National Cancer Institute

Recommendations from the 

NCI-designated Cancer Center Directors Accelerating Successes

AgainstCancer

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health
Accelerating Successes Against Cancer 

 2 Contributors

 4 Statement of Purpose

 The Cancer Centers Directors’ Working Group

 8 Executive Summary

14 Prevention

 Summary

 Introduction

 Current Knowledge, Issues and Problems

 Accomplishments

 Emerging Therapeutic and Interventional Strategies

 Identification and Prioritization of Opportunities for Advancement

 Action Items for NCI-designated Cancer Centers

 Anticipated Outcomes and Potential Impact

 References

30 Early Detection

 Summary

 Introduction

 Current Knowledge, Barriers, and Opportunities

 Emerging Technologies

 Imaging for Early Detection

 High-Risk Populations for Early Detection Screening

 Opportunities to Impact Early Detection and to Reduce the Cancer Burden

 Anticipated Outcomes and Potential Impact

 References

40 Treatment

 Summary

 Introduction

 Current Knowledge, Barriers and Opportunities

 Emerging Therapeutic and Interventional Strategies

 Identification and Prioritization of Opportunities for Advancement

 Anticipated Outcomes and Potential Impact

 References

48 Survivorship

 Summary

 Introduction

 Current Knowledge, Issues, and Problems

 Emerging Therapeutic and Interventional Strategies

 Identification and Prioritization of Opportunities for Advancement

 Anticipated Outcomes and Potential Impact

 References

54 Collaborations

 Summary

 Introduction

 Current Knowledge, Issues, and Problems

 Emerging Therapeutic and Interventional Strategies

 Identification and Prioritization of Opportunities for Advancement

 Key Challenges Requiring Large-Scale Collaborations

 References

64 Dissemination

 Summary

 Introduction

 Current Knowledge, Barriers and Opportunities

 Emerging Dissemination Strategies

 Anticipated Outcomes and Potential Impact

 References

70 Appendices

 70 Appendix A: Selected Chemoprevention and Nutritional Intervention Trials 

 72 Appendix B: IOM Survivorship Report Executive Summary

 88 Appendix C: PCP Survivorship Report Executive Summary

 99 Appendix D: Survivorship Activities at Cancer Centers 

 100 Appendix E: Summary of Survivorship Activities at Cancer Centers

 116 Appendix F: Summary of Shared Resources Survey at Cancer Centers

Table of

Contents
 Accelerating Successes Against Cancer

Contributors

Cancer Center Directors Working Group

Steering Committee Members

Chair: John Mendelsohn, MD, Director, MD Anderson Cancer Center

Martin Abeloff, MD, Director, Sidney Kimmel Cancer Center, Johns Hopkins University

David Alberts, MD, Director, Arizona Cancer Center, University of Arizona

William Dalton, MD, PhD, Director, Moffitt Cancer Center, University of South Florida

Judith Gasson, PhD, Director, Jonsson Comprehensive Cancer Center, University of California, Los Angeles

Stanton Gerson, MD, Director, Case Comprehensive Cancer Center, Case Western Reserve University

Leland Hartwell, PhD, Director, Fred Hutchinson Cancer Research Center

Ronald Herberman, MD, Director, University of Pittsburgh Cancer Institute

John Kersey, MD, Director, University of Minnesota Cancer Center

Subcommittee Members

Prevention

Chair: David Alberts, MD, Director, Arizona Cancer Center, University of Arizona

Randall Burt, MD, Interim Director, Huntsman Cancer Institute, University of Utah

Grover Bagby, Jr., MD, Director, Oregon Health Sciences University Cancer Institute

Raymond Dubois, MD, PhD, Director, Vanderbilt-Ingram Cancer Center, Vanderbilt University

Deborah Helitzer, PhD, University of New Mexico

Lisa Hess, MS, University of Arizona

H. Kim Lyerly, MD, Director, Duke Comprehensive Cancer Center, Duke University

Frank Meyskens, Jr., MD, Director, Chao Family Comprehensive Cancer Center, University of California, Irvine

Cosette Wheeler, PhD, University of New Mexico

Cheryl Willman, MD, Director, University of New Mexico Cancer Research and Treatment Center

Early Detection

Chair: Stanton Gerson, MD, Director, Case Comprehensive Cancer Center, Case Western Reserve University

Louise Acheson, MD, Case Western Reserve University

James Basilion, PhD, Case Western Reserve University

Zaver Bhujwalla, PhD, Johns Hopkins University

Jeff Bulte, PhD, Johns Hopkins University

Thomas Chenevert, PhD, University of Michigan

Greg Cooper, MD, Case Western Reserve University

Kenneth Cowen, MD, PhD, Director, Eppley Cancer Center, University of Nebraska

Jeff Duerk, PhD, Case Western Reserve University

Sam Gambhir, PhD, Stanford University

Robert Gillies, PhD, University of Arizona

William Hait, MD, PhD, Director, Cancer Institute of New Jersey

John Hazle, PhD, MD Anderson Cancer Center

Tom Meade, PhD, Northwestern University

Mark Pagel, PhD, Case Western Reserve University

Marty Pomper, PhD, Johns Hopkins University

Brian Ross, PhD, University of Michigan

Georgia Weisner, MD, Case Western Reserve University
Accelerating Successes Against Cancer 

George Wilding, MD, Comprehensive Cancer Center, University of Wisconsin

Max Wicha, MD, Director, Comprehensive Cancer Center, University of Michigan

Treatment

Chair: Martin Abeloff, MD, Director, Sidney Kimmel Cancer Center, Johns Hopkins University

Michael Caligiuri, MD, Director, Comprehensive Cancer Center, Ohio State University

John Glick, MD, Director, Abramson Cancer Center, University of Pennsylvania

John Ruckdeschel, MD, Director, Barbara Ann Karmanos Cancer Institute, Wayne State University

Survivorship

Chair: William Dalton, MD, PhD, Director, Moffitt Cancer Center, University of South Florida

Lucile Adams-Campbell, MD, Howard University Cancer Center

Patricia Ganz, MD, Jonsson Comprehensive Cancer Center, University of California, Los Angeles

Mark Israel, MD, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center

Paul Jacobsen, PhD, Moffitt Cancer Center, University of South Florida

Les Robison, PhD, St. Jude Children’s Research Hospital

Steven Rosen, MD, Director, Robert H. Lurie Comprehensive Cancer Center, Northwestern University

Ellen Stovall, National Coalition of Cancer Survivorship

Stephen Williams, MD, Director, Indiana University Cancer Center

Cheryl Willman, MD, Director, University of New Mexico Cancer Research and Treatment Center

Linda Jacobs PhD, Abramson Cancer Center, University of Pennsylvania

Collaborations

Chair: Leland Hartwell, PhD, Director, Fred Hutchinson Cancer Research Center

David Alberts, MD, Director, Arizona Cancer Center, University of Arizona

Steven Burakoff, MD, Director, New York University Cancer Institute

Walter Eckhart, PhD, Director, Cancer Center, Salk Institute

Peter Emanuel, MD, Acting Director, Comprehensive Cancer Center, University of Alabama at Birmingham

William Hait, MD, PhD, Director, Cancer Institute of New Jersey

Peter Jones, PhD, Director, USC/Norris Comprehensive Cancer Center, University of Southern California

Russell Kaufman, MD, Director, The Wistar Institute Cancer Center

Theodore Krontiris, MD, PhD, Director, City of Hope National Medical Center

Janet Leeds, MBA, Fred Hutchinson Cancer Research Center

Peggy Means, MHA, Fred Hutchinson Cancer Research Center

Myra Tanita, MHA, Fred Hutchinson Cancer Research Center

Dissemination

Chair: Ronald Herberman, MD, Director, University of Pittsburgh Cancer Institute

Paul Bunn, Jr., MD, Director, University of Colorado Cancer Center

Frank Meyskens, Jr., MD, Director, Chao Family Comprehensive Cancer Center, 

University of California, Irvine

Carl-Wilhelm Vogel, MD, PhD, Director, Cancer Research Center of Hawaii, University of Hawaii at Manoa

George Weiner, MD, Director, Holden Comprehensive Cancer Center, University of Iowa

Robert Young, MD, Director, Fox Chase Cancer Center
Statement of Purpose

Never has there been such opportunity and promise for 

improving outcomes for patients with cancer. The human 

genome project and other recent accomplishments in 

molecular biology and technology development have made it 

possible to revolutionize the way physicians and researchers can 

address the challenge of preventing and curing cancer.

In 1971, with the passage of the National Cancer Act, the National Cancer Institute (NCI) initiated creation of centers of excellence and charged them with gathering together the expertise 

to greatly expand research on understanding the causes of cancer 

and improving its treatment. Initially the centers of excellence 

consisted of three NCI-designated Cancer Centers. Today there 

are 61 Centers, spread widely across the United States.

As a result of the government’s increased investment in research 

over a period of more than three decades, we now know that 

cancer is caused by mutations or abnormal functioning of critical 

genes which control the replication and behavior of the cells in 

our bodies. This statement could not have been made in 1971. 

The National Institutes of Health (NIH) Director Dr. Elias Zerhouni’s new NIH Roadmap Initiative contains three key concepts: 

1) exploring new pathways to discovery focusing on molecular 

networks associated with disease, imaging technologies, and nanomedicine; 2) creating interdisciplinary research teams of the future; 

 Accelerating Successes Against Cancer
Accelerating Successes Against Cancer 

and 3) re-engineering the clinical 

research enterprise and incorporating community-based physicians, 

in order to place more patients 

in innovative clinical trials. The 

Nation’s Cancer Centers and 

academic cancer research programs 

are leading the way in all three of 

these areas, and have been doing so 

for decades. By their very 

nature, research programs 

in NCI-designated Cancer 

Centers bring together 

basic, clinical, and population scientists to focus on 

cancer. Since their inception, the Cancer Centers 

have been peer-reviewed 

and scored by NCI based 

upon the strength of their 

intra- and interprogrammatic interactions. This 

model has contributed significantly to the successes 

that have been achieved 

in understanding the 

molecular basis of cancer 

and in developing targeted therapies and new imaging modalities. 

The nationwide program of clinical trials investigating new cancer 

treatments on many thousands 

of patients is a model of clinical 

investigation.

While our knowledge of cancer 

will never be complete, we have 

reached the point where medical 

researchers can at last envision 

ways to greatly improve our ability 

to reduce death and suffering from 

cancer. The age-adjusted rate of 

cancer mortality has been falling for 

a decade. Recently, it was reported 

that in 2003, for the first time, the 

absolute number of cancer deaths 

in the United States was reduced 

from the previous year. This is 

despite the fact that as a whole the 

U.S. population is living longer 

and cancer is a disease whose risk 

increases with aging. We can substantially reduce deaths from cancer 

just by broadening the application 

of knowledge we have today. By 

expanding our knowledge through 

further research, even greater gains 

are well within our reach.

The Cancer Centers Directors 

working group, described below, 

was not in a position to pursue an 

independent economic analysis of 

the benefits of improving cancer 

care. However it is worth making a 

few points from the available literature. The cost of caring for patients 

with cancer reached $40 billion in 

1996. Medicare bears over onethird of these costs. This figure has 

increased during the past decade to 

$72 billion. This does not include 

the cost of screening and the value 

of time lost from work during treatment, as well as the cost of premature death with loss of productivity. 

As an example, the cost of treating 

an early stage breast cancer patient 

over her lifetime is over $70,000. 

There were 213,000 new cases of 

this disease alone in 2006. 

The total impact of cancer on 

health is high. It was recently 

reported that for Americans under 

the age of 85, cancer is the leading cause of death. The American 

Cancer Society reported that last 

year there were 1,399,790 new 

cases of cancer and 564,830 deaths. 

Economists at the University of 

Chicago estimate that a 1% reduction in cancer deaths would be 

worth over $400 billion.

NCI was created as a governmental 

agency to lead cancer research, not 

to deliver health care. In contrast, 

most of the Nation’s NCI-designated Cancer Centers are imbedded 

in academic medical centers which 

have the dual missions of leading 

the fundamental study of disease 

and translating new knowledge to 

change the delivery of health care. 

The NCI’s Strategic Plan published 

in January 2006 outlines a bold 

vision of strategies to investigate 

cancer in the laboratory, in the 

clinic, and in the community, and 

states clearly that dissemination 

and application of research discoveries are required for success. 

The Nation’s Cancer Centers are 
 Accelerating Successes Against Cancer

uniquely positioned to both lead 

in cancer research and lead in this 

dissemination process.

The Cancer Centers 

Directors’ Working 

Group

At the November 7, 2005 meeting 

of the NCI Director with the directors of the NCI-designated Cancer 

Centers, a small working group 

– chaired by Dr. John Mendelsohn, 

President, University of Texas, MD 

Anderson Cancer Center – was 

asked to write a report providing a 

blueprint on how the Cancer Centers can contribute to achieving the 

following goals:

1. Reduce the burden of cancer 

through research in the areas of 

prevention, detection, treatment, and survivorship, and 

create a strategy for success.

2. Identify ways in which NCIdesignated Cancer Centers can 

enhance collaboration with 

each other and with other 

stakeholders in the pursuit of 

our shared mission.

3. Suggest initiatives that will 

enable the Cancer Centers to 

extend their research beyond 

their local communities and to 

provide leadership in the wide 

dissemination of best practices 

in cancer care and prevention.

4. Create a realistic vision of the 

potential for future successes 

and identify the roadblocks 

that must be dealt with.

The working group was subdivided 

into six subcommittees concentrating on the outlined goal areas: 

prevention, detection, treatment, 

survivorship, collaboration, and 

dissemination. The subcommittee 

reports were presented and discussed 

at the NCI Cancer Center Directors 

Retreat in May 2006 and the final 

report of recommendations was reviewed by all of the Cancer Center 

directors.

We Have Made Progress 

Progress has been made during 

the 35 years since passage of the 

National Cancer Act in 1971. During the 10 years between 1990 and 

2002, the age-adjusted death rate 

from cancer declined 1% per year. 

This translates into over 315,000 

lives saved or prolonged beyond 

that period of time. In 2004, the 

total deaths from cancer, which had 

been leveling off for a number of 

years, fell to levels slightly below 

the previous year’s figures.

The American Cancer Society recently published a midpoint analysis 

of progress towards its goal of reducing cancer deaths by 50% over the 

25 year period between 1990 and 

2015. If trends over the first 12 

years continue, the projection is for 

a 23% reduction in cancer deaths by 

2015. However, for breast cancer, 

colon cancer, and lung cancer in 

males, the trends predict a 50% 

reduction.

It is worthwhile considering why 

these significant levels of reduction 

are being achieved and what more 

can be expected. For breast cancer, 

the improvement is attributed to 

a combination of early detection 

due to mammography and manual 

palpation and improved therapy. 

Significantly, only 58% of women 

had mammograms in 1970 while 

by 2002 the number reached 76%. 

That leaves room for helping the 

24% of women who currently do 

not receive the benefits of early 

detection.

For colon cancer, the 50% trend for 

reduced deaths is attributed almost 

entirely to colon endoscopy with 

polypectomy. Polypectomy reduced 

the incidence of cancer by 80% 

in two large studies. Only about 

50% of Americans over the age of 

50 undergo colon examination, so 

there is high potential for further 

improvement in death rates.

For male lung cancer, the 50% 

trend for reduced death is attributed primarily to reduced tobacco use. 

There is likely to be a downward 

trend in lung cancer death rates 

for women, because lung cancer 

incidence rates have begun to fall 

for women in recent years, paralleling the earlier fall for men. These 

gains have resulted from an enlightened behavior on the part of the 

public, supported by educational 

campaigns, clean indoor air laws, 

cigarette taxes, improved access to 

counseling and pharmacologic aids, 

and increased commitment of time 

and effort by the medical profession. Obviously, a great deal more 

can be accomplished. It must be 

emphasized that nearly one-third 

of all cancer deaths in the United 

States (over 180,000 people last 

year) are directly attributed to 

tobacco, with lung cancer leading 

the list.

It is apparent that most of the substantial reduction in cancer deaths 

over the past 12 years has resulted 

from prevention and increased use 

of effective diagnostic studies. This 

report will present measures to further enhance prevention and early 

detection of cancer, as well as new 
Accelerating Successes Against Cancer 

approaches to the treatment of cancer, and management of survivors. 

While it is impossible to precisely 

quantify the anticipated impact 

on death rates, it is reasonable to 

predict that if research efforts and 

use of evidence-based clinical practices are increased in the areas we 

outline, we will reduce the burden 

of cancer far more rapidly and come 

closer to achieving the American 

Cancer Society’s goal for 2015.

Conclusion

We conclude that the Nation’s 

35-year-old cancer plan can be 

re-energized to increase the pace 

of discovery and dissemination 

of improvements in cancer care. 

This document is presented as a 

blueprint for accelerating successes 

against cancer, both by expanding 

knowledge of cancer and by applying these discoveries expeditiously 

to improving the care of cancer 

patients. Our report of recommendations builds on and expands the 

NCI Strategic Plan.

NCI-designated Cancer Centers 

are in the privileged position of 

being able to contribute to both 

research and patient care goals, and 

we make a renewed commitment to 

do so in partnership with the NCI. 

We invite collaborators from the 

many sectors of our society with 

an interest in reducing the burden 

of cancer to join in this endeavor 

with renewed commitment of their 

efforts and resources.

We wish to emphasize that this 

must be a joint effort, involving 

academia, medical care providers, 

professional organizations, governmental agencies and the U.S. 

Congress, pharmaceutical and biotechnology companies, and – most 

importantly – patient advocacy 

groups and the public. These stakeholders will need to synchronize 

their goals and actions. From the 

beginning of planning the National 

Cancer Act, and continuing up 

to the present, patient advocacy 

groups have played a critical role 

in bringing together the public, the 

government, and the biomedical 

research community, and reminding 

us all to focus on the patient.

References

Murphy K, et al. Diminishing 

returns? The costs and benefits of 

improving health.

Perspect Bio Med 2003; 46(3 

Suppl): S129-37.

NIH Cost of Illness Report to the 

U.S. Congress, (FY 2000).

Warren JL, et al. Costs of treatment for elderly women with 

early-stage breast cancer in fee-forservice settings. J Clin Oncol 2002; 

20(1):307-316. 

Byers T, et al. A midpoint assessment of the American Cancer 

Society Challenge Goal to Halve 

the U.S. Cancer Mortality Rates 

Between the Years 1990 and 2015. 

Cancer 2006; 107(2):396-405.

Marks JS, et al. On the Threshold of a Dream. Cancer 2006; 

107(2):217-220, 2006.

Weinberg RA. The Biology of 

Cancer. Garland Science, Taylor 

and Francis Group, LLC, 2007.

NCI Strategic Plan 2006; http://

strategicplan.nci.nih.gov/.
Executive Summary

T

he following is a summary of the major recommendations in 

each of the six areas targeted for review by the working group 

of the Cancer Center directors.

Prevention

In addressing the challenge of reducing the burden of cancer, prevention is the most desirable goal. Population studies have identified lifestyle changes that can reduce the risk of cancer, the most 

prominent of which is avoidance of tobacco use and exposure. 

We also have discovered that molecular and biological changes 

in blood and tissue specimens from patients can serve as markers, 

identifying individuals who bear higher risk for developing certain 

cancers, including those who show the very earliest biological 

 Accelerating Successes Against Cancer
Accelerating Successes Against Cancer 

changes in the development of 

cancer. These individuals may 

benefit from active interventions 

in their lifestyle and behavior and, 

in the future, from treatment with 

agents that can retard or prevent 

the development of cancer.

We endorse the recommendations 

of the National Cancer Policy 

Board on cancer prevention and 

early detection, which are summarized in this report.

Strategies that Can Immediately Begin 

to Reduce the Risk of Cancer

Implement known methods and 

investigate improved methods 

for preventing initiation and 

enabling discontinuation of 

tobacco use. If successful, this 

measure alone can reduce the 

incidence of cancer by more 

than 30%, after an estimated lag 

time of about two decades.

Implement other evidencebased changes in lifestyle that 

will reduce the incidence of 

cancer, including a healthy 

diet, avoidance of obesity, and 

increased physical activity.

Implement scientifically 

established medical strategies, 

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including administration 

of tamoxifen or raloxifene 

to prevent breast cancer in 

high-risk postmenopausal 

women and HPV vaccination 

to prevent cervical cancer in 

young females.

Utilize rapidly developing 

knowledge of inherited and 

environmentally induced 

mutations to begin to establish 

risk profiles for high-risk 

populations, to set the stage for 

rational chemoprevention and 

other strategies.

Cancer Centers can partner with 

governmental agencies and health 

care providers to extend these 

measures to the entire U.S. population through improved delivery 

and targeted education. Vaccination against certain cancers should 

eventually become as standard in 

medical practice as vaccination 

against serious viral infections.

Strategies Involving Either Change 

in Policies or Further Research and 

Requiring a Decade or More Before 

Clinical Application

Perform research on the 

application of “personalized 

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medicine” to intraepithelial 

neoplasias (IENs) and 

precancerous conditions, by 

carrying out clinical trials to 

discover molecular targets for 

both early detection of highrisk lesions and targets for 

chemoprevention treatments.

Increase clinical research in the 

behavioral sciences that will 

identify improved methods for 

changing personal lifestyles and 

promote informed decisions 

about health-related behaviors.

Continue to pursue 

chemoprevention clinical 

trials, based on the successes 

with anti-estrogen agents in 

preventing or postponing breast 

cancer in high-risk groups.

While Cancer Centers can collaborate in carrying out these large-scale 

and long duration clinical studies, funding will be needed from 

governmental agencies or from 

companies willing to partner in 

these efforts.

Early Detection

Early detection of cancer can 

enhance the chances of achieving 

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10 Accelerating Successes Against Cancer

cure or prolonging life for individuals diagnosed with cancer. 

In spite of the great interest in 

identifying markers in blood or 

cells that can identify the presence 

of cancers at the earliest possible 

time, progress in research has been 

slow. This is due to limitations in 

available technology and lack of 

adequate funding to support the 

large-scale and expensive clinical 

trials required to first identify and 

then validate these markers.

The effort and expense involved are 

highly worthwhile. This is because 

the chances for cure of most early 

stage cancers is typically higher 

than 90%, whereas cure rates for 

advanced stage cancers can be 

lower than 5% for most, but not all, 

solid tumors. Detection at an early 

stage can yield tremendous benefits 

in reducing death rates in cancers 

of the breast, colon, lung and prostate, which together account for 

nearly two thirds of all cancers.

Strategies that Can Immediately 

Increase Early Detection of Cancer

Cancer Centers should 

partner with governmental 

agencies and health care 

providers to expand the use of 

currently validated screening 

methods for early detection, 

especially in underserved 

populations. These methods 

include colonoscopy, Pap 

tests, mammography, and the 

PSA test.

Cancer Centers should join 

advocacy groups in pursuing 

payment for validated early 

detection tests by Centers 

for Medicare and Medicaid 

(CMS), insurance companies 

and health plans, and for 

extending access to uninsured 

Americans.

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Cancer Centers should partner 

with state departments of 

health and medical provider 

systems to disseminate 

information on the benefits of 

early detection of cancer and 

on locations where access to 

these measures are available.

Cancer Centers should partner 

with each other to develop 

collaborative networks and 

cross-disciplinary teams that 

can share tissue resources and 

advanced technology platforms.

Strategies Involving Further Research 

and Requiring Up to a Decade or More 

Before Clinical Application

Cancer Centers should 

perform large-scale, 

collaborative clinical 

trials designed to identify 

potential markers, using 

the expanding technologies 

of genomics, proteomics, 

immunohistochemistry and 

molecular imaging. These must 

be followed by clinical trials 

validating the capacity of these 

markers to accurately predict 

the presence of cancer. This 

research will require large-scale 

funding from the NCI or other 

sources. 

Fundamental research 

investigating specific genetic 

and molecular abnormalities 

that contribute to the 

malignant phenotype must 

continue full force because 

this approach will continue 

to contribute importantly to 

identification of markers that 

predict risk, prognosis, and 

appropriate therapy.

With guidance and support 

from the NCI, Cancer Centers 

should develop and adopt a 

standardized and secure webbased tool for collecting and 

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querying histories of patients 

and their families in a uniform 

way that will enable informed 

communication between 

patients and families and their 

health care providers, and 

provide data for researchers 

seeking to identify high-risk 

populations.

Standardized and uniformly 

utilized electronic medical 

records would support 

initiatives in detection, 

treatment, and survivorship 

and should be a national 

priority. Collection, storage, 

and annotation of tissue 

specimens from each patient 

in a standardized way would 

also support these initiatives. 

Both initiatives will require 

substantial funding, collegiality, 

and visionary leadership.

Treatment

There has been tremendous progress 

in research leading to an understanding of the fundamental genetic 

and molecular causes of cancer and 

the development of new therapies 

that target these abnormalities. 

This has been accompanied by advances in surgery, radiation therapy, 

and systematic therapies which 

have already improved outcomes for 

cancer patients. 

Because it already is uniformly 

acknowledged that fundamental 

research must continue to be pursued and funded, this report focuses 

primarily on the need for collaboration, coordination, standardization, 

and infrastructure support in clinical investigation. This will require 

participation by all stakeholders, 

including oncology specialists, providers, payers, regulatory agencies, 

government sponsors (e.g., NCI), 

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Accelerating Successes Against Cancer 11

and patients. It also will require 

adequate funding specifically designated for these purposes. Cancer 

Centers are in an optimal position 

to lead in this effort, but the funding for clinical research must come 

from outside sources.

We endorse the findings of NCI’s 

Clinical Trials Working Group 

(CTWG) entitled “Restructuring 

the National Cancer Clinical Trial 

Enterprise,” which was adopted 

by the National Cancer Advisory 

Board in 2005. The CTWG action 

items are summarized below.

Strategies that Can Be Implemented 

Immediately to Improve Treatment 

Research

Activate the recommendations 

of the CTWG for improving 

the NCI’s capacity to lead in 

coordinating and supporting 

innovative clinical research.

Place a top priority 

on supporting clinical 

investigators and funding the 

clinical research infrastructure 

needed for Cancer Centers, 

academic medical centers, and 

practicing physicians to carry 

out innovative and timely 

clinical trials.

Increase collaborations 

between Cancer Centers in 

designing and performing 

clinical trials, sharing 

specialized core services 

and new technologies, and 

exchanging tissue specimens.

Increase collaboration in 

new drug development 

between Cancer Centers and 

pharmaceutical/biotechnology 

companies. This will be 

greatly enhanced by agreement 

on both sides to reach 

compromise with regard to 

control of intellectual property, 

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while protecting the interests 

of the inventors.

Strategies for Implementation in the 

Long Term

Implement the extensive 

CTWG recommendations, 

which will lead to more 

efficient investigation of new 

treatments and more timely 

regulatory approval.

Investigate new technologies 

and targeted therapies for the 

treatment of cancer, alone and 

in combination.

Continue intensive research 

on the genetics and biology 

of cancer, which will provide 

increased understanding of the 

malignant process and identify 

promising targets for anticancer 

agents.

Collaborate with the 

NCI, FDA, CMS and 

pharmaceutical/biotechnology 

companies in creating a 

unified and standardized 

web-based clinical trials 

information technology system 

for recording, reporting, and 

analyzing clinical research data.

Survivorship

Today there are over 10 million 

Americans who have survived cancer. A risk of recurrence continues 

beyond 5 years for some types of 

cancer. In addition, cancer survivors have a higher than average 

risk of a second malignancy. In 

fact, approximately 16% of cancers 

occur in survivors of the disease. 

Survivors also are subject to longterm sequellae caused by either 

their cancer or the therapy they 

received.

With the increasing mobility 

of the U.S. population and the 

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frequency with which patients 

change their health care providers, 

there is a serious need for uniform 

guidelines and electronic summaries of medical records to enable 

appropriate follow up for cancer 

survivors. In addition, research is 

needed on ways of preventing the 

late side effects of cancer treatments and for dealing with them 

when they occur.

The result of these activities will 

be a decrease in deaths from second cancers due to earlier detection, and improved duration and 

quality of life due to control or 

elimination of late sequellae of the 

cancer or its therapy.

Strategies

Cancer Centers should 

collaborate with the NCI 

Office of Cancer Survivorship 

to establish and populate a data 

warehouse containing clinical 

information, research protocols, 

educational materials, and 

descriptions of outreach 

activities for the public and for 

medical professionals.

Cancer Centers should 

collaborate with the 

American Society of Clinical 

Oncology (ASCO) and other 

organizations in developing 

clinical practice guidelines 

for long-term follow up of 

cancer survivors and mobilizing 

adoption of these guidelines 

by the states and health care 

providers.

Cancer Centers should take 

leadership in designing 

collaborative clinical trials 

that explore ways of avoiding 

late complications of cancer 

therapy or evaluate treatments 

which can control them.

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12 Accelerating Successes Against Cancer

Collaborations

The Cancer Center directors agree 

with the statement in the NCI 

Strategic Plan that: “Our success 

will depend on our ability to integrate our activities across a seamless 

continuum of discovery, development and delivery.” The academic, 

commercial, and governmental 

sectors each have critical contributions to make. The effectiveness 

and efficiency of their interfaces 

need to be addressed with creativity 

and compromise.

Chemoprevention

Chemoprevention trials involve 

large, lengthy, and extremely 

expensive studies of both high-risk 

and healthy populations, requiring large infrastructures to access 

and monitor data for many years. 

Collaborations between industry 

and clinical investigators – both 

academic and in the community 

– must be long term, with careful 

prioritization and planning, and 

thorough scientific review in order 

to optimize the use of scarce human and financial resources.

Strategy

Form a collaborative 

chemoprevention trial 

consortium of Cancer Centers 

and academic medical centers 

with centralized infrastructure 

and data management, funded 

by the NCI and pharmaceutical 

companies.

Biomarkers and Imaging

The discovery and validation of 

useful biomarkers and imaging tests 

are under-explored at companies 

and Cancer Centers because of 

limited available funding, in spite of 

the critical role of markers in plans 

to speed up drug development and 

•

personalize cancer care. Multiple 

markers are likely to be required for 

early detection and for selection of 

therapies for each type of cancer. 

The economic case has not been 

made adequately for the utility of 

biomarkers for both patient care and 

drug development.

Strategies

A consortium of companies 

should be encouraged to jointly 

invest in the discovery of new 

technologies in proteomics, 

marker identification, and 

imaging agents as a precompetitive activity, much like 

the successful SNP Consortium.

Research on biomarkers can 

be expedited by exploring 

many candidate markers at the 

same time in a comprehensive 

validation trial that provides 

long-term follow up of a 

number of surrogate markers 

and predictors, until mortality 

endpoints are reached.

Regulatory agencies could 

provide financial and fast-track 

review incentives for companies 

to encourage early exploration 

and identification of markers 

that predict the efficacy of new 

therapies.

For each of the topics covered 

in this report, research can 

be strengthened by bringing 

together expertise across 

Cancer Centers. Sharing of 

specialized, high-tech core 

facilities will also enhance the 

quality of research.

Treatment

Therapeutic clinical trials require 

a series of contractual partnerships 

between companies and clinical 

investigators which must last for 

a number of years. The timeline 

for preclinical and clinical studies 

•

•

•

•

leading to possible FDA approval is 

typically 10-15 years. Shortening 

this timeline will require increased 

collaboration in new drug development between companies and 

academia, collaborative efforts 

to validate and implement use of 

biomarkers and imaging technologies as endpoints in clinical trials, 

elimination of redundancy in the 

numerous reviews required for 

approval of trials, and the use of 

standardized licensing contracts 

that create agreed upon sharing of 

intellectual property.

Strategy

Facilitate collaboration 

between companies and 

academic institutions, by 

developing shared licensing 

agreements which can be 

used to speed up contract 

negotiations.

Survivorship

Research on the factors influencing 

the health of cancer survivors requires expensive, long-term studies 

of many patients. As with prevention research, the requirement for 

funding of these extensive studies 

and for collaboration between 

institutions serving cancer patients 

must be acknowledged and dealt 

with effectively. 

Strategies

Collaborations led by Cancer 

Centers should develop and 

implement standardized 

databases for collecting and 

analyzing information on 

cancer survivors. 

Research to identify the 

problems experienced by large 

cohorts of cancer survivors 

and to explore treatments and 

interventions that predict or 

manage these problems should 

•

•

•
Accelerating Successes Against Cancer 13

be carried out collaboratively 

between Cancer Centers, and 

must be funded adequately from 

external sources.

Dissemination

Advances in diagnostic tests and 

treatments for cancer usually are 

made available to patients rapidly by Cancer Centers, academic 

medical centers, and major health 

care providers. However, reaching all patients with cancer and 

their health care providers is a goal 

obtainable only through concerted 

efforts in education and widespread 

adoption of best practices, especially by physicians for underserved 

populations. The Cancer Centers 

should insure that opportunities to 

participate in clinical trials of new 

cancer treatments are made available to greater numbers of individuals, including underserved and 

diverse populations.

Strategies

The Federal government needs 

to designate a lead agency 

within the Department of 

Health and Human Services 

(HHS) to coordinate funding 

and dissemination of cancer 

control efforts to the entire 

U.S. population, by bringing 

together the fragmented efforts 

of NCI, CDC, CMS, and other 

HHS agencies.

Cancer Centers should take the 

lead in disseminating cancer 

care guidelines throughout their 

states, in collaboration with 

state health departments and 

state cancer plans.

Cancer Centers should work 

with state cancer registries to 

convert them into outcomes 

registries, and should use them 

to identify populations with 

•

•

•

disproportionate needs for 

cancer prevention and care.

Demonstration of the medical 

and financial benefits of best 

cancer control practices 

should be accomplished by 

establishing demonstration 

projects in regions served by 

Cancer Centers, funded by 

CMS and led by the Cancer 

Centers.

•
14 Accelerating Successes Against Cancer

Summary 

I

n addressing the challenge of reducing the burden of cancer, 

prevention is the most desirable goal. Population studies have 

identified lifestyle changes that can reduce the risk of cancer, 

the most prominent of which is avoidance of tobacco use and 

exposure. We also have discovered that molecular and biological 

changes in blood and tissue specimens from patients can serve as 

markers, identifying individuals who bear higher risk for 

developing certain cancers, including those who show the very 

earliest biological changes in the development of cancer. These 

individuals may benefit from active interventions in their lifestyle 

and behavior and, in the future, from treatment with agents that 

can retard or prevent the development of cancer.

We endorse the recommendations 

of the National Cancer Policy 

Board on cancer prevention and 

early detection, which are summarized in this report.

Strategies that Can Immediately Begin 

to Reduce the Risk of Cancer

Implement known methods and 

investigate improved methods 

for preventing initiation and 

enabling discontinuation of 

tobacco use. If successful, this 

measure alone can reduce the 

incidence of cancer by more 

than 30%, after an estimated lag 

time of about two decades.

Implement other evidencebased changes in lifestyle that 

will reduce the incidence of 

cancer, including a healthy 

diet, avoidance of obesity, and 

increased physical activity.

Implement scientifically 

established medical strategies, 

including administration 

of tamoxifen or raloxifene 

to prevent breast cancer in 

high-risk postmenopausal 

women and HPV vaccination 

to prevent cervical cancer in 

young females.

•

•

•

Cancer Centers can partner with 

governmental agencies and health 

care providers to extend these 

measures to the entire U.S. population through improved delivery and 

targeted education.

Strategies Involving Either Change 

in Policies or Further Research and 

Requiring a Decade or More Before 

Clinical Application

Perform research on the 

application of “personalized 

medicine” to intraepithelial 

neoplasias (IENs) and 

precancerous conditions, by 

carrying out clinical trials to 

discover molecular targets for 

both early detection of high-risk 

lesions and chemoprevention 

treatments.

Increase clinical research in the 

behavioral sciences that will 

identify improved methods for 

changing personal lifestyles and 

promote informed decisions 

about health-related behaviors.

