Appropriations, 2001	$3,716,064,000
Budget estimate, 2002	4,153,398,000
Committee recommendation	4,258,516,000

The Committee recommends an appropriation of $4,258,516,000 for the National Cancer Institute [NCI]. This is $105,118,000 more than the budget request and $542,452,000 more than the fiscal year 2001 appropriation. The comparable amounts for the budget estimate include funds to be transferred from the Office of AIDS Research.

Mission- The NCI conducts and supports basic and applied cancer research in prevention, early detection, diagnosis, treatment, and rehabilitation. The Institute provides training support for research scientists, clinicians, and educators, and maintains a national network of cancer centers, clinical cooperative groups, community clinical oncology programs, cancer prevention and control initiatives, and outreach programs to rapidly translate basic research findings into clinical practice.

The Committee continues to regard scientific investigation into the cause, cure, prevention, and treatment of cancer as one of the Nation's top priorities. Research offers the only hope for putting a stop to a disease that wastes precious human resources and contributes to spiraling health care costs.

Behavioral science research- The Committee commends NCI for expanding its infrastructure to fund behavioral and population research in cancer prevention, treatment, and control. NCI is encouraged to expand its investigation of the effective provision of mental health services to improve the course of cancer treatment and to aid in the adjustment to cancer survivorship. NCI is also encouraged to build upon its collaborations with the National Institute on Drug Abuse to more thoroughly investigate issues of youth tobacco use. In particular, the Committee is interested in expanding health promotion research focused on children and youth, and interdisciplinary research on tobacco addiction and cessation. The Committee also encourages NCI to expand its research on adherence to treatment regimens and to health-promoting behaviors such as physical activity and healthy diet.

Blood cancers- The Committee is interested in NCI's upcoming Progress Review Group report on leukemia, lymphoma, and multiple myeloma, and it is eager to know what research strategies NCI is pursuing to improve treatments for these blood cancers. In particular, the Committee urges NCI to expand its research on myelodysplasia, a serious blood disorder affecting primarily older adults and individuals who have previously undergone radiation or chemotherapy treatment for cancer.

The Committee has listened to testimony about the devastating effects that multiple myeloma has on its victims and recognizes that, despite recent advances, median survival for patients responding to treatment is only 3 to 5 years. The Committee urges continued research and effort to seek new and better treatment for this disease. The Committee also requests that the NCI and NIEHS develop a joint report by April 1, 2002, on the progress of lymphoma and hematological cancer research. The report should address how the PRG has determined funds will be expended to expand the current base of lymphoma and hematological cancer research.

Bone metastasis- The Committee encourages NCI to conduct research to develop a better understanding of the unique role the bone microenvironment plays in metastatis of cancer to bone, in particular, breast cancer, prostate cancer and myeloma. The Committee also encourages NCI to support research on the development of animal models of bone metastasis and the identification of novel therapeutic targets and modalities to prevent and treat bone metastases.

Brain tumors.--The Committee is concerned that insufficient attention is being given by NCI and the National Institute for Neurological Diseases and Stroke (NINDS) to brain tumor research. The recently issued report of the NCI/NINDS-sponsored Brain Tumor Progress Review Group has called for substantially greater effort into this little-understood area of tumor research and treatment. The Committee encourages NCI to fund at least three Specialized Program of Research Excellence in Brain Tumors (SPORE) grants in the upcoming fiscal year, with particular emphasis on those proposals which include both basic research and clinical treatment applications.

Breast cancer- The Committee continues to be concerned over the disparity in breast cancer mortality and morbidity among African-American women. The Committee therefore encourages the NCI to report to Congress by April 1, 2002, about existing efforts, as well as planned future efforts, to better understand and respond to this disturbing phenomenon.

The Committee is aware of the importance of restoring sensitivity of tumor cells to standard chemotherapy drugs by reversing the effects of low oxygen stress on the cells. Cancer researchers have developed methods of achieving this important scientific tool, and the Committee encourages the NCI to consider this important research.

Breast implants- The Committee encourages the NCI to continue to collect and analyze data from the women in its three recent studies of the health risks of breast implants, to determine whether there is a link between breast implants and breast cancer, other cancers, or mortality from all causes.

Cancer and minorities- The Committee remains concerned over recent statistics citing higher incidences of cancer among the native Hawaiian population. In comparison to other ethnic and racial groups, native Hawaiians have the highest incidence of the most common forms of cancer such as breast, colon, and lung cancer. The Committee encourages continued research in the areas of prevention and detection, utilizing nurse practitioners in community-based centers for screening and education for the underserved populations.

