Most of us have known someone who died of cancer and we know all too clearly what we've lost. Researchers want to know, too. They want to know if we lost a smoker, someone who worked with asbestos, or a machine assistant at a printer's shop. The more they know about cancer's victims, the better equipped they are to help them and to prevent more.

"Technology has always been at the service of medicine and information technology is no exception," explains Mark Gross, President of Data Conversion Laboratory (DCL). "It's no different than laser treatment or cameras going inside the human body. To me it seems as inevitable as the introduction of anesthetics, which wasn't that far in the past."

The latest and certainly one of the most exciting examples of this "inevitable" trend is IARCancerDisc, which DCL played a crucial role in creating. This disc, slotted for release in the first quarter of 1994, contains all of the data on cancer collected in IARC's monograph program. For 25 years the International Agency for Research on Cancer, part of the World Health Organization, has been researching and summarizing reports and studies on cancer. The monographs they write on these studies are edited and approved by experts in the field, and collected in over 50 volumes. Now this same information is being made available on a single compact disc.

I. S. Grupe, Inc., an Illinois-based firm that specializes in building and maintaining medical information databases, was put in charge of this project. They knew how to organize the information for CD-ROM but this technology, which allows for fast and convenient data retrieval, demands its data in a highly specialized format. The sophisticated translation necessary for this project was assigned to DCL. Data Conversion Laboratory, based in New York City, is at the forefront of conversion technology and was more than ready for this daunting task.

The Trip to CD-ROM

DCL has at its disposal specialized hardware and software developed by Calera Recognition Systems, which scans books, papers, etc. and converts them to computer files by using optical character recognition (OCR). DCL's proprietary software makes the most of this high-speed scanning capability, and the results for the IARCancerDisc were impressive. Both time and money were saved by DCL's efficiency, with a formidable improvement over data that is inputted solely from a keyboard. DCL was faced with all the complexity textual sources are capable of, including footnotes, marginalia, superscript and subscript, etc. When they were finished, all the information was in one format in this case, WordPerfect.

But the demands of CD-ROM do not end there. In order for users to retrieve statistics and other data easily, the information must be organized into one database. Once DCL made this material available electronically, I. S. Grupe built it into a relational database with hypertext functions that would allow data from across the individual databases to be called up simultaneously.

According to Peter Schipma, the president of I. S. Grupe, Inc., "This phase required considerable human effort. We had some things going for us, like the use of a common terminology, but we had to deal with a vast number of images and graphics. A completely automated solution was impossible. As a matter of fact, it took us two years and a grant to pull it off [funding was provided by the National Cancer Institute's Small Business Innovation Research Fund (grant #5R44CA50842)]."

The Realities of CD-ROM

Although IARCancerDisc has not been released at the time of this writing, I was able to speak to some Beta testers. Dr. Bruce Dunn, head of the Environmental Carcinogenesis Section of the Division of Epidemiology, part of British Columbia's Cancer Agency, had this to say about this new technology: "IARCancerDisc is a distillation of hundreds of millions of dollars of research. It's well worth it to make this material available."

Currently, the price of buying the IARC books is prohibitive, about $10,000. Only huge bureaucracies (governments, for instance) can afford them. Publication on CD-ROM will tremendously increase the distribution, and thus the possible uses, of this information. George Zizka, who was the Information Scientist for the CD-ROM project, noted that scientists working on research proposals or new projects could find out what has already been done in their specialty; findings on carcinogenic chemicals can be provided to workers for increased occupational safety; and litigants can find evidence to support health claims.

While I was on the telephone with Mr. Zizka, he searched for studies that involved the printing industry. In seconds, he found a study done on over 10,000 Liverpudlian machine assistants. The results showed a higher level of lung cancer than normal. This is an example of another important difference between CD-ROM and books: cross-referencing and speed of retrieval. As another example of the system's flexibility, Mr. Zizka was also able to see a listing of all studies done on the livers of rats in which a particular type of tumor formed.

IARCancerDisc has three sections: IARC monographs, which study the carcinogenicity of chemicals; the genotoxicity of chemicals; and IARC epidemiology studies, which are primarily a compilation of cancer registries from those nations that have such records. This information is retrieved with a menu interface that allows for the sort of quick cross-referencing to which Mr. Zizka subjected his beta copy.

Dr. Dunn notes that we are "on the verge of another publishing revolution just as big as the one that Guttenberg started." There is already an indexing service for medical literature that allows Dr. Dunn and other participants to see abstracts on medical journal articles just by calling in with a modem. This sort of access is an important part of the "revolution" Dr. Dunn is talking about: critical information at your fingertips when it's needed. IARCancerDisc, one of the first CD's put out by the World Health Organization, is paving the way for this revolution.

The current market for informational CD-ROM discs on medical topics has been estimated at several million dollars. New offerings on disc will help expand this market. Furthermore, the willingness of federal health-related agencies such as the National Cancer Institute to fund the development of databases and other information on disc, where data are easily retrievable, acts as a further incentive for software developers in this field.

Many hospitals have already invested in the hardware necessary to access databases on CD-ROM. It is becoming more and more apparent that quick and reliable data retrieval is a necessity to the medical community.

Is the Trip more Important than the Destination?

A database on CD-ROM is only one example of the variety of formats and platforms that high technology makes available for information. As this technology continues to grow, so will its complexity, and the need for data conversion.

"If you ask someone about computer technology," says Mr. Gross, "you'll more than likely hear names like 'Windows,' 'WordPerfect,' and 'Lotus.' The companies that produced these applications all deal directly with the user. DCL works behind the scenes, so you may not think of it first but remember that 'Lotus' uses data. They all use data, and if you can't convert that data from one format to another then you'll be lost in today's pluralistic environment. Data Conversion Laboratory is a new and exciting company willing to take risks, but as far as I'm concerned our money is on a safe bet. New systems mean change, and change means data conversion."

To think of cutting edge technology only in terms of its show-stealing hardware, from laser beams to optical computers, is unrealistic, and in the medical industry it is simply unacceptable. The future is information, and the more we know about victims of cancer, the fewer victims of cancer we will know.