Testimony before the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies
March 21, 2000
Margaret Foti, Ph.D.
Chief Executive Officer, American Association for Cancer Research
Good morning, Mr. Chairman and Members of the Subcommittee on Labor, Health and Human Services, Education and Related Agencies. My name is Margaret Foti. I am the Chief Executive Officer of the largest and most prestigious cancer research organization in the world, the American Association for Cancer Research (AACR), with over 15,500 members worldwide. The mission of the AACR is the prevention and cure of cancer through cancer research, scientific communication, and public education. In my 35-year tenure with the AACR, I have seen our past investments in cancer research begin to pay off, as our members have "unraveled" the mystery of what makes a normal cell transform into a cancer cell that no longer responds to the body's established control mechanisms. As we enter the 21st Century, we have unprecedented opportunities to accelerate progress against cancer through the translation of this wealth of scientific discovery into new treatments and preventive strategies for cancer. We can conquer cancer - but only if we are willing to allocate the required resources, and provide the continuity of funding needed to win a full-scale national effort to conquer cancer.
We know that the Committee and all Members of Congress are faced with many priorities and requests to provide funding increases for a range of diseases and healthcare needs. In considering these requests, we ask that you reflect on the range of opportunities that exist today that will allow us at last to mount a real "war" to conquer cancer, and we further request that you undertake a multi-year National effort to cure and prevent this tragic disease for all of our citizens. It is time to make cancer one of our highest health care priorities, so that millions of lives can be saved and future generations will no longer face the specter of cancer that robs too many of us of our families and friends.
As a result of progress in all areas of cancer prevention, detection, and treatment research, new cases of cancer and death rates have shown a modest decline for the first time in decades. This is a remarkable achievement and means that our new treatments and early detection and prevention programs are beginning to have an effect. However, although these recent declines in cancer mortality and new cancer cases are encouraging, we must remember that cancer still kills more Americans each year than have died in all the wars we fought in the last century, and that 1 of every 2 men and 1 of every 3 women will get cancer in their lifetimes. This year alone, over 1.2 million Americans will be stricken with cancer and over 552,000 will die from their disease - 1500 people every day.
We must also point out to the Committee that even in the face of these encouraging results, the cancer epidemic is likely to reach crisis proportions in the next 10 to 20 years due to the aging of our population and the changing demographics of America. Using current cancer rates, the number of estimated new cases of cancer is expected to increase by 29% by the year 2010. Looking beyond 2010, the number of cancer cases could approach 2 million new cases per year by 2025. This epidemic will be a tremendous burden on patients, their families, and most certainly on this country and its health care system. Conservatively estimated, the projected economic burden due to the direct cost of treatment of cancer will increase to approximately $65 billion per year, and the "productivity" cost (lost economic productivity due to disability and death) from cancer care will grow to over $135 billion, for a total expected economic burden of over $200 billion annually in 10 years. Unfortunately, this looming cancer increase will hit those hardest who can least afford it, the elderly, medically underserved, and minority populations.
It is also our responsibility to tell you that we can do a great deal to improve all aspects of cancer prevention and treatment now and proactively address this expected rise in new cancer cases to minimize its impact - if we are willing to act now. Past achievements in cancer research and recent progress in the prevention, early detection, and treatment of cancer provides a solid foundation on which to launch a full-scale national effort to eradicate cancer.
For example, we are finally beginning to make significant progress in cancer prevention. Smoking, which is responsible for more than 30% of all cancer deaths, is declining due in large measure to stop smoking programs and education through cancer control programs of the Centers for Disease Control and Prevention (CDC). Unfortunately, increased smoking by adolescents may eradicate this progress against lung cancer in years to come. We have also demonstrated through clinical trials research that the antihormonal agent, Tamoxifen, reduces the risk of breast cancer in high-risk women. In these studies, Tamoxifen reduced the risk of invasive breast cancer by 49% and early (non-invasive) breast cancer by 50%. We are currently doing further studies to determine if the side effect of the drug will limit its use, but the reduction in risk is a very important research finding.
We are also making major strides in detecting cancer earlier. For example, improved mammograms for early detection of breast cancer, examinations of stool for blood and colonoscopy to detect colon cancer, and tests for PSA levels to detect prostate cancer have helped us to find these cancers at earlier stages when they are more curable. Research in molecular biology and genetics also promises to provide clinicians with new tools to identify individuals at elevated risk for cancer. However, with a few exceptions, our ability to translate these advances into benefits for patients remains limited.