Cancer centers- The Committee recognizes the high quality of care provided by NCI-designated Cancer Centers, but notes that many cancer patients must travel great distances to receive care from these centers. In addition, many other smaller institutions provide excellent patient care, perform high-caliber basic research, address unique cancer prevention and treatment issues, and lend great expertise to cancer treatment and control. The Committee encourages the NCI to further expand their Cancer Centers Program and give full consideration to applicants that care for a large number of underserved patients from rural and economically distressed areas.

Cancer gene therapy- With the sequencing of the human genome nearly complete, the challenge is no longer to identify genes but to understand the functions of these genes in order to find cures and treatments for cancer--especially prostate, breast and pancreatic cancer. As a result, the Committee and the NCI have previously supported cancer genomics projects that investigate the role of oncogenes in the CaSm, Ets 2 and ESF genes. The Committee expects the NCI to continue these projects with the goal of identifying potential cancer therapies.

Chronic lymphocytic leukemia (CLL)- The Committee, during its fiscal year 2002 hearings, heard compelling testimony from patients regarding the devastating effects of chronic lymphocytic leukemia (CLL). This disease has evaded a satisfying cure, as only 50 percent of patients with CLL survive 6 years and only 25 percent survive 10 years. The Committee urges the NCI to increase research on CLL, its underlying cause, and improved therapies. The Committee is pleased to learn that the NCI awarded a program project grant last year to establish and lead a multidisciplinary national research consortium to study CLL at both the cellular and clinical levels. The Committee strongly encourages the NCI to give full and fair consideration to expanding the scope of research activities funded through the CLL Research Consortium and the participating partners involved.

Complementary and alternative cancer therapies- The Committee expects NCI to expand its work and its collaborative efforts with the National Center for Complementary and Alternative Medicine to support research on promising complementary and alternative cancer therapies as well as on their integration with traditional therapies. Thousands of Americans are turning to these therapies, and consumers will benefit from a rigorous scientific review of them.

DES- The Committee continues to strongly support increased efforts to study and educate the public and health professionals about the impact of exposure to the synthetic hormone diethylstilbestrol (DES). The Committee expects NCI to continue its support of research in this area. In addition, the Committee urges NCI to continue its agreement with CDC to implement a national education program for consumers and health professionals. The Committee expects NCI and these other agencies to continue to consult with organizations representing individuals impacted by DES as they carry out DES research and education efforts.

Gynecologic cancer- Ovarian cancer remains one of the deadliest cancers for women, in part due to the lack of effective early screening methods. The Committee strongly urges NCI to expedite current research on screening methods to detect, diagnose, and identify staging of ovarian cancer. The Committee is pleased that NCI has fully funded four ovarian cancer SPOREs, and it encourages the Institute to consider issuing a new request for applications for additional ovarian cancer SPOREs. The Committee also believes that identification of a cost-effective screening strategy could result in earlier diagnosis for women and higher cure rates. NCI is strongly urged to accelerate research in this area.

Healthy eating- The Committee commends the NCI's national 5-A-Day program. The Committee recognizes that a diet including a minimum of five servings of fruits and vegetables is a critical factor in reducing cancer risk. The Committee encourages NCI to fund behavioral research on how best to promote healthy eating, especially fruit and vegetable consumption. New research projects could include, but not be limited to (a) children and adolescents, the general adult population, policymakers, and low-income and disparate groups, especially African Americans and Latinos; (b) program channels such as the mass media, restaurants, supermarkets, schools, and faith organizations; and (c) transfer of already-developed technologies to other units and levels of government and to non-profit, civic, and other organizations.

Hepatocellular carcinoma- The Committee is aware that the incidence of hepatocellular carcinoma in the United States has increased by more than 70 percent in the last two decades. Given the limited treatment options available, most cases are fatal. Viral hepatitis is the leading predisposing factor contributing to this affliction. With 4 million Americans infected with hepatitis C virus, it is predicted that the incidence of hepatocellular carcinoma will continue to increase. The Committee is aware that too little is known about the mechanisms and natural history of this disease. The Committee, therefore, strongly encourages the NCI to work closely with the NIDDK to develop a comprehensive liver cancer research initiative to investigate prevention, diagnosis, and therapy.