Implement a strong, 

molecularly-targeted detection 

and chemoprevention drug 

development program. 

•

•

•

Prevention
Accelerating Successes Against Cancer 15

Continue to pursue promising 

agents in chemoprevention 

clinical trials, based on the 

successes with anti-estrogen 

agents in preventing or 

postponing breast cancer in 

high-risk groups.

While Cancer Centers can collaborate in carrying out these large-scale 

and long duration clinical studies, 

funding will be needed from governmental agencies or from companies 

willing to partner in these efforts.

Introduction

The goals of cancer prevention are 

to reduce the incidence, morbidity, and mortality due to cancer by 

preventing initiation of primary 

tumors (primary prevention), intraepithelial neoplasias (secondary 

prevention), or second cancers or 

disease-related complications (tertiary prevention). The incidence 

and mortality from cancer has been 

decreasing slowly during the past 

decade. Unfortunately, our aging 

population will reverse this trend 

in the next decade, despite recent 

advances in the understanding of 

the genetic and molecular bases of 

the common cancers and the development of molecularly-targeted 

biological therapies. 

The cancer patient is not well one 

day and the next day diagnosed 

with cancer. It is estimated that 

in most cases there is an average 

lag of at least 20 years between the 

development of the first cancer cell 

and the onset of metastatic disease 

for a broad range of solid tumors. 

In fact, using sensitive molecular 

genetic methods, there is now 

evidence that potentially neoplastic cell populations can exist at 

the time of birth and that only in 

some cases is there progression to 

full-blown malignancy later in life. 

Based on the fact that there were 

more than 570,000 cancer deaths 

in the United States in 2005, and 

given the estimated 20-year lag 

time, more than 10 million currently “healthy” Americans may 

harbor ultimately deadly cancers.

It is increasingly apparent that virtually all cancers proceed from the 

first initiated tumor cell (through 

somatic mutations); to mild, moderate, and severe dysplasia; invasive carcinoma (invasion of cells 

through the basement membrane); 

and metastatic disease (Figure 1). 

Precancerous lesions are termed 

intraepithelial neoplasias (IENs) 

and can often be identified through 

increasingly sensitive screening 

technologies, both histologically 

and molecularly, using a variety of 

analytical methods (e.g., cDNA 

microarrays).

The best cancer is that which 

never occurs, so primary prevention (e.g., preventing and treating 

tobacco use, reducing sun exposure, promoting healthy diets and 

exercise) is both the most effective 

and least costly approach because 

it can reduce the likelihood that 

the first initiated tumor cell will 

occur. Thus, given the average 

20-year cancer lag time, secondary, 

and tertiary prevention strategies 

represent effective and cost-effective opportunities to dramatically 

reduce cancer mortality in the 

next decades (Figure 2). 

Unfortunately, a pervasive problem 

in the United States is poor access 

to health care, including prevention 

measures, because of a lack of 

health insurance. In 2001, an estimated 15% of the U.S. population 
16 Accelerating Successes Against Cancer

(41.2 million individuals) was uninsured during the entire year. 

Current Knowledge, 

Issues and Problems

The development of effective cancer 

prevention strategies has the potential to impact more than 8 million 

cancer diagnoses and to prevent 

more than 5.2 million cancer-related 

deaths each year worldwide. The 

American Cancer Society (ACS) 

has estimated that 564,830 cancer 

deaths will occur in the United 

States in 2006, and that half of all 

cancer deaths could be prevented. 

Tobacco use alone, which represents 

the greatest preventable cause of 

cancer death by far, is predicted to 

cause 30% (170,000) of the cancer 

deaths in the United States this year. 

It is thought that one of the primary 

reasons why current knowledge 

and information about cancer and 

its prevention is not applied to the 

general public is due to an overload 

of complicated information. The 

dissemination of complicated information is problematic, but comprehensive information is essential to 

reduce the burden of cancer.

There are many factors known to 

reduce overall cancer incidence, 

such as minimizing exposure to 

carcinogens (e.g., avoiding tobacco), vaccination for some cancers, 

dietary modification, reducing body 

weight, increasing physical activity, 

or through medical intervention 

(e.g., surgery and/or chemoprevention) (Table 1). 

However, research on developing 

and implementing effective cancer 

prevention and control interventions lags in funding relative to 

its potential impact on reducing 

the cancer burden in the United 

States. For example, only one 

non-nicotine medication is currently approved by the Food and 

Drug Administration (FDA) for 

smoking cessation, though others 

are in the pipeline, and the existing medications achieve smoking 

cessation quit rates of 25% at best. 

Since many health care organizations do not include smoking 

cessation medications as a covered 

benefit, the incentive for pharmaceutical companies to prioritize the 

development of smoking cessation 

medications is not high – thus 

fostering a negative feedback loop 

that discourages health care organizations from covering medications 

Table 1. Factors associated with cancer risk, adapted from Giovannucci 

(Giovannucci 1999)

Association to Cancer Risk

Height

Physical 

inactivity

Obesity

Increases prostate, colon, and breast cancer risk

Increases colon cancer risk; may increase breast and prostate 

cancer risk

Increases colon, breast, kidney, endometrial, and gallbladder cancer risk; 

may increase ovarian cancer risk

Factor

Figure 1. Progression of precancer to cancer in humans is a multi-year process, adapted from O’Shaughnessy et al. (O’Shaughnessy, Kelloff 

et al. 2002)
Accelerating Successes Against Cancer 17

because the effectiveness of those 

medications is low. 

Similarly, pharmaceutical companies have traditionally been 

unwilling to invest in the development of chemopreventive agents, 

because of the required length 

of time and the size and cost of 

Phase III confirmatory trials. 

Furthermore, these companies are 

concerned about the uncovering 

of unexpected, life-threatening 

toxicities that may be observed 

with the long-term exposure required for many cancer prevention 

intervention strategies. This can 

have an extremely negative impact 

on safety profiles of approved drugs 

(e.g., celecoxib twice-daily dosing 

increased cardiovascular events in 

at least two blinded, prospective 

trials by 4-5%).

The high “cost” of cancer prevention trials and the need to develop 

reliable and meaningful intermediate endpoints are significant 

barriers that must be overcome. 

Cancer prevention clinical trials, like the recently completed 

STAR (Study of Tamoxifen and 

Raloxifene to reduce the risk of 

breast cancer in post-menopausal 

women) and the ongoing SELECT 

(Selenium and Vitamin E to reduce 

the risk of prostate cancer) take 

between 5 and 10 years or more to 

complete, and require thousands of 

participants. The cost to complete 

such large-scale trials is in the 

$100- to $200 million range and, 

of course, a positive outcome may 

not be achieved – e.g., the recently 

announced unsuccessful results 

of intervention with calcium plus 

Vitamin D in the Women’s Health 

Initiative (WHI) to reduce the risk 

of colorectal cancer. 

Obviously, the need to develop 

risk-reducing preventive strategies for large populations who may 

develop common solid cancers 

remains a high priority for NCI 

and the Cancer Centers. To reduce 

the need for large populations in 

chemoprevention studies, there 

must be a clear identification of 

high-risk populations for prevention efforts. This will reduce the 

size of the study population and 

will likely reduce the risk of attrition by accruing individuals likely 

to be highly motivated to prevent 

cancer. However, by reducing the 

study population, there is a risk 

of insufficient statistical power if 

the risk is overestimated, and the 

results of these trials will not be 

generalizable to the overall population that is potentially at risk.

An alternative solution is the 

development of intermediate 

biomarker endpoints – whether 

molecular, biochemical, or imagebased – that can serve to reduce the 

size, duration, and cost of cancer 

prevention trials. One illustrative example relates to a 2,297 

participant trial of oral Vitamin A 

standard dose (25,000 IU daily) for 

up to 5 years (versus placebo) in 

individuals with moderate to severe 

actinic keratosis (i.e., a cutaneous 

IEN associated with a high risk 

for squamous cell cancer of the 

skin). The primary endpoint for 

this trial was the risk of developing 

a squamous cell skin cancer. This 

Phase III chemoprevention trial 

– funded by NCI in the middle 

Figure 2. Issues in secondary prevention for physicians and the public
18 Accelerating Successes Against Cancer

1980s and concluded in the middle 

1990s – documented a statistically 

significant, nearly 30% reduction in 

the risk of developing a squamous 

cell cancer of the skin associated 

with prolonged Vitamin A dosing 

(HR=0.74; 95% confidence interval, 0.56-0.99; p = 0.04). 

Knowing that standard dose 

Vitamin A can reduce the risk of 

developing a squamous cell cancer 

of the skin, there was additional 

interest to determine if doubling or 

tripling the Vitamin A dose further 

enhanced its skin cancer preventive 

activity. Thus, a Phase IIb, placebo-controlled trial was designed 

to compare the relative activities 

of three different doses of Vitamin 

A (i.e., 25,000 IU, 50,000 IU, and 

75,000 IU per day). The primary 

endpoint of the follow-up study 

was an evaluation of Vitamin A 

effects on sun-damaged skin of the 

lateral forearm, using skin biopsy 

nuclear chromatin pattern abnormality at one year of Vitamin A 

dosing versus baseline. A quantitative efficacy endpoint was obtained 

through karyometric analysis of 

formalin-fixed, paraffin-embedded, 

hematoxylin and eosin (H & E) 

stained biopsies. The results documented that the placebo group’s 

skin damage worsened while there 

was a clear dose-related response 

between 25,000 and 50,000 IU/day 

of Vitamin A. This 1-year trial 

required only 130 participants, 

cost approximately one-twentieth 

as much as the original Phase III 

trial, and successfully established a 

50,000 IU/day dose of Vitamin A as 

both safe and possibly more effective than standard dose Vitamin A. 

There is an absolute need to identify and validate markers that can be 

integrated into chemoprevention 

research to reduce the cost and duration of these trials while assuring 

that sufficient statistical power to 

detect change is not compromised. 

Biomarkers must be necessary steps 

in the pathway of carcinogenesis, 

assays must be accurate, precise and 

reproducible, and biomarkers must 

be validated. 

Accomplishments

As stated earlier, barriers to accelerated success in cancer chemoprevention include: the relative 

impotency of chemopreventive 

agent drug discovery and early 

phase drug development programs 

in academia, NCI, and in the 

pharmaceutical industry; the long 

duration and high cost of Phase III 

cancer chemopreventive clinical 

trials; and the shrinking NCI budget, coupled with a relatively lower 

priority for cancer prevention, as 

compared to research funding for 

cancer treatments. Despite these 

barriers, cancer prevention efforts 

have contributed substantially to 

the reduction of morbidity and mortality due to cancer (Table 2). 

Cancer chemoprevention and 

dietary intervention Phase III trials 

have been limited by relatively 

small amounts of funding for drug 

discovery, preclinical pharmacology, and toxicology available in 

NCI’s Division of Cancer Prevention (DCP). There has also been an 

almost total lack of interest by the 

pharmaceutical industry. Nevertheless, there have been an increasing 

number of high-impact intervention trials targeting intermediate- to 

high-risk populations for breast, 

cervix, colorectal, prostate, and skin 

cancers. Listed in Appendix A are 

the primary results of paradigmshifting trials funded by the NCI 

and/or the U.S. pharmaceutical 

industry that have been reported 

over the past 10 years. As this table 

demonstrates, there is increasing 

evidence that chemoprevention 

strategies are increasingly effective in pre-empting the pathway 

of carcinogenesis in intermediate 

to high-risk populations for many 

common cancers.

Medications, new screening technologies, and chemoprevention 

agents are critically important tools 

to prevent and control cancer, 

but their effectiveness depends on 

behavioral and psychosocial factors that are also, by themselves, 

important factors in the prevention 

of cancer. Patient-provider communications, for example, play a 

critical role in determining who will 

engage in health-enhancing lifestyles 

that reduce cancer risk. They impact 

the likelihood that a person at risk 

for cancer will seek and engage in 

appropriate screening, and they 

Table 2. Increase in 5-year cancer survival, 1975-2005

Disease site 1975 2005 Modalities responsible

Breast 50% 90% Screening, Education, Adjunct Therapy

Colon 40% 55% Screening, Education, Adjunct Therapy

Cervix 60% 90% Screening, Education, Adjunct Therapy

Prostate 50% 99% Screening, Education

Melanoma 50% 90% Screening, Education

Head/Neck 40% 50% Education, Early Neoadjuvant Therapy
Accelerating Successes Against Cancer 19

Figure 3. Multi-step carcinogenesis pathway, adapted from Alberts, et al. (Alberts 1999)

also determine whether appropriate 

pharmacotherapies are used, and 

used appropriately to effectively 

blend with critical behavioral and 

lifestyle changes. As new genetic 

and molecular discoveries improve 

our ability to develop personalized 

treatments, similar advances are 

needed to tailor behavioral and 

psychosocial interventions so that 

they are individually and culturally appropriate, work to eliminate 

disparities, and assure that personal 

responsibility for sustaining and improving health is not outweighed by 

the perception that cancer prevention and control is assured via the 

medicine cabinet.

It is important for primary caregivers, as well as the research 

community, policy–makers, and 

government agencies to take a 

multidisciplinary approach to 

investigating, understanding, and 

improving the success of cancer 

prevention. 

Emerging Therapeutic 

and Interventional 

Strategies

In the United States, approximately 44.5 million adults (21% of 

the U.S. population) continue to 

smoke, despite current prevention 

and cessation efforts. Tobacco use is 

the leading cause of cancer and the 

greatest leading cause of preventable death. Tobacco use causes 

over 440,000 premature deaths 

– 198,000 of which are cancer 

deaths from smoking and environmental tobacco exposure. 

According to a 2002 report from 

the International Agency for Research on Cancer (IARC), tobacco 

exposure is a direct causal factor of 

at least 13 different cancers, such 

as cancers of the lung, pancreas, 

cervix, liver, stomach, head/neck, 

and leukemia. Nearly 90% of all 

lung cancers are directly due to 

tobacco exposure (tobacco use or 

environmental exposure). As a 

noted researcher pointed out, if 

we are able to prevent just 10% of 

all lung cancer deaths, it would be 

equivalent to preventing all deaths 

from glioma or ovarian cancer. 

Each year, approximately 5 million 

people worldwide die prematurely 

due to tobacco exposure and that 

number is expected to exceed 10 

million by 2020 if current tobacco 

exposure rates remain unchanged. 

In the United States, most smokers become dependent before the 

age of 18, and once dependence 

occurs, the chances of quitting 

on any one occasion is approximately 5%. Use of the most 

effective treatments increases that 

percentage to 15-25%, thereby 

demonstrating that more effective 

treatment for tobacco dependence 

is needed. 

A recent NIH State of the Science 

conference on tobacco identified 

the following priority research 

areas to reduce tobacco exposure: 

(1) developing new pharmacological and behavioral treatments; 

(2) community-based interventions; (3) assessing cancer risks of 

various smokeless tobacco products; (4) implementing policy interventions that will increase cessation; 
20 Accelerating Successes Against Cancer

and (5) studying genetic predisposition to tobacco dependence. 

Many cancers are also now known 

to be directly attributable to viral 

infections. The family of infectious agents most closely linked to 

cancer are viruses such as: human 

papillomavirus infection (HPV), 

which is a necessary factor in the 

development of cervical cancer and 

possibly squamous cell carcinomas 

of the oropharynx or anus; hepatitis 

B and C virus infection which are 

initiators and promoters for hepatocellular carcinoma; human T lymphotropic virus (HTLV-1) which 

has been implicated in the development of T-cell leukemia; human 

herpes virus type 8 (HHV8) which 

has been implicated in Kaposi’s 

sarcoma; Epstein Barr Virus (EBV) 

which has been implicated in 

Burkitt’s lymphoma, as well as other 

B-cell malignancies and nasopharyngeal cancer; and simian virus 40 

(SV40) which may be implicated in 

mesothelioma. 

Less commonly, other infectious 

agents may lead to cancer, such as 

bacterial infections of Helicobacter 

pylori (H. pylori), which may be an 

initiator and promoter for gastric 

cancer, and helmenth infections 

such as Schistosoma haematobium 

which is associated with urinary 

bladder cancer. 

A number of primary prevention 

efforts exist or are being developed 

such as vaccines against HPV (see 

sidebar, “Cervix Cancer Prevention with HPV Vaccines”) and 

hepatitis B and C, and vaccines 

against H. pylori to prevent the 

development of cervical, liver, 

and gastric cancers respectively. In 

some cases, eradication of chronic 

viral or bacterial infections by immunotherapy, antiviral therapy, or 

antibiotic therapy may be viewed as 

a form of secondary prevention. For 

example, administration of antiEBV specific T-cells in transplant 

patients known to be high risk for 

post-transplant lymphoproliferative 

disorders can reduce the circulating 

EBV viral load, and reduce the rate 

of lymphoproliferative disorders. 

Research into the biology of these 

cancers, strategies to prevent infection, and therapies to eliminate 

chronic infection will all play a role 

in preventing such cancers. Because 

prevention depends on unambiguously understanding the cause of 

the disease, basic cancer research 

efforts impact cancer prevention 

research in important ways.

The vast majority of current treatment modalities are used to treat 

advanced or metastatic cancers. 

However, now that it is possible to 

identify IENs for many solid tumor 

types, lifestyle changes, simple 

surgical procedures, and chemopreventive agents may be used to 

impede the development and progression of potentially dangerous 

precancerous lesions (Figure 3).

Furthermore, multiple lifestyle 

changes, taken together, could 

profoundly reduce the risk of the 

first initiated cell progressing to 

mild dysplasia. This would include 

severely reducing dietary fat intake 

(e.g., as demonstrated by a 25% 

reduction in the risk of breast 

cancer recurrence rates in the 

Women’s Interventional Nutrition 

Study), increasing the number of 

servings of fruits and vegetables, 

minimizing alcohol intake, tobacco 

exposure cessation, and markedly 

increasing physical activity. These 

changes may potentially reduce risk 

for several cancers by up to 60%.

Furthermore, the addition of an 

effective chemoprevention agent, 

such as tamoxifen for moderately 

or severely dysplastic IENs such 

as ductal carcinoma in situ, can 

reduce cancer risk by as much as 

Figure 4. Chemoprevention of intraepithelial neoplasia (IEN)
Accelerating Successes Against Cancer 21

50%. Figure 4 presents the concept 

that an effective chemopreventive 

agent could prevent IEN growth, 

progression, or ultimately, invasion 

through the tissue basement membrane (as did Proscar in the 18,000 

participant Prostate Cancer Prevention). Thus, the concept of cancer 

prevention is now entering the 

mainstream of cancer therapeutics. 

Of course, any chemopreventive 

agent intervention may be associated with toxicity and the risk to 

benefit ratio for any of these agents 

must be taken into consideration 

at both the individual person and 

larger population levels.

The National Cancer Policy Board 

of the Institute of Medicine (IoM) 

concluded that to save the most 

lives from cancer, health care 

providers, health plans, insurers, 

employers, policy-makers, and 

researchers should be concentrating 

their resources on helping people to 

stop smoking, maintain a healthy 

weight and diet, exercise regularly, 

keep alcohol consumption at low to 

moderate levels, and to follow recommendations for breast, prostate, 

skin, cervical, and colorectal cancer 

screening. Additionally, these efforts might also help alleviate the 

disproportionate burden of cancer 

borne by members of racial and 

ethnic minority groups.

Identification and 

Prioritization of 

Opportunities for 

Advancement

IoM’s National Cancer Policy Board 

recommended that several steps be 

taken to increase the rates of adoption, the reach, and the impact of 

evidence-based cancer prevention 

and early detection interventions. 

We have adapted these recommendations to identify and prioritize 

opportunities to advance cancer 

prevention efforts.

(1) Congress and state legislatures 

should enact and provide funding 

for enforcement of laws to substantially reduce and ultimately 

eliminate the adverse public health 

consequences of tobacco use and 

exposure.

Reduction in tobacco use 

offers the greatest opportunity 

to reduce the incidence, 

morbidity, and mortality of 

cancer. 

Efforts to increase the cost 

of tobacco, and to eliminate 

environmental tobacco smoke 

exposure in public places and 

worksites, and by children in 

homes, are effective in reducing 

cancer risk and in encouraging 

a lifestyle that is tobacco free.

Tobacco consumption 

reduction efforts by Cancer 

Centers, the health care 

community, policy-makers, 

and government agencies 

should apply to U.S. tobacco 

products marketed and sold 

internationally.

Although tobacco exposure 

causes more than 30% of all 

cancer deaths, only about 3% 

of the current NCI budget is 

directed to tobacco control 

efforts. There is a tremendous 

need for behavioral and social 

research and intervention. 

(2) A national strategy should be 

developed and coordinated by the 

U.S. Department of Health and 

Human Services (HHS) to address 

the epidemic of obesity, unhealthy 

diet, and physical inactivity in 

America. Effective interventions 

need to be identified and broadly 

•

•

•

•

applied to reduce cancer risk 

among the general population and 

among populations at higher risk.

Obesity and physical activity 

have recently joined unhealthy 

diet as leading risk factors for 

cancer.

Efforts to maintain a healthy 

weight that start early in 

childhood and continue 

throughout adulthood are likely 

to be more successful than 

efforts to achieve and maintain 

weight loss once obesity is 

established.

Over time, even a small 

decrease in the number of 

calories consumed and a small 

increase in physical activity 

can help prevent weight gain or 

facilitate weight loss.

(3) Sufficient Federal appropriations should be made to fund 

NCI-designated Cancer Centers 

to support innovative public and 

private partnerships to develop, 

implement, and evaluate comprehensive community-based 

programs in cancer prevention 

and early detection. Every state 

should have and implement a comprehensive cancer control plan.

A) Federal Efforts

n The Centers for Disease 

Control and Prevention 

(CDC), as the Federal 

link to the Nation’s public 

health infrastructure, needs 

to build the capacities of 

states - and, in turn, their 

local partners (Cancer 

Centers, academic medical 

centers, and health care 

systems) - to develop and 

implement comprehensive 

cancer control plans.

n Support for the CDC’s 

National Breast and 

Cervical Cancer Early 

Detection Program 

•

•

•
22 Accelerating Successes Against Cancer

(NBCCEDP) should 

be increased. The 

NBCCEDP has succeeded 

in improving screening 

rates among medically 

underserved populations, 

but the program reaches 

only 15% of eligible 

women because of 

limited financial support. 

Under funding of CDC’s 

NBCCEDP contributes 

to lost opportunities for 

prevention.

n Because screening for 

colorectal cancer is 

a proven strategy for 

reducing cancer mortality 

in people over 50 years 

of age, a CDC program 

similar to NBCCEDP 

is needed to provide 

colorectal cancer 

screening to people 

who are uninsured and 

underinsured.

B) State Efforts

n State efforts in cancer 

prevention and early 

detection should be 

reformed because in many 

cases current programs are 

piecemeal and organized 

around categoricallyfunded programs.

(4) Public and private insurers 

and providers should consider 

evidence-based cancer prevention 

and early detection services to 

be essential benefits and should 

provide reimbursement for them. 

These services at a minimum 

should include interventions 

recommended in the U.S. Public 

Health Services’ 2000 clinical 

practice guideline on treating 

tobacco use and dependence, 

screening for breast cancer among 

women age 50 and older, screening for cervical cancer among all 

Cervix Cancer Prevention 

with HPV Vaccines

The dramatic reduction in the incidence and mortality from cervical cancer in 

the United States over the past 50 years is a direct result of the widespread 

and effective screening using cervicovaginal (or Pap) smears. Yet, despite a 

greater than 70% reduction in death in the U.S., as many as 10,000 women 

each year who fail to be screened adequately develop cervical cancer and 

nearly 4,000 women still die annually of this disease. Worldwide, deaths from 

cervical cancer could reach 1 million per year unless effective screening and 

prevention programs are implemented. 

In the past 25 years, tremendous research advances have demonstrated that 

virtually all cases of cervical cancer are caused by infection with human papillomavirus (HPV). A recent series of clinical trials testing HPV vaccines have 

yielded dramatic results. As a result, on June 8, 2006, Merck’s quadrivalent 

HPV vaccine, GardasilTM, targeting HPV types 6, 11, 16 and 18, was approved 

by the FDA for vaccination of females aged 9 to 26 years of age. In clinical trials, Gardasil was 100% effective in preventing HPV 16- or 18-related cervical, 

vulvar, or vaginal intraepithelial neoplasia (IEN) grades 2-3 or adenocarcinoma 

in situ (AIS) among women who had not been exposed to HPV. However, 

there was no clear evidence of protection from disease caused by HPV types 

for which subjects were PCR or seropositive at study entry. The efficacy of 

Gardasil was 39% for the protection of HPV 16- or 18-related cervical IENs and 

AIS and 69.1% for the prevention of HPV 16- or 18-related vulvar or vaginal 

IENs grades 2-3 among women with any HPV status at baseline who received 

at least one vaccine dose. A second HPV vaccine, CervarixTM, manufactured 

by GlaxoSmithKline, is currently being tested in Phase III clinical trials. 

While the development of HPV vaccines has the potential to eliminate the 

majority of cervical cancer cases worldwide, a number of critical questions 

remain that provide particular opportunities for research in cancer surveillance, 

prevention, dissemination, communication, HPV persistence and progression 

– all of which have a tremendous public health impact. Furthermore, there 

is a need to be engaged in areas of investigation related to co-factors (such 

as cigarette smoking) that play a role in viral persistence and progression to 

cervical cancer.
Accelerating Successes Against Cancer 23

sexually-active women with an 

intact cervix, and screening for 

colorectal cancer among adults age 

50 and older.

Public and private health 

insurers and providers should 

include in their benefit 

packages coverage for evidencebased interventions for cancer 

prevention and early detection.

Nicotine replacement 

therapy and treatment (e.g., 

Bupropion SR) and counseling, 

for example, are effective 

in helping individuals quit 

smoking.

(5) Congress should increase 

support for programs that provide 

primary care to uninsured and lowincome people. These programs 

increase the use of cancer prevention and early detection services 

among medically underserved 

populations.

The differences in morbidity 

and mortality from cancer 

among various racial and ethnic 

groups and among the underand uninsured present both a 

challenge to understand the 

reasons for and an opportunity 

to reduce the burden of cancer.

In a Nation of increasing 

diversity, interventions to 

improve cancer prevention 

and early detection must 

accommodate different 

languages, cultural values, 

and beliefs.

Public and private initiatives to 

reduce disparities in the cancer 

burden (e.g., programs at NCI 

and the American Cancer 

Society) should be supported.

 (6) HHS should complete a 

comprehensive review to assess 

whether evidence-based prevention services are being offered and 

successfully delivered in Federal 

health programs.

•

•

•

•

•

The Federal government 

administers or funds programs 

that do not always reflect best 

practices in cancer prevention 

and early detection.

The evidence is clear that 

disease prevention is not 

only effective, but highly cost 

effective. Thus, investments 

in supporting healthy lifestyles 

and appropriate screening 

will have not only improved 

the quality and quantity of 

life, but will save money for 

the U.S. health care systems. 

Additional research is needed 

to optimize and disseminate 

cancer prevention and early 

detection approaches to achieve 

the broadest implementation 

nationally. Support for 

programs like the NCI’s 

Cancer Research Network, 

and collaboration between 

organizations like NCI, 

Veterans Administration (VA), 

the Agency for Healthcare 

Research and Quality (AHRQ), 

and CMS to improve and 

expand health care services 

research, will improve cancer 

prevention and control 

implementation.

The lack of coverage for 

effective prevention services 

in public programs introduces 

a significant barrier to those 

most burdened by cancer: the 

uninsured population and 

members of racial and ethnic 

minority groups who often 

depend on government-funded 

programs for care.

(7) Programs are needed for health 

care providers to improve their 

education and training, monitor 

their adherence to evidence-based 

guidelines, and enhance their practice environments to support the 

•

•

•

provision of cancer prevention and 

early detection services.

Primary care providers in 

health care settings are 

effective agents of behavioral 

change. When counseled 

about smoking in clinical 

settings, 5-10% of individuals 

are able to quit.

Evidence suggests that 

physicians and other 

practitioners are not providing 

effective clinical interventions 

such as counseling and 

screening tests as often as 

would be beneficial.

(8) Congress should provide 

sufficient support to HHS for the 

U.S. Preventive Services Task 

Force and the U.S. Task Force on 

Community Preventive Services 

to conduct timely assessments of 

the benefits, harms, and costs associated with screening tests and 

other preventive interventions. 

Summaries of recommendations 

should be made widely available to 

the public, health care providers, 

and state and local public health 

officials and policy-makers.

Evidence-based guidelines 

for clinical and community 

practice provide maps for 

action.

Assessments of prevention 

services (such as those by 

the U.S. Preventive Services 

Task Force) are needed on a 

continual basis to ensure that 

public health recommendations 

incorporate the latest scientific 

evidence.

As state efforts to implement 

comprehensive cancer control 

plans gain momentum, 

guidance on the effectiveness 

of public health interventions 

(such as those identified by the 

U.S. Community Services Task 

Force) will be critically needed.

•

•

•

•

•
24 Accelerating Successes Against Cancer

(9) Public and private organizations should take steps to improve 

the public’s understanding of cancer prevention and early detection 

with a focus on promoting healthy 

lifestyles and informed decisionmaking about health behaviors and 

cancer screening.

Raising public awareness of the 

benefits of cancer prevention 

and early detection is central to 

reducing the cancer burden.

One barrier to effective 

communication is the 

contradictory and sometimes 

questionable research reported 

by the news media.

Expanded health 

communications research, 

particularly via the Health 

Communications and 

Informatics Branch at 

NCI, is needed to improve 

understanding of which 

communications approaches 

– both individual (e.g., patientprovider) and communitybased (e.g., news media) – are 

most effective with specific 

populations to prevent and 

control cancer.

(10) Public and private sponsors 

of research should expand their 

support of studies that integrate 

cancer control and behavioral 

research with advanced imaging 

and systems biology technologies. Such integrated strategies 

more rapidly advance understanding of some key barriers to the 

development of healthy behaviors 

and other risk-reducing strategies in children and adults, and 

will foster personalized medicine 

approaches that take into consideration not just unique genetic 

characteristics of individuals but 

also the unique behavioral and 

social characteristics of those 

individuals. 

•

•

•

The culture of clinical cancer 

research has been dynamically 

influenced by advances in 

imaging, molecular validation 

studies, the human genome 

project, and systems biology 

so that it is now possible 

to discover underlying 

mechanisms for environmentdiet-behaviors-health. 

Companion studies are common 

today in the conduct of clinical 

trials and molecular profiling 

is also being applied to drug 

discovery and development.

Integration of such studies in 

the field of cancer prevention 

has not been given the 

prominence it deserves in 

NCI’s Division of Cancer 

Prevention (DCP) and 

Division of Cancer Control and 

Population Sciences (DCCPS) 

or extramurally in the Cancer 

Centers and Specialized 

Programs of Research 

Excellence (SPOREs).

NCI should invest in a longterm, coordinated national 

program that specifically 

supports transdisciplinary, 

integrated research in cancer 

prevention and control which 

brings together the biological 

and behavioral sciences 

in a way that reflects the 

critical roles that each play in 

preventing cancer.

DCP and DCCPS have been 

chronically under funded 

by NCI. This has greatly 

diminished and slowed progress 

in cancer prevention and 

control. NCI should increase 

funding for both divisions by 

at least 100% over the next 

5 years. We recognize that 

in an environment of flat or 

decreasing NCI budgets, such 

•

•

•

•

a recommendation means 

reduced funding elsewhere, 

but the evidence is clear 

that the greatest advances in 

reducing cancer morbidity 

and mortality are likely to be 

achieved by rapidly reducing 

or eliminating preventable 

causes of cancer. More 

specifically, we recommend 

major expanded collaboration 

between DCP and DCCPS, 

particularly via NCI’s 

Rapid Access to Preventive 

Intervention Development 

(RAPID) program, to assure 

that $50 million is invested per 

year for 10 years with the goal 

of discovering, developing, 

and implementing new 

medications to prevent and/or 

treat tobacco dependence. 

To further strengthen cancer 

prevention and control 

research activities within 

the Cancer Centers, we 

recommend that to obtain 

short-term or long-term 

comprehensive cancer center 

designated status by NCI, 

that all comprehensive cancer 

center members must work for 

the common good, and thus 

establish a major wellness and 

cancer survivorship site within 

the scope of their clinical 

trials.

(11) Public and private sponsors 

of research should expand their 

support of applied behavioral 

research and how best to disseminate evidence-based prevention 

interventions. Effective strategies 

are especially needed to encourage 

healthy behaviors among children and their families, medically 

underserved populations, and the 

public at large through multicomponent interventions. 

•
Accelerating Successes Against Cancer 25

Tobacco use, physical activity, 

and diet are among the most 

significant lifestyle behaviors 

related to cancer risk. In 

addition, alcohol, sun safety, 

and sexual practices are also 

important contributors to 

cancer risk.

Unfortunately, minimal 

research resources have been 

allocated to understanding the 

details of behavioral risk as it 

relates to cancer. This includes 

the environmental and societal 

aspects of individual behavior 

and population-wide norms. 

n It is critical to focus not 

on the basic question of 

whether interventions 

work, but how they work, 

for whom, and under 

which circumstances. This 

can be achieved through 

better research questions 

and improved measures. 

Doubling the funding 

to DCCPS (see above) 

is needed to expand the 

dissemination research 

PAR into a funded RFA 

mechanism. 

n Cancer Centers must 

address primary prevention 

at the community level 

and must be given greater 

resources, and this focus 

must be given greater 

attention. Moreover, cancer 

prevention and control 

clinical trial accruals should 

not only be considered 

equal to therapeutic 

accruals in cancer center 

core grant renewals, but 

should be considered 

for special merit in the 

review process as a means 

of increasing prevention 

and control research at 

Cancer Centers in order 

•

•

to speed efforts to prevent 

cancer more effectively. At 

present, there is minimal 

incentive for Cancer 

Centers to expand their 

cancer prevention and 

control portfolio.

n For a number of years, 

behavioral neuroscientists 

have used systems 

biology approaches in 

assessing the genetic 

basis of behavioral risks 

(e.g., studies on alcohol 

and drug addiction). 

Cancer Centers should 

be encouraged to 

integrate such analyses 

collaboratively in their 

studies on behavioral and 

cancer risk.

(12) Governmental health care 

policy-makers and professional and 

educational organizations should 

institute programs to educate both 

the public and medical professionals that certain persons, families, 

groups and even subpopulations are 

at significantly increased familial 

and inherited risk for cancer and 

constellations of cancers, and thus 

need more aggressive screening and 

surveillance. 

Familial and inherited 

predispositions to cancers 

of various types account for 

a significant fraction of the 

overall burden of cancer and 

represent a population at 

significantly higher risk of 

certain cancers. 

Evidence-based studies 

document remarkable decreases 

of both incidence and mortality 

of cancer in high-risk groups 

with appropriate surveillance. 

The knowledge of the risk 

groups, the recommended 

screening and surveillance 

strategies, and the appropriate 

•

•

•

application of genetic testing 

when indicated are very poorly 

appreciated or understood 

by the public and medical 

community. 

Action Items for 

NCI-designated 

Cancer Centers

(1) Reducing the rate of smoking toward levels of the recently 

reported California adult smoking 

rate of 14% through comprehensive efforts to stop tobacco use. 

Recent data from the California 

Department of Health Services 

document that smoking among 

45 to 64 year olds declined from 

15.3% in 2004 to 13.8 % in 2005. 

This is 25% lower than that rest of 

the Nation.

