Infrastructure and Support
A considerable portion of NCI's budget is dedicated to building the capacity of the cancer research enterprise by providing infrastructure, resources, and other support. We focus on the support essential to carrying out cancer research and intervention development and promoting and learning from their delivery. Our intramural and extramural programs, NCI-supported Cancer Centers and Centers of Excellence, and various networks, consortia, and other partnerships all facilitate the development of and access to vital resources. We also support education and training programs for investigators and clinicians at all levels of experience and provide vital patient education services.
NCI Extramural Program
NCI Intramural Program
Cancer Centers and Centers of Excellence
Networks and Consortia
NCI-Supported Clinical Trials
Technology Development
Cancer Surveillance
Communication, Education, and Dissemination
Training and Career Development
Other Partnerships
For more information
NCI Extramural Program
The largest portion of NCI research funds goes to supporting the work of scientists conducting research in universities, teaching hospitals, and other organizations outside the National Institutes of Health. Proposals submitted by these extramural investigators are selected for funding by peer review, a process by which cancer experts from around the country identify the best science and most needed areas of discovery by evaluating the approximately 5,000 new research proposals we receive every year. With guidance and oversight from program experts in NCI's Divisions of Extramural Activities, Cancer Biology, Cancer Treatment and Diagnosis, Cancer Prevention, and Cancer Control and Population Sciences, cancer research is conducted with NCI funding throughout the United States and in more than 20 other countries.
The Division of Extramural Activities (DEA)
The Division of Cancer Biology (DCB)
The Division of Cancer Control and Population Sciences (DCCPS)
The Division of Cancer Prevention (DCP)
The Division of Cancer Treatment and Diagnosis (DCTD)
The Division of Extramural Activities (DEA) provides high quality scientific peer review of proposed extramural research as well as systematic surveillance of active awards to ensure a balanced research portfolio. This portfolio includes over 7,000 research and training awards across the spectrum of discovery, development, and delivery. Other portfolio components address long-term survivorship, rehabilitation, and end-of-life issues. In addition, DEA serves as a focal point for information about NCI's peer review and grants policies. DEA staff provide advice and guidance to potential applicants about grant policies and procedures, refer incoming grant applications to appropriate programmatic areas within the NCI, coordinate and administer most advisory board activities, and establish and disseminate extramural policies and procedures.
The Division of Cancer Biology (DCB) manages a diverse portfolio of grants, cooperative agreements, and contracts to advance the science of cancer biology. DCB scientists and staff work with individual investigators, professional societies, and research institutions to provide information, advice, and guidance on a variety of research opportunities. Discussions, meetings, workshops, and conferences are among the mechanisms DCB uses to identify and address needs in various scientific areas. DCB uses a variety of communication media to keep the scientific community abreast of areas of special interest and scientific opportunity. The Division regularly reports scientific progress and program accomplishments to the scientific community, the Institute, Congress, and the public.
The Division of Cancer Control and Population Sciences (DCCPS) supports the NCI mission through an integrated program of high quality genetic, epidemiologic, behavioral, social, applied, and surveillance research. DCCPS-supported research aims to understand the causes and distribution of cancer in populations, supports the development and implementation of effective interventions, and monitors and explains cancer trends in all segments of the population. Central to these activities, the process of synthesis and decision making aids in evaluating what has been learned, identifies new priorities and strategies, and translates research discoveries.
The Division of Cancer Prevention (DCP) manages extramural programs focused on basic prevention science, cancer biomarkers, chemopreventive agent development, community oncology and prevention trials, early detection, and nutrition science. The Division manages large clinical trials for the prevention and early detection of specific types of cancer. Organ system research focuses on groups of common cancers — e.g., breast and gynecologic cancers, gastrointestinal cancers, lung and upper aerodigestive cancers, and prostate and urologic cancers — for which better prevention and early detection approaches are needed.
The Division of Cancer Treatment and Diagnosis (DCTD) works to identify and exploit the most promising areas of science and technology and to initiate, enable, and conduct research to identify and develop better diagnostic and therapeutic cancer interventions. Division programs focus on cancer diagnosis, imaging, therapy evaluation, developmental therapeutics, radiation, and biometrics. DCTD manages an extensive clinical trials program covering a broad range of cancers and age groups, oversees large initiatives to support drug development and cancer imaging, and supports studies on the special needs of patients with AIDS-related malignancies.
