National Cancer Institute 

U.S. DEPARTMENT 

OF HEALTH AND 

HUMAN SERVICES 

National Institutes 

of Health 

The Nation’s 

Investment 

in Cancer Research 

A Plan and Budget Proposal for Fiscal Year 2007 

Prepared by the Director, National Cancer Institute 
Our Challenge Goal to the Nation:


Eliminate the suffering and


death due tocancer by 2015

Director’s Message 

Excitement continues to build across the cancer community about the progress we are making 

toward our Challenge Goal to eliminate the suffering and death due to cancer by 2015! Continued 

advances in high throughput computing, bioinformatics, imaging technology, nanotechnology, 

genomics, proteomics, and computational modeling are paving the way for new discovery and accelerated intervention development and delivery. Collaborative efforts are streamlining the availability of tissue 

specimens, microarrays, image libraries, and epidemiological data. Newly established partnerships with 

other agencies within the Department of Health and Human Services, with other Federal and state agencies, and with the private sector are helping us all to leverage limited resources and to join together to 

ensure timely delivery of new cancer interventions to patients and people at risk. We have enormous 

responsibility in a time when resources are more precious than ever. 

NCI staff are working daily to facilitate new opportunities for both individual and interdisciplinary team 

research to flourish. We are working to carry out the recommendations of the Clinical Trials Working 

Group and supporting a similar effort on Translational Research, both supported by the National Cancer 

Advisory Board. We are implementing more robust and integrative programs in cancer imaging, bioinformatics, and health disparities. We are working with internal and external stakeholders to identify needs 

and plan strategies related to specific diseases like lung cancer and groups of cancers, such as those 

that disproportionately affect our adolescent and young adult population. 

In this budget proposal for Fiscal Year 2007, we describe five high impact areas requiring an infusion of 

resources in order to maximize our ability to move forward. Each is essential for us to not only accelerate our progress against cancer but to also contribute to the overall health of our Nation. Our investments in health information system technology, for example, can serve as a model and pilot for broader 

application to the national effort. Our leadership in bridging technology and science and in facilitating 

interdisciplinary research will help to strengthen a new integrative science paradigm across the entire 

biomedical community. 

We as a Nation will succeed when everyone works in close harmony to relay cancer information and 

ensure the adoption of evidence-based interventions. We must help all of our citizens maintain healthy 

lifestyles, get screened regularly, obtain prompt treatment when cancer is diagnosed, and have access 

to quality follow-up care. Researchers across many disciplines, technology experts, public health specialists, healthcare providers, patients, people at risk, and healthy people must work to define and do 

their part. People all over the world demonstrate their ability to overcome the odds every day. Cancer 

will be no exception. 

Andrew C. von Eschenbach 

October 2005 
The Nation’s Investment in Cancer Research: 

A Plan and Budget Proposal for Fiscal Year 2007 

This plan and budget proposal for Fiscal Year 2007 describes continuing and new activities that, in the best judgment of the 

leadership of the National Cancer Institute, will accelerate achievement of our Challenge Goal to eliminate the suffering and 

death due to cancer. Our Annual Report for 2004, The Nation’s Progress in Cancer Research, highlights just a few of the many 

recent scientific and programmatic advances we have seen in our fight against cancer. Later this fall, we will also publish 

our long-range NCI Strategic Plan for leading the Nation to achieve our Challenge Goal. 

NCI engages in a number of ongoing planning and priority setting activities to ensure that we are responsive to 

new discoveries and opportunities and maximize use of our resources. NCI staff work with researchers and other 

representatives from the scientific, medical, and advocacy communities to determine what is needed and how best 

to move the science forward. We keep our research portfolio balanced and our support structure strong through 

ongoing program assessment and response to recommendations arising from those assessments. We convene scientists from diverse settings to work with NCI staff in developing new initiatives and redesigning programs. We 

track implementation and report regularly on our progress. 

Our planning activities encompass three key components required for a strong cancer research enterprise: 

Capitalizing on powerful scientific 

opportunities 

We continually assess our portfolio and plan for research needed 

to uncover molecular characteristics common to different types of 

cancer and those that are unique 

to specific cancers. We seek those 

opportunities that hold greatest 

promise for accelerating the prevention, control, early detection 

and diagnosis, and effective treatment of the disease. 

Targeting specific public health needs 

As we assess our Nation’s progress 

in addressing critical issues, we 

focus investments in areas such as 

tobacco and tobacco-related cancers; energy balance and the importance of diet, exercise, and weight 

management; health related quality 

of life for cancer patients and survivors; the quality of cancer care; 

and cancer health disparities. 

Maintaining a sound research infrastructure and building capacity for 

the future 

We give priority to developing 

the investigational, technological, 

and personnel resources needed 

to support changing needs and 

the translation of evidence-based 

interventions into clinical practice.
Table of Contents

The Current NCI Portfolio and Budget

Our Research Portfolio

2 Preempting Cancer at the Earliest Opportunity

5 Ensuring the Best Outcomes for All

Our Research Infrastructure and Support

8 NCI Extramural Program

10 NCI Intramural Program

12 Cancer Centers and Centers of Excellence

13 Networks and Consortia

14 NCI-Supported Clinical Trials

16 Technology Development

18 Cancer Surveillance

19 Communication, Education, and Dissemination 

20 Training and Career Development

22 Other Partnerships

New Strategic Investments in Fiscal Year 2007

26 NCI Cancer Centers — Driving Progress toward 2015

28 Reengineering Cancer Clinical Trials

30 Building Bridges to Link Science and Technology

32 Advancing Medical Informatics 

34 Integrating Cancer Science

NCI Budget Request for Fiscal Year 2007
Cancer in America


Where We Stand Today


The national investment in cancer research is making a difference in the lives of Americans every day. 

However, cancer remains one of our most urgent health concerns and the disease many fear most. This 

year, more than 1.3 million new cancer cases will be diagnosed and more than a half million people 

will succumb to the disease. 

What the Statistics Tell Us 

Overall cancer mortality continues the gradual decline that began in the early 1990s. Deaths 

from some of the most common cancers — colorectal, breast, and prostate — have declined 

faster. Lung cancer mortality among men also is falling, and the rate for women is stabilizing. 

These achievements can be traced to research that has produced better imaging and other diagnostic tools, along with more effective treatments. Information dissemination, a key component 

of NCI’s mission, has improved public understanding of the disease and motivated the increased 

use of cancer screening tests and adoption of lifestyle changes that minimize cancer risk. 

Today, nearly 10 million people are living with a cancer history. Of this growing population, 

1.5 million were diagnosed more than 20 years ago. This means that people who develop cancer are living longer and with a better quality of life than ever before. More than two-thirds 

of people diagnosed with cancer can now expect to live for five years or longer. For children 

diagnosed with cancer, five-year overall survival now exceeds 75 percent. Increasingly, we are 

finding cancers at earlier, more curable stages, and our ability to control cancer symptoms that 

affect quality of life has improved. 
The Continuing Need for Research 

More than ever before, we understand that cancer is a varied and complex disease. Likewise, 

our success in preventing, treating, and ameliorating the effects of specific cancers is varied. 

Despite intensive efforts, we have made marginal progress against the most intractable cancers, 

such as pancreatic, lung, and liver cancers. For reasons not well understood, the incidence of 

certain malignancies — including adenocarcinoma of the esophagus, multiple myeloma, and 

kidney cancer — is rising. 

Research also demonstrates that some populations, most notably minorities and the poor, 

continue to bear a disproportionate cancer burden. Lack of insurance or a steady source of 

care and sociodemographic limitations are factors that often result in lower utilization of 

screening services and late diagnosis in these populations. Cancer mapping is helping to 

target cancer control efforts by revealing — down to the county level — geographic areas in 

which incidence and mortality for specific cancers are exceptionally high. 

Adolescents and young adults with cancer have been an understudied group that has experienced little or no gain in survival rates and whose needs for tailored treatment regimens and 

psychosocial support are now being recognized. Some evidence suggests that certain cancers 

common in this age group may have important biological differences compared with the same 

disease in an older adult. 

Further, the risk of being diagnosed with cancer increases with age. Currently, about threefourths of all new cancer cases occur in people 55 years of age or older. By 2030, the population over age 62 will number almost 83 million, approximately twice its current size. 

As our population continues to age and life expectancy lengthens or remains constant, we 

must prepare for a dramatic rise in cancer incidence. By some estimates, the annual number 

of new cancer cases may double by 2050. It is therefore imperative that effective treatments 

and symptom control are available to all who need them, and we must develop reliable 

interventions that prevent cancers from occurring. 

We still have much to learn about the most effective ways to reach diverse groups — including 

youth, the elderly, people of various ethnicities and cultures, rural residents, migrants, and 

people with limited literacy — with cancer services and related health messages. We must learn 

how to better communicate up-to-date information about cancer screening, prevention, and 

treatment, including palliative care, and to encourage the adoption of new interventions by 

community healthcare workers who provide the majority of cancer care and are responsible 

for encouraging cancer prevention and early detection behaviors by their patients. 
Cancer in America


NCI Maintains Several Sources of Information to Track the Status of Cancer and Cancer Research 

Annual Report to the Nation on the Status of Cancer 

First issued in 1998, this publication is a collaborative effort among the American Cancer Society, the 

Centers for Disease Control and Prevention, the National Cancer Institute, and the North American 

Association of Central Cancer Registries. It provides updated information on cancer rates and trends 

in the United States. NCI’s Surveillance, Epidemiology, and End Results databases are a major source 

of information for this publication that can be found at seer.cancer.gov/report_to_nation. 

Cancer Progress Report 

This is a biannual NCI publication about our Nation’s progress against cancer, including prevention, 

early detection, diagnosis, treatment, life after cancer, and end of life. The information is gathered 

through a collaborative effort with other key agencies and groups, such as the Centers for Disease 

Control and Prevention and the American Cancer Society. The report was first issued in 2001 and 

will be updated in late 2005. The 2003 update is available only online at progressreport.cancer.gov. 

Surveillance, Epidemiology, and End Results (SEER) 

The NCI SEER program currently collects and publishes cancer incidence and survival data from 14 

population-based cancer registries and three supplemental registries covering approximately 26 percent of the U. S. population. The program is the only comprehensive source of population-based information in the United States that includes stage of cancer at the time of diagnosis and survival rates 

within each stage. The mortality data reported by SEER are provided by the National Center for Health 

Statistics and cover the entire U. S. population. Go to seer.cancer.gov. 

Cancer Mortality Maps and Graphs 

The Cancer Mortality Maps and Graph Web Site provides interactive maps, graphs (accessible to the 

blind and visually impaired), text, tables, and figures showing geographic patterns and time trends of 

cancer death rates from 1950 – 1994, for more than 40 cancers. Go to cancer.gov/atlasplus. 

The Nation’s Progress in Cancer Research 

This annual NCI publication highlights recent scientific, technological, and programmatic advances 

resulting from NCI-supported programs. First published to highlight achievements in 2003, the latest 

report is available online at cancer.gov/nci-annual-report. 

NCI Cancer Bulletin 

The NCI Cancer Bulletin is a weekly publication available online from NCI. It provides updates on 

NCI activities, the research and clinical trials funded by the Institute, and other activities of the 

United States and international cancer communities. Go to cancer.gov/ncicancerbulletin.
The National Cancer Institute works to advance fundamental knowledge about 

cancer across a seamless and dynamic continuum of discovery, development, and 

delivery. We provide vision and leadership for NCI-funded researchers across the 

United States and around the world and strive to ensure that the results of research 

are used in public health programs and clinical practice to reduce the burden of 

cancer for all people. 

Building on past discoveries and technological advances, we plan, conduct, coordinate, and support cutting-edge research and its application. We support the 

development of, access to, and use of new technologies by cancer researchers. 