(2) Implement outstanding compliance with the newly FDA-approved HPV vaccine for young 

girls and recommendations for the 

use of raloxifene to reduce the 

risk of breast cancer in high-risk, 

post-menopausal women. There 

have been two remarkable cancer 

prevention breakthroughs in the 

past year. First is the FDA approval 

of a safe vaccine for HPV types 16 

and 18 – which cause most cervical 

cancers – to be used in adolescent 

girls. Second was documentation that raloxifene was equally 

as active as tamoxifen in reducing 

incidence of breast cancer among 

high-risk women, but with reduced 

incidences of endometrial cancers, 

pulmonary emboli, and cataracts 

compared to tamoxifen. The 

Cancer Centers must be heavily 

engaged in methods to enforce 

compliance to these extremely 

important prevention methods.
26 Accelerating Successes Against Cancer

(3) Strongly support research 

on the application of “personalized medicine” to IENs for the 

purpose of identifying high-risk 

lesions and specific molecular 

targets for both early detection 

and personalized chemoprevention. Molecular profiling of IENs 

and determination of susceptibility 

through genetic testing, family history, and lifestyle for the purpose 

of personalized medicine may have 

an even stronger rationale than 

molecular profiling for early and 

advanced cancers, because the 

critical molecular targets are likely 

better defined and the long-term 

impact on cancer outcomes more 

dramatic.

Anticipated Outcomes 

and Potential Impact

IoM’s National Research Council has stated, “The nation needs 

new strategies to prevent cancer 

and, when cancer occurs, to catch 

it at its earliest stages. Smoking, 

unhealthy diet, obesity, sedentary 

lifestyles, and failure to get screened 

all contribute to the excess burden 

of cancer. Failure to implement 

proven methods of cancer prevention leads to avoidable disease and 

death. A 19% decline in the rate 

at which new cancer cases occur 

and a 29% decline in the rate of 

cancer deaths could potentially 

be achieved by 2015 if efforts to 

help people change their behaviors 

that put them at risk were stepped 

up and if behavioral changes were 

sustained. This would equate to 

the prevention of approximately 

100,000 cancer cases and 60,000 

cancer deaths each year by the year 

2015. The possible reductions in 

cancer incidence are particularly 

striking for certain cancers: 

accelerated changes in risk behavior 

could halve the number of smoking-related cancers such as lung 

cancer and reduce the numbers of 

cases of colorectal cancer by up to 

one-third.” 

The United States is at a crossroads 

in cancer prevention research. 

Discoveries in basic biological and 

behavioral science, along with 

epidemiology and surveillance, are 

advancing knowledge in a number of 

areas, from the relationship between 

cancer and modifiable behavioral risk 

factors all the way to the molecular 

pathways that mediate the actions of 

those risk factors. 

At the same time, applied research 

is illustrating how the already vast 

amount of available evidence can be 

better used to more rapidly reduce 

cancer rates. To effectively reduce 

the national cancer burden, there 

needs to be greater emphasis on 

two key strategies: action-oriented 

research and interdisciplinary research that takes best advantage 

of advances in informatics, human 

genetics, functional genomics, imaging and systems thinking (biology 

and social interaction), and behavioral sciences. 

The first strategy addresses the problem that scientific knowledge about 

the solutions to health problems and 

their causes do not automatically 

guarantee that appropriate steps are 

taken in our clinics and communities to implement the changes required for the conversion of research 

to practice. The second strategy 

addresses the overarching principle 

that best practices in cancer prevention will evolve only when etiological knowledge is linked to cancer 

prevention research projects in an 

iterative way such that the results 

from basic research informs clinical 

and community practice, and that 

clinical and community practices 

inform basic science. Furthermore, 

it reflects the need to implement, 

whenever possible, community participatory approaches to discovery 

so that the public better understands and supports science and to 

foster incorporation of science into 

practice whenever feasible. Once 

programs of support evolve from 

these strategies, our potential to 

reduce the burden of cancer will be 

very substantially improved. 

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Early

Detection

Summary

Many, but not all cancers are curable through medical and 

surgical intervention after early diagnosis. While methods 

for early detection of cancer, including mammography, 

PSA testing, PAP smear, and colonoscopy, have been counted as 

important public health approaches to reducing the burden of cancer, much remains to be done. Most cancers cannot be detected 

early by conventional techniques. Use of screening methodologies 

for early detection is far below recommended levels. New methodologies for early detection have not been introduced broadly 

into the population, while others have yet to be validated. Nonetheless, early detection leading to cure of cancer is likely to be the 

most powerful and cost-effective method of reducing the burden 

and death rate from cancer in our lifetime.

The key opportunities for early 

detection include:

Improve use of existing 

detection approaches including 

mammography, colonoscopy, 

PSA, and PAP smear 

Promote new technologies 

in imaging, proteomics, and 

genomics through biomarker 

identification, test population 

validation, and population-wide 

screening to define biomarkers 

of early disease

Concentrate on high-risk 

populations to evaluate the 

most cost-effective new 

technologies in early detection 

by identifying and validating 

these technologies in cancer 

survivors, those with a genetic 

predisposition, and those with 

either an environmental or 

lifestyle exposure or high-risk 

family history of cancer

NCI-designated Cancer Centers 

have led the discovery of new 

markers of cancer, improved imagebased detection, and the development of genomic and proteomic 

approaches. Providing resources 

for this discovery effort and supporting the large-scale validation 

•

•

•

in high-risk populations will lead 

to improved early detection, 

improved cancer cure rates, and 

decreased rates of suffering from 

cancer. The cost-effectiveness 

of current detection strategies is 

clear, while that of new technologies will need to be defined.

NCI-designated Cancer Center 

Action Plan

Cancer Centers should develop 

collaborative efforts for 

screening new early detection 

technologies 

Cancer Centers should 

coordinate evaluation of 

genetic early detection 

markers for colorectal, lung 

and pancreatic cancers, 

because preclinical detection 

will increase the potential of 

curative surgery

Cancer Centers should 

promote development 

of registries of high-risk 

populations for colorectal, 

breast, ovary, prostate and lung 

cancers who would benefit 

from early detection screening. 

Examples include: breast MRI 

in carriers of BRCA1 and 2 

genes, and mismatch repair 

•

•

•

30 Accelerating Successes Against Cancer
Accelerating Successes Against Cancer 31

protein mutation analysis in 

families with colon, gastric and 

endometrial cancers

Introduction

Many, but not all cancers are curable through medical and surgical 

intervention after early diagnosis. 

While methods for early detection 

of cancer, including mammography, PSA testing, Pap smears, and 

colonoscopies, have been counted 

as important public health approaches to reducing the burden of 

cancer, much remains to be done. 

Most cancers cannot be detected 

early by conventional techniques. 

In addition, usage levels of proven 

screening methodologies for early 

detection are far below recommended levels. New methodologies for early detection have not 

been introduced broadly into the 

population, while others have 

yet to be validated. Nonetheless, 

early detection leading to the cure 

of cancers is likely to be the most 

powerful and cost-effective method 

of reducing the burden and death 

rate from cancer in our lifetime.

We are at an exciting crossroad 

in cancer research. The ability to 

align outstanding basic discovery 

of genetic and molecular causes 

of cancer; imaging, protein and 

genetic discovery technologies; 

and population-based research, 

combine to provide a compelling capability to rapidly translate 

and disseminate these discoveries 

towards early detection of cancer 

in at-risk populations. 

The potential impact is enormous. 

Today, early cancers of the skin, 

breast, colon, and bladder can 

be controlled by surgery, chemotherapy, and/or radiation therapy. 

Early stage disease can be cured by 

rapid intervention. Validating the 

most cost effective new methods for 

cancer detection will have extraordinary impact reducing the burden 

of cancer in the population.

Current Knowledge, 

Barriers, and 

Opportunities

Stage I and Stage II breast cancer, 

colorectal cancer, small solitary 

lung cancers, localized prostate 

cancers, early cervical cancer, and 

many cutaneous malignancies 

– basal cell, squamous cell, and 

melanoma – are cured through early 

detection, intervention, and medical therapy. 

However, many other cancers need 

further investigation into their 

etiology, which would allow early 

screening to have an effective impact on overall outcome and suffering. For instance, many early stage 

ovarian cancers are not cured even 

with early surgical intervention. 

Likewise, most pancreatic carcinomas, even when localized, cannot 

be cured by surgical and medical 

techniques. Gliomas are almost 

never cured, even when diagnosed 

early. Prognoses for leukemias and 

lymphomas do not appear to be primarily influenced greatly by stage at 

the time of diagnosis, but rather by 

the biology and molecular characteristics of molecular abnormalities 

associated with the diseases. 

Therefore, efforts at early detection 

should be focused on those tumors 

in which early detection makes 

a current difference in patient 

outcome and survival (see sidebar, 
32 Accelerating Successes Against Cancer

“Optimizing Current Screening 

Technologies”). With this in mind, 

however, patients with deep tissue 

tumors, such as ovarian cancer and 

pancreatic cancer, which are normally diagnosed later, may still have 

an improved survival and outcome 

were they to be diagnosed early in 

the course of the tumor progression, 

even though curative impact is less 

likely to be achieved. 

Colonoscopy Colonoscopy is considered by most experts to be the 

most accurate available procedure 

for the diagnosis of colonic neoplasia and is the only test that allows 

for simultaneous removal of lesions. 

However, population-based data 

from the Behavioral Risk Factor 

Surveillance System indicate that 

as recently as 2005, only 53.1% of 

adults aged 50 and older had ever 

undergone sigmoidoscopy or colonoscopy. In addition, as currently 

practiced, colonoscopy is associated 

with a “miss rate” for large polyps of 

as high as 12.5% and up to 0.9% of 

patients develop interval cancer following a colonoscopy with removal 

of adenomatous polyps. Thus, improvements in colonoscopic practice 

and technology are needed, with the 

net result of providing thorough examinations to a greater proportion 

of the population at risk. Although 

Medicare has provided coverage for 

screening colonoscopy since 2001, 

fewer than half of the states have 

laws that requires this coverage from 

private insurers. 

Advances in imaging technology 

are also being applied to enhance 

detection of colorectal neoplasia. 

Variations on standard techniques 

that have been proposed include 

high magnification devices and 

chromo-endoscopy with spraying 

of the mucosa with stains, which 

highlight and thereby facilitate 

detection of flat or depressed neoplastic lesions. Imaging technology 

is developing “virtual” colonoscopy 

as a new technology.

Pap Testing Pap testing has been 

widely used for several decades, 

and currently approximately 86% 

of women aged 18 and older have 

been examined within the past 3 

years. This represents the highest delivery of all cancer screening services. Despite widespread 

screening, approximately 10,000 

American women will be newly 

diagnosed with cervical cancer 

annually and 3,700 deaths will be 

attributed to this disease. InciOptimizing Current Screening Technologies

Breast MRI screening is more sensitive than mammography and has been shown to have value. For high-risk populations, 

such as Ashkenazi Jewish women who have a 45% to 65% lifetime risk of developing breast cancer, breast MRI screening 

is more cost-effective for BRCA1 carriers than BRCA2 carriers, who have mammographically dense breasts. 

MRI screening is at least 10 times more expensive than standard screening and generates higher diagnostic costs. Adding 

annual MRI screening tests for women aged 25 to 69 years in this high-risk population would cost $88,651 per year of life 

gained for BRCA1 carriers and $188,034 per year of life gained for BRCA2 carriers. As a general rule, breast MRI, as with 

other technologies, becomes more cost-effective as risk of breast cancer increases and is less cost-effective as the risk 

decreases. Genetic screening in this population may increase average survival and may also be cost-effective.

A second technology for breast cancer is digital mammography. However, fixed costs may be one-and-a-half to four times 

more expensive than film-based systems. While overall the advantage is unclear, digital screening has advantages for 

women under the age of 50 years with radiographically dense breasts. Improved detection using digital mammography has 

reduced cancer mortality in select populations by more than 15%. 

PSA screening of men for prostate cancer has lead to early detection, down-staging of early lesions, a lower rate of radical 

prostatectomies, and a better understanding of the impact of a rising PSA in an asymptomatic male. Nonetheless, PSA 

screening is not uniform and many high-risk populations are not routinely screened. African American males have lower 

screening rates, higher PSA at screening, and a higher incidence of prostate cancer. Research into the proper management 

of the isolated rising PSA, the impact of false negatives using the current PSA cut off of 4 ng/ml, and long-term follow-up of 

individuals identified during screening will help to define the value of population-wide screening of asymptomatic individuals. Refined PSA testing will likely reduce the need for biopsies and improve accuracy.
Accelerating Successes Against Cancer 33

dence rates are highest in African 

American and Latino women and 

death rates are almost twice as high 

in African American women compared to Caucasians.

As currently practiced, approximately 7% of all Pap tests – or 3.5 

million per year – are abnormal and 

require further evaluation. Screening intervals can be increased from 

every 1 to every 2 years if liquidbased Pap tests are used. HPV testing identifies high risk individuals 

since virtually all cases of cervical 

intraepithelial neoplasia (IEN) are 

associated with HPV infection. 

More frequent testing is still recommended for members of high risk 

groups such as immune suppressed 

and HIV-positive women and those 

with in utero exposure to DES. It 

is recognized that certain subtypes 

of HPV, specifically types 16 and 

18, are associated with most cases 

of cervical neoplasia. The recently 

approved HPV vaccine will impact 

the rate of cervical cancer but is not 

effective in women already infected 

with HPV. 

With respect to cervical cancer, 

mortality rates have declined by up 

to 46% in the United States over 

the past four decades. This success is due to the widespread use of 

the Pap smear screening programs. 

Recently, the FDA approved HPV 

DNA testing with cytology screening for women more than 30 years 

of age. Every three year screening 

with liquid-based cytology and 

screening using HPV DNA testing 

provided economic benefits greater 

than those provided by annual tests 

with costs of $95,300 and $228,700 

per year of life gained. 

In comparison, these same tests 

conducted annually only provide a 

few hours of additional life expectancy and had costs of more than 

$2 million per year of life gained. 

Screening every two years is 

slightly more costly and has a costeffectiveness estimate of $257,400 

per year of life saved. Of available 

options, liquid-based cytology may 

be most inexpensive although, 

when coupled with the HPV test, it 

is more accurate. 

Mammography Breast carcinoma 

remains the most commonly diagnosed cancer and second leading 

cause of cancer death in women. 

Consistent with a greater detection of early stage cancer, incidence rates have increased since 

the 1980’s, but death rates have 

decreased over that time interval. Although African American 

women have a lower breast cancer 

incidence than Caucasians, mortality rates are higher which may 

relate to a more aggressive genetic 

signature of the tumors. 

Population-based rates of mammography within the previous two 

years has increased from 61.5% in 

1990 to 75.9% in 2002, but almost 

one-fourth of women age 40 and 

older have not been screened. 

Rates of mammography in the 

previous year are especially low 

among uninsured women younger 

than age 65 (33.2%). 

As currently practiced, mammography is associated with defined 

false positive and false negative 

rates. For example, in a recent 

large clinical trial of screening 

mammography, standard film 

mammography had an overall 

sensitivity of 66%, a specificity 

of 92%, and a positive predictive 

value of only 5% when a 5-point 

scoring system (BIRADS score) 

was used to quantify mammographic findings. 

PSA Screening PSA screening to 

detect prostate cancer has lead to 

down-staging of early lesions, a 

lower rate of radical prostatectomies, and a better understanding 

of the impact of a rising PSA in an 

asymptomatic male. Nonetheless, 

many high-risk populations are 

not routinely screened. African 

American males have lower 

screening rates, higher PSA at 

screening, and a higher incidence 

of prostate cancer than the general 

population. Research into the 

proper management of the isolated 

rising PSA, the impact of false 

negatives using the current PSA 

cut off of 4 ng/ml, and long-term 

follow-up of individuals identified 

during screening will help to define the value of population-wide 

screening of asymptomatic individuals. Refined PSA testing will 

likely reduce the need for biopsies 

and improve accuracy.

Emerging Technologies

Imaging for Early Detection

Imaging and Cancer Detection

The use of ultrasound, x-ray computer tomography, MRI, positron 

emission tomography (PET), and 

more recently combined imaging 

systems, have been the backbone 

of early detection of cancer. With 

completion of the sequencing 

of the human genome (and the 

ongoing cancer genome project), 

there is little question that the 

emerging development of molecular and cellular imaging will 

further revolutionize the way we 

treat and manage cancer in the 

next few decades. 
34 Accelerating Successes Against Cancer

Cellular and Molecular Imaging 

Molecular imaging techniques must 

be designed to detect a molecular 

signature of cancer, in which the 

combination of multiple molecular biomarkers provide sufficient 

accuracies to identify tumor tissues 

and likely therapeutic responses, 

especially at the earliest stages. 

Molecular imaging probes must be 

designed for high throughput, high 

sensitivity, and specificity to differentiate tumor tissues and normal or 

inflammatory tissues. 

Nanodetectors The most promising 

technologies for early cancer detection will be new developments in 

both in vitro diagnostics and in vivo

molecular imaging. For example, 

in the area of in vitro diagnostics, 

the development of new nanosensors utilizing the latest advances in 

nanotechnology (e.g., magnetonano 

and nanowire) should allow very 

sensitive detection of low levels of 

serum proteins. It still remains to 

be seen which serum proteins are 

relevant for early detection, but 

they will likely be discovered over 

the next 5-10 years. Nanosensors, 

coupled to good reagents (e.g., 

antibodies and aptamers), should 

allow for other reliable clinical tools 

for early detection. In vivo molecular imaging with optical and other 

technologies could then also be 

used to localize disease. 

Imaging Early Cancers

Biomarkers of Disease Altered 

metabolism detected by PET and 

altered blood flow detected by 

DC-MRI represent two promising 

approaches to imaging early cancers. An emerging approach and 

intensive area of study is directed 

towards the role of tissue remodeling in the growth and metastasis of 

tumors. The enzymatic breakdown 

of extracellular matrix is believed 

to be an essential step in both the 

production of new blood vessels to 

support tumor growth (angiogenesis) and the migration of tumor 

cells to distant locations (metastasis). Recent attention has focused 

on inhibiting matrix-degrading enzymes in order to halt the progress 

of cancer. The activity of these 

enzymes can be detected by high 

molecular weight contrast agents or 

blood flow.

Imaging of Tumor-Targeted Peptides 

The emerging identification of tumor-homing peptides for both therapeutic and imaging purposes offers 

exciting opportunities to develop 

novel peptides and small molecules 

for early cancer detection. Attachment of tumor-homing molecules 

to nanoparticles and radioactive 

labels offers excellent potential 

for using multimodality imaging 

approaches to detect precancerous and cancerous lesions prior to 

existing imaging approaches. 

Novel Development of Imaging 

Technologies

Advances in imaging will continue 

to be made through investment in 

discovery and validation of cancer 

specific imaging. Promising areas 

include the following:

“Smart” MR probes

New optimized reporter genes 

(PET, BLI, SPECT, MRI)

Agents targeted to the cell 

surface

Optimizing agents for 

intracellular targets

Incorporating imaging into 

therapy trials for the purpose 

of identifying response and 

predictive biomarkers

Hardware development (i.e., 

PET/MR, SPECT/MR systems), 

integration of imaging agents, 

•

•

•

•

•

•

biomarker identification/

qualification, and informatics

Proteomics for Early Detection

Proteomics involves the detection 

of novel peptides in bodily fluids 

that provide specific fingerprints 

of various tumors. Advances for 

early detection currently require 

improvements in both methodologies and applications of technology 

to noninvasively screen for colon 

and ovarian cancer, as well as other 

cancers. At many NCI-designated 

Comprehensive Cancer Centers, 

active screening programs are 

underway to discover new peptide 

markers and improve sensitivity 

and specificity of existing markers in colon, ovarian, pancreatic, 

prostate, and other cancers. The 

availability of robust biobanks with 

consistent collection and annotation is critical to this effort. This 

highlights the importance of these 

resources to the development of 

novel early detection approaches. 

Also, critical to these systems 

biology approaches are the use and 

continual improvement of bioinformatic pathway tools to annotate 

and organize the targets identified 

to be up- and down-regulated. 

Validation Research of Proteomic Biomarkers The goal of these research 

efforts is to define the capacity of 

proteomics approaches to identify 

novel biomarkers that will provide 

better and cost-effective risk assessments in screening both high-risk 

patients and the general patient 

population as well as guide therapeutic decision-making for patients 

undergoing treatment. All of these 

promising leads need to be validated in retrospective and prospective cohort trials. The availability 

of screening and validation sets of 

blood samples will be needed, with 
Accelerating Successes Against Cancer 35

attention to proper collection and 

storage of material, selection of 

patients, and broad distribution of 

cohorts across populations. Current 

barriers exist in the availability of 

these samples, and the lack of collected samples in populations not 

yet diagnosed with cancer.

Genomics in Early Detection

Single nucleotide polymorphisms 

(SNPs) are variations in DNA 

sequences that occur within the 

3 billion base pairs of the human 

genome. Although 99% of human 

gene sequences are the same, it is the 

subtle variations that contribute to 

individuality, predispose to cancer, 

and impact response to treatments. 

By identifying those who are predisposed, interventions can be carried 

out to prevent or delay the onset of 

cancer, thereby ultimately reducing 

the national cancer burden.

Current Knowledge, Issues, and 

Problems in Cancer Genomics The 

NIH Human Genome Project and 

the SNP Consortium – formed by 

collaborating pharmaceutical companies – are mapping the SNPs in 

the human genome. It is estimated 

that there are 3 million SNPs and 

that these make up 90% of human 

genomic variation. The ultimate 

location of these SNPs will serve 

as useful sequence landmarks and 

begin to help define susceptibility to 

disease and response to treatment. 

Researchers have found SNPs in 40 

candidate genes that appeared to 

predispose Japanese men to habitual 

smoking and drinking. Other investigators found SNPs that alter the 

metabolism of carcinogenic components of tobacco smoke, thereby 

helping to define smokers at high 

risk for cancer who would be prime 

targets for intensive screening and 

prevention.

Investigators at the Institute for 

Advanced Studies and the Cancer 

Institute of New Jersey identified a 

common variant in the promoter 

region of the murine double minute gene (mdm2) that blunts the 

normal physiological response to 

cellular damage. In collaboration 

with investigators at MD Anderson 

Cancer Center, they found that 

individuals with inherited p53 

mutations (Li Fraumeni Syndrome) 

– who also harbor the mdm2 SNP 

– were prone to the onset of multiple cancers at younger ages when 

compared with those with wildtype mdm2 alleles. This likely 

represents one of many SNPs that 

might be strong predictors of predisposition to particular malignancies and who would be identified as 

at high risk and in need of intense 

cancer screening.

Opportunities for Advancement in 

Genomics for Early Detection The 

significance of the SNPs will 

ultimately depend on their impact 

on individuals. This will require 

the formation of research teams 

that will include statistical geneticists, epidemiologists, molecular 

biologists, pathologists, informatics 

experts, pharmacologists, and clinicians. No better place exists than 

the NCI-designated Cancer Centers 

to bring these groups together. 

Thus, it will be critical for NCI to 

provide incentives for the formation of these collaborative teams, 

through award mechanisms and 

review panels that are familiar with 

the complexities of this research. 

Potential problems exist whenever genetic information is being 

requested from patients. Therefore, 

it will be incumbent upon Federal, 

state, and local policy-makers to 

clarify current regulations that have 

hampered the approval of research 

protocols and the enrollment of 

patients into these cohorts. 

Validation Process for New 

Technologies

Any new technology in the area 

of early detection needs to provide 

accurate, cost-effective screening 

for cancer and to be capable of dissemination to a broad population. 

Mammography and colonoscopy 

have emerged as effective methods 

for screening of large populations 

despite their need for advanced 

technology, imaging, and informatics. With these as examples, 

there is a high-cost barrier for 

a new technology, which could 

become a commonplace cancerscreening device. 

A major barrier remains in the 

area of population validation for 

sensitivity and specificity of cross 

populations and particularly for 

high-risk populations (see below). 

Methods for such validation are not 

commonly employed in academic 

laboratories and require complex 

cross-disciplinary teams including 

medical technology experts, physicians, epidemiologists, statisticians, 

human geneticists, and clinical 

laboratory pathology, radiology, 

and public health experts. Among 

available technologies, we would 

anticipate that validation of a 

novel early detection screen would 

take 2 years at the level of Phase II 

validation, 3-4 years for Phase III 

validation, and 5-7 years to validate 

across populations. 

New Screening Methods

The NCI-designated Cancer 

Centers will continue to be a nidus 

for discovery of new technologies. Efforts are ongoing among 

the Centers to establish the value 
36 Accelerating Successes Against Cancer

of a number of different approaches 

towards early detection using lead 

discoveries in genomics, imaging 

technology, colonoscopy, ultrasound, and advances in minimallyinvasive technologies – such as 

CCD color bronchoscopy, MRI of 

the breast, and proteomics. New 

scientific discoveries in cancer 

etiology and cancer detection will 

lead to new approaches for early 

detection. These areas include: 

Novel colon cancer blood tests 

based on novel gene expression

Proteomics screening for 

ovarian, prostate, lung, and 

head and neck cancers

DNA methylation analysis of 

peripheral blood circulating 

tumor cells for colon, pancreas, 

and perhaps gliomas

Glycomics and metabolomics 

as blood screens for a number 

of cancers

High-Risk Populations 

for Early Detection 

Screening 

Cancer Survivors Patients who have 

survived a diagnosis of cancer, and 

now are in clinical remission, have 

a risk of recurrence and are the 

single group at the highest risk for 

developing another primary cancer. 

While this population is often 

followed either by their medical 

oncologist or internist, broad-based 

screening of this population for all 

cancer types is often suboptimal. 

National standards for long-term 

screening of these individuals are 

not established. For instance, patients with lymphoma and chronic 

lymphocytic leukemia (CLL) are at 

increased risk for skin tumors, while 

patients with hereditary nonpolyposis colorectal cancer (HNPCC) are 

•

•

•

•

at risk for endometrial and ovarian 

carcinoma.

Underserved Populations While 

the overall incidence of cancer in 

underserved populations is only 

slightly higher than the general 

population, cancers are often detected much later in the course of 

the disease leading to a much worse 

prognosis, higher rates of metastatic 

disease, increased pain and suffering, increased need of medical 

treatment, higher costs of treatment, and higher death rates from 

cancer. Thus, underserved populations are targets for early detection 

with the potential for considerable financial and socioeconomic 

benefits. Underserved populations 

include minorities, the poor, urban 

inner city populations, the medically uninsured, rural populations, 

and older individuals. 

Ethnic Groups With Increased Risk 

for Specific tumors These include 

African American males who are at 

increased risk of prostate cancer and 

American Indians who are at increased risk for gallbladder cancers.

Behavioral, Environmental, and Work 

Place Risk Groups These include 

obese patients, smokers, those exposed to secondary smoke, and environmental exposures to pesticides, 

benzene, and organic molecules.

Family Cancer History Family history has also been identified as a 

demonstrable risk, however, only a 

few genes accounting for this have 

been identified. One of the most 

important aspects of early detection 

is to identify the target population. 

Some early detection studies should 

be performed on all individuals 

in an age-dependent fashion. For 

instance, all women over the age of 

40 with such histories should have 

mammograms. In other instances, 

the optimal target populations still 

need to be defined. 

Genetic Risk Easy 

Assessment Tool 

(GREAT)

The Genetic Risk Easy Assessment 

Tool (GREAT) has been developed 

at Case Comprehensive Cancer 

Center to facilitate systematic 

collection, interpretation, and 

communication about the family 

history of cancer. The web-based 

GREAT tool (https://family.case.

edu) allows people to record a 

detailed family history via a 

secure Internet connection at a 

time and place convenient for 

them, using a reliable, computerized questionnaire that has been 

validated by comparison with 

genetic counselors. The program 

then automatically constructs 

and displays a digital family tree 

(pedigree), and automates risk 

analysis for breast, ovarian, and 

colorectal cancer. In 2007, the 

GREAT system could be made 

available to multiple NCI Cancer 

Centers for interest, validation, 

utility, and for development of 

identifiable families that would 

then be approached to participate 

in early detection clinical trials.
Accelerating Successes Against Cancer 37

Opportunities to Impact 

Early Detection and 

to Reduce the Cancer

Burden

Resource Allocations

1. Improve use of current early 

detection screening especially 

for underserved populations

2. Increase research funding for:

Imaging technologies for 

early detection

Genomics for SNPs and 

other genomic screening 

efforts

Development of proteomics 

for screening tests

Use of family history to 

define at risk populations

Large-scale, populationbased screening initiatives 

to validate new technology

3. Coordinate regional and statewide initiatives for population 

dissemination of early detection efforts and technology

4. Develop collaborations with 

state departments of public 

health, insurance carriers, 

medical systems

5. Increase the proportion of the 

population covered for existing 

and standard early detection 

screening including colonoscopy, mammogram, PSA, and 

Pap test

6. Coordinate and support efforts to identify high-risk 

populations based on the above 

criteria

7. Facilitate and expand efforts to 

identify families with cancer 

histories and support development of cancer family history registries, allowing such 

high-risk groups to have more 

intensive screening

•

•

•

•

•

NCI-designated Cancer Centers Action 

Plan

Cancer Centers should:

1. Develop collaborative efforts 

evaluating new early detection 

technologies

2. Coordinate evaluation of 

genetic early detection markers 

for cancers because preclinical detection will increase the 

potential of curative treatment

3. Promote development of registries of high-risk populations 

for colorectal, breast, ovary, 

prostate, and lung cancers 

that would benefit from early 

detection screening. Examples 

would include breast MRIs 

in carriers of BRCA 1 and 2 

genes, and mismatch repair 

protein mutation analysis in 

families with colon, gastric 

and endometrial cancers

Anticipated Outcomes

and Potential Impact

Colon Cancer Current nationwide 

screening rates for colon cancer 

by colonoscopy is approximately 

27% and approximately 40% for 

the use of occult blood testing 

in patients over age 50. Increasing screening to over 80% of the 

population would improve early 

detection of colon cancer and 

improve survival rates.

Breast Cancer Current methods for 

detecting breast cancer by mammography are proven to increase 

early detection, decrease late-stage 

diagnosis, increase cure rates, and 

prolong survival. However, mammography in underserved populations is performed in only 47% of 

women. Increasing annual mammography utilization in women 

over the age of 40 in underserved 

populations would improve early 

detection, intervention, cure, and 

prolong survival of affected individuals while providing a strong 

support to underserved populations. 

Skin Cancer Skin cancer screening 

efforts can be improved by increasing primary care physician detection 

capabilities for visual inspections 

and increasing referrals to dermatologists for questionable lesions. 

For cancers like melanoma, this will 

dramatically decrease progression to 

local, regional, and metastatic disease in the vast majority of patients.

Prostate Cancer Improved prostate 

cancer detection methods would 

allow early intervention against 

high-grade prostate cancer lesions 

and reduce the overall morbidity 

and mortality from this disease. 

Cervical Cancer The underserved 

populations continue to have a 

reduced rate of cervical Pap smears 

performed, leading to the diagnosis 

of advanced cervical cancer and 

death. Even with the availability 

of the new HPV vaccine, it is likely 

that the underserved populations 

will be the last to receive this vaccine and will receive it at a late 

date, increasing their overall risk of 

cervical cancer and making it quite 

likely that this disease will reseed to 

the boundaries of the underserved 

population. Aggressive ongoing 

efforts to both vaccinate with the 

new HPV vaccine and to screen underserved patients with the cervical 

Pap smear will dramatically decrease 

the impact of this disease.

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http://www.preventcancer.org/colorectal/upload/NCCRA_reportcard.pdf
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M, Karrison T, Janisch L, Ramirez 

J, Rudin CM, Vokes EE, Ratain 

MJ. Genetic variants in the UDPglucuronosyltransferase 1A1 gene 

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22(8):1382-1388.

Itzkowitz SH, Present DH, Crohn’s 

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colorectal cancer screening and 

surveillance in inflammatory bowel 

disease. Inflamm Bowel Dis 2005; 

11(3):314-21.

Jemal A, Murray T, Ward E, et al. 

Cancer statistics, 2005. CA Cancer 

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Kauhava L, Immonen-Raiha P, 

Parvinen I, et al. Population-based 

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in substantial savings in treatment 

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Cancer Res Treat 2006; 95(1)1-8.

Koroutsky LA, Ault KA, Wheeler 

CM, et al. A controlled trial of a 

human papillomavirus type 16 vaccine. NEJM 2002; 347(21):1645-51.

Ladabaum U, Phillips KA. Colorectal cancer screening: differential 

costs for younger versus older 

Americans. Am J Prev Med 2006; 

30(5):378-84.

Lewin JM, Hendrick RE, D’Orsi CJ, 

et al. Comparison of full-field digital 

mammography with screen-film 

mammography for cancer detection: 

results of 4,945 paired examinations. Radiol 2001; 218(3):873-80.

Lindfors KK, McGahan MC, 

Rosenquist CJ, Hurlock GS. 

Computer-aided detection of breast 

cancer: a cost-effectiveness study. 

Radiol 2006; 239(3):710-7.

Liu Y, Yoshimura K, Hanaoka T, 

Ohnami S, Ohnami S, Kohno T, 

Yoshida T, Sakamoto H, Sobue T, 

Tsugane S. Association of habitual 

smoking and drinking with single 

nucleotide polymorphism (SNP) 

in 40 candidate genes: data from 

random population-based Japanese samples. J Hum Genet 2005; 

50(2):62-68.

Mandelblatt JS, Schechter CB, 

Yabroff KR, et al. Benefits and costs 

of interventions to improve breast 

cancer outcomes in African American women. J Clin Oncol 2004; 

22(13):2554-66.

Mysliwiec PA, Brown ML, 

Klabunde CN, Ransohoff DF. 

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Noller KL. ACOG technical assessment in obstetrics and gynecology: 

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E, et al. Diagnostic performance of 

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Plevritis SK, Kurian AW, Sigal BM, 

et al. Cost-effectiveness of screening 

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Titus-Ernstoff L, Goodrich ME, 

Tosteson AN. Screening mam-

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Treatment

Summary

Recent national data indicate that the multimodality treatment of cancer is making a significant contribution to the decline in the overall cancer mortality rate. This is particularly gratifying in that these statistics do not even reflect some of 

the exciting recent advances due to the application of molecularly-targeted therapies. These encouraging statistics reflect the 

success of multidisciplinary and multimodality therapies which 

increasingly include a wide spectrum of combinations of surgery, 

radiotherapy, chemotherapy, hormonal therapy, and newer targeted therapy – both small and large molecules. 

There is a substantial basis for 

optimism for accelerating advances 

in the treatment of responsive as 

well as refractory tumors if cancer 

researchers can more efficiently 

and effectively move discoveries in 

cancer biology to clinical trials and 

to ultimate application in the community at large. The major thrust 

of this commentary on cancer 

treatment is to emphasize that an 

extraordinary level of collaboration 

– as well as alignment of incentives 

– will be required by all stakeholders in the cancer therapeutic 

enterprise if we are to significantly 

accelerate the rate of progress. 

This section on cancer treatment 

presents a broad outline of such a 

blueprint and highlights an important new NCI initiative developed 

by the Institute’s Clinical Trials 

Working Group (CTWG) which 

aims at restructuring the national 

cancer clinical trials enterprise. 

This type of national plan for cancer treatment research – coupled 

with continued robust support for 

fundamental science – has the 

potential of revolutionizing cancer treatment during the next few 

decades. 

Introduction

Recent cancer statistics indicate 

continued improvement in survival. Between 1991 and 2001, the 

drop in cancer mortality rate was 

10%, translating into as many as 

321,000 lives saved. Furthermore, 

for the first time in over 70 years, 

the absolute number of cancer 

deaths dropped in 2003. Certainly, 

screening, early detection, and a 

wide range of prevention activities 

account for a significant amount of 

this improvement, but it is becoming increasingly clear that cancer 

treatment, particularly combined 

with early diagnosis, is having a 

major impact on cancer mortality. 

The goals of cancer treatment 

are to decrease the mortality and 

morbidity from cancer by preventing the emergence of clinical 

metastasis at the time of diagnosis 

with primary and adjuvant therapy; 

and to eradicate or significantly 

reduce metastatic disease which 

has become clinically significant. 

