“I vividly remember watching television with my older sister, Suzy, and marveling at President Nixon’s signing of the National Cancer Act in December 1971, and thinking ‘for me, this was like a man going to the moon,’” writes Nancy G. Brinker in the foreword to the recently published Centers of the Cancer Universe: A Half-Century of Progress Against Cancer. The authors of this historical narrative are Donald L. Trump, MD, President and Chief Executive Officer of the Roswell Park Cancer Institute from 2007 to 2014 and first Chief Executive Officer and Executive Director of the Inova Schar Cancer Institute in Fairfax, Virginia, until his retirement in January 2019; and Eric T. Rosenthal, an award-winning independent medical journalist who has written for such publications as Oncology Times and MedPage Today.
Title: Centers of the Cancer Universe: A Half-Century of Progress Against Cancer
Authors: Donald L. Trump, MD, and Eric T. Rosenthal
Publisher: Rowman & Littlefield Publishers
Publication Date: October 2021
Price: $35.00, hardcover, 312 pages
In her introduction, Ms. Brinker, Founder of the Susan G. Komen Breast Cancer Foundation, correctly notes that Centers of the Cancer Universe should be of great interest not only to those already familiar with cancer, but to those who seek a deeper understanding about the history of how far we have come in dealing with this disease and how large a part our national cancer centers program has played in reducing mortality, pain, and suffering over the past half century.
Passage of the National Cancer Act
Organized into 11 chapters, Centers of the Cancer Universe gives readers a succinct yet comprehensive appreciation of the rise of the national network of National Cancer Institute (NCI)-designated cancer centers. The National Cancer Act, signed into law in December 1971, provided for the establishment of 15 National Research & Demonstration Centers, which, initially, were all defined as comprehensive cancer centers. Its passage represented the culmination of nearly 3 decades of efforts to formalize the U.S. government’s place in cancer research. Over the years, the original 15 NCI-designated comprehensive cancer centers have grown to 71 nationwide.
Interestingly, the authors noted: “In 1970, a blue--ribbon panel of physicians and scientists presented to President Richard M. Nixon and the Congress the ‘Report of the National Panel of Consultants on the Conquest of Cancer,’ which set the scientific baseline and recommended a plan for progress. Presciently, it stated: ‘The long-term future may belong to the immunologist and geneticist.’” Many readers of The ASCO Post may naturally wonder, what took so long?
The history of cancer care in the United States has been told in many iterations; however, the Centers of the Cancer Universe gives readers an in-depth backdrop to the passage of the National Cancer Act. It also delves into the subsequent development of the NCI-designated comprehensive cancer centers national network, which accelerated the research, diagnostic, and treatment models responsible for greatly reducing cancer mortality and morbidity in the United States.
It’s important to note that the National Cancer Act specifically mandated that attention be focused on the etiology and effect of cancer on large populations, known today as public health science. That evolving recognition led to a greater understanding of what cancer is, the gene mutations driving specific cancers, and the subsequent development of many more efficacious and less-toxic therapies.
The road from the original NCI-designated comprehensive cancer centers to the full array of centers today that provide the highest quality cancer care in the world is a complex tale of politics, egos, failure, triumph, and unflagging determination. Telling it in compelling fashion is challenging, given its often dry content; however, the authors of Centers of the Cancer Universe overcome this hurdle by giving readers personal stories of the people and events that energized the journey. They include the inimitable Bernard -Fisher, MD, the surgeon and clinical scientist at the University of Pittsburgh who played a key role in developing the clinical concept of cancer’s risk for systemic spread.
Dr. Fisher notably argued that more extensive surgery for breast cancer was not the answer; instead, equally good outcomes could be achieved with less invasive surgery, sometimes a simple lumpectomy. His battle to end the more invasive Halsted radical mastectomy is etched in oncologic history, but here we see the story as part of a larger narrative, adding more intrigue.
Early Years of Chemotherapy
Equally interesting is the history of modern-day chemotherapy, which emerged from the observation that soldiers exposed to mustard gas during World War I often had lowered white blood cell counts. The argument went that if mustard gas could kill speedily developing normal blood cells, it should also eradicate many rapidly growing cancer cells. From that observation, which today might seem simplistic, intrepid scientists and their supporters infused bench scientists with a new and highly motivated path forward.
To get a sense of the advances we sometimes take for granted, the authors pointed out that, in 1970, when the National Cancer Act legislation was being drafted, there were only 23 U.S. Food and Drug Administration–approved anticancer drugs, of which 10 were alkylating agents. Oncology fellows are now entering a field that offers hundreds of chemotherapeutics, with novel agents continually streaming out of the pipeline.
Science and Politics
This story is equal parts science and politics. Not surprising, the politics to secure funding and research was as complicated in the past as it is today. The authors reach back to 1927, when Matthew M. Neely, a Democratic senator from West Virginia, was the first congressional backer for federal support of cancer research. He introduced a bill that would have provided a $5 million reward for “the first person who discovered a practical and successful cure for cancer.” Although his proposed legislation was never passed, the Congressional Record noted that Senator Neely received more than 2,500 communications from people across the country claiming they had the cure for cancer.
This section is one of the best of the book, as it gives readers a real insider’s glimpse into the difficult challenges faced by the pioneers in oncology. Readers of The ASCO Post will enjoy reading about oncology luminaries such as NCI’s “Gang of Five”—Drs. Young, DeVita, Canellos, Schein, and Chabner—the investigators who developed the first curative regimens for Hodgkin lymphoma and diffuse aggressive lymphomas.
There are parts of this fine history that require patience, such as the center-by-center rundown of comprehensive cancer centers and, particularly, Chapter 7 on “Medicine or Marketing,” which could have been edited down a bit. However, these gripes are small for such an engaging and informative book, which gives readers much more than the title suggests. Centers of the Cancer Universe is highly recommended for readers of The ASCO Post.