One of the biggest changes in biomedical research over the past decade is how we view the group of diseases collectively known as cancer. We are moving beyond the notion of cancer as a disease that affects a single tissue or organ; rather, we are increasingly viewing it as a disruption of molecular mechanisms. This is allowing us to make important strides toward more individualized and targeted interventions, based on factors such as genetic polymorphisms, aberrant signal transduction pathways, or how patients respond in real time to a particular therapy. Although there are a number of new tools that are aiding these shifts, imaging technologies in particular are playing a central role.

In fact, whether it's as a minimally invasive screening tool, a surrogate marker for clinical endpoints in clinical trials, or a method of guiding the delivery of treatment, imaging will be an indispensable tool in the march toward the 2015 goal of eliminating the suffering and death due to cancer.

NCI had recognized that biomedical imaging was a critical area for future development and emphasis, establishing in 1997 the Biomedical Imaging Program - now called the Cancer Imaging Program (CIP). More recently, we established the Molecular Imaging Program (MIP) within the NCI Center for Cancer Research (CCR). Both programs, along with initiatives such as NCI's collaboration with the American College of Radiology Imaging Network to conduct imaging-focused clinical trials, are just some of the creative ways the institute - guided by the invaluable advice of the research and clinical communities - is bolstering the dramatic advances being made in the imaging sciences.

For example, new, nanosized contrast agents are allowing researchers to use conventional MRI technologies to determine whether breast or prostate cancer has metastasized to nearby lymph nodes - potentially making it possible to spare patients from biopsies and excision.

Imaging also is demonstrating its value as a molecular detective. Biopsies and focal gene/protein assays, while providing snapshot information about the cancer cell, may not capture the heterogeneous biological phenomena that occurs in the tumor. With imaging, however, we can more easily obtain serial information over time and better recognize this dynamic heterogeneity. We could track, for instance, how cancer cell phenotypes change in response to a drug over time. Such information will be used in clinical trials to document the molecular response to therapies, and will eventually be used by clinicians to determine whether and how treatment should be modified.

In addition to the excellent work of CIP, led by Dr. Dan Sullivan, in promoting the translation of imaging research to the clinic, MIP, led by Dr. Peter Choyke (see this week's Spotlight) is helping to move novel imaging probes, contrast agents, and imaging techniques into cancer clinical trials. NCI also is working on other fronts. The institute, for example, plays an important leadership role on the Interagency Council on Biomedical Imaging in Oncology, a group of federal health agencies and imaging technology developers, to expedite the delivery of new products to the market.

Imaging is influencing every area of cancer research. It's for that reason that imaging is one of the central components of the NCI National Advanced Technology Initiative for Cancer, or NATIc - an effort that, at its core, aims to deliver the advantages of technologies like imaging to the entire research community. The enthusiasm that surrounds this technology is well deserved, and I'm entirely confident that our investment in it will help to improve and save countless lives.

Dr. Andrew C. von Eschenbach
Director, National Cancer Institute