NCI Director’s Message: Fiscal Year 2023 Annual Plan & Budget Proposal
It’s Time to End Cancer as We Know It
In the 50 years since the National Cancer Act of 1971 was signed into law, we have made remarkable progress in cancer research. Cancer death rates have declined 31% since their peak in 1991. In fact, the rate of decline has accelerated in recent years. We’ve also seen record numbers of Food and Drug Administration approvals for cancer treatments emerge from decades of fundamental research and exciting new technologies that have created new opportunities across the spectrum, from prevention to diagnosis to treatment to survivorship. Even COVID-19 could not stop us.
These advances have led us into a golden age of cancer research. If we harness the promise of this golden age, we can end cancer as we know it. This means transforming the tragedy of cancer, especially in younger and otherwise healthy people. A major step on our path toward this goal would be to cut the cancer death rate in half from its peak in the 1990s. I believe we will do this, and I believe we’ll get there soon.
It has been the National Cancer Institute’s work to create the structures that enable this progress, and our current work is poised to accelerate the pace of research progress. Progress-enabling efforts take many forms and include supporting foundational basic research, training the next generation of cancer caregivers and researchers, and providing the data infrastructure and data sets needed for research. NCI also works across the federal government to support the development of policies that support cancer care and research.
Examples of key infrastructure include the Cancer Research Data Commons and Childhood Cancer Data Initiative. These linked efforts offer access to clinical and molecular data and research tools that have unleashed opportunities for studies that were never possible before. In addition, the Cancer Moonshot℠ has enabled us to create interdisciplinary teams that work together to lead and spread the reach of cutting-edge research, such as immunotherapy approaches for children and adults. With Cancer Moonshot funding drawing to a close at the end of fiscal year (FY) 2023, we will look for ways to sustain this bold effort that has accelerated progress in cancer research.
To end cancer as we know it will require sustained strong investments and team-based efforts. Advances in our understanding and treatment of cancer are built on foundational research, which is largely supported through grants for investigator-initiated projects. It is therefore essential that NCI achieves its goal to increase the fraction of applications that can be funded to the top 15th percentile of R01 applications by FY 2025. Research project grants, including R01 grants, are the source of some of the most innovative and transformative ideas in cancer research. This investment would increase the number of meritorious research proposals NCI funds and ensure that we take advantage of the recent boom in applications from new investigators entering the field.
Without robust and sustained budget increases, paylines cannot be raised, and we would miss out on many great ideas that could advance cancer research.
President Biden’s goal is to end cancer as we know it for all Americans, regardless of race, ethnicity, or income. To achieve this, NCI is fully committed to promoting health equity in all our work. We will ramp up our efforts to grow a more diverse and inclusive cancer research workforce and foster a culture in which everyone flourishes. NCI has long been a leader in supporting research on cancer disparities, and we will build on that strong tradition to ensure that reducing disparities remains a priority throughout our research.
VCU Massey Cancer Center’s Dr. Vanessa Sheppard, a cancer survivor and researcher highlighted in this Annual Plan & Budget Proposal, typifies the kind of researchers we believe will help us overcome cancer disparities. She champions the approach that “we must embed community voices in what we do” and that through dialogue we can increase much-needed cancer screenings and clinical trial participation in these communities.
Looking to the future, we have highlighted four scientific opportunities in this Annual Plan & Budget Proposal that would greatly accelerate progress:
- For people with cancer, participating in a clinical trial should offer hope, not additional burdens to bear. We have the opportunity to bring clinical trials to more people, no matter where they live, by making it possible for them to enroll in their own communities and by using the latest technology, including telemedicine.
- Far too many people face cancers for which there are no effective treatments. Computer-based drug design could dramatically speed up drug discovery and, ultimately, help shorten the 10 to 15 years it typically takes for a new medicine to complete its journey from initial discovery to patient benefit.
- Precision prevention offers the promise of personalized prevention and screening approaches tailored to a person’s individual cancer risk based on their genetic makeup, family history, environmental exposures, and behavioral factors.
- The staggering complexity of tumors makes it difficult to predict how a person’s cancer will progress or respond to treatment. We plan to use the latest technologies, such as artificial intelligence, to enhance the study of tumor dynamics to help learn why some tumors evolve into malignant cancers, how they progress, and why they either respond to or resist therapy.
The proposed Advanced Research Projects Agency for Health (ARPA-H) would be a great partner to help realize the scientific opportunities before us. Pairing NCI’s world-class basic and translational research expertise with ARPA-H's envisioned capability to foster rapid innovation at unprecedented scale would surely save more lives.
Thanks to the progress we have achieved since the National Cancer Act of 1971, the hope of ending cancer as we know it may finally be within our reach—not just for a few, or even many, but for all people. Because of the hard work and dedication of researchers and clinicians like Dr. Sheppard, continued support from Congress, and our partnership with patients, survivors, and their loved ones, I know we can achieve our goal.
- NCI is committed to investigator-initiated research. The FY 2023 budget proposal would enable NCI to increase R01 paylines to the 13th percentile, allowing NCI to fund a greater number of meritorious applications. Robust and sustained investments are needed to achieve the 15th percentile R01 payline by FY 2025.
- NCI is seizing new opportunities in cancer research and building on progress in established areas. Beyond NCI’s broad research portfolio, opportunities include expanding access to clinical trials, improving cancer drug design, understanding tumor dynamics, and advancing precision prevention. In addition to funding research project grants, investments are needed across a multitude of programs, including the NCI-Designated Cancer Centers and clinical trials networks that help translate scientific discoveries into new approaches for patients.
- NCI’s goal is to make health equity a priority in everything we do. NCI will ramp up its commitment to building a diverse and inclusive cancer research workforce and support disparities research to ensure advances in cancer research benefit all people.
- NCI seeks to sustain and leverage the unprecedented opportunities and progress created by the Cancer Moonshot once funding ends after FY 2023. In its 7 years, the Cancer Moonshot will have initiated many new networks and established an infrastructure to conduct cancer research and share resources on a massive scale.