Written Testimony
from the
American Association for Cancer Research (AACR)
Submitted to U.S. House and Senate Appropriations Committees
April 16, 2010
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
The American Association for Cancer Research (AACR) recognizes and expresses its thanks to the United States Congress for its longstanding support and commitment to funding cancer research. The continuing investment in research through the American Recovery and Reinvestment Act of 2009 (ARRA) and the fiscal year 2010 budget will support current projects and provide for new efforts in the fight against cancer. These new efforts are now under way and promise to yield innovative and potentially breakthrough approaches to understanding, preventing, treating and ultimately curing cancer. The full potential, however, will not be fully realized in a short one- or two-year period. Sustained, stable funding through regular appropriations will be necessary to allow researchers to uncover the discoveries today that will lead to more lives saved tomorrow.
Unquestionably, the nation's investment in cancer research is having a remarkable impact. Cancer deaths in the United States have declined in recent years. This progress is occurring in spite of an aging population and the fact that more than three-quarters of all cancers are diagnosed in individuals aged 55 and older. Yet this good news will not continue without stable and sustained federal funding for critical cancer research priorities.
The American Association for Cancer Research urges the United States House of Representatives to strongly support biomedical research funding at the National Institutes of Health (NIH), including carrying out President Obama's vision for doubling cancer research funding in order to find a cure for cancer in our time. Therefore, the AACR supports the biomedical community's recommendation of sustaining the current funding for NIH, which would amount to $35.2 billion in FY2011.
AACR: Fostering a Century of Research Progress
The American Association for Cancer Research has been moving cancer research forward since its founding in 1907. Celebrating its 101st Annual Meeting in Washington, D.C., this April, the AACR and its more than 30,000 members worldwide strive tirelessly to carry out its important mission to prevent and cure cancer through research, education and communication. It does so by:
- Fostering research in cancer and related biomedical science;
- Accelerating the dissemination of new research findings among scientists and others dedicated to the conquest of cancer;
- Promoting science education and training; and
- Advancing the understanding of cancer etiology, prevention, diagnosis and treatment throughout the world.
Facing an Impending Cancer "Tsunami"
Over the last century, enormous progress has been made toward the conquest of the nation's second most lethal disease (after heart disease). Thanks to discoveries and developments in prevention, early detection and more effective treatments, many of the more than 200 diseases called cancer have been cured or converted into manageable chronic conditions while preserving quality of life. The five-year survival rate for all cancers has improved over the past 30 years to more than 65 percent. The completion of the doubling of the NIH budget in 2003 is bearing fruit as many new and promising discoveries are unearthed and their potential realized. However, there is much left to be done, especially for the most lethal and rare forms of the disease.
We recognize that the underlying causes of the disease and its incidence have not been significantly altered. The fact remains that men have a one in two lifetime risk of developing cancer, while women have a one in three lifetime risk. The leading cancer sites in men are the prostate, lung and bronchus, and colon and rectum. For women, the leading cancer sites are breast, lung and bronchus, and colon and rectum. And cancer still accounts for one in four deaths, with more than half a million people expected to die from their cancer in 2010. Age is a major risk factor — this nation faces a virtual "cancer tsunami" as the baby boomer generation reaches age 65 in 2011. A renewed commitment to progress in cancer research through leadership and resources is essential to avoid this cancer crisis.
Blueprint for Progress: NCI's Strategic Objectives
Basic, translational and clinical cancer research in this country are conducted primarily through three venues — government, academia and the nonprofit sector, and the pharmaceutical/biotechnology industry. The Congress provides the appropriations for the National Institutes of Health and the National Cancer Institute (NCI), through which most of the government's research on cancer is conducted. The NCI has developed documents and processes that describe and guide its priorities — established with extensive community input — for the use of these finite resources. "The NCI Strategic Plan for Leading the Nation" and "The Nation's Investment in Cancer Research: An Annual Plan and Budget Proposal Fiscal Year 2011" are the recognized professional blueprints for what needs to be done to accelerate progress against cancer.
The American Association for Cancer Research and many in the cancer research community concur that if the NCI receives the increased investment of $1.2 billion as proposed for FY2011, the NCI will have the capability to rebuild America's research infrastructure capacity and accelerate research progress in critical priority areas:
- Understanding the causes and mechanisms of cancer;
- Accelerating progress in cancer prevention;
- Improving early detection and diagnosis;
- Developing effective and efficient treatments;
- Understanding the factors that influence cancer outcomes;
- Improving the quality of cancer care;
- Improving the quality of life for cancer patients, survivors and their families; and
- Overcoming cancer health disparities.
Federal Investment for Local Benefit
Over half of the NCI budget is allocated to research project grants that are awarded to outside scientists who work at local hospitals and universities throughout the country. More than 6,500 research grants are funded at more than 150 cancer centers and specialized research facilities located in 49 states. In over half the states, grants and contracts to institutions exceed $15 million. This federal investment also provides needed economic stimulus to local economies. For example, on average, each dollar of NIH funding generated more than twice as much in state economic output in fiscal year 2007. Many AACR member scientists across the nation are engaged in this rewarding work, and many have had their long-term research jeopardized by grant reductions caused by the flat and declining overall funding for the NCI since 2003. The recent increase in fiscal year 2010 appropriations and the ARRA funding will help to revitalize America's research infrastructure; however, sustained and stable funding is critical to reap the benefits of this investment. Thus, the AACR supports sustaining the current investment in the NCI with a budget of $5.8 billion.