NCI Intramural Program
About 16 percent of NCI research dollars stay at NIH in Maryland, to support the work of intramural scientists in NCI's Center for Cancer Research (CCR) and Division of Cancer Epidemiology and Genetics (DCEG). These intramural investigators focus on basic laboratory investigation and long-term epidemiologic and genetics studies and their rapid translation to intervention development and clinical testing. Patients benefit from access to the research protocols and treatment available at the NIH Clinical Center facility.
A world leader in developing lifesaving treatments for cancer and home to many of the major breakthroughs in cancer research and care, the CCR is at the forefront of cancer scientific investigation. CCR scientists and clinicians are finding better ways to diagnose, prevent, and treat cancer and related illnesses. They work together to help translate new scientific discoveries into state-of-the-art diagnostic tools and therapies for cancer patients. Intramural investigators work in a highly interactive, interdisciplinary environment that maximizes the use of researcher expertise and technology to perform cutting-edge basic, translational, and clinical investigations and facilitate quick response to promising research findings.
DCEG intramural scientists conduct population and multidisciplinary research to discover the genetic and environmental determinants of cancer and new approaches to cancer prevention. The Division conducts broad based, high quality, high impact research through its programs in cancer epidemiology, genetics, statistics, and related areas. DCEG maintains a national and international perspective and gives priority to emergent issues identified through clinical-laboratory, and epidemiologic observations as well as public health concerns. Major areas of investigation include lifestyle and nutritional factors, environmental and occupational exposures, genetic susceptibility and gene-environment interactions, pharmacoepidemiology, infectious agents, radiation exposure, and methodologic research.
With a steady presence on the NIH campus, DCEG is uniquely able to conduct epidemiology research projects that are high-risk or need long-term commitments of funding and scientific staff. The Division conducts and coordinates epidemiologic and interdisciplinary research that responds quickly to emerging public health or scientific issues that might go unattended by other groups without a national or international reach. DCEG scientists and staff develop critical resources, infrastructures, and strategic partnerships in molecular epidemiology as well as fellowship programs that train the next generation of scientists in cancer epidemiology and related fields.
Cancer Centers and Centers of Excellence
The NCI Cancer Centers Program supports major academic and research institutions throughout the United States to sustain broad based, coordinated, interdisciplinary programs in cancer research. These institutions are characterized by scientific excellence and capability to integrate a diversity of research approaches to focus on the problem of cancer. The Centers organize and integrate multidisciplinary research across departments and schools within a single institution or within consortia of institutions. Cancer Centers provide scientists with the most advanced technologies and promote new research opportunities, work collaboratively with industry, perform state-of-the-art translational research, and conduct education, outreach, and information programs. Several are highly effective in leveraging their resources for cancer research and education with other organizations in the public as well as private sectors. Of the 60 Cancer Centers supported by NCI, 39 are designated as Comprehensive Cancer Centers because of their coverage of basic, translational, and population research. In addition, Center planning grants are underway at eight institutions that hope to receive NCI Cancer Center designation. NCI is creating new Cancer Center models to extend services to a wider geographic reach within states that do not have the institutional infrastructure to sustain the more traditional NCI-supported Cancer Center. NCI is proposing new investments to support technology development and its linkages to cancer science.
NCI Centers of Research Excellence also bring together groups of cancer scientists from different areas of expertise. Centers of Excellence are smaller in scale and generally focus on one or a few types of cancer or scientific areas. For example, more than 40 Specialized Programs of Research Excellence (SPOREs) bring together groups of scientists with specialized expertise in translational research for specific cancers. Other examples of NCI Centers of Research Excellence are the Transdisciplinary Tobacco Use Research Centers, In Vivo Cellular and Molecular Imaging Centers, the Centers of Excellence in Cancer Communications Research, and newly established centers for Transdisciplinary Research on Energetics and Cancer and Centers of Cancer Nanotechnology Excellence. Centers of Excellence support interactive, interdisciplinary research, make research resources and flexible exploratory funds available to investigators, and provide research training and career development opportunities.
