Building the Right Kind of NCI for the Future
NCI’s Commitment to All
Because cancer is, in reality, not a singular disease but many conditions, its causes, its progression,
and its effects vary tremendously. Despite its heterogeneity, there is perhaps one common trait of all
cancers that particularly stands out: fear. Virtually all of us fear cancer. We fear that, as we age,
cancer may come to us. If we have survived cancer, we fear it may return. We fear that cancer may take our
lives or the lives of those we care about.
The National Cancer Institute is, of course, dedicated
to research. And dedicated research can help replace fear with hope. In the years to come, NCI will remain
focused on its work and its missions that will, by their very nature, require great change.
- We will need to change how we think about
cancer prevention. Choosing the right
healthy behaviors — diet and exercise, for example — and avoiding exposure to certain environmental
risk factors, none more important than tobacco, can help prevent the development of cancer. Yet, why one
person will develop cancer and another will not, given the same exposures, remains largely unknown. We need
to apply our rapidly increasing knowledge of both the tumor and its microenvironment, as they relate to
specific organ sites, in order to find new targets and markers of early carcinogenic events and, additionally,
to study transcriptional regulation and epigenetic changes. We must then find ways to take highly characterized
individuals whom we have determined are at high risk and intervene, with manipulations or prevention measures,
to mitigate their risk. We need to include earliest diagnosis as a preventive strategy and more deeply incorporate
biomarkers and imaging technology into our prevention portfolio.
- We will need to change how we contemplate
cancer survivorship. Cancer is rarely a
transitory event: something that is dispatched with and then disappears. For a significant proportion of
cancer patients, second, third, and even fourth malignancies are a lingering worry. NCI is committed to research
that studies the genetics of survivorship in order to better reveal those individuals most at risk for new cancers
— and then to design prevention and early detection protocols for each patient.
- We must change how we fight the disparities in cancer care that lead to unequal outcomes.
Cancer does not discriminate, but its outcomes are all too frequently affected by race, ethnicity, income, age,
and frailty. We must not allow those differences to alter the care we offer. As we bring cancer care closer to
patients in their communities, through efforts like the NCI
Community Cancer Centers Program, and work to reduce barriers to care through programs like the
Community Networks Program, the
Minority Institution/
Cancer Center Partnership Program, and the Patient
Navigation Research Program, we must ensure that all patients who need care have equal access to the latest
treatments and techniques — the fruits of our latest science. We must also work to understand the genetic
differences that may lead to different disease burdens, such as the disproportionate rates of prostate cancer
among African American men.
- We must remember that research into the causes of cancer equals progress against many
diseases. Cancer research studies biological processes at their most basic, molecular level.
The knowledge we gain about cancer, about its growth, nourishment, and spread, have been shown time
and again to have significance against many diseases. For example, recent studies show that the leukemia
drug Gleevec may help in an array of illnesses that have nothing to do with cancer. Among them: diabetes,
Crohn’s disease, pulmonary arterial hypertension, rheumatoid arthritis and scleroderma and maybe
even seasonal allergies. Our models for cancer care also can lead the way for improved, less costly
medical care — from the adoption of electronic medical records, to electronically interconnected
hospitals and patients, and to greater use of evidence-based care.
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