The Goal The last 25 years of American cancer research have been a period of explosive discovery. Who is responsible for these successes? An enormous share of the credit must go to individual scientists working in laboratories throughout the country. Their productivity is a testament to the principle that dedication, preparation, and creativity in ample measure can surmount the most difficult problems. By careful design, governmental commitment, and a bit of good luck, America has created a remarkable engine for discovery in cancer. The most important product of the engine is tangible progress--ever-expanding knowledge available to all scientists, important clinical insights, and a vibrant and stimulating atmosphere for cancer research. If maintained carefully, this discovery engine will transform our knowledge of clinical oncology and ultimately cure cancer. Although we have been highly successful thus far, learning to prevent and cure cancer involves a set of highly complex problems requiring all of the intellectual commitment and hard work we can muster. Much more discovery is needed about why normal cells become cancer cells. Greater insights must be gained concerning the nature of cancer cells, their genes, their behavior in tumor masses, and the mechanisms by which they survive therapy and spread before we will be able to vanquish these diseases. The faster these discoveries are made, the sooner clinical mastery of cancer will be achieved.
The Goal 1. Accelerate the pace of the discovery.
2. Increase opportunities for individuals to contribute to cancer research.
Increased opportunity for discovery will be required if we are to capitalize on the four previous investment opportunities. Each is and must remain inextricably tied to the engine of discovery. Many of the advances in cancer research of the last 25 years have sprung from scientists supported by investigator-initiated research grants. Their collective discoveries form the intellectual basis for ongoing clinical advances, the explosion in basic knowledge, and the development of biotechnology.
The funding of investigator-initiated grants is highly competitive. Researchers from across the country submit detailed proposals in which their ideas are described. Applicants' proposals are reviewed by a group of their scientific peers, scores are assigned, and funds are awarded to those of highest merit. At present only those grants in the top 25 percent of those eligible for funding receive awards. More than these should be funded; many outstanding ideas go untested for lack of funds.
We must make a commitment to fund an adequate number of research grants so that all of the most promising ideas can be tested. Only in this way can we ensure the continued flow of discovery that leads to improved cancer care and effective cancer prevention.
The plan for progress is simple. Successful mechanisms for attracting and supporting the best research are already in place, but we need to reverse the trend of shrinking grant dollars. The NCI is currently funding one-fourth of all grant applications judged eligible for funding. This number should increase to one-third. Funding one-third of grant applications will maintain healthy competition and ensure that only outstanding research is funded. We must ensure that the best ideas in cancer biology, cancer prevention, behavioral science, genetics, diagnosis, and therapeutic research are tested and developed.
In addition, the lifeblood of the cancer research enterprise--its scientists and clinical investigators--must be continually renewed. Funds presently available are insufficient to ensure that the brightest and most creative young people enter the cancer field. Therefore, the NCI must increase its support of young trainees from every segment of the American population. The support should be available from the start of trainees' research education through the time that they are independently established investigators. At the same time, we must recognize that even with adequate training opportunities, we will fail to recruit and retain gifted new investigators if they despair of being able to receive research grant funding once they embark upon independent research careers.
Funds invested in the support of cancer research will stimulate the brightest young scientists to commit their energies to the challenge of cancer and will keep the remarkable stream of discovery flowing. These two elements are the true keys to our success. The strength of our investment in research is the most direct meter of scientific progress. Research investments stimulate progress in all of the unexpected and creative ways that cannot be predicted by the more focused efforts discussed in the previous four opportunities. In a very real sense, the existence of those four exciting opportunities springs from the discovery process. As those opportunities came from our past accomplishments, our future successes will come from our strong support of the research process now. We must continue to attract and train the best young minds, and we must ensure that the discovery process advances as quickly as possible.
The speed with which cancer is ultimately conquered depends in the simplest terms on how well our research program works. Not providing an increase in research project support will slow the pace of scientific discovery and threaten the excellence of the discovery engine. With so many lives at stake, the speed of discovery is a crucial measure of success in cancer research. The investment that fuels the discovery engine is directly linked to how many future lives can be saved and how much suffering will be alleviated.
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