American Association for Cancer Research (AACR)
Submitted to U.S. House and Senate Appropriations Committees
April 15, 2011
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) is the world’s oldest and largest scientific organization focused on every aspect of high-quality, innovative cancer research. The mission of the AACR and its more than 33,000 members is to prevent and cure cancer through research, education, communication and collaboration. We thank the United States Congress for its longstanding, bipartisan support for the National Institutes of Health (NIH) and for its commitment to funding cancer research.
The AACR urges the House of Representatives to continue this commitment to NIH in the coming fiscal year. To sustain the momentum generated through past investments in biomedical research and to improve the health of all Americans, the AACR recommends $35 billion for the NIH in FY 2012. This level of funding is needed to sustain the momentum generated over the past two years through regular appropriations and the additional funds from the American Recovery and Reinvestment Act of 2009. We request a commensurate increase for the National Cancer Institute (NCI), to bring its budget to $5.795 billion in FY 2012.
Cancer research saves lives
Unquestionably, the nation's investment in cancer research is having a remarkable impact. We are in a time of unprecedented scientific opportunity: researchers are gaining momentum, uncovering the insights and developing the tools needed to reverse the cancer epidemic. We are now able to accelerate progress against cancer by translating a wealth of scientific discoveries, such as the mapping of the human genome, into new treatments and preventive strategies for cancer. We can continue to make significant advances—but only if we continue to allocate the required resources to do so. Providing continuity in funding will greatly aid a full-scale national effort to lessen the burden of the more than 200 diseases we collectively call cancer.
This year marks the 40th anniversary of the enactment of the National Cancer Act. In the four decades since President Richard M. Nixon signed this landmark legislation:
- Annual cancer deaths in the United States have declined.
- The five-year survival rate for all cancers combined has improved to more than 65 percent.
- The five-year survival rate for childhood cancers has increased from 30 percent in 1976 to 80 percent today.
- Twelve million Americans have become cancer survivors, compared with only 3 million in 1971.
These remarkable achievements are a direct result of our national commitment to funding cancer research, screening and treatment programs at the NCI, NIH and other agencies across the federal government. Yet this substantial progress will be slowed without stable, predictable federal funding for critical cancer research priorities.
In the last 40 years, innumerable advances in basic science, cancer prevention and detection, therapeutic development and clinical cancer management have been achieved. While these advances are too numerous to list here, the following cancer research advancements occurred in 2010 alone, as a direct result of funding by the NIH:
- Twelve new cancer drugs or cancer drug uses were approved by the FDA, including the first-ever therapeutic vaccine, Provenge, which was approved for men with metastatic prostate cancer.
- Drug inhibitors for specific genetic targets are being developed that will lead to new treatments for multiple types of cancers, including melanoma and lymphoma. New inhibitors not only target specific tumor genes, but also target the tumor micro-environment.
The opportunities and the science currently under way promise many more successes in improved treatment and prevention of cancer. Currently, there are:
- More than 800 cancer therapies from industry in some step of the trial process;
- More than 200 clinical trials accepting children and young adults in progress; and
- More than 200 cancer prevention trials open.
It is imperative that predictable, regular appropriations be provided to the NIH so that these opportunities and other promising areas such as personalized medicine and cancer prevention do not slip from our grasp.
Cancer remains a significant public health challenge
Despite the significant progress we have achieved, we cannot afford to slow down; cancer remains the leading cause of death for Americans under age 85, and the second-leading cause of death overall. In 2011, 1.5 million new cancer cases will be diagnosed and nearly half a million American lives will be lost to this terrible collection of diseases.
Moreover, the United States is facing what some have termed a "cancer tsunami" as the baby boomer generation reaches age 65 this year. More than three-quarters of all cancers are diagnosed in individuals aged 55 and older, and the number of cancer cases is estimated to approach 2 million new cases per year by 2025. This will dramatically exacerbate the current problems with the health care system and it will undoubtedly hit those who can least afford it the hardest—elderly, medically underserved and minority populations.
Beyond the enormous toll cancer takes on the lives of affected individuals and their loved ones, cancer places a heavy burden on the U.S. economy, costing an estimated $228 billion in direct medical costs and indirect costs associated with lost productivity due to illness and premature death.
Targeted therapies as the future of cancer treatment
The future of cancer treatment lies in the ability to treat patients based on the specific characteristics of a patient and his or her cancer—often referred to as personalized medicine. Cancer research is leading the way toward the realization of personalized medicine, in no small part thanks to federal investment in deciphering the fundamental biology of cells, such as the Human Genome Project and, more recently, The Cancer Genome Atlas, an NCI project that is identifying important genetic changes involved in cancer.