We encourage creativity and innovation in all of our endeavors. We provide 

research training and career development opportunities and maintain support 

mechanisms and collaborative environments to link scientists with their colleagues and with critical technological and information resources. As leader of 

the National Cancer Program, we provide the public with scientifically sound 

cancer information using communication methods carefully designed to meet 

the needs and preferences of cancer patients, their families, and caregivers. 

NCI supports a broad range of research to expand our understanding of cancer and 

develop improvements in prevention and care. Some investigators conduct basic 

laboratory research on genes that may cause cancer. Others are studying the incidence of cancer in specific populations, such as people of low socioeconomic status and former smokers. Still other scientists focus on translational research such 

as developing tests to identify patients who carry genes that may make them susceptible to cancer or conducting early clinical trials to determine the readiness of 

new preventive agents, diagnostic tools, or treatment drugs for full clinical testing. 

The paragraphs that follow describe the NCI research portfolio and the multitude 

of resources that are currently available with NCI funding. 

The Current 

NCI Portfolio 

THE NATION’S INVESTMENT IN CANCER RESEARCH 1 
2 N ATIONAL CANCER INSTITUTE

Preempting Cancer at the Earliest Opportunity

Continued discovery in etiology and biology and the subsequent development of interventions in prevention, early detection, diagnosis, and treatment will provide the means by which we can preempt the

initiation and progression of cancer at every stage, from precancer through metastasis. 

Understanding the Causes and Mechanisms of Cancer 

NCI’s etiology research focuses on identifying and understanding the origins and causes of

cancer. Genetic, environmental, and lifestyle factors can all contribute to cancer development.

Genetic factors may include inherited genes known to be involved in familial cancer syndromes and spontaneous mutations to genes involved in regulation of cell growth. Examples

of environmental factors that may affect cancer development include exposures to radiation,

organic solvents, asbestos, other pollutants, and infectious agents such as viruses or bacteria.

Lifestyle factors that put people at risk include smoking, alcohol consumption, parity, sun

exposure, diet, level of exercise, and obesity. NCI’s research portfolio includes population

studies that identify the cancer risks associated with

interactions between susceptibility genes and environmental or lifestyle factors as well as biological studies

to elucidate causal pathways. Other studies assess 

disruptions to normal cellular biology caused by the

dynamic interaction of these risk factors. For example,

increased production of free radicals and changes in

levels of certain hormones and growth factors has

been implicated in the development of certain cancers.

NCI’s cancer biology portfolio addresses the cellular

and molecular mechanisms of cancer initiation, progression, and metastasis as well as normal biological

functioning. The portfolio includes studies of abnormal chromosomes or genes, DNA damage or mutation, aberrant gene expression or protein function, epigenetic1 changes, cancer

causing viruses, angiogenesis2

, and the movement of cells within the body. Approximately 10

percent of the biology portfolio supports research to understand normal biology, especially at

the cellular and molecular level. This research includes studies of cellular metabolism and

growth, the structure and function of genes and proteins, developmental biology, and cell to

cell interactions.

Our Research Portfolio

1 Epigenetics refers to factors which influence the behavior of a cell without directly affecting its DNA or other 

genetic machinery.

2 Angiogenesis is the growth of new capillaries, or microscopic blood vessels, to supply the circulatory needs 

of tissues.
Accelerating Progress in Cancer Prevention 

NCI is dedicated to exploring new approaches to prevent the onset of cancer through a 

broad portfolio of prevention research. Our investigations support the identification of 

medical and behavioral approaches to cancer prevention that can be translated to public 

health settings. The majority of the prevention research portfolio addresses strategies for 

preventing or delaying the onset of cancer, including nutritional approaches, vaccination, 

and chemoprevention. Nutrition related research includes investigation of the role of nutrients and micronutrients on human health, the effects of nutrients or nutritional status on 

cancer incidence, and techniques for assessing dietary intake. Prevention vaccine research 

explores strategies to stimulate the immune system to attack infectious cancer causing 

agents or tumor specific antigens and identifies effective vaccine delivery strategies. 

Chemoprevention research is focused on drugs that can be used to prevent development of 

a primary or secondary cancer. Approximately one quarter of our prevention portfolio supports investigation of behavioral factors that affect cancer risk and strategies to change these 

behaviors. These projects focus on risk factors such as poor diet, lack of physical activity, 

sun exposure, and tobacco use. A small proportion of the portfolio addresses complementary 

and alternative methods for cancer prevention, such as diet, herbs, and other supplements 

that are not widely used in conventional medicine, as well as biobehavioral techniques such 

as hypnotherapy, relaxation, meditation, spiritual healing, massage, and biofeedback. 

Improving Early Detection and Diagnosis 

Much of this research portfolio focuses on the discovery and development of biomarkers and 

imaging techniques for cancer screening, early detection, diagnosis, and prognosis. Biomarkers 

are genes, proteins, or other molecules that indicate the presence of cancer based on their 

patterns or levels of expression. For example, prostate specific antigen (PSA) levels are used to 

THE NATION’S INVESTMENT IN CANCER RESEARCH 3
Our Research Portfolio 

screen for prostate cancer. New research focuses on finding additional biomarkers for prostate 

cancer. Researchers are using proteomic technologies to develop biomarker panels to detect 

insidious cancers, such as ovarian and pancreatic cancer. Similarly, anatomical and molecular 

imaging techniques are used to detect tumors, inform prognosis, and identify metastasis. 

Promising new biomarkers or imaging technologies undergo preclinical evaluation before 

advancing to Phase I clinical trials for preliminary safety and efficacy testing. Later stage 

clinical trials evaluate biomarkers or imaging techniques for clinical specificity, predictive 

value, quality assurance and quality control, reproducibility, and effectiveness in reducing 

morbidity and/or mortality. This portfolio also supports research to determine how patients 

accept and comply with cancer screening methods. 

Developing Effective and Efficient Treatments 

A large part of NCI’s research portfolio focuses on the discovery, development, and evaluation 

of therapeutic strategies for destroying cancer cells or modulating and controlling metastasis. 

These include localized, systemic, molecularly targeted, combination, or alternative approaches 

that do minimal harm to healthy tissue. Localized therapies, such as surgery or radiotherapy, 

directly target the tumor and sometimes neighboring tissue. Systemic therapies are usually 

administered intravenously or orally and include cytotoxic or hormonal agents, vaccines, antibodies, gene therapy, angiogenesis inhibitors, and differentiating agents. Molecularly targeted 

therapies are usually administered systemically, but are designed to interact specifically with the 

tumor and associated tissues. Combination therapies use two or more drugs and/or treatment 

modalities to increase treatment efficacy. NCI also conducts research on complementary and 

alternative treatment approaches. New intervention strategies emerging from the treatment 

research portfolio are first evaluated preclinically and then moved sequentially through Phase 

I, II, and III clinical testing. 

4 NATIONAL CANCER INSTITUTE 
Ensuring the Best Outcomes for All 


The successful application of evidence-based interventions for preempting cancer through prevention,


detection, diagnosis, and treatment depends on our ability to move effective interventions into practice.


NCI works with others to ensure that the results of our research and development efforts are adopted,


that they accomplish their intended purpose, and that they adequately address issues in quality of can­


cer care, survivorship, and health disparities. 


Improving the Quality of Cancer Care 

NCI’s portfolio includes critical research on the quality of care provided to cancer patients. 

This portfolio covers the discovery, development, measurement, and dissemination of interventions aimed at improving the quality of cancer care and health related outcomes across 

the cancer continuum. Quality of care research includes refinement of process and outcome 

measures, including the development of assessment metrics. Research on patterns of care 

include studies that link key data sources for tracking information on prevention and treatment interventions with NCI’s surveillance programs. Other research focuses on understanding 

behavioral and sociocultural factors that influence the quality of 

cancer care, developing interventions that target the patient and 

their families, improving symptom management and palliative 

care, and training specialized care 

providers. Our quality of cancer 

care portfolio also supports use of 

claims data, design of functional 

evaluation tools, development of 

quality indicators for advanced 

cancer care, and dissemination of end of life resources to Cancer Centers. Researchers also 

evaluate patient psychosocial distress, the quality of supportive care for advanced cancer 

patients, and the impact of aging on quality of care. 

Improving the Quality of Life for Cancer Patients, Survivors, and Their Families 

Survivorship research focuses on the health and life of cancer patients following acute 

diagnosis and treatment phase and encompasses both the prevention and control aspects 

of chronic disease epidemiology. NCI’s survivorship portfolio includes investigations into 

the broad spectrum of physiologic, psychosocial, economic, and behavioral effects of cancer 

and its diagnosis and treatment on survivors and their families with a strong emphasis on 

long-term and late effects. NCI supports both descriptive and intervention survivorship 

THE NATION’S INVESTMENT IN CANCER RESEARCH 5
Our Research Portfolio 

research. For example, researchers study the genesis 

of recurrent cancer and second primary tumors, late 

effects of cancer treatment, and strategies for the 

early detection of residual disease in adult cancer 

survivors. Because breast cancer survivorship is most 

prevalent, the majority of studies examine the longterm and late effects related to this disease. In addition, pediatric cancer survivorship research is well 

represented in the research portfolio and a large portion of this research focuses on survivors of childhood acute lymphocytic leukemia. 

The Center to Reduce Cancer Health Disparities 

The Center to Reduce Cancer Health Disparities seeks to integrate studies across NCI research divisions in order to identify scientific and policy areas that provide opportunities to reduce cancer health 

disparities. In addition, the Center supports investigations to define and monitor disparities; develop 

and implement new policy, community and clinical interventions, and evaluate their impact; and expand 

minority participation, both as investigators and as patients, in health disparities research and clinical 

trials. Current initiatives illustrate the central importance of the Center’s work. 

The Community Networks Program expands upon the highly successful Special Populations 

Networks program to reduce cancer disparities through community-based participatory cancer 

education, training, and research among racial and ethnic minorities and underserved populations. 

Interventions include cancer prevention activities such as proven approaches for quitting smoking, 

increasing healthy eating and physical activity, and early detection and treatment of breast, cervical, and colorectal cancers. 

The Patient Navigator Research Program represents a new approach to providing individualized 

assistance to patients, survivors, and their families. The Program places patients in contact with 

trained health care workers — or “navigators” who assist those in need of cancer care services. 

The overall goal of this program is to develop innovative patient navigator interventions designed to 

decrease the time between a cancer-related abnormal finding, definitive diagnosis, and delivery of 

quality standard cancer care services. 

6 NATIONAL CANCER INSTITUTE 
Overcoming Cancer Health Disparities 

It is well known that many population groups across the United States and around the world 

suffer disproportionately from cancer and its sequelae. Gender, ethnicity, and socioeconomic 

status are among the major factors that influence disparate rates of cancer incidence, morbidity, and mortality. Areas in which cancer health disparities are particularly evident include 

reduced access to cancer screening and diagnostic services, treatment disparities, lack of 

awareness about cancer risk and prevention, lack of access to clinical trials, and differential 

exposures to cancer causing agents. NCI efforts focus on improving the status of economic, 

social, cultural, psychologic, behavioral, and biologic factors that contribute to cancer health 

disparities. Research in NCI’s biology, etiology, prevention, detection, and treatment portfolios addresses many of these issues. Resources and infrastructure necessary for disparities 

research include informatics, specimen resources, clinical trial groups, statistical methodology, 

drug and reagent resources, centers, consortia, and education and training of people prepared to work in careers focused on cancer health disparities. NCI’s investments are accelerating the development and application of interventions for overcoming disparities across 

the cancer control continuum and among all underserved populations. 

THE NATION’S INVESTMENT IN CANCER RESEARCH 7 
Our Research Infrastructure and Support


A considerable portion of NCI’s budget is dedicated to building the capacity of the cancer research 

enterprise by providing infrastructure, resources, and other support. We focus on the support essential 

to carrying out cancer research and intervention development and promoting and learning from their 

delivery. Our intramural and extramural programs, NCI-supported Cancer Centers and Centers of 

Excellence, and various networks, consortia, and other partnerships all facilitate the development of 

and access to vital resources. We also support education and training programs for investigators and 

clinicians at all levels of experience and provide vital patient education services. 