At the time of the launching of 

the National Cancer Program in 

1971, there had been considerable improvement and refinement 

40 Accelerating Successes Against Cancer
Accelerating Successes Against Cancer 41

in surgical and radiation therapy 

techniques resulting in improved 

removal and eradication of the 

primary tumor with decreased 

morbidity. However, the effectiveness of systemic therapy was largely 

limited to a relatively small subset 

of cancers including childhood 

cancers, choriocarcinoma, Hodgkin 

and non-Hodgkin lymphoma and 

certain leukemias. There was little 

to offer patients with the common 

solid tumors in either the adjuvant 

or advanced settings and the explosion in our understanding of the 

molecular basis of cancer was just in 

its infancy.

In the ensuing three decades, there 

has been a tremendous increase in 

our understanding of the genetic 

and molecular pathogenesis of 

cancer, accompanied by new 

technologies and model systems, 

leading to a large number of 

new approaches to cancer treatment. The advent of combination 

chemotherapy, multidisciplinary 

therapy particularly in the setting of earlier diagnosis of cancer, 

newer approaches to endocrine 

therapy, and the remarkable gains 

in cellular and molecular biology 

coupled with the introduction of 

molecularly-targeted therapy have 

transformed the entire treatment 

approach to cancer. This was 

made possible by the adoption 

of formal clinical trials of new 

therapies which are carried out 

in Cancer Centers and academic 

institutions, and to some degree 

by practicing oncologists.

In order to build on these accomplishments and accelerate the rate 

of progress, we must understand 

as much as possible about the interventions that have lead to this 

improvement in survival. There 

are now data available from the 

Cancer Intervention and Surveillance Modeling Network (CISNET) – a consortium of NCIsponsored investigators – whose 

purpose is to measure the effect 

of cancer control interventions 

on the incidence of and risk of 

death from cancer in the general 

population. CISNET data indicate that screening and treatment 

have contributed to the observed 

decline in the rate of death from 

breast cancer, and that the decline 

can be explained by a combination of screening and therapy and 

not by either one alone. When 

reviewing the improving survival 

statistics in breast cancer and 
42 Accelerating Successes Against Cancer

other malignancies, it should be 

noted that the impressive benefits 

now being demonstrated with 

targeted therapy (e.g., Herceptin 

in the adjuvant therapy of breast 

cancer) have yet to be represented 

in the survival statistics. 

The opportunities and challenges 

that now face therapeutic researchers include:

Building on the recent 

advances in the therapy of 

responsive neoplasms

Beginning to make progress in 

the cancers refractory to current 

therapeutic approaches

Continuing and enhancing 

fundamental research in order 

to accelerate translational 

research in both responsive and 

nonresponsive cancers

Significantly improving delivery 

of advances in therapeutics to 

the community at large and 

in particular to underserved, 

minority populations

Current Knowledge, 

Barriers and 

Opportunities

Our current understanding of 

cancer therapy is in a rapid state of 

transition. Traditionally, we have 

employed modalities with minimal 

or no specificity for a particular 

cancer (e.g., chemotherapy, radiation, surgery) and often with the 

inability to avoid damaging normal 

cells. With the recent stunning 

advances in molecular genetics, epigenetics, and cell biology, the major 

task before us over the next decade 

is to sort out the molecular targets 

and the drugs that impact them and 

study their role in the therapy of 

patients with cancer. This ‘translational’ aspect of cancer is not solely 

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an engineering problem. It is also a 

scientific problem. 

Our scientific challenge is to 

maximize the number of studies that 

identify targets and their inhibitors 

and to get them to clinical trial as 

expeditiously as possible. Our engineering task is to find better ways 

to move the knowledge we already 

have to the broader and diverse 

community at every level including 

early detection, prevention, and 

therapy. The Cancer Centers have 

been steadily growing over the past 

40 years in their ability to do cutting edge science and translate its 

discoveries into clinical trials. Their 

success is a testimony to the wisdom 

of creating the NCI Centers’ Program and enhancing the extent of 

extramural funding for research. 

The Cancer Centers have not, however, been as successful in the role 

of enhancing care delivery in their 

respective regions. In part, this is 

because that role has not been adequately funded by the NCI or other 

sources. Perhaps an even greater 

impediment to this critical phase of 

translational research is the lack of 

a coherent, effective national health 

system that is designed to provide 

quality care to all the citizens. Even 

if these barriers are removed, there 

are still fundamental engineering 

challenges in the process of translational research and its movement 

into the broader public arena.

These challenges include: 

1. The ability of Cancer Centers 

and industry to more effectively 

interact. Removal of bureaucratic hurdles, standardization 

of clinical research and reporting methodologies, and alignment of incentives between 

industry and academia should 

be more actively explored to 

make progress in this area. 

2. There is not a clear recognition that our supply of clinical 

and translational investigators 

is dangerously low. The “perfect storm” of medical schools 

relying on faculty practice 

plans, the Medicare/Medicaid 

cuts, the impact of medical 

school costs on career choices, 

and the excessive regulation 

of clinical research are making the process of identifying, 

training, and retaining investigators extremely difficult. 

3. Past Federal and state efforts 

to grow or shrink specific areas 

of the physician work force 

are now leading us to an era 

of critical shortages in several 

cancer-related specialties. 

4. The grant process at the Federal 

and state level is focused on 

individual outcomes without 

recognizing the critical need for 

broader, more flexible funding 

that is critical for the institutions that serve as the backbone 

for the collaborative activities 

of these investigators. 

5. Mentoring and tenure and promotion policies at universities 

are often focused on individual 

accomplishments without appropriate recognition of the 

collaboration required for clinical/translational research. 

6. There are limited funds for 

pursuit of truly innovative, 

risky research. This is also true 

for strategies to move knowledge out to the community 

where it can ultimately impact 

survival curves. 

7. The competition for intellectual property has reached a 

level which inhibits or greatly 

slows advancements that 

require collaborations to move 
Accelerating Successes Against Cancer 43

novel ideas and agents into 

clinical trials.

Emerging Therapeutic 

and Interventional 

Strategies

A thorough understanding of molecular carcinogenesis (genetic and 

epigenetic) has led to the capacity to identify targets which are 

most suitable for preventive and 

therapeutic interventions. These 

target identification studies need 

to be undertaken on a large scale 

cooperative basis and appropriate 

biomarkers identified in order to 

evaluate the effectiveness of such 

interventions in a timely fashion. 

Rapidly evolving technologies to 

sequence the human genome have 

allowed for the discovery of an 

abundance of genetic mutations 

in cancer. Structural analysis of 

such mutations should result in the 

discovery and development of drugs 

that are specific for the defined lesion and nontoxic for the patient. 

The challenge lies in the heterogeneity of such mutations under the 

umbrella of specific cancers. Thus, 

proving the efficacy of molecularly-targeted cancer therapies will 

depend on comparable advances in 

molecular diagnostics to ensure that 

these therapies are tested in cohorts 

of cancer patients that have the 

relevant mutation. For successful 

development of therapeutic strategies, acquisition of tissue through 

minimally-invasive procedures 

needs to be combined with outstanding tissue procurement infrastructure and molecular diagnostics. 

Technological advancements in 

molecular, cellular, and tissue imaging may provide opportunities for 

noninvasive discovery of markers 

and targets for both therapeutic and 

prevention studies.

Molecularly individualized therapy 

with its resultant diminished market size has the potential to dampen 

enthusiasm from the industry’s 

perspective. Current intellectual 

property concerns also inhibit the 

use of new agents from different pharmaceutical/biotechnology companies in designing novel 

combinatorial regimens. A new 

comprehensive therapeutic development plan that aligns incentives 

between academia, industry, and 

government is required to overcome 

these obstacles.

Taking advantage of these opportunities and surmounting these 

obstacles are critical if we are to 

achieve multimodality therapy 

which is designed and targeted for 

appropriate cohorts of patients. 

Currently, the therapeutic options 

for cancer therapy include:

Surgery

Radiation therapy

Chemotherapy 

Endocrine therapy

Molecularly-targeted therapy: 

small molecules that regulate 

tumor growth, survival, and 

angiogenesis

Immunotherapy

n Monoclonal antibodies

n Cancer vaccines

n Cytokines

Gene therapy

Increasingly, patients receive several of these treatment approaches 

in combinatorial regimens. Individualizing this combination therapy is 

now a feasible way of improving the 

antitumor response while avoiding 

adverse effects. New methodologies and paradigms must be pursued for designing and evaluating 

•

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•

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•

individualized therapy based on the 

specific molecular abnormalities of 

a patient’s tumor. 

Identification and 

Prioritization of 

Opportunities for 

Advancement

In the 2006 NCI strategic plan, the 

NCI leadership highlights general 

principles on which to base the 

overall strategy. These include:

Discover, develop, and 

validate cancer biomarkers for 

cancer prognosis, metastasis, 

treatment response, and cancer 

progression. The discovery and 

application of these markers 

are now possible through 

recent advances in biomedical 

technology such as genomics, 

proteomics, nanotechnology, 

molecular imaging; all coupled 

with bioinformatics. 

Accelerate identification of 

potential targets for cancer 

treatments by integrating 

preclinical and clinical 

research.

Develop individualized 

therapies tailored to the 

specific characteristics of a 

patient’s cancer to cure or 

prolong survival with little or 

no adverse effects. 

Develop more effective 

symptom management and 

palliative strategies to better 

reduce the toxicities of cancer 

therapy to insure the highest 

quality of life. 

In order to achieve these ambitious 

translational research goals, Dr. 

Andrew von Eschenbach, former 

director of the National Cancer 

Institute, established in January 

2004 the Clinical Trials Working 

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•

•

•
44 Accelerating Successes Against Cancer

Group (CTWG) which advised the 

National Cancer Advisory Board 

(NCAB) on whether and in what 

ways the NCI-supported national 

clinical trials enterprise should be 

restructured. The CTWG was a 

broadly constituted panel of experts 

from academic research institutions, 

community oncology practices, 

pharmaceutical and biotechnology 

industries, cancer patient advocacy 

groups, NCI, the Food and Drug 

Administration, and the Center for 

Medicare and Medicaid Services. 

The full report titled “Restructuring 

the National Cancer Clinical Trials 

Enterprise” was issued in June 2005 

and is available online at http://integratedtrials.nci.nih.gov/ict/CTWG_

report_June2005.pdf. The summary 

vision of the CTWG is to “enhance 

the best of all the components of 

the NCI-supported clinical trials 

system, to develop a cooperative 

enterprise built on a strong scientific 

infrastructure and a broadly engaged 

coalition of crucial stakeholders.” 

The detailed blueprint for achieving this vision is described in detail 

in this report in four thematic areas 

which are summarized below:

Coordination Initiatives

Create a comprehensive 

database containing 

information on all NCI-funded 

clinical trials to facilitate better 

planning and management 

across clinical trial venues.

Realign NCI and academic 

incentives to promote 

collaborative team science.

Increase cooperation between 

NCI, FDA, and industry 

to enhance the focus and 

efficiency of oncology drug 

development.

•

•

•

Expand awareness of the 

NCI-FDA expedited approval 

process to speed trial initiation. 

Work with CMS to identify 

clinical studies that address 

both NCI and CMS objectives, 

and for which CMS may be 

able to reimburse some routine 

and investigational costs.

Prioritization/Scientific Quality 

Initiatives

Create an Investigational 

Drug Steering Committee to 

work with NCI to enhance 

the design and prioritization of 

early phase drug development 

trials.

Create a network of Scientific 

Steering Committees, which 

leverage current Intergroup, 

Cooperative Group, Specialized 

Programs of Research 

Excellence (SPOREs), and 

Cancer Center structures, to 

work with NCI in the design 

and prioritization of Phase III 

trials to better allocate scarce 

resources, improve scientific 

quality, and reduce duplication.

Increase community oncologist 

and patient advocate 

involvement in clinical trial 

design and prioritization to 

improve the rate of patient 

accrual, and better address 

practical and quality of life 

concerns in the design of trials.

Develop a funding and 

prioritization process to ensure 

that critical correlative science 

and quality of life studies can be 

conducted in a timely manner 

in association with clinical 

trials.

Develop a standards-setting 

process for the measurement, 

analysis, and reporting of 

biomarker data in association 

with clinical trials to enhance 

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•

data comparisons, reduce 

duplication, and facilitate 

data submission for regulatory 

approval.

Investigate integration of 

Phase II trials into the overall 

prioritization process to further 

coordinate the national clinical 

trials system.

Standardization Initiatives

Create, in partnership with 

the extramural cancer research 

community, a national cancer 

clinical trials information 

technology infrastructure 

fully interoperable with NCI’s 

Cancer Bioinformatics Grid 

(caBIG) to improve cost 

effectiveness and comparability 

of results across trials and sites.

In consultation with 

industry and FDA, develop 

standard Case Report Forms 

incorporating Common 

Data Elements to improve 

information sharing among 

cancer researchers and optimize 

data requirements.

Build a credentialing system 

for investigators and sites 

recognized by NCI and industry 

to allow faster trial initiation 

and keep the investigative 

community abreast of legal, 

safety, and regulatory changes.

Develop commonly accepted 

clauses for clinical trial 

contracts with industry to 

reduce the lead-time needed to 

open trials.

Operational Efficiency Initiatives

Restructure the Phase III 

funding model to promote 

rapid patient accrual rates and 

cost-effectiveness.

Reduce institutional barriers to 

timely trial initiation.

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Accelerating Successes Against Cancer 45

Increase patient and public 

awareness and understanding of 

clinical trials.

Increase minority patient access 

to clinical trials to improve the 

participation of underserved 

and underrepresented 

populations.

Promote adoption of the NCI 

Central Institutional Review 

Board facilitated review 

process to reduce the time and 

resources needed to open trials 

at individual sites.

The Cancer Center Directors working group endorses this restructuring 

effort and would like to highlight 

•

•

•

the following critical responsibilities and key collaborative efforts of 

the stakeholders:

1) Individual Cancer Centers and 

academic medical centers must 

work toward achieving the goals of 

the NCI strategic plan and the restructuring of the national cancer 

clinical trials enterprise The individual Cancer Centers must 

remain the engines of discovery 

and see that promising laboratory discoveries are promptly 

taken into early phase clinical 

studies with the collection of 

biological materials for appropriate correlative research. 

Mechanisms must be developed 

All All

cancer other

Year sites Lung/Men Lung/Women Colorectal Breast/Women Prostate sites

1990 216.0 91.9 37.1 24.5 33.3 38.4 101.3

1991 215.2 90.0 37.8 23.7 32.7 38.9 101.5

1992 213.5 88.1 38.8 23.4 31.6 38.9 101.0

1993 213.5 87.6 39.4 23.1 31.4 39.0 101.1

1994 211.7 85.6 39.7 22.7 30.9 38.2 100.9

1995 209.8 84.2 40.3 22.4 30.5 37.0 100.1

1996 206.7 82.6 40.4 21.7 29.5 35.7 99.3

1997 203.5 81.2 40.9 21.4 28.2 33.9 98.0

1998 200.7 79.7 41.1 21.1 27.6 32.4 96.9

1999 199.4 78.1 40.9 20.9 26.5 30.9 96.9

2000 198.3 78.2 40.9 20.8 26.6 30.0 95.6

2001 194.3 78.0 42.0 20.1 25.9 28.5 94.3

2002 192.3 76.2 41.7 19.7 25.5 27.5 92.7

Average % 1.0 1.6 -1.0 1.8 2.2 2.7 0.7

decline

per year †

 * Rates are per 100,000 population for all races/ethnicities and were adjusted to the 2000 U.S. age distribution by using the direct method. Rates for the 

years 1999 to 2002 were adjusted further to account for the change in coding from the International Classification of Disease, 9th Revision (ICD-9) to the 

ICD-10 (see Anderson et al., 2001[13]).

 † The average percent declines per year are the means of the changes across the 12 yearly intervals between 1990 and 2002.

Source: Byers, et al. Cancer, 2006, 107(2) 396-405.

within these individual Cancer 

Centers and academic medical 

centers to decrease bureaucracy, 

reduce legal barriers, overcome 

potential conflict of interest 

problems, facilitate necessary 

preclinical studies, and ensure 

the expedited filing of INDs 

with the FDA. 

2) Collaboration between Cancer 

Centers Individual Cancer 

Centers must be encouraged 

and incentivized to work 

closely together to implement 

and complete early clinical 

trials in an accelerated timeframe. Likewise, an inventory 

of unique core services at 

Table 1. Trends in Cancer Mortality Rates in the U.S. by Cancer Site 1990 to 2002*

Cancer site/Gender
46 Accelerating Successes Against Cancer

individual Cancer Centers 

should be available for access 

across the entire Cancer Centers network. Mechanisms to 

share tissue specimens across 

institutions through biorepositories should be further 

developed.

3) Collaboration with other entities 

Current relationships between 

Cancer Centers, cooperative 

groups, industry, as well as with 

the FDA and CMS should be 

improved and streamlined particularly in the area of development and implementation of 

Phase III trials. 

4) Collaboration with the health care 

providers and payer systems Although progress has been made 

in certain areas of the country 

and with specific payers, there 

must be a coherent national 

approach to approval of the 

costs of patient care in clinical 

research approved by the NCI, 

NIH, VA, cooperative groups 

as well as trials approved by an 

NCI-designated Cancer Center 

with an approved Protocol Review and Monitoring System.

5) Collaboration with policy-makers 

and government agencies The 

closer ties between FDA and 

NCI should be further developed. The development of a 

national clinical trials management system utilized by Cancer 

Centers, community oncologists, industry, and government 

agencies would have an enormous effect on the ultimate 

productivity of translational 

research in the United States.

6) Collaboration with pharmaceutical/biotechnology companies 

Issues surrounding technology 

transfer –including intellectual 

property, confidentiality, conflict of interest, access of drugs 

for combinatorial regimens 

– constitute major bureaucratic 

impediments to timely development of new diagnostics and 

therapeutics. 

7) Enlightened and responsible 

behavior of people Improved 

education of the public is essential to impact on personal 

behavior regarding tobacco use, 

diet, and other lifestyle issues, 

screening and cancer prevention as well as to enhance 

the public understanding of 

research. Cancer prevention 

should be regarded as the leading edge of a continuum which 

includes cancer treatment. An 

educated public will take better 

care of themselves and can be 

a highly effective supporter of 

research. 

Anticipated Outcomes 

and Potential Impact

In 1996, the Board of Directors of 

the American Cancer Society set 

an ambitious challenge goal for 

the United States to reduce cancer 

deaths rates by 50% between 1990 

and the year 2015. An article 

published in the July 15, 2006 issue of Cancer provides analysis of 

progress toward that goal through 

2002, the mid-point of the challenge. This analysis has shown 

that if the current rate of decline 

in death rates continues into the 

future, the United States will have 

approximately a 23% lower age 

standardized death rate from cancer 

in the year 2015 compared to the 

year 1990. While this is only approximately half of the ACS’ 2015 

goal, it is an impressive decrease. 

The authors further note that if the 

current overall rate of decrease in 

death rates continues on the same 

trajectory, cancer death rates will be 

50% lower than 1990 only after the 

year 2040. It should be noted, however, that the trends for reduction 

in death rates for cancers of the colorectum, breast, and prostate have 

been tracking toward the ACS 50% 

goal while trends for other cancer 

sites have declined at a much slower 

rate (Table 1).

To predict the potential impact of 

advances in cancer treatment on 

survival statistics, we must be able 

to assess the current contribution 

of treatment to improving survival. 

In the previously quoted CISNET 

study, the proportion of the decrease in the rate of death from 

breast cancer that was attributable 

to adjuvant treatment ranged from 

35% to 72% with a median of 54%. 

The authors of this report point out 

that in spite of the variability in 

the quantitative conclusions across 

the seven independent statistical 

models of breast cancer 

incidence and mortality in this 

study, it demonstrates a significant 

interplay between screening and 

treatment. They conclude that 

screening and treatment appear to 

have contributed approximately 

equally to the improvement in 

survival that has occurred. It does 

not seem unreasonable to expect 

that similar conclusions might be 

reached regarding the analysis of 

survival improvement in colorectal 

and prostate cancer.

Given the progress that has been 

made with currently available 

treatments in breast, prostate, and 

colorectal cancer and the advances 

being made in molecularly-targeted 

diagnostics and therapeutics, an 

accelerated decline in the rate of 

deaths from responsive neoplasms 

might well be anticipated. As 
Accelerating Successes Against Cancer 47

pointed out in this report’s section 

on Prevention, immediate measures 

to reduce death rates are available 

through application of validated 

screening procedures to underserved 

and underutilizing populations. 

The challenges for treatment of 

cancers that have thus far been 

largely refractory and more difficult to detect – such as pancreatic 

cancer – are obviously more difficult 

and require major investment of 

resources.

Implementation of the NCI 

Strategic Plan – with emphasis on 

a highly coordinated and collaborative national blueprint accompanied by the recommended 

restructuring of the cancer clinical 

trials national enterprise – can be 

expected to accelerate treatment 

progress in both currently responsive and nonresponsive neoplasms. 

However, unlike the situation with 

the successful space exploration 

projects, these accelerated gains in 

cancer therapy are dependent not 

only on skillful application of what 

we currently know, but also on continued fundamental research into 

the biologic behavior of cancer.

Three specific action items that 

should be advocated and promoted 

during the next year are:

1. Cancer Centers’ leadership 

must play a vital role in prioritizing and implementing initiatives of the CTWG.

2. A unified national cancer clinical trials information technology system must be created with 

full collaboration of the Cancer 

Centers, cooperative groups, 

and pharmaceutical companies, 

and coordination with the NCI 

and the FDA.

3. Investment in translational 

research infrastructure in 

Cancer Centers should be a 

high priority, despite budgetary 

constraints, with recognition 

that translational research 

largely originates in Cancer 

Centers and within cancer programs at academic institutions. 

For example, funding:

a. Biorepositories

b. Easy access to shared resources across centers

c. Enhancement/improvement 

of mechanisms like the 

Rapid Access to Intervention Development (RAID) 

program

References

Berry et al. Effect of screening and 

adjuvant therapy on mortality 

from breast cancer. NEJM 2005; 

353(17): 1784-92

Byers T, et al. A midpoint assessment of the American Cancer Society challenge goal to halve the U.S. 

cancer mortality rates between the 

years 1990 and 2015. Cancer 2006; 

107(2) 396-405.
48 Accelerating Successes Against Cancer

Survivorship

Summary

With an estimated 10 million cancer survivors in the United States, the demand for addressing the long-term needs of cancer survivors is clear and optimally accomplished 

through the partnerships of academic medical centers, Cancer 

Centers in particular, the community, and cancer survivors.

Cancer Centers, through collaborations with other Cancer Centers and community providers, play a critical role in survivorship 

research, development of evidence-based guidelines for cancer 

survivors, and education. 

Surveys need to be conducted to 

identify existing resources and 

deficiencies or gaps that must be addressed to meet the needs of adult 

survivors, such as those unique 

needs of survivors with less common forms of cancer, and the gap 

related to the period immediately 

following completion of initial 

treatment. Adopting the pediatric 

cancer model of survivor programs 

and clinics may help address the 

needs of adult cancer survivors.

Partnerships must be developed between various stakeholders including academia, community practices, 

patient advocacy groups, thirdparty payers, and industry (e.g., 

pharmaceutical and biotechnology 

companies) to provide the necessary infrastructure for research, with 

an emphasis on the development 

of biomarkers for early detection 

and identification of risk factors 

for common problems, including 

second primary cancers experienced 

by cancer survivors.

The Survivorship Subcommittee 

recommends the following action 

items be accomplished over the 

next year:

1. A shared resource warehouse 

should be established through 

the NCI Office of Cancer 

Survivorship. This warehouse 

would provide for a central 

source of tools on survivorship. Cancer Centers should 

collaborate and participate in 

the establishment and population of this data warehouse, to 

include the following tools:

a. Research protocols

b. Educational materials

c. Detailed descriptions of 

clinical, research, educational, and outreach activities being conducted at each 

Cancer Center

2. Cancer Centers, in collaboration with ASCO and other 

professional organizations, 

should take a leadership role in 

the development and implementation of clinical practice 

guidelines for survivors and 

mobilizing adoption of these 

guidelines as part of their respective states’ cancer control 

plans. This work should also 
Accelerating Successes Against Cancer 49

involve looking at model programs and practices and ways 

to improve reimbursement for 

survivorship services. 

3. Working groups drawn from 

the Cancer Centers should be 

convened to work on implementing the two action items 

listed above. Consideration 

should given to having a meeting, hosted by the NCI Office 

of Cancer Survivorship, that 

brings together experts on 

these topics, develops specific 

plans on how to achieve these 

objectives, and establishes a 

process for monitoring and 

ensuring progress. 

Introduction

The Cancer Center Director 

Working Group Survivorship 

Subcommittee adopts the NCI 

definition that “an individual is 

considered a cancer survivor from 

the time of diagnosis, through 

the balance of his or her life.” 

Consistent with the definition, 

the domain of cancer survivorship 

covers the physical, psychosocial, 

and economic issues of cancer, 

from diagnosis until the end of 

life. It includes issues related to 

the ability to get health care and 

follow up treatment, late effects 

of treatment, second cancers, 

and quality of life. Survivorship 

programs at Cancer Centers should 

address the uniqueness of each 

individual’s disease experience, as 

impacted by:

Type of cancer

Stage at diagnosis

Age or life stage at time of 

treatment

Long-term disabilities or 

impairments, including 

the risk of second primary 

malignancies, caused by 

treatment or disease

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50 Accelerating Successes Against Cancer

Current Knowledge, 

Issues, and Problems

Over the past 20 to 30 years, 

Cancer Centers excelled in preparing patients for treatment, but the 

time has come to move with greater 

emphasis towards preparing patients 

for recovery and survivorship. This 

preparation should include the 

implementation of early detection 

protocols since second primary 

malignancies among this group account for approximately 16% of all 

cancer incidence. 

Cancer survivors, including their 

families, experience a spectrum of 

mental and physical problems in 

transitioning from active treatment 

to follow-up care. Many find they 

need assistance in adjusting to their 

“new normal.” 

Longitudinal research on quality of 

life and symptom management is 

needed to better serve the needs of 

cancer survivors. This longitudinal 

research should begin at the point 

of diagnosis. The ability to follow 

these individuals and their families 

throughout their life span would be 

enhanced by the ability of Cancer 

Centers to establish affiliations 

with community practitioners that 

provide ongoing medical care to 

cancer survivors once active treatment ends.

According to the Institute of 

Medicine’s (IOM) reports, titled 

Childhood Cancer Survivorship: 

Improving Care and Quality of Life

and From Cancer Patient to Cancer 

Survivor: Lost in Transition (see 

Appendix B of this report), and consistent with the President’s Cancer 

Panel 2003/2004 Annual Report, 

Living Beyond Cancer: Finding a 

New Balance (see Appendix C of this 

report), there is a need for cancer 

patients to receive a comprehensive 

care summary and follow-up plan. 

Such a care plan would summarize 

critical information needed for the 

survivor’s long-term care. 

Moreover, there is a consensus 

agreement on the need to work 

toward development of evidencebased clinical practice guidelines for 

the care of survivors.

Cancer Centers have a substantial 

number of activities in survivorship. 

However, for adults in particular, 

these activities are focused on the 

most common forms of cancer and 

on longer-term aspects of survivorship. Therefore, deficiencies or 

gaps may exist in addressing the 

needs of survivors of less common 

forms of cancer and in the period 

just following completion of initial 

treatment. 

Emerging Therapeutic 

and Interventional 

Strategies

Many Cancer Centers have 

established programs and clinics 

for survivors of pediatric cancers, 

recognizing the long-term care 

needs of this patient population. 

This comprehensive approach to 

survivorship research and followup care has only recently been 

applied to populations diagnosed 

with cancer in adulthood. As a 

successful model of a multidisciplinary comprehensive cancer 

survivorship program, we refer to 

The Lance Armstrong Foundation 

Living Well After Cancer Program 

at the Abramson Cancer Center 

of the University of Pennsylvania 

(see sidebar). 

The adoption and refinement of 

this pediatric model will allow 

Cancer Centers to develop multidisciplinary teams that can provide 

not only a comprehensive array of 

services to meet the needs of adult 

survivors, but to do so within a 

research-based environment. This 

approach provides a foundation 

for research efforts, such as the 

determination of optimal surveillance strategies for survivors and 

the development of new biomarkers to facilitate the early detection 

of disease recurrence and second 

primary cancers, while facilitating 

continuity of care. 

The interventional strategies offered in these multidisciplinary 

clinics should address the common 

acute and long-term problems associated with survivorship, such as:

Fatigue

Depression

Sexual problems

Cognitive problems

Second cancer risk

Therapy-related chronic 

disease (e.g., cardiac, 

pulmonary, endocrine)

Psychosocial function 

(e.g., education, marriage, 

employment)

Health behaviors (e.g., tobacco 

use, diet, exercise, medical 

screening)

Reproduction and offspring

Furthermore, as the medical sequellae of treatments become better 

understood, research to identify 

useful interventions during cancer 

treatment should be greatly expanded in the form of cross-institutional clinical trials.

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Accelerating Successes Against Cancer 51

Lance Armstrong Foundation’s Living Well After Cancer

A Model Program in Cancer Survivorship

The Lance Armstrong Foundation (LAF) Living Well After Cancer (LWAC) Program at the Abramson Cancer Center of the University of Pennsylvania is a successful model of a multidisciplinary survivorship program in a large, complex Comprehensive 

Cancer Center. The program consists of specialists from medical oncology (physicians and nurse practitioners), cardiology, 

rehabilitation medicine, and exercise physiology, psychiatry and behavioral science, social work, nutrition, and primary care 

– working in a collaborative environment. 

The LWAC team determined that a research focus would be critical to its success and sustainability. To facilitate this, they 

have developed databases and chose tools to evaluate medical and psychosocial aspects of survivorship. During the first 

2 years of the program, LWAC developed and refined their practice and consultative models of care. They also developed 

a transition program for young adult survivors of childhood cancers. LWAC’s strategy is to include treatment teams who 

care for a specific population as sub-protocol PIs responsible for identifying eligible patients. This strategy has been well 

received by the oncology practice teams at the university. 

Developing the LAF LWAC program required that the team members go through a number of cycles of implementing, evaluating, and redesigning their care models and assessment tools. The initial aim was to develop a single clinical care/research 

center for cancer survivors. However, after piloting this it was evident that more than one model of care was needed; differences in patient populations and the needs of providers meant that a ‘one size fits all’ approach to program development 

was unlikely to provide the best care possible.

After careful consideration, the LWAC team developed parallel practice and consultative models. The practice model provides routine follow-up care, surveillance, and an individual risk profile for late effects of treatment based on age, family 

history, co-morbidities, and cancer treatment history. 

In addition to the large volume of survivors that mandates a separate clinical program, the issue of continuity of care with 

the primary oncology practice teams was an important consideration for patients and oncologists. Consequently, LWAC developed the consultative model to pilot and determine feasibility. LWAC serves as research consultants to the treating teams 

to allow for continuity of survivorship care while generating useful data for research. 

Patients are followed prospectively from diagnosis with yearly mailings of study packets. These data are combined with 

clinical data to provide a prospective understanding of the survivor experience. This approach may prove particularly useful, 

as it allows for the use of baseline indicators in the construction of models to predict differing trajectories in the survivorship experience among populations of patients with different cancer diagnoses, which may allow for early identification of 

individuals at risk for developing difficulties during survivorship. 

The goal of the LAF LWAC Program is to improve the care provided to cancer survivors. To accomplish this, stakeholders are 

included in the design and implementation of programs, focusing on issues that they find pressing, and overcoming identified barriers to uptake of services.
52 Accelerating Successes Against Cancer

Identification and 

Prioritization of 

Opportunities for 

Advancement

Individual Cancer Centers and 

Academic Medical Centers

Academic medical centers, and 

Cancer Centers in particular, 

have an important role in survivorship research, clinical care, 

and education. With regard to 

research, studies are needed that 

can contribute to evidence-based 

guidelines for the optimal care of 

pediatric, adolescent, and adult 

survivors of cancer. With regard to 

clinical care, new service delivery 

models are needed that will allow 

Cancer Centers to work closely 

with community providers to provide follow-up care. With regard 

to education, Cancer Centers 

need to take the lead in informing 

patients, families, and the medical community about the common 

problems experienced by cancer 

survivors and their management. 

As an initial effort to describe 

the survivorship activities at the 

Nation’s Cancer Centers, we 

solicited narrative descriptions of 

research, clinical, and education 

efforts in this area. These narratives are found in Appendix D of 

this report which is available at 

www.cancer.gov/cancercenters/. We 

subsequently developed a template 

that provided an opportunity to 

collect standardized information on 

these activities. The data submitted 

by the Cancer Centers were compiled into an extensive grid that 

provides a basis for further analysis 

and interpretation of the various 

categories of survivorship activities 

currently being provided and what 

may be lacking and needed to reach 

the goal of ending the suffering 

and death from cancer. The grid, 

found in Appendix E of this report, 

provides a more effective means of 

communicating the breadth and 

depth of activities currently taking place at Cancer Centers, and 

identifies opportunities to share best 

practice models, as well as provides 

focus on survivorship activities that 

may be lacking. 

The Survivorship Subcommittee 

recommends that systematic data 

collection occurs using a welldefined, online survey method to 

gather commonly codified data. 

This will allow for a deeper analysis of those activities available at 

Cancer Centers, and identify gaps 

that exist. 

Cancer Center Collaborations 

Cancer Centers can generate the 

knowledge base related to survivorship issues, conduct pilot programs, 

and coordinate large-scale studies 

and demonstration projects. In 

addition to generating new knowledge, Cancer Centers can utilize 

and disseminate existing knowledge 

to ensure that best practices become 

part of routine clinical care. 

Community Collaborations

Work in survivorship is seen as a 

continuum that will require partnerships of Cancer Centers with 

community care practitioners. Cancer Centers can serve as the hub of 

networks involved in clinical care, 

education, and research at it relates 

to survivorship. These networks 

can also serve as the foundation for 

the conduct of multisite demonstration projects. One such demonstration project should be the 

development of community-based 

alliance models that evaluate the 

quality of care provided to cancer 

survivors through the monitoring of both health outcomes and 

processes of care. 

Health Care Providers and Payer 

Systems

Reimbursement for psychosocial 

and palliative care and for symptom 

management must be integrated 

into health insurance plans. Cancer 

Centers can assist advocacy groups 

in pursuing this activity. 

Policy-makers and Government 

Agencies

The NCI should consider establishment of survivorship programs and 

survivorship research as an essential element of an NCI-designated 

Comprehensive Cancer Center. 

Modest funding of survivorship activities by NCI would leverage the 

ability of Cancer Centers to attract 

other funding sources to this area.

Pharmaceutical/Biotechnology 

Companies

Pharmaceutical and biotechnology 

companies should be considered 

among the stakeholders that have 

a vested interest in survivorship 

activities. In addition to support 

for educational efforts, assistance 

should be sought from pharmaceutical companies for the conduct 

of clinical trials of pharmacologic 

agents with the potential to address common problems of cancer 

survivorship (e.g., depression and 

fatigue). In addition, support 

should be sought from the biotechnology industry to support research 

on development of new biomarkers 

for early detection and on identification of genetic risk factors for 

common problems (e.g., second 

malignancies, cognitive difficulties). 
Accelerating Successes Against Cancer 53

Individual Behaviors

Cancer Centers play a significant 

role in educating cancer survivors, 

their families, and health care providers about issues faced by cancer 

survivors. Most Cancer Centers 

have already established programs 

that provide information and support for patients undergoing cancer 

treatment. This work now needs to 

be extended to the post-treatment 

period. In addition, education 

and service programs are needed 

that can foster adoption of positive health behaviors (e.g., regular 

exercise, diets high in fruits and 

vegetables) among survivors.

