I am gratified that NCI has adopted the recommendations of the Lung Cancer I2 team that I was asked to chair in September 2004. Our mandate was to implement the recommendations of the 2001 Lung Cancer Progress Review Group and develop a business plan to reduce lung cancer mortality and morbidity by 2015.

Our team identified the need to transform how NCI and the cancer community deal with the daunting challenges of lung cancer. We faced the inescapable facts that 5-year lung cancer survival rates have improved only modestly over the past three decades, that only a fraction of lung cancers are diagnosed at an early stage, and that even the most intensive smoking cessation programs succeed less than 25 percent of the time. Therefore, merely doing more of the same - even with higher levels of funding support - would be unlikely to dramatically improve the status quo.

Rather, we recognized the urgency of developing a trans-NCI approach transcending divisional boundaries. I was assisted in that task by the aptly named "Tiger Team" of 10 scientists from virtually every NCI research division, as well as 2 outside panelists. I would like to thank the entire team for the hard work and enthusiastic spirit they brought to our endeavor. We agreed on the need to alter the way in which NCI manages its investments in lung cancer prevention and therapy and developed a work plan built around three critical strategies: achieving more effective tobacco control, accomplishing earlier detection and treatment of early lung cancer and precancer, and developing new targeted therapies.

We found that there were several programs within NCI dedicated to lung cancer initiatives in prevention, diagnosis, and therapy, but no single operational focus. We reviewed NCI's diverse portfolio and prioritized the programs, through meetings of the entire I2 team and subgroups, and through countless phone conferences and e-mails over a 9-month period.

Our implementation plan is crafted as a comprehensive approach that does not duplicate any current or planned initiatives. We recognized the unique opportunity to harness existing NCI efforts by developing strategic alliances. For example, we proposed pilot lung projects within the Human Cancer Genome Project and the Molecular Biomarkers Initiative. We bootstrapped recommendations of the parallel I2 Imaging and Informatics teams, as well as initiatives proposed by the Clinical Trials Working Group to provide an efficient clinical trials infrastructure.

To coordinate all of these activities, we recommended the appointment of a program director who would operate within the office of the NCI Director and would be empowered to implement the plan, monitor progress, and recommend any changes in priorities and assignments depending upon the changing environment and the progress already made. The program director would chair a new Lung Cancer Scientific Advisory Committee to advise the NCI Director on the status of cross-cutting lung cancer research activities across research entities. This committee would have broad intra- and extramural multidisciplinary representation. To achieve success, we need to select a program director who is knowledgeable, well respected, strong, and charismatic.

Looking ahead, I am hopeful that we can achieve our expansive goals of transforming lung cancer prevention, detection, and treatment.

Dr. Margaret R. Spitz
Professor and Chair
Department of Epidemiology
University of Texas M.D. Anderson Cancer Center