Senate Subcommittee on Labor-HHS-Education Appropriations
John E. Niederhuber, M.D.
Director, National Cancer Institute
National Institutes of Health
May 21, 2007

Remarks as prepared for delivery

Chairman Harkin, Senator Stevens, and members of the staff: Thank you for the opportunity to testify today on behalf of the National Cancer Institute and the National Institutes of Health. Over the next few minutes, I would like to describe some of the progress NCI has made in cancer research, along with some of the exciting opportunities we are pursuing.

For two years now, we have seen unprecedented decreases in the actual number of cancer deaths nationally. That is remarkable news, considering that cancer is largely a disease of aging - and, as you know, our country is not only growing older, its population is also growing.

Today's progress is occurring, in no small part, because researchers are coming to understand cancer's basic biologic processes.

The sequencing of the human genome, a singular landmark in biomedical research, is providing a foundation for NCI's new Center of Human Cancer Genomics and its mission to systematically identify all important inherited and acquired genetic alterations that contribute to a person's cancer risk - and how, if cancer occurs, it will behave. We are diligently working to understand these genetic changes and apply them to cancer prevention and treatment.

Consider, if you will, that under the microscope, diffuse large B-cell lymphoma tumors from different patients look the same. However, when subjected to gene expression analysis, they have distinct genetic signatures. These differences in genetic signature predict prognosis and enable us to individually characterize a patient's cancer - and match him or her with the best treatment. Importantly, this is not a futuristic technique; we are already beginning to apply this technology in clinical settings, such as lymphoma, lung, and breast cancer.

At the same time, we are learning more about the mechanisms of the cancer cell, including a small subset of cells within the tumor that drive the steps of invasion and growth. This subset of cells may enable the tumor to spread and - interestingly - these cells have stem cell-like characteristics. Evidence is building that these so-called cancer initiator, or transformed tissue stem cells, are the driving force behind many tumors and are the basis for long-term risk of cancer recurrence. Clearly, these cells will be a necessary target for treatment in the future.

As we move toward an era of personalized medicine, advanced technologies will play a significant role in cancer prevention and preemption, telling us, in real time, if a new drug treatment is reaching its target within the cell, if the novel drug is saturating that target and if it is changing the function of the target. These early-phase tests in patients will make possible "go or no-go" decisions within hours, not months, for early cancer drug development, thus shortening development time and decreasing cost.

We also realize, however, that most cancer patients have yet to see the benefits of our science. Too many patients lack the means, the mobility, or even the language capacity to travel to a premier facility. It is clear that access to care will be one of the greatest determinants of cancer mortality in the years ahead.

Mindful of our mission to conduct research in all areas of science - including the behavioral sciences, such as how best to provide patient education and access to optimal care - NCI will, in the next few weeks, launch the pilot phase of a Community Cancer Centers Program that, if fully implemented, will help bring state-of-the-art cancer care to patients in community hospitals across the United States. This program will encourage and foster the collaboration of private-practice medical, surgical, and radiation oncologists - with the opportunity for close links to NCI's research and to our NCI-designated Cancer Centers.

There is great cause for optimism in cancer science, but it must be tempered by an understanding of the hurdles we face. Cancer is a disease of staggering complexity with a singular name. Our progress is exciting; it is certainly encouraging, but we are continually challenged by our fellow citizens living with cancer to make faster progress.

Again, thank you for the opportunity to testify before the Subcommittee.

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