Should cancer spending be focused on the most common cancers? Or the most deadly cancers?
That’s the dilemma for the cancer research community as it struggles to divvy up limited funds. After news yesterday that actor Patrick Swayze had been diagnosed with pancreatic cancer, several readers questioned the nation’s cancer funding priorities. I decided to look at the numbers.
The National Cancer Institute has proposed a $6 billion budget in the war on cancer, allocating some funds for general cancer research and some for studies of specific cancers. But a review of the N.C.I.’s 2006 funding for five of the biggest cancers showed a wide disparity in the amounts of money spent relative to each cancer death and each new case of cancer. The data offer only a partial snapshot of public cancer spending in this country, as other government offices, such as the U.S. Department of Defense, also fund breast and prostate cancer research.
The big loser in the cancer funding race is lung cancer. It is the biggest cancer killer in the country, yet on a per-death basis receives the least N.C.I. funding among major cancers. In 2006, the N.C.I. spent $1,518 for each new case of lung cancer and $1,630 for each lung cancer death, according to data from the institute and the American Cancer Society.
Among the big cancers, breast cancer receives the most funding per new case, $2,596 — and by far the most money relative to each death, $13,452. Notably, prostate cancer, the most common cancer, receives the least funding per new case at just $1,318. But on a per-death basis it ranks second, with $11,298 in N.C.I. funds.
Here’s a look at the N.C.I. cancer funding based on 2006 death rates and incidence rates for some of the most common and deadliest cancers.
| Cancer (Deaths) | N.C.I. Funding per Death |
| Lung (162,460) | $1,630 |
| Colon (55,170) | $4,566 |
| Breast (41,430) | $13,452 |
| Pancreas (32,300 ) | $2,297 |
| Prostate (27,350) | $11,298 |
| Cancer (New cases) | N.C.I. Funding per New Case |
| Prostate (234,460) | $1,318 |
| Breast (214,640) | $2,596 |
| Lung (174,470) | $1,518 |
| Colon (106,680) | $2,361 |
| Pancreas (33,730) | $2,200 |
Healthy living doesn't happen at the doctor's office. The road to better health is paved with the small decisions we make every day. It's about the choices we make when we buy groceries, drive our cars and hang out with our kids. Join columnist Tara Parker-Pope as she sifts through medical research and expert opinions for practical advice to help readers take control of their health and live well every day. You can reach Ms. Parker-Pope at 
The easiest and most pleasurable way to eat well is to cook. Recipes for Health offers recipes with an eye towards empowering you to cook healthy meals every day. 
From 1 to 25 of 175 Comments
When you look at how many deaths versus new cases, the numbers are really staggering. 33,730 new cases of pancreatic cancer to 32,300 deaths? What a scary diagnosis.
— CarolineFrom TPP — Same with lung cancer. At least with the other types of cancer, it seems you have a fighting chance.
My only observation on this is based on what I’ve seen in real life. When people lose their mothers or sisters or friends to breast cancer, they become– and remain– active in fund raising for breast cancer research to an extent I don’t see people get involved in fund raising for other cancers, even if they have lost family members to other cancers. I am going to guess we’re dealing with something primal on many levels, and therefore more saleable. It’s not just that breast cancer is more ’sexy’ the way some people have suggested, but that it is related to a fundamental way in which we identify women– in which women identify themselves, and in which men and children feel about them. Everyone has strong primal feelings about breasts. It’s just not the same with any other part of the human body. With that primal underpinning, breast cancer research becomes an unassailable brand with pins and coffee mugs and magnets and teddy bears (Barbara Ehrenreich wrote a great essay about breast cancer merchandising–would we give a man with prostate cancer a blue teddy bear?). To me it’s a lot like the fervor that went into polio research in the 40s and 50s–because it was robbing children of their lives, something else that strikes at a primal level– even as other diseases and cancers took lives.
