Written Testimony Submitted to U.S. House and Senate Appropriations Committees
March 31, 2006
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
The number of cancer deaths is falling and the number of cancer survivors is increasing each year. This remarkable progress has occurred because of the advances in cancer research, discovery, detection, prevention, and treatment made possible, in part, by a strong and steady level of funding and commitment by the Federal government.
The National Cancer Program supports an incredible array of cancer research programs that shows great promise for benefit to patients with cancer. To sustain the research momentum that has been so carefully built up over the past decade - and to continue to give hope to those with cancer - the Congress must provide sufficient resources to preserve the scientific infrastructure and foster new discoveries.
The American Association for Cancer Research (AACR) stands ready to contribute its share to accelerate our progress against this devastating disease. The AACR joins with other leaders in the cancer community to call upon the Congress to take the following actions to enable these invaluable programs to continue their contributions to improving the lives of patients with cancer and other life-threatening diseases:
1) Provide a five percent increase in funding for the National Institutes of Health
to $29.75 billion for FY 2007; and
2) Provide a five percent increase in funding for the National Cancer Institute to
$5.03 billion for FY 2007.
Early this year, it was reported that the number of cancer deaths every year in the United States fell for the first time in more than 70 years. Coupled with the fact that observed cancer death rates from all cancers combined dropped 1.1 percent each year from 1993 to 2002, these persistent declines in cancer mortality rates are evidence of the success of the National Cancer Program and its research, prevention, and treatment advances.
Among these advances are a series of new targeted cancer therapies that have evolved from a process of rational drug design based upon our expanded understanding of the genetic basis of disease. For example, Herceptin became the first targeted therapy for breast cancer in 1997 - it is an injectable antibody that targets and blocks the function of HER2 protein when it is overproduced in the body, which leads to cancer. In 2001, Gleevec became the first approved kinase inhibtor for cancer, shutting down the BCR-ABL kinase that causes chronic myeloid leukemia. These discoveries have led to a half-dozen other more recent drug approvals that are based upon these and other novel mechanisms of action.
Exciting, life-saving scientific progress such as this will only continue if it is nurtured and sustained by an adequate level of federal research investment. The American Association for Cancer Research (AACR) calls upon the President and the United States Congress to make the commitment to sustain this research momentum by increasing the appropriations for the National Institutes of Health (NIH) to $29.75 billion and the National Cancer Institute (NCI) to $5.03 billion for FY 2007. Without such a commitment, promising research will be abandoned, new treatments may never come to fruition, and patients with cancer will lose the hope of enjoying a life beyond cancer.
The AACR stands ready to contribute its share to accelerate our progress against this devastating disease. As AACR approaches its Centennial Year in 2007, with more than 24,000 members, it is well positioned to foster and facilitate the scientific developments that will underpin our forward movement in basic, translational, and clinical cancer research. Through its five prestigious scientific journals - including Cancer Research, the most frequently cited cancer journal in the world - AACR rapidly disseminates cutting-edge, peer-reviewed findings throughout the medical research community. AACR's Annual Meeting attracts more than 16,000 scientists worldwide to cross-disciplinary sessions led by the world's leading experts. The AACR has been at the forefront of the art of anticancer drug development and the science of cancer prevention, and originated the annual International Conference on Cancer Prevention Research. Through these high quality scientific meetings, along with prestigious awards and research training programs and grants, the AACR utilizes a multilayered approach to stimulate and foster the best science that will lead to the conquest of cancer.
No single sector or entity alone can successfully tackle the complex set of diseases known as cancer. Academic scientists and clinicians have a large role to play in discovery and the translation of discoveries into standard clinical care. Biotechnology and pharmaceutical companies, with their vast research and development and manufacturing and distribution capabilities, are also essential for the smooth, efficient, and effective delivery of cancer medicines to hospitals and patients. Barriers or roadblocks in any aspect of the research, discovery, development, or delivery path will have an adverse impact on achieving the goal of conquering cancer and saving lives.
