Thursday, March 23, 2023

The National Cancer Institute was established in 1937 as the lead institution for the federal government to plan and monitor the conduct of research and for the disbursement of research funds for cancer research. While it is part of the broader National Institutes of Health, it is considered an independent entity with its own budget and theoretically reports directly to Congress and the President.

In 1971, the War on Cancer was passed by Congress under President Nixon, which greatly expanded the budget and mandate of the NCI. That created a program for cancer prevention and control. It also created a cancer centers program. These centers were given substantial support funds from the NCI to assist in the mission of the NCI in the development of prevention, treatment and other advances in the field of cancer research.

In 1971, when this program was initiated, the original group of NCI-funded cancer centers included 15 such centers nationally. Three had already been funded and established even before the War on Cancer was funded, and we can think of them as the first three cancer centers, the vanguard: MD Anderson Cancer Center in Houston, Memorial Sloan-Kettering Cancer Center in New York and Roswell Park Cancer Center in Buffalo.

Over time, this program has expanded enormously and thus at present there are 71 cancer centers nationwide that are considered NCI-funded. They fall into three categories. The most prestigious type is the comprehensive cancer center. This type of center is expected to have expertise and ongoing outstanding research across the spectrum of public health/epidemiology/prevention, basic laboratory research and clinical research. These comprehensive centers are also expected to provide community outreach and education to their surrounding geographic areas as well as exemplary clinical services. Presently there are 52 such comprehensive cancer centers nationally.

There are also clinical centers. Clinical cancer centers have many of the characteristics of the comprehensive cancer centers, but may be lacking expertise in one or more areas in order to qualify for comprehensive status. Currently there are 12 such centers nationally.

Finally, there are basic laboratory cancer centers which provide specific areas of expertise in laboratory research and do not necessarily provide clinical resources. There are seven such centers nationally. A well known local example is the Cold Spring Harbor Laboratory on Long Island or the Wistar Institute in Philadelphia.

Most of the comprehensive cancer centers are fairly well dispersed geographically so that most individuals are not too distant from one. However, given the large number of outstanding medical schools in our tri-state area, there is a large number of comprehensive cancer centers to choose from locally. There is the Yale Cancer Center in New Haven, Roswell Park Comprehensive Cancer Center in Buffalo, Memorial Sloan-Kettering Cancer Center in NYC, Herbert Irving Comprehensive Cancer Center at Columbia also in NYC, Perlmutter Cancer Center at New York University and the Cancer Institute of New Jersey at Rutgers. The John Theurer Cancer Center at Hackensack is affiliated with Georgetown Lombardi Cancer Center in Washington.

These cancer centers represent about 3-4% of the cancer centers that are extant nationally. They are reviewed for their quality and productivity every five years and must comply with a strict and comprehensive set of guidelines and standards, by a large committee of expert and experienced reviewers. This insures that they maintain their quality. A comprehensive cancer center can devote one to two years to preparing its five-year competitive renewal to try to insure that it is renewed. The last renewal application for MD Anderson Cancer Center ran to more than 3,000 pages. On occasion, centers lose their status and must recompete a year or two later with revisions and changes to their programs in order to be reinstated.

At this time, approximately 250,000 new cancer cases are diagnosed annually at NCI-funded cancer centers. In any given year, 350,000 cancer patients may be entered into clinical trials at these NCI-funded centers; thus, one can see how they have extended the reach of the NCI in providing outstanding cancer research nationally. Furthermore, it is estimated that there are now 11 million cancer survivors in the U.S. Many of the comprehensive cancer centers have established programs for helping these cancer survivors in a variety of ways.

Alfred I. Neugut, MD, PhD, is a medical oncologist and cancer epidemiologist at Columbia University Irving Medical Center/New York Presbyterian and Mailman School of Public Health in New York.

This article is for educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and does not constitute medical or other professional advice. Always seek the advice of your qualified health provider with any questions you may have regarding a medical condition or treatment.

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