2015 James Ewing Lecture: The 75-Year History of the Society of Surgical Oncology—Part II: The Transitional Years (1966–1990)
11 Seminal events in Society of Surgical Oncology (SSO) history
1940: Formation of the James Ewing Society in New York City
1948: First Annual Cancer Symposium of the James Ewing Society
1966: First Presidential Address by Dr Glenn H. Leak
1975: James Ewing Society renamed the Society of Surgical Oncology
1983: First surgical oncology fellowship training program approved
1994: Launch of the SSO journal Annals of Surgical Oncology
2003: First Breast Oncology Fellowship training program approved
2010: First “Best of SSO” presented by SMeO in Cancun
2011: First Fellows Institute program in Cincinnati Ohio
2011: American Board of Surgery-approved Surgical Oncology subspecialty certification
2012: SSO administration move to self-management
Adequate clinical resources in the institution. These clinical resources include a sufficient variety and volume of clinical material, access to all diagnostic and treatment disciplines, and various basic science resources that would allow a well-rounded program
A cancer program approved by the Commission on Cancer of the American College of Surgeons
A 2-year program of broad training on a surgical oncology service in addition to the time required to make the individual eligible for certification by the American Board of surgery or other surgical specialty board
An adequate operative experience that should include standard curative and palliative procedures as well as the more unusual radical operations with formal documentation of the total operative experience
Exposure to and participation in basic or clinical research
Interaction with other surgical specialties related to cancer
A full-time assignment to radiation oncology and medical oncology services, preferably early in the training program and of sufficient duration to permit the trainee to gain confidence and knowledge in these disciplines
Adequate and continued exposure through the entire course of the program to pathology, including anatomic pathology, clinical immunology, and microbiology
Adequate exposure to the nonclinical and allied health disciplines, provided in part by some formal structured course work over the entire span of the training program
A formal audit of progress in the learning process by means of formalized evaluation testing methods developed by the program director for every aspect of the program
The First Presidential Address of the James Ewing Society
Dr. Leak cited advances in cancer treatments: methotrexate for choriocarcinomas, cobalt irradiation, Pap smears, and smoking cessation.1 He was the first to present publicly his vision for the Society when he stated, “Some of us have learned that cancer was treated quite well in many places west of First Avenue.” He further stated, “Our aim [of the Ewing Society] has changed to unite in membership those people interested in cancer.” He concluded, “I doubt whether a president 50 years from now will ever bother to read these words …I hope and pray that 50 years from now, there will be no need for this Society because one of its members will have discovered the cause and another the cure of cancer.”1
James Ewing Society Renamed as the Society of Surgical Oncology
In 1975, the James Ewing Society was renamed as the SSO. An event this significant did not occur spontaneously but evolved after many often contentious discussions during several years. For instance, Dr. Sam Wilkins in his 1969 Presidential Address stated, “Some have voiced the opinion that our Society can never reach its greatest potential bearing the name of a single man… I do not believe that so long as we retain a man’s name can we hope to interest other related societies in coming together. While I am not yet prepared to recommend changing the name of the Society, I do feel the matter should be given serious consideration as to what it might mean to the future of the Society and what it might accomplish if its name were less personal and more connotative of our purpose and scope…The James Ewing Society should in deed and in truth be a national cancer society in the fullest sense, regardless of name. I believe we have a unique opportunity, a great challenge, and a serious responsibility to develop into such an organization.”2
One significant influence on the change in name came from a group of academic surgeons interested in forming an academic surgical oncology society. As Walter Lawrence stated later, “At a time [circa 1974–1975] when some academic surgeons [primarily Donald Morton and Tapas Das Gupta] were suggesting the formation of an academic surgical oncology society, it appeared that the transformation of this well-established oncology society, with strong surgical oncology input, would be a better solution to this need for a national subspecialty organization. The field of surgical oncology, poorly defined as it was at that time, could hardly undergo the further confusion of having two separate organizations representing it.”3 In his James Ewing Lecture in 1990, Dr. Lawrence recalled this event, “There was considerable controversy in the James Ewing Society over the name change; however, the major argument against it was the potentially negative impact on the memory of the beloved Dr. James Ewing, a true hero of all the membership as well as the oncology community of the day. Many of us felt that the creation of an entirely new and separate national surgical oncology society, rather than merely changing the name of this society, would seriously threaten the future of the James Ewing Society by leading to a loss of valuable surgical members, while a name change would give this society an expanded role and purpose.”4
In the run-up to the James Ewing Society meeting in March 1975, President Ed Scanlon made a proposal to the Commission on Cancer of the American College of Surgeons that surgical oncology should be formally designated as a specialty.5 The minutes of the Commission on Cancer Executive Council on 12 January 1975 reflected this proposal: “Dr. Scanlon stated there had been much activity within the past 2 years by a number of surgeons directed toward bringing about recognition of surgical oncology as a definite surgical specialty. This issue has come to a head as a result of acceptability of the designations of medical oncologist, radiation oncologist, gynecological oncologist, pediatric oncologist, etc. In an effort to promote the recognition of surgical oncology, the James Ewing Society was to consider at its next meeting a change in its name to the SSO. A resolution had been prepared for presentation at the meeting. It now seemed important that this (Commission on Cancer) Executive Committee prepare a resolution to be presented to the (American College of Surgeons) Board of regents indicating approval of the designation `surgical oncologist’.”
