National Cancer Institute
Women's Health Report, Fiscal Years 2001-2002*
March 2003

Executive Summary

This report describes many of the activities and accomplishments of the National Cancer Institute's (NCI's) research programs in fiscal years 2001 and 2002, addressing cancers specific to or primarily affecting women, as well as those cancers with high incidence or mortality among women. Included are breast, cervical, ovarian, endometrial, colorectal, lung and other tobacco-related cancers, as well as AIDS (acquired immunodeficiency syndrome) associated malignancies.

Please note: Incidence and mortality statistics reported for 2003 will be age-adjusted to the 2000 U.S. population standard. Previous statistics based on the 1970 population standard should not be compared to new data generated from 2000 age-adjusted population standard. Additionally, some of the rates, particularly for different racial/ethnic groups, will be changed as the new statistics are calculated.

Cancer continues to take a devastating toll on American women. By the end of 2003, an estimated 658,800 women will have been diagnosed with cancer, and approximately 270,600 women will have died of the disease. Despite these grim statistics, our nation is making important progress in the fight against cancer. In the 1990s, cancer incidence rates for all cancers decreased for men and remained relatively stable for women. Cancer mortality rates for both women and men declined through the 1990s. However, lung cancer mortality rates for women have been increasing. Breast cancer incidence rates showed little change in the 1990s, but death rates have declined by about 3 percent of January 1999, there were 8.9 million people, or 3 percent of the U.S. population, who were cancer survivors, and 56 percent of these survivors were women.

NCI is committed to continuing efforts to reduce the toll of cancer through scientific discovery and its application to people. In 2000, NCI formally established an Office of Women's Health. Organizationally located within the Office of Science Planning and Assessment, the Office of Women's Health is responsible for assisting in planning, evaluating, and coordinating activities related to cancers in women. Among the other programs and activities in NCI that focus on women's cancers are the Breast and Gynecologic Cancer Research Group in the Division of Cancer Prevention, and the multidisciplinary Breast Cancer and Gynecologic Malignancies Faculties of NCI intramural researchers. NCI staff participate in multiple, diverse relevant scientific partnerships and collaborative activities with other federal and non-federal scientists.

NCI supports and coordinates broad based research programs investigating all aspects of cancer in men and women. Through its strategic planning process, NCI has identified many of the questions that need to be answered, areas of research and care that need to be further investigated, and infrastructure that needs to be strengthened to advance our knowledge in the study of cancer. By focusing research on areas with high potential, we have the opportunity to accelerate the pace of discovery and facilitate the translation of research knowledge to clinical application.

The strategies are outlined in The Nation's Investment in Cancer Research: A Plan and Budget Proposal for Fiscal Year 2004 and include descriptions of areas that will advance discovery and its application and address areas of public health emphasis. As part of the planning process, NCI convenes Progress Review Groups (PRGs) to assist in setting priorities for organ site specific research. Between 1998 and 2002, 10 PRG reports were completed including breast, colorectal, lung, and gynecologic cancers. Following release of the reports, NCI develops strategic plans for implementing PRG recommendations. Reports for all completed PRGs, strategic plans, and additional information are available at the PRG website.

Genetic and Environmental Factors

To develop more effective approaches to cancer prevention, early detection, and treatment, we need to better understand the interactions between inherited genetic and environmental factors. Consortia and resource networks bring multidisciplinary researchers together to pool data and resources for large population studies. For example, NCI Breast and Ovarian Cancer Family Registries and the Cancer Genetics Network provide resources for characterizing predisposing genes in high-risk families. Increasing knowledge of the molecular changes that cause cancer enables us to identify potential targets for prevention and treatment drug discovery. New technologies help to define the molecular signatures of cancer cells and the microenvironment with which they interact. Recent exciting advances in proteomics have resulted in a new procedure for recognizing patterns of protein expression in normal and cancerous blood samples. A test for early detection of ovarian cancer using proteomics is now in clinical trials.

Imaging and Biosensor Technologies

Advances in imaging and biosensor technologies are resulting in improved cancer detection, diagnosis, and treatment through the development of novel imaging agents, improved functional imaging methods, and the development of molecular and digital imaging databases. Investigators are studying the use of digital mammography to enhance the interpretation of conventional mammography. Tools such as ultrasound, molecular resonance imaging, and positron emission tomography are being studied for their potential to improve the accuracy of screening and diagnosis of breast and other cancers.