NCI Extramural Program 

The largest portion of NCI research funds goes to supporting the work of scientists conducting research in universities, teaching hospitals, and other organizations outside the 

National Institutes of Health. Proposals submitted by these extramural investigators are 

selected for funding by peer review, a process by which cancer experts from around the 

country identify the best science and most needed areas of discovery by evaluating the 

approximately 5,000 new research proposals we receive every year. With guidance and 

oversight from program experts in NCI’s Divisions of Extramural Activities, Cancer 

Biology, Cancer Treatment and Diagnosis, Cancer Prevention, and Cancer Control and 

Population Sciences, cancer research is conducted with NCI funding throughout the United 

States and in more than 20 other countries. 

The Division of Extramural Activities (DEA) provides high quality scientific peer review of 

proposed extramural research as well as systematic surveillance of active awards to ensure a 

balanced research portfolio. This portfolio includes over 7,000 research and training awards 

across the spectrum of discovery, development, and delivery. Other portfolio components 

address long-term survivorship, rehabilitation, and end-of-life issues. In addition, DEA 

serves as a focal point for information about NCI’s peer review and grants policies. DEA 

staff provide advice and guidance to potential applicants about grant policies and procedures, 

refer incoming grant applications to appropriate programmatic areas within the NCI, coordinate 

and administer most advisory board activities, and establish and disseminate extramural policies and procedures. 

The Division of Cancer Biology (DCB) manages a diverse portfolio of grants, cooperative 

agreements, and contracts to advance the science of cancer biology. DCB scientists and staff 

work with individual investigators, professional societies, and research institutions to provide 

8 NATIONAL CANCER INSTITUTE 
THE NATION’S INVESTMENT IN CANCER RESEARCH 9

information, advice, and guidance on a variety of research opportunities. Discussions, meetings,

workshops, and conferences are among the mechanisms DCB uses to identify and address

needs in various scientific areas. DCB uses a variety of communication media to keep the scientific community abreast of areas of special interest and scientific opportunity. The

Division regularly reports scientific progress and program accomplishments to the scientific

community, the Institute, Congress, and the public.

The Division of Cancer Control and Population Sciences (DCCPS) supports the NCI mission through an integrated program of high quality genetic, epidemiologic, behavioral,

social, applied, and surveillance research. DCCPS-supported research aims to understand

the causes and distribution of cancer in populations, supports the development and implementation of effective interventions, and monitors and explains cancer trends in all segments of the population. Central to these activities, the process of synthesis and decision

making aids in evaluating what has been learned, identifies new priorities and strategies,

and translates research discoveries.

The Division of Cancer Prevention (DCP) manages extramural programs focused on basic

prevention science, cancer biomarkers, chemopreventive agent development, community

oncology and prevention trials, early detection, and nutrition science. The Division manages

large clinical trials for the prevention and early detection of specific types of cancer. Organ

system research focuses on groups of common cancers — e.g., breast and gynecologic cancers,

gastrointestinal cancers, lung and upper aerodigestive cancers, and prostate and urologic cancers — for which better prevention and early detection approaches are needed.

The Division of Cancer Treatment and Diagnosis (DCTD) works to identify and exploit the

most promising areas of science and technology and to initiate, enable, and conduct research

to identify and develop better diagnostic and therapeutic cancer interventions. Division programs focus on cancer diagnosis, imaging, therapy evaluation, developmental therapeutics,

radiation, and biometrics. DCTD manages an extensive clinical trials program covering a

broad range of cancers and age groups, oversees large initiatives to support drug development and cancer imaging, and supports studies on the special needs of patients with AIDSrelated malignancies.
Our Research Infrastructure and Support 

NCI Intramural Program 

About 16 percent of NCI research dollars stay at NIH in Maryland, to support the work of 

intramural scientists in NCI's Center for Cancer Research (CCR) and Division of Cancer 

Epidemiology and Genetics (DCEG). These intramural investigators focus on basic laboratory investigation and long-term epidemiologic and genetics studies and their rapid translation 

to intervention development and clinical testing. Patients benefit from access to the research 

protocols and treatment available at the NIH Clinical Center facility. 

A world leader in developing lifesaving treatments for cancer and home to many of the major 

breakthroughs in cancer research and care, the CCR is at the forefront of cancer scientific 

investigation. CCR scientists and clinicians are finding better ways to diagnose, prevent, and 

treat cancer and related illnesses. They work together to help translate new scientific discoveries into state-of-the-art diagnostic tools and therapies for cancer patients. Intramural investigators work in a highly interactive, interdisciplinary environment that maximizes the use of 

researcher expertise and technology to perform cutting-edge basic, translational, and clinical 

investigations and facilitate quick response to promising research findings. 

DCEG intramural scientists conduct population and multidisciplinary research to discover 

the genetic and environmental determinants of cancer and new approaches to cancer prevention. The Division conducts broad based, high quality, high impact research through its 

programs in cancer epidemiology, genetics, statistics, and related areas. DCEG maintains 

a national and international perspective and gives priority to emergent issues identified 

through clinical-laboratory, and epidemiologic observations as well as public health concerns. Major areas of investigation include lifestyle and nutritional factors, environmental 

10 NATIONAL CANCER INSTITUTE 
and occupational exposures, 

genetic susceptibility and geneenvironment interactions, pharmacoepidemiology, infectious 

agents, radiation exposure, and 

methodologic research. With a 

steady presence on the NIH campus, DCEG is uniquely able to 

conduct epidemiology research 

projects that are high-risk or need 

long-term commitments of funding and scientific staff. The 

Division conducts and coordinates 

epidemiologic and interdisciplinary research that responds quickly to emerging public health 

or scientific issues that might go unattended by other groups without a national or international reach. DCEG scientists and staff develop critical resources, infrastructures, and strategic 

partnerships in molecular epidemiology as well as fellowship programs that train the next 

generation of scientists in cancer epidemiology and related fields. 

HIV/AIDS– Related Research at NCI 

Working through a new Office of AIDS Malignancy, NCI continues its commitment to meeting the 

needs of people infected with HIV and AIDS who are often more susceptible to some types of cancer. The NCI Intramural Research Program is an internationally recognized center for research in 

HIV and AIDS, integrating studies across multiple areas including epidemiology, correlative science, 

and treatment research. Some intramural scientists assess changes in the cancer burden among 

HIV/AIDS patients whose lives have been extended as a result of improved treatments. Others focus 

on the development of novel targeted treatments, prevention interventions, and drug resistance for 

cancers in HIV infected individuals. Still others work to combine their expertise in cancer with that 

of retroviral vaccines to promote cross fertilization and progress in both areas. The NCI Extramural 

Research Program supports vital investigator driven HIV/AIDS research as well as the AIDS 

Malignancy Consortium (AMC), the only clinical trials group aimed at improving the treatment and 

prevention of cancer in the context of HIV infection. The AMC works closely with National Institute 

of Allergies and Infectious Disease (NIAID) to manage AIDS associated co-morbidities. We co-fund 

the Center for AIDS research with NIAID, support collaborative initiatives that leverage other NIH 

studies, and supply tissue resources for use in HIV/AIDS studies. NCI is also partnering with others 

on international initiatives including the dissemination of information on AIDS associated malignancies. 

THE NATION’S INVESTMENT IN CANCER RESEARCH 11 
Our Research Infrastructure and Support 

Cancer Centers and Centers of Excellence 

The NCI Cancer Centers Program supports major academic and research institutions throughout the United States to sustain broad based, coordinated, interdisciplinary programs in cancer research. These institutions are characterized by scientific excellence and capability to integrate a diversity of research approaches to focus on the problem of cancer. The Centers organize and integrate multidisciplinary research across departments and schools within a single 

institution or within consortia of institutions. Cancer Centers provide scientists with the most 

advanced technologies and promote new research opportunities, work collaboratively 

with industry, perform state-of-the-art translational 

research, and conduct education, outreach, and information programs. Several are highly effective in leveraging their resources for cancer research and education 

with other organizations in the public as well as private sectors. Of the 60 Cancer Centers supported 

by NCI, 39 are designated as Comprehensive Cancer 

Centers because of their coverage of basic, translational, and population research. In addition, Center planning grants are underway at eight institutions that 

hope to receive NCI Cancer Center designation. NCI 

is creating new Cancer Center models to extend services to a wider geographic reach within states that do not have the institutional infrastructure 

to sustain the more traditional NCI-supported Cancer Center. Our proposed new investments to support NCI-designated Cancer Centers are described on page 26. 

NCI Centers of Research Excellence also bring together groups of cancer scientists from different areas of expertise. Centers of Excellence are smaller in scale and generally focus on one 

or a few types of cancer or scientific areas. For example, more than 40 Specialized Programs 

of Research Excellence (SPOREs) bring together groups of scientists with specialized expertise 

in translational research for specific cancers. Other examples of NCI Centers of Research 

Excellence are the Transdisciplinary Tobacco Use Research Centers, In Vivo Cellular and 

Molecular Imaging Centers, the Centers of Excellence in Cancer Communications Research, 

and newly established centers for Transdisciplinary Research on Energetics and Cancer and 

Centers of Cancer Nanotechnology Excellence. Centers of Excellence support interactive, 

interdisciplinary research, make research resources and flexible exploratory funds available to 

investigators, and provide research training and career development opportunities. 

12 NATIONAL CANCER INSTITUTE 
THE NATION’S INVESTMENT IN CANCER RESEARCH 13

Networks and Consortia

Networks and consortia are geographically dispersed multidisciplinary groups whose goals

require inter-institutional collaborations. They focus on the development and sharing of

resources and the development or validation of new interventions ranging from new therapies to genetic risk counseling to outreach. For example, NCI brings investigators together

through networks like the Early Detection Research Network, which assembles groups of

scientists to identify markers and develop and validate tests to detect early signs of cancer

or cancer risk. The Cancer Genetics Network is a nationwide system of research sites located

within NCI-designated Cancer Centers that specializes in the study of inherited predispositions to cancer. The Cooperative Human Tissue Network provides investigators with the

human tissue specimens that are so critical to cancer research. Six member institutions in

this network coordinate the collection and distribution of tissues across the United States

and Canada.

NCI’s Mouse Models of Human Cancers Consortium provides a vehicle for scientists

from around the world to share their expertise and resources in creating strains of mice

that develop cancers similar to those seen in humans. The InterLymph Consortium is an

open scientific forum for epidemiologic research in non-Hodgkin’s lymphoma. NCI’s

recently formed Consortium of Cohorts addresses the need for large-scale, international

collaborations for study of gene-gene and gene-environment interactions in the etiology

of cancer. More than 20 cohorts, involving 1.2 million individuals are participating. 

With an expected enrollment of 11,000 patients with newly diagnosed lung or colorectal cancer, the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium project

will collect data that reflect the entire span of care from diagnosis through end-of-life care,

capturing data from patients, their physicians (surveys and medical records from specialists

and non-specialists), and their informal caregivers. Data collected by eight research teams will

be used to determine the factors that influence the interventions that cancer patients receive

and to evaluate the effects of that care on patient survival, quality of life, and satisfaction

with care.
14 NATIONAL CANCER INSTITUTE

Our Research Infrastructure and Support

NCI-Supported Clinical Trials

NCI-supported clinical trials have helped to save or extend the lives of millions of people in

the United States and around the world. Over 1,500 NCI-supported cancer trials are conducted annually, involving more than 12,000 investigators at the NIH Clinical Center and about

3,000 other sites across the United States. The NCI clinical trials system has been a model for

other research institutions. The program is currently working to build a more interactive and

coordinated system, one that will be used to prioritize and accelerate the development of new

interventions and ensure that those interventions found to be effective are efficiently and

seamlessly incorporated into medical practice.

