AACR CANCER PROGRESS REPORT

Much progress has been made in cancer treatment, prevention, and diagnosis, with a corresponding decrease in the associated mortality rate, according to the annual Cancer Progress Report released by the American Association for Cancer Research (AACR).

"There has never been a time of greater excitement in the cancer field," said Margaret Foti, PhD, chief executive officer of the AACR. "The rapid pace and broad scope of the progress against cancer are extraordinary."

"We have the scientific knowledge, cutting-edge technologies, and capability to deliver a new wave of innovations that will stimulate more lifesaving progress," said Foti in a statement.

However, despite the promising inroads and advances, enormous public health challenges still remain.

The report highlights how federally funded research discoveries are affecting the development of new therapeutic agents, along with more effective methods of detecting and diagnosing cancer and even more effective ways to prevent, detect, diagnose, and treat cancer.

The authors emphasize that it is vital that biomedical research "remains a high priority for our nation's policy makers" if the pace of progress is to be accelerated. Research supported largely by federal investments in the National Institutes of Health (NIH) and National Cancer Institute (NCI) is altering the trajectory of cancer, the report notes, by driving advances in public health and improvements in patient care across the entire cancer care continuum.

Key Advances

The report highlights some of the most important advances that have been made in cancer care. These include the following:

• Between August 1, 2017, and July 31, 2018, 14 new cancer therapies received approval from the US Food and Drug Administration (FDA), 11 drugs already on the market received approval for expanded indications, and 1 new surgery guiding system was approved.
• New approved treatments include chimeric antigen receptor (CAR) T-cell therapies, new targeted radiotherapeutics, and other new targeted agents.
• The number of cancer survivors has reached a record high of more than 15.5 million.
• The cancer death rate declined by 26% from 1991 to 2015.
• The rate of cigarette smoking among US adults has plummeted to 14%, which is a dramatic decline from 42% in 1965.

"The unprecedented progress we are making against cancer has been made possible largely through basic research," said Elizabeth M. Jaffee, MD, president of the AACR and deputy director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University in Baltimore, Maryland, in a statement. "A continued increase in federal funding for both basic, translational, and clinical research will allow us to make major headway moving forward."

Challenges Remain

The AACR report also outlines the challenges that remain in cancer care. Despite advances in treatment and detection, the number of new cancer cases is projected to increase dramatically in the coming decades, rising from more than 1.7 million in 2018 to almost 2.4 million by 2035 in the United States alone. This increase in cases will be primarily due to the growing numbers of individuals who are age 65 years and older.

Globally, the number of cancer cases has been steadily rising during the past decade, from 13.4 million in 2006 to 17.4 million in 2016. The burden of cancer is expected to show the most growth in low-income nations.

While the rate of death from cancer has been declining, an estimated 609,000 individuals are projected to die from the disease in 2018. That number is also projected to escalate to over 1 million deaths in 2035, as the number of cancer cases increases.

Another pressing issue are cancer health disparities, both globally and nationally. Complex and interrelated factors contribute to disparities in the US, where certain groups experience a disproportionate cancer burden as compared with other populations. Cancer disparities reflect the complicated interplay of socioeconomic factors, culture, lifestyle, geographic location, diet, stress, type of health insurance, the environment, and biology. Recently identified examples of disparities in cancer include incidence rates, death rates, and stage at diagnosis.

One example, the report notes, is that black men have a prostate cancer–related mortality that is more than double that for men in any other racial or ethnic group. Another disparity example is that adolescents and young adults with head and neck cancer who have Medicaid coverage or no insurance are 61% and 51% more likely  to die of their disease than those who have private insurance.

The report also notes that an estimated 40% of all cancer cases diagnosed in the United States in 2014, along with nearly half of all cancer deaths, were caused by potentially avoidable risk factors. These include tobacco use, poor diet, alcohol intake, physical inactivity, and obesity. In addition, vaccination against infection with the human papillomavirus (HPV) and decreasing exposure to ultraviolet radiation from the sun and indoor tanning devices can further reduce the cancer burden.

A critical issue hindering improvements in public health, says AACR, is the current inability to effectively communicate knowledge on avoidable cancer risk factors to the general population as well as implementing interventions to minimize these risks. Most adults are still unaware of the significant cancer risks associated with obesity and alcohol use, for example, and less than 50% of adolescents age 13 to 17 years have received the full HPV vaccination series.

Call to Action

Finally, the report emphasizes the need for new strategies and prevention, but for that to happen, more funding is needed to support federally funded efforts. Of highest priority is the continued support of the NIH and to increase the budget by at least $2 billion in fiscal year (FY) 2019, for a total funding level of at least $39.1 billion.

However, it does appear that funding for the NIH is a priority. AACR emphasizes that thanks to the "remarkable, bipartisan efforts in Congress," the NIH budget is back on track for real and sustainable annual growth. There have been 3 consecutive years of robust funding increases that were significantly above the annual rate of biomedical inflation, despite the "political and budgetary challenges." The NIH budget has increased by $7 billion, or 23%, since FY 2015.

Another priority is to ensure that the $711 million in funding allocated through the 21st Century Cures Act for targeted initiatives, including the National Cancer Moonshot, is fully appropriated in FY 2019 and is supplemental to the increase for the NIH's base budget.

A third priority is to increase the FDA base budget in FY 2019 to $3.1 billion, which would be a $308 million increase above its FY 2018 level. This is the amount needed, says AACR, to ensure support for regulatory science and accelerate the pace of development products that are safe and effective. More specifically, the AACR supports a funding level of $20 million for the FDA Oncology Center of Excellence in FY 2019.

Finally, the Centers for Disease Control and Prevention Cancer Prevention and Control Programs should receive total funding of at least $517 million. This amount would include funding for comprehensive cancer control, cancer registries, and screening and awareness programs for specific cancers.

"If we are to seize these opportunities to further transform cancer care, we must ensure that biomedical research remains a high priority for our nation's policymakers," said Foti.