Expand Use of Proven Cancer Prevention and Early Detection Strategies

Millions of Americans, and others around the world, remain at high-risk for cancers for which there are proven prevention and early detection strategies. This is particularly true among medically underserved and hard to reach populations, as barriers continue to inhibit the widespread adoption and implementation of these strategies.

The goal of this recommendation is to research, develop, test, and adopt evidence-based strategies to significantly reduce cancer risk in all populations. Researchers will identify effective, sustainable cancer prevention and early detection strategies that involve individuals, family members, caregivers, health care providers and systems, and the community at large, and significantly improve the degree to which they are integrated within clinical and community care settings.

Ultimately, these projects aim to improve the availability and use of early cancer detection and preventive interventions to reduce cancer risk and mortality, and to address cancer health disparities in these areas.

NCI has awarded funding to several research projects that align with the panel's recommendation to expand the use of proven cancer prevention and early detection strategies:

Cancer Center Cessation Initiative (C3I)

Multidisciplinary teams at NCI-Designated Cancer Centers are developing sustainable and effective tobacco cessation treatment programs for cancer patients. These tobacco cessation projects are examining interventions and relapse prevention strategies, including tobacco cessation support methods, counseling, and medications, and how they can be implemented and sustained within care settings. Additionally, the researchers are evaluating tobacco screening approaches, use of the tobacco cessation programs, costs for patients, and tobacco cessation outcomes in cancer patients.

Human Papillomavirus (HPV) Vaccine Trial

HPV is a major cause of cervical cancer that has led researchers at NCI to develop the technology used to create an HPV vaccine to prevent cervical cancer. However, there are issues with the adoption and dissemination of HPV vaccines, especially in low- and middle-income countries where most cervical cancer cases and deaths occur.

To improve cancer prevention through increased HPV vaccination, NCI researchers, in collaboration with investigators in Costa Rica, are studying HPV vaccine efficacy. Specifically, they are testing the effectiveness and durability of a single dose of the vaccine compared with the recommended multiple doses. Using a single dose of the HPV vaccine would reduce challenges to vaccine uptake in many parts of the world, including the cost and lack of medical infrastructure for multiple vaccination visits. Additionally, the researchers are examining the durability and long-term protective effects of HPV vaccination in follow-up studies.

Accelerated Cervical Cancer Control

There are several challenges to cervical cancer control worldwide. Areas with ample resources still face the issues of inefficient screening, overtreatment, and low HPV vaccine‒uptake rates. In contrast, areas with limited resources struggle with lack of follow-up by patients, limited treatment options, and lack of access to HPV vaccines.

To overcome these barriers, NCI researchers are creating new cervical cancer screening approaches that are effective and more efficient. For high resource settings, the investigators are designing a quick and cost-effective HPV genotyping assay to improve the detection and management of cervical cancer.

Additionally, NCI researchers are developing an artificial intelligence approach, called automated visual evaluation, that can analyze digital images of a woman’s cervix and accurately identify cervical precancers. This method could improve the reach and effectiveness of cervical cancer screening in low-resource settings, since it requires minimal training with the use of a cellphone or camera.

Accelerating Colorectal Cancer Screening and follow-up through Implementation Science (ACCSIS)

ACCSIS is improving colorectal cancer screening, follow-up, and referral for care among populations that have low colorectal cancer screening rates. ACCSIS will focus on underserved groups in particular, including racial and ethnic minority populations and people living in rural or difficult-to-reach areas.

The two-phase projects in this program are designing multilevel interventions to reduce the burden of colorectal cancer. The first phase of these projects focuses on pilot studies that demonstrate the feasibility and potential effectiveness of multilevel interventions for increasing colorectal cancer screening and follow-up. The second phase involves testing the implementation and impact of the multilevel interventions in target populations with low colorectal cancer screening rates.

The ACCSIS Coordinating Center provides, collects, and shares resources with ACCSIS centers and the broader research community, and contributes to the evaluation of approaches to increase CRC screening.

More information about this program can be found at the ACCSIS website.

Dissemination of a Colorectal Cancer Screening Program Across American Indian Communities in the Southern Plains and Southwest United States

The overall death rate from colorectal cancer has been dropping steadily for several decades, largely due to increased screening rates, better screening methods, and improved treatment options. However, many American Indian populations have shown either no change or increases in mortality rates for patients with colorectal cancer during that time. American Indian patients are often diagnosed with late-stage cancer and have poorer survival rates compared with other populations.

Although colorectal cancer screening approaches have been shown to reduce the burden of the disease, they are under-utilized by American Indians, which may be due to the underfunding of health care services and lack of disease prevention efforts in American Indian communities. Other barriers to colorectal cancer screening in American Indian populations include: cost, fear of screening or diagnosis, lack of transportation to medical care, privacy concerns, and cultural beliefs.

NCI-Designated Cancer Centers that collaborate with American Indian communities are working to overcome these barriers to colorectal cancer screening by disseminating and implementing effective multilevel screening interventions to American Indian populations at high risk for colorectal cancer. Collaborative efforts between American Indian tribes, cancer researchers, and epidemiologists in these projects are leading to the development of screening interventions based on tribal preferences, tribal and clinical approvals for colorectal cancer screening interventions in American Indian populations, and data sharing guidelines that protect the personal information of American Indians.

Implementation Science Centers for Cancer Control (IS-C3)

The IS-C3 Program supports multidisciplinary and collaborative research centers that form a network for improving cancer control through advancing implementation science. The centers are creating implementation laboratories in clinical and community settings capable of

• supporting a range of innovative and impactful studies
• developing shared implementation science methods to improve study design and metrics for implementation research
• performing innovative pilot projects to determine the best strategies for evidence-based cancer care
• providing data resources on implementation science for broad use within the field
• sharing findings about implementation approaches with the cancer research community

The ultimate goal of IS-C3 is to reduce the burden of cancer by enhancing the adoption, implementation, and sustainability of evidence-based cancer control interventions.

Cancer Prevention and Early Detection Projects Awarded Cancer Moonshot Funding