Leading the Nation’s Progress against Cancer
The National Cancer Institute’s mission is to lead, conduct, and support cancer research across the nation and around the world to advance scientific knowledge and help all people live longer, healthier lives. In advancing this mission, NCI is the world’s largest funder of cancer research and manages a broad range of associated activities, including training, information dissemination, and infrastructure and resource development for cancer research and patient care.
The Return on Investments in Cancer Research
NCI collects and analyzes data to generate statistics on cancer incidence, mortality, and survivorship, so trends in the burden of cancer among Americans can be measured. As examples of this progress, the most recent statistics show that:
- The overall rate of cancer deaths in the United States declined steadily for more than two decades. From 1991 through 2016, the age-adjusted rate of death for all cancers combined fell by more than 27%. In 2017 alone (the most recent year for which statistics are available), the age-adjusted rate of death from cancer was 2.1% lower than it was in 2016.
- From 2007 through 2016, the rate of new cancer cases fell by 1.5% each year. This trend stands in sharp contrast with the rising rate of cancer incidence before the beginning of the 21st century. However, the reduction in cancer incidence has not been equivalent for men and women. From 2007 through 2016, the rate of new cancers cases declined for men but was stable for women.
- The incidence and mortality rates for several cancer types fell significantly over time. These improvements varied by sex and race/ethnicity, with notably greater improvement among minorities compared with whites for certain forms of cancer. For example, the greatest declines in lung and bronchial cancer incidence from 2007 through 2016 were observed among Hispanic males and black females, with declines 17% and 6% larger than those observed among white males and females, respectively. During the same period, the greatest declines in lung and bronchial cancer mortality were observed among black males and black and American Indian/Alaska Native females (tied), with declines 17% and 12.5% larger than those observed among white males and females, respectively.
- From 2007 through 2016, the greatest declines in cancer incidence and mortality were observed among blacks compared with other racial and ethnic groups. In spite of this, cancer mortality remains highest among blacks. From 2012 through 2016, cancer mortality was 15% higher among blacks than among whites.
The Need for Greater Progress
Advances in detecting and diagnosing certain cancers at an early stage, improvements in treatment, and public health initiatives that encourage people to adopt proven cancer prevention and screening strategies have all contributed to the progress made against cancer to date. Yet, progress in preventing, diagnosing, and treating cancer is not uniform for all types of the disease. The death rates for some cancers, such as bladder cancer, have not declined, and rates for others, such as liver cancer, have increased.
There is still much work to do. The challenges that lie before us are once again reflected in the most recent cancer statistics:
- Too many people are still diagnosed with cancer and die from it. It is estimated that more than 1.7 million adults in the United States will be diagnosed with cancer in 2019, and more than 600,000 will die from it—more than one person every minute. In addition, more than 16,000 new cases of cancer and nearly 1,800 cancer deaths will occur among children and adolescents in the United States in 2019. Furthermore, as the population ages, the numbers of new cancer cases and deaths among adults will continue to grow, even if the age-adjusted incidence does not go up.
- Too many cancers are still not preventable, readily detectable, or curable. Several deadly types of cancer, including pancreatic, ovarian, and kidney cancers, are often diagnosed at late stages because they do not cause early symptoms, and screening tests to detect them early do not exist. Current treatments for some cancer types, including sarcomas, glioblastoma, and liver and pancreatic cancer are not very effective. Progress against all cancers that affect children and adolescents is urgently needed. The Cancer MoonshotSM is supporting this critical need, including uncovering the mechanisms governing how fusion oncoproteins drive childhood cancers to facilitate drug discovery. Several childhood cancers driven by fusion oncoproteins, such as Ewing sarcomas and fibrolamellar carcinoma (a type of liver cancer), are in need of effective therapies.
- All people do not benefit equally from research advances. Specific populations in the United States, including certain racial/ethnic groups and rural populations, suffer disproportionately from some cancers. Two factors that may contribute to these disparities are inadequate access to cancer screening tests and inadequate access to quality cancer care. Research indicates that genetics, modifiable risk factors, and environmental exposures 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.
- Declining cancer mortality means the number of survivors and the challenges they face will continue to grow. In January 2019, it was estimated that there are 16.9 million cancer survivors in the United States. This number, which represents 5% of the US population, is projected to increase by 28%, to 21.7 million, by 2029. Unfortunately, cancer survivors often face numerous challenges following successful treatment. For example, they have an increased risk of developing a second cancer, other serious health conditions, or both. Survivors of childhood cancers, on average, will have to cope with these effects for much longer periods of time than adult survivors. The needs of cancer survivors require greater attention to ensure that they have the best possible quality of life.
