Leading the Nation's Progress against Cancer

Groundbreaking research and training supported by the National Cancer Institute (NCI) has led to a substantial reduction in the burden of cancer in the United States. The development of improved screening and prevention methods, novel approaches for the diagnosis and detection of cancer, and innovative treatments have all contributed to this progress.

The National Cancer Institute

NCI is the federal government’s principal agency for cancer research and training. It is part of the National Institutes of Health, which is one of 11 agencies that comprise the Department of Health and Human Services. NCI leads, conducts, and supports cancer research across the nation to advance scientific knowledge and help all people live longer, healthier lives.

As the largest funder of cancer research in the world, NCI supports investigators working across the United States and in other countries. This support is advancing a broad portfolio of research—from basic laboratory science to clinical trials and population science—to improve our understanding of cancer and cancer prevention, diagnosis, treatment, and survivorship. NCI encourages collaboration between scientists and organizations, conducts a rigorous and accountable funding process, and works with stakeholders to ensure that the nation’s investment in cancer research has maximum impact.

The NCI Annual Plan and Budget Proposal

The National Cancer Act of 1971 authorizes NCI to prepare an annual budget proposal directly for the President and Congress. This proposal represents NCI’s best professional judgment about the funding needed to make the most rapid progress against cancer.

The Annual Plan and Budget Proposal for Fiscal Year 2019 highlights the impact of the nation’s continuing investment in cancer research and directs attention to several areas for which additional support will enable greater and faster progress. The stories of investigators who have devoted their careers to cancer research illustrate some of the innovations driven by NCI-supported science. The stories of patients and survivors highlight how NCI’s investments in research can improve lives and reveal challenges that remain to be addressed.

As this plan shows, the research community—under NCI’s leadership—is making pivotal advances against cancer. However, much more still needs to be done to increase our understanding of the many diseases we call cancer and extend the benefits of research to even more people.

The Return on Cancer Research Investment

From 1990 to 2014 the overall cancer death rate in the United States fell by 25 percent

Improvements in cancer prevention, screening, and treatment, fostered by dedicated researchers across the nation and patients who volunteer to participate in clinical trials, have helped to reduce the burden of cancer in the United States. The clearest sign of this progress is the steady decline in the rate of cancer deaths, which has continued for more than two decades. Specifically, the cancer death rate among adults declined by 25% from 1990 through 2014, and the death rate among children and adolescents (age 19 and younger) declined by 35%. Moreover, of the top 10 causes of death among Americans, only cancer showed a decrease from 2014 to 2015.

For most of the last half of the 20th century, the rate of cancer deaths rose sharply, driven largely by cigarette smoking. Beginning in the early 1990s, however, cancer death rates started to decline because of reductions in tobacco use, as well as increased utilization of other cancer prevention measures, better screening, and new treatments. Continued progress in these areas should ensure that the downward trend in the overall rate of cancer death is sustained or accelerated to prevent the loss of even more lives.

Chart showing that 2.1 million cancer deaths were averted in the United States from 1991 to 2014

Another sign of progress is that the overall rate of cancer incidence for men and women combined declined steadily from 2007 through 2014. However, when the rates for men and women were analyzed separately, a decline was observed only for men; the incidence rate for women remained stable during this period. Nevertheless, these separate trends for men and women stand in sharp contrast with the rising rates of cancer incidence observed for both sexes before the beginning of the 21st century.

The Need for Greater Progress

The surest indicator of the need for greater progress is that an estimated 1.7 million new cases of cancer and 600,000 cancer deaths will occur among U.S. adults in 2017 and approximately 15,000 new cases of cancer and 2,000 cancer deaths will occur among U.S. children and adolescents. In addition, the incidence and mortality rates for some cancers, such as liver cancer, are still increasing, and the numbers of new cancer cases and cancer deaths will continue to grow as the population ages.

Infographic showing the annual rate of new cancers cases per 100,000 people.
Infographic showing the annual death rate from cancer per 100,000 people.

Cancer Disparities

Chart showing the incidence rate of liver and intrahepatic bile duct cancer per 100,000 people from 1992 to 2014. Information broken out by race/ethnicity

Despite the overall decreases in U.S. cancer incidence and mortality, certain population groups in this country suffer disproportionately from some cancers. Although many of the differences in cancer incidence and mortality between population groups can be attributed to access to cancer screening tests and quality cancer care, additional factors, including genetics and lifestyle factors, are also important. More research is needed to better understand and mitigate the effects of both biological and nonbiological factors that contribute to cancer disparities.

Liver cancer is one example for which disparities exist. The rates of incidence and death for this cancer are substantially higher among American Indians/Alaska Natives, Asian Americans/Pacific Islanders, Hispanics, and African Americans than among whites. The reasons for these disparities are not clear and represent an area of research opportunity.

One new NCI initiative focused on understanding biological factors that may contribute to cancer disparities is the Early Onset Malignancies Initiative (EOMI), which was announced in 2016. In this initiative, researchers are seeking to understand why certain racial and ethnic groups have increased risks of developing specific cancers at an early age. Samples of early-onset tumors from four different racial/ethnic populations will be collected for detailed molecular analyses, along with information about treatment(s) received, tumor response, and patient outcomes. Characterization at the molecular level will enable researchers to determine if genetic factors are contributing to disparities in early-onset cancer among the different population groups. Data from the study may enable researchers to answer questions about the molecular determinants of early-onset disease and possible associations with treatment response or prognosis.

Global Burden of Cancer

Infographic showing that from 2012 to 2030 the number of cancer cases worldwide will increase by 51 percent and cancer deaths will increase by 63 percent

Worldwide, more than 21 million new cases of cancer are predicted to occur in 2030, an increase of 50% over the 14 million cases that occurred in 2012. It is also predicted that 13 million cancer-related deaths will occur in 2030, an increase of nearly 63% over the 8 million cancer-related deaths that occurred in 2012. Most of this growing burden of cancer incidence and mortality will be borne by low- and middle-income countries.

To address this growing global burden of cancer and to gain knowledge that can be applied in the United States as well, NCI facilitates global collaborations with other U.S. agencies, foreign governments, nongovernmental organizations, and companies to support clinical trials and medical device development for use in low-resource settings.

The Cancer Moonshot℠

In 2016, NCI was afforded a unique opportunity to advance cancer research through the Cancer Moonshot initiative. The goals of this initiative are to accelerate progress in cancer research, increase cooperation and collaboration among members of the cancer research community and other stakeholders within and outside the federal government, and expand data sharing.

Under the initiative, the research community identified 10 areas of research opportunity where progress could be accelerated with additional funding. NCI was given primary responsibility for scientific oversight of the initiative.

In December 2016, Congress passed the 21st Century Cures Act, authorizing $1.8 billion in funding for the Cancer Moonshot over 7 years. An initial $300 million was appropriated in fiscal year (FY) 2017 to fund the Moonshot recommendations.

Illustration comparing the Cancer Moonshot to an express lane on a highway.

Key Takeaways

  • As the largest funder of cancer research in the world, NCI invests in research ranging from basic science to clinical trials to population research to advance scientific knowledge and help all people live longer, healthier lives.
  • These investments have led to improved cancer prevention, detection, and treatment methods and declines in the rates of cancer incidence and death in the United States.
  • Strong and sustained support for cancer research is necessary to make advances against this disease, both in the United States and worldwide.
  • Increased investments in cancer research will enable us to make even greater progress.