My biggest beef with all of this is that very little research funding –for any cancer– goes into studying the environmental causes of cancer. They are all geared toward genetic and behavioral causes. As a result, I believe many cancers will remain a mystery to us.
— francoisWhat about ovarian cancer? This is surely one of the most deadly cancers, as well as one of the most difficult to detect.
From TPP — 2006 funding for ovarian cancer was $95.1 million. There were 20,180 new cases and 15,310 deaths. That translates to $6,212 per death and $4,713 per new case.
— Kim SchneidermanIn the field of Economics there is something called the “equimarginal principle”. Briefly, it states that, when a fixed amount of money must be distributed among competing demands, the money should be allocated so that the last (marginal) dollar spent on each demand should purchase the same amount of utility as the last dollar spent on every other competing demand. Thus even though a particular type of cancer may be very common and/or deadly, there may not be additional promising avenues of research to pursue so that spending more money on it won’t buy very much. Conversely, spending additional money on promising research for a less common type of cancer may save more lives.
I’m not saying that this principle will be easy to implement in the case of health care research in general, not just cancer. But it should be the guiding principle when it comes to allocating scarce research dollars. It makes a lot more sense than spending money based on the political power of particular interest groups.
— KeithThis is interesting. I think it shows that women are better at organizing (for breast cancer research, etc.) and that “sexy” cancers get more (as someone mentioned yesterday). My father has advanced prostate cancer and is on the board of a national advocacy group. They have trouble getting prominent men with prostate cancer to help them, even in non-financial ways. On the other hand, ever famous woman who has been affected by breast cancer in any way seems to be doing something for the cause. You would think that with so many old men in congress, they would fight to get money for the disease they would be likely to get!
— LisaTo riff a little on comment #2, there is also a great deal of funding given to cancers that have survivors. A disease that leaves survivors, like breast cancer or leukemia is likely to have more advocates for fundraising than ones that kill quickly, like ovarian or pancreatic cancers.
— ekbCancers may be distinct, but research findings for one kind of cancer are often helpful for research in a related kind. There are also probably diminishing returns to studying each particular type of cancer.
Therefore, if you are looking to get the most “bang for the buck” out of cancer research, it makes sense to study obscure types of cancer more intensively than the per-person funding numbers would suggest.
Research funding should be allocated based on how useful it is, not just on how many people are affected by that particular cancer.
— JackTo echo Francois, the real disparity in cancer research funding is exploring the environmental causes of cancer versus treatments. Why is there a disparity?
— Hal ConnollyPerhaps because finding what causes cancer could cost some large companies a lot of money while finding a treatment is a large revenue source.
Within the past decade, several innovative methods of treatment for various cancers have been introduced and made available to appropriate patients, but referrals by oncologists to these technologies are generally scarce. Today, there is sterotactic/conformal photon therapy, proton therapy, and - in Japan and Germany - the use of heavy ions in carbon therapy. These are all non-invasive treatments targeting tumors with a preciseness exceeding the skills of any leading neurosurgeon, as well as surgeons of other disciplines. There is not a single patient diagnosed with a brain tumor who benefits greater from a craniotomy for resection of a lesion than simply undergoing targeted radiotherapy. It is arguable, but in my opinion neurosurgery for a brain cancer is obsolete, but surgery, hospitalization, chemotherapy and all the adjunct services connected to some cancers are important sources of revenue.
— F.W. FischerWe are burning billions of dollars in Africa on AIDS (a preventable disease, just use a condom) when cancer is stalking our own people and striking them down in their prime. It’s time to put cancer research and America first and find a cure.
— ChrisI think a substantial part of the funding equation is neither number of cases or number of deaths, but politics. People perceive lung cancer suffers as smokers - who have thus brought the disease on themselves. On the other hand, budgetmakers cannot resist the large and vocal advocacy groups for a cancer like breast cancer.
