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HUMAN SERVICES

National Institutes

of Health

U.S. DEPARTMENT

OF HEALTH AND

The Nation’s

Investment

in Cancer Research

A Plan and Budget Proposal for Fiscal Year 2008

Prepared by the Director, National Cancer Institute

as mandated by The National Cancer Act (P.L. 92­218)
Moving Forward ...

has resulted in a real and continuing decline in cancer mortality rates. Cancer deaths in the United

States have declined—for the first time since 1930, the year our country began compiling statistics

on its toll. This comes despite a rapidly aging population. In 1971, at the time of the National Cancer

...as patient survival tells a compelling story of the promise for continued advances

One of the many places where research success is translated to real hope for cancer patients is the

from the many testimonials the Clinical Center receives each year from patients, clinicians, and families.

Progress in our understanding of cancer, coupled with increased detection and treatment abilities,

Act, there were three million cancer survivors. Today, there are more than 10 million.

in reducing the burden of cancer.

NIH Clinical Center, the world’s largest clinical research complex. These quotations were excerpted

“Do you know what you were doing five years ago? I do — you were saving my

life. It will be five years soon that I will be in remission. I’m a mother of two little

children, have a full career, and I feel very good.”

“I don’t know how widely it is known that you save lives at the National Cancer

Institute — offering hope and treatment to people, like my son, who have run out of

options. Patrick was deteriorating... having correctly diagnosed PCNS Lymphoma, you

offered to develop a state­of­the­art chemotherapy regimen, using new medications.

Were it not for the quick action in diagnosing and then treating his Lymphoma, Patrick

would not now be rebuilding his life with a healthy future ahead of him.” 
Director’s Message 

Each of us, in some way, has been touched by this terrible disease we call cancer. At the

National Cancer Institute, we begin each day with an acute awareness of our responsibility

to lead this country’s researchers and cancer physicians in the difficult work of conducting

quality research that continues to drive down cancer mortality.

This document takes an in­depth look at our nation’s investment in cancer research, current and

future. It tells the story of our work on numerous fronts to provide a scientific basis for more­successful

outcomes tailored to the individual, along with our efforts to reduce the impact of cancer on the lives

of all Americans and on our country’s economy.

We live in a period of unparalleled scientific opportunity. The pace at which we accumulate new

knowledge has never been so great, and it is making possible unprecedented opportunities to

accelerate progress against cancer. At NCI, we support the strongest, most­promising research,

and we continuously seek to leverage new knowledge, so that effective interventions can get to

patients as quickly as possible.

Scientists now understand that cancer is a disease of genetic changes that accumulate over a lifetime—or that add to genetic alterations we inherit. We are gaining new insight into the biological

processes that render a cell malignant and into the complex interactions of the cancer cell with its

microenvironment and host. By understanding the workings of a tumor and its biological support

system, we are starting to develop highly targeted treatments that minimize harm to healthy tissue.

We are now beginning to individualize cancer treatment for patients. We are also employing the

skills, talents, and unique perspectives of experts in related scientific and technology fields, to

share knowledge more extensively and diagnose cancers earlier. 

The pages ahead highlight many accomplishments and opportunities, from broad analyses of cancer

research trends to specific examples of targeted projects. We are confronting the rapidly approaching time when “access” to optimal state­of­the­art therapies and preventions may be the greatest

determinant of mortality from cancer. To address this issue of access for all, we have developed a

research pilot project with community­based cancer centers, to study the best ways to bring science

to patients—wealthy or poor, young or old—in the communities where they live. This program also

has the potential to harness electronic medical records and interconnected informatics systems, to

create a national cohort of cancer patients.
Leadership that effectively advances cancer research requires disciplined fiscal management. In

this era of essentially flat budgets, NCI’s leadership team is carefully planning and optimally investing our research dollars. That means we must aggressively address NCI’s strategic objectives, honor

our commitment to a base of ongoing research, and fund critical new initiatives. At the same time,

we must support the training and mentored research of new investigators, who will enhance our

country’s scientific capacity for years to come. With the input of researchers, advisory boards, and

the larger cancer community, our leadership team is making difficult decisions among competing

priorities. We will also work to foster responsible, productive partnerships with other government

agencies, academia, and the private sector.  And we seek ways to share the story of scientific

opportunity and its immense potential economic impact, with a stronger, more unified voice throughout

the cancer community.

The Institute’s investment proposal for Fiscal Year 2008 is outlined at the end of this document. In our

judgment, the proposed budget will enable NCI to ensure outcomes from currently­funded research,

fund key strategic new initiatives, and provide training support to draw the best minds to a field vital

to our nation’s health and economy.

Ultimately, we recognize our responsibility to the American people is to deliver return on investment.

We hope this document will serve as an important guide to the President and Congress, as we strive

to reduce the burden of cancer.

October 2006

John E. Niederhuber, M.D.
Table of Contents 

Science Leads the NCI

2 Current Patterns Shaping the Future of Research 

Advances in 2006

6 A Year of Unprecedented Progress

Looking to the Future

10 NCI Community Cancer Centers Program

Strategic Objectives—Moving Research Forward

11 Introduction

12 Understanding the Causes and Mechanisms of Cancer

14 Accelerating Progress in Cancer Prevention 

16 Improving Early Detection and Diagnosis

18 Developing Effective and Efficient Treatments

20 Understanding the Factors that Influence Cancer Outcomes

22 Improving the Quality of Cancer Care

24 Improving the Quality of Life for Cancer Patients, Survivors,

and Their Families

26 Overcoming Cancer Health Disparities

How We Work

29  Introduction

30 Intramural Research

30 Extramural Research

31 Clinical Trials

32 Centers, Networks, and Consortia

33 Technology Development

35 Surveillance and Outreach

37 Training and Career Development

38 Cancer in America—What the Statistics Tell Us

NCI Budget Request for Fiscal Year 2008

Links to Additional Information

THE NATION’S INVESTMENT IN CANCER RESEARCH 1
Science Leads the NCI

Current Patterns Shaping 

the Future of Research

Remarkable advances have been made in the fight against

cancer since the National Cancer Act became law in 1971, as

each success fuels new scientific ideas, discoveries, and the

creation of new technologies. We are driven to acquire new

knowledge, build upon the findings gained and lessons learned

from our past progress, and continue creating the foundations

for future advancements.

The Promise of the Future

Imagine a time when doctors no longer determine cancer treatments based upon estimates for the entire population and interventions are tailored specifically to meet individual needs—in

many cases preventing the disease process before it starts.

Current science is ripe with potential for exponential progress

against cancer. Our combination of rich scientific ideas and talent, infrastructure, interconnected knowledge, partnerships, and

expertise is coupled with an extraordinary array of advanced

technologies. NCI leadership has brought to life five key forces

that will drive the promise and hope for a better world where

cancer is preempted and the best outcomes are assured for all. 

2 N ATIONAL CANCER INSTITUTE
Convergence— where

advanced technology and 

science meet

It is now understood that cancer is

caused by molecular disruptions

that can be treated with molecular

interventions, yet it is difficult to

understand why individual responses to interventions are different

systematic identification and

characterization of human proteins

and their biological functions.

Computational biology will provide

computerized models to process

and understand the amazing

amount of information that will

be available, which physicians 

to treat cancer as a complex biological system can be modeled to

provide predictions of disease

behavior, prognosis, and a patient’s

response to therapy. In the past,

as different fields of science were

explored in depth, they became

highly specialized and isolated.

Over the past five years, we have

even when the pathology is the can then use to inform and improve discovered that areas of research

same. Furthermore, with the ever the care of individual patients. that once were thought to be comincreasing amount of information Nanotechnology has enabled us to partmentalized now are beginning

available, the human mind can’t create instrumentation on a very to intersect. With the understanding

possibly sort all the possibilities. small scale that will make it possi­ that tumors are collections of interble for us to perform molecular active parts, it has become apparent

The convergence of proteomics, classification of tumors, deliver that the focus in studying cancer

computational biology, and nan­ treatments with precision, and needs to broaden.

otechnology will allow researchers predict therapeutic effectiveness. 

to use this growing knowledge to This objective can only be accomdevelop and refine interventions Integrative Approaches— plished by bringing together indiagainst cancer. Cutting­edge tech­ where the understanding of biology viduals with diverse perspectives

nologies directly enhance pro­ and a systems approach meet  that address complex information

teomics research to speed the  As we learn more about the molec­ issues, including scale, modeling,

ular events that lead to the devel­ simulations, and interpretation of 

opment of cancer, new approaches 

THE NATION’S INVESTMENT IN CANCER RESEARCH 3
Science Leads the NCI

the information. In addition, we

must maintain a keen awareness of

how the information is interrelated

and connected. NCI is supporting

efforts designed to bring together

collaborative groups with unique

specialties spanning the clinical

and basic research spheres. The

hope is that their research findings

can be linked together to inform

new ways of preventing, detecting,

and treating cancer. 

Connectivity—where different

disciplines and common goals meet

The talents and solutions needed

to address scientific problems no

longer rest in the hands of any one

investigator or discipline. When

researchers join together—and as 

these partnerships begin to connect

to a broader scientific picture—the

individual knowledge of each investigator is amplified and leveraged.

Multidisciplinary teams composed

of physicians, mathematicians,

engineers, chemists, computational

biologists, epidemiologists, geneticists, sociologists, nanotechnologists, and others hold the collective

keys to our future advancements in

cancer research.

NCI is forging partnerships with

others to build upon the information gained from NIH’s human

genome project to understand 

the genetic and molecular basis

of cancer. The goal is to create an 

extensive knowledge base that will

enable scientists from all fields of

biomedical research to establish

new standards of cancer care.

Leveraging Resources and

Knowledge—where collaborative efforts and entities meet 

The partnerships multiplying

between the public and private

sectors, nonprofit organizations,

our national laboratories, and academia are changing the way we

work together to address the burden of cancer. Efforts to involve

individual state government agencies in these types of partnerships

are increasing to better harness

the advances made in local universities and regional biotechnology

sectors. In addition, such collaborations not only span the United

States but also extend globally.

Collaborations with national and

international universities and

commercial firms yield expanded

capabilities and resources. Success

in cancer research will be predicated

by mechanisms and models that

encourage such collaborations and

consortia to form and grow.

Cooperative relationships also

make other scientific resources and

tools available. NCI’s research

4 N ATIONAL CANCER INSTITUTE
facilities in Frederick, Maryland

comprise a unique resource by

offering world­class biomedical

research and technology support

through collaborations within

NCI and with other NIH Institutes,

Government agencies, and extramural investigators. NCI­Frederick

Community— where scientific

advances and community­based

cancer care meet

The dawning of the era of personalized medicine will require new programs that deliver state­of­the­art

oncology care to community settings as efficiently as possible. The 

advances in cancer care and prevention are the direct result of participation in clinical trials. Ensuring

widespread participation in these

studies by more people can be

achieved by fostering strong relationships between Comprehensive

Cancer Centers, community­based

is also home to a fully­integrated,

high­performance, scientific supercomputing facility.

