Letter to the Editor: Who was first?
To the Editor:
We read with great interest the July 9, 2021, article in The Cancer Letter, titled, “Which cancer center was first? The answer depends on what you mean by ‘cancer center’” (The Cancer Letter, July 9, 2021)—especially since this discussion is central to our book, Centers of the Cancer Universe: A Half-Century of Progress Against Cancer, to be released this October by Rowman & Littlefield.
We agree with Katie Goldberg that the answer is complex, revolving around subsidiary questions such as what is a cancer center, what is a cancer hospital, or even what is considered cancer research.
Also, we found that the definition depends on who you ask, what institution they consider to be first, and how legitimate was their source of information.
Ms. Goldberg was careful to point out that the timeline provided by the NCI notes that in “1963: The first Cancer Center Support Grant or ‘core grant’ was awarded to the ICR [Institute for Cancer Research] in Philadelphia. This was followed by another core grant awarded to support Dr. Henry Kaplan’s Radiotherapy Research Program at Stanford University.”
This apparently is the first core grant but hardly qualifies as support for a comprehensive cancer center, as the example of the second core grant illustrates.
Examination of the history of the core grant funding mechanism suggests that it was originally envisioned to simplify the grant review and accounting process rather than to support multiple complex and interrelated research projects, as it does now.
Ms. Goldberg also recounts the founding history of what we agree are very likely the first “cancer centers,” defined as treatment facilities where some research is conducted (Memorial Sloan Kettering, MD Anderson, and Roswell Park Memorial Institute).
Reflection also reminds one that there were several other early, often government-sponsored facilities for the treatment of cancer patients that very likely conducted some research, although that part of their history remains largely unelucidated, e.g., Pondville State Hospital1, Norfolk MA – founded in 1927; Francis Delafield Hospital2, NY, NY – founded in 1951; Ellis Fischell State Cancer Hospital3, Columbia, MO – founded in 1940.
Our research showed that these institutions were among the very first cancer research institutes,4 but for a variety of reasons, mostly clouded in the mists of time, they never received the NCI designation one might have anticipated in their early years.
In 2019 we began work on our book dealing with the establishment of NCI-designated cancer centers and their impact on the evolution of cancer research and treatment since the signing of the National Cancer Act (NCA) of 1971 by President Richard Nixon5.
Among the many questions we sought to address was: “What was the first NCI designated center?” Following two years of research and interviews with more than 75 past and present cancer center directors and leaders in the cancer community, we learned that the answer is less than clear and cancer centers claiming that distinction should probably qualify their assertions.
The National Cancer Act signed December 23, 1971, provided for the establishment of “15 National Research & Demonstration Centers,” which initially were all defined as Comprehensive Cancer Centers. These centers, in the minds of the supporters6 of increased national investment in cancer research, would conduct basic, clinical and what we now call translational research, and were exemplified by the existing “multifaceted programs” at Memorial Sloan Kettering Cancer Center, Roswell Park Memorial Institute, and MD Anderson.
When we began our research, we anticipated that thorough investigation and interviews would provide an answer to the fundamental question: Which was the first NCI-designated cancer center in the United States?
However, what we found was that the individuals with whom we spoke and institutions whose records we reviewed, including many from the NCI, were often uncertain or imprecise about significant parts of their histories; further confounding a look back is the fact that many records at the National Cancer Institute are destroyed every seven years due to a federal records management mandate, which left even high-ranking officials unable to answer questions that may have predated their tenures.
We asked Linda Weiss, PhD, former director of the NCI Office of Cancer Centers (2002-2015), about the specific chronology of NCI designation, and she replied via email: “The definitive start dates for these first cancer centers have always been a bit fuzzy and when we were asked about it in the past, we tended to hedge a bit; even the initial number of centers was not entirely clear.
Information from different sources seemed to vary a bit as I recall, and it is probably in part due to the fact that several centers had precursor grants of varying kinds (some clinical infrastructure, some research project based, etc.) prior to the official implementation of the program.”
She went on to explain that she seemed to recall “some lack of standardization historically” regarding how various grants were numbered, citing that she remembered “some evidence indicating that Fox Chase was the first center, under its old name, and that eight others followed.” Weiss’s recounting of the murky history was entirely consistent with the views of Henry P. Ciolono, PhD, current director of the NCI OCC.
The answer to the question “who was first?” is primarily of historical importance 50 years later and would accomplish nothing more than providing one center with the bragging rights to the claim of first NCI-designated cancer center.
That said, as we neared the end of our research, we did find an NCI document “…that comes close to addressing that question, albeit with an imprecision that is regrettable7.
In August 1974 the NCI published its Operational Plan, FY1976-1980 that noted: ‘During 1973 and 1974, the NCI recognized that the following institutions were proceeding rapidly toward meeting [italics added] the criteria for becoming Comprehensive Centers: Fred Hutchinson Cancer Research Center affiliated with the University of Washington, Seattle; University of Southern California, Los Angeles; University of Alabama, Birmingham; University of Wisconsin, Madison; University of Miami, Florida; Duke University, Durham, North Carolina; The Johns Hopkins University, Baltimore, Maryland; Dana Cancer Center, Boston, Massachusetts; The Mayo Clinic, Rochester, Minnesota.’”
