New Directions in Cancer Research

In his presentation, Harold Varmus started by referring to the federal government report “Annual Report to the Nation”, March 2011, on the state of cancer, which shows a 1% decrease in incidence and mortality rates, have been decreasing for the last decade. However, certain cancers, such as pediatric cancers, kidney cancers, and others, have experienced an increased rate for incidence (see below), and  pancreatic and liver cancers, have also seen an increase in mortality.  The latest data are available for the years 2003 to 2007.

This is also the first year (the period 2003-2007) in which the mortality rate for lung cancer in women has finally begun to decrease, a decade after the decline started in men. This decrease is due to a reduction in incidence (due to a decrease in the smoking rate), rather than improved treatment. 

The annual NCI budget is called the bypass budget. The NCI put together a summary of the status of current research and their plan for 2012, entitled “Changing the Conversation” (http://www.cancer.gov/aboutnci/budget_planning_leg/plan).   The NCI emphasizes that cancer is not a single disease, but rather several diseases that require a multi-disciplinary approach. Although the NCI budget doubled from 1998 – 2003, there has been nearly a decade of sub-inflationary funding for the NCI.  The current budget is $5 billion, but it is unclear what the cuts will be due the budget deal of August 2011. In 2010, 1250 grants were awarded to extramural research, which represented 80% of the total budget. The NCI hopes to award a similar number of grants this year by reducing administrative expenses and making cuts to the NCI’s internal research program. Within the new budget, Varmus wants to reorganize the clinical trial groups, maintain the cancer genome work, and fund some new projects such as: the creation of a center of cancer genomics to ensure that products of this effort get out into the community. 

Varmus indicated that he doesn’t want all of the NCI’s research priorities to come from top-down decision-making. To that end, the NCI created a web portal to accept “Provocative Questions”, and they have held four workshops so far to generate some of these questions and have accepted questions on the NCI website. By looking at these questions, one also gets an insight into what cancer researchers don’t know about the disease, and how much work lies ahead to conquer it. Among the interesting  questions already posed are: 

  • Why are some disseminated (metastatic) cancers cured by chemotherapy alone, e.g., testicular cancer and certain lymphomas. What is special about those cancers?
  • Do drugs that are used chronically for other diseases such as cardiovascular disease prevent cancer or cancer deaths?  For example, as reported in the January 1, 2011 issue of Lancet,  based on reports from eight randomized trials, an aspirin a day reduced cancer mortality by 21% overall and 34% after five years for certain cancers. How do anti-inflammatory drugs work to reduce cancer?
  • What are the environmental factors that change the risk of cancer when people move from one geographical location to another. Here, the implication is that environmental and cultural factors are important determinants of developing cancer.  
  •  How does obesity contribute to cancer rates – 20% of cancer mortality is attributed to obesity. It is one of the highest risk factors for developing kidney cancer.  It has also been shown that losing weight reduces cancer risk. What is the mechanism that links obesity to the development of cancer?
  • Why don’t people change behaviors, such as ceasing to smoke, when they know they are at risk of cancer?
  • What protects some people from cancers? Not all heavy smokers get lung cancer. Patients with neurological diseases such as Parkinson’s, Huntington’s, and Alzheimer’s seem to be at lower risk for developing cancer, although there is more melanoma in Parkinson’s patients. 
  • What properties of non-malignant lesions such as  in situ carcinoma of the breast or prostate, predict aggressiveness of disease?  An ancillary question is, what is the clinical significance of finding primary tumor cells at a distant site? It turns out that not all of these instances are life-threatening. Basically, what are determinants of cancer aggression?
  • Why are certain cancers such as kidney and esophageal higher in men than in women?
  • What are the biological mechanisms that explain that mutant genes can have an oncogenic effect (cause cancer) in one cell type, but not have an oncogenic effect in other cell types?

The NCI hopes to promote work on these questions and the mechanism to do so is being discussed. They intend to hold additional workshops and accept questions on their website. Anyone can post a question. Go to the following website and sign up: http://tinyurl.com/3ozxdrx.