A brief history of the American Cancer Society Extramural Research Program
Authors: Otis W. Brawley
Journal: CA A Cancer Journal for Clinicians (2012)

In this issue, Dr. Vincent DeVita, incoming president of the American Cancer Society (ACS) and one of the most distinguished physicians in medicine, opines on the ACS and its support of cancer research.1 The following is a brief history of the research program, its review, and its evolution. In preparation for its 100th anniversary, the ACS entered into a strategic planning and reorganization in order to meet the needs of our second century. This process was termed “Transformation,” and included a comprehensive review of the ACS Extramural Research Program. This review was conducted over a period of 12 months by a group of distinguished cancer researchers and laypersons. Below is a description of the program and the group's findings. The ACS was founded as the American Society for the Control of Cancer in 1913 to support anticancer efforts through public education and patient service. A reorganization in the mid-1940s gave the society a new name, the American Cancer Society, and created the ACS research program. This program was charged with funding promising cancer research at universities and institutes throughout the United States. More specifically, in 1946, the grants program was charged with determining the causes, prevention, early detection, and cure of cancer as quickly as possible. Since 1946, the ACS has invested more than $3.6 billion in cancer research to fund nearly 31,000 grants to approximately 21,000 researchers and health care professionals at more than 1000 academic institutions. The ACS was the major source of cancer research funding in the United States from 1946 until the early 1960s, when the National Cancer Institute (NCI) surpassed it. The ACS Extramural Research Program is still the nation's largest private, not-for-profit provider of funds for cancer research and training and one of the largest private funders of medical research in the world. In 2011, the ACS spent over $105 million on research grants to nearly 200 institutions. By comparison, the NCI spent over $3 billion on research grants. If the ACS research program was merely a smaller version of the NCI, its effect would be relatively small. Optimizing the impact of the Society's research program depends on leveraging our unique strengths as a nongovernmental voluntary health organization to complement (rather than duplicate) the existing federal cancer research endeavor. Over the past 65 years, the ACS research program has evolved, with specific grant programs being created and others phased out in accordance with changing scientific and training needs and opportunities as determined by outside peer reviewers. Most ACS grants have been for laboratory research. A few have been to provide partial support for clinical studies. In the past 15 years, a growing percentage has been devoted to cancer control science, with the majority centering around research aimed at finding methods to reduce health disparities. The early 1990s was a period in which the NCI and the overall research infrastructure had very few programs to support scientists early in their career. In response, the ACS changed its research program, devoting most of its research funds to support young investigators. The science supported was still largely laboratory-based and basic. Young investigators were defined as scientists who were within 8 years of starting an independent research career. Due to budget constraints and a desire to spread the money as far as possible, the program began supporting scientists who were within 6 years of starting an independent research career around 2005. During the 1990s, an effort to provide more support to cancer prevention, survivorship, oncology nursing, and social science also began. The ACS also started soliciting more grant proposals for work in health disparities. Still, laboratory science dominated. In 2005, a group of advisers suggested that the ACS increase targeted applied research in areas of high interest and relevance to the Society. These areas included behavioral, psychosocial, clinical, health policy, and health services research, with the goal of more balanced funding of basic and nonbasic applied research. Research funding in 2011 by category is listed in Table 1. Tobacco control. Breast cancer screening. Colorectal cancer screening. A focus on improving nutrition, increasing physical activity, and reducing obesity. Survivorship and quality of life. Implementation of the Patient Protection and Affordable Care Act. Better link the ACS research program with its areas of focus by funding more applied research. Increase the amount allocated to research over time as the ACS budget increases. Substantially increase funding for research that approaches the historic levels of the last few decades. The committee noted that a substantial body of research (some of it ACS-funded) indicates that mortality rates are going down due to the application of research findings.2 At the same time, many Americans do not enjoy the fruits of completed research. More consistent application of this knowledge has the potential to prevent many thousands of cancer deaths per year. For example, nearly one-half of all adults who should receive colorectal screening do not, and nearly one-third of women who should undergo breast screening do not. Of the patients diagnosed with cancer, a substantial percentage get less-than-optimal care.3 “How can we provide adequate care to all?” is an important scientific question. Given these considerations, one-half of the ACS extramural research budget should be for “applied research.” While the committee sees a greater need for “cancer control research” to reduce short- and intermediate-term morbidity and mortality from cancer, the committee also considers continued support of the early career investigator (in basic, clinical, and cancer control research) as imperative if we are to have mid-career investigators after 2025. No other organization appears willing to fill the void if the ACS stops its early career investigator program. One-half of the ACS extramural research budget should continue to be for early investigators doing primarily basic research. The committee was very concerned that the decreasing size of the research program and declining percentages of grants funded were decreasing the importance and influence of the ACS in the cancer community. It was noted that the extramural research budget of approximately $105 million and the intramural research budget of approximately $14 million represent less than 15% of the entire ACS budget. In the past, research has been as much as 25% of the entire ACS budget. The Research 3.0 committee has tremendous respect for the other missions of the ACS, but believes that continued support of research is critical to the ACS mission of saving more lives from cancer. The committee suggests that the ACS set a long-term goal of raising research funding to $250 million per year. It is understood that this goal is not achievable without increased fundraising by the ACS. The decision to align grants to the ACS mission (areas of focus) is being done with the belief that it can lead to an accelerated saving of lives. It adds no additional areas to the research portfolio but does call for an expansion of the number of cancer control grants that are funded. While some may consider this a broadening of the traditional definition of research, it is very congruent with the definition of cancer control research originally espoused by Greenwald and Cullen in 1984 and still used by the NCI today. “Cancer control is the reduction of cancer incidence, morbidity, and mortality through an orderly sequence from research on interventions and their impact in defined populations to the broad, systematic application of the research results.”4 Ironically, this new path for extramural research is very congruent with the purpose of the program as defined at its founding in 1946.