Anticipated Outcomes 

and Potential Impact

These efforts by Cancer Centers 

should lead to improvements in the 

quality of care provided to cancer 

survivors and their families and, 

by extension, improvements in the 

quality of their lives. Cancer Centers are uniquely positioned to lead 

these efforts and in doing so, can 

galvanize public and medical community support for the view that a 

comprehensive approach to cancer 

care should extend throughout a 

patient’s life span.

 

The Survivorship Subcommittee recommends evaluating the 

establishment of a shared resource 

data warehouse containing a single 

source of resources for patients, 

academic center faculty, and community practitioners. Such a data 

warehouse would create a remarkable resource to facilitate research 

and comparability. 

Cancer Centers could provide their 

information online, within in a 

public domain, which may include 

the following examples:

Follow up procedures

Common sets of data elements

Survivorship protocols, 

especially coordinated with 

prevention activities relative to 

tobacco use, obesity, etc.

Questionnaires

Definitions

Educational materials

This warehouse would not only 

facilitate Cancer Center collaborations, but would also provide an 

outstanding resource to disseminate 

information to the community. 

References

NCI Strategic Plan 2006; http://strategicplan.nci.nih.gov/

Travis LB, et al. Cancer survivorship—genetic susceptibility and 

second primary cancers: research 

strategies and recommendations. 

JNCI 2006; 98(1): 15-25.

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•
Summary

While great progress could be made to reduce cancer mortality, roadblocks to collaborations exist that will be necessary to overcome in four primary areas of consideration 

– chemoprevention trials, therapeutic trials, deployment of biomarker and imaging agents, and survivorship. Below summarizes 

these roadblocks, and key action items are proposed that could be 

undertaken by Cancer Centers to begin to overcome them.

Chemoprevention trials

Difficulties in accruing large 

patient volumes, a lack of infrastructure within Cancer Centers, 

declining funding, and the size, 

complexity, and expense of these 

trials mandates a need for collaborations between Cancer Centers 

to conduct large chemoprevention 

trials. Liability concerns and lack 

of profitability have made it difficult to engage pharmaceutical and 

biotechnology companies in large 

prevention trials. 

Action item: We recommend that 

a Cancer Center consortium be 

formed to centralize chemoprevention trial infrastructure activities.

Therapy trials

It is difficult for partnerships to 

remain intact for the 10-15 years 

required to take a therapeutic from 

concept to clinical practice. Many 

industry collaborators are abandoning their traditional academic 

partners in therapeutic trials due 

to difficulties of dealing with legal 

issues and the technology licensing and contracting offices of these 

institutions. 

Action item: Collaborations 

between institutions would be 

facilitated by a shared licensing 

agreement that reduces the burden 

of individual contract negotiations 

with each partner. 

Biomarkers and Imaging

Technology advancements are 

acutely needed in the rapid development of assays for proteins 

in blood and other body fluids for 

early detection that are inexpensive, sensitive, and quantitative. 

One major challenge to the use 

of surrogate biomarkers in clinical 

trials is the difficulty of establishing 

a predictive relationship between 

the surrogate and mortality from 

the disease. 

Scientists involved in the commercial side of diagnostic tests 

complain of an inadequate source 

of human samples for marker validation. There is a need for greater 

understanding of the value added 

by a good diagnostic test because 

currently, there is little economic 

incentive to develop diagnostic 

tests. For example, the opportunity 

for early detection and risk assessment is very poor due to the lack 

Collaborations

54 Accelerating Successes Against Cancer
Accelerating Successes Against Cancer 55

of reimbursement by Medicare and 

Medicaid for disease prevention. 

The necessary interdisciplinary 

collaborations needed to discover 

new imaging agents is lacking in 

most Cancer Centers. Regulatory 

bodies are often overly restrictive in their application of vague 

safety and consent requirements to 

imaging trials that are designed for 

therapy trials.

Action item: A consortium of 

companies should be organized to 

fund a precompetitive academic 

activity to improve the technology 

for biomarker discovery, particularly 

protein biomarkers, much like the 

SNP Consortium.

Survivorship

Research requires longitudinal 

studies, multiple sites of care, or 

studies at multiple institutions to 

obtain sufficient samples sizes. The 

lack of uniformity or standardization of quality control can impede 

combining data from different 

sources. Provisions of the Health 

Information Privacy and Accountability Act (HIPAA) inhibit the 

ability to track and collect data 

for research.

Action item: A consortium of 

Cancer Centers should be formed 

to coordinate research efforts 

and funding strategies in order to 

facilitate the conduct of multi-institutional studies and the creation 

of a comprehensive research infrastructure.

Introduction

The NCI goal as expressed in the 

2006 Strategic Plan is to “Reduce 

the burden and eliminate the adverse outcomes of cancer by leading 

an integrated effort to advance fundamental knowledge about cancer 

across a dynamic continuum of discovery, development and delivery.” 

The strategy for meeting this goal 

depends on successful collaboration across the entire spectrum of 

stakeholders. “We as a Nation will 

achieve this vision by optimizing 

new approaches in interdisciplinary 

collaborations and transdisciplinary 

science,” NCI explains. “Our success will depend on our ability to 

integrate our activities across a 

seamless continuum of discovery, 

development, and delivery; partner 

with others to leverage resources, 

and build synergy.” Most of the 

goals in the NCI Strategic Plan 

require large-scale collaboration 

across two or more entities.

Current Knowledge, 

Issues, and Problems

There are many potential arenas 

for collaboration for NCI-designated Cancer Centers. Moreover, 

these collaborations extend from 

a micro-scale – involving individuals within a Cancer Center 

collaborating with individuals or 

organizations outside the Center 

– to the macro-scale involving 

institution to institution collaboration and consortia of institutions. In general, micro-scale 

collaborations are frequent and 

productive and depend more upon 

the initiative of the individual 

than the leadership of the institution. A survey was taken of the 

NCI-designated Cancer Centers 

to identify core resources that 

could be shared among centers 

(Appendix F). We will focus our 

consideration for this report in the 

macro-scale collaborations. 

Many areas of medical science are 

evolving toward larger scale science projects motivated by opportunities to apply the abundance of 

new knowledge to patient needs. 

Application of new discoveries 

into standard medical practice is, 

by its nature, a much larger undertaking than discovery science, 

requiring highly organized, systematic activity involving collaborations across research institutions, 

industry, patient care providers, 

governmental agencies, and regulatory entities.

The subcommittee was greatly 

aided by a recent report from 

National Research Council and 

Institute of Medicine (NRC / IoM) 

titled “Large-Scale Biomedical 

Science.” This report is strongly 

recommended for a much greater 

depth of consideration of these 

topics than can be provide here. 

Emerging Therapeutic 

and Interventional 

Strategies

The NCI Strategic Plan for 2006 

lays out a large number of strategic aims, many of which are big 

science projects requiring collaboration across many sectors of the 

discovery, commercialization, and 

implementation pipeline. As part of 

the academic medical community, 

Cancer Centers have had limited 

success with these larger scale collaborations. Four areas described 

below– prevention, diagnostics, 

therapeutics, and survivorship 

– might benefit from more effective 

large-scale collaboration. 
56 Accelerating Successes Against Cancer

Identification and 

Prioritization of 

Opportunities for 

Advancement

Prevention

Focus on Collaborations in Chemoprevention Trials During the past decade 

several prominent task forces of 

national experts have identified 

chemoprevention as a major area 

of cancer prevention research that 

could have a significant impact on 

the cancer burden. Studies have 

shown that chemopreventive agents 

can be effective in preventing cancer in a high-risk population (e.g., 

the Breast Cancer Prevention Trial, 

testing tamoxifen in women at high 

risk for breast cancer that showed 

a 49% reduction in incidence of 

invasive breast cancer). 

Currently, NCI has about 400 

compounds under study and has 

identified five classes of promising 

chemopreventive agents that are 

considered priority. Because the 

chemoprevention research pipeline 

is complex and involves large, longterm, expensive studies of high-risk 

and healthy populations, the collaborations required – among NCI, 

Cancer Centers, research networks, 

and industry – are substantial to 

continue to advance this area of 

cancer prevention.

NCI’s Chemoprevention Program 

Among the cancer prevention 

initiatives, the NCI Strategic Plan 

has identified strategies to advance 

chemoprevention research that will 

require broad-scale collaborations 

within the cancer research community, including supporting a robust 

cancer prevention agent development program, large-scale clinical 

trials to evaluate cancer prevention 

agents, and a consortium of research 

centers for conducting chemoprevention trials.

At present, there are focused 

programs within NCI’s Division of 

Cancer Prevent (DCP) that support 

collaborative work on chemoprevention agents and Phase I clinical 

trial development, including:

The Rapid Access to 

Preventive Intervention 

Development (RAPID) 

program provides contract 

resources to the research 

community for preclinical and 

early clinical drug development 

of potential chemopreventive 

agents. This facilitates the 

process of bringing discoveries 

from the laboratory to clinical 

trials, potentially enhancing 

the attractiveness of licensing 

candidates for industry.

The Early Detection 

Research Network (EDRN) 

is a national network and 

scientific consortium for the 

development, evaluation, 

and validation of biomarkers 

for early detection and risk 

assessment for cancer. With 

relatively small funding, experts 

note that this mechanism has 

done a “commendable job” 

developing collaborations across 

Cancer Centers, SPORES, and 

Program Projects.

Clinical trials for chemoprevention 

agents are currently coordinated 

through consortium groups of 

research centers conducting ongoing Phase I and II trials, Cancer 

Centers, and cooperative groups, 

with additional participation of 

community physicians through the 

Community Clinical Oncology 

Program (CCOP).

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•

A set of initiatives supported by 

NCI’s National Cancer Advisory 

Board (NCAB) for revamping the 

NCI clinical trials system is addressing the need for enhanced scientific 

quality and clinical trial prioritization, including increased collaboration with the broad oncology community. The plan is to investigate 

expansion of these initiatives in 

the future to include studies of new 

preventive agents.

Key Challenges 

Requiring Large-Scale 

Collaborations

Chemoprevention

While there has been significant 

progress and promising outcomes in 

the developing chemoprevention 

field, it faces some significant challenges and an overarching need for 

large-scale collaborations:

Size, expense, and timeframe Largescale Phase III clinical trials, 

involving hundreds to thousands of 

high-risk and healthy populations, 

and multi-institutional participation, are required to test whether 

cancer risk can be reduced by chemoprevention interventions as well 

as to provide opportunities to validate potential biomarkers. These 

trials are expensive and require a 

long timeframe for completion (10 

years or more). 

Clinical trial infrastructure Within 

individual Cancer Centers, the 

infrastructure for supporting large 

Phase II and Phase III chemoprevention trials is viewed by many 

experts as “gravely lacking” and 

a key research barrier. Cancer 

Center clinical trials offices and 

data management support are 

primarily focused on therapeutic 
Accelerating Successes Against Cancer 57

trials involving cancer patients 

rather than population-based trials 

requiring specialized support (i.e., 

data management, statistical, trial 

recruitment, etc.). Only institutions 

with large Program Project grants 

– which have been an effective 

mechanism for advancing cancer 

prevention translational research, 

although such funding is declining 

– have been able to develop the 

capacity for Phase IIB or Phase III 

chemoprevention trials. However, 

individual Cancer Centers generally 

do not have the ability to accrue 

large patient volumes for Phase III 

trials or to coordinate and conduct 

large-scale intermediate biomarker 

endpoints required for translational 

research success. 

The lack of infrastructure within 

Cancer Centers – coupled with 

declining Program Project funding and the size, complexity, and 

expense of these trials – mandates 

a need for collaborations between 

Cancer Centers to conduct large 

chemoprevention trials. Mechanisms need to be considered – 

potentially centralized or through 

a consortium arrangement– that 

most effectively address infrastructure deficiencies for large-scale 

trials. Collaborations will also be 

needed with cooperative groups 

and research networks, which will 

likely benefit from consortium 

arrangements comprised of organizations that are best suited for, 

and interested in, population-based 

chemoprevention trials.

Safety and trial design The results of 

some recent large chemopreventive 

studies have varied significantly 

from expectations. For example, 

the Beta-Carotene and Retinol 

Efficacy Trial (CARET), testing a 

combination of beta carotene and 

vitamin A supplements in persons 

at high risk for lung cancer, showed 

a 28% increase in lung cancers and 

17% higher death rate compared to 

the placebo group. This has raised 

concerns about the safety of using 

chemopreventive agents in otherwise healthy subjects and the need 

for scientific collaboration to ensure 

that long-term benefits outweigh 

major side effects. 

Concerns have also been raised 

about past chemoprevention 

agents moving into Phase III 

studies without adequate justification. These concerns have been 

attributed to issues such as appropriate dose scheduling; singleversus multiple-agent regimens; 

and inadequate underlying animal 

pharmacology/mechanistic studies, 

Phase I and early Phase II studies, 

and intermediate biomarker endpoints. Some of these concerns are 

beginning to be addressed through 

DCP’s Phase I/II chemoprevention 

consortium effort.

Additional challenges include 

engaging the interest and involvement of pharmaceutical and 

biotechnology companies. To date, 

they have had a lack of interest in 

the cancer chemoprevention field, 

in contrast to embracing cardiovascular chemoprevention. This 

has been in part due to safety and 

liability concerns and the alleged 

lack of profitability of chemoprevention agents.

Treatment

As discussed in the NCI’s 2006 

Strategic Plan, the most important 

scientific strategies for advancing 

cancer treatment are: understanding 

the fundamental differences between 

metastatic and non-metastatic cancers; developing biomarkers and 

imaging agents to improve monitoring of treatment response; and 

developing molecularly-targeted 

agents with fewer toxicities. The 

Plan emphasizes the importance of 

integrating preclinical and clinical 

research and recognizes that collaboration among clinical scientists, cancer modelers, and imaging 

researchers through public/private 

partnerships will be an important 

implementation strategy. 

However, NCI’s Strategy does not 

address how these collaborations 

and partnerships can be facilitated 

so they are more effective than 

past NCI efforts to foster partnerships among these groups. Recent 

examples include the NCI Cancer 

Genome Anatomy Project (CGAP) 

program for development of early 

drugs in clinical trials, SPORE 

grants, and the AP4 initiative, 

all of which are popular with the 

participating institutions, but 

which have not yet demonstrated 

their value through promising new 

therapeutic targets. 

A challenge of all of these types of 

initiatives is the long time frame 

required to take a therapeutic 

agent from concept to practice. 

Therefore, collaboration models 

must be measured over a 10-15 

year time horizon, and it is difficult 

for partnerships to remain intact 

for such a long period. Cancer 

Center directors were surveyed 

about successful inter-institutional 

partnerships at their organizations. Two interesting models that 

were presented for further analysis were: the State of California, 

the University of California and 

various industry groups; and the 

Immune Tolerance Network, 

which is a nonprofit organization 

that provides funding, clinical 
58 Accelerating Successes Against Cancer

trials support, and access to assays, 

agents, and equipment.

Interviews with academic and 

industry scientists revealed many inherent difficulties with academic/industry partnerships that will require 

significant leadership in the field to 

overcome. Although academic institutions bring a wealth of expertise 

to the table, most industry partners 

have become extraordinarily wary 

about dealing with the legal, technology licensing, and contracting 

offices of these institutions. Agreements can take months or years to 

negotiate, and many institutional 

review boards are unsophisticated 

and cumbersome. Most industry 

representatives have abandoned 

academic institutions as a clinical 

trials venue and try to eliminate 

them from the drug development 

process at the earliest possible time. 

It is ironic that community hospitals, 

community oncology groups and 

overseas health systems are easier to 

work with than organizations that 

were created and structured for this 

very purpose. Furthermore, many 

of the new technologies that show 

promise toward shortening the longterm costs of clinical trials – such as 

biomarkers and new imaging modalities – are very expensive on a costper-case basis. Much work remains 

to be done to communicate the cost 

effectiveness of these studies to payers and industry representatives. 

A discipline that receives little 

mention in the therapeutics section 

of the NCI Strategic Plan is health 

economics. Nonetheless, in these 

difficult times in the Federal budget, 

the therapies with the highest likelihood of adoption by Medicare and 

other payers are those that reduce 

the total cost of cancer care.

There are two working groups within the NCI that are endeavoring to 

understand how barriers to partnership in therapeutics can be overcome. The first is the Translational 

Research Working Group (TRWG) 

and the second is the Clinical Trials 

Working Group (CTWG). Both 

have representation from most 

of the key stakeholders and their 

recommendations will help shape 

the changes that need to be made to 

create an environment more favorable to partnership. Both groups 

must assure that their recommendations are reviewed by economists 

because, in the end, development 

of translational discoveries must be 

funded by the financial markets and 

the health care payers. NCI’s ability 

to fund this development effort is 

extremely limited and Cancer Centers must look to industry partners 

for this effort.

In addition, several Cancer Centers 

are willing to partner with other 

Centers and with industry to bring 

together the strengths of each organization. However, many of them 

will need help to overcome administrative barriers that transcend the 

creative skills of academic officials. 

NCI should consider taking some of 

the key resources that the NIH has 

invested in – such as the San Diego 

Center for Chemical Genomics, 

Harvard’s Initiative for Chemical 

Genetics, the Mouse Model Consortium – and hiring top-tiered intellectual property lawyers to work 

with the institutions involved on 

a shared licensing agreement that 

reduces the burden of individual 

contract negotiations with each 

partner. Industry groups and foundations have found ways to manage 

these licensing issues and nonprofit 

and governmental organizations 

must adopt their best practices.

Biomarkers and Imaging

The NCI Strategic Plan relies 

heavily on advances in biomarkers 

and targeted imaging for improving the diagnosis, treatment, and 

prevention of cancer. The pipeline 

for both biomarkers and targeted 

imaging agents involves a series 

of steps from discovery to validation, commercialization, regulatory 

approval, and implementation. 

For both there is a continuum of 

partnerships needed involving 

research funding from the NIH or 

foundations, discovery in academic or commercial laboratories, 

commercialization by companies, 

approval by FDA and implementation by CMS and other insurers, and adoption by health care 

agencies and patients. Incentives 

and bottlenecks along this pipeline were considered, and points 

at which innovative solutions are 

needed are identified below.

Need for Protein Biomarkers Many 

applications of DNA-based biomarkers require direct biopsy of 

diseased tissue, which requires that 

the tumor be identified, localized, 

and accessible, and hence are only 

applicable between the stages of 

tumor localization and removal. 

Biomarkers that can be accessed 

noninvasively are needed at all 

stages of disease management, 

from risk assessment to treatment. 

The most informative biomarkers 

are likely to be proteins because 

of their diversity and proximity to 

function. They are also likely candidates for imaging targets.

Diagnostics Work in a System Our 

goals in applying biomarkers to 

disease management are: to identify 

persons with potentially life-threatening cancers at the earliest stage 

possible; to avoid false-positive 
Accelerating Successes Against Cancer 59

tests and unnecessary treatments; 

and to minimize the overall cost of 

the program. Since no single test 

performs perfectly, sensitivity, specificity, and cost become tradeoffs in 

the application of diagnostics to 

disease management. Ultimately, 

the goal will be to optimize overall 

performance of a system of tests and 

interventions. The advantage of a 

systems approach is that biomarkers 

whose performance may be inadequate when considered at a single 

stage of the disease continuum may 

actually be of great value when integrated into a disease management 

continuum. 

Discovery of Protein Biomarkers 

Although there have been significant advances in proteomics, the 

discovery of new protein biomarkers appears to be stalled. NCI has 

recently moved to accelerate the 

field with programs that foster discovery in mouse models of cancer, 

provide for informatics support, reagents, and large grants for centers 

for technology development. Technology advancements are acutely 

needed in the rapid development 

of assays for proteins in blood and 

other body fluids that are inexpensive, sensitive, and quantitative. In 

the area of collaborations, most of 

the effort is currently being made 

between NIH and academic laboratories. A consortium of companies 

that would invest in discovery technology as a precompetitive activity, 

much like the SNP consortium, 

could be highly effective in moving 

the field forward.

Validation of Biomarkers Protein 

biomarker validation is currently 

conducted either via collaborations between NCI and academia 

(for example, the EDRN program) 

or as a commercial activity with or 

without an academic partner. Few 

protein biomarkers are currently in 

the validation stage. The bottleneck 

at discovery means that validation studies are often limited to a 

single biomarker at a time. If the 

bottleneck to discovery were solved, 

biomarkers could be multiplexed by 

the hundreds in validation studies, 

dramatically decreasing the cost per 

marker and increasing the probability that some would be validated. 

At the other end of the pipeline, 

the perception of low reimbursement and thus insignificant profits 

to cover development cost inhibits 

companies from undertaking validation studies unless the biomarker 

is necessary for a drug therapy 

that will yield significant financial 

return. One major challenge to the 

use of surrogate markers in clinical 

trials is the difficulty of establishing 

a predictive relationship between 

the surrogate and mortality.

Commercialization of Biomarkers 

Commercialization of biomarkers 

for diagnostic tests usually involves 

a commercial entity to provide the 

necessary investment and quality 

control, and an academic partner 

to provide biological insight, assays, and tissues. Industry scientists 

complain of an inadequate source of 

well-annotated human samples for 

marker validation. Obtaining such 

samples is the single most expensive 

aspect of diagnostic test development. New health privacy regulations (HIPAA) and differences in 

interpretation of what constitutes 

informed consent further exacerbate 

this problem.

Another serious impediment to 

biomarker commercialization stems 

from intellectual property (IP) 

issues. Use of panels of biomarkers 

in the future will be very difficult if 

different entities own IP rights to 

different markers. 

The total market for a successful 

diagnostic may be $50-100 million 

per year but the cost of development can be more than $100 

million. As a consequence, there is 

not enough economic incentive to 

develop diagnostic tests that will 

only be used once regardless of their 

importance in health care. The 

opportunity for early detection and 

risk assessment is very poor due to 

the lack of reimbursement by CMS 

for disease prevention practices.

Approval of Biomarkers Both the 

FDA and CMS regulate diagnostic 

tests. FDA regulates tests that are 

sold as kits or systems in interstate 

commerce while CMS oversees 

laboratory testing services commercially offered at single sites, 

in-house or “home-brew” or sold 

commercially to CLIA-approved 

laboratories as analyte-specific 

reagents. Several hurdles frequently 

thwart the FDA approval process. 

As a result, the CLIA home-brew 

policy is an easier route to approval 

and may obtain higher reimbursement by dealing directly with the 

user. There is concern in some 

quarters that the home-brew procedures for approval do not assure 

enough patient protection and that 

this option should be eliminated. 

This recommendation would be a 

disaster for the implementation of 

biomarkers in cancer.

Given the likelihood that many 

biomarker tests will be developed 

for use in guiding molecularly-targeted therapeutic interventions, 

there are not currently procedures 

for co-review or co-approval by 

FDA and CMS, although these are 

under consideration.
60 Accelerating Successes Against Cancer

Implementation of Biomarkers The 

economic incentive for diagnostic 

tests is low because most tests will 

be performed infrequently on a 

patient. Reimbursement is calculated based on the cost of doing the 

test rather than considering value 

added by the test or the costs of its 

development. This is entirely different than reimbursement for therapeutics. There is a need for more 

understanding of the value added by 

a good diagnostic test. Two government commissioned reports have 

recommended a re-evaluation of 

reimbursement rates for diagnostics.

Three diagnostic companies 

compete for control of clinical 

laboratory testing. Tests are standardized utilizing primarily antibody 

tests and polymerase chain reaction (PCR) technology. Any new 

technology platform for diagnostics 

would be difficult to introduce.

The promise of biomarkers for reducing mortality by early detection 

of cancer is completely undermined 

by the fact that Medicare does not 

reimburse for screening tests unless 

mandated by Congress, as is the 

case for colonoscopy.

Recommendations for Biomarkers A 

specific statement from NCI as to 

the clinical problems for which 

tests are needed, what performance 

standards need to be met, and funds 

to support their development might 

provide motivation for development 

of new biomarker tests.

Discovery of Imaging Agents Discovery of new imaging agents 

seems to be most productive in 

academic centers that involve 

collaboration across academic 

departments and disciplines, with 

funding from NIH and one of the 

three large companies that produce 

imaging instrumentation. The 

NCI has established a series of 

such imaging centers. While these 

provide a strong focus for collaboration, progress is often less than 

optimal because of the difficulty of 

collaborating across disciplines. In 

many academic institutions these 

collaborations are not effective. 

Validation of Imaging Agents Fasttrack FDA approval for new 

agents only works for drugs with 

known toxicities that are adapted 

to imaging strategies. Completely 

new drugs do not fare as well. The 

preclinical burdens hamper development in terms of cost and time. 

Medical ethics committees do not 

understand the low risks imaging 

studies pose to subjects, and are often overly restrictive in their application of vague safety and consent 

requirements that are designed for 

therapy trials. 

Commercialization of Imaging

Agents The major instrumentation providers will be the likely 

entities to commercialize new 

imaging markers that achieve the 

necessary validation and approval. 

Reimbursement is good for imaging used in clinical diagnosis and 

treatment so there is both sufficient 

resources for commercialization 

and incentive to do so.

Approval of Imaging Agents Preclinical and validation components 

for imaging studies should focus on 

optimally defining the initial human 

trial. The rules of evidence for prognostic studies are not nearly as well 

defined as they are for treatment 

trials or for simple diagnostic measures. These need to be developed 

through a dialogue involving FDA, 

NCI, academia, and industry groups 

and should address the appropriate 

use of new imaging procedures in 

early clinical trials of experimental 

therapies. New imaging agents for 

targeted therapy cannot be developed and validated independent of 

the treatment protocols.

Implementation of Imaging Agents 

Since most new imaging agents 

will be designed to be used in one 

of a half dozen instruments that are 

widely available in health care settings, and since diagnostic imaging 

tests are well reimbursed, there are 

both the technical platforms and 

trained personnel to implement 

new imaging agents. 

However, one of the most important applications of imaging agents 

– to inform therapeutic outcomes 

in clinical trials – has not been 

effectively implemented. More 

than 80% of drugs entering clinical 

development do not receive FDA 

approval, with many failing late in 

development, often after prolonged 

Phase III trials, because of unexpected safety issues or difficulties in 

determining efficacy. This contributes to the high costs of oncology 

drug development and highlights 

the need for tools to identify promising candidates early in development. To that end, NCI, FDA, academic researchers, and industry are 

discussing ways to collaborate with 

the goal of identifying biomarkers 

that will provide a clear and timely 

picture of a patient’s cancer and its 

response to therapy. 

In oncology, the gold standard 

clinical trial endpoint is overall survival, which may require long-term 

studies and may be confounded by 

a patient’s death from causes other 

than cancer. Over the years, the 

oncology community and the FDA 
Accelerating Successes Against Cancer 61

have come to rely on endpoints 

that are regarded as correlates of 

clinical benefit or surrogate endpoints (SEP). However, the measurements of SEPs using standard 

anatomic imaging techniques are 

often inadequate, especially for 

monitoring the effects of drugs that 

do not cause tumor shrinkage or 

for cancers that progress slowly or 

metastasize diffusely.

Newer imaging modalities, including volumetric and functional 

imaging, show high promise as 

additional biomarkers in cancer. 

For example, clinical trials in 

breast cancer and other settings 

(e.g., non-small cell lung cancer and esophageal cancer) have 

demonstrated that FDG-PET – a 

physiologic imaging modality – may 

provide an early indication of therapeutic response that is well-correlated with clinical outcome. If the 

use of FDG-PET can be confirmed 

as a biomarker in such settings, 

unnecessary chemotherapy may 

be avoided for some patients and 

the costs of unnecessary long-term 

follow up reduced. The FDG-PET 

imaging modality has the potential 

to facilitate oncologic drug development by shortening Phase II 

trials and detecting clinical benefit 

earlier in Phase III investigations.

Current obstacles to including correlative imaging studies in clinical 

trials are: cost; the perception that 

adding a correlative imaging study 

will make the trial more difficult to 

implement and may hamper accrual; and the investigators’ concerns 

that the imaging study will not add 

value in terms of yielding publishable findings or as a validated 

endpoint that can be used in trial 

design. Collaborations are needed 

to define and develop imaging 

biomarkers based on newer imaging technologies for use in oncology drug development, particularly 

evaluation of therapeutic response. 

Ultimately, the outcome of these 

studies will inform the development 

FDA guidance and best practices in 

oncology.

Survivorship

Advances in the ability to detect, 

treat, and support cancer patients 

have turned cancer into a chronic 

or readily managed disease for many. 

There are 10 million Americans 

alive today with a personal history 

of cancer and as of 1997 there were 

270,000 survivors of childhood 

cancer. 

Recently, task forces of national 

experts have evaluated and identified the requirements for a comprehensive approach to addressing 

the needs of cancer survivors and 

patients diagnosed or treated for 

cancer. In accordance with those 

task force recommendations, the 

NCI Strategic Plan focuses on the 

following areas:

Discovery

n Expanding research 

efforts to understand 

the biological, physical, 

psychological, and social 

mechanisms, and their 

interactions, that affect a 

cancer patient’s response 

to disease, treatment, and 

recovery.

n Expanding the 

development and use of 

tools to assess the healthrelated quality of life and 

quality of care of cancer 

survivors and their family 

members, and tracking 

outcomes for these 

populations. 

•

Delivery

n Ensuring the delivery 

of new information, 

interventions, and best 

practices in collaboration 

with other Federal, 

professional, and nonprofit 

organizations.

Development

n Accelerating intervention 

research in order to reduce 

cancer-related chronic 

or late morbidity and 

mortality.

Key Challenges The majority of 

survivors (62%) are 5 years or more 

post-treatment. Thus research to 

understand the multiple factors 

influencing the health of survivors requires longitudinal studies, 

multiple sites of care, or studies at 

multiple institutions to obtain sufficient samples sizes. 

Funding Strategies Funding for 

research has traditionally been 

based on shorter-term projects 

rather than the longitudinal approach required for the long-term 

studies fundamental to survivorship 

research.

Complexities of Conducting MultiInstitutional Studies and Long-term 

Studies Multi-institutional studies 

may require data from a variety 

of sources and the lack of uniformity or standardization of quality 

control can impede combining data 

from different sources. Data collected in large-scale projects is often 

placed in publicly accessible databases, giving rise to issues of patient 

confidentiality and consent. The 

provision of HIPAA may inhibit 

the ability to track and collect data 

for research. Obtaining appropriate 

patient consent can be challenging 

for longitudinal studies and studies 

•

•
62 Accelerating Successes Against Cancer

conducted on data collected over a 

long period of time.

Coordination Among Health Care 

Providers Given that the majority 

of follow-up care for survivors is 

provided in the community, coordination between health specialists 

at Cancer Centers and community-based providers is critical but 

underdeveloped.

Infrastructure for a Comprehensive 

Database on Cancer Survivorship 

While the NCI has provided statistical information on cancer survivors 

in the United States, further work 

is required to improve coordination 

between existing resources [e.g., the 

Surveillance, Epidemiology, and End 

Results (SEER) program], and to 

develop the infrastructure for largescale studies.

Successes and Opportunities There 

are opportunities for further coordination between the NCI, Cancer 

Centers, foundations, community 

groups, and advocacy organizations. 

NCI is successfully partnering with 

local and national organizations 

including the American Cancer 

Society, the Intercultural Cancer 

Council, and the Lance Armstrong 

Foundation to provide informational 

resources on cancer survivorship 

to patients, family members and 

medical providers. These collaborations are ideal for the dissemination 

of educational materials including 

statistical information about cancer 

survivors, survivors’ second malignancies, quality of life, and other 

information such as current research 

grants and post-treatment resources.

Future collaborations to consider 

include coordination of efforts and 

funding strategies. For example, the 

Lance Armstrong Foundation is 

funding the development of cancer 

survivorship programs in multiple 

sites. Coordination of these efforts 

with NCI can provide efficiencies 

and contribute to a more comprehensive approach.

References

Chemoprevention

Interviews with and email communications:

David Alberts MD, Director of 

Arizona Cancer Center

John Baron MD, Dartmouth 

Medical School

John Crowley PhD, Southwest 

Oncology Group Statistical 

Center

John Potter MD, PhD, Fred 

Hutchinson Cancer Research 

Center

Ross Prentice PhD, Fred 

Hutchinson Cancer Research 

Center/Coordinating Center 

for Woman’s Health Initiative 

Alberts DS, et al. What happened 

to the coxibs on the way to the cardiologist? Can Epid Bio Prev, March 

2005 14(3): 555-556.

Exploring the Role of Cancer 

Centers for Integrating Aging 

and Cancer Research. Report of 

“Working Group 4: Prevention, 

Risk Assessment, and Screening”, 

from the NIA/NCI workshop June 

13-15, 2001. 

Greenwald P, McDonald SS. 

Cancer prevention: the roles of diet 

and chemoprevention. Can Contr J 

1997; 4(2).

Jankowski JA, Hawk ET. A methodologic analysis of chemoprevention and cancer prevention studies 

for gastrointestinal cancer. Nature 

Clin Prac Gastro & Hep 2006; 3(2): 

101-111.

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-

-

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NCI Strategic Plan. http://strategicplan.nci.nih.gov. January 2006.

NCI meeting minutes related to 

recommendations and developments from the Chemoprevention 

Implementation Group: NCI/

NCAB September 1997 meeting 

minutes and NCI Board of Scientific Advisors 11/08/99 meeting 

minutes.

Restructuring the National Cancer 

Clinical Trials Enterprise. Report of 

the Clinical Trials Working Group 

of the National Cancer Advisory 

Board. June 2005.

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June 1997.

Report from THE MARCH Research Task Force, September 1998.

Sporn MB, Libey KT. Cancer chemoprevention: scientific promise, 

clinical uncertainty. Nature Clinical Practice Oncology 2005; 2(10): 

518-525.

Therapy

Interviews:

Mac Cheever, MD

John Crowley, MD

Ben Shapiro, PhD

Spencer Lemons

Communications:

Kristiina Vuori, MD, PhD

Ronald Herberman, MD

Bruce Stillman, PhD

Catalyzing Team Science. Report 

from the 2003 BECON Symposium

DTP-NCI Academic Public-Private Partnership Program (AP4) 

http://dtp.nci.nih.gov/docs/ap4/ap4-

index.jsp.
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Hon ML. Can anyone make money 

from biomarkers? Start-Up September 2005.

NCI Strategic Plan. http://strategicplan.nci.nih.gov. January 2006.

Policy issues in the evaluation of 

clinical genetic testing for complex 

conditions. A University of Cambridge/Wellcome Trust Research 

Project.

Restructuring the National Cancer 

Clinical Trials Enterprise. Report of 

the Clinical Trials Working Group 

of the National Cancer Advisory 

Board. June 2005.

Simon JA, et al. Accelerating 

cancer drug discovery and development: leveraging the Nation’s academic cancer centers. Unpublished 

manuscript.

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Gutman S, Kessler L. The Food and 

Drug Administration perspective 

on development of biomarkers for 

cancer. (submitted for publication).

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Research. Report of the Institute 

of Medicine / National Research 

Council. 2003.

Phillips KA, et al. Diagnostics and 

biomarker development: priming 

the pipeline. Nat Rev Drug Dis (in 

press).

Phillips KA. A marriage made in 

heaven? Health policy implications 

of the integration of biotechnology 

and pharmacogenomics. (submitted 

for publication).

Ransohoff DF. Rules of evidence for 

cancer molecular-marker discovery 

and validation. Nature Rev Can 

2004; 4(4):309-314.

Medicare Laboratory Payment 

Policy Now and in the Future. 

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Medicine http://www.nap.edu/

books/0309072662/html.