The need to find new ways to

exploit insights, derived from

research data, highlights the 

need to foster innovation and entrepreneurship, and emphasizes the

importance of novel partnerships

with the private and philanthropic

sectors. Among the challenges that

must be addressed for successful

public­private partnerships are intellectual property strategies that will

not only ensure public availability

of discoveries but also preserve

incentives for commercialization.

major problem we will face is one

of patient access to science advances

and new technologies that are

increasingly capable of preventing

cancer and providing early diagnosis, novel therapies, and highlyspecific treatments when cancer

occurs. Innovative programs are

in development that will play a

major role in communities with

the goal of bringing together the

many facets needed to improve

cancer prevention, screening, and

treatment, and reduce health disparities. Furthermore, continued 

clinical oncology programs, and

organizations that reside in and

serve local neighborhoods. 

Looking to the future, as we leverage all five scientific forces through

collaboration with key partners, we

imagine achieving the goal of a

world free from cancer. We envision

care that is evidence based, that

focuses on prevention and wellness

with patient education and navigation, and that includes programs to

address health disparities, so that

the results of our research reach all

segments of our population.

THE NATION’S INVESTMENT IN CANCER RESEARCH 5
Advances in 2006

A Year of Unprecedented Progress

The nation’s investments in cancer research returned unprecedented gains in 2006. For example, knowing the sequence of

the human genome catapulted our understanding of cancer at

the genomic and proteomic level to a new height. Together, this

knowledge and recent advances in biomedical technologies and

bioinformatics are ushering in a new era of personalized medicine. The paragraphs below highlight examples of the exciting

advances made in 2006 in cancer prevention, diagnosis, treatment research, and infrastructure development that will enable

us to understand, pre­empt, and manage cancer based on

patient­specific disease characteristics.

6 N ATIONAL CANCER INSTITUTE
A New Era of Cancer

Prevention, Diagnosis,

and Treatment

These featured advances demonstrate the potential to drastically

reduce the burden of cancer through

a comprehensive understanding of

critical steps in cancer development.

Vaccines for Cervical Cancer

Prevention. Cervical cancer,

claiming more than 200,000 lives

worldwide last year, is caused

almost exclusively by human

papillomavirus (HPV) infection.

This year, the Food and Drug

Administration (FDA) approved

Gardasil®, a vaccine that is 100

percent protective against the

development of cervical cancer

and genital warts caused by four

subtypes of HPV. A second vaccine is being reviewed by the

FDA. These vaccines show how

basic discoveries arising from population studies, molecular biology,

and immunology can be rapidly

translated through public and private research efforts to solve significant public health problems,

and in this case, perhaps the elimination of cervical cancer as a threat

to women’s health.

Advances in Lymphoma Diagnosis.

NCI researchers used gene expression arrays, which measure the levels of activity of thousands of genes

in cells, to identify three distinct

subclasses of diffuse large B­cell

lymphoma (DLBCL), each requiring

a different approach to therapy.

Importantly, the researchers were

able to distinguish between DLBCL

and Burkitt’s lymphoma, which are

similar in appearance microscopically but require very different

treatments that dramatically affect

survival rates. This research also

shows clearly that an individual’s

response to therapy is based both

on the tumor’s molecular characteristics and inherited genes that control the patient’s response to drugs.

Infrastructure to Advance

Personalized Medicine 

NCI and some of its partners

undertook several bold projects to

provide new knowledge and integrate diverse components of infrastructure across the cancer research

enterprise. This infrastructure will

help overcome major barriers to

generating, integrating, sharing,

and deploying critical cancer information to hasten and support a

new era of personalized medicine.

Examples include:

The cancer Biomedical Informatics

Grid (caBIGTM). As investigators

increasingly rely on computerized

data analysis and bioinformatics,

managing and sharing data in real

time has emerged as a major challenge. This movement toward “digital biology” is made more daunting

by the serious lack of consistent

data formats, vocabularies, standards, and tools for bioinformatics

THE NATION’S INVESTMENT IN CANCER RESEARCH 7
Advances in 2006

applications. This year, the pilot

phase of caBIGTM, an open source

“plug and play,” grid­based computing program, was successfully

completed. The 80 participants in

this achievement included 40 major

Cancer Centers, FDA, and the 

private sector. caBIGTM will expand

partnerships to increasingly provide

the connectivity needed to support

the advent of personalized medicine.

Cancer Genetic Markers of

Susceptibility (CGEMS). Genetic

changes called single nucleotide

polymorphisms (SNPs) may be 

associated with increased risk of

some cancers. In 2006, NCI initiated CGEMS to scan the entire

human genome and identify SNPs

associated with either increased

or decreased risk for breast and

prostate cancer. Data from CGEMS

and similar studies will provide

the basis for predicting cancer risk

and taking appropriate steps to

prevent it.

The Cancer Genome Atlas (TCGA).

NCI and the National Human

Genome Research Institute

launched TCGA as a three­year

pilot program to take the first

step in identifying all important

genetic changes in every cancer.

TCGA leverages data from thousands of researchers working over

several decades. The project also

capitalizes on data from the completed human genome project and

advances in genome analysis technologies and bioinformatics. The

pilot will develop and test the

complex science and technology

framework needed to systematically identify and characterize the 

8 N ATIONAL CANCER INSTITUTE
genomic changes associated with

cancer. All data will be publicly

available to researchers worldwide

through caBIGTM.

The Repository for Molecular

BRAin Neoplasia DaTa (REMBRANDT). NCI and the National

Institute of Neurological Disorders

and Stroke created REMBRANDT,

a publicly available bioinformatics

knowledge base of primary brain 

tumor data. REMBRANDT integrates extensive clinical and

genomic data from brain tumor

patients participating in clinical trials. This single resource enables

data sharing among many institutions and investigators, helping

researchers and clinicians identify

and evaluate personalized, molecularly­targeted therapies for patients

with brain cancer. 

Essential Infrastructure. A new

Clinical Proteomics Program is

developing the standards needed

to characterize patterns of protein

markers in human serum for very

early detection of cancer. NCI’s

Integrative Cancer Biology Program

in computational and mathematical

models began the difficult task of

analyzing the accelerating volume

of data generated by so many

advanced technologies. Finally, 

the NCI’s Nanotechnology Alliance

for Cancer began harnessing nanotechnologies for cancer diagnostics, targeted imaging, and drug

delivery. These and other efforts

will fill critical knowledge gaps and

provide the level of understanding

needed to realize a new era of

molecular­based personalized cancer medicine in the next decade. 

THE NATION’S INVESTMENT IN CANCER RESEARCH 9
Looking to the Future 

NCI Community Cancer Centers Program 

A Case Study: Implementing NCI Strategic Objectives Through Integration of Research 

Across the Cancer Continuum 

To deliver state-of-the-art oncology care to the community setting, including the earliest phase 

translational science, NCI is launching a community cancer care project — the NCI Community 

Cancer Centers Program (NCCCP). This initiative, in partnership with NCI-designated Cancer 

Centers, will have clear-cut goals of improving cancer prevention, screening, and treatment; 

increasing participation in clinical trials; and reducing healthcare disparities. Additional focus 

will include increased participation in biospecimen 

and electronic medical record initiatives. The centers will facilitate a multi-specialty approach to 

cancer with organ-based clinical programs and 

specialized training of cancer practitioners. 

The NCCCP cross-cuts the NCI strategic objectives, described on the following pages, and demonstrates how specific initiatives are moving from 

“silo” research arenas into integrative approaches 

that span the research continuum. Success will 

depend on the ability to fully integrate activities 

and partner with others to develop specific initiatives, such as the NCCCP. In all of our planning we aim to remain responsive to the power 

of new scientific and technologic opportunities as we leverage community resources in the 

accomplishment of a world free of cancer. 

10 N ATIONAL CANCER INSTITUTE 
In January 2006, the National Cancer Institute issued a pivotal planning document to advance cancer research and outcomes: The NCI Strategic Plan for

Leading the Nation. Expert and wide­ranging teams from NCI staff and the

cancer research community contributed to the plan, and also agreed that it

would be a living document for the coming years. This Plan and Budget

Proposal for Fiscal Year 2008 marks NCI’s first opportunity to describe the

proposed implementation of the Strategic Plan’s stated goals and objectives. 

To lessen the burden of cancer, NCI conducts and leads intensive work to

advance cancer research progress in knowledge discovery, patient­centered

translation of discovery, and bench­to­bedside delivery. Our partners are

critical to this complex set of endeavors.

NCI’s Strategic Objectives are central to the focus of these efforts:

To Preempt Cancer at Every Opportunity

> Understand the causes and mechanisms of cancer

> Accelerate progress in cancer prevention

> Improve early detection and diagnosis

> Develop effective and efficient treatments

To Ensure the Best Outcomes for All

> Understand the factors that influence cancer outcomes

> Improve the quality of cancer care

> Improve the quality of life for cancer patients, survivors, and their families

> Overcome cancer health disparities

The following pages provide background for each of these strategic objectives.

The section titled Today’s Research lists components of NCI’s current portfolio

of funded research. The section titled Tomorrow’s Strategies outlines next steps

for achieving the objectives. The Moving Research Forward section provides a

glimpse of the many emerging research results for each objective. 

NCI Strategic

Objectives and

Progress THE NATION’S INVESTMENT IN CANCER RESEARCH 11
Understanding the Causes and Mechanisms of Cancer

We will conduct and support basic, clinical, and population research to better understand how genetic,

epigenetic, environmental, behavioral, and sociocultural factors relate to cancer. Our work will focus

on the biologic processes that affect our resistance to or likelihood of developing cancer; allow cancer

to start (initiation), grow (progression), and spread (metastasis); and cause it to regress or recur.

Today’s Research

Research to discover the causes and mechanisms of cancer is essential to enable us to develop and apply treatments or interventions to keep cancers from starting or progressing.

NCI’s diverse portfolio of research projects and programs addresses this need, spanning

research on cancer risk to studies on the process of metastasis. Examples of ongoing NCI

research include:

> Identifying cancer risks associated with interactions between genes and both environmental 

and lifestyle factors 

> Investigating cellular and molecular mechanisms of cancer initiation, progression, 

and metastasis

• Epigenetic pathways, genes, and proteins

• Factors related to cancer development, including certain viruses, angiogenesis (new 

blood vessel growth), and the movement of cells within the body

• Normal cell and molecular biology

• Cell metabolism and growth

• Structure and function of genes and proteins

• Developmental biology and cell­to­cell interactions

> Understanding how cancer risk factors disrupt normal cells

Tomorrow’s Strategies

Cancer is a complex set of diseases that must be understood from many perspectives. NCI

will use the following strategies to pinpoint the causes and mechanisms of cancer:

> Increase our understanding of behavioral, environmental, genetic, and epigenetic causes 

of cancer and how they interact.