Understanding the Causes and Mechanisms of Cancer
Basic research into the causes and mechanisms of cancer is at the heart of what the NCI and many of AACR's member scientists do. The focus of this research includes: investigating the underlying basis of the full spectrum of genetic susceptibility to cancer; identifying the influence of the macroenvironment (tumor level) and microenvironment (tissue level) on cancer initiation and progression; understanding the behavioral, environmental, genetic and epigenetic causes of cancer and their interactions; developing and applying emerging technologies to expand our knowledge of risk factors and biologic mechanisms of cancer; and elucidating the relationship between cancer and other human diseases.
Basic research is the engine that drives scientific progress. The outcomes from this fundamental basic research — including laboratory and animal research, in addition to population studies and the deployment of state-of-the-art technologies — will inform and drive the cancer research enterprise in ways and directions that will lead to unparalleled progress in the search for cures.
Accelerating Progress in Cancer Prevention
Preventing cancer is far more cost-effective and desirable than treating it. NCI's strategic plan supports research in: understanding and modifying behaviors that increase risk; reducing the influence of genetic and environmental risk factors; and interrupting the initiation of cancer through early medical intervention. A critical component of this multifaceted approach is ensuring that evidence-based advances that have been shown to inform and motivate people toward healthy behaviors are widely disseminated and accessible.
The NCI uses multidisciplinary teams and a systems biology approach to identify early events and determine how to modify them. More than half of all cancers are related to modifiable behavioral factors, including tobacco use, diet, physical inactivity, sun exposure and failure to get cancer screenings. The NCI supports research to understand how people perceive risk, make health-related decisions and maintain healthy behavior. Prevention is the keystone to success in the battle against cancer.
Developing Effective and Efficient Treatments
The future of cancer care is all about developing individualized therapies tailored to the specific characteristics of a patient's cancer. The NCI’s research in this area concentrates on: identifying the determinants of metastatic behavior; validating cancer biomarkers for prognosis, metastasis, treatment response and progression; accelerating the identification and validation of potential cancer molecular targets; minimizing the toxicities of cancer therapy; and integrating the clinical trial infrastructure for speed and efficiency. The completion of the Human Genome Project and breakthroughs resulting from The Cancer Genome Atlas project are leading the way toward an era of personalized medicine.
Overcoming Cancer Health Disparities
Some minority and underserved population groups suffer disproportionately from cancer. Solving this issue will contribute significantly to reducing the cancer burden. The NCI's investments in this area include: studying the factors that cause cancer health disparities; working with underserved communities to develop targeted interventions; developing the knowledge base for integrating cancer services to the underserved; collaborating to implement culturally appropriate information dissemination approaches to underserved populations; and examining the role of health policy in eliminating cancer health disparities. One size does not fit all in cancer research — special populations require special treatment to achieve success.
Training and Career Development for the Next Generation of Researchers
Of critical importance to the viability of the long-term cancer research enterprise is supporting, fostering and mentoring the next generation of investigators. The NCI historically devotes approximately 4 percent of its budget to support training and career development, including sponsored traineeships, a Medical Scientist Training Program, special set-aside grant programs and bridge grants for early career cancer investigators. Increased funding for these foundational opportunities is essential to retain the scientific workforce that is needed to continue the fight against cancer.
AACR's Initiatives Augment Support for the NCI
The NCI is not working alone or in isolation in any of these key areas. NCI research scientists reach out to other organizations to further their work. The AACR is engaged in scores of initiatives that strengthen, support and facilitate the work of the NCI. Just a few of AACR's contributions include:
- Sponsoring the largest meeting of cancer researchers in the world, with more than 14,000 scientists, where 6,000 scientific abstracts featuring the latest basic, translational and clinical scientific advances are presented;
- Publishing more than 3,400 original research articles each year in six prestigious peer-reviewed scientific journals, including Cancer Research, the most frequently cited cancer journal;
- Sponsoring the annual International Conference on Frontiers of Cancer Prevention Research, the largest such prevention meeting of its kind in the world;
- Supporting the work of the AACR Chemistry in Cancer Research Working Group;
- Convening and supporting the AACR-FDA-NCI Cancer Biomarkers Collaborative;
- Hosting, with NCI, the Molecular Targets and Cancer Therapeutics Conference;
- Sponsoring and supporting a Minorities in Cancer Research Council and a Women in Cancer Research Council;
- Conducting the scientific review and grants administration for the over $100 million donated to Stand Up To Cancer; and
- Raising and distributing more than $5 million in awards and research grants.
Stable, Sustained Increases in Research Funding
Remarkable progress is being made in cancer research, but much more remains to be done. Cancer costs the nation more than $228 billion in direct medical costs and lost productivity due to illness and premature death. Respected University of Chicago economists Kevin Murphy and Robert Topel have estimated that even a modest 1 percent reduction in mortality from cancer would be worth nearly $500 billion in social value. In addition, investments in cancer research stimulate the local economy today and promise huge potential returns in the future. Thanks to successful past investments, promising research opportunities abound and must not be lost. To maintain our research momentum, the American Association for Cancer Research urges the United States House of Representatives to support a budget of $35.2 billion for the National Institutes of Health, including $5.8 billion for the National Cancer Institute.