A National Map of NCI-Designated Cancer Center Catchment Areas on the 50th Anniversary of the Cancer Centers Program

Fifty years ago, the National Cancer Act (NCA) established a flagship program for “cancer research and demonstration centers” to be administered by the NCI (1). Through a competitive application process, the NCI Cancer Centers Program—now representing 71 basic, clinical, and comprehensive cancer centers—remains a central part of the cancer research, education, and oncology care enterprise in the United States.

In 2012, NCI published a revised funding opportunity announcement for the P30 Cancer Center Support Grant (CCSG) that contained guidance for defining the cancer center's geographic catchment area (2), which has been sustained through subsequent reissuances of the P30 CCSG funding opportunity (3). Initially, the concept of understanding the geographic footprint of areas served by the NCI-designated cancer centers stemmed from conversations among state and national partners, including NCI and the Centers for Disease Control and Prevention, about how to best coordinate cancer prevention and control efforts across the United States. Holistically, the catchment area definition provides a geographic scope for monitoring cancer trends, identifying pronounced socioeconomic- and health-related disparities, informing high impact translational science, and guiding the implementation of evidence-based interventions in clinical and community settings (2, 4). Understanding local sociodemographic and epidemiologic characteristics allows NCI cancer center administrative leaders, researchers, and clinicians, and community outreach and engagement staff to focus on issues that are most relevant to their communities (5–7).

The place-based research strategy was supported by additional activities pertaining to the NCI-designated cancer centers. In 2016, the NCI Office of Cancer Centers, in collaboration with the Division of Cancer Control and Population Sciences (DCCPS), announced a P30 grant administrative supplement opportunity to support population health assessments among the catchment populations (8). DCCPS funded 29 NCI-designated cancer centers to conduct local-area surveys to characterize cancer-relevant knowledge, attitudes, beliefs, and behaviors across the breadth of the catchment area (9). Following this initiative, NCI incorporated the sustainment of local-area assessments into the core CCSG funding mechanism (10). In 2017, the CCSG was revised to include a new Community Outreach and Engagement component, which extended NCI cancer centers' involvement in their respective catchment areas and promoted community input into Center activities (11). In 2019, a stakeholder listening session and community impact forum helped galvanize the paradigm of “research driven by the catchment area of a cancer center” (4, 12, 13).

Coinciding with the celebration of the 50th anniversary of the NCA, herein, this effort presents a national map of NCI-designated cancer center catchment areas, representing 63 actively funded comprehensive and clinical cancer centers. Standardized geographic codes were used to link each catchment area with population-based datasets to visualize social, behavioral, or environmental factors in communities served by NCI-designated cancer centers. The purpose of this presentation and data linkage is not to advocate for specific policies or NCI Cancer Centers Program coverage goals, but rather to inform the broader context of cancer research and community engagement efforts across the United States. The geographic dataset strengthens the ability to communicate clear, consistent evidence on issues that affect catchment area residents. The map can be used, in part, to support cancer control research, program planning for community outreach and engagement, and communication and dissemination activities related to the NCI Cancer Centers Program.

The P30 CCSG asks each applicant to describe their catchment area. With permission from the NCI-designated cancer center directors (i.e., principal investigators of the P30 CCSG awards), the catchment area definitions were collected from grants that were funded during the most recent application cycle in fiscal years 2016–2021. In May 2021, NCI staff asked NCI-designated cancer center directors to report any catchment area updates or changes that occurred after the most recent competitive resubmission.

NCI-designated cancer centers are typically affiliated with academic medical centers and research institutions located in large cities, with catchment areas extending to surrounding communities. NCI-designated cancer centers define their catchment area boundaries by U.S. state, county, zip code tabulation areas (ZCTA), public use microdata areas (PUMA), or other geographic landmarks [e.g., U.S.-affiliated Pacific Islands (U.S.-API)] (Supplementary Table S1). The corresponding shapefiles for the state, county, ZCTA, or PUMA boundaries were retrieved from the 2018 U.S. Census Bureau Topologically Integrated Geographic Encoding and Referencing (TIGER)/Line database (14). Each catchment area was then assembled into a separate, unique shapefile. The total surface area (square miles) of each catchment area was calculated by summing the geographic area within the included boundaries.

