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 in the adoption and dissemination of the HPV vaccine, especially in low and middle-income countries where most cervical cancer cases and deaths occur.

To improve cancer prevention through 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 to 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 available still face the issues of inefficient screening, overtreatment, and low HPV vaccine uptake rates. In contrast, areas with limited resources struggle with unsustainable multi-visit screening programs, limited treatment options, and reduced accessibility to HPV vaccines.

To overcome these barriers, NCI researchers are creating new cervical cancer screening approaches that are effective and 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 only requires minimal training with the use of a cell phone 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 that increase colorectal cancer screening and healthcare delivery, as well as scaling up and implementing these 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 South-West United States

American Indian populations currently show either no change or increases in mortality rates for patients with colorectal cancer. As a result, these patients are often diagnosed with late-stage cancer and have poorer survival rates compared to other populations. Although colorectal cancer screening approaches may help reduce the burden of the disease, they are under-utilized by American Indians, which may be related 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 in American Indian populations, and data sharing guidelines that protect the personal information of American Indian populations.

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, and sharing findings about implementation approaches with the cancer research community. The ultimate goal of the program is to reduce the burden of cancer by enhancing the adoption, implementation, and sustainment of evidence-based cancer control interventions.

Cancer Prevention and Early Detection Projects Awarded Cancer Moonshot Funding