Cancer Trends: Influencing Care and Research Priorities
, by Lynne Penberthy, M.D.
The following is the first in a series of posts from senior NCI scientists and leaders on NCI's Annual Plan and Budget Proposal for Fiscal Year 2017, which was officially submitted to the President on September 17, 2015. The proposal provides an overview of NCI’s priorities and key initiatives and the institute's funding request for the President to consider in formulating his own Fiscal Year (FY) 2017 budget proposal.
In this first post, Lynne Penberthy, M.D., associate director of the Surveillance Research Program in NCI's Division of Cancer Control and Population Sciences, discusses how NCI tracks key cancer trends and how those trends influence NCI's research priorities.
NCI has been collecting data on cancer cases and their treatment and survival for decades. The trends that are derived from analyzing these data are important indicators of the progress we are making in reducing cancer incidence and mortality for individual cancer types and for cancer overall, and for identifying cancers that may be increasing in incidence.
NCI's chief means of monitoring key cancer trends is the Surveillance, Epidemiology, and End Results (SEER) program, and changes being implemented to the program reflect the institute’s response to the evolving needs of cancer researchers in this new era of precision medicine.
As we document in NCI's Annual Plan and Budget Proposal for Fiscal Year 2017, many of the trends that we're seeing are changing how we view cancer and how we address it, from prompting research to identify the underlying causes of cancers that are increasing in incidence to informing research on cancer treatment and prevention.
As an example, the "Progress & Trends" section of the FY 2017 Annual Plan shows trends in racial and ethnic disparities in the incidence and mortality of certain cancers are changing how we think about the prevention or early detection of these cancers in specific populations. For instance, given the documented disparities in colorectal cancer among African Americans in relation to the general population, NCI is funding studies that are testing ways to improve screening rates in this population group. And the growing obesity epidemic, paired with research suggesting that obesity plays a causal role in at least eight different cancer types, not only allows us to tailor our approaches to prevention, but has also encouraged researchers to more closely study the biology underlying obesity-related cancers.
Increasing the Power of SEER
In the case of SEER, we are taking critical steps to make it an even more powerful research tool. Paramount among these steps is incorporating clinically relevant data on subtypes of specific cancers, based on histology, cell type, or molecular characteristics, into our data collection—a change that has been greatly aided by the inclusion of electronic pathology reports in SEER’s cancer registries.
What this means for an individual diagnosed with cancer is very important in helping them better understand their disease. For example, we now know that breast cancer, like many other cancers, is not a single disease. Since 2010, SEER has been collecting information on the four main subtypes of breast cancer. As women with breast cancer become more familiar with the concept of breast cancer subtypes, they will be able to work more closely with their doctors to understand how their subtype influences their treatment options and what the implications are for their health outcomes. And, as researchers learn more about cancer subtypes, including trends in the diagnosis of certain subtypes, this information can help to guide research priorities, including the need for new therapies.
Importantly, the collection and presentation of data on trends by subtype is being expanded to include many other types of cancer, such as esophageal, pancreatic, thyroid, head and neck, and lung cancer.
Another new emphasis of SEER is obtaining more detailed information about the treatment patients receive. Including more complete treatment information will improve our ability to understand the prognosis of specific cancer subtypes and the effectiveness of standard treatments in different patient groups. Currently, most data on the effectiveness of treatments are from limited numbers of patients in clinical trials or cohorts of patients at certain institutions. Having such data on a population-wide basis will help us understand the differences in outcomes we now see and can go a long way toward defining research needs and providing clinicians and patients with the knowledge they need to make truly informed treatment choices.
Cancer Registries and Future Cancer Research
Systems like SEER and other cancer registries—both domestically and, increasingly, globally—will be critical in tracking our progress and identifying areas of research needs.
Of course, the most important trend that we have seen is the continued decline in the overall cancer death rate in the United States: proof positive that we’re making important progress. And, as the Annual Plan and Budget Proposal lays out, we believe that even greater progress is possible. Your feedback is an important part of this process, so I encourage you to offer your thoughts in the Comment section below on the trends you’re seeing in your clinical practices, your communities, your research, and where you see the greatest possibilities for maintaining and accelerating progress.
For a discussion on cancer registries and how they inform scientific directions, please join my colleague, Kathy Cronin, Ph.D., for a webinar, “Understanding Population Trends in Cancer,” on Tuesday, October 6 at 2:30 pm Eastern Time. Register for the webinar.
I also encourage you to read the forthcoming posts in this series. Taken together with the Annual Plan and Budget Proposal, these blog posts will provide important insights into the future of cancer and cancer research.
NCI FY 2017 Annual Plan & Budget Proposal Blog Series
December 10: Precision Medicine Trials for Cancer: A New Era