Focus on the Division of Cancer Prevention and Control
As indicated above, a major responsibility for the NCI cancer prevention program lies within DCPC. Consequently, much of the activity of the Review Group centered on an analysis of this division's role in establishing the NCI cancer prevention agenda, providing the necessary leadership, representing the research interests of cancer prevention, and serving as an effective spokesperson for the intramural and extramural research communities.
After receiving oral and written testimony and conducting interviews with intramural and extramural scientists (see appendix A), the Review Group perceived: a) an apparent absence of a well-delineated, scientifically sound, long-term strategy for directing cancer prevention research into the next century; and b) a paucity of outstanding scientists in leadership roles within DCPC. These perceptions also focussed the Review Group's analysis of the cancer prevention research program on DCPC.
Because this report focuses on the cancer prevention agenda as directed by DCPC, a brief review of its current administrative structure is appropriate. A more detailed organizational chart for DCPC is presented as an appendix. The division includes three programs, Early Detection and Community Oncology, Cancer Prevention Research, and Cancer Control Research, plus the Biometry Branch and several smaller efforts.
The Early Detection and Community Oncology Program includes Early Detection, Community Oncology and Rehabilitation, and Preventive Oncology branches. The Cancer Prevention Research Program includes Cancer Prevention Studies, Chemoprevention, and Diet and Cancer branches. The Cancer Control Research Program includes Special Population Studies, Applied Research Cancer Statistics, Prevention and Control Extramural, and Public Health Applications branches.
The goals of the Biometry Branch are to a) plan and conduct investigations on cancer epidemiology, prevention, screening, diagnosis, treatment, and control by using mathematical and analytical statistical methods; b) develop biostatistical and epidemiologic methodology, and mathematical modeling of cancer prevention research areas; c) provide consultation in biostatistical and study design for DCPC staff and other NCI investigators; and d) supply expertise in statistics and biometry to program managers and other decision-makers.
Of all the branches within DCPC, only the Cancer Prevention Studies Branch and the Biometry Branch are classified as "intramural." All others are considered as serving the extramural community. However, as detailed in chapter 8, the Review Group was concerned about the appropriateness of this classification.
CCOP links community cancer practioners and primary care physicians with the clinical NCI Cooperative Groups and the NCI Cancer Centers, in order to increase the participation of patients in clinical cancer treatment, prevention and control trials. In addition, several Minority-Based CCOPs are active in enhancing the participation of minority populations in these clinical trials. The organizational positioning of the CCOP within DCPC appears to be a remnant of the past when the Cancer Centers Program also resided in this division.
Several mechanisms have been created to fulfill the mission of DCPC in cancer prevention. The Prevention Trials Decision Network is a system for selecting preventive agents that would be incorporated into large-scale clinical prevention trials. In particular, this group, which meets quarterly, prioritizes prospective large prevention trials and makes recommendations to the NCI Executive Committee.
DCPC also operates a major Cancer Registry which has proven to be of great value to intramural and extramural investigators with interests in cancer statistics. This annually updated database-the Surveillance, Epidemiology, and End Results (SEER) Program-provides a means for monitoring the contributions of individual, organizational, and societal factors to the cancer burden within the United States. The SEER Program, which was established in 1973, provides information on cancer incidence, survival and mortality obtained from 11 state and regional registries covering approximately 14 percent of the total U.S. population. In 1992, the SEER data base was expanded to increase the representation of U.S. Hispanic, Asian/Pacific Islander, and African American populations.
As newly reorganized under the leadership of the NCI Director, DCPC does not contain any programs or branches in which "bench" research is conducted. Previously however, two DCPC laboratories, the Laboratory of Nutritional and Molecular Regulation, and the Biomarkers and Prevention Research Branch, conducted bench science. These units have been transferred to the Division of Basic Sciences and the Division of Clinical Sciences, respectively.
As the Review Group assessed the administrative structure of DCPC, the need for change became obvious. Furthermore, the necessity for an enhanced role of the prevention division in training, and in providing additional databases that could be readily accessible by the community of cancer prevention researchers, became apparent. These recommendations are detailed in chapter 8 of this report.