Peter Corr / Pfizer

 

Steve Gutman / Director of the Office of InVitro Diagnostics, Center 

for Devices & Radiologic Health 

Arthur Holden, Chairman and 

Executive Director, DMD Translational Research Consortium / 

Chairman and Founder, Pharmaceutical Biomedical Research Consortium, Ltd

Bob Zivin / Johnson & Johnson

Jean-Luc Vanderheyden / GE 

Healthcare

Steven Seelig / VP, Abbott-Vysis 

Kathryn Phillips / School of Pharmacology / UCSF

Kenneth Hillan, VP of Development / Genentech & Bill Pignato 

(contractor for Genentech)

Alessandra Cesano / Amgen

Greg Rossi / Amgen

Judith Yost / Div of Lab Svcs (gov)

Lucy Lu, VP Technology Management, Head of US Chief Tech Office and Linda McAllister / Roche

Sam Gambhir / Stanford

Ken Krohn / University of 

Washington

Janet Eary / University of 

Washington

Ralph Weissleder / MGH

Bob Day / Fred Hutchinson Cancer 

Research Center

Tim Yeatman / Moffitt Cancer 

Center

Les Robinson / St. Jude

Dan Sullivan / NCI

Survivorship

Childhood Cancer Survivorship: 

Improving Care and Quality of Life. 

Report of a committee established 

by the Institute of Medicine, 2003.

From Cancer Patient to Cancer 

Survivor: Lost in Translation. Report of a committee established by 

the Institute of Medicine, 2006.

A National Action Plan for Cancer 

Survivorship: Advancing Public 

Health Strategies. Report sponsored 

by Centers for Disease Control and 

Prevention and the Lance Armstrong Foundation, 2004.

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a New Balance. Report of the 

President’s Cancer Panel, 2003-

2004 Annual Report.

National Cancer Institute web site 

www.cancer.gov

Interviews with Drs. Debra Friedman, Jean Sanders, Stephanie Lee, 

Paul Martin
Dissemination

Summary

Advances in diagnostic tests and treatments for cancer usually 

are made available to patients rapidly by Cancer Centers, 

academic medical centers, and major health care providers. However, reaching all patients with cancer, and their health 

care providers, is a goal obtainable only through concerted efforts 

in education and widespread adoption of best practices, especially 

by physicians for underserved populations. The NCI-designated 

Cancer Centers should ensure that opportunities to participate in 

clinical trials of new cancer treatments, preventative strategies, 

and early detection tests are made available to greater numbers of 

individuals, including underserved and diverse populations.

Highest Priority Strategies

The Federal government needs 

to designate a lead agency 

within the Department of 

Health and Human Services 

(HHS) to coordinate funding 

and dissemination of cancer 

control efforts to the entire 

U.S. population, by bringing 

together the fragmented efforts 

of NCI, CDC, CMS, and other 

HHS agencies.

Cancer Centers should take the 

lead in disseminating cancer 

care guidelines throughout 

their states, in collaboration 

with state health departments 

and state cancer plans.

Cancer Centers should work 

with state cancer registries to 

convert them into outcomes 

registries, and should use them 

to identify populations with 

disproportionate needs for 

cancer prevention and care.

Demonstration projects on the 

medical and financial benefits 

of best cancer control practices 

should be initiated in regions 

served by Cancer Centers, 

funded by CMS and led by the 

Cancer Centers.

•

•

•

•

Introduction

In order to fulfill as quickly as 

possible NCI’s Challenge Goal to 

eliminate the death and suffering 

from cancer – and to realize the 

potential for known best practices 

and research advances – it is essential to extend the expertise and 

infrastructure that has been extraordinarily well developed at the 

NCI-designated Cancer Centers to 

all the relevant populations in the 

United States that are currently 

beyond the areas and communities 

that are traditionally serviced by 

the Cancer Centers. 

There is ample evidence that even 

when advances are made in cancer 

treatment, early detection, and 

prevention, the overall populations 

that can and should benefit have 

insufficient knowledge of and access 

to these advances and evidencebased best practices.

64 Accelerating Successes Against Cancer
Accelerating Successes Against Cancer 65

Current Knowledge, 

Barriers and 

Opportunities

The main focus of the Cancer 

Centers and NCI support for them 

has been on basic, translational and 

clinical research. Participation of 

Cancer Centers in education and 

outreach activities has generally 

not been encouraged, or has taken 

the form of unfunded mandates. 

Dissemination of research advances 

to all appropriate populations 

– including ethnic minorities and 

the underserved, uninsured and 

uninformed – has been suboptimal. 

There are well known barriers to 

enlisting various populations into 

clinical research studies, including 

cultural and language issues, and 

adequate dissemination of clinical 

research access to these populations 

will require culturally-sensitive 

approaches.

It is widely recognized that participation in cancer therapeutic 

trials only involves 3-5% of cancer patients in the United States. 

There are considerable efforts being 

made to reduce barriers to participation in the Phase III clinical trials 

conducted under the auspices of 

the cooperative groups, CCOPs, 

and other multicenter collaborative 

consortia supported by NCI and by 

the pharmaceutical and biotechnology industries. 

Similarly, only a very small proportion of individuals at high risk 

for cancer participate in clinical 

research studies of cancer prevention or early detection. A major 

bottleneck and rate-limiting issue 

is the low participation in the 

large number of translational and 

innovative early phase investigator-initiated trials, which are now 

performed almost entirely at the 

Cancer Centers. There currently 

is little access to such studies by 

the overall appropriate population. 

Effective linkages to community 

hospitals and to clinical oncologists and primary care physicians in 

the regions served by the Cancer 

Centers could provide much wider 

access and also substantially accelerate accrual to such studies. 

There is striking heterogeneity in 

the United States in the knowledge 

of best practices or evidence-based 
66 Accelerating Successes Against Cancer

approaches to cancer therapy, early 

detection, prevention, and survivorship issues, and also in their implementation by health care providers. 

To address these disparities, most 

of the NCI-designated Cancer 

Centers have – in addition to their 

research excellence – developed 

the expertise, and needed faculty 

and well-trained staff, to provide to 

the populations that they serve the 

best practices and evidence-based 

approaches for cancer (see sidebar, 

“UPMC Cancer Centers Network: 

Dissemination Beyond NCI-designated Cancer Centers”). However, 

there have been relatively little 

attention, processes, or resources directed toward the capability of these 

Cancer Centers to disseminate their 

knowledge and expertise to most 

of the communities in the United 

States, especially those that are not 

directly proximal to or traditionally 

linked to the Cancer Centers. 

It is very encouraging that national 

organizations such as the CDC, 

American Cancer Society, and 

C-Change – and also a substantial number of the state governors 

– have promoted the development 

and implementation of cancer control plans in all of the states in the 

country. Many of the state plans 

are very well conceived, comprehensive, and feasible. However, 

these plans have largely remained 

only on paper, due to lack of sufficient and effective infrastructure 

and resources for implementation. 

Implementation of the cancer 

control plans is the responsibility 

of the departments of health in 

each state, which often lack the 

needed cancer-relevant expertise to 

implement the best practices and 

evidence-based approaches encompassed in the plans. Linkage of the 

state plans to the NCI-designated 

Cancer Centers, which often have 

this expertise, is not supported. 

Another major current barrier to 

effective dissemination of best 

practices for cancer control is the 

limited reimbursement by CMS or 

private payers for cancer prevention, early cancer detection screening, or survivorship issues.

Emerging Dissemination 

Strategies

The important problems summarized above are clearly multifaceted 

and will require enhanced collaborative efforts among many organizations and sectors, including the 

Federal government – not just NCI 

and other relevant NIH institutes, 

but even more importantly, CMS, 

CDC, AHRQ and HRSA – along 

with state governments, local governments, academic cancer centers, 

community-based cancer centers, 

and other health care providers, private insurers, and the business community, especially the pharmaceutical and biotechnology industries. 

There is a real opportunity for the 

network of NCI-designated Cancer 

Centers across the United States to 

play a major role in linking together 

these key stakeholders in order to 

mount effective dissemination of 

both research advances and best 

practices for addressing cancer prevention, early detection, treatment 

and improved survivorship. 

The following specific recommendations are proposed:

Strengthening of current 

overall infrastructure for 

dissemination of research and 

best practices by clinical and 

comprehensive Cancer Centers 

to their region, and also to 

•

disseminate to those states that 

lack NCI-designated Cancer 

Centers.

Designation by the Federal 

government of a lead agency 

within the Department of 

Health and Human Services 

(HHS) for dissemination of 

cancer control programs to the 

entire population of the United 

States and to coordinate 

what are currently relatively 

fragmented efforts by various 

HHS agencies, including NCI 

and CDC. An appropriate 

level of resources needs to be 

provided to the designated lead 

agency in order to effectively 

promote dissemination of 

cancer control throughout the 

country.

Provide leadership by the HHS 

lead agency for cancer control 

dissemination to forge effective 

linkages between NCIdesignated Cancer Centers 

and state governments, CDC 

and CMS to implement action 

plans to address the areas of 

greatest need.

Added support for NCI’s 

Cancer Centers program to 

allow substantive involvement 

in, and leadership role for, 

cancer control plans in states 

that have one or more Cancer 

Centers, for working together 

and with other health care 

providers in their state. Various 

mechanisms and processes 

might be implemented to 

facilitate a central role by 

the NCI-designated Cancer 

Centers in dissemination. 

Development of effective 

processes for substantive 

involvement of the Cancer 

Centers in the CDC-funded 

cancer control efforts in 

the states, with the CDC 

•

•

•

•
Accelerating Successes Against Cancer 67

UPMC Cancer Centers Network

Dissemination Beyond NCI-Designated Cancer Centers

The University of Pittsburgh Medical Center (UPMC) Cancer Centers, one of the largest clinical cancer networks in the United 

States, provides highly specialized cancer care to patients within their own communities. This truly multifunctional cancer 

care network is economically integrated and uniformly managed and operated across multiple settings. 

In a regional “hub and satellite” structure, inpatients and specialized treatment are provided at UPMC’s central hub facility, 

the Hillman Cancer Center in Pittsburgh. Outpatient care in medical oncology, radiation therapy, and surgery is offered at 

more than 40 UPMC Cancer Centers’ regional satellite sites across western Pennsylvania, eastern Ohio, and northern West 

Virginia. 

UPMC Cancer Centers works in tandem with the University of Pittsburgh Cancer Institute (UPCI), western Pennsylvania’s only 

NCI-designed Comprehensive Cancer Center. As the academic and research partner, UPCI is nationally and internationally 

renowned for its translational, clinical, cancer control and population sciences research programs, thus providing a strong 

scientific base for the dissemination of knowledge and best practices to the community network of UPMC Cancer Centers. 

UPMC Cancer Centers’ integrated cancer care delivery network treats more than 36,000 new patients each year for hematologic and oncologic disorders. This translates to more than 285,000 patient visits annually. The working partnership with 

UPCI allows for the expedited implementation of new, more efficient ways of delivering cancer care by:

Translating research discoveries to clinical therapeutic, early detection and prevention applications which are available at 

both the academic medical center and community satellite centers 

Providing cutting-edge treatments and technologies, including access to more than 150 clinical trials

Developing and implementing clinical pathways for major types of cancer, to provide standardized approaches and best 

practices for care, to improve patient outcomes and efficiencies while decreasing operating costs

Offering access to cancer control and ancillary support services such as symptom and side effect management, nutrition 

advice, family counseling, psychological care, stress management, close follow-up of cancer survivors, and cancer 

education resources 

In addition to these activities in western Pennsylvania, UPCI is also playing a key role in implementation of the Pennsylvania Comprehensive Cancer Control Plan, that includes the establishment of the Coordinating Center for the Pennsylvania 

Cancer Control Consortium(PAC3) at UPCI, a statewide biorepository and clinical and tissue informatics network, as well as 

a statewide clinical trials network to facilitate the completion of innovative, investigator-initiated clinical trials originating in 

the academic cancer centers.

•

•

•

•
68 Accelerating Successes Against Cancer

promoting partnerships 

between the NCI-designated 

Cancer Centers and the state 

health departments for maximal 

collaboration and utilization of 

the expertise and capabilities 

of the Cancer Centers in 

implementing the state cancer 

control plans. 

Provide funding by CDC 

for demonstration projects 

in some regions or states, 

particularly those led by NCIdesignated Cancer Centers, for 

implementation of populationbased cancer control efforts, 

especially those focused on 

cancer prevention and early 

detection of cancer. 

In states without an NCI-designated cancer center, a mechanism should be developed for 

some cancer centers, especially 

those in the same region of 

the country, to partner with 

academic medical centers and 

community hospitals, in order 

to play a significant role in dissemination. It is proposed that 

10 such demonstration projects 

be implemented, each with an 

annual cost of $2.5 million.

NCI-designated Cancer 

Centers, which generate 

most of the innovative early 

phase investigator-initiated 

clinical research studies, could 

disseminate these studies more 

widely by various mechanisms 

and processes. 

Supplements to NCI’s Cancer 

Center grants (CCSGs) 

could be used to develop and 

implement infrastructure to 

effectively link together Cancer 

Centers in a region and to link 

those Centers with community 

hospitals, clinical oncologists, 

and primary care physicians 

•

•

for wider implementation of 

early phase studies on new 

treatments, early cancer 

detection, risk assessment, 

prevention, and improved 

survivorship.

Support telemedicine 

approaches as important 

infrastructure for the Cancer 

Centers to effectively and 

conveniently communicate 

with other organizations 

and health care providers in 

the region, as well as to link 

the Cancer Centers with 

community hospitals, clinical 

oncologists, and primary care 

physicians. 

Support should be provided for 

developing a mechanism for 

Cancer Centers to effectively 

partner with state cancer 

registries to convert these 

registries from what are now 

mainly incidence registries, to 

outcomes registries. 

These converted registries 

would include detailed data 

on stage of disease, treatments administered, response 

to treatments, recurrence or 

development of metastatic 

disease, as well as deaths from 

cancer, development of a 

second primary cancer, side 

effects of therapy, and persistence of known environmental 

risk factors that may modify 

prognosis. It is estimated that 

such conversions would entail 

a one-time cost of $50 million, 

with maintenance then borne 

by the states and individual 

medical institutions.

Supplements to CCSGs should 

be provided for use of state 

cancer registries and SEER data, 

coupled with GIS mapping, to 

identify areas and populations 

•

•

•

of disproportionate need for 

focusing outreach efforts.

Leveraging of Federal 

support and leadership to 

obtain needed corporate 

and philanthropic support 

for effective dissemination 

of cancer control, including 

facilitation of close cooperation 

between Cancer Centers, 

community hospitals, and other 

health care providers in each 

region of the United States.

Support for Cancer Centers, 

by CMS and private payers, 

to develop specific clinical 

pathways for best practices for 

treatment of patients at each 

stage of each type of cancer, 

and similarly for early detection 

approaches for the major types 

of cancer.

Support, perhaps as 

supplements to CCSGs, for 

research studies of behavioral 

barriers to compliance by the 

relevant populations, with 

recommended best practices 

for cancer prevention, early 

detection, treatment, and 

improved survival, and ways 

to overcome the identified 

barriers. 

Defining and overcoming 

barriers to screening and early 

detection is a priority because 

after primary prevention, the 

greatest improvements in 

outcomes will be realized by 

identifying cancers early, when 

treatments are most effective. 

Support from CMS should 

be sought for demonstration 

projects, led by the Cancer 

Centers, to evaluate and 

demonstrate effectiveness of 

various dissemination efforts 

for maximal implementation 

of best practices in a region, 

•

•

•

•
Accelerating Successes Against Cancer 69

and for compliance with the 

recommended practices.

Education of relevant 

populations about the 

importance of availing 

themselves of dissemination 

programs, and education of 

health care providers about 

the value and importance 

of promoting and utilizing 

the relevant dissemination 

programs for their patients.

Anticipated Outcomes 

and Potential Impact

The NCI-designated Cancer Centers can play a major role in education of various key groups about 

dissemination if the Centers are 

provided with needed support from 

the Federal and state governments 

and from philanthropic and business sources. This would support 

education programs for:

Cancer patient populations 

about the importance of 

seeking out clinical oncologists 

and centers with cancer 

experts, about innovative 

clinical research programs, and 

utilization of best practices.

General population and, most 

importantly, those at increased 

risk for cancer, about best 

practices for cancer prevention, 

risk assessment, and early 

detection of cancer.

Health care providers about 

the value of clinical cancer 

research studies, best practices, 

and the technology needed 

for effective treatment, 

diagnosis, early detection, and 

prevention of cancer. Such 

educational programs could 

include various approaches for 

continuing medical and nursing 

•

•

•

•

education on best practices, 

including electronic tumor 

boards conducted by the NCIdesignated Cancer Center.

It will be important not only to implement programs for dissemination 

beyond the Cancer Centers, but 

also to objectively evaluate the efficacy of the various efforts, e.g., the 

degrees of increased access to prevention, screening, clinical trials, 

and survivor services. Evaluation 

should also include monitoring the 

key outcomes in the regions served, 

e.g., cancer incidence, disease-free 

interval, morbidity, quality of life, 

and survival. National outcomes 

studies also should be planned and 

supported.

The economic benefits of dissemination can also be measured 

and support should be provided to 

NCI-designated Cancer Centers for 

this activity.

Together with the evaluation of the 

effects of the new program, there is 

a need for benchmarking to assess 

if quality of care is maintained and 

improved. This can be obtained 

through a national cancer data 

system working in connection with 

SEER and the National Cancer 

Data Base (NCDB).

References

Ensuring Quality Cancer Care. 

Report by the Institute of Medicine. 1999.

Translating Research into Cancer 

Care: Delivering on the Promise. 

Annual Report of the President’s 

Cancer Panel. 2005.
70 Accelerating Successes Against Cancer

Appendix A

Selected positive phase III chemoprevention and dietary intervention trials funded by the National 

Cancer Institute and/or pharmaceutical industry

Site

 Trial Name Reference Trial Design Major Result Comments

Breast Cancer

 Breast Cancer 

Prevention Trial 

(BCPT)

Fisher et al. (1998) 13,388 women at 

intermediate to high 

risk; tamoxifen vs 

placebo for up to 5 

years

50% reduction in the 

risk of invasive breast 

cancer 

Equivalent effect of tamoxifen 

on DCIS; increased incidence of 

endometrial cancer and pulmonary 

embolism

Study of Raloxifene 

and Tamoxifen in 

Postmenopausal 

Women (STAR)

Wickerham et al. 

(2006)

19,747 women at 

intermediate to high 

risk; raloxifene versus 

tamoxifen for up to 5 

years

Approximately 50% 

reduction in the risk 

of invasive breast 

cancer by both agents

Raloxifene was associated with 

a lower incidence of endometrial 

cancer, pulmonary embolism and 

deep vein thrombosis

Women’s 

Interventional 

Nutrition Study 

(WINS)

Chlebowski et al. 

(2005)

2,437 women at high 

risk for developing 

second primary 

cancer (stage I and II 

breast cancer, within 

1 yr of dx): low fat 

(<20% calories) vs 

standard diet

24% reduction 

in breast cancer 

recurrence risk 

associated with low 

fat diet

In contrast to low fat diet of up to 

31% calories from fat at end of 

WHI trial, low fat diet in WINS was 

maintained 

Cervix Cancer

HPV-16 L1 viruslike–particle 

vaccine study

Koutsky et al. 

(2002)

2,392 women (age 

16-23), HPV negative, 

randomized to 

placebo or vaccine

100% efficacy against 

HPV 16 infection

Trial led to recent FDA approval of 

Merck HPV 16/18 vaccine in June, 

2006

Quadrivalent HPV 

6, 11, 16, 18 

vaccine study 

Villa et al. (2005) 1,158 women (age 

16-23), randomized 

to one of three 

vaccine preparations 

or placebo

90% efficacy (95% CI 

71–97) against HPVspecific infection/

disease in the treated 

versus placebo 

groups

Trial led to recent FDA approval of 

Merck bivalent HPV 16/18 vaccine in 

June, 2006

Bivalent HPV 16/18 

vaccine

Harper et al. 

(2004); Harper et 

al. (2006)

1,113 women (age 

15–25), randomized 

to placebo or vaccine

95.1% efficacy (CI: 

63.5–99.3) against 

persistent cervical 

infection with HPV16/18 at close of 

study. 

significant vaccine 

efficacy against 

HPV-16 and HPV-18 

endpoints at 4.5 year 

follow up: persistent 

infection: 6 month 

definition, 94.3 (CI: 

63.2–99.9); 12 month 

definition, 100% (CI: 

33.6–100)

GSK vaccine continues in 

development for future submission 

to FDA
Accelerating Successes Against Cancer 71

Site

 Trial Name Reference Trial Design Major Result Comments

Colon Cancer

Dartmouth 

Calcium Polyp 

Prevention Study

Baron et al. (1999) 930 polyp patients 

randomized to 

calcium carbonate 

versus placebo for 3+ 

years

Significant 19% 

reduction in risk of 

polyp recurrence at 

endpoint colonoscopy 

(adjusted risk ratio)

Significant 25% reduction in risk of 

the largest recurrent adenoma being 

> 5mm (unadjusted risk ratio)

Dartmouth Aspirin 

Polyp Prevention 

Study

Baron et al. (2003) 1121 polyp patients 

randomized to ASA 

81 mg or 325 mg/day 

for 3+ years

Significant 19% 

reduction in polyp 

recurrence in 81 mg 

group

81 mg, but not 325 mg ASA dose 

effective; unadjusted risk ratio for 

advanced lesions 0.59 (CI: 0.38-0.92)

CALGB Aspirin Trial Sandler et al. 

(2003)

635 patients with 

previous colorectal 

cancer randomized 

to 325 mg ASA or 

placebo

Signficant 35% 

reduced risk of 

new adenoma with 

ASA (CI:0.46-0.91), 

adjusted relative risk

No significant difference in advanced 

adenomas 

NCI/Pfizer 

Adenoma 

Prevention with 

Celecoxib Trial 

(APC)

Bertagnolli et al. 

(2006) 

2,035 polyp patients 

randomized to 

200 mg or 400 mg 

celecoxib BID or 

placebo

45% and 33% 

reduction in risk of 

polyp recurrence 

at 3-5 years, more 

pronounced in 400 

mg group

Significant reduction in advanced 

adenoma (p<0.0001), but increased 

cardiovascular events, especially in 

400 mg group 

Pfizer American/ 

Israeli Celecoxib 

Polyp Prevention 

Trial (PreSAP)

Arbor et al. (2006) 1,561 polyp patients 

randomized to 400 

mg QD or placebo for 

up to 5 years

36% reduction in risk 

of polyp recurrence at 

3-5 years

Increased risk of cardiovascular 

events seen only in those with 

preexisting CV disease (1.3%)

Prostate Cancer

Prostate Cancer 

Prevention Trial 

(PCPT)

Thompson et al. 

(2003)

18,882 men (age 

55 or over) with 

normal DRE and PSA 

< 3 randomized to 

finasteride or placebo 

for 7 years

Significant 25% 

reduction in risk 

of biopsy-proven 

prostate cancer

Increase in sexual dysfunction 

(p<0.001) and increased incidence 

of advanced Gleason grade cancers 

associated with finasteride (6.4% vs 

5.1% for placebo)

Skin Cancer

Vitamin A 

Prevention Trial

Moon et al. (1997) 2,290 patients with 

evidence of moderate 

to severe actinic 

keratosis randomized 

to Vitamin A 25,000 

IU/day for up to 5 yrs 

vs placebo

Significant 26% 

reduction in risk of 

squamous cell cancer 

of the skin

No effect of basal cell cancer risk; 

little or no Vitamin A toxicity

Nutritional 

Prevention Study 

with Selenium

Clark et al. (1996) 1,303 patients 

with resected nonmelanoma skin 

cancers randomized 

to selenium 300 mcg 

QD vs placebo for up 

to 5 yrs

No effect on risk 

of developing new 

primary skin cancers

49% reduction in risk of prostate 

cancer as a secondary analysis 

(Duffield-Lillico, et al. 2003)
72 Accelerating Successes Against Cancer

Appendix B
Accelerating Successes Against Cancer 73
74 Accelerating Successes Against Cancer
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76 Accelerating Successes Against Cancer
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78 Accelerating Successes Against Cancer
Accelerating Successes Against Cancer 79
80 Accelerating Successes Against Cancer
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82 Accelerating Successes Against Cancer
Accelerating Successes Against Cancer 83
84 Accelerating Successes Against Cancer
Accelerating Successes Against Cancer 85
86 Accelerating Successes Against Cancer
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88 Accelerating Successes Against Cancer

Appendix C
Accelerating Successes Against Cancer 89
90 Accelerating Successes Against Cancer
Accelerating Successes Against Cancer 91
92 Accelerating Successes Against Cancer
Accelerating Successes Against Cancer 93
94 Accelerating Successes Against Cancer
Accelerating Successes Against Cancer 95
96 Accelerating Successes Against Cancer
Accelerating Successes Against Cancer 97
98 Accelerating Successes Against Cancer
Accelerating Successes Against Cancer 99

Survivorship Activities 

at Cancer Centers

Due to the amount of information available, 

this appendix can be viewed at the following website:

www.cancer.gov/cancercenters/

Appendix D
100 Accelerating Successes Against Cancer

Appendix E

Survivorship Activities at NCI Cancer Centers

Cancer Center Survivorship Activity Research Clinical Care Education * Community 

Outreach

Siteman Cancer Center Survivorship Activity

 Psychosocial Clinical Service

Medical care and counseling X

Psychiatric and psychological services X

Support groups for patients and family members X

Nutritional counseling X

Quality of life assessment and activities (institutional and NCI/

NIH-funded clinical studies)

X X

 Help Us Give Support (HUGS) program in breast cancer (Deshields Komen local funding)

Education and support activities for children related to breast 

cancer patients (Deshields Komen local funding)

X X

Support groups for children related to breast cancer patients 

(Deshields Komen local funding)

X X

 Young Women’s Breast Cancer Program (Ivanovich Komen local funding)

Genetic counseling for young women (Ivanovich Komen local 

funding)

X X X

Risk assessment for young women (Ivanovich Komen local 

funding)

X X X

 Witness Program (Mathews Komen local funding)

Support groups for breast cancer patients/survivors (Mathews 

Komen local funding)

X

Educational and support materials for breast cancer patients/

survivors (Mathews Komen local funding)

X

Relationships with local organizations, such as the Breakfast 

Club (Mathews Komen local funding)

X

 Cancer Center Support Grant (CCSG) Shared Resources (Eberlein NCI P30)

Hereditary Cancer Core (Eberlein NCI P30) X

Health Behavior and Outreach Core (Eberlein NCI P30) X X X

 Community Education and Screening Activities

Community education events (prevention, care, and survivorship) touching more than 28,000 people annuallyX X

Screening activities across the spectrum of cancers X X

 Clinical Support Services

Siteman Cancer Center at Barnes-Jewish Hospital - St. Peters: 

AWARE Program (guided imagery and relaxation); Conquer 

program (general support group); KIDScope (support group for 

children 4-13 whose parent or caregiver has cancer/adults 

meet at the some time to discuss parenting); Massage Therapy 

(offered weekly to patients and caregivers); DHHS/CDC skin 

cancer programs; and ACS programs (Look Good, Feel Better; 

Daffodil Days, ACS Days)

X X

Siteman Cancer Center at Barnes-Jewish Hospital - West Co. X X

Bone Marrow Transplant X X

 Palliative Care Service

Routine medical follow-up and surveillance X

Pain and symptom management X

Medical management and counseling X

Hospice management X X

* Education may be student, patient or community education
Accelerating Successes Against Cancer 101

Cancer Center Survivorship Activity Research Clinical Care Education * Community 

Outreach

Barnard Health and Cancer Information Center (BHCIC)

Print educational materials on cancer survivorship X

Aduiovisual educational materials and kiosks on cancer survivorshipX

Information about websites related to cancer survivorship X

 Program for the Elimination of Cancer Disparities (PECaD) Community Networks Program 

 (Farria NCI U01)

X X X

Research projects focused on reducing cancer-related disparities X X X

Educational programs focused on reducing cancer-related 

disparities

X X

Community (disease-oriented) action teams (community-based 

participatory research and education)

X X X

Training programs for investigators and communities X X X

 Prevention and Control Research Program (Eberlein NCI P30)

Quality of life over time: DCIS vs early breast cancer (Jeffe NCI R01) X

Geographic variation of breast cancer survival (Schootman NCI R01) X X

Neighborhood effects on quality of life in breast cancer (Schootman NCI R01)X X

Comorbidity prognostic impact in elderly cancer patients (Piccirillo NCI R01)X

Centers of Excellence in Cancer Communications Research 

(CECCR) (Kreuter NCI P50)

X X

Minority pre-doctoral education to reduce disparities (Kreuter R25) X

Health promotion and disease prevention research center 

(Brownson U48)

X X X

Predictors of Relapse to Smoking in Lung Cancer (Walker NCI R01) X

Mental Health History and Survival Among Breast Cancer 

Patients (Walker Longer Life Foundation funding)

X

 Translational and Clinical Research Program

Phase 2 Trial of Estradiol Therapy for Advanced Breast Cancer 

(Ellis NCI/Avon P30 supplement)

X

Impact of Neodadjuvant Chemotherapy With or Without Zometa 

on Occult Micrometastases and Bone Density in Women with 

Locally Advanced Breast Cancer (Aft Novartis and Pfizer funding)

X

Overcoming Barriers to Early Phase Clinical Trials: Coaching 

Promotion for Minority Recruitment (Fracasso NCI R21)

X X

Estimating the probability of death from prostate cancer or other 

competing risk factors (Yan Longer Life Foundation funding)

X

 Siteman Clinical Research Affiliates

Affiliates for clinical studies (two satellite/affiliate Siteman 

Cancer Centers, other study affiliates)

X X

Prevention and control affiliate (Columbia, MO) X X

Member of Mayo Phase II Consortium (NCI funded) X X

Member of Northwestern Phase II Chemoprevention Consortium 

(NCI funded)

X X

* Education may be student, patient or community education
102 Accelerating Successes Against Cancer

Cancer Center Survivorship Activity Research Clinical Care Education * Community 

Outreach

Abramson Cancer Center Survivorship Activities

 The Lance Armstrong Foundation Living Well After Cancer Program:

Consultative Programs: x x TBA Penn 

Network 

Hospitals

Breast Cancer Survivors

Lymphoma Survivors

BMT Survivors

Clinical Programs: (TBA Penn Network Hospitals) x x x TBA Penn 

Network 

Hospitals

Testicular Cancer Survivors

Transition program-Young Adult Survivors of Childhood Cancers

 (CHOP-PENN Model)

 The Abramson Cancer Center Patient and Family Services Program:

Psychosocial Counseling x x

Nutrition Counseling x x

 Patient & Family Services x x

Genetic Risk Evaluation Program:

Breast Cancer x x x x

Testicular Cancer x x x x

Consultations:

Breast Ca Survivors

Lymphoma Survivors

BMT Survivors

Nutrition Counseling

Patient & Family Services

Psychosocial Counseling

Breast Cancer Genetic Risk Evaluation Program

Testicular Cancer Genetic Risk Evaluation Program

Databases:

Consultative Programs (Breast, Lymphoma, BMT)

Clinical Programs (Testicular, Young Adult)

Psychosocial Counseling

Breast Cancer Genetic Risk Evaluation Program

Testicular Cancer Genetic Risk Evaluation Program

Survivorship focused: Presentations (poster & podium), 

Consultations, Educational Programs, National working 

groups

ACC support groups for survivors of breast, prostate, head 

& neck, GI cancers & their families

* Education may be student, patient or community education
Accelerating Successes Against Cancer 103

Cancer Center Survivorship Activity Research Clinical Care Education * Community 

Outreach

Robert H. Lurie Comprehensive Cancer Center of Northwestern University

Cancer Survivors’ Celebration and Walk X

Cancer Therapy Cutaneous Adverse Reaction Clinic X X

Community education programs X X

EndLink X X

EPEC-O Project X

Fertility Preservation Program X

Geriatric Oncology Consultation Services X X X

Health Learning Center Satellite X X

Hospice/Palliative Medicine Program X X X

Lunchtime Lectures: Cancer Prevention/Control X X

Lynn Sage Breast Cancer Symposium X X

Lynn Sage Breast Cancer Town Hall Meeting X X

Office of Special Population Initiatives x X

Ovarian Cancer Survivor Course X X

Patient Advisory Board X X

Patient Navigator Program X X X

Patient Support Groups X X

Psychosocial Oncology Program X X X X

STAR (Survivors Taking Action and Responsibility) X X X

Survivors’ Day with the Chicago White Sox X

Norris Cotton Cancer Center Survivorship Activities 

Community Outreach and Education

Cancer Help Line X X

Cancer Support and Information Groups X X

Patient and Family Libraries X X

The Women’s Health Resource Center X X

Community Information and Education: Conferences, etc. X X

Charting Your Course: Breast Cancer X X

Programmatic Development at the State Level X

American Cancer Society X

Survivorship Research

 Cancer Prevention and Risk Reduction

 Chemoprevention Research X

 SunSafe X X X

 Tobacco Control X X

 Cervical Cancer Prevention X X

 The Familial Cancer Program X X X

 Screening and Early Detection

 Breast Imaging X X

 The New Hampshire Mammography Network X X

 The National Lung Screening Trial (NLST) X X

 Interdisciplinary Prostate Cancer Risk Clinic X X

 Primary Care Colon Cancer Screening Consortium X

 Quality of Life/Quality of Care

 Psycho-Oncology X X X

* Education may be student, patient or community education
104 Accelerating Successes Against Cancer

Cancer Center Survivorship Activity Research Clinical Care Education * Community 

Outreach

Clinical Care/Supportive Services for Cancer Survivors

Multidisciplinary Second Opinions X X

The Palliative Care Program X X X

The Haelan Program of Complementary Therapies X

Peer Mentorship X X

Programs for Pediatric Cancer Survivors X X

The Center for Shared Decision Making X X X

Chaplaincy Services X

Rehabilitation X

Case Management and Financial Planning Consultation X X

M. D. Anderson Cancer Center Survivorship Program

 Follow-up/Surveillance

Life After Cancer Care (LACC) - Evaluates medical sequelae 

for survivors of any malignancy

X

Long-term Follow-up Clinics

Breast Survivorship Clinic X X X

Life After Cancer Care (LACC) X

Melanoma X

Pediatrics and the Children’s Cancer Hospital (Childhood Cancer 

Survivors Study)

X

Prostate X

Surveillance of Secondary Cancer

Cancer and Screening Prevention Clinic - surveillance of early 

cancer including 2nd malignancies 

X

Melanoma and Skin Center - monitoring skin for changes in 

lesions 

X

Prognostic risk characteristics for secondary primary cancers 

(Epidemiology research)

X

 Cancer/Treatment Effects

Fatigue

Fatigue Clinic - evaluates and treats cancer or cancer related 

fatigue

X

Fatigue and other symptoms in ovarian cancer patients (Behavioral Science research)

Co-morbidities 

Chemotherapy Treatment Complications Clinic X

General Internal Medicine Clinic - evaluates and treats survivors 

co-morbidities

X

Inpatient Service - survivors need acute mgt co-morbidity and 

symptoms

X

Blood sugar control to prevent steroid-induced hyperglycemia 

(Diabetes research)

X

Cognitive functioning 

Behavior Interventions Clinic - addresses and remediate’s 

cognitive dysfunction

X X

Cognitive and vocational rehabilitation (Neuro-oncology) X

* Education may be student, patient or community education
Accelerating Successes Against Cancer 105

Cancer Center Survivorship Activity Research Clinical Care Education * Community 

Outreach

Neuro-cognitive function hematological and testicular cancer 

(Cancer Medicine Research)

X

Pain Management and Palliative Care

Integrative Medicine Program

Complementary/Integrative Medicine Education Resources 

(CIMER) - website health information

X

Place...of wellness - complementary therapies to manage 

symptoms, relief stress & improve QOL 

X

Research examining intervention programs to improve quality of 

life and clinical outcomes

X

Physical and Occupational Rehabilitation

Lymphedema X

Treatment Effects

Cardiology - Post chemo CHF/cardiomyopathy (Cardiology 

Research)

X

GvHD - Late toxicities of GvHD (Pulmonary Research) X

Neuropathy - defining mechanisms of chemotherapy induced 

peripheral neuropathy (Anes research)

