Written Testimony Submitted to U.S. House and Senate Appropriations Committees
April 15, 2005
Submitted by:
Margaret Foti, Ph.D., M.D. (h.c.)
Chief Executive Officer
American Association for Cancer Research
615 Chestnut Street, 17th Floor
Philadelphia, PA 19106
(215) 440-9300/fax (215) 440-9313
Executive Summary
The American Association for Cancer Research (AACR) strongly supports the Director of the National Cancer Institute's Challenge Goal to eliminate the suffering and death due to cancer by the year 2015. This ambitious Challenge Goal reflects the multitude of rich opportunities for making research progress that exist in the current state of the science. To capitalize on this remarkable research climate, it is imperative that the federal government make the conquest of cancer a national priority. The AACR calls upon the Congress to provide a sufficient level of support to the National Institutes of Health (NIH) and the National Cancer Institute (NCI) to maintain the research momentum generated by the five-year doubling of the NIH budget. The AACR commends for consideration the detailed strategic plan and budget proposal for FY 2006 put forth by the Director of the NCI.
In furtherance of these objectives, the American Association for Cancer Research urges the Congress to take the following actions:
- Appropriate $30.1 billion for the National Institutes of Health for FY 2006
- Appropriate at a minimum $5.21 billion for the National Cancer Institute for FY 2006
- Reauthorize the National Institutes of Health and preserve the four key authorities of the National Cancer Institute
The American Association for Cancer Research (AACR) strongly supports the Director of the National Cancer Institute's Challenge Goal to eliminate the suffering and death due to cancer by the year 2015. This extraordinarily ambitious Challenge Goal reflects the multitude of rich opportunities for making research progress that exist in the current state of the science. To capitalize on this remarkable research climate, it is imperative that the federal government provide a sufficient level of support to the National Institutes of Health (NIH) and the National Cancer Institute (NCI) to maintain the research momentum generated by the five-year doubling of the NIH budget. The AACR commends your consideration of the detailed strategic plan and budget proposal for
FY 2006 put forth by the Director of the NCI. This document represents the best professional judgment of the cancer community on the work and priorities that are required now to meet the Director's 2015 Challenge Goal.
The American Association for Cancer Research (AACR) is the world's oldest, largest, and most prestigious professional society of cancer research scientists and clinicians. The AACR embraces the mission of our 23,000 members to advance the prevention, detection, control and cures of cancer through research, education, and communication. The AACR is the authoritative voice for those who constitute a continuum of cancer research. It is the work of those within this continuum who contributed to reduced death rates and stabilized incidence in lung, breast, prostate and colorectal cancers during the last decade. Our members recognize that the effort to contain cancer is achievable, is within their grasp, and that the progress we have made gives hope for the future.
Basic Cancer Facts: A Sense of Urgency
Cancer has recently become the number one disease-related cause of death in individuals under the age of 85. One out of every four deaths in the United States is caused by cancer. The impact of cancer will become far more serious as the population ages over the next two decades. About 76% of new cancer cases are diagnosed in people at ages 55 and older. Unless we reverse the current trends, 1 in 2 males and 1 in 3 females alive today - or 113 million Americans - will develop cancer. The incidence of many types of cancer (for example, breast, colon, and lung) continues to rise in women and minorities.
Nearly 1.37 million people in the United States are expected to be diagnosed with cancer in 2005, and 570,280 Americans are expected to die from the disease in 2005. This translates to more than 1,500 people dying of cancer each day, or more than one each minute. In addition to the pain and suffering inflicted by cancer, the economic costs - including medical expenses, lost productivity and death - are staggering. The overall cost of cancer was estimated at $189.8 billion in 2004. The 5-year survival rate for all cancers combined is 64% and more than 9.8 million Americans with a history of cancer were alive in January 2001.
What Should Our Priorities Be?
Cancer is a devastating disease that affects every one of us, either directly or through our families, friends and acquaintances. No one is left untouched by cancer and national surveys and polls repeatedly confirm that cancer is the disease that people fear most, more than Alzheimer's, more than heart disease or any other illness. Those same surveys confirm that a sizable majority of the American public does not feel the government is doing enough and wants to see more funding for cancer research. The American Association for Cancer Research believes that additional government support could be wisely directed and judiciously spent to further a series of critical priorities to accelerate progress in the conquest of cancer. To do so, the AACR recommends increased emphasis and support for the following initiatives through the NIH and the NCI.
