National Cancer Institute
Annual Progress Report 2010

by John E. Niederhuber, MD, outgoing director, National Cancer Institute

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As the 13th director of the National Cancer Institute, virtually every day brought me a fresh reminder of the privilege and excitement that stem from being part of a proud organization with an extraordinary history of groundbreaking biomedical research. Since 1937, when it became the first disease-based institute of what would become the National Institutes of Health, thousands of women and men have devoted their professional lives to NCI and to alleviating the burden of cancer for all who suffer its pain. The honor of serving this federal agency – and the millions of cancer patients and survivors who count on its vital efforts – only grew stronger as I prepared to step aside from its directorship.

It is impossible to serve as NCI director without feeling every day the magnitude of this unique institute’s responsibilities, both nationally and internationally. NCI responds each year to many dozens of inquiries from Congress and seemingly countless more questions from the public. In 2009, I received more than 250 requests to attend national and international conferences, and my office handled more than 12,000 pieces of correspondence. NCI routinely communicates with over 200 cancer advocacy organizations in 34 states and responds each year to more than 5,000 inquiries from the news media. Most important, all of these functions add up to a tremendous opportunity to represent groundbreaking cancer science and new technologies affecting cancer care to our legislators, the scientific community, and the public. They are opportunities to show how NCI is continuing to make great strides toward better cancer treatment, the earliest detection, and improved strategies of decreasing cancer risk.

It is impossible to serve as NCI director without feeling every day the magnitude of this unique institute’s responsibilities, both nationally and internationally.

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Dr. John Niederhuber

Today’s progress stands atop a proud history of drug development at NCI that has resulted in more than 50 novel compounds used in the treatment of advanced cancer. Together, these advances have helped decrease the cancer death rate from 199 per 100,000 in 1973 (the year I accepted my first academic appointment) to an estimated 184 per 100,000 in 2009, despite a 44 percent increase in the U.S. population and an increase of approximately 25 percent in Americans over the age of 65. Clearly, this number is still far too high, but real progress is being made, especially considering the fact that cancer is largely a disease of aging.

Two decades ago, the five-year survival rate for women diagnosed with breast cancer was 84.3 percent. Because of NCI-supported research, that rate has risen by nearly 6 percent. Two decades ago, the five-year survival rate for ovarian cancer was 40 percent. Today, it is 46 percent, and women diagnosed in the earliest stages have a five-year survival rate of nearly 94 percent. Two decades ago, the five-year survival rate for bladder and kidney cancers was about 58 percent. Today, because of NCI-supported research, that rate is approaching 69 percent. These figures should be of great interest and great pride to all of the thousands of cancer survivors who have participated in cancer clinical trials and who are probably some of the most avid readers of Coping®.

Over the past five years, NCI has started no fewer than eight major new initiatives designed to hasten the pace of research and to get new therapies to people faster and at lower cost and has committed to the expansion of many more.

For example, over the past five years, NCI has more fully embraced the power of the genome. The Cancer Genome Atlas (TCGA), a joint project with the National Human Genome Research Institute, has moved from a pilot project striving to sequence the genomes of three cancers to an established program that has set an ambitious goal of sequencing the genomes of 20 more tumors and potentially, in time, all major cancers.

Over the past five years, NCI has begun to take the mountains of data emanating from TCGA to the laboratory, where sequencing and genomic characterization information are increasingly being turned into knowledge of protein structure and biologic function. This work contributes to a new understanding of cellular processes, which then makes it possible, in an increasing number of instances, to establish new targets for enhanced, individualized therapies. The result, we firmly believe, will significantly reduce the time and cost of bringing new, safe, effective drugs to people with cancer. Recently, NCI has led an effort to develop electronic health records for cancer, to help make our oncology care system ready for a time when people will be, as a matter of course, genomically profiled at various life stages. This idea of characterized, electronically linked patients will be the basis for an entirely new system of clinical trials, in which we will much more quickly – and far more precisely – match people with newly developed drugs, molecularly based methods of cancer prevention, and enhanced techniques for the very earliest detection of small numbers of transformed cells. Detecting cancer as it begins, when it is most curable, will certainly change outcomes.

Recently, NCI has led an effort to develop electronic health records for cancer, to help make our oncology care system ready for a time when people will be, as a matter of course, genomically profiled at various life stages.

Over the past five years, the NCI Community Cancer Centers Program has come into existence, with a network that now numbers 30 hospitals in 22 states working together to find better ways to bring the latest benefits of cancer science to all people in their home communities, whether in a city center or a distant rural area.

The long list of NCI’s accomplishments over these years includes efforts to attract outstanding young scientists to the study of cancer and to adequately support their development. NCI has instituted programs that are drawing established scientists from disciplines not traditionally involved in the study of cancer, including physics, mathematics, and physical chemistry, for example. NCI is leading in exciting efforts to create new, genetically engineered computer and mouse models of cancer and to develop new methods of diagnostics and treatments based on nanoparticles that can penetrate a cancer cell. NCI has come a long way toward fully understanding the dynamic nature of the relationship between host and tumor (the tumor microenvironment) and the potential of targeting the components that support growth and invasion.

NCI’s science also extends to those who have concluded cancer treatment, with work to distinguish why some fare better than others – and why certain people are more prone to second, third, and even fourth malignancies. NCI’s survivorship program has changed how we conceive of life after cancer and how we work to support cancer survivors and their loved ones, too.

Every effort NCI puts forward has the goal of benefiting all people and reducing the inequities of race, ethnicity, age, income, language, and education that keep Americans from receiving equal cancer care.

These examples are just a small sampling of the unparalleled research infrastructure and power of the National Cancer Institute and its outstanding community. It gives me great pride to see everything NCI has accomplished in my time there.

NCI’s lifesaving efforts certainly do not begin or end with the tenure of a director. I have often said that I believe the job of NCI director to be the best position in the government. As I leave that job, my commitment to that belief is even stronger. It has been a genuine honor to serve.

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Read the National Cancer Institute Annual Progress Report 2009.

This article was published in Coping® with Cancer magazine, July/August 2010.