The Clinical Trials Cooperative Group Program promotes clinical trials of new cancer treatments, explores

methods of cancer prevention and early detection, and

studies quality of life issues and rehabilitation during

and after treatment. The Cooperative Group Program

involves more than 1,700 institutions that contribute

patients to group-conducted trials. Thousands of individual investigators also participate in NCI-supported

cooperative group studies. Cooperative groups place

more than 22,000 new patients into cancer treatment

trials each year. The online Cancer Trials Support Unit

(CTSU) Web site centralizes the common administrative, financial, and data collection activities of the

cooperative groups. With the CTSU in place, physicians outside NCI’s cooperative groups can also

enroll patients into NCI-supported clinical trials.

The NCI-supported Community Clinical Oncology

Program (CCOP) has also been highly successful in

bringing the benefits of clinical research to cancer

patients in their own communities. The 60 CCOPs

currently supported by NCI, 13 of which are minoritybased programs (MCCOPs), involve more than 400

community hospitals in 36 states, Washington, D.C.,

What are the Specific Goals of

Cancer Clinical Trials?

Phase I trials are studies involving

small numbers of patients to evaluate how new drugs should be given

(by mouth, injected into the blood,

or injected into the muscle), how

often, and at what dose level.

Phase II trials continue to test the

safety and efficacy of drugs, usually focusing on how effective they

are for specific types of cancer.

Phase III trials test new drugs,

new combinations of drugs, or

new surgical procedures in comparison to the current standard.

Phase III trials generally enroll

larger numbers of people and are

frequently conducted at multiple

locations–e.g., doctors’ offices,

clinics, and Cancer Centers.
THE NATION’S INVESTMENT IN CANCER RESEARCH 15

and Puerto Rico, who participate along with the Cooperative Groups and Cancer Centers

in NCI-supported clinical trials. CCOPs make it possible for community oncologists to

be involved in clinical research and to provide access for their patients to state-of-the-art

cancer care close to home.

NCI is facilitating progress on several new clinical trials initiatives. We are developing a common clinical trials informatics platform that will be overseen by, and made available to, the full

range of investigators working within the cancer clinical trials system. This includes NCI clinical faculty, staff, academicians, community physicians, representatives of regulatory agencies

and the pharmaceutical industry, research nurses, and patient advocates. We are working with

the Food and Drug Administration and the Office of Human Research Protections to develop

more effective policies and procedures specific to cancer clinical trials. We are also partnering

with the Centers for Medicare and Medicaid Services to develop a systematic process for supporting patients enrolled in cancer diagnostic and therapeutic intervention trials.

Looking to the Future

The Clinical Trials Working Group has recently identified 22 recommendations for restructuring the clinical trials enterprise to accommodate advances in molecular medicine. The recommendations include enhancement initiatives that will expand activities already underway

and new initiatives that propose fundamental and significant operational changes. Our proposed new investments to implement some of these recommendations in Fiscal Year 2007 are

described on page 28.

Community-Supported Cancer Trials Make a Difference in the Lives of Many 

Several large-scale cancer prevention trials have been made possible through the Community Clinical

Oncology Program (CCOP) supported by NCI. Indeed, the first cancer prevention drug, tamoxifen, might

never have reached patients without the CCOP network that conducted the Breast Cancer Prevention

Trial, the study on which the approval was based. The trial tested the efficacy of tamoxifen in preventing breast cancer in women at high risk for the disease. Another CCOP trial, the Prostate Cancer

Prevention Trial, evaluated finasteride as a prostate cancer prevention drug.

The CCOP network remains a strong partner in ongoing studies as well. The Study of Tamoxifen and

Raloxifene (STAR) compares raloxifene with tamoxifen in breast cancer prevention. Initial results

from STAR are expected in 2006. The Selenium and Vitamin E Cancer Prevention Trial (SELECT) is

evaluating the supplements to prevent prostate cancer. Results from SELECT should be available in

2013. A perhaps underappreciated component of the CCOP is its support to symptom management

trials. These trials may not garner headlines, but their importance in developing interventions to

reduce side effects of treatment such as nausea and mucositis is critical.
16 N ATIONAL CANCER INSTITUTE

Our Research Infrastructure and Support

Technology Development

Identifying many of the complex mechanisms responsible for cancer through genetic and

protein microarrays, molecular imaging, and high throughput screening is proving to be

pivotal in accelerating our ability to preempt cancer at its various stages. Similarly, technology-dependent, molecularly targeted therapies based on a patient’s disease-specific profile

of markers provide hope that the cancer burden will be lightened and patients will enjoy a

higher quality of life. We are able to make rapid gains against cancer because of the development and availability of advanced technologies that enable accelerated research and create effective interventions.

Bioinformatics

Using the power of modern information technology, NCI is leading the way in developing a

bioinformatics platform, cancer Biomedical Informatics Grid (caBIGTM) that promises to revolutionize the biomedical research enterprise. Scientists in various disciplines will have access

to a common infrastructure for collaboration and integration of findings that will make it

possible for investigators to accelerate their research. Informatics systems will also assist the

cancer community with priority setting, decision making, and participation in order to accelerate the completion of cancer clinical trials. Databases and analytical tools will make information from all clinical trials available to NCI-supported researchers for efficient patient

accrual, information retrieval, and data analysis. Confidential clinical and proprietary information will be protected by controlled, secure access. Advocacy groups and individual

patients will be empowered to participate in clinical research, and healthcare providers will

become full partners in the research enterprise and educated consumers of research findings.

Cancer Imaging

Advanced imaging technologies are dramatically improving our understanding of cancer

biology and facilitating cancer preemption and the clinical management of cancer and cancer risk. Clinicians are increasingly relying on imaging methods as biomarkers for cancer
risk and treatment efficacy. Image guided cancer intervention is a rapidly evolving area that 

may be used to cure some cancers and precancerous lesions, and also to provide minimally 

invasive, well-tolerated palliative therapies. Imaging informatics optimizes the availability and 

effectiveness of cancer imaging data in research as well as clinical environments. Imaging methods are used hand-in-hand with emerging technologies such as nanotechnology, proteomics, 

and high throughput screening to identify cancers earlier and help assess the effectiveness of 

therapy. Imaging of small animals used in research, particularly genetically engineered mice, is 

increasingly recognized as a powerful discovery tool in cancer research. As our knowledge of 

the molecular basis of cancer increases, molecular imaging methods are providing clinicians 

with telling details about the environs of patients’ tissues. 

Proteomic Technologies 

Scientists are taking new steps to 

identify profiles, or signatures, of 

proteins and peptides (fragments of 

proteins) that are found in tumors 

and often in the circulating blood 

that signal early phases of cancer 

development. Proteins serve complex and diverse functions in the 

body, from giving structure to our 

cells to regulating processes such 

as digestion, respiration, and the 

growth rate of cells. When proteins 

do not function properly, normal 

body processes can go awry. For example, cancer is caused by errors in proteins that regulate when and how fast cells replicate themselves, as well as the timing of cell death. One of 

the goals in cancer research is to develop technologies that measure these abnormal proteins 

and can eventually be used as simple diagnostic blood tests. However, there are some sizeable technical challenges that stand in the way of achieving that goal. These abnormal proteins are found in minute quantities in the blood. The net effect is that we need to refine the 

technology so that it can find “a needle in the haystack” with unprecedented reliability. 

NCI is supporting the development of advanced technology platforms for overcoming these 

barriers and preparing diagnostic methods ready for clinical testing. Mass spectroscopy, a 

favored approach involving high energy lasers, high powered electronic sensing, and computing, is used to identify specific proteins and their fragments based on their size and electrical 

THE NATION’S INVESTMENT IN CANCER RESEARCH 17 
Our Research Infrastructure and Support 

charge. Another avenue is to use DNA and antibodies to capture proteins and measure their 

quantity on electronic chips. In the near future, patients may have small samples of their 

blood analyzed using mass spectroscopy and protein chips that will, within minutes, identify abnormal proteins that indicate early, treatable cancers. New infrastructures will help 

researchers speed development of these technologies and bring them to the clinic. Through 

a new Mouse Models of Human Cancers Consortium initiative, researchers will create 

new resources including antibodies, data that provide standards for future measurement 

comparison, serum specimens, and histologic data. These resources will enable investigators to develop the technology platforms needed to detect proteins at very low levels. 

Nanotechnology 

Nanotechnology offers an unprecedented and paradigm changing opportunity to study and interact 

with normal and cancer cells at molecular and cellular scales, in real time and during the earliest stages 

of the cancer process. Nanotechnology will enhance 

cancer diagnosis and treatment in numerous ways. 

Imaging agents and diagnostics will allow clinicians 

to detect cancer in its earliest, most treatable, presymptomatic stage and provide real time assessments of 

therapeutic and surgical efficacy for accelerating 

clinical translation. Multifunctional targeted devices 

capable of bypassing biological barriers will deliver multiple therapeutic agents at high local 

concentrations — and with physiologically appropriate timing — directly to cancer cells and 

tissues that play a critical role in the growth and metastasis of cancer. Nanoscale agents will 

be capable of monitoring predictive molecular changes and preventing precancerous cells 

from becoming malignant. Our proposed new investments to support technology development and its linkages to cancer science are described on page 30. 

Cancer Surveillance 

Cancer researchers depend on comprehensive surveillance data to assess the effectiveness of 

current cancer interventions, to identify areas of cancer health disparities, and to prioritize 

areas for further research. NCI’s Surveillance, Epidemiology, and End Results (SEER) program serves as the foundation for a national system of data resources on all aspects of cancer surveillance and an authoritative source of information on cancer incidence and survival 

18 NATIONAL CANCER INSTITUTE 
in the United States. The SEER program currently collects and publishes cancer incidence 

and survival data from 14 population-based cancer registries and three supplemental registries covering approximately 26 percent of the U.S. population. Information on more than 

3 million in situ and invasive cancer cases is included in the SEER database, and approximately 170,000 new cases are added each year. The SEER registries routinely collect data on 

patient demographics, primary tumor site, morphology, stage at diagnosis, first course of 

treatment, and follow-up for vital status. 

The SEER program supplies researchers with quality data on risk factors, health behaviors, 

extent of disease, treatment and lifestyle factors, and quality of life for cancer survivors. 

Scientists use the Economic Studies in Cancer Prevention, Screening, and Care and Cancer 

Surveillance Using Health Claims-Based Data Systems, both generated using SEER data, 

to assess trends, quality, and the cost of cancer care. Researchers use information generated by SEER Patterns of Care studies to assess the extent and quality of care that cancer 

patients receive. 

The SEER program is the only comprehensive source of population-based information in the 

United States that includes stage of cancer at the time of diagnosis and survival rates within 

each stage. The mortality data reported by SEER are provided by the National Center for 

Health Statistics. 

Communication, Education, and Dissemination 

Although the delivery of cancer interventions is ultimately the responsibility of healthcare and public health organizations, NCI works to ensure that our research findings 

reach the community and are translated into practices that help public health professionals, healthcare providers, and patients make better health choices and obtain quality 

care. NCI proactively disseminates information on research findings, opportunities to 

THE NATION’S INVESTMENT IN CANCER RESEARCH 19 
Our Research Infrastructure and Support 

participate in clinical trials, and new interventions through a range of cancer communications activities that supplement the efforts of medical journals and news media. For 

example, NCI provides Web-based information on cancer and clinical trials, toll-free 

telephone cancer information service in all regions of the country, and printed brochures 

and educational packages distributed directly to consumers and through physicians and 

advocacy organizations. 

NCI-supported researchers continuously work to improve methods for reaching all who 

need to learn about cancer with critical information. 

> Public surveys help assess reactions to media coverage about cancer and aid us in 

communication planning and evaluation, especially in evaluating the public's reaction 

to controversial coverage. 

> Training workshops and toolkits for journalists enhance the quality and quantity of 

media coverage about cancer science. 

