The Division of Cancer Prevention (DCP) conducts and supports research in cancer prevention, early detection, and screening, and on prevention and management of symptoms and toxicities in cancer patients. As an extramural division, DCP supports and promotes investigators around the country and internationally in these critical areas of cancer science. Our Cancer Prevention Fellowship Program trains future leaders in the field of cancer prevention and control.

Our growing understanding of the cancer process shows that both genetic risks and exposures combine to put a person at risk for the disease. Molecular and genetic pathways within the body are affected by exposures to cancer-causing substances through multiple factors. These include behaviors (such as using tobacco products and alcohol, diet, obesity, and exercise); chemical and emissions exposures (including ultraviolet rays from sunlight, radon, medical radiation, metabolites created by your own microbiome, your own hormones, and pollutants); and infections (such as human papillomavirus (HPV), hepatitis viruses, and HIV).

The overarching goal of DCP’s prevention and early detection efforts is to use this understanding to develop interventions to target these pathways in populations that can be accurately identified as at risk for cancer. Interventions may be drugs, vaccines, surgery, or behavioral modifications. The populations at risk may be found using biomarkers or new screening technologies.

NCI Cancer Moonshot^SM

The Cancer Moonshot^SM to accelerate cancer research aims to make more therapies available to more patients, while also improving our ability to prevent cancer and detect it at an early stage. Within the Cancer Moonshot^SM, the Division is part of these initiatives:

• Immuno-Oncology Translational Network (IOTN), supporting researchers investigating preventive cancer vaccines;
• Human Tumor Atlas Network (HTAN), supporting Precancer Atlas Research Centers;
• Symptom Management, analyzing and interpreting clinician- and patient-reported adverse event data to better understand tolerability;
• Improving the Management of Symptoms during and following Cancer Treatment (IMPACT);
• Cervical Cancer and HPV Vaccine Trial; and
• Cancer Moonshot^SM Biobank, carrying out a Tissue Acquisition pilot study that will inform the actions of the greater Biobank project.

Development of Prevention Agents

The identification and development of prevention agents with the potential to block, reverse, or delay the early stages of cancer is carried out through independent researchers via grants and in the PREVENT Cancer Preclinical Drug Development Program. PREVENT supports development of the best ideas in cancer prevention intervention and biomarkers using NCI contract resources instead of direct funding to researchers. The program is a peer-reviewed pipeline that focuses on research needs that are not adequately addressed by the private sector.

Early Phase Trials

While cancer prevention drug discovery is identifying many new agents, including those that intervene in specific molecular pathways thought to be critical to cancer development, early phase trials are the place to assess these interventions in humans. Since cancer prevention studies focus on high-risk populations that do not necessarily harbor a detectable cancer, they require extensive biomarker analysis, investigation of the biologic effects of the cancer preventive agents on their intended molecular targets, and correlation with clinically relevant endpoints. DCP is studying cancer prevention agents (including drugs, small molecules, vaccines and biologics) and approaches (including medical devices, preventive surgery, risk-reducing surgery, and non-surgical ablative techniques) using measures of efficacy that include modulation of cancer biomarkers and cancer incidence and risk reduction.

These studies are supported both by investigator grants and through the Phase 0/I/II Cancer Prevention Clinical Trials Program, a contract consortium. The Cancer Prevention Clinical Trials Network (CP-CTNet) a grant-funded network, will be funded in late FY2019 and will eventually replace the contract studies. CP-CTNet will perform early phase clinical trials to assess the safety, tolerability, and cancer preventive potential of agents and interventions of varying classes, many of which target molecules or processes known to be important during carcinogenesis.

The Barrett's Esophagus Translational Research Network (BETRNet) is a multi-disciplinary, multi-institutional collaboration co-sponsored by DCP and the Division of Cancer Biology, to centralize and enhance efforts to understand Barrett's esophagus (BE) and to prevent esophageal adenocarcinoma (EA). BE is the only known pre-cursor lesion to EA. BETRNet aims to speed the translation of important research findings from laboratory and clinical studies into useful medical applications. This includes validated diagnostics, improved patient management, cancer risk stratification and prediction, prevention strategies, and accurate criteria for BE screening and endoscopic surveillance.

Small cell lung cancer (SCLC) is a recalcitrant cancer, with a 5-year relative survival rate of less than 7% and the loss of approximately 30,000 lives per year. Treatment of SCLC has not changed in the last 30 years; avoidance of the use of tobacco is the only known way to prevent the disease. Research teams of the SCLC Consortium are conducting research to expand the understanding of the critical molecular changes in the lung that precede the development of frank SCLC and/or, to identify populations at particularly high risk for SCLC. A related program in NCI’s Division of Cancer Treatment and Diagnosis is addressing therapeutic issues in this cancer.

The US-Latin American-Caribbean Clinical Trials Network (ULACNet) will also be funded in late 2019 to create Partnership Centers to propose, develop, and conduct clinical trials focused on prevention of HPV-related cancers in HIV-infected individuals. These clinical trials will be conducted jointly by a U.S. research institution and a LAC region country institution at clinical sites in these countries. Results of these clinical trials are expected to inform improvements in clinical cancer preventive care and reduce the burden of highly preventable HPV-related cancers in HIV-infected individuals.

