The American Association for Cancer Research (AACR) recently released its Cancer Progress Report for 2012,1 providing a snapshot of the major advances in cancer research, and highlighting the great need for continued funding for the field.
“It is a new day for cancer research and cancer patients,” said Margaret Foti, PhD, MD (hc), Chief Executive Officer of the AACR. “The inspiring stories of courage that are narrated in this report should serve as a catalyst for strengthening our nation’s resolve to eradicate cancer as a major threat to American lives.”
Nevertheless, the report points out, about 577,000 Americans will die of the disease this year. Since cancer is largely a disease of aging, the number of cancer deaths will likely increase dramatically in the future.
That said, the NIH budget has remained essentially flat for the past decade, but because of biomedical inflation the agency has effectively lost 20% of its ability to fund lifesaving research within its current budget parameters. Moreover, a budget mechanism called sequestration will likely be put into effect on January 2, 2013. This means that the NCI and NIH will be forced to absorb an actual 8% cut in funding.
Impact of Sequestration
Sequestration is an economic maneuver arising from the Gramm-Rudman-Hollings Deficit Reduction Act of 1985. It is designed to reform Congressional voting procedures to make the size of the federal budget a matter of choice rather than the outcome of a somewhat arbitrary appropriations process. That is, if the various appropriations bills that Congress passes provide for total government spending in excess of previously delineated budget limits—and if Congress cannot agree to decrease that total—then automatic spending cutbacks are triggered.
Sequestration is based on the monetary difference between the budget cap and the amount appropriated but not yet handed over to agencies. In theory, every agency has the same percentage of its appropriation withheld, but in practice, some large agencies and programs have been exempted (for example, Defense and Social Security). The number of exempted programs has increased, so other agencies have ever-bigger bites taken out of their appropriations, virtually crippling some of their programs, including those of the NIH and NCI.
Cancer will soon be the leading cause of American deaths, said the AACR report, and without major new advances to prevent and treat it, the economic burden will be staggering.
The report highlighted numerous treatment advances. For instance, in the past year, the FDA approved eight new cancer drugs and four new uses for three already approved. These agents are generally more effective and less toxic. However, progress varies from one type of cancer to another, which points to the need for continued research, especially in the genetic underpinnings of the disease and the repurposing of proven treatments for different cancers.
The AACR authors also acknowledged the advances to date in our understanding of biologic, genetic, and molecular processes that drive the growth and spread of cancer. “We have never been better positioned to capitalize on our hard-won understanding of cancer. Unfortunately, continued progress is in jeopardy as investments have steadily declined since 2003,” the report noted.
Prevention and Early Detection
“Advances in cancer prevention and early detection have resulted in some of the greatest reductions in cancer mortality,” said the authors. These have been achieved by translating scientific discoveries into action by means of public health initiatives in education and policy, as well as personalized care.
The report also noted points of intervention when certain cancers can be stopped in their tracks. However, two out of every three cancer deaths in the United States still will be due to preventable causes. Therefore, public health measures must be implemented to reduce exposure to cancer-causing agents, infectious causes of cancer must be prevented or treated, and population-based screening and public education need to be stepped up, the authors continued.
Moreover, since most tumors are a result of genetic changes and since we are learning more about the timing, sequence, and frequency of these changes, we now have unique opportunities for earlier identification of aberrations and, thus, new prospects for early intervention.
Cancer Health Disparities
As it has in the past, AACR noted the significantly higher incidence of certain cancers in certain populations, as well as poorer treatment outcomes (see sidebar). These populations include racial and ethnic minorities, low-income people, and the elderly. The causes of these disparities are many, complex, and poorly understood, but they include unequal access to care, varying behavioral, environmental, and genetic risk factors, lack of inclusion in some clinical trials, and social and cultural biases that affect the relationship between patients and providers.
Lack of health insurance is a major factor in health-care disparities. Overall, 14% of Americans are uninsured, whereas 37% of Latinos and 20% of blacks are uninsured. When insurance coverage is not the problem, there are fewer providers and facilities to meet the needs of minorities and other underserved populations. Further, even when care is available, social and cultural factors often inhibit patients from taking advantage of it.
Congressional support is the critical ingredient to further cancer research. AACR urges Congress to work in a constructive, bipartisan fashion to prevent sequestration. In addition, Congress should designate NIH-NCI as a top national priority by providing annual budget increases at least comparable to the biomedical inflation rate.
The report noted that if the proposed sequestration cuts are enacted, the cancer research and biomedical science enterprise could be destroyed. For example, NIH would be able to fund 2,300 fewer grants than planned for 2013—a particularly devastating consequence at a time when the number of opportunities in cancer research has never been greater. ■
Disclosure: Dr. Foti reported no potential conflicts of interest.
1. AACR Cancer Progress Report Writing Committee: AACR Cancer Progress Report 2012. Clin Cancer Res. September 11, 2012 (early release online).
The ASCO Post asked AACR President Frank McCormick, PhD, Director, UCSF Helen Diller Family Comprehensive Cancer Center, about the ongoing problem of health-care disparities among minorities and other subpopulations.
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