Finally, we are beginning to accelerate the translation of laboratory discoveries into new and novel treatments for cancer. There are over 360 new treatments for cancer currently under evaluation by the FDA. New molecular targets for potential cancer therapies are being discovered every day and patients have already begun to realize the benefits of agents such as genetic therapies and anti-angiogenesis molecules through their participation in clinical trials. We are also having much greater success in treating advanced cancer in patients due to the increased therapeutic efficacy of new agents.
Additionally, during last year's Annual Meeting of the AACR, the organization's meeting where the most recent advances in cancer research are reviewed and information is exchanged among over 10,000 scientists from all fields of cancer research, several significant findings were presented. For example, dramatic evidence was presented indicating that lycopene, a naturally occurring substance in tomato products already linked to cancer prevention, may also be effective in treating prostate cancer. Additionally it was shown that NSAIDs, common compounds such as aspirin, may work together with other agents as powerful new anti-cancer agents, and play a vital role in preventing colon cancer. We are only a couple of weeks away from the 2000 AACR Annual Meeting in San Francisco, where we anticipate that exciting new advances and discoveries in cancer research will provide the basis for translation into future prevention and treatment strategies.
In summary, these advances indicate that cancer can be conquered through basic, translational, and clinical cancer research, if we have the will to take the bold steps required to make it happen. Although the resource needs for all aspects of cancer research and applications are significant, we must ensure that we continue the pace of scientific discovery in parallel with the efficient translation of these advances from the laboratory to cancer patients. The following initiatives are critical to accelerating progress against cancer:
Increase the level of funding for investigator-initiated research. Our best ideas to cure and prevent cancer come from individual scientists working in the laboratory and with patients. Currently, less than a third of peer reviewed and approved research grant requests are funded. There are just too many good research projects, which cannot be done because of a lack of funding for good research ideas. We recommend that the NCI budget should be increased to a level to eventually allow the funding of 45% of scientifically meritorious grant proposals.
Increase participation of cancer patients in clinical trials and increase the funding to expand our national clinical trials program. Currently, only 2% of adult patients with cancer participate in clinical trials. It has been shown that patients participating in clinical trials have better survival rates and that these trials are highly cost effective. Through clinical trials more patients will receive the most advanced treatment and prevention approaches for their particular cancers. We recommend that participation in clinical trials for cancer patients, especially minority and underserved patients, increase from the current abysmal level of 2% to 10%.
Provide significant increases in federal funding to attract, educate, and train more clinical and translational cancer researchers. We need continued replenishment of leaders to bring findings from the laboratory bench to the bedside. The ongoing uncertainties associated with federal funding for cancer research for basic researchers, and a near lack of funding for translational and clinical cancer researchers, will affect our ability to defeat cancer in the near future. We must recruit new clinicians to become involved in clinical cancer research. This is becoming more and more difficult as managed care tightens budgets and allows little if any time for young physicians to engage in research. We must address this issue if we are to have the trained personnel needed to prevent and cure cancer in the next 10 to 20 years.
Double funding for cancer prevention, and establish "centers of excellence" to support a proactive national initiative in cancer prevention. By far the best way to beat cancer is to never get it. What was once a dream is an achievable reality and cancer is, in many instances, becoming a preventable disease. We must redouble our efforts to further reduce smoking, understand and improve dietary habits and undertake a national effort to identify and test potential cancer chemopreventive agents.
Capitalize on the unprecedented number of opportunities to create new cancer therapeutics through increased funding for cancer therapeutics consortia and public-private partnerships. The final delivery of new cancer drugs to treat cancer depends on the overall process of drug development and clinical trials. Academic institutions, cancer centers and the private sector all carry out these expensive processes. To fully leverage the strengths of all of these sectors to validate new cancer targets and increase the number of new drugs in clinical development, the National Cancer Institute (NCI) must have the resources to fund the development of unprecedented and novel public-private partnerships.
Increase funding for earlier detection of cancer and ensure that these technologies are applied to all populations. The sequencing of the human genome and advances in molecular biology and imaging technologies are allowing us to diagnose cancer at earlier stages when it can be more effectively treated. We will cure more cancer if we detect it early. We have the tools to do it, but we must fund more effective national programs to effectively translate and apply these technologies.