> Gain a full understanding of how changes in genes can cause cancer to develop. 

> Improve cancer diagnosis through an integrative approach to improving our understanding of:

• Normal cellular and molecular biology

• Macroenvironmental influences (i.e., outside the body)

• Microenvironmental influences (i.e., within the body)

> Apply new technologies to expand our knowledge of cancer risk factors and 

biologic mechanisms. 

> Investigate links between cancer and other human diseases.

12 N ATIONAL CANCER INSTITUTE
Moving Research Forward 

...through Identifying and Understanding Cancer Risk Progression 

NCI supports large­scale studies to identify exposures, lifestyles, and genes that affect cancer risk. For

example, scientists linked recent, rapidly rising rates of esophageal cancers to two factors: increasing

rates of obesity and gastrointestinal acid reflux, which increases the risk of a pre­malignant condition

called Barrett’s esophagus.

NCI also supports research to understand the many factors involved in a normal cell becoming cancerous and spreading to other parts of the body. Basic laboratory and animal research provides clues

about the inner workings of cells that would otherwise be beyond our reach. 

...and Progress in Pursuit of our Goal

> Understanding the Role of Bone Marrow Cells in Metastasis. A recent study in mice 

shows that normal bone marrow cells may play an important role in metastasis, the 

spread of cancer. The researchers replaced the bone marrow cells of the mice with bone 

marrow cells tagged green with a biochemical marker, so they could be tracked. Then 

the researchers injected the mice with red­tagged cancer cells that were expected to travel 

to the lungs. However, the bone marrow cells reached the lungs first, appearing to prepare 

a niche for the cancer cells to use when they arrived in the lungs. When the researchers 

inhibited the migration of the bone marrow cells, they prevented metastases from forming 

in the mice. Further research will explore how cancer cells recruit bone marrow cells 

and use them to establish new tumors. This may help researchers learn how to stop the 

movement of bone marrow cells as a way to prevent metastasis.

> Understanding the Normal Biology of Aging. NCI researchers reported that a gene 

known for its link to a premature aging syndrome, Hutchinson­Gilford Progeria 

Syndrome (HGPS), also appears to play a role in the normal aging process. Mutations

in a gene called LMNA produce a faulty form of the protein lamin A that has been 

linked to HGPS. Investigators found that, compared with cells in young individuals, 

cells from HGPS patients and those of healthy older individuals shared many of the 

same cellular defects. Laboratory experiments showed that the lamin A protein probably 

has a role in causing the age­related defects. A better understanding of the mechanisms 

of normal and premature aging will help scientists understand the molecular mechanisms 

involved in creating the microenvironment required for a cell to become cancerous.

THE NATION’S INVESTMENT IN CANCER RESEARCH 13
Accelerating Progress in Cancer Prevention

We will accelerate the discovery, development, and delivery of cancer prevention interventions

by focusing on risk assessment, systems biology, behavior modifications, environmental and policy

influences, medical and nutritional approaches, and training and education for research and

health professionals.

Today’s Research 

Prevention is our first line of defense against cancer. NCI’s portfolio supports research to

identify medical and behavioral approaches to cancer prevention that can be applied in

public health settings. Examples of ongoing NCI research include:

> Understanding the role of nutrients and micronutrients in human health and 

cancer occurrence

> Developing prevention vaccines to stimulate the immune system to attack cancer cells 

or cancer­causing agents 

> Identifying effective vaccine delivery strategies

> Developing drugs to prevent primary and secondary cancers

> Investigating behavioral factors that affect cancer risk and developing strategies to

change these behaviors

> Exploring complementary and alternative methods for cancer prevention

Tomorrow’s Strategies 

Research must identify the most promising advances and translate them into new prevention

approaches. NCI will broaden and strengthen its prevention portfolio with a rigorous agenda: 

> Support a systematic review of epidemiologic evidence on possible carcinogens and risk

factors for cancer. 

> Develop and promote the adoption of medical interventions, including nutritional 

approaches, chemoprevention drugs, and prevention vaccines that suppress cancer 

initiation and progression. 

> Develop and test behavioral approaches for reducing cancer risk. 

> Study the impact of environmental and policy interventions on cancer risk. 

> Explore the biology behind successful cancer prevention interventions through a 

transdisciplinary systems approach.

> Evaluate the impact of knowledge and intervention dissemination and diffusion programs 

for cancer prevention using an outcome monitoring system. 

> Train scientists, clinicians, and other health professionals for cancer prevention research.

14 N ATIONAL CANCER INSTITUTE
Moving Research Forward 

...with Cancer Chemoprevention Studies

Chemoprevention is the use of natural or synthetic substances to reduce the risk of developing

cancer, or to reduce the chance that cancer will recur. Chemoprevention trials look at possible ways 

to prevent cancer with interventions that include drugs, vitamins, diet, hormone therapy, or other

agents. NCI’s chemoprevention research effort, started in the early 1980s, is yielding exciting

results. For example, based on findings of the NCI Breast Cancer Prevention Trial, the U.S. Food

and Drug Administration approved tamoxifen for reducing the incidence of breast cancer in

women at high risk for the disease. This success confirms the usefulness of large­scale chemoprevention clinical trials for identifying ways to stop many of the people at risk for cancer from

becoming cancer patients.

...and Progress in Pursuit of our Goal

> Results of the Study of Tamoxifen and Raloxifene (STAR) Trial. STAR, the largest 

breast cancer chemoprevention trial ever conducted, compared two selective estrogen 

receptor modulators (SERMs). These drugs work by blocking the tumor­promoting 

effects of estrogen that are seen in about two­thirds of breast cancer patients. STAR 

findings show that the anti­osteoporosis (anti­bone thinning) drug raloxifene (Evista®) 

reduces breast cancer risk in postmenopausal women as well as tamoxifen. Moreover, 

raloxifene appears less likely to cause some of the rare but serious side effects seen with 

tamoxifen, such as uterine cancer. These findings are promising because this combination 

of effective treatment and reduced chance of serious side effects may be what is needed 

to make breast cancer prevention more of a reality for many women. 

> SELECT (the Selenium and Vitamin E Cancer Prevention Trial). Previous studies suggest 

that the mineral selenium and vitamin E (alone or in combination) may reduce the risk of 

prostate cancer. Only a large clinical trial, such as the NCI SELECT, can confirm those 

initial findings. SELECT finished enrolling patients in June 2004, with 35,534 participants.

The trial is expected to end by 2011. 

> Finasteride Follow­up Studies. In June 2003, the Prostate Cancer Prevention Trial (PCPT)

was stopped early because of a clear finding that finasteride reduced the incidence of 

prostate cancer. However, men who did develop prostate cancer while taking finasteride 

experienced a slightly higher incidence of high­grade tumors. Follow­up studies are 

investigating whether finasteride actually caused high­grade tumors.

NCI also is supporting chemoprevention research to benefit patients at high risk for other

cancers, including colorectal, lung, esophageal, bladder, cervical, and oral cavity cancer.

THE NATION’S INVESTMENT IN CANCER RESEARCH 15
Improving Early Detection and Diagnosis

We will support the development and dissemination of interventions to detect and diagnose

early­stage malignancy. 

Today’s Research

Detecting and diagnosing tumors early in the disease process, before the tumor invades surrounding tissue, can dramatically improve the patient’s odds for successful treatment and

eliminate a large portion of cancer deaths. Examples in this area include:

> Identifying genes, proteins, or other molecules that signal the presence of cancer based on 

their patterns or levels of expression (the extent to which they are activated)

• Identifying protein biomarkers for hard to detect cancers, such as ovarian and pancreatic

cancers, and finding new biomarkers for prostate cancer

• Using genomic and proteomic profiling to improve prognosis and guide treatment

• Developing anatomical and molecular imaging techniques to detect tumors, improve 

diagnostic accuracy, and find metastases

• Supporting preclinical evaluation and clinical testing of biomarker and imaging technologies

> Understanding how and why patients accept and comply with cancer screening methods

Tomorrow’s Strategies 

NCI will help bridge the gaps across the translational spectrum to speed the movement of

effective early detection and diagnostic approaches to the clinic. To achieve this, we will: 

> Promote collaborative, multidisciplinary research to validate biomarkers of early detection

and screening. 

> Develop better diagnostic and screening tools for early detection, risk assessment, and 

disease recurrence. 

• Apply evidence­based research findings to intervention development.

• Encourage and provide investigator training to facilitate the development and application

of new tests. 

> Develop risk factor profiles for identifying patients who are likely to benefit most from 

cancer screening. 

> Determine why abnormal findings from screening examinations have less than acceptable 

rates of follow­up and develop strategies to improve this part of the health care system. 

> Make experimental data accessible across the cancer research community. 

> Translate evidence­based research into public health and medical practice. 

16 N ATIONAL CANCER INSTITUTE
Moving Research Forward 

...with Molecular Profiling of Cancer

Our nation’s investment in identifying molecular profiles, or signatures, of cancer has been producing impressive results. As early as 2000, NCI researchers were using gene expression profiling to

distinguish between different subtypes of lymphoma. Two years later, investigators were reporting

preliminary success using proteomic technologies to detect and diagnose some cancers at early

stages. Since then, researchers have been discovering and validating molecular profiling techniques that many experts believe are setting the stage for improved cancer detection and diagnosis.

...and Progress in Pursuit of our Goal

> Defining Ovarian Cancer Subtypes. A new study helped clarify the relationship between 

low malignant potential (LMP), low­grade, and high­grade serous ovarian tumors. The 

study suggests that LMP tumors are not early precursors of aggressive ovarian cancer, as 

had been suspected, but may be part of an entirely different class of tumors. Moreover, 

the study showed that low­grade serous tumors are more similar to LMP tumors than to 

high­grade tumors. These findings suggest the need to reexamine treatment options for 

women with low­grade disease, who currently receive the same therapy as patients with 

high­grade disease.

> Improved Diagnosis of Burkitt’s Lymphoma. A worldwide team of researchers, including 

some from NCI, showed that gene expression profiling can accurately distinguish between

Burkitt’s lymphoma and diffuse large B­cell lymphoma (DLBCL). Burkitt’s lymphoma 

and DLBCL cells appear similar when viewed under a microscope, but correct diagnosis 

is critical because they require very different treatments. If Burkitt’s lymphoma patients 

are treated with intensive therapy, the survival rate is roughly 80 percent. However, if 

they are misdiagnosed and treated with the lower intensity chemotherapy recommended 

for DLBCL patients, the survival rate drops to 20 percent or less. 