- Cancer is a growing global health burden. Improvements in nutrition, health care, and other factors are increasing life expectancy for most of the world. However, this benefit is accompanied by higher rates of many diseases associated with aging, including cancer. This negative trend is being exacerbated by greater tobacco consumption in many low- and middle-income countries. Worldwide, more than 27 million new cases of cancer are predicted to occur in 2040, an increase of 50% over the 18 million cases that occurred in 2018. It is also predicted that more than 16 million cancer-related deaths will occur in 2040, an increase of 60% over the nearly 10 million cancer-related deaths reported in 2018.
Recent Advances in Cancer Research
Every year, NCI-supported scientists in the United States and around the world publish their latest research findings in peer-reviewed biomedical journals. Improving the prevention, diagnosis, and treatment of cancer depends on many kinds of science, including basic, preclinical, clinical, and population research.
Advances in cancer research are also cumulative. Today’s investments in basic science will lay the foundation for tomorrow’s advances in clinical research—just as many of today’s advances were built on discoveries made many years ago.
Recent examples of NCI-supported research advances are highlighted below.
Today’s investments in basic science will lay the foundation for tomorrow’s advances in clinical research.
Understanding the Mechanisms of Cancer
- Learning how melanoma cells escape immune destruction: A research team led by scientists at the University of Pennsylvania recently demonstrated that melanoma cells continuously shed small vesicles, called exosomes, that are coated with a protein called PD-L1. When this exosomal PD-L1 binds to a protein called PD-1 on the surface of immune cells known as cytotoxic T cells, the T cells become inactivated, thereby preventing them from destroying melanoma tumors. The researchers also showed that measuring the level of exosomal PD-L1 in the blood may help identify patients who are less likely to respond to drugs that boost immune responses by blocking the interaction of PD-L1 and PD-1.
- Developing a new strategy to treat pancreatic cancer: Nearly all pancreatic cancers are driven by mutated proteins called RAS. However, treatments that directly inactivate these mutant proteins are lacking. Recently, research teams at the University of Utah and the University of North Carolina at Chapel Hill independently showed that blocking the activity of proteins downstream from RAS induces a cell-survival process called autophagy. During autophagy, cells actively recycle proteins and other components to continue growing under conditions of stress. The researchers showed that disrupting RAS signaling while, at the same time, inhibiting autophagy with the drug chloroquine blocked the growth of pancreatic cells in the laboratory and caused human pancreatic tumors in mice to shrink. This approach may represent a new treatment strategy for pancreatic and other RAS-driven cancers. New research advances hold promise for directly targeting RAS in the future.
- Using artificial intelligence to prevent cervical cancer: Although cervical cancer is preventable, it remains a leading cause of cancer morbidity and mortality worldwide. Most new cases and deaths from this disease occur in low- and middle-resource settings, where access to screening and prevention programs is limited. Recently, a research team of scientists in NCI’s intramural research program and their collaborators reported the development of a computer algorithm that analyzes images of a woman’s cervix and accurately identifies precancerous changes and cancers. A study using cervical images from women in Costa Rica revealed that automated evaluation was significantly more accurate in detecting tissue abnormalities than conventional Pap tests. This finding suggests that effective point-of-care cervical screening might become achievable worldwide using contemporary digital cameras. Read about Mark, who led this work.
- Preventing prostate cancer with finasteride: Prostate cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among US men. In 1994, NCI launched the Prostate Cancer Prevention Trial (PCPT) to determine whether the drug finasteride could reduce the incidence of prostate cancer in men aged 55 and older. Initial results from the trial, published in 2003, indicated that finasteride could reduce the overall incidence of prostate cancer by 25% but that it might also increase the risk of high-grade tumors. The initial concern about high-grade tumors was recently shown to be unwarranted. After a median follow-up of 18.4 years, PCPT researchers have reported that finasteride reduced the number of prostate cancer deaths among the trial participants by 25%.
Effective point-of-care cervical cancer screening might become achievable worldwide using contemporary digital cameras.
Detecting and Diagnosing Cancer
- Analyzing tumor DNA in urine to detect bladder cancer recurrence: After treatment for localized bladder cancer, patients usually undergo cystoscopy (examination of the lining of the bladder) and urine cytology (looking for cancer cells in urine) to monitor for disease recurrence. However, cystoscopy is invasive, and urine cytology can be inaccurate. Recently, a team of scientists led by researchers at Stanford University reported the development of uCAPP-Seq, a new method to detect bladder tumor DNA in urine. uCAPP-Seq accurately detected tumor DNA in the pretreatment urine samples of patients with early-stage bladder cancer and post-treatment urine samples of patients whose cancers later recurred. When used to monitor a patient’s condition after treatment, uCAPP-Seq significantly outperformed cystoscopy and urine cytology combined in detecting recurrent disease.