— RoseI wish there were no “most common cancers” or “most deadly cancers” for which to priortize funding. Unfortunately, cancer is very personal. I am thankful that so many more women are surviving breast cancer, and I have to attribute that to funding for research. I understand why survivors and their families fight hard for funding for “their” diseases, especially those with known familial risks. I am a 49 year old breast cancer survivor. I lost my mother to the side effects of breast cancer treatment while I was undergoing my own treatment. I have a nine year old daughter who already believes she will get breast cancer. I have nieces in their 30’s who are already having mammograms and biopsies. Before my mother’s and my diagnosis (less than four years apart), we had no family history for breast cancer. Now we do and we are scared for our daughters.
And even though prostate cancer is very common and relatively rarely fatal, I lost my father to prostate cancer after a horrible nine year fight. Yes, my brothers are scared of prostate cancer, and we are scared for our sons.
With breast cancer and prostate cancer (as with most cancers), it is hard to point to something the cancer patient did that caused it.
When my grandfather developed cancer of the esophagus after many years of smoking cigarettes and a pipe, the “why” seemed a lot more clear. It doesn’t take a lot of research dollars to tell people to stop using tobacco.
— PennyInstead of looking at incidence of cancers and deaths, how about looking at quality of life years lost?
— SethMost fatal breast cancers occur in premenopausal women. These women may have careers, contribute to household income, have children that look up to them.
Another peak in breast cancer occurs in elderly women who are more likely to have higher 5 year survival rates.
Most lung cancers and prostate cancers occur in older individuals.
A few quick points
1. You may wish to look at research spending per life year (or quality adjusted life year) lost, given the different prognoses for different types of cancer.
2. Additional funding isn’t the only metric: With a condition like lung cancer that has a longer history research, there is a stock of research knowledge that additional dollars contribute less to than they do with conditions that have a shorter history of research.
3. It’s also interesting to see where global research (Europe in particular) tallies up. Research efforts are complementary and spill over across borders.
— Rajeev C.When my father–a near-lifelong smoker–was diagnosed with lung cancer, he felt it was his “fault.” When I told others of his illness, they immediately asked “Did he smoke?” When I responded in the affirmative, they’d nod and say “Oh…well, what can you do?”
I think many see lung cancer as predictable retribution for a smoker’s habit, so it is much less likely to garner sympathy than cancers that seem to strike out of the blue–like breast cancer, or even those lung cancers that afflict non-smokers.
Yes, lung cancer is almost entirely preventable. And I thank God that many people will be saved by our society’s shift away from smoking. But for many others, it’s already too late.
And, if you’d been there to see my father’s last days, you’d know that no one–lifelong smoker or not–deserves to die like that.
From TPP — I agree and get so frustrated at this culture of blame. Smoking is addictive and there have been generations not aware of how deadly it is. One of the most powerful marketing/advertising machines in the history, the tobacco industry, continues to solicit new smokers from the ranks of children and teenagers and less educated people around the world. I think our tendency to blame smokers for their cancer has more to do with our own sense of relief when we can explain something. When we understand the reason someone is sick, that gives us a feeling of control. It’s meaningless random disease — like pancreatic cancer — that scares us so much. But smokers deserve compassion and empathy. Those of us who are not addicted to cigarettes are fortunate — it is a powerful force and my sympathy to those who are caught in its clutches.
— CarolynThe numbers are a bit misleading in the sense that, to some extent, cancer cells don’t know if they are arising in a prostate, a lung, or a breast. The mechanisms of growth, cell cycle control, and signaling overlap.
It is a dance and researchers are forced to identify research projects as being related to anatomic regions, e.g., breast or prostate, when they are actually studying mechanisms that might be common to all cancer sites.
Fortunately, breakthroughs can have wider use. For example, imatinib has had a real impact on the care both of certain leukemias as well as certain GI tumors.
— BruceFrom TPP — Yes, one of the best articles written on the subject was by Jerome Groopman in the New Yorker. It makes the point that the way we study cancer may be misguided, losing the advantage of serendipity. The polio vaccine, antibioitics and even Viagra were all discovered by brilliant scientific accidents. Read his amazing article HERE.