Basic Science: The Engine of Discovery
Molecular Epidemiology. Cancer is a group of diseases involving the malfunction of genes that is characterized by the uncontrolled growth and spread of abnormal cells. Increasing research at the basic level to expand our understanding of the behavioral, environmental, genetic, and epigenetic causes of cancer will yield invaluable insights and avenues for further research progress. For example, recent advances in molecular profiling research have exposed differences that explain why one patient with a diffuse large B-cell lymphoma responds well to chemotherapy while another with the same disease shows no response at all. A closer examination of the molecular signature of each cancer reveals subtle differences that call for distinctly different approaches to obtain similar results.
Expanded research in the area of cancer-prone family-based studies, especially through existing international consortia, shows great promise to rapidly increase our knowledge and understanding of how specific cancers develop and evolve. More support is essential to expand studies on the complex influence of behavioral and environmental factors on the risk of cancer. Similarly, the convergence of epidemiologic and molecular approaches and the integration of population science with genomics will enable us to greatly augment the knowledge of cancer risk factors and emerging biomarkers of cancer risk.
Integrative Cancer Biology. While much remains to be learned at the level of the individual cell, there is even more to learn when cancer is studied as a complex biological system, with relationships among cells, between cells and their microenvironment, and between the organism and its macroenvironment. Increased support must be provided to study these interactions with their vast potential to uncover targets for new and more rationally designed interventions to prevent, detect, and treat cancer. Cancer biologists will depend heavily on a multidisciplinary approach to make progress in the development of computational models and improved animal models for assessing the communication malfunctions that initiate the cancer process.
The tumor microenvironment - the local and systemic architecture surrounding a cancer cell - is another complex target that requires expanded study to understand its dynamic and often destructive interactions. The microenvironment influences the effectiveness of therapeutic agents and interacts with the immune system during all phases of cancer progression. Recent advances in the field of immunology have generated new hope for harnessing the body's own immune system in the fight against cancer cells. The technique of adoptive transfer has been developed to strengthen the body's innate ability to recognize and attack cells from a specific cancer. Using a new method for growing T cells outside the body - T cells are the immune cells that recognize and kill foreign cells - this process was used to successfully treat patients with advanced melanoma.
Additional research is also needed to understand the role of the tumor macroenvironment, including the effects of an individual's exposure to various elements such as unhealthy air and water and the effect of diet, obesity, physical activity, tobacco use, and certain microbial agents associated with certain cancers (HPV with cervical cancer; helicobacter with stomach cancer). Recent advances in the development of a vaccine that is effective against cervical cancer show great promise. A large-scale efficacy trial has demonstrated that a virus-like particle (VPL) vaccine is well tolerated and induces a strong protective response by the immune system against infection by the human papillomavirus (HPV), a common sexually transmitted disease that is the main cause of cancer of the cervix.
Focus on Prevention
Cancer prevention can play a role that is far larger and more effective than other approaches to reducing the suffering and death from cancer. Based upon the scientific evidence we now possess, we know that all cancers caused by cigarette smoking could be prevented completely - in 2005, more than 175,000 cancer deaths are expected to be caused by tobacco use. Another one-third of the 570,280 cancer deaths expected to occur in 2005 will be related to the preventable causes of nutrition, physical inactivity, and overweight or obesity. Thus, more than three-fifths of all cancer deaths could be prevented based upon our current understanding of the science. It is essential that increased support and funding be directed towards prevention efforts to take advantage of the immense return - and lives saved - on this investment.
Expanded research to increase our understanding of the biological and behavioral basis of nicotine addiction and energy balance is vitally important to make progress in identifying the most effective preventive measures, including medications, behavioral modifications, and control techniques. For example, recent research has discovered that smokers with certain genetic variants may be more likely to remain abstinent and less prone to relapse when trying to quit smoking. Such information will allow for rational tailoring of treatment to an individual's genetic profile and increase the chances of success.
More research is urgently needed to enhance our understanding of the mechanisms underlying the association among energetics, energy balance, and cancer and to develop effective approaches for the prevention of obesity. Further work on the development of prevention vaccines and drugs to suppress the carcinogenic process at its earliest stages in high risk populations is also critical to leverage the application of prevention strategies where they will do the most good. For example, the recently completed large-scale Prostate Cancer Prevention Trial identified the first-ever drug to reduce prostate cancer risk. Researchers are following up to learn more about the molecular biology of the disease to determine which subset of men would benefit most from use of the agent.