Imaging systems technologies- The Committee is encouraged by progress made by NCI following its August 1999 conference on biomedical imaging, and it urges NCI to continue to take a leadership role with the Health Care Financing Administration and the Food and Drug Administration to avoid duplicative reviews of new imaging technologies that may prevent their benefits from reaching patients on a timely basis. The Committee is aware of the great potential for improved patient care and disease management represented by molecular imaging technologies, especially positron emission tomography (PET). The Committee continues to support NCI's increased emphasis on examining the molecular basis of disease through imaging technologies such as PET and MicroPET. The Committee continues to encourage the large-scale testing of women for breast cancer and of men for prostate cancer to demonstrate and quantify the increased diagnostic and staging capabilities of PET relative to conventional diagnostic and staging technologies, including mammography.

Melanoma- The Committee is aware of numerous epidemiologic accounts and personal stories of melanoma. The Committee believes that public knowledge of overexposure to sunlight and its connection with melanoma may be lacking. The Committee urges the NCI to continue seeking new therapies for melanoma as well as educate the public through campaigns that encourage appropriate protection from sunlight.

National cancer registries- The Committee encourages the Registries program to establish, with the States, high-risk registries for the digestive cancers (liver, pancreatic) and other cancers with significantly low survival rates following diagnosis.

Neurofibromatosis (NF)- Neurofibromatosis research has significant potential for cancer patients since NF genes have been implicated in the signaling process that determines cell growth and cell differentiation. The Committee encourages NCI to strengthen its NF research portfolio in such areas as further development of animal models, natural history studies, therapeutic experimentation and clinical trials.

Neurological cancer- The Committee is pleased to learn of innovative research on the uniformly fatal brain cancer glioblastoma multiorme. Investigators have developed a transgenic mouse model in which tumor growth can be reduced by replacing a new gene that helps transport the brain chemical glutamate. The Committee is also aware of the importance of this research in the study of epilepsy. The Committee encourages the NCI to take note of these exciting developments.

Pancreatic cancer- The Committee commends NCI for its report on the Pancreatic Cancer Progress Review Group. The Committee urges the NCI to develop a professional judgment budget in line with the Progress Review Group for the period from fiscal year 2003 to fiscal year 2008. This budget should be presented to the Committee by April 1, 2002. In addition, the Committee encourages NCI to develop an initiative to raise the awareness of pancreatic cancer in the general public and the research community.

Population health- The Committee congratulates the NCI for building and nurturing an infrastructure to support rigorous community-based research. Community-based research makes it possible for interventions developed at taxpayer expense to reach the greatest number of people. The National Research Council has called attention to the need for additional research at multiple levels of analysis (individual, family, community) that integrates population health dynamics with behavioral, psychosocial, and environmental factors. One challenge is the development of methodologies that can enable such multilevel analyses. The Committee encourages NCI to continue its leadership in this area.

Primary immunodeficiencies (PI)- The Committee notes that NCI held a symposium in March 2000 concerning the relationship between primary immunodeficiencies and cancer. The symposium showed, among other things, that PI patients have a 200 times greater risk of developing cancer (including lymphomas) than someone without PI. The Committee strongly encourages the Institute to develop a comprehensive research portfolio on the basis of the data generated at that conference and to supply the Committee with a report concerning its research plans not later than April 1, 2002. In addition, NCI is urged to greatly expand its role in the national education and awareness campaign sponsored by the Jeffrey Modell Foundation.

Prostate cancer.--The Committee believes that prostate cancer research has not kept pace with the scientific opportunities and the proportion of the male population who are afflicted with the disease. This has resulted in significant gaps in scientific and clinical knowledge that contribute to the ongoing impact of prostate cancer on patients and their families. NIH has begun to address this shortcoming in the 5-year prostate cancer research strategy presented to Congress in June 1999. The Committee strongly urges the NIH to renew its commitment to prostate cancer research with special emphasis on accelerating new avenues for basic research, drug development and clinical research. The Committee further requests that NIH submit a prostate research plan for fiscal year 2003 to fiscal year 2008 by April 1, 2002. In developing this plan, the Committee urges the NIH to consult and work closely with the research community, clinicians, patient advocacy groups and the Congress.

The Committee is aware of a novel DNA-based tumor vaccine that has proven effective in pre-clinical, phase I and phase II studies for the treatment of advanced prostate cancer. The Committee is also aware of complementary research in prostate cancer treatment using Cox-2 inhibitors. The Committee encourages NCI to explore the use of these important research initiatives.

Transdisciplinary tobacco use research centers- The Committee commends the Institute for its collaboration with the National Institute on Drug Abuse and private foundations in establishing seven new Transdisciplinary Tobacco Use Research Centers. These Centers establish critical links across diverse scientific disciplines in order to evaluate new models of nicotine addiction; heredity factors in vulnerability, treatment success, and deleterious consequences of tobacco use; cultural determinants of successful prevention efforts; treatment-resistant populations; and determinants of relapse.

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