Investment in Cancer Control and Research: A Sure Bet
Authors: C. D. Runowicz
Journal: CA A Cancer Journal for Clinicians (2006)

In the early 1970s, a diagnosis of cancer was often construed by patients and their families as a death sentence. Yet despite this, funding for cancer research was declining. In 1969, the appropriation for the National Cancer Institute (NCI) was up only 1% from the preceding year and in 1970 was down 2% from 1969, a situation eerily similar to the present NCI funding situation.1 Responding to a call for action from the public and private sectors, President Richard Nixon signed the National Cancer Act in 1971 setting the stage for a major expansion of federal financing of cancer research. And the investment made a difference. Since 1990, the US cancer mortality rates have been declining about 1% per year. Declines have been especially favorable for cancers of the breast and colorectum for women and for cancers of the prostate, colorectum, and lung for men. The 5-year survival rate for patients with cancer diagnosed from 1974 to 1976 was only 49.6%. Individuals diagnosed from 1996 to 2001 fared substantially better, with a 5-year survival rate of 65%.2 Today, people are increasingly living with cancer rather than dying from it—a testament to our nation's investment in biomedical research, prevention, early detection, improved therapies, new technologies, and a better understanding of the molecular basis of cancer. We now understand that cancer is a continuum that can be interrupted at many stages from susceptibility to initiation to clinically detectable disease. Cancer research has clearly been a sound investment. Despite the progress in 5-year survival rates and a decrease in the mortality rates, cancer remains the most feared disease in America. One in two men and one in three women will hear the words “you have cancer,” and one of every four deaths is from cancer. Cancer takes approximately 8.6 million years of life from Americans each year,2 and in 2005 will cost the nation an estimated $210 billion in medical expenditures and lost productivity.3 The American population is graying, with a growing percentage of people in their 60s and older. The number of Americans over the age of 65 will double in the next 30 years. By the year 2030, one in five Americans will be 65 years or older. Approximately six of every 10 new cases of cancer are diagnosed at age 65 years and older.4 With the projected number of new patients diagnosed with cancer, it is imperative that we increase funding for research now to improve therapies and develop prevention strategies to avoid these cancers altogether. Thanks to knowledge amassed in the past decade in particular, we are at a point in which a bold investment in cancer would reap tremendous rewards. We are now able to target cancers at the molecular level and have witnessed an explosion of technological advances. We can now actually envision a time when the outcomes of cancer—suffering and death—can be eliminated. To continue this war on cancer, we need to sufficiently fund research. Adequate funding to develop new therapies, technologies, and to change the current treatment paradigm from detection and treatment of disease to prediction of risk and prevention of disease must be a nationwide priority. In October 2003, the Institute of Medicine of the National Academy of Sciences reported that 60% of cancer can be prevented through reducing one's risk and through early detection.5 On September 10, 2001, the National Cancer Legislation Advisory Committee issued a report entitled, “Conquering Cancer: A National Battle Plan to Eradicate Cancer in our Lifetime.”6 This report called for an increased NCI research investment to achieve and sustain at least a 40% success rate for approved investigator-initiated research grants and program projects grants. Unfortunately, attention to this report and its recommendations seem to have been diminished in the aftermath of the following day's tragic events. The NCI has not been awarded this funding and the success rate for approved grants is almost half of what was recommended by this group. In recognition of the importance of research, the ACS included research as one of its four leadership roles along with quality of life, information and prevention, and early detection. In 2006, the ACS is funding $115 million of cancer research—more than any other private nonprofit organization in the United States—focused on beginning investigators, investigator-initiated grants, and high-impact research. As part of this leadership role, the ACS strongly advocates for more research funding from the private and public sector. It is imperative to continue to fight for more funding for research—for ACS-supported research, NCI-supported research, and from the private sector. In a national survey, Research! America reported that two-thirds of Americans are willing to pay $1/week more in taxes to support medical research.7 The public understands the return on investment for monies allocated for research. America can provide the best cancer care in the world, with the greatest concentration of health care resources and services. Yet there are disparities in cancer care in the United States; minority, elderly, and medically underserved Americans are disproportionately burdened by cancer. The American Cancer Society (ACS) believes that all individuals with a cancer diagnosis should have timely access to quality cancer care, and that there is a societal obligation to facilitate access to care for the uninsured and underinsured. The health care system needs significant revision to meet the demand of the future. The ACS will help to meet these challenges by working for policies that will address universal access for patients with cancer, alleviate the financial devastation of people uninsured or underinsured for cancer care, and have the greatest impact on reducing disparities in cancer prevention, screening, diagnosis, and treatment. We need to look to a future in which there is universal access to high-quality cancer care. Unless Americans unite to demand changes in our health care system, the current already strained system will collapse with the challenges of tomorrow. In addition to access, it is critical to support research to continue our fight against cancer and to win this war—once and for all. The ultimate conquest of cancer in America is as much a public policy issue as it is a scientific and medical challenge. We can dramatically change the outcome of cancer right now, today, by investing in research and applying what we already know about cancer prevention, early detection, and care. We need to implement strategies now so that we can meet these goals.