Fund new programs to improve the quality of life for cancer patients. Cancer is a tragic disease that extracts a great deal in terms of human suffering from its victims and their families. We must provide programs that address critical issues such as pain and fatigue in cancer patients, and end-of-life issues for patients and families.
Increase funding to address the research questions dealing with the disparity in cancer rates in minority, elderly, and underserved populations, and accelerate programs to ensure the application of current technologies to improve early detection, treatment, and prevention of cancer in these populations. We must make every effort to reduce and equalize cancer rates across all populations. AACR supports increased funding for these programs to ensure that all populations receive the benefits of cancer research and that these disparities in rates do not continue.
What will be required to turn the tide against cancer and proactively head off the looming increases in cancer rates associated with the aging and changing demographics of America? The answer is relatively simple, a multi-year plan and approach to this daunting problem and an appropriate level of resources to get the job done. In order to accelerate progress against cancer significantly, the AACR strongly supports funding the ByPass Budget of the NCI at the $4.2 billion level requested. This budget will provide funding to make progress in many of the programs outlined above and allow the NCI to pursue several extraordinary opportunities in areas such as cancer imaging, molecular targets for new therapies and preventives, and research on tobacco and tobacco related diseases. The AACR also recommends that the National Institutes of Health (NIH) be granted an increase of 15% over FY 2000 to continue progress toward the current goal of doubling its budget in 5 years. Lastly, we support increasing the budget of the CDC to ensure that programs in early detection, cancer prevention, and cancer control are sufficient to address the needs of all populations, especially those minority and underserved populations that need them most.
Last year in our Testimony to this Committee, we made a bold recommendation. We strongly recommended, and continue to recommend, the implementation of a 5-year plan to conquer cancer with a budget target of $10 billion in five years. This overall proposal, with a set of specific recommendations to accelerate progress against cancer, was outlined in a document entitled the "Report from THE MARCH Research Task Force" that was circulated to Congress last year. This was a bold effort, which for the first time laid out in simple fashion why now is the time to move decisively in a national effort to wage a real "war" to conquer cancer for America and the world. This Report, developed by more than 150 of the Nation's leading cancer researchers, clinicians, advocates, and business leaders, stated that the five-year budget target was both strategic and appropriate, given the enormity of the cancer burden that we face in the future. Further, this cogent set of recommendations projected that undertaking such a plan and providing funds at this level would result in a significant reduction in cancer incidence and mortality. The AACR believes that this Report presented an extraordinary plan to undertake a real, full-scale, unified national plan to conquer cancer and that this should not be forgotten. We encourage Congress to look beyond 2001 to define a multi-year strategy to defeat cancer and provide the funds to do it. In the spirit of the Research Task Force, the AACR plans to offer its own status report and recommendations for accelerating progress in all areas of cancer research and clinical applications early next year and looks forward to reviewing it for the Committee.
In closing, on behalf of the AACR, I would like to take this opportunity to thank the Chairman and members of the Committee for your past support of cancer research through increased funding for the NCI, NIH, the CDC, and other agencies under your jurisdiction that conduct cancer research. It has made a difference for cancer patients and families across this Nation. However, when you receive a cancer diagnosis, it is hard to appreciate all that has been and is being done to conquer this tragic killer. As can be seen by the increasing number of cancer advocacy and survivor groups, coalitions, and efforts to educate the public about cancer, Americans want to prevent and cure cancer and there is a real sense of urgency to do it now. Finally, after 35 years of hard, rewarding work to facilitate all types of cancer research and translation to cancer patients, I was forced to face the crisis that is visited on every family when one of their own receives a diagnosis of cancer. It has been both a terrifying and enlightening experience that has made me understand even more clearly that everyone in America - legislators, cancer researchers, physicians, survivors, business leaders, and the public - must stand together to conquer this tragic killer.
Thank you for your attention. I would be glad to answer any questions you might have concerning my oral remarks or written testimony.
Defeating Cancer - A Sense of Urgency and a Need for Strategic Continuity
Testimony before the House Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies
March 21, 2000
Margaret Foti, Ph.D.