This is what drives me crazy. I know the NCI can’t be expected to fund diabetes research, but diabetes is now responsible for the deaths of over 225,000 Americans per year—and unlike every form of cancer, that number is *rising*. Unfortunately, it’s estimated that for every $100/patient our nation spends researching breast cancer—a disease that, admittedly, takes the lives of roughly 20% of its patients—we spend 1¢/patient researching diabetes—a disease that kills roughly 100%.
And no, I’m not a diabetic; I just know and love several of them.
— JeffRajeev C (#14) is just right. We should spend money to reduce the number of people who get likely-fatal cancers when they’re relatively young. So, breast cancer is important to spend money on, as it often targets women when they’re relatively young. Prostate cancer is not that important to spend money on, since it’s often not malignant, and mostly affects men who will likely die of something else sooner anyway.
— HarlanI’m not sure what the supposed disparity is here. Prostate and breast cancer are the most common cancers found and diagnosed by gender. Shouldn’t it make the most sense that resources should be allocated to help the most people?
The most common cancers overall are lung and colorectal cancer. 90%+ of the ~150,000 lung cancer is entirely preventable (don’t smoke, and make sure your family members don’t smoke), and colorectal cancer is a very slow-growing, 100% early curable cancer that can be diagnosed and treated by colonoscopy. Why do we need a big surge of funding in these relatively well-understood diseases?
Poster #2 re: “My biggest beef with all of this is that very little research funding –for any cancer– goes into studying the environmental causes of cancer.” Like… Tobacco? Air pollution? Alcohol? Epstein-Barr virus? Hepatitis B/D virus? Human Papilloma virus? Frequent CT scans? I’m not sure what environmental factors you’re talking about needs a lot of funding, unless you’re venturing into the fringe category (deodorant, etc.).
Poster #1, there is very little to be done about pancreatic cancer because the disease doesn’t become symptomatic until it has already reached a late stage (and usually metastasized). There’s some interesting basic research being done with adenoviruses and related viruses in regards to finding new treatments. Unfortunately there’s no good screening technique available to catch it early (where it could possible receive a surgical cure), and the same goes for lung cancer. There was a clinical trial conducted to use MRIs to screen for lung cancers in asymptomatic smokers, but found no significant benefit in doing so.
— JasonThe real question is, when faced with the inequality in funding for different cancers, do we as a society simply re-allocate the existing funds (i.e. take away money from breast cancer research and give it to prostate cancer research), or do we advocate and vote for increases in the overall NIH/NCI budget to allow for more funding of cancers that have been traditionally underfunded without cutting back on funding of other cancers. Don’t forget that the reason that there are relatively fewer deaths from breast cancer compared to the number of new cases of breast cancer (compared to the statistics for lung or pancreatic cancer) is exactly because of advances in treatment that could not have occured without significant research funding and long-term commitment from doctors, patients, and advocates.
— MaryWhat about children’s cancers, which are a unique set that are different than adults’ diseases? Every time we cure a 2-year-old, we may have saved them for another 80 or 90 years.
I would guess that the $ of research money invested in children’s cancers is much much less than that spent for research into adult tumors. How about prioritizing this vulnerable group, who cannot vote and advocate for themselves?
— J KandelHow many of those lung cancer cases are caused by smoking? I’d rather not have my money spent on researching a cure to a disease that people choose to get.
— MattThe comparative spending figures are doing just what they were designed to do. Keep us fighting and thinking about side issues and not about what is really wrong with the funding in the first place. In medical care we worry about price and little about results. Under the influence of today’s shamans, we are constantly offered the Promised land, if not today, maybe tommorow.
The war on cancer goes back to Nixon’s era. It is and has been a bust. But in this case not even more warriors in the form of another $6 billion will make a valued, safe and sustainable solution, not now and maybe not for a long time.
