The National Cancer Act of 1971 established an unprecedented government-wide plan to eradicate a major disease, creating institutions that have no equivalent in other therapeutic areas and galvanizing the nationwide conversation about cancer.
Alas, 50 years ago, the framers of this landmark law were in no position to foresee the challenges ahead. A lot of scientific discoveries had yet to be made, NCI director Ned Sharpless said during his Calabresi Memorial Lecture at Yale Cancer Center Nov. 2.
“As visionary as the National Cancer Act was, it was also naïve,” Sharpless said in a talk titled “Working Together to End Cancer as We Know It: 50 Years of the National Cancer Act.”
“The optimism induced by the legal mandate and strong infrastructure was soon tempered by the realization that this objective was going to be so challenging,” Sharpless said.
Those present at the start of the National Cancer Act thought there would be a cure in five to 10 years, he said. The likes of Sidney Farber thought a cure could be achieved by 1976.
Eradicating all cancer is no longer the goal, Sharpless said. “Based on what we know about human biology today, we don’t believe that’s possible at the NCI, at least any time soon,” he said. “But, we do think we can dramatically change the experience of cancer—that is, the tragedy of cancer, the way the American public knows cancer today.”
Since Cancer Moonshot was launched in 2016, President Biden has been pushing for research breakthroughs to “end cancer as we know it” (The Cancer Letter, April 6, 2021). Sharpless said NCI has been thinking about what it means to “know” cancer, particularly in light of the 50th anniversary of the National Cancer Act.
Part of this reflection has been clearly defining what an end to cancer would look like.
“Patients, I think we should be clear, still want to be cured of their disease. And if that’s not possible, they want their cancer to be turned into a manageable chronic disease so they’ll have more quality time with their loved ones,” Sharpless said. “So, that’s really what we’re talking about when we say ending cancer as we know it, or knowing cancer today, and that’s what the president wants us to do.”
What NCI is doing about health disparities
Population sciences, public health measures, and refining of metrics figure in the National Cancer Act. Today, these measures guide NCI’s pursuit of health equity.
“I would argue that we need to look at all our work through a lens of health equity, we need to ask to what extent might this study reinforce existing inequities, or might reflect hidden biases,” Sharpless said.
“Let’s build a reality in which your location, or your race, or your education doesn’t predict the outcome of your disease. And let’s take what we’ve learned and create tests that identify cancer at its earliest stages. And let’s ensure that once these cancers are detected, each cancer can be treated and treated effectively.
“Socioeconomic status alone can’t really capture what’s going on here. We need more sophisticated approaches to understand this interaction between rurality and poverty, particularly through time,” Sharpless said. “A key for cancer disparities is to stop single-variable analyses and start working on these populations in their totality, with all their complexity.”
The next steps for NCI are “to advance health equity, to personalize cancer care, to embrace new technologies and innovations, to inspire the next generation of cancer researchers, and to prepare for the challenges of the future.”
To improve representation in the oncology workforce, the NCI has established two programs, CURE (Continuing Umbrella of Research Experiences)—which offers opportunities to promising young researchers—and First (Faculty Institutional Recruitment for Sustainable Transformation)—which aims to diversify faculty in biomedical research.
“You see, the NCI invested in the cohort approach with FIRST, and the pipeline approach through CURE, and we are really trying to consider whatever approach might work best in terms of developing faculty diversity.”
Looking toward the future
“Having discussed some of the challenges we face, cancer as we know it today, the reality is that we will still need more progress for early detection, disparities, and advances in rare and difficult to treat cancers,” Sharpless said.
“What are we working toward? If we’re building a bridge to the future of cancer, what’s on the other side of that bridge? A world where these statements are no longer true, where we will have changed cancer as we know it. And I think that future is within our reach. Let’s focus on a future where all people with cancer have the support and resources needed to navigate their care.”
Sharpless said the National Cancer Act marked a “modern era of cancer research” that is still unfolding.
“The years ahead will be sharper and focused, different in tone, and more practical, more cognizant of the size and timelines of these challenges, and more based on the foundational molecular biology and biological understanding of cancer,” Sharpless said.
Sharpless addressed several areas the cancer community should focus on to “confront the current reality of cancer and unravel it,” including:
- Rigorously testing screening modalities and updating screening guidelines
- Developing multi-cancer early detection tests (MCEDs)—potentially through ARPA-H, an NCI partner organization proposed by President Biden to advance groundbreaking cancer research
- Supporting research into the complex factors leading to disparities in cancer incidence and outcomes along racial, gender, and geographical lines
- Diversifying the oncology workforce to better reflect the populations it serves
- Designing clinical trials geared toward rare cancers that often aren’t amenable to traditional trial structures
- Tackling childhood cancer by aggregating data through the NCI’s Childhood Cancer Data Initiative