Chief Executive Officer, American Association for Cancer Research
As a result of progress in all areas of cancer prevention, detection, and treatment research, new cases of cancer and death rates have shown a modest decline for the first time in decades. This is a remarkable achievement and means that our new treatments and early detection and prevention programs are beginning to have an effect. However, although these recent declines in cancer mortality and new cancer cases are encouraging, we must remember that cancer still kills more Americans each year than have died in all the wars we fought in the last century, and that 1 of every 2 men and 1 of every 3 women will get cancer in their lifetimes. This year alone, over 1.2 million Americans will be stricken with cancer and over 552,000 will die from their disease - 1500 people every day.
It is also our responsibility to tell you that we can do a great deal to improve all aspects of cancer prevention and treatment now and proactively address this expected rise in new cancer cases to minimize its impact - if we are willing to act now. Past achievements in cancer research and recent progress in the prevention, early detection, and treatment of cancer provides a solid foundation on which to launch a full-scale national effort to eradicate cancer.
For example, we are finally beginning to make significant progress in cancer prevention. Smoking, which is responsible for more than 30% of all cancer deaths, is declining due in large measure to stop smoking programs and education through cancer control programs of the Centers for Disease Control and Prevention (CDC). Unfortunately, increased smoking by adolescents may eradicate this progress against lung cancer in years to come. We have also demonstrated through clinical trials research that the antihormonal agent, Tamoxifen, reduces the risk of breast cancer in high-risk women. In these studies, Tamoxifen reduced the risk of invasive breast cancer by 49% and early (non-invasive) breast cancer by 50%. We are currently doing further studies to determine if the side effect of the drug will limit its use, but the reduction in risk is a very important research finding.
We are also making major strides in detecting cancer earlier. For example, improved mammograms for early detection of breast cancer, examinations of stool for blood and colonoscopy to detect colon cancer, and tests for PSA levels to detect prostate cancer have helped us to find these cancers at earlier stages when they are more curable. Research in molecular biology and genetics also promises to provide clinicians with new tools to identify individuals at elevated risk for cancer. However, with a few exceptions, our ability to translate these advances into benefits for patients remains limited.
Finally, we are beginning to accelerate the translation of laboratory discoveries into new and novel treatments for cancer. There are over 360 new treatments for cancer currently under evaluation by the FDA. New molecular targets for potential cancer therapies are being discovered every day and patients have already begun to realize the benefits of agents such as genetic therapies and anti-angiogenesis molecules through their participation in clinical trials. We are also having much greater success in treating advanced cancer in patients due to the increased therapeutic efficacy of new agents.
Additionally, during last year's Annual Meeting of the AACR, the organization's meeting where the most recent advances in cancer research are reviewed and information is exchanged among over 10,000 scientists from all fields of cancer research, several significant findings were presented. For example, dramatic evidence was presented indicating that lycopene, a naturally occurring substance in tomato products already linked to cancer prevention, may also be effective in treating prostate cancer. Additionally it was shown that NSAIDs, common compounds such as aspirin, may work together with other agents as powerful new anti-cancer agents, and play a vital role in preventing colon cancer. We are only a couple of weeks away from the 2000 AACR Annual Meeting in San Francisco, where we anticipate that exciting new advances and discoveries in cancer research will provide the basis for translation into future prevention and treatment strategies.
In summary, these advances indicate that cancer can be conquered through basic, translational, and clinical cancer research, if we have the will to take the bold steps required to make it happen. Although the resource needs for all aspects of cancer research and applications are significant, we must ensure that we continue the pace of scientific discovery in parallel with the efficient translation of these advances from the laboratory to cancer patients. The following initiatives are critical to accelerating progress against cancer:
Increase the level of funding for investigator-initiated research. Our best ideas to cure and prevent cancer come from individual scientists working in the laboratory and with patients. Currently, less than a third of peer reviewed and approved research grant requests are funded. There are just too many good research projects, which cannot be done because of a lack of funding for good research ideas. We recommend that the NCI budget should be increased to a level to eventually allow the funding of 45% of scientifically meritorious grant proposals.
Increase participation of cancer patients in clinical trials and increase the funding to expand our national clinical trials program. Currently, only 2% of adult patients with cancer participate in clinical trials. It has been shown that patients participating in clinical trials have better survival rates and that these trials are highly cost effective. Through clinical trials more patients will receive the most advanced treatment and prevention approaches for their particular cancers. We recommend that participation in clinical trials for cancer patients, especially minority and underserved patients, increase from the current abysmal level of 2% to 10%.