Smarter Clinical Trials
Most new advances in cancer prevention, detection, and treatment must undergo rigorous testing in clinical trials before they can be placed into the mainstream of patient care. The clinical trials system that has served so well is urgently in need of thoughtful and serious reform to enable it to handle the demands and the revolutionary new devices and agents that it is called upon to evaluate. To improve scientific prioritization and coordination, increased support and funding is necessary to make clinical trials more efficient, reduce regulatory barriers, expand patient access, and expedite the incorporation of imaging and other devices into clinical trials practice. Increased efforts are also needed to speed new agent development and biomarker validation through clinical trials. Regulatory barriers that have delayed trials in the past need to be resolved. The recent partnership between the NCI and the US Food and Drug Administration is an encouraging first step to work together to streamline and accelerate the drug delivery process.
Laying the Groundwork: Advanced Technologies
The rapid pace of discovery over the past decade has generated unimaginable volumes of data and information about the cancer process at the genetic, molecular, and cellular levels. To make the most effective use of this data, it must be analyzed and integrated in optimal fashion to produce further breakthroughs and advances. Increased funding and support for building the powerful computers, sophisticated software, and networking that enables collaboration on a global scale is essential to make rapid gains with the information that we already possess. For example, the NCI's powerful bioinformatics platform - the cancer Biomedical Informatics Grid (caBIG) - will make it possible for researchers at cancer centers across the country to access data on the molecular characteristics of patients with a particular type of cancer who are being treated with a specific drug. Expanding this system will provide the unifying architecture needed to connect researchers around the world and vastly expand research capacity.
Cancer imaging is another advanced technology that needs support so that it can be fully utilized both in understanding cancer biology and in guiding cancer interventions. Expanding research in proteomic technologies will lay the groundwork for simple diagnostic blood tests that will be able to detect and identify abnormal proteins that indicate early, treatable cancers. The development of nanotechnology - structures, devices, and systems at the atomic or molecular level - offers unprecedented opportunities for enhancing cancer diagnoses and treatments that bypass the usual biological barriers to reach their targets. To retain the nation's leadership in this field, these advanced technologies must be brought together into an integrated pipeline of cancer diagnostics and therapeutics development. The NCI has proposed, and the AACR supports, a National Advanced Technologies Initiative for Cancer to coordinate, integrate, and capitalize on the most innovative and promising technologies to bridge the gap between discovery and delivery.
Eliminate Cancer Health Disparities
To overcome the unequal burden of cancer experienced by various population groups, expanded research and funding support are needed to discover fundamental causes and develop and deliver effective interventions to reduce disparities. This work must involve epidemiological and behavioral research as well as community-based collaborations and special training programs for minority health care providers and researchers.
Reauthorize the NIH: Preserve the Authorities of the NCI
The National Institutes of Health was last authorized in 1993. Many changes and much progress have been made in biomedical science in the intervening dozen years. The Congress has expressed interest in reexamining the structure of the National Institutes of Health to help streamline and enhance its effectiveness as the nation's premier biomedical research institution. The National Cancer Institute, as the largest institute within the NIH, plays a vital role in all of the research activities of the NIH. Under the National Cancer Act of 1971, the NCI was endowed with several key authorities that have contributed immensely to its ability to control, direct, and produce a vast amount of productive research in support of the fight against cancer. Four of those authorities - the presidential appointment of the NCI director, the National Cancer Advisory Board, the President's Cancer Panel, and the NCI director's bypass budget - have been instrumental to the NCI's three decades of research success. The cancer community is united in its support for the preservation of these authorities in the reauthorization process. Their loss could signal the diminution of the nation's commitment to and urgency of finding a solution to the cancer problem.
The Impact of Flat Funding
There is great excitement in the cancer community around the myriad promising scientific opportunities that exist today for the advancement of biomedical research. That sense of excitement is seriously tempered, however, by the nation's failure to provide an adequate level of funding to sustain the research momentum that was generated by the recent doubling of the NIH budget. Since 2003, appropriations for the NIH have fallen well below the biomedical research inflation rate, resulting in shrinking, rather than expanding, the nation's biomedical research capacity. Flat funding means thousands of lost scientific opportunities. Worse, it means the loss of promising young researchers to the field of cancer research and delays - unforgivable delays - in the delivery of new therapies, and new hope, for thousands of cancer patients. Conquering cancer must be a national priority supported by adequate funds to achieve that goal.
The American Association for Cancer Research urges the Congress to make cancer a national priority. Untold scientific opportunities exist for making advances against cancer and the Congress must appropriate sufficient funds to carry forward the research progress. To do so, the AACR urges the Congress to take the following actions:
- Appropriate $30.1 billion for the National Institutes of Health for FY 2006
- Appropriate at a minimum $5.21 billion for the National Cancer Institute for FY 2006
- Reauthorize the National Institutes of Health and preserve the four key authorities of the National Cancer Institute