> Sputum Testing for Early Lung Cancer Detection. A prospective clinical trial has found 

that testing the sputum (coughed up mucus and other matter) of individuals at high risk 

for lung cancer, by analyzing certain genes and chemicals, may help identify early signs of 

the disease. The experimental test screens 14 genes associated with lung cancer for the 

presence of chemicals called methyl groups that can modify genes and silence them (turn 

them off). The test identified 65 percent of individuals who later developed symptoms of 

lung cancer, but it also identified 35 percent of cancer­free control participants. Therefore,

at this point a patient who tests positive would also need to receive a diagnostic bronchoscopy or x­ray to see if tumors exist.

THE NATION’S INVESTMENT IN CANCER RESEARCH 17
Developing Effective and Efficient Treatments

We will support the development and dissemination of interventions to treat malignancy either by

destroying all cancer cells or restraining and controlling metastasis, both with little or no harm to

healthy tissue.

Today’s Research

A large part of NCI’s research portfolio focuses on discovering, developing, and evaluating

more efficient and effective treatment strategies. Developing cancer treatments that leave surrounding healthy tissue unharmed is at the heart of NCI’s research agenda. Examples of NCI

research include:

> Developing and improving localized therapies such as surgery or radiation therapy to 

directly target the tumor and if necessary, surrounding tissue

> Investigating systemic (whole body) therapies including cytotoxic (cell­killing) or hormonal 

agents, vaccines, antibodies (immune system proteins), gene therapy, angiogenesis inhibitors,

and differentiating agents 

> Researching molecularly targeted therapies that act primarily on the tumor and 

associated tissue

> Developing combination therapies that use two or more drugs and/or treatment types 

to increase treatment effectiveness 

> Investigating complementary/alternative treatment approaches

Tomorrow’s Strategies 

NCI’s portfolio will include a special focus on facilitating the research and development of

individualized therapies tailored to the specific characteristics of a patient’s cancer. Treatment

strategies may include localized, systemic, molecularly targeted, complementary and alternative,

or combination treatment approaches. NCI will:

> Identify the molecular and cellular factors that cause metastatic behavior. 

> Validate biomarkers for cancer prognosis, metastasis, treatment response, and progression.

> More quickly identify, develop, and validate potential targets and strategies for cancer 

treatment by integrating preclinical (laboratory and animal) and clinical research. 

> Integrate clinical trial networks and programs to ensure that the most promising treatment

opportunities are identified, the necessary clinical trials are conducted rapidly, and clinicians

have effective use of information and resources. 

> Work to manage the toxic effects of cancer therapy. 

18 N ATIONAL CANCER INSTITUTE
Moving Research Forward 

...with Improved Treatment Delivery

FDA approval of a new drug to fight cancer and its availability to patients are only the beginning 

of the story of cancer treatment research. Even before a new drug is used in the first patient,

researchers are planning how to improve ways of giving the drug to patients to make it more effective. For example, part of the remarkable improvement in childhood leukemia survival over the past

20 years has been achieved by modifying the delivery methods and dosing schedules of successful

treatment drugs. NCI continues to test both established and new ways to improve the delivery of

cancer drugs.

...and Progress in Pursuit of our Goal 

> A New Approach to Immunotherapy. An NCI research team confirmed the effectiveness 

of using a new cell­based immunotherapy approach combined with chemotherapy for 

treating advanced stage metastatic melanoma. The goal is to fight cancer tumors by 

stimulating and reintroducing a patient’s own T cells (rare disease­fighting immune cells). 

The promise of this therapy is that a patient’s own immune system may be used to 

effectively treat existing tumors.

In a recent clinical trial using this immunotherapy approach, 51 percent of the patients (18

of 35) experienced a significant reduction in the size or the disappearance of their tumors —

patients who previously had not responded to treatment. A Phase II trial is under way that

will enable researchers to evaluate the effectiveness of this immunotherapy approach among

a larger group of participants.

> Abdominal Chemotherapy for Ovarian Cancer. A recent NCI study shows that 

intraperitoneal (IP) chemotherapy, which delivers drugs directly to the abdominal cavity 

through a catheter (tube), can significantly increase survival for some women with ovarian

cancer. About 400 women in the study were given chemotherapy after successful removal 

of their tumors. Half received intravenous (IV) cisplatin and paclitaxel, and the others 

received IV paclitaxel, plus IP cisplatin and paclitaxel. The women who received IP 

chemotherapy lived on average 16 months longer than women who had IV chemotherapy

alone, an unusually large survival benefit for a clinical trial. One year after treatment, 

both groups of patients reported a similar quality of life. As the results of the study were 

made public, NCI issued a rare clinical announcement to inform physicians and patients 

about the potential benefit of IP chemotherapy for ovarian cancer. 

THE NATION’S INVESTMENT IN CANCER RESEARCH 19
Understanding the Factors that Influence Cancer Outcomes 

We will support and conduct studies to increase our understanding of and ability to measure the 

environmental, behavioral, sociocultural, and economic influences that affect the quality of cancer 

care, survivorship, and health disparities. 

Today’s Research 

Building on more than two decades of population-based surveillance research (tracking and 

studying cancer trends), NCI is intensifying its efforts to define, foster, and support studies to 

improve our understanding of the factors that affect the outcomes of cancer and the impact 

of cancer care. Examples of NCI research include: 

> Improving measurement of cancer outcomes 

• Alternative approaches to measuring health-related quality of life, economic burden, 

and satisfaction in cancer care 

• Psychometric (psychological measurement) approaches to increase the accuracy and 

reduce the cost of outcomes assessment conducted at the patient level 

> Supporting large, prospective cohort (defined population) studies to investigate 

cancer outcomes 

• The impact of high-profile interventions on patient-centered outcomes 

• Dissemination of new therapies in the community 

• The influence of modifiable risk factors 

• Racial/ethnic- and gender-related disparities in care 

• Use the results of outcomes research from community settings to improve methodology 

Tomorrow’s Strategies 

NCI will improve outcomes research methods, increase use of evidence-based cancer interventions, and expand use of research knowledge to guide cancer policies. NCI will: 

> Develop standardized measures of cancer care outcomes across the cancer continuum 

(prevention, early detection, diagnosis, treatment, survivorship, and end of life). 

> Identify research databases to study influences on cancer care and outcomes. 

> Use improved outcome measurement techniques and database resources to increase the 

understanding of behavioral and sociocultural factors that influence cancer outcomes. 

> Study the factors that affect access to cancer care. 

> Build sustainable community-based structures to support research on cancer outcomes. 

> Understand how to disseminate research results and promote the adoption of evidencebased cancer interventions by a diverse population of patients, health care providers, and 

the public. 

20 N ATIONAL CANCER INSTITUTE 
Moving Research Forward 

...by Transforming Cancer Care Outcomes Research

In 1999, NCI launched its Quality of Cancer Care Initiative to improve the state of the science for

defining, monitoring, and improving the quality of cancer care. Since then, research on several

fronts is shaping a new model for moving research results from the laboratory bench to the bedside, particularly the effects of cancer care interventions on patients’ lives.

NCI’s wide­ranging outcomes research agenda focuses on the many aspects of cancer care to

improve the experience of individuals after a cancer diagnosis. This research is intended to generate

tools and information to enhance the quality of cancer care decision making and ultimately the quality

of cancer care.

...and Progress in Pursuit of our Goal

> The Patient­Reported Outcomes Measurement Information System (PROMIS). NCI is 

taking an important role in PROMIS, a National Institutes of Health Roadmap Initiative. 

PROMIS aims to develop ways to measure patient­reported symptoms, such as pain and 

fatigue, and aspects of health­related quality of life across a wide variety of chronic diseases 

and conditions, including cancer. Two years into development, researchers are designing 

and building an innovative technology that promises to revolutionize how patients report 

clinically important symptoms and outcomes. This technology will provide clinical research 

communities with a consistent and validated approach to measure these clinically relevant,

but subjective and difficult­to­measure outcomes. 

> The Cancer Care Outcomes Research and Surveillance Consortium (CanCORS). 

Through CanCORS, NCI is supporting the largest ever observational study of cancer 

care delivered in diverse, population­based health care settings. This prospective cohort 

study has enrolled 10,000 patients with newly diagnosed lung or colorectal cancer. Vital 

information will be collected on how clinical practices affect outcomes, and what influence 

certain characteristics — of patients, providers, and community health care delivery

systems — have on the services that patients eventually receive. CanCORS is providing a 

unique opportunity to examine community practices regarding palliative (non­curative 

symptom control) and end­of­life care. This study takes into account the perspective of 

the patient, caregiver, and providers among a diverse group of patients followed over 

time. NCI is supporting developmental research to test the feasibility of collecting such 

measures routinely within clinical practice.

THE NATION’S INVESTMENT IN CANCER RESEARCH 21
Improving the Quality of Cancer Care

We will support the development and dissemination of quality improvement interventions and measure

their success in improving health­related outcomes across the cancer continuum.

Today’s Research

For cancer, high quality care means delivering the full range of evidence­based interventions

that are safe, patient­centered, effective, timely, efficient, and equitable. Such care must be provided with technical competence and cultural sensitivity and must foster patient choice based on

informed decision making. Examples of NCI research include: 

> Refining process and outcome measures

> Researching patterns of care

> Improving and disseminating quality of care research resources

> Understanding behavioral and sociocultural factors that influence the quality of cancer care

> Developing interventions that target patients and their families

> Improving symptom management and palliative care

> Improving the training of specialized care providers

> Evaluating patient psychological and social distress, the quality of supportive care for 

advanced cancer patients, and the impact of aging on quality of care

Tomorrow’s Strategies 

NCI will foster the development and dissemination of research resources for quality of care

studies and will help make quality of care interventions available to the people who need

them. We will support research to:

> Foster the use of research evidence about patterns of care and care outcomes, to develop 

quality improvement interventions. 

> Begin using advanced information systems and interoperable electronic health records to 

inform future research and guide clinical practice. 

> Turn symptom management and palliative care research findings into interventions to 

improve care for patients and survivors throughout their cancer experience, and particularly 

at the end of life. 

> Ensure that the best scientific evidence about quality measures and assessment informs 

Federal, state, and private sector decision making about cancer care. 

> Ensure that new information about cancer prevention, treatment, and follow­up reaches

the people who need it. 

> Strengthen the methods used to evaluate quality improvement efforts. 

22 N ATIONAL CANCER INSTITUTE
Moving Research Forward 

...with Improved Access to Quality Cancer Care

NCI supports research to provide the scientific evidence needed for public and private decision

making related to care delivery, insurance coverage, purchasing, regulation, and standard setting.

This research gives cancer patients, survivors, and caregivers the information they need to enhance

the efficiency and quality of cancer care services. For example, some NCI research findings provide

guidance to the cancer community on how to improve cancer patients’ and survivors’ access to the

full range of evidence­based interventions that may benefit them.

