Director's Update: August 27, 2003

In 1971, the National Cancer Act proposed a goal to find the "cure" for cancer. Resources poured into the National Cancer Program, but as knowledge began to accumulate, we came to understand the complexity of the problem and the reality that the goal was really just a dream.

For more than 30 years, we have been dreaming about eradicating cancer, while becoming progressively more frustrated by witnessing the toll that cancer takes. But we have stayed the course, and through our continued commitment of financial and intellectual capital, cancer is no longer mysterious. We have new insights into its vulnerability.

Today, we still may not be able to "cure" cancer, but we can now implement a comprehensive strategy to preempt the onset and progression of the disease. The exponential advances in cancer research are defining with ever greater specificity the many genetic, molecular, and cellular events that determine the disease process of susceptibility, disease initiation, and fatal progression. And this new knowledge can be translated into innovative and more effective strategies of prevention, elimination, and modulation.

Today, where previously we have failed, we can now succeed, not in the elimination of cancer but in the elimination of the outcomes of cancer - the suffering and death. To achieve this, we must plan for success. So, as director of the National Cancer Institute, I have issued a challenge: to eliminate the suffering and death from cancer, and to do so by 2015. This challenge goal is not a promise. It is a call to do what is possible to do, not what is certain to be done. It requires a concerted effort by the entire cancer community. We must seize upon the astounding trajectory of progress in biomedical research achieved since 1971 to discover, develop, and deliver the interventions that will prevent many cancers, detect and eliminate many others, and modulate the behavior of the remainder so that, ultimately, no one has to suffer and die as a result of this disease.

There is much to discuss about the important medical and scientific challenges, as well as the socioeconomic and cultural obstacles, but one important question is: What will be NCI's contribution to this effort?

Over the course of the past year, my senior leadership team - the Executive Committee of NCI and other leaders from our Divisions and Centers - and I have grappled with that question. We had the benefit of numerous recent internal and external reviews of our programs to guide our thinking - e.g., review of the Cancer Centers and the Specialized Programs of Research Excellence (SPOREs), the Tumor Immunology Workshop, re-engineering the Intramural Program, the Training Commission, and the P01 review, to name a few. We have concluded that, while NCI's major programs are fundamentally on track, a number of important factors have impeded both NCI and the entire cancer community's progress in the discovery, development, and delivery of cancer interventions.

To remove these impediments, we must focus on the following areas: understanding the behavioral, environmental, genetic, and epigenetic causes of cancer; understanding the complex networks within cancer cells and between cancer cells and their environment; applying proven interventions, whether for preventing, detecting or treating cancer, equitably, across all subsections of our population; developing a more efficient clinical trials system - the system of studies that use human patients to test interventions - to bring promising interventions more quickly into the healthcare system; enhancing the system of procedures, interaction, and resource sharing, such as improved biospecimen (particularly human tissue) accessibility, among the members of the cancer community; and standardizing research data elements and developing the ability to interconnect data sets, which are requisite for comparing results from related studies.

As a consequence, we decided that, in addition to our current programs, NCI's most logical and helpful contribution to the challenge goal is to mount initiatives that overcome factors which broadly impede progress throughout the cancer community. To that end, we are developing seven proposed initiatives:

• An integrative cancer biology initiative that will expand our understanding of the complex networks within and between cancer cells and their environments, and enable rapid in silico (i.e., computer-based) testing of new ideas, for the purpose of discovering new directions for cancer prevention, detection, diagnosis, and treatment.
• A molecular epidemiology initiative that will merge the insights of the genetic revolution with those of population sciences, and thereby expand our understanding of the behavioral, environmental, genetic and epigenetic causes of most cancers, driving the discovery of new ways to prevent cancer and more effectively treat cancer patients.
• A bioinformatics initiative that will develop a virtual web of interconnected data, individuals, and organizations and thereby dramatically enhance our ability to conduct all types of cancer research - from bench to bedside, and back to the bench.
• An initiative to develop and deploy an integrated clinical trials system to accelerate the development of cancer interventions and ensure that those interventions are efficiently incorporated into the care of all populations in need.
• An initiative focused on developing other high-priority resources (e.g., a national biospecimens resource bank) and procedures (e.g., streamlining the regulatory review process) - and especially focused on harnessing the full potential of advanced technologies - to efficiently and cost-effectively develop new cancer prevention, early detection, and treatment interventions.
• An initiative to identify public health and medical interventions that prevent, detect and predict cancer, and to promote the rapid and full adoption of these measures for the benefit of all.
• An initiative focused on overcoming the unequal burden of cancer that is borne by various population groups in our nation.

This is only a beginning and only a portion the overall effort that will include other institutes and centers of NIH; other federal agencies, like the Food and Drug Administration and the Centers for Disease Control and Prevention; and other public and private ventures in the community. If successful, these initiatives will accelerate the progress of cancer research and pay considerable dividends for all members of our community. And most of all, they will directly benefit cancer patients and members of the public, both in the near-term and even more dramatically as we get closer to 2015.

These proposed initiatives are currently undergoing several rounds of internal review, after which they will be presented to our advisory boards. Finally, and most importantly, I will be releasing drafts of these initiatives early in 2004 and asking for input from the entire community. Together, we will find the common ground necessary to reach the challenge goal.

A world in which the burden of cancer has been eliminated is no longer a dream; it is a vision taking shape as a plan. Let's work together to make that plan a reality.

Andrew C. von Eschenbach, M.D.
Director, National Cancer Institute