> Applied communications studies identify how to best integrate electronic and interpersonal 

communication systems to improve decision making and facilitate positive changes in 

health behavior. 

> Basic communication research partnerships accelerate discoveries about how cancer 

information is processed and used. 

> The New Media Collaborative focuses on developing tailored communications strategies 

to benefit specific populations, including medically underserved communities. 

> A collaboration between the U.S. Department of Health and Human Services and the 

Department of Agriculture has been responsible for furthering dissemination of the 5-

to-9 A Day message promoting the consumption of fruits and vegetables to diverse 

populations. 

> Research on doctor-patient communications provides practical strategies for dialogue 

and examines the use of mediated communications to help patients cope with cancer. 

These efforts include a special focus on minority and underserved patients. 

Training and Career Development 

Rapid developments in the frontiers of science and technology, including molecular biology 

and translational medicine, have broadened the scope of cancer research and have presented 

new challenges for training future cancer researchers in diverse disciplines. NCI devotes 

20 NATIONAL CANCER INSTITUTE 
approximately four percent of its annual budget and multiple strategies to preparing the 

next generation of cancer researchers for challenges that are increasingly multidisciplinary 

and span basic, clinical, behavioral, and applied research. Each year, we provide cancer 

research training and career development opportunities to more than 2,000 graduate students, postdoctoral fellows, and oncologists. Some of this training takes place on the NIH 

campus, but most occurs in universities and teaching hospitals around the United States. 

All sponsored traineeships are intended to increase the number of scientists who specialize 

in the basic or clinical biomedical research fields. We invest in training to support the use of 

advanced technologies and provide career opportunities to equip scientists to address cancer 

in underserved populations. We foster development of interdisciplinary teams of scientists to 

carry out critical translational research. These investments will ensure a steady flow of well 

trained investigators to focus on the problem of cancer. 

NCI Advisory Groups 

Scientists, medical experts, and advocates work together to help shape NCI’s policies and programs 

through a number of standing and ad hoc advisory groups. Advisory groups provide seasoned assessment of progress and problems in the Nation's effort to reduce the burden of cancer. 

> The National Cancer Advisory Board provides overall guidance for NCI and a final assessment 

of the research proposals selected for funding through peer review. 

> The Board of Scientific Counselors evaluates the progress, performance, and productivity of 

the Institute's intramural research programs and scientists through regular site visits to NCI. 

> The Board of Scientific Advisors plays a similar role for NCI’s extramural program, reviewing 

the progress of ongoing programs and providing feedback on proposed new research activities. 

> NCI is strongly influenced by the President’s Cancer Panel, which monitors the development 

and execution of the activities of the National Cancer Program and reports directly to the 

President. 

> The Director’s Consumer Liaison Group is an all-consumer advisory committee that provides 

advice not only to the Director but to a number of specific program areas such as cancer 

communications, survivorship, and science planning. 

> Progress Review Groups of scientific and medical experts and advocates examine the 

research needs and opportunities for specific types of cancer. 

THE NATION’S INVESTMENT IN CANCER RESEARCH 21 
Our Research Infrastructure and Support 

Other Partnerships 

Partnerships, traditional and beyond, are vitally important to eliminate bottlenecks, leverage resources, take advantage of expertise outside of the Institute, and build synergy. NCI 

is increasingly looking beyond its institutional boundaries to engage in various kinds of 

collaborative efforts. 

> The Consortium of Cohorts is an international collaboration of investigators responsible 

for independently funded population studies involving over a million people. By pooling 

their data, these scientists have adequate samples sizes to conduct numerous studies 

leading to valuable insights for cancer prevention and control. 

> The Leukemia/Lymphoma Molecular Profiling Project includes a consortium of NCI 

intramural and extramural investigators who have pooled resources and talent to create 

a framework for the molecular classification of lymphomas. The large number of samples, 

substantially more than any single institution could have acquired, has allowed researchers 

studying diffuse large B-cell lymphoma to draw reliable conclusions about how best to 

diagnose and treat patients based on the molecular subtype of their disease. 

> Through an interagency agreement, NCI and the FDA collaborate to share knowledge 

and resources to facilitate the development of new cancer drugs and speed their delivery 

to patients. NCI is also partnering with the Centers for Medicare and Medicaid Services 

to develop a systematic process for evaluating new diagnostics and therapeutics to aid in 

payment and coverage decision making. 

> The Annual Report to the Nation on the Status of 

Cancer is a collaborative effort involving NCI, the 

Centers for Disease Control and Prevention (CDC), 

the American Cancer Society, and the North 

American Association of Central Cancer Registries. 

> In 1999, NCI and the pharmaceutical company 

Genentech entered into a Cooperative Research and 

Development Agreement to test treatment of renal 

cell carcinoma (RCC) patients with the monoclonal 

antibody AvastinTM (bevacizumab). Based in part 

on this research, Avastin was approved by the FDA 

in 2004 for treatment of RCC patients, in combination 

with the standard chemotherapeutic drug ironotecan, 5-fluorouracil, and leucovorin (ILF). 

Avastin also looks promising for treatment of breast, colorectal, and other cancers. 

22 NATIONAL CANCER INSTITUTE 
> NCI recently established a partnership with pharmaceutical companies Aventis, 


Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, and Novartis to provide funding 


to Cancer Centers for the design and implementation of new approaches to increasing 


the participation of newly diagnosed cancer patients in early stage clinical trials. 


> The Avon-NCI Progress for Patients Awards Program funds clinical investigation 


important to breast cancer prevention, early detection, diagnosis, prediction, 


prognosis, and treatment.


> NCI’s Academic Public Private Partnership Program (AP4) is supporting a new 


paradigm in the discovery of new agents and the development of cancer drugs, 


and their rapid translation to human clinical trials. Through this program, NCI 


fosters collaborations among universities, pharmaceutical companies, biotech 


companies, and nonprofit organizations. 


> NCI has partnered with CDC, the Substance Abuse and Mental Health Services 


Administration, the American Cancer Society, and the Agency for Healthcare 


Research and Quality to provide evidence-based tools to help states and communities 


plan, implement, and evaluate evidence-based comprehensive cancer control programs. 


The Web-based tools are available through the Cancer Control PLANET (Plan Link 


Act Network) portal located at cancercontrolplanet.cancer.gov.


The Advocate Role in Cancer Research 

Cancer advocates may be cancer survivors, family members or life partners, or people involved in 

cancer-related activities, such as support group leaders or hotline workers. They come from diverse 

age groups, races, ethnicities, educational levels, and geographic locations. Cancer advocates are 

intimately familiar with the hopes, struggles, joys, losses, and successes of cancer patients, those 

at risk for cancer, and their loved ones. Their advocacy helps present the human face of cancer to 

scientists, administrators, and the general public, reminding us of the “why” in cancer research. 

NCI draws upon the expertise of cancer advocates through two major vehicles. The Director’s 

Consumer Liaison Group (DCLG) is made up of 15 cancer advocates, each representing a unique constituency in the advocacy community. DCLG members advise the Director of NCI on a wide variety of 

issues, programs, and research priorities. NCI also solicits the advice of patients and their family 

members through the recently created Consumer Advocates in Research and Related Activities 

(CARRA) program. Through this program, approximately 200 individuals serve as resources to participate in a wide range of NCI activities. For example, they sit on advisory boards of basic and clinical 

researchers to help assess research needs for specific cancers, provide advice on the design of 

clinical trials, and review educational materials. 

THE NATION’S INVESTMENT IN CANCER RESEARCH 23 
Our Research Infrastructure and Support 

Cancer Research Fosters Medical Advances for Other Diseases 

With the stewardship of our resources in recent years, NCI is fostering numerous efforts with results 

important not just for cancer but for a number of diseases. The early detection work in proteomics 

conducted through a partnership with FDA is potentially applicable to most acute and chronic diseases. The Cancer Genome Anatomy Project contributed extensively to accelerating the national 

effort to map the human genome. New high-resolution molecular imaging methods promise to lead to 

new approaches to the early detection, screening, diagnosis, and image-guided treatment of cancer 

and other diseases. Infrastructures for therapeutics development such as the Rapid Access to 

Intervention Development program are being applied to foster new treatments for type 1 diabetes. 

Apoptosis (programmed cell death) has been heavily researched for cancer but also has implications 

for neurobiology, immunology, aging, and human development and strong association with autoimmunity and degenerative diseases and conditions. Angiogenesis research is informing the treatment of 

cancer and the complications of diabetes. In addition, cancer research has shown that the extracellular matrix is associated with cell death, influences angiogenesis, impacts blood vessels and nerves 

in aging tissues of the musculoskeletal system and skin, and may be important to our understanding 

of the vascular and neurological changes that accompany aging. The results of studies on tobacco 

addiction and cessation have implications for the control of heart and lung disease, stroke, and other 

serious illnesses. As discoveries about the bioactive components arise from NCI nutrition studies, it 

will be possible to develop more personalized approaches to disease prevention. Multi-agency collaborative research on diet, physical activity, and weight control is identifying societal and environmental 

approaches that will make it easier for people to make healthy dietary and physical activity choices. 

Such choices will improve prognosis for overall health and reduce the occurrence of many chronic 

diseases. In addition, the cancer Biomedical Informatics Grid promises to serve our vital need to 

develop medical and health information systems that will serve people all across our Nation. 

24 NATIONAL CANCER INSTITUTE 
Each of the five new investment areas described on the following pages represents a critical path for reaching NCI’s Challenge Goal to the Nation. Each promises to yield high return but will require a substantial investment of resources.

Fostering more integration within and among NCI-designated Cancer Centers will

boost synergism, reduce redundancy, and leverage resources. A more extensive,

robust, and active Cancer Center system will foster community-based research

and service programs targeted to medically underserved populations. 

Reengineering our clinical trials system will allow us to move the growing

backlog of potential prevention and therapeutic agents through clinical testing.

New strategies for improving trial accrual, prioritization, coordination, and efficiency will dramatically accelerate the movement of new interventions into

medical practice.

Building better linkages between emerging technologies and cancer science will

reduce the cost, improve precision, and reduce harmful side effects of medical procedures. Advanced imaging, clinical proteomics, and nanotechnology will improve

our understanding of cancer biology, facilitate the management of cancer risk, and

help make “personalized” medicine a reality.

Common platforms and tools for medical informatics and health information systems

will be used to support national efforts to develop and use electronic medical

and personal health records. The cancer Bioinformatics GridTM and the cancer

clinical trials system provide ideal test beds for development of electronic

health systems.

A more integrative approach to understanding cancer will help researchers identify

biomarkers for predicting who is at high risk for cancer; identify molecular targets

of prevention, diagnosis, and treatment; develop strategies for intervening early in

the cancer process; and improve the quality of cancer services.

New Strategic

Investments in

Fiscal Year 2007

THE NATION’S INVESTMENT IN CANCER RESEARCH 25
Cancer Centers are vital scientific and geographic hubs of progress for basic discovery. They are central platforms for development of effective approaches to prevention, diagnosis, and therapy. They provide life saving interventions and other advances to 

patients, their families, and the public. The research endeavors of Cancer Centers contribute new knowledge, improved treatments, and other advances to lower the incidence of cancer and improve survival rates. Increased investment is required to 

expand the geographic coverage and impact of Cancer Center services. 

The NCI Cancer Centers — Driving 

Progress toward 2015 

NCI-designated Cancer Centers extend their reach into the community through networks that 

link Centers, community hospitals, and private oncology practices to provide patients with 

state-of-the-art care and access to clinical trials. They bring together the best of basic, translational, and population research to achieve improved cancer prevention, diagnosis, and 

treatment. Translational research networks link basic research-oriented Centers with the 

Comprehensive Cancer Centers. Centers also link to their communities and regions through education and 

outreach networks, provide a locus for stable and integrated consortia and other partnerships, and are an 

important element of state cancer planning processes nationwide. Cancer Centers are also expected to be at 

the forefront of cancer prevention intervention development and the dissemination of these approaches to 

their communities and regions. 