Quality of Care

Ongoing and planned initiatives support research to understand disease and treatment-related effects and develop effective interventions to improve quality of life and disseminate clinical guidelines to improve quality of care. Numerous initiatives focus on research on the social, cultural, environmental, biological, and behavioral determinants of cancer, and how they contribute to disparities in cancer care and prevention in population groups that are disproportionately impacted by cancer. For example, The Center to Reduce Cancer-Related Health Disparities (CRCHD) has identified as a high priority, the need to understand and reduce the high rate of cervical cancer mortality in some regions of the United States. During 2001 and 2002, the CRCHD has consulted with experts from these regions and from other federal and state health agencies to develop interventions that ultimately reduce this preventable cancer.

Tobacco

The devastating impact of tobacco use and exposure to tobacco is being addressed by studies to better understand the genetic and environmental factors involved in tobacco addiction, screening trials in current and former smokers, clinical research to identify behavioral and pharmaceutical interventions for prevention and treatment of addiction, and better treatments for tobacco-related cancers. NCI has taken the lead in a public/private partnership effort to address the high rate of tobacco-related cancers in women and adolescent girls. Recommendations from a priority setting meeting held in early 2003 will provide the basis for the development of action plans to increase our understanding of the sex-based differences in women's smoking behaviors, susceptibility to tobacco addiction and tobacco-related cancers, and translation of current knowledge to effective prevention and treatment interventions.

Clinical Trials

NCI supports a broad program of clinical research to develop new agents and novel approaches for the prevention, early detection, and treatment of cancer. Clinical trials to evaluate improved and novel prevention, detection, and treatment strategies are carried out within a clinical trials infrastructure that includes NCI Cancer Centers, Cooperative Clinical Trials Groups, Specialized Programs of Research Excellence, and the Community Clinical Oncology Program (CCOP) and Minority-based CCOPs.

The following report was prepared and submitted by the National Cancer Institute to the Director of the Office of Research on Women’s Health, NIH as part of the legislative requirement of the NIH Revitalization Act of 1993 [Sec. 486B(a)(1)] that, with respect to research on women's health, the Director of the Office shall biennially prepare a report describing and evaluating the progress made during the preceding two fiscal years in research and treatment [on women's health] conducted or supported by NIH.