...and Progress in Pursuit of our Goal 

> Health Insurance and Quality of Cancer Treatment. Researchers recently studied the 

association between treatment received and insurance status (private insurance, Medicaid 

or Medicare only, or no insurance) for 10 common cancers with established evidencebased treatment guidelines. The study was based on a sample of more than 7,000 

patients identified through NCI’s Surveillance, Epidemiology, and End Results (SEER) 

program. Patients who depended on Medicare or Medicaid alone for insurance, especially

non­Hispanic Black patients with Medicaid only, were least likely to receive guidelinesbased treatment. In a follow­up study, the investigators will examine how insurance status

affects survival after cancer diagnosis. 

> Factors Affecting Completion of Colon Cancer Treatment. A recent study showed that 

colon cancer patients who were female, widowed, elderly, or hospitalized during treatment

were less likely to complete adjuvant (post­surgical) chemotherapy, even though stopping 

meant increasing their risk of dying from the disease. The strongest predictor of an 

incomplete treatment course was a hospital stay after surgery and after beginning 

chemotherapy, perhaps because of complications from treatment. The investigators 

suggest that improving social and physical support during treatment may be needed to 

increase the number of patients who complete treatment.

THE NATION’S INVESTMENT IN CANCER RESEARCH 23
Improving the Quality of Life for Cancer Patients, Survivors, and Their Families

We will support the development and dissemination of interventions to reduce the adverse effects of

cancer diagnosis and treatment and improve health­related outcomes for cancer patients, survivors,

and their families/caregivers.

Today’s Research

Advances in our ability to detect, treat, and support cancer patients are turning this disease

into one that is chronic or readily managed for many and curable for increasing numbers.

NCI quality­of­life research includes: 

> Investigating the effects of cancer and its diagnosis and treatment on survivors and their 

families/caregivers

• Long­term and late effects of breast and other cancers

• Impact of physical, psychosocial, economic, and behavioral factors

> Supporting both descriptive and intervention survivorship research

> Researching pediatric cancer survivorship

• Acute lymphoblastic leukemia

• Other pediatric cancers

Tomorrow’s Strategies 

NCI will support survivorship research to improve the health and quality of life of all cancer

patients following their diagnosis and initial treatment. These studies will include both the

prevention and control aspects of chronic disease epidemiology. NCI will:

> Increase research to understand biologic, physical, psychological, and social factors and 

their interactions that affect a cancer patient’s response to disease, treatment, and recovery. 

> Expand the development and use of tools to assess the health­related quality of life of 

cancer survivors and their family members and caregivers. 

> Increase the pace of intervention research designed to reduce cancer­related acute, chronic,

or late morbidity (adverse effects caused by treatment) and mortality. 

> Ensure that new information, interventions, and best practices for addressing the health 

needs of survivors and their families reach the people who need them.

24 N ATIONAL CANCER INSTITUTE
Moving Research Forward 

...with Motivation for Healthy Behavior Change after Cancer

The challenges imposed by a cancer diagnosis can be life­altering, particularly in terms of changing

the health behaviors of patients and survivors. Indeed, some feel that cancer represents an important

“teachable moment” for many cancer survivors that can lead to positive choices and healthier

lifestyles. These changes may improve the emotional outlook and overall health of cancer survivors,

and even alter the course of their disease. 

NCI supports research on the motivation potential of a cancer diagnosis. This research is of special

importance because cancer survivors are at increased risk for progressive or recurring disease, second cancers, osteoporosis, obesity, cardiovascular disease, diabetes, and functional decline. Although

more research is needed, opportunities exist for medical teams to promote lifestyle changes that may

improve the length and quality of survivors’ lives. 

...and Progress in Pursuit of our Goal

> Physical Activity to Extend Survival and Improve Quality of Life. Physical inactivity 

following cancer is a known risk with an adverse effect on weight and health. A number 

of researchers have shown that exercise interventions can improve survivors’ physical and

emotional health, functional well­being, and quality of life. Moreover, evidence now shows 

that physical activity interventions can alter the course of disease recurrence or death. Two

recent NCI studies found that patients with early­ to later­stage colorectal cancer (but not

distant metastases) who engaged in regular activity after diagnosis decreased the chance 

of cancer recurrence and mortality by 40 to 50 percent or more, compared with patients 

who engaged in little to no activity.

> Lowering Dietary Fat to Reduce Breast Cancer Recurrence. Similarly, the first evidence 

of a positive effect of dietary change on cancer has been reported. The NCI­sponsored 

Women’s Intervention Nutrition Study (WINS) was the first large­scale intervention trial 

to study the influence of dietary fat on breast cancer outcomes in postmenopausal women

treated for early­stage breast cancer. WINS investigators reported that lowering dietary 

fat may lower the risk of breast cancer recurrence in this population. 

These behavioral change studies hold the promise of reducing cancer­related morbidity

and promoting general health. At the same time, these interventions also appear to have

great appeal to cancer survivors eager to reduce the stress in their lives and to regain control

of their lives and bodies after cancer diagnosis and treatment.

THE NATION’S INVESTMENT IN CANCER RESEARCH 25
Overcoming Cancer Health Disparities

We will study and identify factors contributing to disparities, develop culturally appropriate approaches,

and disseminate interventions to overcome those disparities across the cancer control continuum

from disease prevention to end­of­life care. 

Today’s Research

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

suffer more severely from cancer and its sequelae (after­effects). Overcoming cancer health

disparities is one of the best opportunities we have for lessening the burden of cancer. NCI’s

investments are speeding the development and use of interventions to combat disparities

across the cancer control continuum and among all underserved populations. Examples of

NCI research include:

> Supporting health disparities research through NCI’s biology, etiology, prevention, detection,

and treatment research portfolios

> Addressing economic, social, cultural, psychological, behavioral, and biologic factors that 

contribute to cancer health disparities 

> Developing and supporting resources and infrastructure for health disparities research

• Informatics 

• Specimens, drug, and reagent resources

• Clinical trials groups

• Statistical methodology

• Centers and consortia

> Supporting education and training for careers in cancer health disparities research

Tomorrow’s Strategies 

Addressing the needs of the medically underserved by applying emerging evidence­based findings

and research resources is a critical component of NCI’s strategies to reduce cancer health

disparities. Specifically, we will:

> Build on our understanding of the factors that cause cancer health disparities. 

> Work with communities to develop interventions targeted to the specific needs of underserved populations. 

> Provide the knowledge base for and develop interventions to better coordinate and integrate

cancer services for underserved populations. 

> Develop innovative, educationally­ and culturally­appropriate approaches for disseminating

information on research results to underserved populations. Work with others to put 

these approaches into practice.

> Examine the role of health policy in reducing and eliminating cancer health disparities. 

> Work with others to develop a workforce of researchers and clinicians who will address 

cancer health disparities.

26 N ATIONAL CANCER INSTITUTE
Moving Research Forward 

...by Addressing the Causes of Cancer Health Disparities

With support from NCI, scientists are learning more about why some population groups have higher

cancer incidence and mortality rates than others. For example, we know that many evidenced­based

interventions, including cancer screening, are not adequately reaching all populations. Other research

shows that, in addition to uneven access to cancer care interventions, there may be a genetic component to some cancer health disparities. 

...and Progress in Pursuit of our Goal

> Interventions to Improve Cancer Screening. An NCI study found that centralized telephone

care management increases screening rates for breast, cervical, and colorectal cancer in 

women. The study included more than 1,400 women who obtained care at community 

and migrant health centers in New York City. Women who were overdue for cancer 

screening were randomly assigned to one of two groups. Women in the usual care group 

received one telephone call to answer questions and review their status. Women in the 

intervention group received a series of telephone calls that provided information about 

screening, scheduled appointments, and motivational support. Screening rates in the 

intervention group increased by 10 percent for Pap testing for cervical cancer, 17 percent 

for mammography, and 60 percent for colorectal cancer screening. The findings show 

how a modest intervention can increase screening rates in largely minority populations. 

> Differences in Smoking­related Lung Cancer Risk. In one of the largest prospective studies

of its kind, NCI researchers found significant racial and ethnic differences in smokingrelated lung cancer risk, after ruling out differences in diet, occupation, and education 

level. Analyzing data from almost 200,000 study participants, researchers found that 

among individuals who smoked 10 cigarettes or less a day, Whites had a 55 percent

lower risk of lung cancer than Blacks, and among those who smoked 11 to 20 cigarettes 

daily, the risk was 43 percent lower. Among Hispanics and Japanese Americans, the 

percentages were lower still. However, the risk difference was minimal among people 

who smoked 30 cigarettes or more a day. While research into the environmental factors 

that influence lung cancer risk across populations is still vital, the investigators suggest 

that genomic research may eventually pinpoint genes that increase susceptibility to smokingrelated lung cancer and may help explain these racial and ethnic differences.

THE NATION’S INVESTMENT IN CANCER RESEARCH 27
National Cancer Institute Director John E. Niederhuber, M.D.

Dr. John Niederhuber was appointed the 13th Director of the National Cancer

Institute in August 2006. Throughout his distinguished career, he has had ties to

both NCI and the National Institutes of Health. In addition to his work as a surgeon, professor, researcher, department chair, senior associate dean, and cancer

center director, Dr. Niederhuber has also been the chair of the National Cancer

Advisory Board, an external NCI advisor and grant reviewer, and a laboratory

investigator supported by NCI and the NIH. He joined NCI in September 2005 as

deputy director for translational and clinical sciences, and became NCI’s acting

director in June 2006.

In addition to his leadership of the NCI, Dr. Niederhuber heads the Laboratory of

Tumor and Stem Cell Biology in NCI’s Center for Cancer Research, and also holds a

clinical appointment on the NIH Clinical Center Medical staff. His lab is studying tissue stem cells as the cell­of­origin for cancer, as well as the complex relationship

between tumor cells and their microenvironment.

As a surgeon, Dr. Niederhuber’s clinical emphasis is on gastrointestinal cancer, hepatobiliary (liver, bile duct, and gallbladder) cancer, and breast cancer.

Recognized for his pioneering work in hepatic artery infusion chemotherapy,

he was also the first to demonstrate the feasibility of totally implantable vascular

access devices.

Prior to his coming to NCI, Dr. Niederhuber spent his years as Director of the

University of Wisconsin School of Medicine Comprehensive Cancer Center, 

and a professor of surgery and oncology at that same university. Earlier in his

career he chaired the Department of Surgery at Stanford University, and held

professorships at the Johns Hopkins University School of Medicine and at the

University of Michigan.

A native of Steubenville, Ohio, Dr. Niederhuber is a graduate of Bethany College in

West Virginia and the Ohio State University School of Medicine.

28 N ATIONAL CANCER INSTITUTE
As NCI supports the full continuum of cancer research, it is crucial that we

observe, analyze, understand, and integrate the emerging trends that will

determine how Science Leads the NCI. Tracking Advances in 2006 is key to

recognizing both the impact of research results and the emergence of new

findings and opportunities. Our Strategic Objectives allow the Institute to

chart a course focused on targeted, collaborative efforts to realize a future

free of cancer.

