Chair, Committee on the Treatment of Malignant Diseases, 1922–1933

Robert Battey Greenough, MD, FACS, was born November 9, 1871. He was the founder of the American College of Surgeons (ACS) Committee on the Treatment of Malignant Diseases, now known as the Commission on Cancer, and served as its chair from 1922 to 1933. He was a practicing surgeon at the Massachusetts General Hospital until he retired in 1932. He served on the ACS Board of Governors (1923–1925), the ACS Board of Regents (1924–1937), and as ACS President (1934–1935). At the time of his death, he was serving on the Board of Managers of the Memorial Hospital for the Treatment of Cancer and Allied Diseases in New York City, on the Medical Advisory Committee on Social Security, and as president of the Society for the Control of Cancer.

Dr. Greenough recognized the importance of collecting data on cancer to standardize treatment approaches. He established the Committee on the Treatment of Malignant Disease to set standards and study the outcomes of cancer patients, knowing this would improve their care and prognoses. As chair, he began with the study of cancer of the cervix. The Committee sent out “cards” to hospitals across the country to collect data on diagnoses, therapeutics, and outcomes. The cards were diligently collected, data organized, and analyzed. He reported the progress at each meeting of the Committee and kept the process transparent.

During his 10-year tenure as chair, this collection of information was extended to 16 cancers including cancer of the breast, cervix, fundus of the uterus, ovary, thyroid, colon, rectum, lung and chest, esophagus, larynx, mouth including the tendon left, prostate, kidney, bladder, testicle, and bone tumors. He recognized that there was a difference in outcome not only by treatment, but also by pathologic subtype, and recommended that information on pathology was collected along with other variables such as stage and treatments. His recommendation was to collect follow-up for five years per cancer type to obtain adequate information on outcomes.

To that end, he created the first cancer clinics in the United States to be set up at general hospitals and established minimum standards for these programs. They included:

• An organization of the service with an officer and representatives of all departments in the hospital concerned with the diagnosis and treatment of the cancer.
• Conferences were to be held regularly by all members who were concerned with the cases.
• Patients needed to be referred to the cancer clinic.
• Equipment was essential in the diagnosis and therapeutic treatment of the cancers.
• Records needed to be capped detailing the history and exam, details of the treatment, with periodic exams in follow-up intervals for at least five years.
• The treatment of cancer patients of interest to the members of the cancer clinic.

Through his vision, members of the Committee traveled throughout the country to help hospitals organize these cancer clinics and apply for accreditation, much as the site reviewers do today. Those hospitals meeting accreditation were announced through the American College of Surgeons at meetings and in publications. He noted that programs that established these cancer clinics developed better data collection systems, thereby making future record keeping much easier. He resigned as chair of the Committee in 1932 and passed away on February 16, 1937.