Networks and Consortia
Networks and consortia are geographically dispersed multidisciplinary groups whose goals require inter-institutional collaborations. They focus on the development and sharing of resources and the development or validation of new interventions ranging from new therapies to genetic risk counseling to outreach. For example, NCI brings investigators together through networks like the Early Detection Research Network, which assembles groups of scientists to identify markers and develop and validate tests to detect early signs of cancer or cancer risk. The Cancer Genetics Network is a nationwide system of research sites located within NCI-designated Cancer Centers that specializes in the study of inherited predispositions to cancer. The Cooperative Human Tissue Network provides investigators with the human tissue specimens that are so critical to cancer research. Six member institutions in this network coordinate the collection and distribution of tissues across the United States and Canada.
NCI's Mouse Models of Human Cancers Consortium provides a vehicle for scientists from around the world to share their expertise and resources in creating strains of mice that develop cancers similar to those seen in humans. The Inter Lymph Consortium is an open scientific forum for epidemiologic research in non-Hodgkin's lymphoma. NCI's recently formed Consortium of Cohorts addresses the need for large-scale, international collaborations for study of gene-gene and gene-environment interactions in the etiology of cancer. More than 20 cohorts, involving 1.2 million individuals are participating.
With an expected enrollment of 11,000 patients with newly diagnosed lung or colorectal cancer, the Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium project will collect data that reflect the entire span of care from diagnosis through end-of-life care, capturing data from patients, their physicians (surveys and medical records from specialists and non-specialists), and their informal caregivers. Data collected by eight research teams will be used to determine the factors that influence the interventions that cancer patients receive and to evaluate the effects of that care on patient survival, quality of life, and satisfaction with care.
NCI-Supported Clinical Trials
NCI-supported clinical trials have helped to save or extend the lives of millions of people in the United States and around the world. Over 1,500 NCI-supported cancer trials are conducted annually, involving more than 12,000 investigators at the NIH Clinical Center and about 3,000 other sites across the United States. The NCI clinical trials system has been a model for other research institutions. The program is currently working to build a more interactive and coordinated system, one that will be used to prioritize and accelerate the development of new interventions and ensure that those interventions found to be effective are efficiently and seamlessly incorporated into medical practice.
The Clinical Trials Cooperative Group Program promotes clinical trials of new cancer treatments, explores methods of cancer prevention and early detection, and studies quality of life issues and rehabilitation during and after treatment. The Cooperative Group Program involves more than 1,700 institutions that contribute patients to group-conducted trials. Thousands of individual investigators also participate in NCI-supported cooperative group studies. Cooperative groups place more than 22,000 new patients into cancer treatment trials each year. The online Cancer Trials Support Unit (CTSU) Web site centralizes the common administrative, financial, and data collection activities of the cooperative groups. With the CTSU in place, physicians outside NCI's cooperative groups can also enroll patients into NCI-supported clinical trials.
The NCI-supported Community Clinical Oncology Program (CCOP) has also been highly successful in bringing the benefits of clinical research to cancer patients in their own communities. The 60 CCOPs currently supported by NCI, 13 of which are minority-based programs (MCCOPs), involve more than 400 community hospitals in 36 states, Washington, D.C., and Puerto Rico, who participate along with the Cooperative Groups and Cancer Centers in NCI-supported clinical trials. CCOPs make it possible for community oncologists to be involved in clinical research and to provide access for their patients to state-of-the-art cancer care close to home.
NCI is facilitating progress on several new clinical trials initiatives. We are developing a common clinical trials informatics platform that will be overseen by, and made available to, the full range of investigators working within the cancer clinical trials system. This includes NCI clinical faculty, staff, academicians, community physicians, representatives of regulatory agencies and the pharmaceutical industry, research nurses, and patient advocates. We are working with the Food and Drug Administration and the Office of Human Research Protections to develop more effective policies and procedures specific to cancer clinical trials. We are also partnering with the Centers for Medicare and Medicaid Services to develop a systematic process for supporting patients enrolled in cancer diagnostic and therapeutic intervention trials.