Building on the tremendous progress in the understanding of the molecular mechanisms of cancer, numerous novel agents have been developed in recent years and many more are in development. New and innovative clinical trials are now being conducted, such as the I-SPY 2 trial (Investigation of Serial Studies to Predict Your Therapeutic Response with Imaging And Molecular Analysis 2), which uses molecular tests to identify which patients should be treated with which drugs. Importantly, this trial is designed to allow researchers to evaluate patient outcomes during the course of the study to guide treatment decisions for new study participants, increasing the likelihood that patients will receive effective care while maximizing resources.
The NCI is investing in efforts that will facilitate the translation of this wealth of basic knowledge into new treatments, including 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.
Accelerating progress in cancer prevention
The AACR has long been a supporter of cancer prevention research aimed at identifying effective strategies to prevent cancer through lifestyle changes, chemoprevention and early detection and treatment. Prevention is the keystone to success in the battle against cancer because preventing the disease is far more desirable—and cost-effective—than treating it. More than half of all cancers are related to modifiable behavioral factors, including tobacco use, diet, physical inactivity and sun exposure. Furthermore, many cancers can be halted in the early stages if individuals have access to, and take advantage of, screening tests. The science of vaccines—one of the most successful approaches for preventing disease—is one of the most promising areas of ongoing cancer prevention research.
Research on cancer prevention at the NCI focuses on three main areas:
- Risk assessment, including understanding and modifying lifestyle factors that increase cancer risk;
- Developing medical interventions (chemoprevention), such as drugs or vaccines, to prevent or disrupt the carcinogenic process; and
- Developing early detection and screening strategies that result in the identification and removal of precancerous lesions and early-stage cancers.
Cancer biology intersects with several areas and disciplines of cancer prevention, pointing to opportunities for, and the importance of, integrative, interdisciplinary efforts to advance clinical cancer prevention through hard-won science. The breadth and excitement of these current opportunities have never been greater.
Addressing and conquering cancer health disparities
Certain minority and underserved population groups continue to suffer disproportionately from cancer. Conquering cancer health disparities will contribute significantly to reducing the nation’s overall cancer burden, and this issue has been an important focus of both the NCI and the AACR. 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 and 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. We must make every effort to reduce and equalize cancer rates across all populations. The AACR supports sustained funding for these programs to ensure that all populations receive the benefits of cancer research and that these disparities in rates do not continue.
Fighting cancer in challenging fiscal times
We are acutely aware of the difficult decisions Congress must make as it seeks to improve the nation’s fiscal stability. However, it is imperative that such efforts be grounded in the goal of securing the prosperity and well-being of the American people. It is not by chance that the United States is the world leader in cancer research and the development of lifesaving treatments. Our pre-eminence is a direct result of the steadfast determination of the American public and Congress to reduce the burden of this devastating disease by supporting and investing in research through the NIH and NCI.
Consider the following:
- Biomedical research is essential to maintaining American global competitiveness. While our nation has been the undisputed leader in research and innovation, other countries are catching up. According to the Organisation for Economic Co-operation and Development (OECD), national expenditures for research and development as a percentage of gross domestic product (GDP) remained static for the United States between 2001 and 2008 while growing nearly 60 percent in China and 34 percent in South Korea. If this trend continues, we risk losing our global pre-eminence in biomedical research.
- Biomedical research has a strong positive impact on state and local economies. NIH dollars are creating and saving high-wage, high-tech jobs at a critical time for the U.S. economy. A recent report issued by Families USA estimated that NIH awards distributed throughout the 50 states resulted in 351,000 jobs with an average annual salary of more than $52,000, accounting for more than $18 billion in wages. The NCI alone funds more than 6,500 research grants 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.
- Biomedical research is an effective and efficient use of public dollars. NIH funding does not stay inside the Beltway. Nearly 85 percent of the dollars appropriated to the National Institutes of Health are distributed throughout the United States to the most worthy research projects. In fact, NIH has consistently received the highest possible ranking of “effective” under the Office of Management and Budget’s Program Assessment Rating Tool (PART), demonstrating that its programs set ambitious goals, achieve results, and are well-managed and efficient.
The NIH needs stable, predictable increases in funding
Cancer remains a costly burden in terms of its human and economic toll. As NCI Director Harold Varmus has said, “There is no better time to lead the nation’s cancer research efforts… we have a portrait emerging of all the cancers. We know the parts and how the parts interact.” Thanks to successful previous investments, promising research opportunities abound and it is crucial that such possibilities are not lost.
We thank Congress for its past support for the NIH and cancer research and urge you to continue your longstanding, bipartisan commitment. The American people are depending on you to ensure the nation does not lose the health and economic benefits that result from our extraordinary commitment to medical research. The AACR looks forward to working with you to assure that our collective commitment to ending the pain and suffering inflicted by cancer is upheld and that researchers have the resources needed to continue to deliver hope and tangible progress.