Geographic Information System tools and R software were used to link geographic locations with publicly available datasets. Federal Information Processing Standard (FIPS) codes for each catchment area and the tidycensus package were used to retrieve sociodemographic data from the 2015–2019 American Community Survey (15, 16). If the NCI-designated cancer center used PUMA or ZCTA boundaries, the corresponding FIPS codes for all counties within the defined catchment area, including all partial counties, were selected. This study reports total population estimates and four demographic characteristics (sex, age, race, and ethnicity) because they correspond with federal reporting guidelines (17, 18). Specifically, descriptive statistics of the catchment populations, such as percent female, percent greater than 65 years old, and percent per race and ethnicity are presented herein. In addition, SEER*Stat software (version 8.3.9) was used to link cancer mortality data from the National Center for Health Statistics, available through the NCI Surveillance, Epidemiology, and End Results (SEER) program (19, 20). Variables were selected that align with Healthy People 2030 objectives—a federal public health initiative to improve health and well-being over the next decade (21). Specifically, the 2015–2019 age-adjusted overall cancer mortality rates and site-specific mortality rates for lung, breast (female), prostate, and colorectal cancers are presented herein.

The seven NCI-designated basic laboratory centers were excluded for this mapping exercise because they are not required to identify a catchment area. St. Jude Children's Research Hospital was also excluded because its unique mission is solely devoted to pediatric cancers. The NCI-designated University of Hawaii Cancer Center catchment area includes the U.S.-API; however, the U.S.-API was not included in the descriptive analysis due to data reporting limitations of the U.S. Census demographic characteristics and National Vital Statistics System cancer mortality data. Instead, statistics for the NCI-designated University of Hawaii Cancer Center catchment population were reported using the state of Hawaii only.

For each of the included NCI-designated cancer centers, the point location was geocoded on the basis of textual name matching of the center's address in Google Earth Pro (version 7.3.3.7699). The statistical software R (version 4.1.0) was used to visualize the NCI-designated cancer centers and their catchment areas (22). The tigris package (15) was used to obtain the U.S. Census TIGER/Line files, the sf package to collate the geographic information (23), and the ggplot2 package to render the map (24). R code used to generate the geographic visualizations has been deposited in a repository on GitHub (https://github.com/idblr/NCI_Cancer_Center_Catchment_Areas).

The data generated in this study are available within the article and its Supplementary Data files. Demographic data analyzed in this study were obtained from the 2015–2019 American Community Survey 5-Year Estimates, available from the U.S. Census Bureau (16). Epidemiologic data analyzed in this study were obtained from National Center for Health Statistics 5-year data (2015–2019), available through the NCI SEER program (19).

The 63 NCI-designated cancer center catchment areas touch 43 states, the District of Columbia, and the U.S.-API (Fig. 1). Catchment areas are bound by state borders (n = 24), county borders (n = 38), ZCTA boundaries (n = 1), PUMA boundaries (n = 1), or other geographic landmarks (n = 1). Multiple NCI-designated cancer centers are located in areas with large populaces such as New York, New York (Supplementary Fig. S1), the Delaware Valley (Supplementary Fig. S2), and Southern California (Supplementary Fig. S3), which are presented as exemplars in the Supplementary Materials and Methods.

There are various catchment area sizes; some catchment areas are smaller than a single county while others exceed 200 counties. In total, the analyzed NCI-designated cancer center catchment area encompasses approximately 2.4 million square miles. As illustrated in Fig. 2, over 77% of U.S. counties have at least one NCI-designated cancer center catchment area assignation (n = 2,069), and 13% of U.S. counties appear in two or more NCI-designated cancer center catchment areas (n = 409). Together, the combined catchment areas account for 285 million residents, which represents nearly 88% of the U.S. population (Fig. 3). As presented in Fig. 4, the catchment areas have a median population of 6.0 million residents (range: 1.4 to 32.6 million residents) and a median area of 26,500 square miles (range: 48 to 524,000 square miles).