A resolution was then forwarded to the Regents, which was approved on 7 February 1975 as follows: “Resolved, that the American College of Surgeons continues to support standards of excellence for surgeons involved in cancer education, research, diagnosis, and treatment, and that these are competent to act as members of the multidisciplinary cancer team as surgical oncologists.”
In March 1975, President Edward Scanlon presided over the annual meeting of the James Ewing Society in New Orleans, where the discussions about the Society’s name change culminated in what was described as “an emotional debate.”6 Dr. Scanlon’s Presidential Address set the stage for this debate. He said, “Clearly, the time has arrived for identifying the surgical oncologist…If the time has arrived, then some organization will be needed to represent surgical oncology. It seems so logical and so natural the James Ewing Society should be that organization. A proposed amendment is before you to effect this change…This will be an important decision.”6
Looking back, President Blake Cady in 1989 described “the angst and turmoil that culminated in the 1975 annual meeting…when the executive committee recommended and the membership approved the name change to the SSO.” He said, “The prolonged prior debate and discussion, not all of it supportive needless to say, demonstrated the deliberate attempt of the farsighted leadership at that time to expand our influence broadly and project us onto the national and even international scene. Ed Scanlon, the president at that time, really put this change together as a response to contrary internal pressures, but other key players who supported his efforts were Don Morton, Murray Copeland, Harvey Baker, Walt Lawrence, and Bill Macomb… The membership approved the name change.”7
This bold move was not only a change in name but a new direction for the Society as a national organization of all surgical oncologists regardless where they trained or practiced. As stated by President Blake Cady, “Concerted and deliberate efforts were made to encourage basic and clinical science in our programs and to encourage debate in our meetings to make ourselves acceptable to the larger community, particularly the academic community.”7
In 1979, Walter Lawrence wrote an editorial stating, “Surgical oncology is new, and still poorly defined. I am convinced, however, that it can and will make a contribution to the surgical care of the cancer patient in our nation… A major recent step in this process of (specialty) identification was the transformation of the James Ewing Society…into a new society, the SSO. With this change in name of the organization there were corresponding modifications in the objectives of the society and the membership requirements.”8
Five years after approval of the designation as the SSO, then President Walter Lawrence summarized the impact of the name change as follows: “The change in the name of our Society to the SSO 5 years ago did cause some consternation on the part of many…Nevertheless, the time had come for surgeons primarily concerned with cancer to work together within some organization to refine and expand the role of surgical oncologist…The surgeons among us who were committed to oncology clearly needed an organizational vehicle to fulfill our responsibilities as surgeons and to oncology as a whole,… and despite some expected criticisms, the transition to the SSO has been accomplished…It is my belief that the growth of the discipline of oncology within general surgery will never reach its full potential without the enthusiastic involvement of the educational system within our universities.”9
The Beginning of SSO-Approved Fellowship Training Programs
Before describing the training of a surgical oncologist, the uniqueness of the specialty had to be defined. Many surgical oncology leaders participated in this process (see Sidebar for quotes from past presidents).