An organization as multi­faceted as the National Cancer Institute requires

effective management at a tactical and operational level to implement its

research priorities. The following section, How We Work, describes NCI’s key

bioscience infrastructure that enables progress in the National Cancer Program.

NCI is organized into an Office of the Director, two intramural divisions (in­house

research) and five extramural divisions (support for research throughout the

United States and internationally). This structure serves as the foundation for

furthering discovery, development, and delivery, through mechanisms for:

investigator initiated research; clinical trials; centers, networks, and consortia; technology development; surveillance and outreach; and career training

and development. 

The following pages describe how NCI uses its bioscience infrastructure to

coordinate and collaborate with the cancer research community, in order to

expedite progress against cancer. The proposed NCI budget request reflects

this vital, integrated approach. 

How We Work

THE NATION’S INVESTMENT IN CANCER RE SEARCH 29
Intramural Research

A portion of NCI’s research dollars supports the work of scientists in the two intramural divisions, the

Center for Cancer Research (CCR) and the Division of Cancer Epidemiology and Genetics (DCEG),

which together comprise the Intramural Research Program (IRP). The IRP is a recognized leader in

identifying genetic and environmental determinants of cancer and AIDS. Improved understanding of

virology, the study of viruses and the diseases caused by them, will help advance progress against

cancer. IRP researchers are able to rapidly translate their discoveries into clinical applications by

utilizing the infrastructure provided by the NIH Clinical Center, the largest clinical research hospital

in the world. Over the years, NCI’s intramural program has produced new drugs and technologies to

treat patients with cancer and AIDS as well as improve their quality of life. 

A Closer Look— Collaborative Science at NCI

Nearly two decades ago, researchers at NCI and other institutions began searching for the

underlying causes of cervical cancer. That scientific quest led to Food and Drug Administration

(FDA) approval of the vaccine Gardasil® this year. Gardasil® protects against infection from the

two types of human papillomavirus (HPV) that cause the majority of cervical cancers worldwide.

Population studies conducted in part by NCI helped to establish the link between HPV infections and the disease. The research revealed that while most HPV infections clear on their own

and do not lead to cancer, virtually all cases of cervical cancer are caused by HPV infection.

NCI scientists then examined ways to boost the body’s immune response to prevent the cancercausing infection. This work led to development of the technology on which the HPV vaccine is

based. The vaccine opens a new era in cancer prevention and has the potential to save women’s

lives, as well as to reduce health disparities in the United States and around the world.

“NCI’s immunology and vaccine research regarding HPV infection is far from finished. We

continue to work on improved vaccines and immunization technology, to make these prevention

strategies even more effective and accessible to women worldwide.” Dr. John Niederhuber,

Director, National Cancer Institute

Extramural Research

Funding and conducting innovative research are the highest priorities at NCI. The largest allocation

of NCI’s budget is dedicated to building the capacity of the cancer research enterprise by providing

infrastructure, resources, and other support. An essential component of this infrastructure is the NCI

Extramural Research Program that supports basic and clinical cancer research in institutions outside of the NIH. The program reaches nearly 650 universities, hospitals, Cancer Centers, and other

sites throughout the United States and in more than 20 other countries. Approximately 85 percent of

NCI’s budget funds extramural research activities.

30 N ATIONAL CANCER INSTITUTE
A Closer Look — Support for Extramural Research 

The majority of NCI’s extramural funding supports investigator-initiated Research Project 

Grants (RPGs); in Fiscal Year (FY) 2007, NCI anticipates investing more than $2.1 billion in 

support of about 5,000 RPGs. NCI also invests in a significant portfolio of extramural projects 

solicited through various initiatives. For instance, in FY07 NCI expects to invest more than 

$440 million in Specialized Programs of Research Excellence (SPOREs), Cancer Centers, and 

specialized centers. NCI’s extramural budget also supports cancer control, investigator training, 

health disparities, research collaborations with the private sector, and other types of research 

and development activities. 

Program experts in NCI’s 

Divisions of Extramural Activities 

(DEA), Cancer Biology (DCB), 

Cancer Treatment and Diagnosis 

(DCTD), Cancer Prevention 

(DCP), and Cancer Control and 

Population Sciences (DCCPS) 

guide and administer the NCI 

investment in extramural biomedical research. Central responsibilities of the DEA involve 

establishing and disseminating 

extramural policy, coordinating 

scientific and merit review, and 

all aspects of grant development 

and tracking. DCB and DCTD 

manage a portfolio of grants, 

cooperative agreements, and contracts in areas relevant to cancer biology (DCB) and diagnostic/therapeutic cancer interventions (DCTD). DCP supports extramural research focused 

on cancer prevention, early intervention, symptom management, and supportive care, while 

DCCPS conducts an integrated program of genetic, epidemiologic, behavioral, social, and surveillance cancer research. 

Clinical Trials 

NCI supports over 1,300 clinical trials a year, assisting more than 200,000 patients. NCI convened the 

Clinical Trials Working Group (CTWG) to identify ways that NCI’s national clinical trial enterprise 

could be restructured in order to realize the promise of molecular medicine. The goal is to markedly 

advance clinical practice for cancer in the 21st century. Ultimately, the true value of the CTWG’s 

restructuring plan will be demonstrated by measures of whether clinical trial initiatives better promote the development of new therapies, diagnostic procedures, and biomarkers that enhance the 

specificity with which cancer treatments are delivered. 

THE NATION’S INVESTMENT IN CANCER RESEARCH 31
A Closer Look— Personalized Treatment Trial for Breast Cancer

A new NCI clinical trial, the Trial Assigning IndividuaLized Options for Treatment (Rx),

dubbed TAILORx, is being hailed by leading breast cancer researchers as an important step

toward more individualized treatment of cancer based on factors such as the expression

(activity) of specific genes within a patient’s tumor cells. TAILORx is designed to determine

whether adjuvant hormonal therapy alone is as effective as adjuvant hormonal therapy in

combination with chemotherapy for certain women with early­stage breast cancer. Trial

results will help individualize treatment for each breast cancer patient in order to achieve

improved clinical outcomes.

The trial will use the results of a new test that measures the expression of 21 genes in tumor

samples from women with early­stage invasive breast cancer to assign participants to their

treatment regimen. The genomic test used in this trial can more precisely estimate a woman’s

risk of cancer recurrence than standard characteristics that doctors normally use to assess

recurrence risk (such as tumor size and grade). The test result is expressed as a “Recurrence

Score.” The higher the score, the greater the chance of breast cancer recurrence if a woman

is treated with hormone therapy alone. The treatment that patients receive in this trial will

depend upon the results of the Recurrence Score.

Although about 90 percent of women with early­stage breast cancer are advised to undergo

adjuvant chemotherapy, studies have shown that it decreases recurrence risk in only a small

percentage of them. TAILORx could change the way breast cancer is treated, helping to

more accurately identify women who are likely to benefit from chemotherapy and those who

are not.

Centers, Networks, and Consortia

The new research paradigm hinges on interdisciplinary science, strategic partnerships, immediate

application of new technologies, optimal information sharing, and close links to health care delivery

systems. The centers, networks, and consortia created and supported by NCI over the last 12 years

32 N ATIONAL CANCER INSTITUTE
comprise a model framework to support team science. They also provide a means of fostering coalitions with other cancer research funding organizations, professional societies, business and industry,

and local and state governments. Examples of NCI centers, networks, and consortia include:

> NCI­designated Cancer Centers integrate multidisciplinary research across single or multiple

institutions and reach out to the local community with education and other services. 

> Specialized Programs of Research Excellence (SPOREs) focus entirely on discovery­to­delivery

research dedicated to specific cancers.

> Clinical Trial Cooperative Groups and the Community Clinical Oncology Program 

extend the opportunity for participation in clinical trials to patients treated in the 

community rather than at Cancer Centers. 

> The SEER (Surveillance, Epidemiology and End Results) network tracks incidence, mortality,

and survival.

> The NCI Community Cancer Centers Program (NCCCP) is a concept designed to work through 

partnerships with NCI­designated Cancer Centers to improve quality of care.

> NCI Centers of Excellence connect specialized groups of scientists.

A Closer Look—The Cohort Consortium

Networks and consortia are geographically dispersed groups that focus on developing or validating new interventions or research in specialty areas. The NCI Cohort Consortium demonstrates

the power of pooling biologic samples and resources in a collaborative effort to enhance our

understanding of genetic susceptibility to cancer. The consortium combines the long­term investment in biobanks from large cohorts of individuals followed for many years. It applies the power

of genome­wide scans on samples from roughly 800,000 individuals to assess 500,000 genetic

markers in order to uncover those that determine cancer risk. Groups of toxicologists, developmental biologists, and epidemiologists studied the effects of specific environmental agents and the

subsequent risk of hormone­related cancers. These and similar studies have begun to identify

genes previously unrecognized as important to cancer susceptibility. Laboratory, clinical, and

population researchers are rapidly following­up on these discoveries to elucidate the underlying

responsible mechanisms.

Technology Development

Research over the past three decades has led to significant progress in our understanding of cancer

at the genetic, molecular, and cellular levels. As we work to apply these discoveries to cancer prevention, early detection, and management, it is increasingly important to integrate research, science,

and technology as effectively as possible. NCI supports a range of studies and projects to pursue the

benefits of these combined approaches. Some of these activities are described below.

Bioinformatics: Using powerful information technology, NCI is leading the development of a

bioinformatics platform that will enable researchers and clinicians to access and integrate cancer research results across scientific disciplines, populations, and geography. Under the cancer

THE NATION’S INVESTMENT IN CANCER RESEARCH 33
As an additional example, the width 

of a human hair is approximately 

80,000 nanometers.

Biomedical Informatics GridTM (caBIGTM) umbrella, NCI and a large group of private and

public collaborators are building a voluntary network or grid, including common terminology

and tools, to connect scientists and institutions into a virtual World Wide Web of cancer

research. The overall goal is to speed the delivery of innovative approaches for preventing and

treating cancer, including increased mutually beneficial flow of bench­to­bedside interactions.

Cancer Imaging: Imaging methods are being combined with emerging technologies such as

nanotechnology, proteomics, and high throughput screening to identify cancers earlier and

help assess the effectiveness of therapy. Imaging informatics brings cancer imaging data to

research and clinical environments more efficiently and effectively. Image­guided cancer

intervention is a rapidly evolving area that may be used to cure some cancers and precancerous lesions, and also to provide minimally invasive, well­tolerated palliative treatments. As

our knowledge of the molecular basis of cancer increases, molecular imaging methods are

providing researchers with powerful discovery tools and clinicians with telling biomarkers

for cancer risk and treatment efficacy.