Looking to the Future
The Clinical Trials Working Group has recently identified 22 recommendations for restructuring the clinical trials enterprise to accommodate advances in molecular medicine. The recommendations include enhancement initiatives that will expand activities already underway and new initiatives that propose fundamental and significant operational changes. NCI is proposing new investments to implement some of these recommendations in Fiscal Year 2007.
Technology Development
Identifying many of the complex mechanisms responsible for cancer through genetic and protein micro arrays, molecular imaging, and high throughput screening is proving to be pivotal in accelerating our ability to preempt cancer at its various stages. Similarly, technology-dependent, molecularly targeted therapies based on a patient's disease-specific profile of markers provide hope that the cancer burden will be lightened and patients will enjoy a higher quality of life. We are able to make rapid gains against cancer because of the development and availability of advanced technologies that enable accelerated research and create effective interventions.
Bioinformatics
Cancer Imaging
Proteomic Technologies
Nanotechnology
Bioinformatics
Using the power of modern information technology, NCI is leading the way in developing a bioinformatics platform, cancer Biomedical Informatics Grid (caBIGTM) that promises to revolutionize the biomedical research enterprise. Scientists in various disciplines will have access to a common infrastructure for collaboration and integration of findings that will make it possible for investigators to accelerate their research. Informatics systems will also assist the cancer community with priority setting, decision making, and participation in order to accelerate the completion of cancer clinical trials. Databases and analytical tools will make information from all clinical trials available to NCI-supported researchers for efficient patient accrual, information retrieval, and data analysis. Confidential clinical and proprietary information will be protected by controlled, secure access. Advocacy groups and individual patients will be empowered to participate in clinical research, and healthcare providers will become full partners in the research enterprise and educated consumers of research findings.
Cancer Imaging
Advanced imaging technologies are dramatically improving our understanding of cancer biology and facilitating cancer preemption and the clinical management of cancer and cancer risk. Clinicians are increasingly relying on imaging methods as biomarkers for cancer risk and treatment efficacy. Image guided cancer intervention is a rapidly evolving area that may be used to cure some cancers and precancerous lesions, and also to provide minimally invasive, well-tolerated palliative therapies. Imaging informatics optimizes the availability and effectiveness of cancer imaging data in research as well as clinical environments. Imaging methods are used hand-in-hand with emerging technologies such as nanotechnology, proteomics, and high throughput screening to identify cancers earlier and help assess the effectiveness of therapy. Imaging of small animals used in research, particularly genetically engineered mice, is increasingly recognized as a powerful discovery tool in cancer research. As our knowledge of the molecular basis of cancer increases, molecular imaging methods are providing clinicians with telling details about the environs of patients' tissues.
Proteomic Technologies
Scientists are taking new steps to identify profiles, or signatures, of proteins and peptides (fragments of proteins) that are found in tumors and often in the circulating blood that signal early phases of cancer development. Proteins serve complex and diverse functions in the body, from giving structure to our cells to regulating processes such as digestion, respiration, and the growth rate of cells. When proteins do not function properly, normal body processes can go awry. For example, cancer is caused by errors in proteins that regulate when and how fast cells replicate themselves, as well as the timing of cell death. One of the goals in cancer research is to develop technologies that measure these abnormal proteins and can eventually be used as simple diagnostic blood tests. However, there are some sizeable technical challenges that stand in the way of achieving that goal. These abnormal proteins are found in minute quantities in the blood. The net effect is that we need to refine the technology so that it can find "a needle in the haystack" with unprecedented reliability.
NCI is supporting the development of advanced technology platforms for overcoming these barriers and preparing diagnostic methods ready for clinical testing. Mass spectroscopy, a favored approach involving high energy lasers, high powered electronic sensing, and computing, is used to identify specific proteins and their fragments based on their size and electrical charge. Another avenue is to use DNA and antibodies to capture proteins and measure their quantity on electronic chips. In the near future, patients may have small samples of their blood analyzed using mass spectroscopy and protein chips that will, within minutes, identify abnormal proteins that indicate early, treatable cancers.