X

Osteoporosis/Bone Disease

 Bone Disease Program of Texas X

 Bisphosphonates relationship to osteonecrosis of the jaw 

 (BDPT research)

X

 Bone health among breast cancer survivors (Breast research)

Radiation and chemotherapy damage to the lung (Pulmonary 

research)

X

Pulmonary Rehabilitation to restore/enhance pulmonary function (Pulmonary)X

Radiation - long term effects of radiation emphasis on pediatric 

patients (Radiation Physics research)

X

Fertility

Cancer related fertility - Parenthood after Cancer Conference 

(Research Behavioral Science )

X

Sexual dysfunction/early menopause

Sexual dysfunction research (Behavioral Science Research) X

 Family/Caregiver Issues

Individual and family counseling (Social Work) X

Psychiatric services (Behavioral Medicine) X

Support groups (Social Work) X

Breast Cancer Survivors, Physical Activity and Quality of Life 

(Behavioral Science research)

X

Predicting exercise among endometrial cancer survivors (Behavioral Science research)X

Psychological & relationship functioning of lung patients & 

spouses (Behavioral Science Research)

X

Prostate cancer survivors (psychosocial status & physical activity) (Behavioral Science Research)X

Weight gain prevention for breast cancer survivors (Behavioral 

Science Research)

X

* Education may be student, patient or community education
106 Accelerating Successes Against Cancer

Cancer Center Survivorship Activity Research Clinical Care Education * Community 

Outreach

Testicular cancer survivors quality of life and health behavior 

(Behavioral Science research)

Male breast cancer survivors (psychosocial status) (Cancer 

Medicine Research)

X

Quality of life and health behaviors (testicular, prostate and anal) 

(Cancer Medicine Research)

X

Providing cancer survivor services for follow-up and early 

detection (Caner Prevention research)

X

Exercise studies (Epidemiology Research) X

Survivorship issues and rare cancers (Epidemiology) X

Biology, anatomy and management grief in cancer survivors and 

caregivers (GI Med Onc research)

X

Psychosocial and neuro-cognitive aspects of pediatric cancer 

survivorship (Pediatrics research)

X

Quality of life (Neuro-oncology research) X

Fear of recurrence or second malignancy (Symptom Research ) X

 Economic Effects

Short-term & long-term labor market performance among 

cancer survivors (Health Services research) 

X

Retaining/returning to previous employment, vocational rehab, & 

insurability (Symptom Research)

X

 Health Disparities

Health Disparities Research - disparities in health care of minority groupsX

Asian Americans/Hepatitis and relationship hepatocellular 

cancer (research)

X

 Instrument Development

System assessment tools (Symptom Research) X

Development of Chronic Graft Versus Host Disease Symptom 

Inventory) (Symptom Research)

X

World Health Organization Collaborating Center for Supportive 

Care (Symptom Research)

X

 Health Promotion

Screening and follow-up care - Cancer Screening Prevention 

Clinic

X

Risk factors/susceptibility- prognostic risk characteristics for 

second cancers (Epidemiology research) 

X

Melanoma risk-reduction practices (Behavioral Science Research)X

Tobacco cessation and control (Behavioral Science Research) X

 Education

The Learning Center - 3 consumer health libraries X X

Texas Medical Association - faculty work with TMA to develop 

programs for primary physicians to address needs of cancer 

survivors 

X X

 Community Outreach

Anderson Network 

 Volunteer patient and survivor support group that shares 

 information and support

X X

Living Fully with Cancer - annual patient/caregiver conference 

(in its 10th year)

X X

 Young Breast Cancer Survivors workshop to take place in 2006 X X

* Education may be student, patient or community education
Accelerating Successes Against Cancer 107

Cancer Center Survivorship Activity Research Clinical Care Education * Community 

Outreach

Brain Tumor Conference for patients and family (biannual 

conference planned with National Brain Tumor)

X X

Gynecologic Awareness Month at Houston Astros X X

Sprint for Life 5K (annual ovarian cancer fundraiser and community awareness event)X X

Skin cancer screening (annual) X X

Tobacco Outreach and Education Program (TOEP)

Holden Comprehensive Cancer Center Iowa Survivorship Activities

 Clinical Components Adults

 Routine Follow-Up and Surveillance x

 Pain and symptom management x

 Emg. Housing Fund & Guest House x

 Sexual Rehabilitation x

 CAM Clinic x

 Support Groups for pts & family x x

 Financial Counseling Counseling x

 Lymphedema Therapy x

 Mindfulness Based Stress Reduction x x

 Nutrition therapy x

 Speech, occupational, physical ther. x

 Psychiatric & psychological services x

 Palliative Care/Spiritual Support x

 Coming Soon: ACS Hope Lodge x

 Clinical Components-Pediatrics

 Routine Follow-up & Surveillance

 Room accomodations for parents x

 Child development activities x

 Procedure support x

 Diversional activities x

 Emotional support x

 Support group-siblings x

 Music Therapy x

 New Do Head Covers x

 Hospital teacher x

 Sperm banking costs covered x

 Amenities for parents

 Massage/spa for parents x

 Breakfasts x

 Vouchers: gas, food, hotels x

 $500.00 per family for co-pays x

 Ronald McDonald House x

 Research Components

 Iowa Cancer Registry x

 Cancer and Aging Program x

 Quality of Life and Breast Cancer x

 Healing Touch and Breast Cancer x

 Quality of Life & Gynecologic Cancer x

* Education may be student, patient or community education
108 Accelerating Successes Against Cancer

Cancer Center Survivorship Activity Research Clinical Care Education * Community 

Outreach

 Neurobehavior Outcomes in Children x

 Adverse Events After Childhood Cancer x

 Education and Outreach Components

 IA Consortium Comp. Ca Control x x

 Holden Cancer Information Service x x

 NCI-CIS/ICCCC Partnership Position x x

 Health for Your Lifetime x x

 Cancer Survivor’s Day x

 BM Transplant Reunion x

 Palliative Care Conference x

 Prof. Psychosocial Oncology Conf. x

 Scofield Adv. Oncology Nurse Conf. x

 Holden Networks

 Iowa City Cancer Care x x

 Outreach Services x x

Huntsman Cancer Center Survivorship Activity

Wellness/Survivorship Program X X X

Family Cancer Registries X X X X

Pain Medicine and Palliative Care X X X X

Social Work Services X X X

Department of Patient and Public Education X X X

Hawaii Cancer Center Survivorship Activity

 Prevention and Control Program (current active projects only)

Quality of life in breast cancer survivors x

CAM use in cancer survivors x

Pilot writing progam x

Quality of life in testicular cancer x

Massage in cancer survivors and partners x

Reflexology in cancer survivors x

Internet-based health promotion for cancer survivors x

 Epidemiology Program

SEER Registry x

Mulitethnic Cohort x

Colorectal Family Registry x

 Clinical Trials Unit

Minority-Based Community Clinical Oncology Program x x x x

Clinical Trials Update x x

 Cancer Information Service x x x

 Community Networks

Imi Hale x x x

AANCART x x x

 Cancer Research Center of Hawaii

Cancer Research Day x x

* Education may be student, patient or community education
Accelerating Successes Against Cancer 109

Cancer Center Survivorship Activity Research Clinical Care Education * Community 

Outreach

Fred Hutchinson Cancer Center Survivorship Activity

Transplant LTFU X X X X

ACCESS X X X X

Prostate Cancer Research X X X X

Womens Wellness Center X X X X

LIVESTRONG Survivorship Center of Excellence X X X X

This incorporates the above programs and will add a 

survivorship program for all medical oncology patients

Albert Einstein Cancer Center Survivorship Activity

Psychosocial Oncology Program x x x

Yoga-based Cancer Rehabilitation Pgm x

Mind-Body Cancer Research Program x

Quit Smoking Program x x x x

Psychosocial Onc / QoL Volunteer Pgm x x

H.O.P.E. Program x x x

Psychosocial Oncology Fellows Seminar x x

Psycho-oncology externship/internship x x

Duke Cancer Center Survivorship Activity

 Prevention, Detection & Control Research Program X

Physical Activity/Diet in Breast and Prostate Cancer Patients X

RENEW: improving physical function in elderly X

STRENGTH: Survivor Training for Enhancing Total Health X

Preoperative exercise program for lung cancer patients X

Value of cardiopulmonary exercise in breast/lung patients X

Endurance training in early stage lung cancer patients X

Endurance training in early stage breast cancer patients X

Efficacy of caregiver-assisted copying skills training X

Coping skills of African American cancer patients X

Efficacy of partner-assisted emotional disclosure intervention X

Efficacy of couple-based cognitive behavioral intervention X

Studying communication in oncologist-patient encounters X

Smoking relatives of lung cancer patients X

 Clinical Intervention

Hereditary Cancer Clinic offers risk assessment for survivors X X

Integrative Oncology Program focuses on care for survivors X

Pathfinder, patient support program within a research project X

Childhood Cancer Survivor Follow-up Program X

 Patient Support and Education

Center for Cancer Survivorship X X

Cancer Patient Support Program X X

Cancer Patient Education Program X X

Oncology Recreation Program X X

Survivorship Patient Focus Group X

Survivorship Advisory Council X

* Education may be student, patient or community education
110 Accelerating Successes Against Cancer

Cancer Center Survivorship Activity Research Clinical Care Education * Community 

Outreach

 Outreach

Power of Knowledge Seminar X X

Melanoma Consortium X X

Rainbow of Heroes - Pediatric Bone Marrow survivor event X

Cancer Survivors Day Celebration X

Cancer Information Service X X

Cancer Center Notes newsletter X X

cancer.dukehealth.org website X X

Brain Tumor Action Week X X

Gynecologic Seminar Series X X

Dana-Farber Cancer Institute Survivorship Activity

Lance Armstrong Foundation Adult Survivorship Clinic X X

David B Perini, Jr., Quality of Life Clinic for Childhood Cancer Survivors X X

Transitioning to Survivorship: What Every Parent Should Know X X X

Health Lifestyles X

Facing Forward for Childhood Cancer Survivors X X

Weekend Retreat for Childhood Cancer Survivors X X

Stop & Shop Family Pediatric Neuro-Oncology Outcomes Clinic X X

Perini Family Survivors’ Center

Living Proof: Celebrating Survivorship X X

Survivorship Education Series (for patients) X

Improving Life After Cancer Treatment (IMPACT) (for patients) X

May 2006 Symposium (collaboration with Breast Oncology)

Nursing Education CEU Course (collaboration with Nursing ed) X

Workshop for Psychosocial Oncology Researchers X

Visiting Scholar Program X X

Survivorship Research Symposium (Oct. 2006) X X

Community Outreach Consortium X X X X

A Group Educational Intervention for Female Hodgkin’s Disease 

Survivors at Increased Risk for Breast Cancer

X

Calculation of cardiac valve irradiation in lymphoma patients 

treated with mantle radiation

Neuroendocrine Function in Survivors of Childhood Leukemia X

Detection of microalbuminuria in survivors of childhood cancer: 

A pilot study. 

X

Cardiac Screening in Survivors of Hodgkin’s disease treated 

with mediastinal irradiation 

X

Breast MRI Screening in Women Treated with Mediastinal Irradiation for Hodgkin’s DiseaseX

 Department of Care Coordination

Facing Forward After Breast Cancer Treatment X X

Stepping Stones X

Young Survivors Support Group X

* Education may be student, patient or community education
Accelerating Successes Against Cancer 111

Cancer Center Survivorship Activity Research Clinical Care Education * Community 

Outreach

 Center for Community Based Research

Exploring the Healthcare Needs of Low Income Cancer Survivors X X

A Web-based smoking cessation intervention for Cancer 

Survivors

X X X

Proxy Information Agents Focus Groups X X

Survivor Care after Cancer Survey X

Coping After Breast Cancer X

Chicago Cancer Center Survivorship Activity 

Quality of Life Studies X

Conflict of Interest Interview of Advanced Cancer Patients X

Factors Related to and Influencing the Disclosure of Prognostic 

Information in the Advanced Cancer Setting

X

Improving Patient Understanding of EarlyPhase Clinical Trials X

Quality of Life in Children Who Survived Neuroblastoma X

Cognitve and Functional Outcomes of Cancer Treatment in 

Elderly Patients

X

Observational Cohort Study of Chemotherapy Decisions & 

Outcomes in Women Ages 55 or Older

X

A Study of Parental Disclosure of Genetic Test Results to Young 

Adolescents 

X

Quality of Life in African American Cancer Survivors X

Perceptions of Chemotherapy Between African Americans and 

Whites

X

Functional Impact of Breast Cancer Treatment in Older Women X

Impact of Comorbidity and Functional Status on Outcome for 

Older Recipients of Allogeneic Transplant

X

Health Related Quality of Life for Hodgkin’s Disease Survivors X

Are the Elderly Capable of Informed Consent for Research 

Participation?

X

Comprehensive Geriatric Assessment to Examine Geriatric 

Domains in Older Prostate Cancer Patients 

X

 Cancer Registry 

The University of Chicago Cancer Research Center Clinical and 

Research Registry Protocol

X

Children’s Oncology Group Registry X

Cancer Registry Data Quality Subcommittee X

Commission on Cancer - Cancer Liaison Committee X

Transplatation Registry Protocol X

 Cancer Genetics 

The Center for Clinical Cancer Genetics X

University of Chicago Cancer Risk Clinic X

Cancer Risk Assessment and Genetic Screening in Cancer Prone 

Families 

X

Genetic Counseling and Testing

A Review of Preganancy Associated Breast Cancer at the University of Chicago Hospitals

 Patient and Family Services

University of Chicago Cancer Resouce Center X

Facing the Mirror X

Smoking Cessation X

* Education may be student, patient or community education
112 Accelerating Successes Against Cancer

Cancer Center Survivorship Activity Research Clinical Care Education * Community 

Outreach

Massage Therapy X

Look Good Feel Better X

The Herbert T. Abelson Family Learning Center X

Living a Healthy Life: How To Balance Good Eating, Exercise, 

Relaxation & Everything Else in Your Life

X

Head and Neck Cancer Support Group X

Lung Cancer Support Group X

Family Nutrition Education Classes X

University of Chicago Blood Bank X

Crochet Classes for Cancer Survivors X

Straight Talk for Teens X X X

 Departments

University of Chicago School of Social Service Administration X X X

Center for Interdiscipinary Health Diparities Research X X X X

 Community Programs

Community Fitness X

Community Empowerment Forum X

University of Chicago Hospitals Office of Community Affairs X X

UNC Lineberger Cancer Center Survivorship Activities

 Behavioral Interventions

NC STRIDES x

Managing uncertainty in prostate cancer x

Managing uncertainty in breast cancer x

Health eCommunities x

Can Thrive x

NC BEAUTY x

 Epidemiological Studies

LIBCSP x

Follow-up of African-American survivors

Head & neck cancer follow-up study

CanCORS x

Patient Family Resouce Center x x

Arizona Cancer Center Survivorship Activity

 Health Outcomes and Behavior

The Effect of Moderate Physical Activity on the Physical and 

Emotional Recovery of Patients with a History of Colon Cancer

x

Assessing the Needs of Long-term Breast Cancer Survivors x

HR-QOL for colorectal cancer long-term survivors x

Neurological Effects of Chemotherapy and Radiation Treatment: 

Colon Cancer

x

Green Tea Intervention for Weight Gain Prevention among 

Women with Breast Cancer

Women’s Healthy Eating and Living (WHEL) Study x

Longitudinal Effects of Intimate Partner Relationship Quality in 

Newly Diagnosed Breast Cancer Patients

x

 Psychosocial and Palliative Care

Routine medical follow-up and surveillance x

* Education may be student, patient or community education
Accelerating Successes Against Cancer 113

Cancer Center Survivorship Activity Research Clinical Care Education * Community 

Outreach

Pain and symptom management x x x

Sexual rehabilitation x x

Cognitive evaluation x x

Psychiatric and psychological services x

Support groups for patients and family members x x x

Speech, occupational and physical therapy x x

Telephone counseling for breast cancer patients x x

Nutritional counseling x x x

End-of-Life Care Curriculum x x

 Patient Education and Resource

Print and video educational material on cancer survivorship x x

Monthly supportive care class for Patients and Survivors, family 

members 

x x x

Information about websites for cancer survivors x x

 Community and Outreach Services

Sunstone Healing Center x x x

Referral to/from other cancer resources/centers (local and regional) x x

Vanderbilt-Ingram Cancer Center

 Health Outcomes and Behavior Program

Cognitive evaluation in pediatric oncology patients x

Cognitive function in breast cancer survivors x

Fatigue in cancer survivors x

 Psychosocial and Palliative Care Program

Routine medical follow-up and surveillance x

Pain and symptom management x x

Integrative Medicine x

Cognitive evaluation x

Psychiatric and psychological services x x

Support groups for patients and family members x x

Speech, occupational and physical therapy x x

Nutritional counseling x x

Patient Education and Resource Center

Education and Community Outreach x

Cancer Information Program (CT referrel service) x x x

Print and audiovisual educational material on cancer survivorshipx

Full-time Patient Education Coordinator and Advocacy Manager x

Survivorship Educational Programs x

Wellness Community Cancer Survivor Program Grant x

CancerHelp Touch Screen Monitor/Computer Education x

Annual cancer survivor conference x

Clinical Trials Mentor Program (pt advocacy) x

Patient Navigation Conference x

 Cancer Survivors Clinic (to be implemented Summer 2006) x x

 Minority Affairs Office

Southern Community Cohort Study x x

Educational programs focused on reducing cancer-related 

disparities

x x x

* Education may be student, patient or community education
114 Accelerating Successes Against Cancer

Cancer Center Survivorship Activity Research Clinical Care Education * Community 

Outreach

 VICC Affiliate Network

Resource for conducting community-based studies x x x

 VICC Family Cancer Clinic

Family Risk Service

Memorial Sloan Kettering Cancer Center

Sexual Health Program X X X

Clinical Genetics X X

 Long-Term Follow-Up

Pediatrics X X X

Young Adults X X X

Adults X X X

 BMT Program

Pediatrics X X

Adults X X

Queens Cancer Center X X X

Post-Treatment Resource 

Program

X X

Integrative Medicine X X

Counseling Center X X

Smoking Cessation 

Program

X X

Physical Rehabilitation 

Program

X X

Behavioral Research X

Late Effects Research X

 Patient Education Program

Patient Library X

Survivorship Website X

MSKCC Medical Library X

Jonsson Comprehensive Cancer Center UCLA

 Patients and Survivors CCSG Program

Breast, lung, CRC, Prostate x

Pediatric young adult x

Geriatrics x

Revlon Breast Center 

Breast CA 

x

Follow-up Program

Prostate Cancer IMPACT 

program

x

UCLA Family Cancer 

Registry

x x x

School of Medicine R-25 

on Cancer Survivors

x

Young adult survivors/

transition clinic

x x

Ted Mann Family Resource Centerx x x

Pediatric Pain Program x x x x

East-West Medicine 

Program

x
Accelerating Successes Against Cancer 115

LAF Center of Excellence x

Cancer Center Survivorship Activity Research Clinical Care Education * Community 

Outreach

Moffitt Cancer Center Survivorship Activity

 Health Outcomes and Behavior Program

Fatigue in Breast Cancer Survivors x

Cognitive Function in Prostate Cancer Survivors x

Sexual Fuctioning in Cervical Cancer Survivors x

Cognitive Function in BMT Survivors x

Mindfulness Meditation for Breast Cancer Survivors x x

Exercise Training for Prostate Cancer Survivors x x

Barriers to Fertility Preservation in Cancer Patients x

 Psychosocial and Palliative Care Program

Routine medical follow-up and surveillance x

Pain and symptom management x

Sexual rehabilitation x

Cognitive evaluation x

Psychiatric and psychological services x

Support groups for patients and family members x

Speech, occupational and physical therapy x

Nutritional counseling x

 Patient Education and Resource Center

Print and audiovisual educational material on cancer survivorship x

Information about websites for cancer survivors x

 Skillbuilding in Psychosocial and Palliative Care

Annual professional education conference x

 Community and Outreach Services

Support group for Latina breast cancer survivors in Central Florida x x

 Tampa Bay Community Cancer Network

Projects focused on reducing cancer-related disparities x x x

 Moffitt Affiliate Network

Resource for conducting community-based studies x x x

* Education may be student, patient or community education
116 Accelerating Successes Against Cancer

Appendix F

Shared Resources Survey

Services

Which of these 

services do 

you currently 

provide?

Which of 

these are you 

particularly 

strong in?

Would you be 

willing to provide 

this service for a fee 

to other centers?

Do you have 

adequate capacity / 

could you expand to 

address expanded 

usage?

If these services 

were available from 

another cancer 

center, would you 

be a customer?

Cell Biology, Immunology & Pathology Services 

Antibody Development

UVA, RP, NW, NE, IA, 

MD, FH, CH, DF, AE, 

FC, PA, CO, WT, MI, 

DM, MSK

UVA, RP, FH, CH, 

DF, AE, FC, CO, 

WT, MI

Y: UVA, RP, NW, NE, IA, 

MD, CH, DF, FC, CO, WT, 

MI, DM, MSK

N: JAX, FH, PA 

Y: UVA, RP, NW, NE, IA, 

MD, CH, DF, FC, CO, WT, 

MI, DM

N: FH, PA

Y: JHU, USC, JAX, FH, 

SJ, OH, WT, NM, DV, 

BI, DM

N: RP, NW, IA, MD, CH, 

FC, PA, CO, MI

Biologics Production – GMP

RP (GLP only), 

JHU, FH, CH, WU, 

PA, SJ, OH-cellular 

and viral, NY, COH, 

MSK

RP, JHU, FH, CH, 

WU, PA, COH

Y: RP, FH, CH, WU, NY, 

COH, MSK

 

N: JHU, JAX, PA, SJ

Y: RP, FH, CH, WU, NY 

 

N: JHU, PA

Y: UVA, RP, WF, NE, IA, 

OH, WT, GT, NM, DM

 

N: JHU, NW, JAX, MD, 

FH, CH, WU, PA, CO, NY, 

BI, COH

Biologics Production 

– Research

RP, IA, FH, CH, PA, 

SJ, WT, COH, MI, 

DM, MSK

RP, PA, COH

Y: RP, IA, MI

 

N: JAX, FH, CH, PA, SJ, 

WT, COH

Y: RP, IA, MI

 

N: FH, PA, WT

Y: RP, NW, NE, OH, WT, 

GT 

 

N: JHU, JAX, IA, MD, FH, 

PA, CO, BI, MI 

Cell Analysis

RP, JHU, USC, NW, 

JAX, NE, IA, MD, FH, 

CH, WU, FC, CO, SJ, 

OH, SF, WT, GT, NY, 

VT, NM, DV, BI, COH, 

MI, OR, DM, IN, MSK

RP, JHU, USC, 

NW, IA, MD, FH, 

CH, WU, FC, CO, 

SF, WT, NY, VT, 

NM, DV, COH, MI, 

DM, IN

Y: RP, USC, NW, NE, IA, 

MD, CH, WU, FC, CO, 

SF, WT, NY, VT, NM, DV, 

MI, MSK

 

N: JAX, FH, SJ, COH, OR, 

DM, IN

Y: RP, USC, NW , NE, IA, 

MD, CH, WU, FC, CO, SF, 

WT, VT, NM, DV, MI, IN 

 

N: JHU, FH, NY, OR, DM

Y: 

 

N: RP, JHU, USC, NW, 

JAX, IA, MD, FH, CH, 

WU, FC, CO, SF, WT, NY, 

VT, NM, DV, BI, MI, OR, 

DM, IN

Cell Sorting

UVA, RP, JHU, USC, 

NW, JAX, WF, IA, 

MD, FH, CH, AE, WU, 

FC, PA, UT, CO, SJ, 

OH, SF, WT, SA, GT, 

NY, VT, NM, DV, BI, 

COH, MI, OR, DM, 

IN, MSK

UVA, RP, JHU, 

USC, NW, JAX, IA, 

MD, FH, CH, AE, 

WU, FC, PA, CO, 

SF, WT, GT, NY, 

NM, DV, BI, COH, 

MI, OR, DM, IN

Y: UVA, RP, JHU, USC, 

NW, IA, MD, CH, WU, 

FC, PA, UT, CO, SF, WT, 

SA, GT, NY, NM, DV, BI, 

MI, MSK 

 

N: JAX, WF, FH, AE, SJ, 

VT, COH, OR, DM, IN

Y: UVA, RP, JHU, USC, 

NW, JAX, IA, MD, CH, 

WU, FC, PA, CO, SF, WT, 

SA , GT, NM, DV, BI, MI, 

OR, IN 

 

N: WF, FH, AE, NY, VT, 

DM

Y: NE 

 

N: RP, JHU, USC, NW, 

JAX, WF, IA, MD, FH, CH, 

WU, FC, PA, CO, SF, WT, 

SA, GT, NY, VT, NM, DV, 

BI, MI, OR, DM, IN

Cellular Immunoassays

RP, USC, JAX, MD, 

FH, CH, CO, SJ, DV, 

COH, MI, DM

RP, MD, CH, CO, 

COH, MI

Y: RP, USC, MD, CH, CO, 

MI, DM 

 

N: JAX, FH, SJ, COH

Y: RP, MD, CH, CO, MI, 

DM

 

N: USC, FH

Y: NW, NE, IA, WU, WT, 

GT, NM 

 

N: RP, JHU, USC, JAX, 

FH, CH, CO, BI, MI, DM

Cytokine Analysis

UVA, RP, USC, NW, 

JAX, MD, FH, CH, 

WU, PA, CO, DV, 

COH, MI, DM

RP, USC, NW, MD, 

FH, CH, COH, MI

Y: UVA, RP, USC, NW, 

MD, FH, CH, WU, CO, 

MI, DM

 

N: JAX, PA, COH

Y: UVA, RP, USC, NW, 

MD, FH, CH, WU, CO, MI 

 

N: PA 

Y: RP, NE, IA, WT, GT, NM 

 

N: JHU, USC, NW, JAX, 

FH, CH, PA, CO, BI, MI, 

DM

ELISA

RP, NW, JAX, MD, 

FH, CH, PA, DV, MI, 

DM, MSK

RP, NW, MD, CH, 

DV, MI

Y: RP, NW , MD, CH, DV, 

MI, DM 

 

N: JAX, FH, PA

Y: RP, NW, MD, DV, MI 

 

N: FH

Y: RP, NE, IA, WU, WT, 

GT, NM 

 

N: JHU, NW, JAX, FH, 

CO, BI, MI, DM

Hematopoetic Cell Production MD, FH, CH, DF, WU, 

PA, CO, OH

MD, CH, DF, WU, 

OH

Y: CH, WU, OH

 

N: JAX, MD, FH, DF, CO

Y: WU, CO, OH 

 

N: MD, FH, DF

Y: RP, NE, IA, WT, NM 

 

N: NW, JAX, FH, WU, 

CO, BI

Hematopoetic Transplantation 

Analysis & Production

MD, FH, CH, DF, PA, 

CO, SJ, OH MD, CH, DF, OH

Y: CH, OH 

N: JAX, MD, FH, DF, 

CO, SJ

Y: CO, OH 

 

N: MD, FH, DF

Y: RP, IA, NM 

 

N: NW, JAX, FH, CO, BI
Accelerating Successes Against Cancer 117

Services

Which of these 

services do 

you currently 

provide?

Which of 

these are you 

particularly 

strong in?

Would you be 

willing to provide 

this service for a fee 

to other centers?

Do you have 

adequate capacity / 

could you expand to 

address expanded 

usage?

If these services 

were available from 

another cancer 

center, would you 

be a customer?

Cell Biology, Immunology & Pathology Services

Immuno-competent Cell 

Production

RP, MD, FH, CH, DF, 

WU, PA

RP, MD, CH, DF, 

WU, PA

Y: RP, CH, WU 

 

N: JAX, MD, FH, DF 

Y: RP, WU 

 

N: MD, FH, DF 

Y: RP, IA, WT, NM 

 

N: NW, JAX, FH, WU, 

CO, BI

Immunohistochemistry

UVA, RP, USC, NW, 

JAX, NE, IV, MD, FH, 

CH, DF, AE, FC, PA, 

UT, CO, SJ, SF, GT, 

NY, NM, COH, MI, 

OR, DM, IN, MSK

RP, USC, NW, 

JAX, IV, MD, FH, 

CH, DF, AE, FC, 

SF, GT, NM, MI, 

OR

Y: UVA, RP, USC, NW, 

JAX, NE, IV, MD, CH, 

DF, AE, CO, SF, GT, NY, 

NM, OR

N: FH, FC, SJ, COH, MI, 

DM, IN

Y: RP, USC, NW, JAX, 

NE, IV, MD, DF, AE, CO, 

GT, NM 

N: FH, FC, SF, NY, MI, 

OR, DM

Y: JHU, IA, OH 

 

N: RP, NW, JAX, IV, FH, 

FC, CO, SF, GT, NY, NM, 

BI, MI, OR, DM

Maybe: USC

Immunotyping

RP, USC, JAX, MD, 

FH, CO, SJ, NM, 

COH, DM, MSK

RP, JAX, NM

Y: RP, USC, NM 

 

N: JAX, MD, FH, CO, SJ, 

COH, DM

Y: RP, USC, CO, NM 

 

N: MD, FH, DM

Y: JHU, NE, IA 

 

N: RP, USC, NW, JAX, FH, 

CH, CO, NM, BI, DM

MHC Tetramers

RP (purchased, 

service to strain, 

analyze), USC, JAX, 

MD, FH, PA, SJ, 

COH, DM, MSK

USC, FH

Y: RP, USC, MD, FH 

 

N: JAX, PA, SJ, COH, DM

 

Y: RP, USC, MD

 

N: FH, PA, DM

Y: RP, JAX, NE, IA, FH, 

CH, OH, WT 

 

N: JHU, USC, NW, PA, 

CO, BI, DM

Necropsy

RP, JAX*, MD, FH, 

AE, CO, SJ, DV, 

COH, MI

RP, JAX, DV, MI

Y: RP, JAX*, DV, MI 

 

N: MD, FH, CO, SJ, COH

Y: RP, JAX, CO, DV, MI 

 

N: MD, FH

Y: NE, IA, CH, WU, WT 

N: RP, JHU, NW, JAX, FH, 

CO, DV, BI, MI

TCR Analysis RP, MD, FH, WU, SJ RP, WU

Y: RP, MD, WU 

 

N: JAX, SJ

 

Y: RP, MD, WU 

 

N:

Y: NE, IA , WT 

 

N: RP, JHU, NW, JAX, FH, 

CH, WU, CO, BI

Veterinary Pathology

NW, JAX, IV-soon, 

MD, FH, AE, FC, CO, 

SJ, OH, GT, NY, DV, 

MI, OR, MSK

MD, FC, DV, MI

Y: MD, FC, NY, DV, MI, 

MSK 

 

N: NW, JAX, FH, CO, 

SJ, OR

Y: MD, FC, CO, DV, MI 

 

N: NW, FH, NY, OR

Y: RP, NE, IA, IV, CH, WU, 

WT, NM, BI, MI 

 

N: JHU, NW, JAX, FH, FC, 

CO, NY, DV, OR

Molecular & Imaging Services

Animal Imaging

UVA, RP, JHU, NW, 

JAX, WF, NE, IA, IV, 

MD, FH, CH, AE, WU, 

FC, PA, CO, SJ, OH, 

SF, GT, NY, NM, DV, 

BI, COH, MI, DM, IN, 

MSK

UVA, RP, WF, IA, 

IV, MD, WU, FC, 

PA, GT, NY, NM, 

DV, COH, MI, IN

Y: UVA, RP, JAX, WF, IA, 

IV, MD, WU, FC, CO, GT, 

NY, NM, DV, BI, MI, IN, 

MSK

N: JHU, NW, NE, FH, PA, 

SJ, COH

Y: UVA, RP, JAX*, WF, IA, 

IV, MD, WU, FC, CO, GT, 

NM, DV, BI, MI, IN 

 

N: JHU, NW, NE, FH, 

PA, NY

Y: RP, IV, MI 

 

N: JHU, NW, JAX, WF, IA, 

FH, WU, FC, PA, CO, WT, 

GT, NY, NM, DV, BI, IN

 

Bioinformatics Analysis

UVA, RP, JHU, NW, 

JAX, WF, NE, IV, MD, 

FH, CH, AE, WU, FC, 

PA, CO, SJ, OH, SF, 

WT, GT, HI, VT, NM, 

DV, BI, COH, MI, OR, 

DM, MSK

RP, JHU, NW, 

JAX, IV, MD, WU, 

FC, PA, WT, GT, 

VT, NM, DV, COH, 

MI, OR

Y: NW, JAX, NE, IV, WU, 

CO, WT, GT, NM, DV, 

COH, MI, OR, MSK

 

N: RP, JHU, WF, MD, FH, 

FC, PA, SJ, SF, HI, VT

Y: NW, JAX, NE, IV, WU, 

FC, PA, CO, WT, GT, NM, 

MI, OR

 

N: RP, JHU, WF, FH, SF, 

HI, VT, DV, COH

Y: IA, WU, WT, HI 

 

N: RP, JHU, NW, JAX, WF, 

IV, FH, FC, PA, CO, SF, VT, 

NM, DV, BI, MI, OR

Cell Analysis

UVA, RP, JHU, JAX, 

NE, IA, MD, FH, CH, 

WU, FC, PA, UT, CO, 

SJ, OH, SF, WT, GT, 

NY, NM, DV, BI, MI, 

OR, PD, DM, IN, 

MSK

UVA, RP, JHU, IA, 

MD, FH, CH, WU, 

FC, CO, SF, WT, 

NY, NM, DV, MI, 

DM, IN

Y: UVA, RP, IA, MD, CH, 

WU, UT, CO, SF, WT, NY, 

NM, DV, MI 

 

N: JHU, JAX, NE, FH, FC, 

SJ, OR, DM, IN

 

Y: UVA, RP, IA, MD, CH, 

WU, FC, UT, CO, SF, WT, 

NM, DV, MI, IN 

 

N: JHU, JAX, NE, FH, NY, 

OR, DM

Y: WT 

N: RP, JHU, NW, JAX, 

IA, FH, CH, WU, FC, CO, 

SF, NY, NM, BI, MI, OR, 

DM, IN
118 Accelerating Successes Against Cancer

Services

Which of these 

services do 

you currently 

provide?

Which of 

these are you 

particularly 

strong in?

Would you be 

willing to provide 

this service for a fee 

to other centers?

Do you have 

adequate capacity / 

could you expand to 

address expanded 

usage?

If these services 

were available from 

another cancer 

center, would you 

be a customer?

