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Public Health Research and Cancer

NCI scientists analyze data to explore how inherited genetic variation contributes to cancer susceptibility and outcomes.

Credit: National Cancer Institute

Cancer has a significant impact on public health in the United States. The years of life lost due to premature deaths, the economic burden to society, the burden to people due to lost wages and the costs associated with treatment, and the long-term effects of cancer and its treatment on the quality of life of survivors take a toll at a population level. Moreover, cancer’s impact on public health will continue to grow as the US population ages and some cancer incidence rates rise.

Researchers are addressing this reality by studying cancer and its burden on a population-wide scale. This research includes:

  • maintaining large registries of information about people diagnosed with cancer that can be used to identify important trends in cancer incidence, survival, and mortality; treatment characteristics; and patient outcomes
  • investigating behavioral patterns (such as tobacco use, diet, and screening practices); occupational, environmental, medical, and other exposures; and inherited genetic factors that can influence cancer risk
  • understanding and addressing factors that contribute to the unequal burden of cancer among certain populations, such as higher cancer death rates, less frequent use of proven screening tests, and higher rates of advanced cancer diagnoses
  • analyzing patterns of cancer care and outcomes in different health care settings
  • analyzing the economics of cancer and how the health care system affects access to care
  • studying ways to improve cancer control programs
  • assessing the risks and benefits associated with cancer screening to inform guidance on screening strategies
  • working on strategies to communicate and implement evidence-based practices for cancer prevention, detection, diagnosis, treatment, and survivorship into public health, clinical practice, and community settings

Although cancer affects individual patients and their families in different ways, studying its impact on large populations can provide important information that influences practices, policies, and programs that directly affect the health of millions of people in the United States each year.

NCI supports a diverse array of research that is helping to address issues in cancer-related public health. This research relies on extensive resources, often requires the participation of a large number of people, and can span many years.

NCI plays an important role in public health research by conducting and funding large research studies and assembling large data collections that can be used by researchers worldwide. NCI also engages with other federal agencies and community members to identify, develop, and test culturally appropriate cancer prevention and intervention strategies with communities in mind. Findings from this work inform public health practices to help improve outcomes for all.

Examples of NCI-supported activities in public health research include the following:

Surveillance, Epidemiology, and End Results (SEER) Program

The SEER Program collects data on cancer incidence and survival from cancer registries representing nearly half of the US population. Researchers worldwide use SEER data to identify important cancer-related trends, such as changes in the incidence of or mortality from specific cancers or cancer subtypes, as well as factors associated with prognosis and the risk of second primary cancers. SEER data are a critical source for studies that can spur important new research and inform decisions and policies on cancer control.

Epidemiologic Studies

Epidemiologic studies led or supported by NCI evaluate important factors that affect cancer risk. These factors include diet; tobacco and alcohol use; physical activity; genetics; workplace and environmental exposures, such as medical radiation and diesel exhaust; and infections, such as human papillomavirus (HPV), hepatitis B and C, and HIV. 

For example, the Connect for Cancer Prevention Study, is a partnership between NCI and nine health care systems across the Unites States to explore the causes of cancer and to learn how to better prevent it. NCI also conducts and supports research on the long-term effects of cancer and cancer treatment to identify strategies to prevent or lessen adverse effects in cancer survivors.

NCI research findings have had a significant impact on public health by providing key evidence for determining whether specific exposures can cause or prevent cancer and for translating research findings into clinical practice guidelines and individual behavior recommendations. These findings come from studies that take years to conduct and require long-term “detective” work by NCI researchers and NCI grantees

Health Care Delivery and Cancer Control Research

Through NCI’s Healthcare Delivery Research Program and the NCI Community Oncology Research Program (NCORP), the institute also supports studies assessing patient, clinician, and organizational factors that influence the delivery of cancer care. These studies can provide important information that has the potential to improve cancer care.

Similarly, the Cancer Intervention and Surveillance Modeling Network (CISNET) uses statistical modeling to understand the population-wide impact of cancer control interventions, including prevention, screening, and treatment. CISNET studies, for example, have been used by the US Preventive Services Task Force to inform their recommendations on screening guidelines for lung, breast, colorectal, prostate, and cervical cancers, as well as by the Centers for Medicare and Medicaid Services to inform coverage policies for related screening.

Results from several large clinical trials led by NCI have also contributed to major changes in public health practice. For example, based on findings from the National Lung Screening Trial (NLST), the US Preventive Services Task Force recommended that people at high risk be offered a low-dose helical CT (LDCT) scan screening for lung cancer. The Centers for Medicare and Medicaid Services now covers the cost of lung cancer screening with LDCT once a year for Medicare beneficiaries who meet the criteria.

Behavioral Research

Behavioral research is also critical to public health. NCI supports numerous programs that study behavior and cancer from a wide variety of perspectives. For example, NCI funds research to understand the potential impact of e-cigarettes, vapes, and other electronic nicotine delivery systems on individual and population health. Other studies examine the factors that influence how population groups perceive their cancer risk and how it influences their behavior, such as decisions about cancer screening or whether parents have their children vaccinated against HPV.

Cancer Disparities Research

Certain populations, including specific racial and ethnic groups, rural populations, sexual and gender minorities, and those in poverty, are affected disproportionately by some cancers. There are many reasons for these disparities, including societal factors and inadequate implementation of cancer prevention and treatment interventions in health care practice.

NCI seeks to address cancer-related disparities by promoting and conducting health equity research that identifies the sources of disparities across the cancer control continuum and throughout the human life span. For example, there are NCI initiatives that support research on cancer control in rural settings and other geographically underserved areas, including research on health disparities in Native American populations.

Cancer Survivorship Research

The number of people who have survived cancer is expected to grow to 26.1 million by 2040, further increasing the importance of understanding and developing interventions that address the unique physical, psychological, and economic issues that cancer survivors often face. 

NCI supports a robust research portfolio devoted to helping survivors of adult and pediatric cancers improve both their quality of life and their long-term survival. The institute funds research on adult survivor follow-up care, pediatric and young adult survivorship, survivors with advanced or metastatic disease, and survivorship needs related to primary care. Survivorship-focused studies examine topics such as ways to improve physical activity and diet among survivors, as well as help survivors manage psychological issues such as depression and anxiety. These studies also examine ways to manage physical side effects of cancer and its treatment, such as functional limitations, lymphedema, and sexual dysfunction.

NCI also conducts and funds a number of studies to identify risk factors—related to treatment, behavior, and genetics—for the development of second primary cancers and other outcomes among cancer patients. This research can point to possible interventions for reducing that risk, such as suggesting ways to alter treatments without sacrificing efficacy and guiding the follow-up care of cancer survivors.

One example of NCI-supported survivorship research is the Childhood Cancer Survivor Study (CCSS). This large cohort study examines the long-term adverse effects of cancer and cancer therapy on survivors of childhood cancer who were diagnosed between 1970 and 1999. The study was created to gain new knowledge about the long-term effects of cancer and its treatment and to educate survivors and the medical community about the potential impacts of a cancer diagnosis and treatment. Results from CCSS are used to help design treatment protocols and interventions that will improve survival, while minimizing harmful late effects.