New infrastructures will help researchers speed development of these technologies and bring them to the clinic. Through a new Mouse Models of Human Cancers Consortium initiative, researchers will create new resources including antibodies, data that provide standards for future measurement comparison, serum specimens, and histologic data. These resources will enable investigators to develop the technology platforms needed to detect proteins at very low levels.
Nanotechnology
Nanotechnology offers an unprecedented and paradigm changing opportunity to study and interact with normal and cancer cells at molecular and cellular scales, in real time and during the earliest stages of the cancer process. Nanotechnology will enhance cancer diagnosis and treatment in numerous ways. Imaging agents and diagnostics will allow clinicians to detect cancer in its earliest, most treatable, presymptomatic stage and provide real time assessments of therapeutic and surgical efficacy for accelerating clinical translation. Multifunctional targeted devices capable of bypassing biological barriers will deliver multiple therapeutic agents at high local concentrations – and with physiologically appropriate timing – directly to cancer cells and tissues that play a critical role in the growth and metastasis of cancer. Nano scale agents will be capable of monitoring predictive molecular changes and preventing precancerous cells from becoming malignant. NCI is proposing new investments to support technology development and its linkages to cancer science.
Cancer Surveillance
Cancer researchers depend on comprehensive surveillance data to assess the effectiveness of current cancer interventions, to identify areas of cancer health disparities, and to prioritize areas for further research. NCI's Surveillance, Epidemiology, and End Results (SEER) program serves as the foundation for a national system of data resources on all aspects of cancer surveillance and an authoritative source of information on cancer incidence and survival in the United States. The SEER program currently collects and publishes cancer incidence and survival data from 14 population-based cancer registries and three supplemental registries covering approximately 26 percent of the U.S. population. Information on more than 3 million in situ and invasive cancer cases is included in the SEER database, and approximately 170,000 new cases are added each year. The SEER registries routinely collect data on patient demographics, primary tumor site, morphology, stage at diagnosis, first course of treatment, and follow-up for vital status.
The SEER program supplies researchers with quality data on risk factors, health behaviors, extent of disease, treatment and lifestyle factors, and quality of life for cancer survivors. Scientists use the Economic Studies in Cancer Prevention, Screening, and Care and Cancer Surveillance Using Health Claims–Based Data Systems, both generated using SEER data, to assess trends, quality, and the cost of cancer care. Researchers use information generated by SEER Patterns of Care studies to assess the extent and quality of care that cancer patients receive.
The SEER program is the only comprehensive source of population-based information in the United States that includes stage of cancer at the time of diagnosis and survival rates within each stage. The mortality data reported by SEER are provided by the National Center for Health Statistics.
Communication, Education, and Dissemination
Although the delivery of cancer interventions is ultimately the responsibility of healthcare and public health organizations, NCI works to ensure that our research findings reach the community and are translated into practices that help public health professionals, healthcare providers, and patients make better health choices and obtain quality care. NCI proactively disseminates information on research findings, opportunities to participate in clinical trials, and new interventions through a range of cancer communications activities that supplement the efforts of medical journals and news media. For example, NCI provides Web-based information on cancer and clinical trials, toll-free telephone cancer information service in all regions of the country, and printed brochures and educational packages distributed directly to consumers and through physicians and advocacy organizations.
NCI-supported researchers continuously work to improve methods for reaching all who need to learn about cancer with critical information.
- Public surveys help assess reactions to media coverage about cancer and aid us in communication planning and evaluation, especially in evaluating the public's reaction to controversial coverage.
- Training workshops and toolkits for journalists enhance the quality and quantity of media coverage about cancer science.
- Applied communications studies identify how to best integrate electronic and interpersonal communication systems to improve decision making and facilitate positive changes in health behavior.
- Basic communication research partnerships accelerate discoveries about how cancer information is processed and used.
- The New Media Collaborative focuses on developing tailored communications strategies to benefit specific populations, including medically underserved communities.
- A collaboration between the U.S. Department of Health and Human Services and the Department of Agriculture has been responsible for furthering dissemination of the 5-to-9 A Day message promoting the consumption of fruits and vegetables to diverse populations.
