Yale, the Georgetown-Howard Univ. combine in Washington D.C., the Illinois Cancer Council in Chi­cago, and the Colorado Regional Cancer Center in Denver are the new “identified” comprehensive can­cer centers.

NCI Director Frank Rauscher revealed last week he had selected those four programs for the highly­-prized comprehensive status from the list of nine that had been certified by the Centers Review Com­mittee as deserving of such recognition (The Cancer Newsletter, May 24).

If there was a surprise in the announcement, it was the selection of Georgetown-Howard over the pro­gram headed by the Univ. of California at San Fran­cisco – surprising not necessarily because of their comparative qualifications but because of geographic considerations. The Washington D.C. area is 40 miles from the already-recognized Hopkins-Univ. of Mary­land comprehensive center; the densely populated Central-Northern California area is 400 miles from the nearest center, at Univ. of Southern California.

Geography is not the overriding factor, however. Georgetown-Howard was deemed farther along toward meeting the comprehensive center guidelines than San Francisco.

Rauscher still has authority to “identify” (the term NCI prefers over “recognize” or “designate”) two more comprehensive centers under the terms of the National Cancer Act of 1971, which would bring the number so identified to 18. When the extension of the act becomes law, the limit of 18 will be re­moved, and Rauscher expects to eventually name as many as 30.

Best guess for the next two centers would be San Francisco, if organizational problems there can be overcome, plus either Ohio State, the budding con­sortium in Philadelphia, or one of four programs in Oklahoma, Kansas and Missouri. UCLA is a long-shot possibility.

The distribution of comprehensive centers by loca­tion now is:

  • Northeast (4) – Boston Children’s, Yale (New Haven), Sloan-Kettering (New York), Roswell Park (Buffalo).
  • Mideast (2) – Hopkins-Maryland, Georgetown­-Howard.
  • South (3) – Duke (Durham), Univ. of Miami, Univ. of Alabama (Birmingham).
  • Southwest ( 1) – M. D. Anderson (Houston).
  • Midwest (3) – Illinois (Chicago), Univ. of Wiscon­sin (Madison), Mayo (Rochester, Minn.).
  • Mountain States ( 1) – Colorado (Denver).
  • Pacific Coast (2) – Univ. of Southern California(Los Angeles), Hutchinson-Univ. of Washington (Seattle).

This leaves some big gaps in meeting the long-range goal of putting a comprehensive center within at least 120 miles of the greatest number of Americans. Some of the biggest gaps, in addition to Northern California: the area between Denver and Chicago, where the competitors for comprehensive recognition are the Univ. of Kansas, Univ. of Oklahoma, and centers in St. Louis and Columbia, Mo.; the area between Bir­mingham and Houston; the Cleveland-Columbus­-Pittsburgh region; and Hawaii and Puerto Rico.

The Chicago program’s recognition may be the most significant in terms of what NCI is looking for, one which those who still harbor hopes of eventual recognition should note. No less than 12 public, pri­vate and non-profit institutions put aside their indi­vidual aspirations, jealousies and antagonisms to form the Illinois Cancer Council. Each is pledged to cooper­ate with the group, an effort that will include person­nel exchanges, patient referrals, collaborative research efforts, cooperatively developed grant programs – all amounting to a surrender of autonomy. It was not an easy achievement.

The 12 institutions are the Univ. of Chicago, North­western, Rush-Presbyterian-St. Luke’s, Univ. of Ill­inois, Chicago Medical School, Southern Illinois Univ., Loyola Univ., Chicago College of Osteopathic Medi­cine, Veterans Administration Hospital, Illinois Dept. of Public Health, Illinois Division of the American Cancer Society, and the Illinois State Medical Society.

The concept of a cooperative comprehensive center was developed by J. Palmer Saunders, retiring director of NCI’s Div. of Research Resources & Centers. A live­ly debate developed within NCI over the cooperative group vs. single institution approach; Saunders’ argu­ment for cooperation wherever possible carried the day.

NCI Centers Program Director John Yarbro and Saunders’ deputy, William Walter. carried out the im­plementation of that decision in Illinois. Through per­suasion and head-knocking, and with the leadership of Sam Taylor of Rush, John Ultmann of the Univ. of Chicago and John Brewer of Northwestern, they worked through months of wrangling to put the group together.

The Colorado program is a cooperative group, al­though not so diverse, with the Univ. of Colorado at Denver and Boulder, Colorado State Univ. at Fort Collins, and Children’s Hospital in Denver.

The 16 comprehensive centers now recognized bring the services of such a center within a maximum 120 miles of about 120 million persons. NCI selected the 120-mile figure because that was determined as the farthest a patient or his family could drive to a center and return home in the same day.

The two additional centers Rauscher can name could raise that figure by 5 to 10 million. From then on, the numbers picked up by each new center drops considerably.