Academic cancer centers are a relatively new invention, closely tied historically to the National Cancer Act of 1971. They were designed to marry optimal in-person care of diagnosed patients with laboratory science intended to advance cancer management. In-person clinical trials grew in importance as the field matured, some asking purely scientific questions but most, especially lately, including government supported ones, involving products in commercial development by industry. The design of cancer centers has thus always evolved to meet the needs and expectations of the public, and to take advantage of novel opportunities. However, major changes in technology and society are now accelerating the process in meaningful ways. Some of these changes involve an emphasis on prevention and diagnosis over just treatment, a shift toward expansion of activities beyond physical contact as by remote access to trials of investigational medicines, the use of telemedicine in both research and care, the establishment of broad based biobanks, the emergence of massive collaborative efforts in both data acquisition and analysis, and the development of knowledge bases to guide clinical decisions using molecular information. What remains to be better addressed is an improved relationship between the centers and industry. A more efficient mechanism for commercially-minded very early development of discoveries and concepts derived from center research, now constrained by limitations in both financial and human resources, would benefit all parties, including the public. Ideally, all these evolutionary advances will not only improve the quality of care, research, education, and but also promote health care equity in diverse populations.