Central to this multisector effort is the National Cancer Program and the fundamental and foundational work of the National Cancer Institute. For 35 years, because of the National Cancer Act, the NCI has spearheaded the research efforts that have led to the declining mortality rates we are experiencing today. The strategies underlying the National Cancer Program have been developed by the NCI in close collaboration with the cancer community. Each year the Director of the NCI engages in an open and transparent priority-setting process to develop a plan and budget proposal for the following year. It is reviewed by the cancer community and published each fall as The Nation's Investment in Cancer Research: A Plan and Budget Proposal. It is the definitive guide to how the NCI is using its funds and how it plans to spend additional funds should they become available.
The scope and breadth of the activities in which the National Cancer Institute is engaged are truly remarkable. As the leader of the nation's grand plan to attack cancer, the NCI must be provided with the resources necessary to carry out its mission on many different fronts and in many different ways. The five-year doubling of the budget of the NIH enabled the National Cancer Institute to begin to expand its activities into promising new areas that had been beyond its reach. However, since the completion of the budget doubling in 2003, negligible NCI budget increases (in the .5 to 2.6 percent range) and an actual hard budget cut in FY 2006, have forced retrenchment and curtailing of some research.
Our nation's current investment in the National Cancer Institute supports a broad range of scientific research, infrastructure, communications structure, and technological advances. The AACR strongly supports continued and increased investments in these key areas as the surest way to guarantee progress against cancer. In particular, the AACR urges that the NCI maintain its focus on:
- Research to understand the causes and mechanisms of cancer, including continued studies into the genetic, environmental, and lifestyle factors that contribute to cancer causation. This research includes population studies that identify cancer risks, studies of normal as well as abnormal biological functioning, and research on cellular and molecular mechanisms of cancer initiation, progression, and metastasis.
- Research on new approaches to prevent or delay the onset of cancer, including nutrition, vaccination, and chemoprevention. This research should continue its emphasis on behavioral factors that affect cancer risk - poor diet, lack of physical activity, sun exposure, and tobacco use - and strategies to change these behaviors.
- Research to improve early detection and diagnosis of cancer through the discovery and development of biomarkers and imaging techniques. This research includes using proteomic technologies to develop biomarker panels and anatomical and molecular imaging techniques to detect tumors and identify metastasis, as well as studying how patients accept and comply with cancer screening methods.
- Research to discover, develop, and evaluate therapeutics for destroying or controlling cancer cells and metastasis. These include localized therapies - such as surgery or radiotherapy; systemic therapies - such as chemotherapy or vaccines; molecularly targeted therapies (such as Herceptin and Gleevec) directed at specific tumors or tissues; and combinations which are often more effective than either therapy alone.
- Research to improve the quality of cancer care and the quality of life of cancer patients, including the development of ways to measure quality, the impact of aging on quality of care, health and lifestyle issues of cancer survivors, and the development and application of interventions to overcome cancer health disparities.
The National Cancer Institute carries out this vast research portfolio through a wide variety of different vehicles and mechanisms in its research infrastructure. The AACR strongly favors continued and increased support for these areas to optimize the return on research dollars. In particular, the AACR recommends that the National Cancer Institute continue to utilize the following successful multisector approaches to implementing the National Cancer Program:
- Extramural program supports independent scientists conducting research in universities, teaching hospitals, and other organizations outside the NIH. The largest portion of NCI research funds is devoted to this program. It supports a balanced portfolio of more than 7,000 research and training awards, as well as grants, cooperative agreements, and contracts with individual investigators, professional societies, and research institutions. Peer-reviewed research under this program includes genetic, epidemiological, behavioral, social, applied, and surveillance research, basic prevention science, cancer biomarkers, chemopreventive agent development, community oncology and prevention trials, early detection, nutrition science, organ system research, cancer diagnostics, imaging, drug development, and biometrics, among others.
