The Commission on Cancer: Ten Decades of Innovation and Leadership

As we celebrate in 2021 the 50th Anniversary of the signing of the National Cancer Act by President Richard Nixon, we are also on the cusp of another milestone in the “war on cancer”—the Centennial celebration of the American College of Surgeons (ACS) Commission on Cancer (CoC). Although the legislation enacted through the National Cancer Act opened avenues for funding and led to many improvements in cancer care, one could argue that the inception of these benefits began 50 years earlier with the creation of the forerunner of the Commission on Cancer.

In 1921, the ACS Board of Regents authorized the formation of the Registry of Bone Sarcoma under the direction of Ernest Amory Codman of Boston, MA. One year later, the cancer initiative of the ACS was formalized under the banner of the Committee on the Treatment of Malignant Diseases with Radium and X-ray. The original name of the committee was changed to the Committee on the Treatment of Malignant Diseases (CTMD). This early committee included George W. Crile of Cleveland, OH; John M. T. Finney of Baltimore, MD; and Henry Pancoast of Philadelphia, PA. The Board of Regents, through the CTMD, announced a policy of emphasizing that the benefits of contemporaneous knowledge of cancer should be available to every cancer patient in the United States.

The concept of developing “cancer clinics” in existing general hospitals was conceived in 1927 and finally launched in 1931 with the first surveys. The first cancer clinic was established at the Massachusetts General Hospital. Early standards included cancer conferences for discussion of patient management, the mandate to include surgical therapy and equipment for “x-ray” therapy and radium sources, appropriate record-keeping on the treatment of each patient and organized surgical divisions within the hospital to support the cancer clinics. Educational programs were developed at the annual Clinical Congresses of the ACS to allow cancer clinic directors to network and learn from each other. During the late 1930s, the members of the newly named ACS Committee on Cancer recognized that not all cancer clinics should be created at large urban hospitals. Several clinics were approved at smaller, rural institutions with the understanding that patients requiring specialized cancer care would be referred to the nearest, fully equipped cancer clinic. The tradition of sending surgical site visitors to evaluate the cancer clinics was launched. This would be the forerunner of the approvals and accreditation activities of the CoC in future decades.