American Association for Cancer Research (AACR)
Submitted to U.S. House and Senate Appropriations Committees
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 AACR, representing 34,000 laboratory, translational and clinical researchers; other health care professionals; and cancer survivors and patient advocates, is pleased to offer the following testimony. As the world’s oldest and largest scientific organization focused on every aspect of high-quality, innovative cancer research, our mission is to prevent and cure cancer through research, education, communication and collaboration.
To improve the health of all Americans, sustain the momentum generated through past investments in biomedical research and restore lost purchasing power due to stagnant budgets, the AACR recommends a funding level increase to $33 billion for the NIH in FY 2013 and a commensurate increase for the National Cancer Institute (NCI). This level of support will enable the future scientific advances needed to seize today’s scientific momentum, save countless lives and spur innovation and economic prosperity for our country and all of our citizens.
The vigorous pursuit of new breakthroughs in cancer research and biomedical science supported through the NIH, as well as the NCI, saves lives and promises to improve the entire spectrum of patient care, from prevention, early detection and diagnosis, to treatment and long-term survivorship. As detailed in the AACR Cancer Progress Report 2011, there has been an amazing acceleration in the rate of advances against the 200 diseases we call cancer, reaching back 40 years to the signing of the National Cancer Act. We are in a time of unprecedented scientific opportunity, driven in large part by the vast new knowledge generated through the mapping of the human genome and growing knowledge of the biology of cancer. This wealth of information is being translated into new treatments and preventive strategies for a number of cancers.
The research community’s ability to sustain this scientific momentum, however, is increasingly jeopardized – particularly given the nation’s current fiscal constraints. Funding for NIH has remained essentially flat for the past decade, and due to the rate of biomedical inflation, the agency has lost approximately $5.5 billion in purchasing power since 2003. Even without adjusting for inflation, enacted spending bills in recent years have imposed outright cuts, and looming sequestration mandated by the Budget Control Act threatens further reductions in 2013.
Furthermore, funding challenges come at a time when we are facing a "cancer tsunami" as the baby boomer generation reaches age 65 and beyond. More than three-quarters of all cancers are diagnosed in individuals aged 55 and older, and the number of new cancer cases is estimated to approach 2 million per year by 2025. This will dramatically exacerbate the current problems with our health care system, and will undoubtedly hit hardest those who can least afford it—the elderly, medically underserved and minority populations. We have reached a critical inflection point in our ability to conquer cancer, and we can only continue to make significant advances if we renew our commitment to allocate the required resources to do so.
Forty Years of Progress in Cancer Research
Cancer researchers have worked tirelessly to understand this disease with which nearly every American has a personal experience. Undoubtedly, the nation's investment in cancer research is having a remarkable impact in our fight against cancer. The historic passage of the National Cancer Act in 1971 focused the attention of the federal government and the general public on the vital need to eradicate this disease as soon as possible. Since that time, investments in cancer research and biomedical science, particularly those supported by public funds through the NIH and the NCI, have accelerated the pace of discovery and the development of new and more effective ways to prevent, diagnose and treat cancer. And because of these investments, today we know that cancer is more complex than what could have been imagined during the signing of the National Cancer Act. Cancer is not just a single disease. It is an extraordinarily complex collection of more than 200 diseases; many of these may comprise a number of different subtypes, depending on which pathways are altered by changes in the cancer genome.
The progress made against cancer in the last four decades is best illustrated by lives saved and an improved quality of life for patients and survivors. 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, up from 50 percent in 1975; the five-year survival rate for childhood cancers has increased from 52 percent in 1975 to 80 percent today; and 12 million Americans are now living as cancer survivors, 15 percent of whom were diagnosed 20 or more years ago. Innumerable advances in basic science, cancer prevention and detection, therapeutic development and clinical cancer management are the reasons for this tremendous progress.
Consider the following advances:
- To date, FDA has approved over 30 molecularly targeted drugs that are less toxic and more effective in treating a number of cancers;
- In 2011 alone, 12 new cancer drugs or cancer drug uses were approved by the FDA;
- In 2011, two newly-approved drugs – one for melanoma and one for lung cancer – were breakthroughs in personalized medicine. Each drug was approved with a diagnostic test that identifies patients for whom the drug is most likely benefit.
These are just a few examples of the numerous achievements that are a direct result of our national commitment to funding cancer research, prevention, screening and treatment programs at the NCI, NIH and other federal agencies. We risk losing emerging opportunities in personalized medicine and cancer prevention without stable, predictable federal funding for critical cancer research priorities.
Cancer remains a significant public health challenge
Despite the significant progress we have achieved, cancer remains the leading cause of death for Americans under age 85, and the second-leading cause of death overall. In 2012, more than 1.6 million new cancer cases will be diagnosed and more than half a million American lives will be lost to this devastating disease. And due to its enormous complexity, progress against certain cancers –such as pancreatic, brain and lung cancers –has been extremely difficult.
Beyond the enormous toll cancer takes on the lives of affected individuals and their loved ones, cancer bears a significant impact on the U.S. economy, costing an estimated $263 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 treatment lies in the ability to treat patients based on the specific characteristics of a patient and his or her disease—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 underlying biology, 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 our 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 that use molecular tests to identify which patients should be treated with which drugs. 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.
Fighting cancer in challenging fiscal times
It is imperative that efforts to improve our nation’s fiscal stability be grounded in the goal of securing the prosperity and well-being of the American people. And it is not by chance that the United States remains a leader in cancer research innovation and the development of lifesaving treatments. Our preeminence 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.
Further, maintaining American global competitiveness is predicated on its commitment to federal support for biomedical research and development (R&D). The United States led the world’s economies in the 20th century because it led the world in innovation. Today we recognize that the competition is more intense; the challenge is tougher; and that is the reason innovation is more important now than ever. A sustained investment into research and development is essential to good, new jobs for the 21st century. Between 1999 and 2009, the U.S. share of global R&D dropped from 38 percent to 31 percent, whereas it grew from 24 percent to 35 percent in the “Asia-10” (China, India, Indonesia, Japan, Malaysia, Philippines, Singapore, South Korea, Taiwan and Thailand). While the U.S. remains a leader in supporting science and technology, that position could soon be overtaken as Asian countries, particularly China, continue to increase their national investments in R&D. Biomedical research not only keeps America competitive globally, it also 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 published by a consortium of science and research medical organizations, estimated that NIH directly and indirectly supported nearly 488,000 public and private sector jobs, and generated $68 billion in new economic activity in 2010 alone.
The NIH needs stable, predictable increases in funding
One out of every three women and one out of every two men in America will develop cancer over their lifetime. More than a half million people will succumb to this disease in 2012–accounting for nearly 1 of every 4 deaths in America. This is the challenge we face today. Only an investment in research will improve this current situation and allow us to build on the improvements that have been made during the past few decades.
The AACR recognizes that Congress is being called upon to make difficult decisions among many competing priorities. However, there is no more important investment our country can make than supporting NIH. Our ability to exploit new and exciting findings for the benefit of cancer patients is contingent on a strong, bipartisan commitment from Congress to provide the necessary funding for the NIH and NCI. Millions of current and future cancer patients and their loved ones are relying on you to help change the face of cancer.