- Diagnosing lymphoma with an automated portable device: The high prevalence of AIDS-related cancers, including diffuse large B-cell lymphoma and Burkitt lymphoma, in sub-Saharan Africa is a major health challenge. Accurately diagnosing and treating these aggressive B-cell lymphomas is often hampered by limited resources for tissue collection and analysis and limited availability of health care specialists. Recently, a research team led by scientists at Massachusetts General Hospital developed a portable, automated, low-cost point-of-care device that can accurately diagnose B-cell lymphomas. The device captures B cells in biopsy specimens, “immunostains” the cells with specific antibodies, and then subjects them to holography (a photographic technique that records light scattered from an object and presents it as a 3D image). The holographic pattern of stained lymphoma cells differs from that of unstained cells, and artificial intelligence is used to analyze the images. The device yields quantitative readouts of malignant cell number, cell size, and differentiation between high- and low-grade subtypes based on biomarkers. This device can be used to distinguish benign growths from lymphomas and to classify lymphomas into those that require prompt chemotherapy and those that do not.
A research team developed a portable, automated, low-cost point-of-care device that can accurately diagnose B-cell lymphomas.
- Introducing a new treatment for hairy cell leukemia: Hairy cell leukemia (HCL) is a type of chronic B-cell leukemia named for the hair-like projections found on their cell surfaces. Although many patients can achieve long-term complete remission with the drugs pentostatin (Nipent) and cladribine, about half of patients will relapse within 16 years and require additional treatment. Therefore, therapies that provide durable complete responses and fewer side effects for patients with relapsed or refractory HCL are needed. Recently, an international research team reported positive results from a clinical trial that tested the immunotoxin (an antibody linked to a bacterial toxin) moxetumomab pasudotox (Lumoxiti) in patients with relapsed or refractory HCL. The immunotoxin, which was developed in NCI’s intramural research program, induced a high rate of durable responses and eliminated detectable disease with acceptable side effects. This finding led the Food and Drug Administration (FDA) to approve moxetumomab pasudotox as a treatment for relapsed or refractory HCL.
- Targeting a genetic abnormality with larotrectinib: Gene fusions involving NTRK genes, which encode proteins called tropomyosin receptor kinases (TRKs), are found in a variety of adult and childhood cancers. The resulting hybrid genes produce proteins, called fusion oncoproteins, that drive tumor growth. An international team of researchers recently reported findings from three early-phase clinical trials, supported in part by NCI, that showed the drug larotrectinib (Vitrakvi) induced lasting responses in patients with 17 different types of cancer whose tumors were positive for an NTRK gene fusion. The overall response rate with larotrectinib, including complete responses, partial responses, and stable disease, was 75%. Seventy-one percent of the responses lasted at least one year. Based on these results, larotrectinib was approved by FDA in 2018. NTRK gene fusions were first discovered by scientists in NCI’s intramural research program in the mid-1980s. Read how Rihanna from Connecticut benefited from this drug.
NTRK gene fusions were first discovered by scientists in NCI’s intramural research program.
Advancing Public Health in Cancer
- Addressing rural–urban disparities in cancer outcomes: Approximately 20% of the US population diagnosed with cancer lives in rural areas, and research has shown that rural patients have worse cancer outcomes overall than urban patients. However, NCI-supported researchers recently reported that rural and urban patients who had uniform access to high-quality care through participation in a clinical trial had similar cancer outcomes. The study compared the outcomes of rural and urban patients treated for cancer in clinical trials conducted by SWOG, a National Clinical Trials Network trial group and NCI Community Oncology Research Program research base, from January 1, 1986, through December 31, 2012. These findings suggest that expanding access to high-quality cancer care may help resolve the disparity in cancer outcomes between rural and urban patients.
- Launching BRCA Exchange to inform our understanding of cancer risk: NCI recently launched a publicly available online resource called the BRCA Exchange, which contains aggregated information from around the world on thousands of inherited variants of the BRCA1 and BRCA2 genes. Researchers have known for many years that certain variants in these genes increase the risk of breast, ovarian, and other cancers, whereas other variants are not associated with disease or are of unknown significance. Physicians and patients need to know whether a given variant is likely to be pathogenic (associated with disease) and how likely a pathogenic variant will cause cancer (the variant’s penetrance). Until now, the data on inherited variants in these genes were not cataloged in a comprehensive manner. The BRCA Exchange demonstrates that comprehensive data sharing is possible, and it could serve as a model for sharing data on other cancer predisposition genes or genes associated with other diseases.