27th Annual Progress Report from the National Cancer Institute
by Norman E. Sharpless, MD, director of the National Cancer Institute
Twelve months ago, I asserted in these pages that 2020 was quite unlike any previous year. I pointed out the obvious – that for the National Cancer Institute, navigating a global pandemic had been an incredible and unique challenge. Today, I believe those assertions, made midway through that year, proved correct, possibly even overly conservative.
In this, NCI’s 27th annual report for Coping® magazine, I am happy to reflect on NCI’s research productivity and accomplishments, despite a very trying year, as well as report on a few opportunities for progress in the months ahead.
Indeed, progress against cancer has been very strong in recent years. I believe we will look back on this period as a golden age of cancer research.
Coping with COVID
Many of the biggest pandemic-related concerns that cancer clinicians and researchers voiced last year have come to pass – interruptions in routine cancer screening, delayed diagnoses, and deferred treatment.
According to several data sources, cancer screening plummeted during 2020. We estimate the United States missed roughly 20 million screening events (such as mammograms, colonoscopies, Pap smears, and lung cancer CT scans). Additionally, new diagnoses of cancer sharply declined during the peak months of the pandemic in 2020. This was true for cancers that are often detected by screening (such as breast and colorectal cancers), but also for cancers that are not detected by screening (such as pancreatic cancer). There is no reason to believe the true incidence of these cancers declined over this period. Therefore, we surmise that the majority of these undiagnosed cancers will eventually become apparent, but at later stages, making treatment more complicated and possibly less effective. We expect that these delays and deferrals of care will lead to more cancer deaths in the years ahead, a tragic result of the pandemic beyond the toll of COVID-19 itself.
To counterbalance this setback, it is imperative that the cancer caregiving, research, and advocacy communities work together to minimize the pandemic’s impact on people with cancer. This includes expressly communicating the disruptions caused by the pandemic and embracing new flexibilities and strategies to combat these disruptions. We need healthcare providers and patients to catch up on missed screenings and other preventive care as quickly as possible. When we do identify people with a new diagnosis of cancer, perhaps diagnosed at a later stage because of pandemic disruptions, we need to ensure those people get excellent care, no matter who they are or where they live. Given strong recent progress in the treatment of many types of cancer, we can hope that by expanded dissemination and implementation of these significant treatment advances, we may be able to counteract the negative effects of delayed diagnosis caused by the pandemic.
Despite these worrisome prospects, the cancer community has shown impressive resilience in the face of the pandemic’s challenges. I’m proud that the NCI has contributed to the nation’s pandemic response – both in regard to its relationship to cancer and with research on the virus itself – while sustaining focus on cancer research as our central mission.
A Promising Advance for Progress Against Cancer
An especially important development over the past twelve months occurred in Washington, DC, with the new president’s declaration in April that “we can and will end cancer as we know it.” One can be certain of President Biden’s commitment on this issue for three reasons. First, the Bidens’ personal commitment to cancer research progress is clear. Having lost their eldest child, Beau, to glioblastoma in 2015, the president and first lady know the devastation of cancer all too well. They know the terrible toll that a cancer diagnosis can take. Second, the president is also well acquainted with the challenges of cancer research, having led implementation of the Cancer Moonshot as vice president during the Obama administration. And, third, the president has translated his commitment to biomedical research into increased funding for research in his recently released budget proposal for fiscal year 2022.
The president’s confidence in the power of cancer research to improve patient outcomes is well placed. Indeed, progress against cancer has been very strong in recent years. I believe we will look back on this period as a golden age of cancer research. Cancer mortality rates, which have been declining over the past 30 years, have declined even more rapidly in the most recent few years for which we have data. Many factors have contributed to this trend, including reductions in tobacco use, effective cancer screening, and more effectual treatments.
I don’t expect to end all cancer death, but I think that eradicating a vast majority of cancer – especially in younger and otherwise healthy groups of people – is doable.