The reasons are not clear to many Americans and often denied. But the sad fact is that should a cure for cancer be found, the US economy would go bust. There would be real survivors and no need to treat them! It is not in the interests of researchers to find a cure. It is in their interest to find something promising, domething that has hope and may possibly be an new avenue to treat cancer. One that will require further research and more funding, but now from a drug company. What is crucial is that the disease, in this case, cancer, will linger on at least until the next big fund raiser.
Now is for Americans to take the time to look back and say: “What have we been doing?” “What has what we have been doing done?” “Are we winning this war?” “And if we are why do we not see any tangible, meaningful results?”
If the answers are not good, that we really have no gained little ground and have no solutions, we need to do something else. Even smart, healthy and flexible mice in the maze could figure out to look elsewhere when the cheese drop location had been changed. Only the foolish, unhealthy ’stay the course’ mice keep going back to the same spot after the cheese is moved. Sooner or later the ’stay the course’ mice die from starvation.
We know that lung and some other cancers are not caused by but only associated with smoking. If this were not true, we should expect all smokers to get cancer and non-smokers to not get cancer. But the common factor is that smoking (and second hand smoke)have the ability to reduce oxygen and reduce the means to bring enough oxygen into the body. In other words, smoking and smoke clog the lungs and the body’s cells cannot get enough oxygen. A lack of oxygen could be a contributing factor in lung and other cancers. In fact, Otto Warburg, M.D. a two time Nobel Laureate came to the conclusion that a lack of oxygen in the human cell was a primary factor in cancer. He did so nearly 100 years ago.
Many researchers have arrived at this and other possible causes of cancer but the medical system and economic need for drugs coupled and based on complicated and costly medical care are the predominant view and as the only way to cure cancer. Alternative views that are not part of this matrix are discarded, discounted and discouraged.
Could there be natural, less costly and less toxic ways to prevent cancer.
As Niels Bohr, another Nobel Laureate said, “No! No! You are just being logical. You are NOT thinking.”
So Americans must start thinking about what $6 billion in independent non-medical research could discover? Would it be possibly yield any less than the current 100 year war?
— healthinfoTara,
While I see your point and agree we should be empathetic towards those who have lung cancer, most of the time smoking is the cause. In essence what you are asking the funding to go to is a type of cancer that is at a higher incidence because people make poor life choices. If you take away the number of cigarette associated cases of lung cancer then the number drops and you can see why that form would get less funding. I think our attention should be turned towards fighting tobacco industries that profit from the deaths of others. This being the case, the final decision does come down to the person, and choosing to smoke, even though addictive, is still a wildly poor decision even short term and they are simply choosing to continue that despite other avenues. As a scientist I agree with the way the money is being partitioned. And at the very base if fund lung cancer more, we are simply trying to play catch up with tobacco companies and trying to put a bandaid on an effect. I feel the most direct approach to limiting the devastation of lung cancer is to attack the source, which is of course tobacco and marketing.
— InterestingFrom TPP — One important point is the fact that the entity that makes the most money off of cigarette smoking is not the tobacco company, the farmer, the retailer or the marketing or advertising industry. It is the federal government. There is a built in financial disincentive against getting serious about stop-smoking efforts. It only seems right that 100% of the money generated by smoking should go toward prevention and treatment of lung cancer, but it doesn’t. The reality is that many of us are sustained by the smoking economy, whether we smoke or not.
As a doctor, I would just like to remind everyone that the #1 cure for lung cancer is simply not smoking. 90-95% of lung cancers are caused by smoking and all-cancer mortality would be reduced 50% by not smoking. Billions can be spent on lung cancer drug development and it will only lead to a 3-4 month added survival. I would like to see the non-smokers get back the health insurance dollars being used on smokers through a $4/pack health insurance tax. The extra cost would reduce smoking through economic reasons and the revenue would pay for care of currently uninsured without having to raise taxes elsewhere. I don’t see any politician spouting this simple advice.
— Dave