Proteomics: Evidence suggests that measurements of proteins and peptides circulating in the

blood may represent reliable indicators of early­stage cancer. Proteins serve complex and

diverse functions in the body, from giving structure to our cells to regulating processes such

as digestion, breathing, and the growth rate of cells. When proteins fail to function properly,

normal body processes can go awry. For example, errors in proteins that regulate when and

how fast cells reproduce, as well as the timing of cell death, can result in cancer. One of the

goals in cancer research is to develop technologies that measure and evaluate these abnormal

proteins with enough accuracy to be used as cancer diagnostic blood tests.

Nanotechnology: Nanotechnology offers researchers a paradigm­changing opportunity to study

and interact with both normal and cancer cells at molecular and cellular scales. For reference, 8

to 10 atoms span one nanometer; the human hair is approximately 70,000 to 80,000 nanometers

thick. Increasing abilities to perform research at this nano level will enhance cancer diagnosis and

treatment. For example, imaging agents and diagnostics designed with nanoscale precision will

optimize their usefulness and function and allow clinicians to detect cancer in its earliest, most

treatable stage. Multifunctional, targeted devices capable of bypassing biological barriers will

34 N ATIONAL CANCER INSTITUTE
enhance our ability to effectively and efficiently treat cancer by delivering multiple therapeutic

agents at high concentrations—and with physiologically appropriate timing—directly to cancer

cells. In preclinical studies, nanotech­based cancer treatments are demonstrating increased efficacy and significant decreases in life­threatening side effects. 

A Closer Look— Nanotechnology Characterization Laboratory

NCI is engaged in efforts to harness the power of nanotechnology to radically change the

way we detect, diagnose, treat, and prevent cancer. NCI has established the Nanotechnology

Characterization Laboratory (NCL) at its NCI­Frederick facility to provide critical infrastructure

support to this rapidly developing field.

The NCL is an effective scientific collaboration between three Federal agencies: NCI, Food

and Drug Administration (FDA), and the National Institute of Standards and Technology

(NIST) of the U.S. Department of Commerce. Scientists from each agency bring critical

knowledge, experience, and skills to the new laboratory setting. NCI brings expertise in the

biomedical research arenas necessary for the biological and chemical characterization of the

nanoparticles and devices. FDA brings a strong and standardized model for evaluating diagnostics, a new integrated program for regulating diagnostic devices, and initial exploratory

methods for evaluating multiple complex technologies for their possible use in drug development. NIST provides expertise in determining the best measurement tools, protocols, and

analysis algorithms for physically characterizing nanoparticles.

The NCL enables researchers to develop their nanotechnology concepts into clinical applications

by characterizing the material’s properties as they relate to biological systems. Tests developed by

the NCL and its partners will be codified and then distributed as a “gold standard” for academic,

industry, and government laboratories. The NCL will serve as a national resource and knowledge

base for cancer researchers to aid the regulatory review of nanotechnologies intended for cancer

therapies and diagnostics. By providing the critical infrastructure and characterization services to

nanomaterial providers, the NCL can accelerate the translation of basic nanoscale particles and

devices into clinical applications.

Surveillance and Outreach

Cancer surveillance provides quantitative measures of the burden of cancer and the impact of cancer control in the general population. Moreover, the national cancer registry system in the United

States provides a powerful tool for cancer research. The system is comprised of interdependent

Federal, state, and private sector programs and provides surveillance data on all cancers. NCI and

other Federal agencies help support cancer registries in all 50 states, the District of Columbia, and

several United States territories. NCI is working with multiple partners to better integrate surveillance data into cancer control planning. This use of cancer surveillance to help guide resource

allocation is essential to reducing the cancer burden in all populations.

THE NATION’S INVESTMENT IN CANCER RESEARCH 35
Outreach through cancer communication empowers people: it can raise their awareness of health

problems and help them make informed cancer­related decisions. Effective cancer communications

are targeted to users’ needs across the cancer continuum—prevention, detection and diagnosis,

treatment, survivorship, and end­of­life issues. Changes in the role and accessibility of this information are continually altering health care practices, patient­physician relationships, and the way

patients acquire and use information. Besides consulting their physicians, many consumers now

seek health information from Internet and other media sources, which can vary in quality and reliability. NCI is working to ensure that everyone has ready access to timely, reliable, understandable

information that is also culturally appropriate. 

A Closer Look— NCI Outreach

NCI launched the Centers of Excellence in Cancer Communications Research (CECCR) initiative

in 2003. CECCR provides the infrastructure for interdisciplinary teams at four centers to promote

advances in cancer communications, develop interventions, translate theory into practice, and

train health communicators. Their recent work includes:

> The University of Michigan’s “Guide to Decide” project is exploring ways of communicating 

risk about using tamoxifen for breast cancer prevention to women at high risk for the 

disease across all sociodemographic groups.

> The University of Pennsylvania is studying cancer­related information searching and 

scanning behavior in the general population, assessing associations with post­diagnosis 

treatment choices or cancer screening and prevention behavior. 

> The Saint Louis University Ozioma News Service project is developing and testing a 

computer­based news service that will contribute community­specific stories and cancer

data to local Black newspapers.

> The University of Wisconsin­Madison is examining whether Comprehensive Health 

Enhancement Support Systems that create “healing relationships” for patients over time

improve cancer outcomes and survivorship experiences. This project supports the Institute

of Medicine goal to improve health outcomes for patients with chronic conditions.

36 N ATIONAL CANCER INSTITUTE
Training and Career Development

Rapid developments on 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 approximately four percent of its annual budget and multiple strategies to preparing the next generation

of cancer researchers for challenges that increasingly are 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 across 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 well­trained investigators to

focus on the challenges of fighting cancer. 

A Closer Look — A Researcher’s Story

NCI training and career development experiences provided a young investigator with the

background and resources that facilitated a notable cancer scientific advance. The Principal

Investigator and his team were able to generate mice that develop pancreatic cancer that

mimics the human disease. They then isolated a molecular signature in the blood serum of

these mice that reliably predicts the presence of early pancreatic cancer. This new mouse

model has helped to advance the work of other researchers studying the development, detection,

and treatment of pancreatic cancer. 

NCI mechanisms of support for the investigator included funding through the Medical Scientist

Training Program for his sub­specialization in medical oncology. He was able to advance his

mouse model research through an NCI fellowship training grant, and as a result of his success

he has received additional funding to continue his investigation in this promising area.

“I have always been attracted to illnesses that had few efficacious treatments, and pancreatic

cancer is at the top of my short list. Finding the right environment to start your career is the most

important thing. Sufficient funding is required from the beginning.” NCI­funded investigator

THE NATION’S INVESTMENT IN CANCER RESEARCH 37
Cancer in America—What the Statistics Tell Us

Although the nation’s investment in cancer research is making a difference in the lives of Americans

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

The lifetime risk for developing cancer is one in two for men, and one in three for women. Nearly 1.4

million new cancer cases will be diagnosed this year and more than a half million people will die of

the disease. In 2005, the economic burden of cancer to the nation was estimated to be over $200 billion. 

Progress has been made toward our goal of reducing the many types of cancer burden in the United

States. Overall cancer mortality continues the gradual decline that began in the early 1990s. The number

of deaths from some of the most common cancers—

colorectal, breast, and prostate continues to decrease.

These trends reflect effective prevention and risk

reduction interventions, better screening and early

detection methods, and improved treatment and

medical management. 

Today, approximately 10 million people are alive with a

history of cancer, and with a better quality of life than

was possible years ago. More than two­thirds of people diagnosed with cancer can expect to live for five

years or longer. For children diagnosed with cancer, five­year overall survival exceeds 75 percent.

Increasingly, with new imaging techniques and the identification of novel biomarkers, we are finding

cancers at earlier, more curable stages, and are able to predict clinical outcomes. Improved diagnostic tools are advancing individualized, tailored therapy, while newly discovered molecular targets are

transforming the way we develop interventions. 

38 N ATIONAL CANCER INSTITUTE
NCI Tracks Cancer Trends and Progress:

Annual Report to the Nation on the Status of Cancer

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

Society (ACS), the Centers for Disease Control and Prevention (CDC), NCI, and the

North American Association of Central Cancer Registries (NAACCR). The publication provides updated information on cancer rates and trends in the United States.

NCI’s SEER databases are a major source of information.

Cancer Trends Progress Report 

This is a biannual NCI electronic 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 CDC and the ACS. The report was first issued in 2001

and will be updated again in 2007. 

Surveillance, Epidemiology, and End Results (SEER) Program

The NCI SEER program currently collects and publishes cancer incidence and survival

data from 14 population­based cancer registries and three supplemental registries covering approximately 26 percent of the U.S. population. 

NCI Cancer Bulletin

The NCI Cancer Bulletin is a weekly online publication that provides updates on NCI

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

both the U.S. and international cancer communities.

THE NATION’S INVESTMENT IN CANCER RESEARCH 39
THE NATION’S INVESTMENT IN CANCER RESEARCH F1

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 to expand existing initiatives. The Current Services increase

is the amount that will be required to sustain 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. The funds needed to

expand existing initiatives are add-ons to the Current Services level. These

funds are distributed by budget mechanism in the column labeled “Additional

Resources” on the following page.

At a Glance* 

(dollars in thousands)

Fiscal Year 2007 Estimate $4,696,227

Current Services Increase 282,998

Subtotal 4,979,225

Fiscal Year 2008 Additional Resources

Increase Success Rate for Research Project Grants 277,000

Expanding Cancer Center Research 77,000

Linking Science and Technology 170,000

Integrating Science through Interdisciplinary Teams 196,000

Cancer Clinical Trials 100,000

Subtotal 820,000

Total NCI 5,799,225

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

NCI Budget 

Request for 

Fiscal Year 2008
Fiscal Year 2008 National Cancer Institute Professional Judgement Budget Request

FY 2006 FY 2007

(dollars in thousands) Estimate Estimate

Research Grants

Research Project Grants

Noncompeting $ 1,621,004 $ 1,594,683

Administrative Supplements 50,461 48,655

Competing 412,596 416,945

Subtotal 2,084,061

94,611

2,060,283

SBIR/STTR 93,735

Subtotal, RPG 2,178,672 2,154,018

Research Centers and SPOREs 463,510 446,818

Other Research

Research Careers 78,044 76,657

Cancer Education 36,134 33,806

Cooperative Clinical Research 146,326 139,302

Biomedical Research Support — —

Minority Biomedical Research Support 3,316 3,116

Other 61,446 41,261

Subtotal, Other Research 325,266 294,142

Total Research Grants 2,967,448 2,894,978

National Research Service Awards 69,492 66,279

Research & Development Contracts 324,420 330,441

Intramural Research 677,724 696,263

Research Management & Support 193,421 183,246

Cancer Prevention & Control 506,805 517,100

Construction (Capital Improvements)  — —

Buildings & Facilities 7,920 7,920

Subtotal, NCI 4,747,230 4,696,227

NCI’s Roadmap Contribution‡ 42,834 57,382

Total, NCI

‡ Roadmap estimate for FY 2008

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 government­wide

Small Business Technology Transfer

(STTR) program promotes technology transfer by helping investigators

form public/private partnerships.

