and community hospitals. The heart disease, cancer, and stroke amendments to the Public Health Service Act of 1965, for example, provided grants-in-aid for the support of regional medical programs (RMPs) for research and training, as well as for the diagnosis and treatment of these major diseases. The RMPs were centered at medical schools and their affiliated hospitals. The intent was to encourage a linkage between the medical centers and the community hospitals, thereby improving the quality of care for these conditions (Bodenhimer, 1969). The President's Commission on Heart Disease, Cancer, and Stroke had also recommended the development of a network of regional comprehensive cancer centers (President's Commission on Heart Disease, Cancer, and Stroke, 1964). These centers were to focus on cancer control programs and conduct studies at the various regional centers. The centers were to be at the forefront of the struggle against cancer, but these recommendations were not realized until later, and in 1974 the RMPs were absorbed into the National Health Planning and Resources Development Act (see Box 1-1 for a timeline of significant events in the War on Cancer, and Box 1-2 for a listing of recent developments in NCI efforts regarding ethnic minority and medically underserved populations).

The Focus on Cancer

The greatest impetus to the effort against cancer came with the enactment of the National Cancer Act of 1971 (P.L. 92-218). The National Panel of Consultants on the Conquest of Cancer (the Yarborough Commission) had emphasized the need for a coherent and systematic attack on the complex problems of cancer and urged the development of a comprehensive national plan to conquer cancer as soon as possible. This was to be the beginning of the real War on Cancer. The National Cancer Act of 1971 increased funding for NCI and made major changes to previous efforts against cancer. It provided for greater authority of the NCI director, who became a presidential appointee and who could submit a budget request directly to the president. It established the President's Cancer Panel and the National Cancer Advisory Board. The Act also called for a National Cancer Program under the leadership of the NCI director, who was to coordinate not only the cancer research programs within the Institute but also the efforts of related federal and nonfederal programs. It also authorized the first cancer centers and an information dissemination program.

Beginning of the War on Cancer

The War on Cancer was launched with great expectations and with



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