- Research on doctor-patient communications provides practical strategies for dialogue and examines the use of mediated communications to help patients cope with cancer. These efforts include a special focus on minority and underserved patients.
Training and Career Development
Rapid developments in the frontiers of science and technology, including molecular biology and translational medicine, have broadened the scope of cancer research and have presented new challenges for training future cancer researchers in diverse disciplines. NCI devotes approximately four percent of its annual budget and multiple strategies to preparing the next generation of cancer researchers for challenges that are increasingly multidisciplinary and span basic, clinical, behavioral, and applied research. Each year, we provide cancer research training and career development opportunities to more than 2,000 graduate students, postdoctoral fellows, and oncologists. Some of this training takes place on the NIH campus, but most occurs in universities and teaching hospitals around the United States.
All sponsored traineeships are intended to increase the number of scientists who specialize in the basic or clinical biomedical research fields. We invest in training to support the use of advanced technologies and provide career opportunities to equip scientists to address cancer in underserved populations. We foster development of interdisciplinary teams of scientists to carry out critical translational research. These investments will ensure a steady flow of well trained investigators to focus on the problem of cancer.
Other Partnerships
Partnerships, traditional and beyond, are vitally important to eliminate bottlenecks, leverage resources, take advantage of expertise outside of the Institute, and build synergy. NCI is increasingly looking beyond its institutional boundaries to engage in various kinds of collaborative efforts.
- The Consortium of Cohorts is an international collaboration of investigators responsible for independently funded population studies involving over a million people. By pooling their data, these scientists have adequate sample sizes to conduct numerous studies leading to valuable insights for cancer prevention and control.
- The Leukemia/Lymphoma Molecular Profiling Project includes a consortium of NCI intramural and extramural investigators who have pooled resources and talent to create a framework for the molecular classification of lymphomas. The large number of samples, substantially more than any single institution could have acquired, has allowed researchers studying diffuse large B-cell lymphoma to draw reliable conclusions about how best to diagnose and treat patients based on the molecular subtype of their disease.
- Through an interagency agreement, NCI and the FDA collaborate to share knowledge and resources to facilitate the development of new cancer drugs and speed their delivery to patients. NCI is also partnering with the Centers for Medicare and Medicaid Services to develop a systematic process for evaluating new diagnostics and therapeutics to aid in payment and coverage decision making.
- The Annual Report to the Nation on the Status of Cancer is a collaborative effort involving NCI, the Centers for Disease Control and Prevention (CDC), the American Cancer Society, and the North American Association of Central Cancer Registries.
- In 1999, NCI and the pharmaceutical company Genentech entered into a Cooperative Research and Development Agreement to test treatment of renal cell carcinoma (RCC) patients with the monoclonal antibody AvastinTM (bevacizumab). Based in part on this research, Avastin was approved by the FDA in 2004 for treatment of RCC patients, in combination with the standard chemotherapeutic drug ironotecan, 5-fluorouracil, and leucovorin (ILF). Avastin also looks promising for treatment of breast, colorectal, and other cancers.
- NCI recently established a partnership with pharmaceutical companies Aventis, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, and Novartis to provide funding to Cancer Centers for the design and implementation of new approaches to increasing the participation of newly diagnosed cancer patients in early stage clinical trials.
- The Avon-NCI Progress for Patients Awards Program funds clinical investigation (PDF) important to breast cancer prevention, early detection, diagnosis, prediction, prognosis, and treatment.
- NCI's Academic Public Private Partnership Program (AP4) is supporting a new paradigm in the discovery of new agents and the development of cancer drugs, and their rapid translation to human clinical trials. Through this program, NCI fosters collaborations among universities, pharmaceutical companies, biotech companies, and nonprofit organizations.
- NCI has partnered with CDC, the Substance Abuse and Mental Health Services Administration, the American Cancer Society, and the Agency for Healthcare Research and Quality to provide evidence-based tools to help states and communities plan, implement, and evaluate evidence-based comprehensive cancer control programs. The Web-based tools are available through the Cancer Control PLANET (Plan Link Act Network) portal.