Cancer Center 

Comprehensive Cancer Center 

The NCI-designated Cancer Centers are vital parts of a 

national strategy to reduce the suffering and death due 

to cancer. They are encouraged to stimulate collaborative research involving more than one field of study. Of 

the 60 Cancer Centers now supported by NCI, 39 are 

Comprehensive Cancer Centers. These Centers conduct research and provide services directly to cancer 

patients. These facilities must demonstrate expertise in 

each of three areas: laboratory, clinical, and behavioral 

and population-based research. In addition, eight institutions around the country currently hold Center planning grants and hope to receive NCI Cancer Center 

designation in the near future.

26 N ATIONAL CANCER INSTITUTE 
Required Resources 

An annual increase of $164 million for five years will 

expand the NCI-designated Cancer Centers program 

from 60 centers to 75 and achieve a more extensive, 

robust, and active program through enhanced integration and outreach. 

Proposed New Investments 

As much as NCI Cancer Centers have contributed to progress 

against cancer, NCI will enhance their impact even further by 

expanding the number of Centers, facilitating stronger interaction among them, and fostering fuller outreach efforts into 

the community. 

> Expansion 

By adding up to 15 new Cancer Centers over the next five 

years —increasing the number of Centers from 60 to as many 

as 75 — it will be possible to establish Centers in states and in 

metropolitan areas where none currently exist. This expanded 

infrastructure will improve the access of minority and underserved populations to their state-of-the-art cancer care services and research, including community-based research. 

> Integration 

Horizontal integration will be achieved by implementing progressive bioinformatics, communication, and related systems 

that will boost synergy, reduce redundancy, and leverage 

resources across the network of Cancer Centers. NCI will 

broaden the geographic impact of the Centers, networks, and 

consortia and vertically integrate them with community and 

regional health care delivery systems. Vertical integration will 

provide new avenues of scientific pursuit within Cancer 

Centers and strengthen outreach to and involvement with 

the communities they serve. NCI will fund additive programs 

in collaborative multidisciplinary research and require integration and sharing of results. 

> Outreach 

New NCI-supported outreach programs will enable Cancer 

Centers to create and strengthen partnerships with government agencies and community organizations. Centers will 

also be able to provide expertise and other support to caregivers, patients and families, and appropriate health agencies to a greater extent than previously possible. Moreover, 

with adequate resources and contemporary technologies, 

specialized services offered by Cancer Centers in the United 

States could be utilized anywhere in the world. 

THE NATION’S INVESTMENT IN CANCER RESEARCH 27 
Each year, NCI provides leadership, resources, and expertise for a clinical trials program that spans the entire spectrum of 

activity — from the discovery of novel molecules to the evaluation and application of new agents and interventions. NCI is 

seeking to develop a more robust infrastructure for cancer clinical trials that will strengthen scientific prioritization and coordination and improve the timeliness with which clinical trials are completed. By embracing this restructuring, NCI will ensure 

that life saving advances, generated by 40 years of research, make a substantive difference in reaching the NCI Challenge Goal. 

Reengineering Cancer Clinical Trials


To this end, NCI recently established the Clinical Trials 

Working Group to advise the National Cancer Advisory 

Board on the optimal coordination and future progress of 

the entire range of intramural and extramural clinical 

research trials. As we look to the future, we recognize the 

need to anticipate scientific and technological advancements and enhance 

partnerships that include an interdisciplinary and translational focus. The 

need to move the growing backlog of potential prevention and therapeutic 

agents through clinical testing places the integration and streamlining of 

clinical trials on a critical path toward improving the quality of care and 

quality of life for cancer patients. 

Clinical oncology is entering a new age, driven by technology and advances 

in molecular medicine. NCI and the cancer research community must determine the best way to adapt clinical trials to meet these new opportunities. 

The enormous potential for more specific cancer treatment, coupled with 

the complexity of evaluating new, highly specific agents, requires nimble 

clinical trial designs. Imaging can play a role not only in monitoring treatment but also in identifying patients who are most likely to respond to a 

particular drug or combination therapy. In addition, imaging will be critical to the pre-clinical screening and validation of new targeted compounds. 

A revamped clinical trials structure will necessitate comprehensive information sharing and close collaboration among clinical, basic, and translational 

scientists as well as researchers who are developing modern molecular diagnostic and imaging techniques. 

Proposed New Investments 

NCI will build a highly interactive and 

optimally coordinated cancer clinical 

trials system that prioritizes and 

accelerates the development of new 

interventions and ensures that they 

are incorporated into medical practice. The report of the Clinical Trials 

Working Group (CTWG), Restructuring 

the National Cancer Clinical Trials 

Enterprise, included 22 recommendations, which emerged from a series 

of deliberations that included public 

comment from stakeholders, academic 

investigators, oncologists, and representatives from government, industry, 

and professional groups. New investments in Fiscal Year 2007 will be used 

to implement the recommendations by 

improving clinical trials coordination, 

prioritization, standardization, and 

operational efficiency. 

28 NATIONAL CANCER INSTITUTE 
THE NATION’S INVESTMENT IN CANCER RESEARCH 29

Required Resources

The Clinical Trials Working Group report includes an

implementation plan with a timeline and budget for

each initiative and recommends that a formal evaluation system be developed to assess the success of the

restructuring effort over time. We anticipate the need

for an annual increase of $171 million over current

base NCI levels for five years to deploy a modern

integrated cancer clinical trials infrastructure. 

> Coordination

NCI initiatives will facilitate cooperation among the functionally diverse components of the current system, including

industry and Federal regulatory agencies. Activities will

include expanding the NCI clinical trials database review

capacity, adjusting grant data reporting requirements, and

modifying NCI award guidelines to reward collaboration. NCI

will institute new forms of recognition, interact with medical

school deans on academic incentives, and build an awareness campaign for an expedited review process with the

Food and Drug Administration (FDA). We will also establish a

process for aligning NCI with the Centers for Medicare and

Medicaid Services to select those studies that are appropriate for reimbursement.

> Prioritization

NCI will improve scientific quality by developing an open and

transparent process for the design and prioritization of clinical

trials that are both science driven and patient centered. We

will establish additional Scientific Steering Committees and

convene State-of-the-Science meetings and focus groups

that include community oncologists and patient advocates. A

budget for correlative science/quality of life studies will be

established. The measurement, analysis, and reporting of biomarker data in association with clinical trials will be funded.

> Standardization

To minimize duplication of effort and integrate a national

cancer clinical trials network, NCI will support the development of a shared infrastructure of tools and procedures for

trial design, data capture, data sharing, and administrative

functions. Through the cancer Biomedical Informatics Grid

(caBIGTM), we will create a Web-based tool for clinical trial

initiation and concur with industry/FDA on the development

of standard Case Report Forms. NCI will hold a conference

among investigators from industry and clinical trial sites to

standardize clinical trial contract clauses.

> Operational Efficiency

NCI will increase the rate of patient accrual and reduce operational barriers so that trials can be initiated and executed in

a timely, cost-effective manner. We will restructure the Phase

III trial funding model, begin to increase funding for sites with

high accrual rates, complete analysis of institutional barriers

to timely trial initiation, and develop approaches to enhance

adoption of the NCI Central Institutional Review Board facilitated process.
30 N ATIONAL CANCER INSTITUTE

More than ever before, biomedical science is dependent on the use of advanced technologies to maximize scientific discovery and the delivery of cancer interventions. Working together across communities of scientists and technology experts is a

new paradigm for cancer research and development. It increasingly requires new kinds of collaborations and a melding of

cultures to achieve an environment friendly to the development, validation, and practical application of promising technologies in cancer discovery, development, and delivery of care.

Proposed New Investments

NCI will provide the leadership to leverage and coordinate

NATIc, caBIGTM, and other resources to optimally integrate

technological advances with cancer science. We will cultivate teams of biological scientists, engineers, physicists,

and others through innovative funding approaches and by

working across public and private settings and with the cancer advocate communities. We will continue to leverage

resources and build partnerships with other Federal agencies— including the National Science Foundation, the

Department of Energy, the Department of Defense, the

National Institute of Standards and Technology, and the

National Aeronautics and Space Administration —to integrate a broad spectrum of technological and scientific

resources. Partnerships among academic and research

institutes, the biotechnology and pharmaceutical industries,

and government agencies will accelerate translational

application and commercialization of advanced technologies and help bridge the gap between discovery and delivery. We will use new investments in Fiscal Year 2007 to

increase our support to science and technology in four

critical areas. 

Technological advances in bioinformatics,

imaging, nanotechnology, genomics,

proteomics, metabolomics, and high

throughput screening have set the stage

for unprecedented progress in our

efforts to reduce the burden of disease. Integrating

technologies with cancer science promises to improve

precision, reduce harmful side effects, and reduce

costs of medical procedures. The National Advanced

Technology Initiative for Cancer (NATIc) provides the

infrastructure for integrating science and technology

for the practical development and dissemination of

evidenced-based, advanced technology applications to

reduce the cancer burden. Through a virtual network

of “hubs” and “nodes,” innovative, interdisciplinary

teams of scientists, mathematicians, engineers, and

others will be linked in cutting-edge collaborations for

technology development. NCI’s cancer Bioinformatics

Grid (caBIGTM) will also be essential to the integration

of science and technology. This resource will help

optimize data accessibility, widely distribute effective

best practices, and conserve resources by preventing

duplication of effort.

Building Bridges To Link Science

and Technology
Required Resources 

New investments in linking advanced imaging, nanotechnology, proteomics and biomarker discovery, 

and computational modeling into cancer applications 

will dramatically accelerate our ability to reduce the 

adverse effects of cancer. We propose a budget 

increase of $194.8 million to continue these efforts in 

Fiscal Year 2007. 

> Cancer Imaging 

NCI will support new cancer imaging technologies to enhance 

understanding of cancer biology and facilitate the preemption 

and clinical management of cancer and cancer risk. Imaging 

technologies will be optimized for data sharing; biomarker 

identification; minimally invasive image-guided prevention, 

treatment, and palliative therapies; and early detection and 

assessment of the effectiveness of therapy involving imaging 

in combination with nanotechnology, proteomics, and high 

throughput screening. 

> Nanotechnology 

We will foster the development of nanotechnology interventions to enhance cancer diagnosis and treatment. We 

will support the development of multifunctional, targeted 

devices capable of bypassing biological barriers to deliver 

multiple therapeutic agents at high local concentrations 

directly to cancer cells and tissues that play a critical role 

in the growth and metastasis of cancer. We will support 

research to design and test nanotechnologies to monitor 

predictive molecular changes and prevent precancerous 

cells from becoming malignant, manage symptoms of cancer that adversely impact quality of life, predict drug resistance, and enable investigators to quickly identify new drug 

targets for clinical development. 

> Genomics, Proteomics, and Biomarker Discovery 

NCI will accelerate the potential of personalized medicine 

through genomic, proteomic, and other biomarker discovery. 

Collaboration between cancer scientists and technology 

experts will accelerate the development of techniques to 

detect minute quantities of biomarkers susceptibility of precancer, or malignancy in tumor tissue, blood, saliva, or 

urine. These efforts will lead to more precise prevention 

interventions, diagnostic testing, prediction of patient 

response to specific treatments, and use of individualized 

treatment plans. Advanced preventives, diagnostics, and 

“designer” therapies will preempt cancer at its earliest 

stages and deliver minimally invasive and well tolerated individualized care. 

> Computational Modeling 

NCI will support interdisciplinary collaboration among computer scientists, physicists, and cancer scientists to create multiscale computational models for computerized prediction of 

outcomes, including patient response to treatment. Computer 

programs that incorporate complex, interactive calculations 

will analyze massive amounts of data about cancer cells and 

their micro- and macroenvironments. Once refined and validated, these models will not only yield insights and knowledge 

about cancer, but will also provide a tool to improve patient 

diagnosis and the planning and monitoring of treatment. 