Additionally, the pace of therapeutic development in cancer has rapidly accelerated in recent years. Since 2017, more than 240 new cancer-related approvals – including more than 80 new medicines – have been issued by the FDA. The number of new devices for cancer cleared during this period is similarly impressive. Many of these new products deliver long-lasting benefit to people with cancer – even cures in some instances – often with greatly reduced side effects compared to prior approaches. Almost all of these new therapies are informed by “precision medicine” approaches – targeting specific molecular aspects of tumors, rather than targeting the location of the cancer in the body. Many new supportive-care therapies, including new agents for treating pain, bone marrow suppression, nausea, and other side effects caused by cancer and its treatments, have been developed as well.
There are many other areas of success, too, such as the remarkable impact of HPV vaccination on cancer incidence. A recent analysis showed that vaccination among girls aged 17 and under led to a 90-percent decrease in the incidence of invasive cervical cancer in later life. This bodes well for the prevention of cervical cancer globally, as well as other HPV-related cancers.
Similarly impressive has been the progress of immunotherapy, which is a type of cancer treatment that recruits the body’s own immune system to fight against the disease. Results with this type of treatment have been particularly promising against melanoma and lung cancer. It is likely that immunotherapy will join chemotherapy, radiation, and surgery as a fourth distinct treatment category. Good news, indeed.
Building on a Golden Age
So, how will the president’s call to end cancer as we know it be met? The task is certainly a tall order. The president did not suggest we could eradicate cancer altogether. Some level of cancer, especially associated with aging, may be an inescapable biological reality. Rather, we should aim to end what we know to be the tragedy of cancer – those agonizing and heartbreaking episodes of cancer with which too many patients and families are familiar. I don’t expect to end all cancer death, but I think that eradicating a vast majority of cancer – especially in younger and otherwise healthy groups of people – is doable.
Further accelerating our progress against cancer will require deploying the prevention and treatment strategies we know work across all communities and populations. In cancer prevention and screening, this includes helping more people quit smoking and preventing young people from starting, continuing to provide HPV vaccination to boys and girls at the recommended ages, and ensuring delivery of effective cancer screenings for all. We will also have to develop effective approaches to address obesity, which is associated with several types of cancer, including a few that are increasing in incidence and mortality in the United States.
A potentially important new technology for cancer screening is the development of blood-based screening tests designed to find early cancer in healthy adults. Several such “multi-cancer early detection” tests are currently being developed, and NCI will have an important role to play in evaluating these tests in rigorous clinical trials. If successful, such tests could have a profound impact on cancer mortality of the U.S. population.
How fitting it would be to build even more on our current golden age of cancer research in this, the 50th anniversary year of the National Cancer Act of 1971. The legislation enacted that December created the foundation for several programs – and made important investments in others – that now form the backbone of the nation’s commitment to defeating cancer. Surely, many of the advocates and lawmakers present when the National Cancer Act was signed saw that day as the beginning of the end of cancer. They thought that a cure was just over the horizon. But it wasn’t then, and sadly, it isn’t now. While we have made important progress against cancer, all of us who have watched a loved one suffer and succumb to cancer – or suffer and triumph – know that our progress against the disease is inadequate. Too many still face or witness extremes of pain and despair, courage and perseverance, and dignity and acceptance, but always against a backdrop of cancer’s basic, pervasive unfairness. Thus, the struggle continues.
“…we can, and we will…” – President Joe Biden
Our biggest challenges still lie ahead. We know that continued progress will require hard work and investment across the whole continuum of cancer research, from prevention to survivorship. And I agree with the president that we can, and we will.
History is replete with examples of great national challenges, which, once surmounted, led to fresh eras of prosperity, progress, and renewal. Our emergence from the global tragedy of COVID-19 hearkens to just such possibilities as they relate to cancer research. I welcome this opportunity to build on our current golden age of progress against this disease to end cancer as we know it, for a brighter future for all.
Since 1994, the National Cancer Institute has written an exclusive annual report for Coping’s July/August Celebration Issue.
This article was published in Coping® with Cancer magazine, July/August 2021.