In characterizing the demographic attributes of each catchment area population (Fig. 5A), the 63 reported NCI-designated cancer center catchment areas reflect the U.S. population on the basis of sex, age, race, and ethnicity. The 2015–2019 total U.S. population estimate falls within the range of the catchment area values for each attribute. Also, geographic variations in these characteristics reflect the spatial differences within the total U.S. population. For example, the proportion of adults over 65 years old varies similarly between catchment areas as it does between states.

Many factors influence cancer health outcomes, and different parts of the country experience different cancer mortality rates. Figure 5B shows examples of the distribution of age-adjusted cancer mortality (2015–2019) when aggregated by catchment area. In the United States, the Healthy People 2030 guidelines specify five objectives to address the overall cancer death rate and site-specific mortality rates for lung, breast (female), prostate, and colorectal cancers. In the preceding decade (2010–2019), all the catchment areas exceeded the benchmark for at least one of these objectives, and 56% of the catchment areas met all five objectives. Among the selected cancer sites, lung cancer mortality exhibits the highest variation between catchment area populations, with a range of 24.4 to 57.6 deaths per 100,000 residents (2015–2019).

NCI-designated cancer centers are an important element of the U.S. cancer control ecosystem. They are expected to collaborate with local, state, and regional partners to identify and address cancer disparities, work with researchers and clinicians on high-impact science and delivery of cancer care, and deploy evidence-based strategies for cancer control. For the first time, the present effort compiled a national map that offers a convenient, precise, and easily accessible portrait of the size, shape, and locations for 63 catchment areas of the 71 NCI-designated cancer centers.

This effort also demonstrated how to geographically link publicly available datasets to the catchment map, which enables the exploration of sociodemographic attributes, epidemiologic trends, and other systemic factors, such as the distribution healthcare services or exposure to environmental risk factors, to document the burden of cancer in NCI-designated cancer center communities and across the NCI Cancer Centers Program. The guidelines for NCI-designation emphasize the importance of research pertaining to the catchment area, which stems from a recognition that community engagement enhances all aspects of the translational research process and ultimately strengthens the benefit to the public. The catchment map may help communicate the priorities and commitments that guide clinical care and community outreach activities of each NCI-designated cancer center. For example, catchment area information can help ensure that accrual to cancer clinical trials reflects the local populations, thus allowing researchers to detect and respond to clinical preferences or molecular variations that affect different patient groups (25–27).

Timely and actionable information gleaned from catchment areas analyses can inform efforts to ensure that all segments of the population benefit from scientific advances in cancer prevention, early detection, treatment, and survivorship care. These advantages were demonstrated in outcomes from 29 population health assessments conducted as part of the P30 CCSG administrative supplement opportunity described earlier (8, 9, 28, 29). In these studies, researchers used catchment area information to inform and improve programs for tobacco control (30, 31), cancer screening (32–35), sun safety (36, 37), risk assessment (38, 39), and other health behaviors (40–42).

The description of the NCI-designated cancer center catchment areas raises several important considerations. First, this article and related visualization efforts are not policy statements and should not be interpreted as such. Future reviewers of CCSG applications should note that the NCI does not prescribe catchment area boundaries, beyond that it is a geographic determination that includes the immediate area of the NCI-designated cancer center and the area from which the NCI-designated cancer center draws the majority of its patients (3). NCI-designated cancer centers define for themselves the most appropriate way to situate their unique organizational, research, and community outreach capabilities. There are myriad ways that an NCI-designated cancer center can be positioned in the catchment area, and one size does not fit all. Second, this study focuses on 63 NCI-designated comprehensive and clinical cancer centers and does not include the valuable contributions of other academic medical centers or community oncology programs. For example, a recent study from the Association of American Cancer Institutes (AACI) reported the catchment areas for 89 AACI-affiliated cancer centers (43). Regardless of pursuit or attainment of NCI designation, the collectivity of cancer research and care delivery programs across the United States advances the mission of cancer prevention and control, including the promotion of cancer health equity among vulnerable and underrepresented populations. The images presented here are not intended to represent the full extent of all NCI-funded activities, but only one element of the larger cancer research enterprise.