Although the major free-standing cancer centers had long-standing fellowship training programs, there was a dearth of post-residency surgical oncology training programs in academic medical centers.9 Among the early champions for expanding the number of surgical oncology training programs was Robert Schweitzer, whose 1974 James Ewing Presidential Address concluded: “It is essential that medical educators continue to recognize the importance of the surgical oncologist and establish training programs that will not only stimulate individuals to enter this field, but will enable them to keep abreast of the changing scene as related to surgery, radiation, and medical oncology… and allow the surgeon to continue to make significant and meaningful contributions in the multidisciplinary approach to cancer control.”10
The original criteria (Table 2) for approving surgical oncology fellowship training programs was used from 1978 until 2014, when the Accreditation Council for Graduate Medical Education (ACGME) began the process of reviewing surgical oncology programs. The first site visits for fellowship training programs approved in 1983 were the Memorial Sloan-Kettering Cancer Center, the Roswell Park Cancer Institute, and Ohio State University. By 1989, there were nine approved programs. Great credit goes to the leadership of Robert Schweitzer and Bernard Gardner as the first SSO Training Committee chairs, both of whom later became SSO presidents.
By 1986, 47 university-based departments of surgery had designated divisions of surgical oncology, which comprised only 38 % of the all the Surgery Departments at that time.2 , 14 Most of the surgical oncology faculty in these 47 institutions provided cancer education and mentoring to graduate and undergraduate trainees in surgery, but only 12 departments provided post-residency training in clinical surgical oncology.14 Clearly, the organizational concept of having a surgical oncology division or section had developed some momentum during the previous two decades, albeit slowly.
1988–1990: “Is Surgical Oncology Withering?”
President Blake Cady in his 1989 Presidential Address described the SSO at a crossroads, which he said, “in many ways is the result of our success, growth, and increasing stature.”7 He then made a prescient statement that “The American Board of Surgery will turn down our request for specialty designation, but this provides an opportunity to analyze our future directions and exert more control of our destiny.”7
However, in the late 1980s, the SSO had lost some of its momentum. Both active membership and meeting attendance were declining. There was no growth in fellowship programs. The 1989 budget was in deficit, and the Society had a negative cash flow, even while management fees were increasing. Presidents Blake Cady, Benjamin Rush, and Alfred Ketcham saw the need to engage the leadership in a call to action (Fig. 1).
Indeed, President Benjamin Rush actually opened his presidential address in 1990 with the question: “Is surgical oncology withering?” He went on to say, “One can find evidence that this may be so…The American Board of Surgery has denied a certificate of added competency in surgical oncology. There was fragmentation of cancer care, especially for head and neck and GI cancers. The membership of the society had plateaued, and younger surgeons were not joining.”15 As described by Dr. Rush, “We had managed to construct membership criteria that excludes individuals who consider themselves surgical oncologists.” He said, “If this Society intends to work successfully on behalf of surgical oncologists, it must represent most of them.”15
Thus, this second quarter century in the Society’s history included the seminal events of renaming and opening up membership to the broader surgical oncology community, as well as the creation and administration of formal training programs in surgical oncology. However, as the Society approached its 50th anniversary, it appeared to have at least lost its momentum and had ended at a low ebb. But the mission of the Society and the resolve of its leadership prevailed, and the SSO moved into a transformative period of growth in all its dimensions during the next 25 years, as described in the third and final segment of its 75-year history.
The authors thank Ms. Karen Hurley and Kathy Sampson in the SSO Headquarters Office for their assistance in gathering materials, Drs. Walter Lawrence and Blake Cady for reviewing the manuscript, and Deborah Whippen for editorial assistance. We also thank Ms. Katherine Brennan at the MSKCC Archives, Rockefeller Archives Center, for her assistance in obtaining some of the original minutes of the James Ewing Society and photos. These documents were located in Record Group 520, James Ewing Society Papers.
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- 3.Lawrence W. The history of surgical oncology. In: Norton JA et al. (eds) Surgery: basic science and clinical evidence. New York: Springer; 2001.Google Scholar
- 4.Lawrence W. Some problems with clinical trials. James Ewing Lecture. Arch Surg. 1991;126:370–8.Google Scholar