Thousands of AACR member scientists participate in and depend upon support from the extramural program to advance their research goals. Investigator-initiated scientific research is the engine driving new discoveries and advances in cancer research and it must remain at the forefront of efforts to conquer this disease. Funding for this aspect of the National Cancer Program must be maintained at a sufficiently high level to promote and advance research progress.
- Training and Career Development to increase the number of scientists who specialize in the basic or clinical biomedical fields is a critical NCI function. Such investments foster the development of interdisciplinary teams and ensure a growing core of well trained investigators to focus on cancer.
- Partnerships, including with other agencies, pharmaceutical companies, academia, and a wide variety of other organizations, are essential to leverage the limited resources of the NCI. Interagency agreements with the Food and Drug Administration and the Centers for Medicare and Medicaid Services have been highly successful in expediting new drug development and coverage for new treatments. The Academic Public Private Partnership Program (AP4) supports a new way of accelerating drug discovery and development through multiple partnerships.
- Additional important means used by the National Cancer Institute to advance its cancer research agenda include Cancer Centers and Centers of Research Excellence at major academic and research institutions across the country; Networks and Consortia, such as the Early Detection Research Network; NCI-Supported Clinical Trials that involve more than 12,000 investigators; Cancer Surveillance through the voluminous data collected by the NCI Surveillance, Epidemiology, and End Results (SEER) program; Technology Development, including the cancer Biomedical Informatics Grid (caBIG) platform for sharing research data; and Communication, Education, and Dissemination of research progress directly to and for the benefit of the public and public health professionals.
Through this wide array of effective mechanisms, the National Cancer Institute seeks to implement the ambitious research goals of the National Cancer Program. Each facet of the strategy is important and generates synergies with other facets to accomplish more than the apparent sum of the parts. Cuts to cancer research funding jeopardize multiple facets of the strategy and have a direct adverse impact on patients by delaying or halting development of promising treatments.
To sustain the research momentum that has been so painstakingly built up over the past decade, the Congress must provide sufficient resources to preserve the current infrastructure and prevent its diminishment through inflation or other means. The American Association for Cancer Research and the cancer community, recognizing the many competing demands on the federal budget, believe that, at a minimum, a five percent increase for the NIH and the NCI, to $29.75 billion and $5.03 billion respect-ively, will enable these valuable programs to continue in a strong, if not robust, way.
To make a quantum push forward with our efforts against cancer, the Director of the National Cancer Institute has identified, with significant communitywide input, at least five additional areas and opportunities that the NCI is poised to exploit if the resources become available. By investing in these new strategic initiatives (at an additional cost of less than $800 million) the Congress will clearly demonstrate its strong commitment to making the conquest of cancer a national priority and a goal that is within our reach.
Several of these areas for strategic new investments to accelerate our progress against cancer include:
- Expand the Number of Cancer Centers to improve access for underserved populations and extend their outreach and collaboration capabilities.
- Reengineer Cancer Clinical Trials through implementation of the recommendations of the Clinical Trials Working Group.
- Link Science and Technology using a variety of new mechanisms and resources.
- Integrate Cancer Science and encourage interdisciplinary team science across the biomedical research community.
This nation has the most sophisticated and highly developed biomedical research infrastructure in the world in the National Institutes of Health. A significant portion of that research investment is directed squarely at the cancer problem. Incredible progress has been made in understanding this disease and in devising cutting-edge approaches to preventing, controlling, and eliminating it. The pace of this research must be maintained to continue our record of advances that is leading to decreased mortality and improved patient care and outcomes.
The American Association for Cancer Research respectfully requests the Congress to support, at a minimum, a five percent funding increase for the National Institutes of Health (to $29.75 billion) and the National Cancer Institute (to $5.03 billion) to preserve the ability of these successful institutions to continue their groundbreaking work toward the conquest of cancer for the benefit of all of our citizens.