Winning the war against cancer, one battle at a time

Abstract

By Joseph V. Simone, MD, former director of the University of Florida Shands Cancer Center and senior adviser to the current director and Elizabeth Connor, MA, MSHA, a writer at the University of Florida Shands Cancer Center Arecent article in The New York Times takes to task the cancer research establishment for playing it safe.1 Too often, author Gina Kolata writes, what gets funded is research that is cautious, timid, and likely to produce incremental progress rather than the gamechanging insights that will produce dramatic reductions in the cancer burden. We're not discouraged by the slow, but sure, drop in cancer mortality rates. … Cancer mortality figures alone mask the improvements we have made in survival rates. Cancer mortality rates are offered as evidence of the failure of the cancer research enterprise. The article notes, correctly, that the mortality rate from heart disease, the nation's number one killer, has dropped precipitously in recent decades. At the same time, cancer mortality declines, while steady, have been grudging at best. On both counts, the article misses the mark. We don't see fatal flaws in the peer-review process by which both public and private grant funds for cancer research typically are distributed. And I am heartened, not discouraged, by the progress we have made in this 40-year war. Peer reviewers are, ideally, the same individuals who are themselves recipients of grant funding. Reviewers, like the scientists whose proposals they are evaluating, are always looking for research that shifts our understanding of the biology of cancer or how to treat it. By definition, such studies are the exception rather than the rule, but even ambitious, outside-the box studies must be scientifically sound. Otherwise, they will not be funded—nor should they be. If scientists are frustrated by the results of the peer review process by which grants are funded, they can look for the source of their frustration among their researcher peers. In a couple of areas, the researchers quoted by Kolata have it right. They are concerned about a lack of funding. Between fiscal year 2006 and fiscal year 2008, the budget of the National Cancer Institute (NCI) barely moved, inching up from $4.75 billion to $4.83 billion.2 (President Barack Obama's proposed NCI budget for 2010 is $5.15 billion, an increase of $181million [3.6%].) If grant awards are indeed more cautious than they might be—and that has yet to be established—it is a normal and prudent response to a tight supply of research dollars. An even better response would be to expand the nation's cancer research expenditure proportionate to the need and our ability to conduct meaningful research. Both are huge. Another section in the article speaks deprecatingly of research that produces small, incremental advances, but that is the nature of most scientific progress. In recent decades, the cure rate for childhood leukemia has climbed from virtually zero to 80% during 50 years with only 2 strategies considered innovative: the use of drugs in combination instead of singly and treatment of related central nervous system involvement before symptoms appear. Finally, we're not discouraged by the slow, but sure, drop in cancer mortality rates. Lung cancer, the leading cancer killer among women, is leveling off and soon will begin to decline as we see the benefits of lower smoking rates among women. Cancer mortality figures alone mask the improvements we have made in survival rates. Someone diagnosed with cancer in the late 1970s had a 50.2%chance of living another 5 years; the overall 5-year survival for someone diagnosed with cancer in 2000 is 67.2%. As I have noted, for some cancers, particularly childhood leukemias, survival rates are much higher. We do not believe the allegation that innovative research does not get funded. Improvements in cancer mortality stem, in part, from cancer research shaped by our best prediction of what will have the greatest impact. And that demands innovation. Innovation, in turn, produces what researchers, patients, and caregivers need most—hope.