When we speak about the future of cancer research, it's important to understand what's at stake, particularly given everything we have achieved over the past several decades.

When interacting with members of Congress, I often relay stories about individual cancer patients. One recent story is of a woman in her late 20s, with two young children, whose body and life had been dismantled by cutaneous T-cell lymphoma. Seemingly out of options, she came to NCI and the NIH Clinical Center. There she found "hope," in the form of the skill and dedication of NCI's Dr. Martin Gutierrez and an experimental drug being developed by NCI's Rapid Access to Intervention Development ¹ program, which has, for a year now, given her optimism for a longer, productive life.

That is what's at stake - individuals, sick patients, families.

As NCI's leadership continually assesses and attempts to manage a challenging budgetary scenario, we recognize that the extent of our progress is inextricably linked to our available resources. Yet we know that progress can and will continue. It will continue by supporting the young investigators who will build on today's remarkable discoveries; by ensuring that those discoveries can and do benefit all cancer patients, regardless of where they live or their socioeconomic status; by maintaining a vigorous intramural and extramural research program and helping to forge collaboration between academia, industry, government, and the nonprofit sector; and by driving the development of new technologies, tools, and resources that can hasten improvements while enhancing efficiency and cost effectiveness.

I always stress to legislators that, despite the challenges, our nation's investment in cancer research is paying great dividends - in lives saved, in a better quality of life, and in cancers prevented. I also emphasize the progress being made toward personalized therapy, and that a continued substantial investment in cancer research is necessary if we are going to realize our vision of therapies specifically designed to treat each individual's cancer in highly targeted ways. This investment - approximately $275 per person over the last 30 years - not only benefits cancer patients, but the advances cancer researchers are making in molecular biology, immunology, and genomics are impacting every disease.

And that's why we continue to push forward, despite the resource constraints we currently face. Because the cost of being content with the current state of affairs - as favorable as they have become for certain cancer types - is unacceptable.

And that cost extends beyond the many lives lost to cancer. According to the American Cancer Society's most recent estimate, the annual personal and financial cost of cancer in the United States is $206 billion. But our population is aging rapidly, and cancer is largely a disease of aging. As a result, NCI estimates that by 2017 - less than a decade from now - the total economic burden of cancer in the United States will be $1.82 trillion.

That's why we are working so diligently to place more emphasis on carefully reviewing and more aggressively funding new applications from young investigators; pursuing genome-wide association studies ² to identify small genetic and environmental factors that contribute to cancer risk; investing in subcellular imaging, in finding markers of disease before the disease is even measurable; investigating through the NCI Community Cancer Centers Program ³ how best to educate, screen, and prevent cancer to make our discoveries readily accessible to people where they live. It's why we have pioneered phase 0 clinical trials ⁴ to help make smarter decisions about which experimental agents to move into phase I and II trials, and why we have developed a program to help small businesses with promising new cancer interventions traverse the so-called "valley of death ⁵" to get those interventions into advanced clinical studies and to market.

What's at stake is clear. We have made tremendous gains and we must sustain and build upon them. Our future success depends upon a sustained commitment to research, so we can deliver on the promise of a world where stories about successful battles against cancer are the only ones to tell. Like the case of our patient with T-cell lymphoma, we need to be able to deliver hope and successful outcomes.

Dr. John E. Niederhuber
Director, National Cancer Institute