The Commission on Cancer: 100 Years of Cancer Care Leadership

‘Life isn’t a matter of milestones, but of moments.’

—Rose Kennedy

The 2022 Clinical Congress of the American College of Surgeons not only is celebrated for the initial in-person gathering following the ebbing of the COVID-19 pandemic, but is also notable as the culmination of a year-long celebration of the establishment of the cancer initiatives of the ACS that first began in 1922. 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, but it was not until 1922 that 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 among its leadership George W. Crile of Cleveland, John M. T. Finney of Baltimore, and Henry Pancoast of Philadelphia.

The concept of developing “cancer clinics” in existing general hospitals was conceived in 1927 and finally launched in 1931 with the first surveys. This concept included defined 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. The Committee on Cancer became the new moniker as uniform templates were developed to achieve standardization in all established 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.

At the 1946 meeting of the Committee on Cancer, Mr. Lane Adams, Chairman of the Board of the American Cancer Society, addressed the Committee. This proved to be an important meeting which further strengthened the relationship between the ACS and the American Cancer Society. In 1950, another important collaboration occurred. The Joint Committee on Reporting Cancer End Results was formed to include members of the ACS, College of American Pathologists, the American College of Radiology and the American Cancer Society. This proved to be the forerunner of the American Joint Committee on Cancer (AJCC), established nine years later. This also paved the way for the entire coding structure that would become mandatory for cancer registry development and data collection in future years.

A landmark standard for cancer program accreditation was introduced by the Committee on Cancer in 1952, becoming operational in December 1955—approved cancer clinics must maintain a cancer registry using the College regulations set forth in the Manual for Cancer Registries and Cancer Clinic Activities. The wisdom of putting emphasis on cancer data collection at the local level was one of the significant decisions of the Committee on Cancer and served as the basis for the development of the National Cancer Data Base (NCDB) 30 years later.

In 1965, the name of the Committee on Cancer was changed to the Commission on Cancer. Eventually the initial emphasis on importance of cancer registries and collection of patient outcomes bore the ultimate fruit with the creation of the National Cancer Data Base (NCDB), a joint venture by the ACS and the American Cancer Society in the late 1980s. A highlight of this centennial year is the featuring of seminal peer-reviewed articles that have used NCDB-derived data. These important data elements originated in the cancer registries housed in the accredited COC institutions, now numbering well over 1,500 in the United States. Using the NCDB data as a backdrop, quality metrics for assessment of cancer care were introduced. These metrics have recently included benchmarks to assess operative strategies for several of the more frequent cancer operations. The effectiveness of these standards created with the input of many of the 59 member organizations of the Commission on Cancer, will, no doubt, resonate well into the eleventh decade of the Commission!

Dr. Greene is the senior medical advisor for General Surgery News.