THE NATION’S INVESTMENT IN CANCER RESEARCH 31 
32 N ATIONAL CANCER INSTITUTE

NCI is well positioned to support the President’s call for Americans to have electronic health records within the next ten

years. Several NCI-supported programs are already contributing to the American Health Information Community efforts to

promote common standards and interoperability. Medical information systems will provide access to data important for all

aspects of cancer research. Electronic patient health records will streamline and personalize cancer clinical trials.

The cancer Bioinformatics GridTM (caBIGTM) is enabling cancer researchers to locate de-identified data on patients with

common diagnoses, conditions, or treatments. Investigators

use this information to determine patterns of disease, successful treatments, and outcomes that can complete the

cycle of science from the bench to the bedside and back to the bench. The

NCI Surveillance, Epidemiology, and End Results (SEER) database contains

information on more than six million in situ and invasive cancer cases with

approximately 360,000 new cases accessioned each year. The SEER registries routinely collect data on patient

demographics, primary tumor site, morphology, histology, extent of disease, stage at diagnosis, first course of

treatment, and follow-up.

NCI is actively integrating a range of diverse services and implementing a plan for bioinformatics that will further enhance our capabilities in medical informatics and support the national effort in health information systems. Our overall vision is to deliver patient-centric molecular medicine, drawn from richly diverse data sources,

in support of improved prevention and treatment. Our enhanced infrastructure will also support cancer patients

and their providers in managing the patient’s health as cancer increasingly becomes a disease that people live

with, rather than die from. We will continue to work closely with the Office of the National Coordinator for

Health Information Technology to integrate the national and regional cancer infrastructure into the emerging

national health information network and regional health information organizations and to share electronic platforms for use in the broader context.

Advancing Medical Informatics

Proposed New Investments

With new investments in Fiscal Year

2007, NCI will be able to provide continued technical expertise and models

from our experience with cancer to

support medical informatics and health

information technology for use in both

research and medical practice.
Required Resources 

NCI will need a budget increase of $80 million in Fiscal 

Year 2007 to support the National health information 

technology efforts and develop cancer-specific applications in medical informatics for use in biomedical 

research and clinical practice. 

> Platforms for Data Exchange 

NCI will continue to build upon the caBIGTM foundation for 

leveraging data, research tools, scientists, and organizations 

in an open environment with common standards and shared 

tools. CaBIGTM will be extended to deliver integrated data 

from diverse sources in support of patient-centric molecular 

medicine at the point of care. We will build upon the Cancer 

Research Network and regional networks developed by 

Cancer Centers to enhance community care. 

> Care Delivery and Research Coordination 

NCI will support research initiatives and innovations to coordinate care delivery through the integration of electronic medical records systems. As the development of standards for 

these records and efforts to promote the use of electronic 

health records have become national priorities, it is important 

to guide information system developers regarding the needs 

of clinical care in order to ensure that the records facilitate 

rather than complicate practice. NCI will support work to help 

patients, providers, and organizations manage movement of 

information and coordination of care across the often complex 

set of providers throughout the course of cancer care. We will 

also support the national agenda for developing a functional 

and integrated nationwide electronic health record system. 

> Health Care Delivery Systems as Research Resources 

NCI will support research to develop innovative approaches 

to evaluate and improve cancer care delivery through systems interventions that utilize medical informatics and Webbased systems within healthcare delivery. We will draw 

from advances in electronic medical records — including 

the patient/provider encounter, pharmaceutical, laboratory 

and claims information, and use of innovations in Internet systems for healthcare coordination — to improve communication and care coordination between providers and institutions, 

between patient and providers, and between communities 

and healthcare delivery institutions. We will work collaboratively with Federal and public partners engaged in improving 

healthcare delivery systems. 

> Medical Informatics Infrastructure 

NCI will develop a medical informatics infrastructure to link 

to national epidemiologic databases and to coordinate communication among the multiple participants in cancer care, 

including primary care practitioners. The system will make 

maximum use of NCI investments in cancer communication, 

statistical modeling, surveillance, cancer treatment, clinical 

trials, and health systems research and serve as a cancerled model for the National Health Information Network. 

> Enhanced Surveillance Data 

NCI will develop software applications to expand and streamline the use of electronic pathology records to include data 

on insurance, co-morbidities, risk factors, genetic markers, 

recurrence, and treatment sequelae. Used in combination 

with existing SEER data, this information will dramatically 

improve the national capability to monitor and report population level cancer data and establish a model for possible use 

with other diseases. The effort will lead to increased knowledge of cancer etiology, more accurate cancer prognosis, 

expanded availability of information on cancer recurrence, 

and better estimates of the effects of co-morbidities on cancer outcomes for different population groups. 

THE NATION’S INVESTMENT IN CANCER RESEARCH 33 
Cancer is a complex disease arising from a myriad of genetic and environmental events that elude and exploit normal cellular 

processes. The disease process is further confounded by its diversity and its progressive nature. Cancer science is currently 

at a crossroad where input and approaches from a breadth of disciplines are necessary to understand and appreciate its complexities. Scientists are recognizing the need for study designs with the power to uncover the environmental, lifestyle, genetic, and molecular determinants and pathways involved in cancer initiation, promotion, and progression. 

Integrating Cancer Science


Cancer research of the future will be energized as people 

from the various disciplines combine forces. New paradigms of collaboration will mean new ways of thinking 

about how we do science. This new culture will require the 

creation of an environment conducive to change, the merging of old disciplines, and the development of new ones. New funding 

mechanisms will accelerate development of infrastructures for cutting-edge 

interdisciplinary research at the intersection of basic, clinical, and population sciences. Integrated review of grant applications will take into account 

the melding of various disciplines, support large-scale team-based consortia 

to foster the inclusion of genomics and other emerging technologies into 

epidemiologic study designs, and use other less formal ways to encourage 

interdisciplinary teams to evolve in both directed and serendipitous ways. 

Investments in integrative science will uncover the many factors influencing 

cancer initiation, promotion, and progression and thereby hasten the development of cancer prevention, detection, and treatment interventions. 

Epidemiologists, geneticists, behavioral scientists, and biologists will be working alongside statisticians, engineers, 

physicists, bioinformaticians and computer scientists, sociologists, psychologists, communication specialists, and 

educators to improve the quality of cancer care, and health outcomes for diverse populations. Large-scale consortial 

efforts involving population cohorts will systematically evaluate and identify molecular and biochemical biomarkers 

of susceptibility, gene-environment interactions, causal pathways and intermediate outcomes, and early-stage lesions 

amenable to early detection and treatment. Disparate perspectives and approaches will build the kind of synergy 

required to facilitate the easy flow of information from basic research to application. 

Proposed New Investments 

NCI will support a broad set of interactions and efforts, both within NCI and 

across the scientific community, to 

develop an integrative approach to cancer research. We will use novel funding 

approaches, promote new paradigms, 

and encourage multicenter partnerships 

that will capitalize on efforts across the 

entire biomedical research community 

for the benefit of cancer patients and 

those who care for them. We will develop training initiatives to introduce new 

and established investigators to the 

integrative science paradigm. NCI will 

use new investments in Fiscal Year 2007 

to foster integration in four critical areas. 

34 NATIONAL CANCER INSTITUTE 
Required Resources 

Implementing new pursuits to promote program integration and interdisciplinary team science will require 

new funding structures and environments conducive 

to team science and effective collaboration. We estimate the need for a budget increase of $190 million 

for new investments in this area. 

> Systems Approach 

NCI will use a systems biology approach to build on the totality 

of information available about cancer processes. The studies 

will examine the interrelationships among the immune system, 

the tumor microenvironment, tumor stem cells and self-renewal genes, cellular response to DNA damage, exogenous and 

endogenous chemicals, epigenetics, inflammation, and mechanisms of cancer susceptibility and resistance. We will support 

development of computational models to facilitate the generation of hypotheses and to predict or explain the complex, multilevel interactions that lead to cancer initiation and progression. 

> Integration of the Biological with the Population and 

Public Health Sciences 

Equally important to the successful understanding of cancer 

and the development of interventions to benefit all people will 

be an integrative epidemiologic framework to address NCI 

strategic research initiatives in cancer prevention and detection, health disparities, and other areas of biological, clinical, 

sociological, and public health importance. We will support 

research that extends beyond molecular epidemiology to 

consider the roles of behavioral, sociocultural and psychosocial factors in cancer susceptibility, utilization of recommended 

screening, and treatment outcomes. 

> Advanced Technologies to Facilitate Integration 

NCI will support the development and availability of advanced 

technologies for use in integrative cancer research. We will 

work to ensure that research teams have access to advanced 

technologies, including informatics and computational 

resources, to enable the generation, integration, and analysis 

of vast amounts of biomedical information. 

> Translation into Practice 

We will use integrative approaches to translate interventions 

to public health and medical practice. NCI will assess and 

implement recommendations from the National Cancer 

Advisory Board Translational Research Working Group which 

will analyze existing research efforts and identify opportunities 

for accelerating the delivery of validated interventions to the 

people who can benefit. We will complete the loop of integrative science by developing approaches to inform basic 

researchers about lessons learned from the application of 

emerging interventions in clinical and public health settings. 

THE NATION’S INVESTMENT IN CANCER RESEARCH 35 
This budget request consists of two components: (1) the increase required to maintain our present level of operations or “current services” and (2) the increases 

required for the five new investments described in this document. The 6% current 

services increase is the amount that will be required to sustain existing NCI programs and provide for some minimal growth. Noncompeting Research Project 

Grants (RPGs) would be funded at committed levels, the success rate for competing 

RPGs would be maintained at its current rate, there would be a small growth in the 

number of Cancer Centers, and most other mechanisms would receive sufficient 

increases to cover cost of living adjustments based on the Biomedical Research and 

Development Price Index (BRDPI). This budget level also includes funds to make 

critically needed capital repairs and improvements at the NCI-Frederick Federally 

Funded Research and Development Center. Adjusting for the capital repairs and 

improvements increase and the BRDPI increase of approximately 3%, the growth to 

NCI within a current services budget is less than 2%. The funds needed for the five 

investment areas are add-ons to the current services level. 

At a Glance* 

(dollars in thousands) 

Fiscal Year 2006 Estimate $4,798,511 

Current Services Increase 291,403 

Subtotal 5,089,914 

New Investments 

Expanding Cancer Center Reach 164,000 

Reengineering Clinical Trials 171,000 

Linking Science and Technology 194,800 

Advancing Medical Informatics 80,000 

Integrating Cancer Science 190,000 

Subtotal 799,800 

Total NCI 5,889,714 

* Does not include the NCI contribution to the NIH Roadmap. 

NCI Budget 

Request for 

Fiscal Year 2007 
Fiscal Year 2007 National Cancer Institute Professional Judgment Budget Request 

Current Services Request for FY 2007 

(dollars in thousands) 

FY 2005 

Obligations

FY 2006 

Estimate

Current 

Services 

Increase 

Subtotal 

Current 

Services † 1 

Research Grants 

Research Project Grants 

Noncompeting 1,595,056 
1,625,758 17,964 1,643,722 

Administrative Supplements 51,840
 54,861 1,756 56,617 

Competing 444,597
 453,405 121,595 575,000 

Subtotal 2,091,493 2,134,024 141,315 2,275,339 

SBIR/STTR 97,775 97,800 5,130 102,930


Subtotal, RPG 2,189,268 2,231,824 146,445 2,378,269 

Research Centers & SPOREs 454,032 454,295 20,537 474,832 

Other Research 

Research Careers 76,652 74,970 2,399 77,369 

Cancer Education 34,581 32,536 1,041 33,577 

Cooperative Clinical Research 142,847 141,357 4,523 145,880 

Biomedical Research Support – – – – 

Minority Biomedical Research Support 3,587 3,853 123 3,976 

Other 42,903 40,146 1,285 41,431 

Subtotal – Other Research 300,570 292,862 9,372 302,234 

Total–Research Grants 2,943,870 2,978,981 176,354 3,155,335 

National Research Service Awards 67,299 67,360 2,236 69,596 

Research & Development Contracts 351,056 329,778 10,553 340,331 

Intramural Research 711,009 707,416 22,637 730,053 

Research Management & Support 182,323 182,246 5,832 188,078 

Cancer Prevention & Control 531,250 524,730 16,791 541,521 

Construction (Capital Improvements) – – 30,000 30,000 

Buildings & Facilities 7,936 8,000 27,000 35,000 

Subtotal, NCI 4,794,743 4,798,511 291,403 5,089,914 

NCI’s Roadmap Contribution ‡ 30,500 43,263 60,000 

Total, NCI 4,825,243 4,841,774 5,149,914 

† For comparability, $8.6M was moved from Other to RMS due to change in FY 06 funding of SREA awards. 1 FY 2006 Estimate reflects adjustments to the FY 2006 President's Budget. 