4,790,064

Research Centers and SPOREs

NCI­designated Cancer Centers

serve as hubs for cutting­edge

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. 

4,753,609

Other Research

Other funding mechanisms 

support the education and 

training of cancer investigators,

Clinical Cooperative Research

grants for large­scale, multiinstitutional clinical trials, and

Resource­Related Research

Project grants to increase the

availability of research resources. 
Current Fiscal Year 2008

Services 

Increase

Current 

Services

Additional 

Resources

Total

Bypass

% Inc Over

FY 2007 

Estimate

$ (36,851) $ 1,557,832 $ 0 $ 1,557,832 (2.3%)

1,849 50,504 — 50,504 3.8%

152,055 569,000 354,000 923,000 121.4%

117,053 2,177,336 354,000 2,531,336 22.9%

3,562 97,297 21,000 118,297 26.2%

120,615 2,274,633 375,000 2,649,633 23.0%

22,979 469,797 199,000 668,797 49.7%

4,913 81,570 37,000 118,570 54.7%

1,285 35,091 — 35,091 3.8%

5,293 144,595 46,000 190,595 36.8%

— — — — 0.0%

118 3,234 — 3,234 3.8%

1,568 42,829 7,000 49,829 20.8%

13,177 307,319 90,000 397,319 35.1%

156,771 3,051,749 664,000 3,715,749 28.4%

3,519 69,798 6,000 75,798 14.4%

12,557 342,998 78,000 420,998 27.4%

26,458 722,721 25,000 747,721 7.4%

6,963 190,209 11,000 201,209 9.8%

19,650 536,750 36,000 572,750 10.8%

30,000 30,000 — 30,000 100.0%

27,080 35,000 — 35,000 341.9%

282,998 4,979,225 820,000 5,799,225 23.5%

— 66,563 — 66,563 16.0%

282,998 5,045,788 820,000 5,865,788 23.4%

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 long­term 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.

40 N ATIONAL CANCER INSTITUTE
National Research Service Awards 1%

Cancer Prevention & Control 10%

Research Management & Support 3%

Research & Development Contracts 7%

Intramural Research 13%

Other Research 7%

Distribution of Fiscal Year 2008 Budget Request ($5,865,788,000)

Construction–Capital Improvements 1%

NIH Roadmap 1%

Buildings & Facilities 1%

Research Project Grants 45%

Research Centers & SPOREs 11%

Buildings & Facilities 

NCI’s building and facilities program

supports repairs and improvements

at the NCI Federally Funded

Research and Development Center

in Frederick, Maryland.

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 state­of­the­art 

laboratories and clinics for basic

and applied research including

biorepositories, imaging, and 

bioinformatics facilities.

THE NATION’S INVESTMENT IN CANCER RESEARCH 41
Links to Additional Information

Cancer Information

National Cancer Institute

http://www.cancer.gov

Searchable for programs or terms

from this document

NCI Cancer Information Service

http://cis.nci.nih.gov/

Specialists provide cancer information

to patients, families, caretakers, and

the public, at no charge

Also by phone: 1­800­4­CANCER 

(1­800­422­6237)

And TDD: 1­800­332­8615

Cancer News

http://www.cancer.gov/newscenter

NCI Cancer Bulletin 

http://www.cancer.gov/ncicancerbulletin

Cancer Topics  

http://www.cancer.gov/cancertopics/

NCI Fact Sheets

http://www.cancer.gov/cancertopics/

factsheet

Cancer Mortality Maps and Graphs

http://www.cancer.gov/atlasplus

Surveillance, Epidemiology, and 

End Results

http://seer.cancer.gov

NCI Planning and Priority Setting

This document online 

http://plan.cancer.gov

Office of Science Planning 

and Assessment

http://planning.cancer.gov/

The NCI Strategic Plan for Leading

the Nation 

http://strategicplan.nci.nih.gov/

Cancer Research Portfolio 

and Funding

NCI Cancer Research Portfolio

http://researchportfolio.cancer.gov

International Research Portfolio

http://www.cancerportfolio.org

NCI Research and Funding 

http://www.cancer.gov/research

andfunding

Centers, Networks, and Consortia

NCI Cancer Centers Program 

http://www.cancer.gov/cancercenters

Specialized Programs of 

Research Excellence 

http://spores.nci.nih.gov

Early Detection Research Network

http://edrn.nci.nih.gov

Mouse Models of Human 

Cancer Consortium

http://emice.nci.nih.gov/

Cancer Care Outcomes Research and

Surveillance (CanCORS) Consortium

http://healthservices.cancer.gov/cancors

Clinical Trials 

Community Clinical 

Oncology Program

http://www.cancer.gov/prevention/ccop/

Cancer Therapy Evaluation Program

http://ctep.cancer.gov/

Cancer Trials Support Unit 

http://www.ctsu.org

Clinical Trials Working Group

http://integratedtrials.nci.nih.gov/ict/

NIH Clinical Center 

http://clinicalcenter.nih.gov

Clinical Studies Support 

Center (CSSC)

http://ccr.cancer.gov/trials/cssc/staff/

services.asp

NCI Clinical Trials

http://www.cancer.gov/clinicaltrials

Technology Development & Cancer

Cancer Genome Atlas

http://www.genome.gov/17516564

NCI Alliance for Nanotechnology 

in Cancer

http://nano.cancer.gov

cancer Biomedical Informatics GridTM

https://cabig.nci.nih.gov

Office of Technology and 

Industrial Relations 

http://otir.cancer.gov

Cancer Imaging Programs

http://imaging.cancer.gov/

Education, Input, and Outreach

Office of Education and 

Special Initiatives 

http://cancer.gov/aboutnci/oesi

Office of Liaison Activities

http://ola.cancer.gov

NCI Advisory Boards

http://deainfo.nci.nih.gov/advisory/

boards.htm

Ordering Copies of this Document

By email: cisocc@pop.nci.nih.gov

By phone: 1­800­4­CANCER

By fax: 301­330­7968

By internet:

http://www.cancer.gov/publications

The National Cancer Institute is one

of the 27 Institutes, Centers, and

Offices of the National Institutes of

Health (http://www.nih.gov). NIH is 

a Federal Government agency in the

U.S. Department of Health and

Human Services (http://www.hhs.gov)

42 N ATIONAL CANCER INSTITUTE
Acknowledgements

Staff of the NCI Office of Science Planning and Assessment (OSPA) provided guidance, planning, and implementation

work for this document, in concert with the leadership of the NCI Director, Dr. John Niederhuber. The OSPA team was led

by Cherie Nichols (OSPA Director), Marianne Kost, and Jane Jacobs, with ongoing participation by Genevieve Medley and

Lisa Stevens. Additional contributions came from staff members Janet Ayres, Jamelle Banks, Julie Bronder, Kevin Callahan,

Buddy Clark, James Corrigan, Norma Davis, Rabiah Hendricks, Jennifer Kwok, Mary Leveck, Anna Levy, Kimberly Myers,

Carlene Neil­Allman, Samir Sauma, Larry Solomon, Bridget Williams­Simmons, Joy Wiszneauckas, and Kevin Wright.

The NCI Executive Committee (EC) provided counsel and review for the development of the overall plan, including: Anna

Barker, Ken Buetow, Nelvis Castro, Mark Clanton, Robert Croyle, James Doroshow, Greg Downing, Dorothy Foellmer,

Joseph Fraumeni, Paulette Gray, Peter Greenwald, John Hartinger, Ernie Hawk, Thomas Hooven, Maureen Johnson, Sandy

Koeneman, Alan Rabson, Craig Reynolds, Kathleen Schlom, Dinah Singer, Sanya Springfield, and Robert Wiltrout.

Additional review came from Michelle Bennett, Daniela Gerhard, James R. Heath, Bradford Hesse, Lori Minasian, Julia

Rowland, Daniel Sullivan, Nada Vydelingum, John Wunderlich, and Shelia Zahm. 

Key budget work and support was provided by the NCI Financial Management Branch, including Jim Dickens, Scott

Marchand, Ann Fitzpatrick, and their colleagues. 

NCI Editorial Board support included Julie Cheh, Daniel Gallahan, Jane Lockmuller, Rick Manrow, and Jaye Viner. Content

was also developed from contributions by NCI staff members Richard Folkers, Addison Greenwood, James Mathews, Sharon

Reynolds, Bill Robinson, and Donna Kerrigan. Specific writing and editing support to NCI came from Kathy Sorrow, Suzanne

Reuben, and Sue Bentley.

Ongoing support from Planning Contacts in NCI divisions and offices included: Anne Benner, Phil Budashewitz, Christina

Bruce, Lynn Cave, Jane MacDonald Daye, Andrea Denicoff, Travis Earles, Brooke Hamilton, Chris Hatch, Marianne Henderson,

Maureen Johnson, LaTonya Kittles, Tarsha McCrae, Anita Ousley, Jennifer Sienko, Kara Smigel­Croker, Stacey Vandor, Jeffrey

White, and Stephen White.

From the NCI Office of Communications, publication guidance and implementation staff included Donna Bonner, Del Harrod,

Paul LaMasters, and Walt Burroughs. Key design and layout support was provided by Howard Clare and Kevin Shackelford.

Scientists in the field providing specific consultation included James Heath, Timothy Kinsella, Joshua LaBaer, Douglas

Lauffenburger, Martin Murphy, Vito Quaranta, and David Tuveson. 

We also acknowledge with appreciation all those who are funded by or partner with the National Cancer Institute, and all

the dedicated scientific, program, and administrative staff members at NCI. You are too numerous to appear by name on

this page, but without your ongoing collaborative work, the life­saving accomplishments and future advances described in

this document would not be possible.

Note: A number of contributors provided support in several areas but are listed only once due to space constraints.
NIH Publication No. 06­6090

Printed October 2006

Each year, as mandated by the National Cancer Act of 1971 (Public Law 92­218), the National Cancer

Institute (NCI) prepares a plan and budget proposal outlining the nation’s investment in research

accomplishments and opportunities to decrease the burden of cancer. Although a document this size

can convey only a cross­section of the National Cancer Program, it covers broad trends, concrete

strategies, and examples of specific projects to provide vital support for the most promising research

progress and its translation to people’s health.

Congress mandated that NCI “prepare and submit, directly to the President for review and transmittal

to Congress, an annual budget estimate for the National Cancer Program”. Because its content is

relevant to all whose lives are affected by cancer, as well as to others whose health or illness is

impacted by NCI’s biomedical discoveries and groundbreaking tools, this document is also valuable

to many other groups. Its audiences include: the research community; healthcare professionals and

their organizations; advisory groups; information, education, and advocacy organizations; policy

makers in both public agencies and private industry; and concerned citizens across the country.