“In addition, three institutions were judged to be comprehensive at the time of the National Cancer Act of 1971 [italics added]: Roswell Park Memorial Institute, Buffalo, New York; Memorial Sloan Kettering Cancer Center, New York City; University of Texas MD Anderson Hospital and Tumor Institute, Houston, Texas.
“The plan further notes: ‘By the end of 1974 these nine’ [referring to those listed as ‘proceeding rapidly toward meeting the criteria for becoming Comprehensive Centers’],‘plus six others’ “[which are not named]8” are expected to be recognized by the NCI as Comprehensive Centers. With the three that were Comprehensive Centers at the time of the Act, together with the 15 centers authorized by the Act, the planned 18 centers will have been designated.’”
“This information had been noted in a discussion of the estimated number of centers that would be necessary to execute the National Cancer Plan and the budgetary requirements for funding this number.5”
The above information is consistent with the information noted by Ms. Goldberg, which was drawn from a document authored by Frank J. Rauscher Jr., PhD, director of the NCI from 1971 to 1976.9
This document appears also to have been drawn from the National Cancer Plan 1976-1980 and contains a similar, albeit somewhat circumspect statement: “Three other institutions were recognized as having Comprehensive Cancer Centers at the time of enactment of the National Cancer Act of 1971: MD Anderson Hospital and Tumor Institute, Houston; Memorial Sloan Kettering Cancer Center, New York; and Roswell Park Memorial Institute Buffalo.”
Ms. Goldberg noted that in: “1971: The National Cancer Act of 1971 formally establishes the definition of a “cancer center,” with Roswell Park, MD Anderson, and MSK as the first three to achieve comprehensive designation in 1972. No document has been located so far identifying which received this designation first.”
We wholeheartedly agree with the last sentence; there appears to be no document that defined which was the first NCI-designated cancer center. In fact, in the available data there is no document or date formally designating any of the first several centers as NCI-designated.
It seems reasonable to assume that Memorial Sloan Kettering, MD Anderson, and Roswell Park began to think of themselves as NCI-designated centers in 1972, and we agree that it seems a stretch (as we have seen some centers contend) that any center received designation in 1971, since there were only eight days (including the Christmas holidays) following the actual signing of the NCA during which this could have been possible.
This discussion and our work to delineate the history and accomplishments of NCI-designated cancer centers emphasize the importance of contemporaneous recording and retention of important historical information to retain the accuracy of history that could otherwise be lost or distorted.
With regards,
Donald L. “Skip” Trump, MD, and Eric T. Rosenthal
Coauthors of Centers of the Cancer Universe: A Half-Century of Progress Against Cancer
References
- Ernest M. Daland, MD Pondville State Hospital Massachusetts Department of Public Health, Post Office Walpole, Massachusetts 02081
- Accessed 7/17/21 https://www.nytimes.com/1950/08/31/archives/new-cancer-unit-dedicated-by-city-francis-delafield-hospital-is.html
- Accessed 5/18/21 https://www.muhealth.org/locations/ellis-fischel-cancer-center/ellis-fischel-history
- In 1959 Pondville State Hospital was a founding member of the Association of Cancer Institute Directors (ACID), whose name was changed to the Association of American Cancer Institutes (AACI) at an ACID meeting in Oklahoma City in 1967.
- Trump, DL and Rosenthal, ET Centers of the Cancer Universe: A Half Century of Progress Against Cancer (in press) Publication date 10/1/2021.
- Mary Lasker, Benno Schmidt, and Sidney Farber, MD were among the prime movers behind the campaign which led to the NCA.
- National Cancer Program Operational Plan FY1976–1980, DHEW Publication No. (NIH) 75-777 August 1974 V3-V5
- Presumably these 6 included American Oncologic Hospital/Institute for Cancer Research which became Fox Chase Cancer Center.
- Frank J. Rauscher Jr, Cancer Program is Well Under Way January 15, 1975. https://cdn.cancerhistoryproject.com/media/2021/03/25104335/18146.1.pdf
Upcoming event
Fifty years after the National Cancer Act of 1971 became law, establishing the effort to tackle cancer as a national priority, Cancer History Project co-editor Otis Brawley, MD, sits down with the directors of America’s first three comprehensive cancer centers to discuss the history, achievements, goals, and future directions of NCI-designated Comprehensive Cancer Centers.
Join Brawley in discussion with directors from the three centers that shaped the NCI Cancer Centers Program as model comprehensive centers:
- Candace S. Johnson, PhD
Roswell Park Comprehensive Cancer Center - Peter WT Pisters, MD, MHCM
MD Anderson Cancer Center - Craig B. Thompson, MD
Memorial Sloan Kettering Cancer Center
A free virtual panel discussion will take place on July 29 at 5:30 P.M., EDT.
Register to attend.
Recent contributions to the Cancer History Project
Children’s Mercy Among Those at the Forefront of Historic Pediatric Cancer Treatment
By The University of Kansas Cancer Center | July 20, 2021
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