Director's Message

The National Cancer Institute is a remarkable enterprise that represents a unique confluence of history, politics, science, technology, and even philosophy. It is a public institution dedicated to reducing the burden of cancer for all our Nation's citizens and people around the world.

Through basic intellectual inquiry, the generation of new knowledge and tools, and the application of discovery, it has the capacity to change the course of history by reducing the terrible toll placed on people and society by that group of diseases we call cancer. NCI is successful because we are part of an extensive network of biomedical and broad scientific research and technology that gives us the tools to ask questions, find and interpret answers, and turn those answers into useful ways of enhancing health and reducing disease.

Each year, my colleagues and I prepare this plan and budget proposal, as prescribed by the National Cancer Act of 1971. To set forth new goals and objectives for the "Nation's investment in cancer research," we first examine the gaps in our understanding of cancer and our ability to translate and apply what we know for the benefit of people. This analysis helps us determine the larger context in which we carry out our mission.

The primary gap upon which all of our efforts are predicated is the one between ignorance and knowledge about this disease. Attempting to address the many unanswered questions about cancer is an incredibly challenging intellectual exercise and an essential step in successfully and predictably reducing its burden. Increasing our knowledge about cancer is difficult, complex, and often confusing. The road to discovery often takes us in unexpected directions and brings us to unexpected outcomes or insights. We must explore blind alleys, question and change old knowledge and beliefs, and figure out how seemingly unrelated pieces of information fit together. Working alone and in groups, we constantly draw on new talent, evolve and use new tools, and capitalize on creativity, intelligence, persistence - and very often, luck!

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Our second task is to close the gap between knowledge gained through science and the translation of that information to the actual experience of people at risk for, diagnosed with, or surviving cancer. This requires moving new knowledge directly into the setting of the disease. We must establish new insights into individual risks for developing cancer; new, more targeted approaches to early detection; a new molecular view of diagnosis; and entirely new approaches to the prevention, treatment, and control of cancer and its consequences. This type of translational research is our first step in the transformation of cancer medicine and public health to more certainty and precision. It is our road to transforming therapy from trial and error to rational design and the development of targeted interventions.

Third, our NCI activities must address the gap between this translational work and actually reducing the burden of cancer - between what might work or looks promising and what really does work. We need to move research results to their application in clinical practice and public health by conducting extensive clinical trials that will define the details of how new approaches will work and determine what the benefits and risks of specific interventions are. This clinical research establishes or refutes the extent of benefit to patients of new approaches to reducing the risk of, preventing, detecting, diagnosing, and treating cancer and provides the bridge to better, less invasive, and longer-term solutions.

The final gap that we strive to close is one of the most frustrating because it seems to be due to things that we should have the power to influence change. This is the discontinuity between what we have already established as effective in reducing the burden of cancer and the practice and availability of that hard-won knowledge for all people regardless of where they live, whether they are rich or poor, or what their cultural backgrounds are. Bridging this divide requires better understanding the unequal burden of this disease, addressing disparities in the quality of cancer care, and implementing the most effective interventions to address them.

We must work to bridge each of these gaps through the dissemination, diffusion, and adoption of new insights. This means finding the most effective ways to share findings and encourage collaborations among researchers. It means applying the best communications technologies to facilitate translational and clinical trial activities. And it means arming practitioners with the information and tools they need to achieve a level of comfort that will allow them to successfully use new approaches in their work with cancer patients, people at risk, and survivors.

The true measure of excellence for an enterprise is both where it can go and where it has been. With our future planning, we look back to the myriad of initiatives supported by NCI and how these have begun to close the gaps, and we look ahead to the many important next steps needed to continue. As stewards of the public trust, we have a grave responsibility to chart a course and develop a plan and budget that will allow us to maintain the superior quality of all of our research programs.

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In addition, we must meet the challenges that come with new approaches, technology, and knowledge and build on past discovery in areas of "extraordinary opportunity" that address all cancers as well as the specific needs of different types of cancer. And through all of these efforts, we must remain vigilant in addressing the barriers to full implementation of new interventions that will bring quality cancer care to all people.

Our plans emerge through the insights and wisdom we gain from the input, questioning, feedback, and collective experience of all involved in the cancer research enterprise. The future plans and priorities we identify now set the rationale for our decisions along the way, give us a systematic framework for assessing progress, and provide a clear and credible means for reporting our performance and results to the public.

But these plans, these strategies, these technologies provide only a framework. The real work begins with people, people who are at the heart of delivering the full promise of our plans and investments. These people, be they patient or health care provider, scientist or administrator, advocate or lawmaker are the ones we must count on to close the gaps between ignorance and knowledge, knowledge and application, and burden and access to or availability of care.

Though the focus and methods have changed as the science has evolved, our goal to improve the plight of all people everywhere is unwavering. With the courage of our cancer research and care community and the continued strength of our resources, hope is stronger and more certain than ever, and the years to come hold promise beyond our imaginations!

Richard D. Klausner, M.D.
Director
National Cancer Institute


September 2001

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