Molecular & Imaging Services

Cell Sorting

UVA, RP, JHU, JAX, 

WF, IA, MD, FH, CH, 

AE, WU, FC, PA, UT, 

CO, SJ, OH, SF, WT, 

GT, NY, NM, DV, BI, 

COH, MI, OR, PD, 

DM, IN, MSK

UVA, RP, JHU, 

JAX, IA, MD, FH, 

CH, AE, WU, FC, 

PA, CO, SF, WT, 

GT, NY, NM, BI, 

COH, MI, OR, 

DM, IN

Y: RP, JHU, IA, MD, CH, 

WU, PA, UT, CO, SF, WT, 

GT, NY, NM, MI 

N: JAX, WF, FH, FC, SJ, 

BI, COH, OR, DM, IN

Y: RP, JHU, JAX, IA, MD, 

CH, WU, FC, PA, UT, CO, 

SF, WT, GT, NM, MI, IN 

N: WF, FH, NY, OR, DM

Y: NE 

 

N: RP, JHU, NW, JAX, WF, 

IA, FH, CH, WU, FC, PA, 

CO, SF, WT, NY, NM, BI, 

MI, OR, DM, IN

Confocal Microscopy

UVA, RP, JHU, USC, 

NW, JAX, WF, NE, IA, 

IV, MD, FH, CH, AE, 

FC, PA, UT, SJ, OH, 

SF, WT, SA, GT, VT, 

NM, BI, COH, MI, PD, 

DM, IN, MSK

UVA, RP, JHU, 

USC, NW, JAX, 

IA, IV, MD, FH, 

CH, AE, FC, UT, 

SF, WT, GT, VT, 

NM, BI, COH, MI, 

DM, IN

Y: UVA, RP, USC, NW, 

JAX, IA, MD, CH, FC, UT, 

SF, WT, GT, NM, BI, MI, 

MSK

 

N: JHU, WF, NE, IV, FH, 

PA, CO, SJ, SA, VT, COH, 

DM, IN

Y: UVA, RP, USC, NW, 

JAX, IA, MD, CH, FC, 

UT, SF, WT, GT, NM , BI, 

MI, IN 

N: JHU, WF, NE, IV, FH, 

PA, SA, VT, DM

 

Y: WU, SA 

 

N: RP, JHU, USC, NW, 

JAX, WF, IA, IV, FH, CH, 

FC, PA, CO, SF, WT, VT, 

NM, BI, MI, DM, IN

Deconvolution Microscopy

NW, JAX, IA, FH, CH, 

AE, FC, UT, SA, GT, 

NM, COH, MI, IN, 

MSK

CH, AE, FC, UT, 

NM, COH, MI, IN

Y: NW, JAX, CH, FC, UT, 

SA, NM, MI, MSK 

 

N: FH, CO, COH, IN

Y: NW, JAX, CH, FC, UT, 

SA, NM, MI, IN

 

N: FH

Y: RP, MD, WU, WT 

 

N: JHU, NW, JAX, IA, FH, 

CH, FC, CO, SA, NM, BI, 

MI, IN

DNA Sequencing

UVA, RP, USC, NW, 

JAX, WF, NE, IA, IV, 

MD, FH, CH, AE, WU, 

FC, PA, UT, CO, SJ, 

OH, SF, WT, GT, VT, 

NM, DV, BI, COH, MI, 

PD, DM, MSK

UVA, RP, USC, 

NW, JAX, IA, MD, 

FH, CH, AE, WU, 

FC, PA, CO, SF, 

WT, VT, NM, COH, 

MI, DM

Y: RP, USC, NW , JAX, 

WF, NE, IA, IV, MD, FH, 

CH, AE, WU, FC, PA, UT, 

CO, SF, WT, GT, VT, NM, 

BI, COH, MI, DM 

N: SJ

Y: UVA, RP, USC, NW, 

JAX, WF, NE, IA, MD, FH, 

CH, AE, WU, FC, PA, UT, 

CO, WT, GT, VT, NM, BI, 

MI, DM 

 

N:

Y: WU, SF, WT 

N: RP, JHU, USC, NW, 

JAX, WF, IA, FH, CH, FC, 

PA, CO, GT, VT, NM, BI, 

MI, DM

Fluorescence Microscopy

UVA, RP, JHU, USC, 

NW, JAX, WF, NE, IA, 

IV, MD, FH, CH, DF, 

AE, FC, PA, UT, SJ, 

SF, WT, GT, VT, NM, 

DV, BI, COH, MI, PD, 

DM, IN, MSK

UVA, RP, JHU, 

USC, NW, IA, IV, 

MD, CH, DF, AE, 

FC, UT, WT, GT, 

VT, NM, COH, 

MI, IN

Y: RP, USC, NW, IA, MD, 

CH, DF, FC, UT, WT, GT, 

VT, NM, DV, MI, MSK

 

N: JHU, JAX, WF, NE, IV, 

FH, PA, CO, SJ, COH, 

DM, IN

Y: RP, USC, NW, IA, MD, 

CH, DF, FC, UT, WT, GT, 

NM, MI, IN 

 

N: JHU, JAX, WF, NE, IV, 

FH, PA, VT, DM

Y: 

N: RP, JHU, USC, NW, 

JAX, WF, IA, IV, FH, CH, 

FC, PA, CO, SF, WT, VT, 

NM, BI, MI, DM, IN

Gel and Blot Imaging

UVA, RP, JHU, NW, 

JAX, NE, IV, FH, AE, 

WU, GT, VT, NM, BI, 

MI, OR, PD, DM

UVA, RP, FH, AE, 

WU, VT, NM, MI

Y: UVA, RP, IV, FH, WU, 

NM, MI, DM

N: JHU, NW, JAX, NE, 

CO, VT, OR 

Y: UVA, RP, FH, WU, NM, 

MI, DM 

 

N: JHU, NW, JAX, NE, IV, 

VT, OR

Y: IA 

 

N: RP, JHU, NW, JAX, IV, 

MD, FH, CH, WT, VT, NM, 

BI, MI, OR, DM

Genotyping (SNP and 

microsatellite)

UVA, RP, USC, NW, 

JAX, IV, MD, FH, CH, 

DF, AE, WU, FC, PA, 

UT, CO, SJ, SF, GT, 

HI, VT, NM, DV, COH, 

MI, OR, IN, MSK

UVA, RP, USC, 

JAX, IV, FH, CH, 

DF, WU, FC, PA, 

UT, CO, SF, GT, HI, 

NM, DV, COH, MI

Y: UVA, RP, NW, IV, MD, 

FH, CH, DF, WU, FC, PA, 

UT, CO, SF, GT, HI, NM, 

DV, COH, MI, OR, MSK

 

N: USC, JAX, SJ, VT, IN

Y: UVA, RP, NW, JAX, IV, 

MD, FH, CH, DF, WU, FC, 

PA, UT, CO, GT, HI , NM , 

DV, MI , OR, IN

 

N: USC, VT

Y: NE, IA, IV, FH, SF, WT 

 

N: RP, JHU, USC, NW, 

JAX, CH, WU, FC, PA, 

CO, HI, VT, NM, DV, BI, 

MI, OR, IN

HPLC

UVA, RP, USC, JAX, 

IA, IV, MD, FH, CH, 

AE, FC, PA, SJ, GT, 

HI, NM, COH, MI, 

PD, MSK

UVA, RP, USC, IV, 

MD, FH, FC, HI, 

NM, COH, MI

Y: RP, USC, IV, MD, FC, 

HI, NM, COH, MI, MSK 

N: JAX, FH, CO, SJ

Y: RP, USC, IV, MD, FC, 

HI, NM , MI 

N: JAX, FH

Y: NE, WT 

 

N: RP, JHU, USC, NW, 

JAX, IA, IV, FH, WU, FC, 

CO, HI, NM, BI, MI

 

Mass Spectrometry

UVA, RP, JHU, USC, 

WF, NE, IA, IV, MD, 

FH, CH, DF, AE, FC, 

PA, UT, CO, SJ, OH, 

WT, SA, GT, HI, NY, 

NM, BI, COH, MI, 

OR, PD, DM, IN, 

MSK

UVA, RP, JHU, 

USC, WF, IV, MD, 

FH, DF, AE, PA, 

UT, OH, WT, HI, 

NY, NM, COH, MI, 

OR, PD, IN

Y: UVA, RP, USC, WF, NE, 

IV, MD, FH, DF, AE, FC, 

UT, CO, OH, WT, SA, HI, 

NY, BI, COH, MI, PD, IN

 

N: JHU, JAX, PA, SJ, 

NM, OR

Y: UVA, RP, USC, WF, NE, 

IV, MD, FH, DF, AE, FC, 

UT, OH, WT, SA, HI , NY, 

BI, MI, PD, IN 

 

N: JHU, PA, CO, NM, OR

 

Y: JAX , CO 

 

N: RP, JHU, USC, NW, 

WF, IA, IV, FH, FC, PA, 

WT, SA, HI, NY, NM, BI, 

MI, OR, IN
Accelerating Successes Against Cancer 119

Services

Which of these 

services do 

you currently 

provide?

Which of 

these are you 

particularly 

strong in?

Would you be 

willing to provide 

this service for a fee 

to other centers?

Do you have 

adequate capacity / 

could you expand to 

address expanded 

usage?

If these services 

were available from 

another cancer 

center, would you 

be a customer?

Molecular & Imaging Services

Microarray

UVA, RP, JHU, NW, 

JAX, WF, NE, IA, IV, 

MD, FH, CH, AE, FC, 

PA, UT, CO, SJ, OH, 

SF, WT, SA, GT, NY, 

VT, NM, DV, BI, COH, 

MI, OR, PD, DM, 

MSK

UVA, RP, JHU, 

JAX, IA, IV, MD, 

FH, CH, AE, FC, 

PA, UT, OH, SF, 

WT, NM, DV, BI, 

COH, MI, OR

Y: UVA, RP, JHU, NW, 

JAX, NE, IA , IV, MD, FH, 

CH, AE, FC, PA, UT, CO, 

OH, SF, WT, SA , NY, NM, 

DV, BI, MI, OR, DM, MSK

 

N: WF, SJ, VT, COH

Y: UVA, RP, JHU, NW, 

JAX, NE, IA, IV, MD, FH, 

CH, AE, FC, PA, UT, CO, 

OH, SF, WT, SA, NM, DV, 

BI, MI, OR, DM

 

N: WF, NY, VT

Y: WU, WT, VT, DM 

 

N: RP, JHU, NW, JAX, WF, 

IA, IV, FH, CH, FC, PA, 

CO, SF, SA, NY, NM, DV, 

BI, MI, OR

Peptide Synthesis

UVA, RP, JHU, USC, 

WF, MD, CH, AE, 

PA, UT, SJ, BI, COH, 

MSK

UVA, RP, MD, UT, 

COH

Y: UVA, RP, USC, WF, MD, 

UT, COH, MSK 

 

N: JAX, CO, SJ

 

Y: UVA, RP, USC, WF, 

MD, UT 

 

N: CO

Y: JAX, NE, IA, FH, WT, 

GT, NM 

 

N: RP, JHU, NW, WF, 

CO, BI

Maybe: USC

Protein Identification / 

characterization

UVA, RP, JHU, USC, 

JAX, WF, NE, IV, MD, 

FH, CH, DF, AE, PA, 

UT, CO, SJ, OH, SF, 

WT, GT, NY, BI, COH, 

MI, OR, IN, MSK

UVA, RP, JHU, IV, 

MD, FH, DF, PA, 

UT, OH, WT, NY, 

COH, MI, IN

Y: UVA, RP, USC, WF, NE, 

IV, MD, FH, DF, UT, OH, 

SF, WT, NY, COH, MI, IN, 

MSK

 

N: JHU, JAX, PA, CO, 

SJ, OR

Y: UVA, RP, USC, WF, IV, 

MD, FH, DF, UT, OH, SF, 

WT, NY, MI, IN 

 

N: JHU, PA, CO, OR

Y: JAX, IA , CO, NM

 

N: RP, JHU, NW, WF, IV, 

FH, PA, SF, WT, NY, BI, 

MI, OR, IN

Maybe: USC 

Real-time PCR

UVA, RP, JHU, NW, 

JAX, NE, IA, IV, MD, 

FH, CH, AE, WU, FC, 

PA, UT, CO, OH, SF, 

WT, SA, GT, NY, VT, 

NM, DV, BI, COH, MI, 

DM, IN, MSK

UVA, RP, JAX, IA, 

MD, FH, CH, FC, 

UT, CO, OH, SF, 

NY, VT, NM, DV, 

COH, MI

Y: UVA, RP, NW, IA, MD, 

CH, FC, UT, OH, SF, WT, 

NY, NM, DV, MI, DM, 

MSK

 

N: JHU, JAX, NE, IV, FH, 

WU, CO, SA, VT, COH, IN

Y: UVA, RP, NW, IA, MD, 

CH, WU, FC, UT, CO, 

OH, SF, WT, NM, DV, MI, 

DM, IN 

 

N: JHU, JAX, NE, IV, FH, 

SA, NY, VT

Y: 

 

N: RP, JHU, NW, JAX, IA, 

IV, FH, CH, WU, FC, CO, 

SF, WT, SA, NY, VT, NM, 

DV, BI, MI, DM, IN

Scanning Electron Microscopy

UVA, RP, USC, JAX, 

WF, NE, IA, IV, MD, 

FH, CH, AE, FC, PA, 

UT, SJ, GT, VT, NM, 

COH, MI, MSK

UVA, RP, USC, 

JAX, WF, IA, MD, 

FH, AE, PA, VT, 

NM, COH, MI

Y: UVA, RP, USC, JAX 

, WF, NE, IA, MD, FH, 

AE, FC, PA, UT, GT, NM, 

COH, MI 

N: IV, CO, SJ, VT

Y: UVA, RP, USC, JAX, 

WF, IA, MD, FH, AE, FC, 

UT, GT, NM, MI 

 

N: NE, IV, PA, CO, VT 

Y: USC, NW, MD, WU, WT 

 

N: RP, JHU, JAX, WF, IA, 

IV, FH, FC, PA, CO, VT, 

NM, BI, MI

Transmission Electron 

Microscopy

UVA, RP, USC, NW, 

JAX, WF, IA, IV, MD, 

FH, CH, AE, FC, PA, 

UT, SJ, WT, GT, VT, 

NM, BI, COH, MI, 

MSK

UVA, RP, USC, 

JAX, WF, IA, MD, 

FH, CH, AE, FC, 

WT, VT, NM, COH, 

MI

Y: UVA, RP, USC, NW, 

JAX, WF, IA, MD, FH, CH, 

AE, FC, UT, WT, GT, NM, 

COH, MI 

N: IV, CO, SJ, VT

 

Y: UVA, RP, USC, NW, 

JAX, WF, IA, MD, FH, 

CH, AE, FC, UT, WT, GT, 

NM, MI 

N: IV, CO, VT

Y: MD, WU, WT 

 

N: RP, JHU, USC, NW, 

JAX, WF, IA, IV, FH, CH, 

FC, CO, VT, NM, BI, MI

 Human Subject Study Services

Data Collection and 

Management

UVA, RP, JHU, USC, 

NW, WF, NE, IA, IV, 

MD, FH, CH, DF, AE, 

WU, FC, PA, UT, CO, 

SJ, GT, HI, NY, VT, 

NM, DV, COH, MI, 

OR, DM, IN

RP, USC, NW, IV, 

FH, WU, FC, UT, 

CO, VT, NM, DV, 

COH, MI, OR, IN

Y: NE, FH, WU, UT, CO, 

NM, DV, COH, MI 

 

N: UVA, RP, JHU, USC, 

NW, WF, IA, IV, MD, DF, 

FC, PA, SJ, HI, NY, VT, 

OR, IN

Y: NE, FH, WU, FC, UT, 

CO, HI, NM, DV, MI, IN 

N: UVA, RP, JHU, USC, 

NW, WF, IA, IV, MD, DF, 

PA, NY, VT, OR

Y: RP (excluding clinical 

research services), DV 

N: JHU, USC, NW, WF, IA, 

IV, FH, WU, FC, PA, CO, 

HI, NY, VT, NM, BI, MI, 

OR, IN

Dietary Assessment RP, FH, SJ, HI, MI RP, FH, HI

Y: RP, FH, HI, MI 

 

N: CO, SJ

Y: RP, FH, HI, MI 

N: CO

Y: WF, NE, IA, FC 

 

N: RP, NW, MD, FH, CO, 

HI, BI, MI

Exercise Studies FH, MI FH

Y: MI 

 

N: FH, CO

Y: MI 

N: FH, CO

Y: IA, FC 

N: NW, MD, FH, CO, 

BI, MI
120 Accelerating Successes Against Cancer

Services

Which of these 

services do 

you currently 

provide?

Which of 

these are you 

particularly 

strong in?

Would you be 

willing to provide 

this service for a fee 

to other centers?

Do you have 

adequate capacity / 

could you expand to 

address expanded 

usage?

If these services 

were available from 

another cancer 

center, would you 

be a customer?

Human Subject Study Services

Feeding Studies RP, FH RP, FH

Y: 

N: RP, FH, CO

Y: 

N: RP, FH, CO

Y: IA, FC 

N: RP, NW, MD, FH, 

CO, BI

Oncology Clinical Trials 

Support

UVA, RP, JHU, USC, 

NW, WF, NE, IA, IV, 

MD, FH, CH, DF, AE, 

WU, FC, PA, UT, CO, 

SJ, OH, SF, GT, HI, 

NY, VT, NM, DV, COH, 

MI, OR, DM, IN

RP, JHU, USC, 

NW, IV, MD, FH, 

CH, FC, UT, CO, 

GT, VT, NM, DV, 

COH, MI, OR, IN

Y: RP, USC, NE, WU, UT, 

GT, DV, COH, MI 

 

N: JHU, NW, IA, IV, MD, 

FH, CH, DF, FC, PA, SJ, 

SF, HI, NY, VT, NM, OR, IN

Y: RP, USC, NE, WU, FC, 

CO, GT, HI, DV, IN

 

N: UVA, JHU, NW, IA, IV, 

MD, FH, CH, DF, PA, SF, 

NY, VT, NM, MI, OR

Y: DV 

 

N: RP, JHU, NW, IA, IV, 

FH, CH, WU, FC, PA, CO, 

SF, HI, NY, VT, NM, BI, MI, 

OR, IN

Prevention Center – Research 

Clinic

RP, MD, FH, UT, CO, 

GT, NM, DV, MI

MD, UT, CO, NM, 

DV, MI

Y: UT, CO, DV, MI 

N: MD, FH, NM

Y: UT, CO, DV, MI 

 

N: RP, MD, FH, NM

Y: NE, IA 

N: RP, USC, NW, FH, CO, 

NM, DV, BI, MI

Programming, Database 

Design and Development

RP, JHU, NW, IV, MD, 

FH, CH, AE, WU, FC, 

PA, UT, CO, SJ, SF, 

GT, NM, DV, COH, 

MI, IN

RP, NW, IV, MD, 

FH, WU, FC, PA, 

UT, GT, NM, DV, 

COH, MI

Y: FH, UT, GT, NM, DV, 

COH, MI 

 

N: RP, JHU, NW, IV, MD, 

WU, FC, PA, CO, SJ, IN

Y: FH, WU, FC, UT, GT, 

NM, DV, MI, IN 

 

N: RP, JHU, NW, IV, MD, 

PA, CO

Y: NE, IA, IV, MI 

 

N: RP, JHU, NW, FH, CH, 

WU, FC, PA, CO, NM, DV, 

BI, IN

Technology & Scientific 

Project Management

RP, JHU, IV, MD, FH, 

CH, WU, UT, NM, MI

IV, MD, WU, UT, 

NM, MI

Y: WU, UT 

 

N: RP, JHU, IV, MD, FH, 

CH, CO, NM, MI

Y: WU, UT 

N: RP, JHU, IV, MD, FH, 

CH, CO, NM, MI

Y: IA 

N: RP, JHU, NW, IV, FH, 

CH, WU, CO, NM, BI, MI

Telephone Interviewing RP, JHU, IV, FH, CO, 

SJ, NM RP, FH, CO, NM

Y: RP, FH, CO 

 

N: JHU, IV, SJ, NM, IN

Y: RP, FH, CO, IN 

 

N: JHU, IV, NM 

Y: NE, IA, CH, FC, SF 

N: RP, JHU, NW, IV, MD, 

FH, CO, NM, BI, IN

Tissue Procurement and 

Banking

UVA, RP, JHU, USC, 

NW, WF, NE, IA, IV, 

MD, CH, AE, WU, 

FC, UT, CO, SJ, OH, 

SF, GT, NY, VT, NM, 

DV, COH, MI, OR, IN, 

MSK

RP, USC, NW, IV, 

MD, CH, WU, FC, 

UT, CO, OH, SF, 

NM, DV, COH, 

MI, OR

Y: UVA, RP, USC, NE, IA, 

IV, CH, WU, UT, CO, OH, 

NY, NM, DV, MI, OR 

N: JHU, NW, WF, MD, FC, 

SJ, SF, VT, COH

Maybe: IN

Y: RP, USC-limited 

space, NE, IA, IV, CH, 

WU, FC, UT, CO, OH, NM, 

DV, OR, IN

 

N: UVA, JHU, NW, WF, 

MD, SF, NY, VT, MI

Y: UVA, WT, VT, DV, BI 

 

N: RP, JHU, USC, NW, 

WF, IA, IV, FH, WU, FC, 

CO, SF, NY, NM, MI, 

OR, IN

Tracking Subjects

RP, JHU, USC, WF, 

IA, IV, MD, FH, DF, 

WU, UT, CO, SJ, GT, 

NY, NM, DV, COH, 

MI, DM

RP, IV, FH, DF, UT, 

CO, NM, COH, MI

Y: RP, IV, FH, UT, CO, 

DV, MI 

 

N: JHU, USC, WF, MD, 

DF, WU, SJ, NY, NM, 

COH, MI, IN

Y: RP, IV, FH, UT, CO, 

DV, IN 

 

N: JHU, USC, WF, MD, 

DF, WU, NY, NM, MI

Y: FC 

 

N: RP, JHU, USC, NW, 

WF, IA, IV, FH, WU, CO, 

NY, NM, DV, BI, MI, IN

Laboratory Support Services

Animal Imaging

UVA, RP, JHU, NW, 

JAX**, WF, NE, IA, 

MD, FH, CH, AE, WU, 

FC, PA, CO, SJ, OH, 

WT, NY, DV, BI, MI, 

DM, IN, MSK

UVA, RP, JAX, WF, 

IA, MD, WU, FC, 

PA, DV, MI, IN

Y: UVA, RP, JAX, WF, IA, 

MD, WU, FC, CO, OH, NY, 

DV, BI, MI, DM, IN

N: JHU, NW, NE, FH, PA, 

SJ, WT

Y: UVA, JAX, WF, IA, 

MD, WU, FC, CO, OH, DV, 

BI, MI, DM, IN 

 

N: RP, JHU, NW, NE, FH, 

PA, WT, NY

Y: RP, MI 

N: UVA, JHU, NW, JAX, 

WF, IA, IV, FH, WU, FC, 

PA, CO, WT, NY, DV, BI, 

DM, IN

Animal Husbandry and 

Veterinary Services

RP, JHU, NW, JAX, 

IV, MD, FH, CH, AE, 

FC, CO, SJ, OH, WT, 

VT, DV, BI, COH, MI, 

MSK

RP, JAX, IV, MD, 

FH, CH, FC, WT, 

DV, COH, MI

Y: RP, JAX , IV, CH, OH, 

WT, DV, MI 

 

N: JHU, NW, IA, MD, FH, 

FC, CO, SJ, VT, COH, IN

Y: RP, JAX, CH, CO, OH, 

WT, DV, MI 

 

N: JHU, NW, IA, IV, MD, 

FH, FC, VT, IN

Y: 

 

N: RP, NW, JAX, IA, IV, 

FH, CH, FC, CO, WT, VT, 

DV, BI, MI, IN
Accelerating Successes Against Cancer 121

Services

Which of these 

services do 

you currently 

provide?

Which of 

these are you 

particularly 

strong in?

Would you be 

willing to provide 

this service for a fee 

to other centers?

Do you have 

adequate capacity / 

could you expand to 

address expanded 

usage?

If these services 

were available from 

another cancer 

center, would you 

be a customer?

Laboratory Support Services

Transgenic / Knockout Mice

UVA, RP, USC, NW, 

JAX, NE, IV, MD, FH, 

CH, AE, FC, PA, UT, 

CO, SJ, OH, WT, SA, 

NY, VT, DV, BI, COH, 

MI, OR, PD, DM, IN, 

MSK

RP, USC, JAX, 

IV, MD, CH, FC, 

PA, UT, WT, VT, 

DV, COH, MI, OR, 

PD, IN

Y: UVA, RP, USC, JAX, 

NE, IV, MD, CH, FC, UT, 

CO, OH, WT, SA, NY, DV, 

COH, MI, OR, PD, DM, 

IN, MSK 

N: NW, IA, FH, PA, SJ, VT

Y UVA, RP, USC, JAX, 

NE, MD, CH, FC, UT, CO, 

OH, WT, SA, DV, MI, PD, 

DM, IN 

 

N: NW, IA, IV, FH, PA, NY, 

VT, OR

Y: FH, VT, DM 

 

N: RP, USC, NW, JAX, IA, 

IV, CH, FC, PA, CO, WT, 

SA, NY, DV, BI, MI, OR, IN

NOD / SCID Mice

RP, NW, JAX, MD, 

FH, CH, AE, FC, CO, 

SJ, OH, WT, BI, IN, 

MSK

RP, JAX, FC, IN

Y: RP, JAX, MD, CO, 

OH, WT 

 

N: NW, IA, FH, FC, SJ, IN

Y: RP, JAX, MD, CO, OH, 

WT, IN 

 

N: NW, IA, FH, FC

Y: IA, IV, FH, WT 

 

N: RP, NW, JAX, FC, CO, 

BI, IN

Research Animal Technical 

Services

UVA, RP, JHU, NW, 

JAX, MD, FH, CH, 

AE, FC, UT, CO, SJ, 

WT, VT, DV, BI, MI, 

MSK

RP, JAX, MD, FH, 

FC, WT, DV, MI

Y: UVA, RP, JAX, UT, CO, 

WT, DV, MI, MSK 

 

N: JHU, NW, IA, MD, FH, 

FC, SJ, VT, IN 

Y: RP, JAX , CO, WT, 

DV, MI

 

N: JHU, NW, IA, MD, FH, 

FC, VT, IN

Y: IV 

 

N: RP, JHU, NW, JAX, IA, 

FH, FC, CO, WT, VT, DV, 

BI, MI, IN

Tissue Culture Supplies

UVA, RP, USC, JAX, 

WF, IA, IV, MD, FH, 

AE, FC, PA, UT, 

CO, WT, OR, MSK 

(media)

RP, USC, IA, MD, 

FC, WT, OR

Y: RP, USC, IA, IV , PA, 

UT, CO 

 

N: JAX, WF, MD, FH, FC, 

WT, OR, IN

Y: RP, USC, IA, IV, FC, 

CO, IN 

 

N: JAX, WF, MD, FH, PA, 

WT, OR

Y: USC, IV 

 

N: RP, JHU, NW, JAX, WF, 

IA, FH, FC, PA, CO, WT, 

BI, OR, IN

Library, Computing and Graphic Services

Analytical Software

RP, JAX, FH, CH, AE, 

WU, FC, WT, VT, BI, 

MI, OR, MSK

RP, JAX, WU, FC, 

WT, MI, OR

Y: JAX, WU, WT, MI, OR 

 

N: RP, FH, CH, FC, CO, VT

Y: JAX, WU, FC, MI 

 

N: RP, FH, CH, WT, VT, OR

Y: WF, IA, MD, FH, OH, 

WT, VT, MI 

 

N: RP, NW, JAX, CH, WU, 

FC, CO, BI, OR 

Biostatistics

UVA, RP, USC, NW, 

JAX, WF, NE, IA, IV, 

MD, FH, CH, DF, AE, 

FC, UT, CO, SJ, OH, 

SF, WT, HI, VT, DV, 

COH, MI, OR, DM, 

IN, MSK

RP, USC, NW, 

JAX, WF, FH, CH, 

DF, FC, UT, CO, 

OH, HI, VT, DV, 

COH, MI, OR, DM

Y: UVA, JAX, NE , CH, UT, 

MI, OR 

N: RP, USC, NW, WF, IA, 

MD, FH, DF, FC, CO, SJ, 

SF, WT, HI, VT, DV, COH, 

DM, IN

Y: USC, JAX, NE, CH, FC, 

UT, HI, DV, MI, OR, IN

 

N: RP, NW, WF, IA, MD, 

FH, DF, CO, SF, WT, VT, 

DM

Y: UVA, OH, WT, BI 

 

N: RP, USC, NW, JAX, 

WF, IA, FH, CH, FC, CO, 

SF, HI, VT, DV, MI, OR, 

DM, IN

Computing Lab RP, JAX, MD, FH, AE, 

FC, WT, BI, MI, MSK

RP, FH, FC, WT, 

MI

Y: RP, WT, MI 

 

N: JAX, MD, FH, FC, CO

Y: RP, FC, WT, MI

 

N: JAX, MD, FH

Y: IA, OH 

N: RP, NW, JAX, FH, FC, 

CO, WT, BI, MI 

Graphic Design and Posters

RP, JAX, NE, MD, 

FH, DF, FC, SJ, BI, 

MI, MSK

RP, JAX, DF, 

FC, MI

Y: NE, FC, BI, MI 

 

N: RP, JAX, MD, FH, DF, 

CO, SJ, IN

Y: RP, FC, BI, MI, IN 

N: JAX, NE, MD, FH, DF

Y: IV, OH, WT 

 

N: RP, NW, JAX, IA, FH, 

FC, CO, BI, MI, IN 

High Performance Computing

RP, JAX, FH, AE, WU, 

FC, UT, SJ, WT, VT, 

BI, MI, MSK

RP, FH, WU, FC, 

UT, VT

Y: RP, UT, WT 

 

N: JAX, MD, FH, WU, FC, 

CO, SJ, VT, MI

Y: RP, JAX, WU, FC, WT 

 

N: FH, VT, MI

Y: JAX, IA, IV, MD, OH, 

WT, VT 

 

N: RP, NW, FH, WU, FC, 

CO, BI, MI

Interlibrary Loan

RP, JAX, NE, MD, 

FH, CH, FC, UT, WT, 

BI, MSK

JAX, CH, FC, WT

Y: JAX, CH, FC, WT

 

N: RP, NE, MD, CO

Y: JAX, CH, FC, WT

 

N: RP, MD, FH

Y: JAX, IV, FH, OH, WT 

 

N: RP, NW, IA, CH, FC, 

CO, BI

Online Databases & Journals

UVA, RP, JAX, NE, 

MD, FH, CH, FC, UT, 

SJ, WT, BI, COH, 

MSK

JAX, FH, CH, 

FC, BI

Y: JAX, CH, FC, WT

 

N: RP, NE, MD, FH, CO, 

SJ, BI, COH

Y: JAX, MD, CH, FC, WT 

 

N: RP, FH

Y: RP, JAX, IV, OH 

 

N: NW, IA, FH, CH, FC, 

CO, WT, BI

Photography and Digital 

Imaging

RP, USC, JAX, MD, 

FH, AE, FC, SJ, WT, 

BI, MI, MSK

RP, USC, FC, WT

Y: USC, FC, WT, MI 

 

N: RP, JAX, MD, FH, 

CO, SJ

Y: RP, USC, JAX, FC, 

WT, MI 

 

N: MD, FH

Y: IV, OH 

 

N: RP, USC, NW, JAX, IA, 

FH, FC, CO, WT, BI, MI
122 Accelerating Successes Against Cancer

Services

Which of these 

services do 

you currently 

provide?

Which of 

these are you 

particularly 

strong in?

Would you be 

willing to provide 

this service for a fee 

to other centers?

Do you have 

adequate capacity / 

could you expand to 

address expanded 

usage?

If these services 

were available from 

another cancer 

center, would you 

be a customer?

Library, Computing and Graphic Services

Programming, Database 

Design and Development

RP, NW, JAX, IV, MD, 

FH, CH, WU, FC, UT, 

WT, BI, MI, MSK

RP, NW, JAX, IV, 

FH, WU, FC, UT, 

WT, MI

Y: RP, FH, WU, UT, WT, MI 

 

N: NW, JAX, IV, MD, 

FC, CO

Y: RP, WU, FC, UT, WT, MI 

N: NW, JAX, IV, MD, FH

Y: RP, IA, IV, FH, OH, WT 

 

N: NW, JAX, WU, FC, CO, 

BI, MI

Scientific Application Hosting RP, JAX, MD, FH, FC, 

UT, WT, BI, MI FC, UT, WT, MI

Y: RP, UT, WT, MI 

 

N: JAX, FH, FC, CO

Y: RP, FC, UT, WT, MI 

 

N: JAX, FH

Y: JAX, IV, MD, OH, WT 

N: RP, NW, IA, FH, FC, 

CO, BI, MI 

Slide Production RP, JAX, MD, FH, BI, 

MSK RP, JAX

Y: 

 

N: RP, JAX, MD, FH, CO

Y: RP 

N: JAX, MD, FH

Y: IV, WT 

 

N: RP, NW, JAX, IA, FH, 

CO, BI

*The Jackson Laboratory could more easily provide necropsy services (on mice only) for animals available from their 

production services—other animals would have to be shipped and possibly imported and bred depending on the specific 

research needs.

**The Jackson Laboratory could more easily provide imaging services (on mice only) for animals available from their 

production services—other animals would have to be imported and bred before the specific research service could be 

carried out.

Key Cancer Center

UVA University of Virginia

RP Roswell Park

JHU Johns Hopkins University

USC University of Southern California

NW Northwestern University

JAX Jackson Laboratory

WF Wake Forest University

NE University of Nebraska

IA University of Iowa

IV University of California-Irvine

MD MD Anderson Cancer Center

FH Fred Hutchinson Cancer 

 Research Center

CH University of Chicago

DF Dana Farber/Harvard Cancer Center

AE Albert Einstein College of 

WU Washington University-St. Louis

FC Fox Chase Cancer Center

PA University of Pennsylvania

UT University of Utah, Huntsman 

 Cancer Center

CO University of Colorado

Key Cancer Center

SJ St. Jude Children’s Research Hospital

OH Ohio State University

SF University of California, San Francisco

WT Wistar Institute

SA Salk Institute

GT Georgetown University

HI University of Hawaii

NY New York University

VT Vermont Cancer Center

NM University of New Mexico

DV University of California, Davis

BI Burnham Institute

COH City of Hope National 

 Medical Center

MI University of Michigan

OR Oregon Cancer Institute

PD Perdue University Cancer Center

DM Dartmouth: Norris Cotton 

 Cancer Center

IN Indiana University Cancer Center

MSK Memorial Sloan Kettering 

 Cancer Center
Accelerating Successes Against Cancer 123

The Burnham Institute’s Cancer Center in La Jolla, CA, has specialized expertise and high-end technologies that 

focuses on various aspects of chemical biology research and early-stage drug discovery. We currently have adequate 

capacity and/or could expand the following services to provide them for a fee to other Centers:

(1) Protein Expression for large-scale production and purification of multi-milligram quantities of recombinant protein in 

bacterial, yeast, insect and eukaryotic cell systems; 

(2) Chemical Library Screening, which provides access to a ~200,000 compound library and fully integrated, robotic 

liquid handling systems for HT screening using either biochemical or cell-based assays;

(3) In silico Screening/Computational Modeling, which utilizes a dedicated Linux cluster, and applies docking algorithms 

for screening a virtual library of >1 million compounds for hits against protein targets when a high quality 3-dimensional 

structure is available; 

(4) High-Throughput Microscopy, which houses several HT microscopes for cell-based screens using high-content 

imaging, along with supporting software for automated image analysis; 

(5) NMR, which includes a 500 MHz instrument equipped with automatic sample changer for applying chemical 

compounds to protein targets, in addition to a 300 MHz instrument dedicated for chemical compound structure 

determination, and a 600 MHz instrument for protein structure determination, as well as supporting computer 

workstations and software for data analysis; 

(6) X-ray Crystallography, which provides x-ray diffractometers and supporting computer workstations and software for 

determination of protein/chemical compound complexes at atomic resolution; 

(7) Medicinal Chemistry, which performs contract-based synthesis and purification of analogs of compounds using 

medicinal chemistry approaches, including using structure-based methods for guiding medicinal chemistry efforts; 

(8) Functional Genomics, which consists of HTS-formatted siRNA libraries. 

Contact:

Kristiina Vuori, M.D., Ph.D

Acting Director, Cancer Center

Burnham Institute for Medical Research

10901 North Torrey Pines Road

La Jolla, CA 92037

Tel (858) 646-3129

FAX (858) 713-9929

e-mail: kvuori@burnham.org

Senior Administrative Assistant:

Ms. Trixi Czink

Tel (858) 646-3100, x3343

FAX (858) 713-6272

e-mail: trixi@burnham.org
124 Accelerating Successes Against Cancer

Notes