The catchment map has several limitations. First, the map is a snapshot of boundaries that are not permanent. In response to the changing health care market, growing cancer patient volume, and community needs, NCI-designated cancer centers may shift their catchment area boundaries over time. Second, NCI-designated cancer center catchment areas often overlap, especially in the densely populated regions near New York City, Philadelphia, and Los Angeles. Overlapping areas are challenging to visualize in a static image; therefore, NCI launched an interactive web application that allows users to navigate between catchment areas (https://gis.cancer.gov/ncicatchment). Finally, catchment areas do not define the presence or absence of medical or scientific infrastructure, nor do they determine the accessibility or quality of health care services. For example, the NCI Community Oncology Research Program (https://ncorp.cancer.gov) expands access to cancer clinical trials to diverse communities within and beyond the NCI-designated catchment areas. It is also important to note that cancer care is not limited to individuals within NCI-designated cancer centers’ catchment areas as patients often come from outside these geographic boundaries. Similarly, NCI-designated cancer centers are also actively engaged in global health research.

The current study also contains technical limitations that influence the results. First, state- and county-level sources were used for demographic and epidemiologic linkages. Therefore, the population estimates do not perfectly represent the geographic catchment areas that utilize PUMA or ZCTA boundaries. The sources for the presented data linkages do not include attributes for the U.S.-API, and therefore, the entire NCI-designated University of Hawaii Cancer Center catchment population is not presented herein. It is important to document the full extent of each catchment area, and individual NCI-designated cancer centers can provide more precise characterizations of their communities than those presented in this study.

As one of the original cornerstones in the NCA of 1971, the NCI-designated Cancer Centers Program continues to contribute to the evolution of more rigorous and ambitious research to improve cancer control in the United States. Key to this mission, NCI requires designated comprehensive and clinical cancer centers to document and address the health issues and priorities that affect residents of their catchment area. Among their many functions, this is one example of how NCI-designated cancer centers mobilize their scientific and organizational capabilities in service to their local communities and the Nation.

No disclosures were reported.

The opinions expressed by the authors are their own and this material should not be interpreted as representing the official viewpoint of the U.S. Department of Health and Human Services, the National Institutes of Health, or the National Cancer Institute.

P.F. DelNero: Conceptualization, data curation, formal analysis, investigation, visualization, methodology, writing–original draft, project administration, writing–review and editing. I.D. Buller: Conceptualization, data curation, formal analysis, investigation, visualization, methodology, writing–original draft, project administration, writing–review and editing. R.R. Jones: Conceptualization, supervision, investigation, project administration, writing–review and editing. Z. Tatalovich: Conceptualization, data curation, supervision, investigation, visualization, methodology, project administration, writing–review and editing. R.C. Vanderpool: Conceptualization, resources, data curation, supervision, investigation, project administration, writing–review and editing. H.P. Ciolino: Conceptualization, resources, data curation, supervision, investigation, project administration, writing–review and editing. R.T. Croyle: Conceptualization, resources, supervision, investigation, project administration, writing–review and editing.

The authors thank the NCI Office of Cancer Centers as well as the NCI-designated Cancer Center community for their support of this project. They also thank James Cucinelli and Jeremy Lyman of Information Management Services, Inc. for their technical assistance. I.D. Buller and R.R. Jones are supported by the Intramural Research Program of the NCI.

The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.