read it in Spanish on the 
     spot, he expressed surprise at what he learned.
       ``Drinking?'' he exclaimed. ``I know it's bad for you, I 
     know it's bad for your liver, but I didn't know it causes 
     cancer.''
       David Sheets, a 45-year-old friend of Mr. Navarro, said 
     that he had saved the brochure at his South End home to read 
     later but that the idea of cancer ``doesn't bother me yet.''
       ``My mother died of it, my father died of it,'' Mr. Sheets 
     said. ``It doesn't faze me.''
       He smokes and refuses to quit, he said. Then, referring to 
     cancer, he added, ``I just think that it won't happen to 
     me.''

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