‡ Roadmap estimate for FY 2007. 

Research Project Grants 

RPGs are the primary funding 

mechanisms for extramural 

research and comprise the largest 

part of the NCI budget. We provide 

about 5,000 RPGs each year to 

nearly 600 institutions across the 

United States at an average cost 

of $400,000 per grant. 

SBIR/STTR 

Small Business Innovation 

Research (SBIR) awards support 

projects that may ultimately have 

commercial viability. The government-wide Small Business 

Technology Transfer (STTR) program promotes technology transfer 

by helping investigators form public/private partnerships. 

Research Centers and SPOREs 

NCI-designated Cancer Centers 

serve as hubs for cutting-edge 

research, quality cancer care, 

and community outreach. Centers 

of Excellence like the SPOREs 

use flexible funding to investigate 

specific focus areas and move 

research quickly from the 

laboratory to the patient. 

Other Research 

Other funding mechanisms 

support the education and 

training of cancer investigators, 

Clinical Cooperative Research 

grants for large-scale, multiinstitutional clinical trials, and 

Resource-Related Research 

Project grants to increase the 

availability of research resources. 
New Investments in FY 2007 

Expanding 

Cancer Center 

Reach 

Reengineering 

Clinical Trials 

Linking 

Science & 

Technology 

Advancing 

Medical 

Informatics 

Integrating 

Cancer 

Science 

Subtotal 

New 

Investments 

FY 2007 

Total 

Request 

% Inc Over 

FY 2006 

Estimate 

– _ _ _ _ _ 1,643,722 

– – – – – – 56,617 

29,500 24,750 59,400 4,950 82,665 201,265 776,265 71.2% 

29,500 24,750 59,400 4,950 82,665 201,265 2,476,604 16.1% 

1,000 – 2,475 – – 3,475 106,405 

30,500 24,750 61,875 4,950 82,665 204,740 2,583,009 15.7%


42,000 33,600 69,300 19,800 50,935 215,635 690,467 52.0% 

11,000 1,000 _ _ 36,630 48,630 125,999 

6,000 – – – – 6,000 39,577 

5,000 32,670 – – – 37,670 183,550 

– – – – – – – 

– – – – – – 3,976 

5,000 – 8,415 – – 13,415 54,846 

27,000 33,670 8,415 – 36,630 105,715 407,949 39.3% 

99,500 92,020 139,590 24,750 170,230 526,090 3,681,425 23.6% 

3,000 – – – – 3,000 72,596 7.8% 

24,500 63,410 46,332 52,200 – 186,442 526,773 59.7% 

– 5,940 6,930 – 17,820 30,690 760,743 7.5% 

2,000 1,710 1,948 1,250 1,950 8,858 196,936 8.1% 

35,000 7,920 – 1,800 – 44,720 586,241 11.7% 

– – – – – – 30,000 100.0% 

– – – – – – 35,000 337.5% 

164,000 171,000 194,800 80,000 190,000 799,800 5,889,714 22.7% 

60,000 38.6% 

5,949,714 22.9% 

National Research Service Awards 

Individual NRSAs enable experienced scientists to enhance and 

expand their research knowledge 

and skills. Institutional NRSAs support predoctoral and postdoctoral 

training at qualified institutions. 

Research & Development Contracts 

Research and development contracts are used for various NCI 

research programs including drug 

development, technology advancement, and epidemiology. 

Intramural Research 

The NCI intramural research 

program provides a uniquely 

interactive, interdisciplinary 

environment for basic laboratory 

and long-term epidemiologic and 

genetics studies and their rapid 

translation to intervention development and clinical testing. 

Research Management & Support 

Research management and support 

funds are used for technical and 

administrative services including 

central administration, overall program direction, grant and contract 

administration, human resources, 

program coordination, and financial 

management. 

36 NATIONAL CANCER INSTITUTE 
Distribution of Fiscal Year 2007 Budget Request ($5,949,714,000)


Construction– Capital Improvements 1% Buildings & Facilities 1% 

NIH Roadmap 1% 

Research Project Grants 42% 

Other Research 7% Research Centers & SPOREs 12% 

National Research Service Awards 1% 

Research & Development Contracts 9% 

Intramural Research 13% 

Research Management & Support 3% 

Cancer Prevention & Control 10% 

Cancer Prevention & Control 

Cancer prevention and control 

funds are used to support research, 

communication, and other activities 

to reduce cancer risk, incidence, 

morbidity, and mortality and 

improve the quality of life for 

cancer patients. 

Construction (Capital Improvements) 

The NCI capital improvements 

program supports the creation 

of additional state-of-the-art 

laboratories and clinics for basic 

and applied research including 

biorepositories, imaging, and 

bioinformatics facilities. 

Buildings & Facilities 

NCI’s building and facilities program 

supports repairs and improvements 

at the NCI Federally Funded 

Research and Development Center 

in Frederick, Maryland. 

THE NATION’S INVESTMENT IN CANCER RESEARCH 37 
38 NATIONAL CANCER INSTITUTE

This document was developed and produced with the participation of a large number of NCI staff and the people who support

their work. 

Staff of NCI Office of Science Planning and Assessment (OSPA) provided overall leadership and guidance from

concept to production. The OSPA team was led by Cherie Nichols and Kathie Reed and included Marianne Kost,

Dee Crouse, Laurencia Hutton, and Julie Mendelsohn. They received valuable assistance from science writers

Kathy Sorrow and Suzanne Reuben and several analysts with Science Applications International. Others in the

office who provided support to the effort were Kevin Callahan, Buddy Clark, Jim Corrigan, Norma Davis, D. J.

Joya, Mary Leveck, Anna Levy, Samir Sauma, Lisa Stevens, Anne Tatem, and Kevin Wright. 

NCI Executive Committee members Andy von Eschenbach, Alan Rabson, Anna Barker, Mark Clanton, John

Niederhuber, John Hartinger, Bob Croyle, Jim Doroshow, Joe Fraumeni, Harold Freeman, Paulette Gray, Peter

Greenwald, Ernie Hawk, Dinah Singer, and Bob Wiltrout provided guidance and review for the development of

the plan. Dotty Foellmer, Kathleen Schlom, Sarah Birckhead, and Sandy Koeneman worked closely with the

Executive Committee and OSPA in these efforts. 

In the Office of Budget and Financial Management, Jim Dickens and Scott Marchand oversaw the development of

the budget proposal.

In the Office of Communications, Donna Bonner, Paul LaMasters, and Del Harrod were responsible for document

design and production. Howard Clare and Kevin Shackelford of HC Creative Communications provided design

support. Walt Burroughs provided guidance to the printing process.

A special thanks goes to Dan Gallahan, Mary Jo Deering, and Maureen Johnson who gave generously of their time. 

Others who provided assistance in conceptualizing and reviewing parts of the plan and budget were Rachel

Ballard-Barbash, Kishor Bhatia, Ken Buetow, Nelvis Castro, Adam Clark, Jane Daye, Greg Downing, Tim Meeker,

John Milner, Dan Sullivan, Stacey Vandor, Nada Vydelingum, and Linda Weiss. 

Acknowledgments
Valuable World Wide Web Locations 

For Cancer Information 

National Cancer Institute cancer.gov 

NCI Cancer Information Service cis.nci.nih.gov 

Clinical Trials www.cancer.gov/clinicaltrials 

Cancer News newscenter.cancer.gov 

Cancer Science newscenter.cancer.gov/sciencebehind 

Cancer Progress Report progressreport.cancer.gov 

Mortality Maps and Graphs www.cancer.gov/atlasplus 

Surveillance, Epidemiology, and End Results seer.cancer.gov 

NCI Progress Report cancer.gov/aboutnci/annualreport 

National Institutes of Health www.nih.gov 

Department of Health and Human Services www.hhs.gov 

Planning and Priority Setting at NCI 

This Document Online plan.cancer.gov 

Office of Science Planning and Assessment planning.cancer.gov 

Disease-Specific Research Agendas prg.cancer.gov 

Disease-Specific Research Initiatives cri.cancer.gov 

NCI Research Funding 

Funding Opportunities cancer.gov/researchfunding 

Initiatives by Type of Research cri.cancer.gov 

Cancer Research Portfolio 

NCI Cancer Research Portfolio researchportfolio.cancer.gov 

International Research Portfolio www.cancerportfolio.org 

NCI Research Tools 

Research Resources resresources.nci.nih.gov 

Cancer Genome Anatomy Project cgap.nci.nih.gov 

Center for Bioinformatics ncicb.nci.nih.gov 

Cancer Imaging Programs imaging.cancer.gov and 

ccr.cancer.gov/tci/imaging.asp 

Developmental Therapeutics Program dtp.nci.nih.gov 

Intramural Resources ccr.cancer.gov/initiatives 

Nanotechnology nano.cancer.gov 

Office of Technology and Industrial Relations otir.cancer.gov 

NCI Clinical Trials Programs and Initiatives 

Clinical Trials Working Group integratedtrials.nci.nih.gov/ict/ 

Community Clinical Oncology Program cancer.gov/prevention/ccop 

Cancer Therapy Evaluation Program ctep.cancer.gov 

Cancer Trials Support Unit www.ctsu.org 

Centers, Networks, and Consortia 

NCI Cancer Centers Program cancer.gov/cancercenters 

Specialized Programs of Research Excellence spores.nci.nih.gov 

Early Detection Research Network cancer.gov/prevention/cbrg/edrn 

Cancer Family Registries epi.grants.cancer.gov/CFR 

Cancer Genetics Network epi.grants.cancer.gov/CGN 

Mouse Models of Human Cancers Consortium emice.nci.nih.gov 

Training and Education 

Research Training, Career Development, and Education 

cancertraining.nci.nih.gov 

Office of Education and Special Initiatives cancer.gov/aboutnci/oesi 

Contacting the NCI Information Service 

By phone 1-800-4-CANCER (1-800-422-6237) 

[For deaf and hard-of-hearing 1-800-332-8615] 

This phone service includes telephone-based assistance 

for smokers who want to quit. 

On the Web cis.nci.nih.gov 

Ordering this Document 

By email cisocc@pop.nci.nih.gov 

By Internet cancer.gov/publications 

By phone 1-800-4-CANCER 

By fax 301-330-7968
Each year, as mandated by the National Cancer Act of 1971 (P.L. 92-218), the National

Cancer Institute (NCI) prepares a plan for building on research successes, supporting the cancer research workforce with the technologies and resources it needs,

and ensuring that research discoveries are applied to improve human health. This

annual plan and budget proposal is provided directly to the President of the United

States for formulating the budget request to Congress. This document is also used by

NCI staff; the researcher community; professional organizations; advisory groups;

cancer information, education, and advocacy organizations; and public and private

policy makers. It is our hope that this document will inspire all who read it to join

the fight against cancer.

NIH Publication No.06-5856

October 2005