About NCI

30 Years Later . . .

Hope and Promise Are Becoming More Real!

Dr. Alan Rabson has seen it unfold.

Alan S. Rabson, M.D., began his career at the National Cancer Institute as a resident in pathological anatomy in 1955. After serving as Deputy Chief for Laboratory Pathology and Division Chief for Cancer Biology, Diagnosis, and Centers, he became NCI's Deputy Director in 1995. Recently, he talked about NCI's accomplishments since the passage of the National Cancer Act in 1971 and about the future of cancer research and care.

Q. In 1971, when the National Cancer Act was signed, the goal was to cure cancer within five years. Thirty years later, we still haven't cured cancer. Why is this?

A. Well, 30 years later we do cure more than half of all cancers. For example, nearly half of all high-grade lymphomas are cured. The overwhelming majority of all testicular cancers are cured. We're curing more breast cancer and ovarian cancer now than ever before, and most all of this has come about since 1971.

We're also much more attuned to the importance of detecting cancer early and the possibilities for preventing its development. For example, when the National Cancer Act was signed, screening mammography was not standard medical practice as it is today. In addition to regular mammography, women at high risk for breast cancer now have the option of taking drugs, such as tamoxifen, that may prevent the disease altogether.

But also, our goal now is to stabilize patients so that while they still may have cancer, they can have the longest period possible of high quality life. The treatments we're developing now are making this possible for more and more people.

For instance, treatment with the drug gemicitabine prolongs the lives of people with pancreatic cancer, and it's possible that new drugs we're developing may prolong these people's lives further. And the development of Taxol™ in the 90s greatly improved and revolutionized the treatment of ovarian cancer.

Q. After the Act was passed, a group of experts was convened to figure out how we should plan and conduct cancer research. What impact did that group have on how we do science today?

A. We convened several large groups out at a retreat facility in Virginia. We brought in around a hundred people at a time - all the top experts in cancer research in the world. We asked them, "If you had infinite resources, what would you do?" It was a wonderful experience, but many of the goals we came up with depended on things we had no technology for. For example, we talked about genes, and what we could do if we could sequence or clone them. We had the right ideas, but we were waiting for molecular biology to catch up. Now we can do things we never dreamed possible.

Q. What has been the most exciting thing that has happened during your tenure at NCI?

A. In my 46 years here, everything has been exciting! But if I had to choose one thing, it would be the advances in molecular biology and genetics that have changed the world of cancer research and opened doors for so many new opportunities to explore.

As we've come to understand the molecular signatures of cancer cells, we can classify tumors according to their genetic characteristics. And the future promises to be even more exciting, as we discover new, targeted, and effective means of cancer treatment and prevention.

One of the best examples of this is the development of a new, targeted treatment for chronic myelogenous leukemia and potentially other forms of cancer. And breast cancer patients whose tumors have certain molecular characteristics have benefited tremendously from the introduction of Herceptin™, another targeted treatment.

In addition, public support for basic biomedical research has become much stronger, in large part because of the growth of the advocacy community. We've also enjoyed tremendous political support, which is a reflection of the popular support.

Q. What can we expect from cancer-related science in the next 5-10 years, and what will it mean for patients?

A. More patients will be cured, but more than that, more people will live with a stabilized disease. Will we ever cure all cancers? No. But we will learn to manage most of them and patients will be able to maintain a high quality of life - just as people with heart disease can live well for many years after their diagnosis.

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How it All Comes Together

When the National Cancer Act was adopted in 1971, there was widespread hope that the additional resources and responsibilities that it would bring to the NCI would soon lead to a "magic bullet" cure for cancer. Instead, as a result of research over the last thirty years, we now know that cancer is a complex set of diseases, for which there is no single cure.

An examination of what we have learned in the major fields of cancer research shows how far we have come and why implementing the plans described in this document is essential for continuing the remarkable progress of the last three decades.

• Cancer Biology - Scientists have learned that cancer is a disease resulting from multiple genetic changes and have identified numerous hereditary, environmental, life style, and infectious agents that initiate the genetic changes that lead to cancer.

  NCI research initiatives related to the Signatures of Cancer Cells and Genes and the Environment focus further exploration into the inner workings of cells and the processes that take place as cancer develops.

• Prevention and Control - We have come to recognize the roles of tobacco, diet, and exercise in cancer development and have identified numerous environmental carcinogens. We also know that some individuals are more susceptible to these exposures than others. Better understanding of the many causes of cancer has opened multiple avenues to prevention, including chemoprevention. Numerous evidence-based interventions have been employed to better control cancer.

  Continued research on Genes and the Environment, Tobacco and Tobacco-Related Cancers, Molecular Targets, and Cancer Communications will lead to further improvements in the future.

• Early Detection and Diagnosis - Thirty years ago, cancer was often detected only when it was so far advanced that it was next to impossible to treat it effectively. Today, physicians are armed with a variety of sophisticated detection tools including mammography, colonoscopy, ultrasound, and CT imaging as well as tests of body fluids or tissue such as the PSA for prostate, HPV for cervical, and CA-125 for ovarian cancer. In some cases, they also can use genetic testing to determine predisposition to a specific type of cancer.

  We will continue to make progress in early detection and diagnosis through research and development on the Signatures of Cancer Cells and Cancer Imaging.

• Treatment - Today, treatment is much less invasive: physicians use image-guided surgery and radiation therapy and surgical techniques such as lumpectomy instead of mastectomy. And we are beginning to develop drugs such as Herceptin™ for breast cancer and Gleevec™ for chronic myelogenous leukemia that target the specific genetic characteristics of cancer. Many more promising treatments are on the horizon based on the discoveries and advances of the past 30 years.

  Our continued efforts in Molecular Targets for and acceleration of NCI's National Clinical Trials Program are critical to making these treatments a reality.

• Surviving Cancer and End-of-Life Issues - At the time the National Cancer Act was passed, many people did not survive cancer at all. Today in the U.S. there are over eight million cancer survivors who need care and support to make the most of their lives. For those who lose the struggle with cancer, we have learned much in the last thirty years about easing their pain at the end of life.

  We are committed to improving our performance in addressing survivorship and end-of-life issues through continued research on the Quality of Cancer Care and initiatives in Cancer Communications.

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Continuing the Progress

Continuing progress in cancer research will depend on our ability to maintain a research system that allows the scientific community to:

• Apply new insights and emerging technologies.
• Pursue innovative ideas.
• Facilitate collaboration among experts from a range of scientific disciplines.

Cross-cutting to all of these are our NCI Challenge efforts for Enhancing Investigator-Initiated Research; building Centers, Networks, and Consortia; Studying Emerging Trends in Cancer; Reducing Cancer-Related Health Disparities; building and maintaining Informatics and Information Flow systems; and preparing future cancer scientists through Cancer Research Training and Career Development programs.

Get more information on the National Cancer Act and the advances against cancer over the past 100 years.