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Executive Summary Introduction Cross-Cutting Initiatives Breast Cancer Cervical Cancer Ovarian Cancer Endometrial Cancer Lung and Other Tobacco-Related Cancers Colorectal Cancer AIDS-Associated Malignancies Requests for Applications (RFAs) and Program Announcements (PAs) Relevant to Women's Health, FY 2001-2002 Selected Meetings of Interest Full Report (PDF)	National Cancer Institute Women's Health Report, Fiscal Years 2001-2002* March 2003 Executive Summary This report describes many of the activities and accomplishments of the National Cancer Institute's (NCI's) research programs in fiscal years 2001 and 2002, addressing cancers specific to or primarily affecting women, as well as those cancers with high incidence or mortality among women. Included are breast, cervical, ovarian, endometrial, colorectal, lung and other tobacco-related cancers, as well as AIDS (acquired immunodeficiency syndrome) associated malignancies. Please note: Incidence and mortality statistics reported for 2003 will be age-adjusted to the 2000 U.S. population standard. Previous statistics based on the 1970 population standard should not be compared to new data generated from 2000 age-adjusted population standard. Additionally, some of the rates, particularly for different racial/ethnic groups, will be changed as the new statistics are calculated. Cancer continues to take a devastating toll on American women. By the end of 2003, an estimated 658,800 women will have been diagnosed with cancer, and approximately 270,600 women will have died of the disease. Despite these grim statistics, our nation is making important progress in the fight against cancer. In the 1990s, cancer incidence rates for all cancers decreased for men and remained relatively stable for women. Cancer mortality rates for both women and men declined through the 1990s. However, lung cancer mortality rates for women have been increasing. Breast cancer incidence rates showed little change in the 1990s, but death rates have declined by about 3 percent of January 1999, there were 8.9 million people, or 3 percent of the U.S. population, who were cancer survivors, and 56 percent of these survivors were women. NCI is committed to continuing efforts to reduce the toll of cancer through scientific discovery and its application to people. In 2000, NCI formally established an Office of Women's Health. Organizationally located within the Office of Science Planning and Assessment, the Office of Women's Health is responsible for assisting in planning, evaluating, and coordinating activities related to cancers in women. Among the other programs and activities in NCI that focus on women's cancers are the Breast and Gynecologic Cancer Research Group in the Division of Cancer Prevention, and the multidisciplinary Breast Cancer and Gynecologic Malignancies Faculties of NCI intramural researchers. NCI staff participate in multiple, diverse relevant scientific partnerships and collaborative activities with other federal and non-federal scientists. NCI supports and coordinates broad based research programs investigating all aspects of cancer in men and women. Through its strategic planning process, NCI has identified many of the questions that need to be answered, areas of research and care that need to be further investigated, and infrastructure that needs to be strengthened to advance our knowledge in the study of cancer. By focusing research on areas with high potential, we have the opportunity to accelerate the pace of discovery and facilitate the translation of research knowledge to clinical application. The strategies are outlined in The Nation's Investment in Cancer Research: A Plan and Budget Proposal for Fiscal Year 2004 and include descriptions of areas that will advance discovery and its application and address areas of public health emphasis. As part of the planning process, NCI convenes Progress Review Groups (PRGs) to assist in setting priorities for organ site specific research. Between 1998 and 2002, 10 PRG reports were completed including breast, colorectal, lung, and gynecologic cancers. Following release of the reports, NCI develops strategic plans for implementing PRG recommendations. Reports for all completed PRGs, strategic plans, and additional information are available at the PRG website. Genetic and Environmental Factors To develop more effective approaches to cancer prevention, early detection, and treatment, we need to better understand the interactions between inherited genetic and environmental factors. Consortia and resource networks bring multidisciplinary researchers together to pool data and resources for large population studies. For example, NCI Breast and Ovarian Cancer Family Registries and the Cancer Genetics Network provide resources for characterizing predisposing genes in high-risk families. Increasing knowledge of the molecular changes that cause cancer enables us to identify potential targets for prevention and treatment drug discovery. New technologies help to define the molecular signatures of cancer cells and the microenvironment with which they interact. Recent exciting advances in proteomics have resulted in a new procedure for recognizing patterns of protein expression in normal and cancerous blood samples. A test for early detection of ovarian cancer using proteomics is now in clinical trials. Imaging and Biosensor Technologies Advances in imaging and biosensor technologies are resulting in improved cancer detection, diagnosis, and treatment through the development of novel imaging agents, improved functional imaging methods, and the development of molecular and digital imaging databases. Investigators are studying the use of digital mammography to enhance the interpretation of conventional mammography. Tools such as ultrasound, molecular resonance imaging, and positron emission tomography are being studied for their potential to improve the accuracy of screening and diagnosis of breast and other cancers. Quality of Care Ongoing and planned initiatives support research to understand disease and treatment-related effects and develop effective interventions to improve quality of life and disseminate clinical guidelines to improve quality of care. Numerous initiatives focus on research on the social, cultural, environmental, biological, and behavioral determinants of cancer, and how they contribute to disparities in cancer care and prevention in population groups that are disproportionately impacted by cancer. For example, The Center to Reduce Cancer-Related Health Disparities (CRCHD) has identified as a high priority, the need to understand and reduce the high rate of cervical cancer mortality in some regions of the United States. During 2001 and 2002, the CRCHD has consulted with experts from these regions and from other federal and state health agencies to develop interventions that ultimately reduce this preventable cancer. Tobacco The devastating impact of tobacco use and exposure to tobacco is being addressed by studies to better understand the genetic and environmental factors involved in tobacco addiction, screening trials in current and former smokers, clinical research to identify behavioral and pharmaceutical interventions for prevention and treatment of addiction, and better treatments for tobacco-related cancers. NCI has taken the lead in a public/private partnership effort to address the high rate of tobacco-related cancers in women and adolescent girls. Recommendations from a priority setting meeting held in early 2003 will provide the basis for the development of action plans to increase our understanding of the sex-based differences in women's smoking behaviors, susceptibility to tobacco addiction and tobacco-related cancers, and translation of current knowledge to effective prevention and treatment interventions. Clinical Trials NCI supports a broad program of clinical research to develop new agents and novel approaches for the prevention, early detection, and treatment of cancer. Clinical trials to evaluate improved and novel prevention, detection, and treatment strategies are carried out within a clinical trials infrastructure that includes NCI Cancer Centers, Cooperative Clinical Trials Groups, Specialized Programs of Research Excellence, and the Community Clinical Oncology Program (CCOP) and Minority-based CCOPs. The following report was prepared and submitted by the National Cancer Institute to the Director of the Office of Research on Women’s Health, NIH as part of the legislative requirement of the NIH Revitalization Act of 1993 [Sec. 486B(a)(1)] that, with respect to research on women's health, the Director of the Office shall biennially prepare a report describing and evaluating the progress made during the preceding two fiscal years in research and treatment [on women's health] conducted or supported by NIH.

National Cancer Institute Women's Health Report, Fiscal Years 2001-2002* March 2003