Provide significant increases in federal funding to attract, educate, and train more clinical and translational cancer researchers. We need continued replenishment of leaders to bring findings from the laboratory bench to the bedside. The ongoing uncertainties associated with federal funding for cancer research for basic researchers, and a near lack of funding for translational and clinical cancer researchers, will affect our ability to defeat cancer in the near future. We must recruit new clinicians to become involved in clinical cancer research. This is becoming more and more difficult as managed care tightens budgets and allows little if any time for young physicians to engage in research. We must address this issue if we are to have the trained personnel needed to prevent and cure cancer in the next 10 to 20 years.
Capitalize on the unprecedented number of opportunities to create new cancer therapeutics through increased funding for cancer therapeutics consortia and public-private partnerships. The final delivery of new cancer drugs to treat cancer depends on the overall process of drug development and clinical trials. Academic institutions, cancer centers and the private sector all carry out these expensive processes. To fully leverage the strengths of all of these sectors to validate new cancer targets and increase the number of new drugs in clinical development, the National Cancer Institute (NCI) must have the resources to fund the development of unprecedented and novel public-private partnerships.
Increase funding for earlier detection of cancer and ensure that these technologies are applied to all populations. The sequencing of the human genome and advances in molecular biology and imaging technologies are allowing us to diagnose cancer at earlier stages when it can be more effectively treated. We will cure more cancer if we detect it early. We have the tools to do it, but we must fund more effective national programs to effectively translate and apply these technologies.
Fund new programs to improve the quality of life for cancer patients. Cancer is a tragic disease that extracts a great deal in terms of human suffering from its victims and their families. We must provide programs that address critical issues such as pain and fatigue in cancer patients, and end-of-life issues for patients and families.
Increase funding to address the research questions dealing with the disparity in cancer rates in minority, elderly, and underserved populations, and accelerate programs to ensure the application of current technologies to improve early detection, treatment, and prevention of cancer in these populations. We must make every effort to reduce and equalize cancer rates across all populations. AACR supports increased funding for these programs to ensure that all populations receive the benefits of cancer research and that these disparities in rates do not continue.
What will be required to turn the tide against cancer and proactively head off the looming increases in cancer rates associated with the aging and changing demographics of America? The answer is relatively simple, a multi-year plan and approach to this daunting problem and an appropriate level of resources to get the job done. In order to accelerate progress against cancer significantly, the AACR strongly supports funding the ByPass Budget of the NCI at the $4.2 billion level requested. This budget will provide funding to make progress in many of the programs outlined above and allow the NCI to pursue several extraordinary opportunities in areas such as cancer imaging, molecular targets for new therapies and preventives, and research on tobacco and tobacco related diseases. The AACR also recommends that the National Institutes of Health (NIH) be granted an increase of 15% over FY 2000 to continue progress toward the current goal of doubling its budget in 5 years. Lastly, we support increasing the budget of the CDC to ensure that programs in early detection, cancer prevention, and cancer control are sufficient to address the needs of all populations, especially those minority and underserved populations that need them most.
In closing, on behalf of the AACR, I would like to take this opportunity to thank the Chairman and members of the Committee for your past support of cancer research through increased funding for the NCI, NIH, the CDC, and other agencies under your jurisdiction that conduct cancer research. It has made a difference for cancer patients and families across this Nation. However, when you receive a cancer diagnosis, it is hard to appreciate all that has been and is being done to conquer this tragic killer. As can be seen by the increasing number of cancer advocacy and survivor groups, coalitions, and efforts to educate the public about cancer, Americans want to prevent and cure cancer and there is a real sense of urgency to do it now. Finally, after 35 years of hard, rewarding work to facilitate all types of cancer research and translation to cancer patients, I was forced to face the crisis that is visited on every family when one of their own receives a diagnosis of cancer. It has been both a terrifying and enlightening experience that has made me understand even more clearly that everyone in America - legislators, cancer researchers, physicians, survivors, business leaders, and the public - must stand together to conquer this tragic killer.
Thank you for your attention. I would be glad to answer any questions you might have concerning my oral remarks or written testimony.