In a Time of Transition, a Strong Foundation for Success
As the outgoing director of the National Cancer Institute, I would like you to know how honored I am to have been asked to serve in this wonderful position. Virtually every day brings a fresh reminder of the privilege and excitement that stem from being part of an extraordinary history of biomedical research. Since 1937, when it became the first disease-based institute of what would become the National Institutes of Health, thousands of women and men have devoted their professional lives to NCI and to alleviating the burden of cancer for all who suffer its pain.
It is impossible to serve as NCI director without feeling every day the magnitude of this unique institute’s responsibilities, both nationally and internationally. In the 2009 fiscal year, for example, NCI responded to 63 formal Congressional letters and many more informal public queries. I received more than 250 requests to attend national and international conferences, and my office handled more than 12,000 pieces of correspondence. NCI routinely communicates with over 200 advocacy organizations in 34 states, and each year NCI responds to more than 5,000 media inquiries. Most important, all of these functions add up to a tremendous opportunity to represent groundbreaking cancer science and the new technologies impacting cancer care to our legislators, the public, and the scientific community. They are opportunities to show how NCI is continuing to make great strides toward early detection and improved strategies of decreasing cancer risk.
Today’s progress stands atop a proud history of drug development at NCI that has resulted in more than 50 novel compounds used in adjuvant therapies and in the treatment of advanced cancer. Together these advances have helped decrease the cancer death rate from 199 per 100,000 in 1973 (the year I accepted my first academic appointment) to an estimated 184 per 100,000 in 2009, despite a 44 percent increase in the U.S. population and an increase of approximately 25 percent in the population over age 65. Clearly this number is still far too high, but real progress is being made.
Two decades ago, the 5-year survival rate for women diagnosed with breast cancer was 84.3 percent. Because of NCI-supported research, the 5-year survival rate has risen by nearly 6 percent. Two decades ago, the 5-year survival rate for ovarian cancer was 40 percent. That rate today is 46 percent, and women diagnosed in the earliest stages have a 5-year survival rate of nearly 94 percent. Two decades ago, the 5-year survival rate for bladder and kidney cancers was about 58 percent. Today, because of NCI-supported research, that rate is approaching 69 percent.
Over the past 5 years, despite a series of below-inflation budgets, NCI has started no fewer than nine major new initiatives designed to hasten the pace of research and to get new therapies to patients faster and at lower cost, including the:
- Chemical Biology Consortium
- Functional Biology Consortium
- Physical Sciences-Oncology Centers
- NCI Community Cancer Centers Program
- Coordinating Center for Clinical Trials
- BIG Health Consortium
- Cancer Target Discovery and Development Network
- Cancer Human Biobank (caHUB)
- Enhanced nanotechnology and proteomics initiatives
Over the past 5 years, NCI has embraced the power of the genome. The Cancer Genome Atlas (TCGA), a joint project with the National Human Genome Research Institute, has moved from a pilot project striving to sequence the genomes of three cancers to an established program that has set an ambitious goal of sequencing the genomes of 20 more tumors and potentially, in time, all major cancers.
Over the past 5 years, NCI has begun to take the mountains of data emanating from TCGA to the laboratory, where sequencing and genomic characterization information are turned into knowledge of protein structure and biologic function. This work contributes to a new understanding of cellular processes, which makes it possible to establish new targets for enhanced, individualized therapies. Building on its rich history in drug development, NCI, through the newly expanded NeXT program, is poised to be a singular national resource for the public, academic, and private sectors to work together in the continuum from discovery through first-in-human studies. The result, we firmly believe, will significantly reduce the time and cost of bringing new, safe, effective drugs to patients. The commissioning of the Dilts study on clinical trial efficiency provides NCI, for the first time, with real data concerning the much-too-burdensome series of steps required to start a clinical trial. These data will clearly empower change.
Recently, NCI has led an effort to develop electronic health records for cancer, to help make our oncology care system ready for a time when patients will be, as a matter of course, genomically profiled at various life stages. This idea of characterized, electronically linked patients will be the basis for an entirely new system of clinical trials, in which we will much more quickly—and far more precisely—match patients with newly developed drugs, molecularly based methods of cancer prevention, and enhanced techniques for the very earliest detection of small numbers of transformed cells. Detecting cancer as it begins, and when it is most curable, would certainly change outcomes.
Over the past 5 years, the NCI Community Cancer Centers Program has come into existence, with a network that now numbers 30 hospitals in 22 states working together to find better ways to bring the latest benefits of cancer science to all patients in their home communities, whether in a city center or a distant rural area.
The long list of NCI’s accomplishments over these years includes efforts to attract outstanding young scientists to the study of cancer and to adequately support their development. We have instituted programs that are drawing established scientists from disciplines not traditionally involved in the study of cancer, including the more theoretical branches of physics, mathematics, and physical chemistry, for example. NCI is leading in exciting efforts to create new, genetically engineered mouse models of cancer and to develop new methods of diagnostics and treatments based on nanoparticles. We have come a long way, through our extramural programs in systems biology and our work in stem cell biology, to understand the dynamic nature of the relationship between host and tumor (the tumor microenvironment) and the potential of targeting the components that support growth and invasion.
NCI is proving a vital ally to the Food and Drug Administration in its efforts to regulate tobacco in the United States. NCI’s science also extends to those who have concluded cancer treatment, as we work to distinguish why some fare better than others—and why certain patients are more prone to second, third, and even fourth malignancies. Our survivorship program has changed how we conceive of life after cancer and how we work to support cancer survivors and their loved ones, too.
As I have said many times during these 5 years, what we invest in, through some 5,500 extramural and 345 intramural principal investigators, is not only about cancer; our work benefits all chronic disease, by increasing the knowledge of the very basic foundations of abnormal cellular and host biology.
Every effort NCI puts forward has the goal of benefitting all people and reducing the inequities of race, ethnicity, age, income, language, and education that keep Americans from receiving equal cancer care. Our programs have also recognized that cancer is a global issue for NCI. We have established very successful programs in the Middle East, Ireland, China, and more recently in Latin America, which benefit patients in those countries, while providing vital research links for NCI.
These examples are just a small sampling of the unparalleled research infrastructure and power of the National Cancer Institute and its outstanding community. It gives me great pride to see everything NCI has accomplished in my time here, to witness the extraordinary commitment of every researcher and clinician, nurse and technician, manager and office worker.
I am particularly mindful of NCI’s accomplishments and its commitment—to the unprecedented scientific opportunities that continually push the institute to the forefront of science and medicine—as I prepare to step aside from my position.
As we hand over the responsibility for leading NCI to Dr. Harold Varmus, who will become its 14th director on July 12, we do so recognizing that there is much to be done on the frontiers of science, and we need important new structures to maximally take advantage of the new era of genomic-driven medicine—the new era of translational science.
Dr. Varmus is a stellar scientist and a recognized scientific leader—at both the NIH, where he was director from 1993 to 1999, and at the Memorial Sloan-Kettering Cancer Center, which he led for the past decade. Perhaps it is because I know Harold so well that I can assure you he will, from his first day at NCI, intimately feel the power of its history and work diligently to create a vision for its future.
Dr. John E. Niederhuber
Director, National Cancer Institute