Biomarkers for Early Detection of Cancer

There are several major programs that promote research to identify, develop, and validate biological markers for early cancer detection and cancer risk assessment. Activities include development and validation of promising cancer biomarkers, collaborative databases and informatics systems, and new technologies or the refinement of existing technologies via several consortia, including: 

• Early Detection Research Network (EDRN) – to accelerate the development of biomarkers that can improve medical practice, ensure data reproducibility and integrity, and adapt to the changing landscape of biomarker science.
• Alliance of Glycobiologists for Cancer Research – to reveal cancer-related dynamics of complex carbohydrates to develop new, validated biomarkers for early detection 
• Consortium for Imaging and Biomarkers (CIB) – to improve cancer screening, early detection of aggressive cancer, assessment of cancer risk and cancer diagnosis by integrating imaging strategies with biomarkers into complementary approaches.
• Consortium for Molecular Characterization of Screen-Detected Lesions (MCL) – to identify screening-detected pre-cancers and early cancers, including within the tumor microenvironment (with the Division of Cancer Biology).
• Liquid Biopsy Consortium – to advance and validate liquid biopsy technologies specifically targeted for early stage cancer detection.
• Pancreatic Cancer Detection Consortium (PCDC) – to develop and test new molecular and imaging biomarkers to detect early stage pancreatic ductal adenocarcinoma and its precursor lesions.
• Translational Liver Cancer (TLC) Consortium – to conduct studies to improve the surveillance of liver cancer in high-risk populations, increase the fraction of liver cancer detected at an early stage, and better stratify patients at risk of developing liver cancer.

Early Detection Trials

DCP supports research that seeks to determine the effectiveness, operating characteristics, and clinical impact (harms as well as benefits) of cancer early detection technologies and practices, such as imaging and molecular biomarker approaches. Two large-scale early detection trials, the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial and the National Lung Screening Trial (NLST) have data and biospecimens available for additional research.

The Etiology and Early Marker Studies (EEMS) is an ongoing component of the PLCO Trial. By collecting biologic materials and risk factor information from trial participants before the diagnosis of disease, PLCO EEMS adds substantial value to the trial, providing a resource for cancer research, focused in particular on cancer etiology and early markers. Specimens are available independently and through  a funding opportunity.

The Cancer Data Access System (CDAS) is a web portal that facilitates access to PLCO data other than the biospecimens in EEMS, as well as data from NLST, and the Interactive Diet and Activity Tracking study (IDATA).

Clinical Trials in the Community

The NCI Community Oncology Research Program (NCORP) is a national network that bring cancer clinical trials and cancer care delivery research studies to people in their communities. The NCORP network designs and conducts cancer prevention, supportive care and symptom management, screening, and surveillance clinical trials; designs and supports health-related quality of life studies for patients on treatment trials; designs and conducts cancer care delivery research (CCDR) studies; participates in treatment and imaging clinical trials conducted by the NCI National Clinical Trials Network (NCTN); and integrates health disparities research questions into NCORP studies. DCP works with the Division of Cancer Control and Population Sciences to carry out CCDR studies.

The NCI Community Oncology Research Group is made up of 34 Community Sites and 12 Minority/Underserved Community Sites directing a network of more than 1,000 locations nationwide. Other research areas include: natural history and mechanisms of cancer and its treatment-related symptoms and toxicities; post-treatment surveillance (such as tumor markers of recurrence, and optimal screening modalities); under- and over-diagnosis of cancer; and management of pre-cancerous lesions.

The New Onset Diabetes Cohort (NOD) (with the National Institutes of Diabetes and Digestive and Kidney Diseases and the PCDC), the Early Onset Malignancy Initiative (with the Center for Cancer Genomics), and the NCORP Tissue Procurement Protocol (with the Division of Cancer Treatment) are all centered out of NCORP sites to create cohorts and tissue repositories for molecular research.

Symptom Care and Symptom Management Research

The Division supports research in three areas: prevention or treatment of acute or chronic symptoms and morbidities related to cancer, its treatment and caregiving (symptom management research); effects on quality of life from cancer, its treatment and caregiving (quality of life research); and end-of-life psychosocial issues, caregiving and treatment strategies (end-of-life research).

Study interventions are aimed at improving quality of life for patients facing problems related to a life-threatening cancer diagnosis, or at preventing and relieving suffering during cancer therapy by means of early identification, assessment, and treatment for pain and other physical, psychosocial, and spiritual problems. Investigator-initiated research includes areas from foundational studies to further understand symptoms through clinical trials. Through NCORP, clinical trials are underway to evaluate therapies to prevent or ameliorate a broad range of symptoms and/or toxicities associated with cancer its treatment and caregiving. Other studies funded separately are investigating a range of treatment effects on health-related quality of life and a variety of influences on the end-of-life cancer experience.

Role of Nutrition and Nutritional Components on Cancer Risk and Prevention

The Division promotes and supports investigator-initiated studies to establish a comprehensive understanding of the precise role of diet and food components in modulating cancer risk and tumor cell behavior. To accomplish this research, DCP encourages response to multiple Funding Opportunity Announcements developed internally and in collaboration with other Divisions and Institutes. Approaches include characterizing molecular targets and variability in individual responses to nutrients and dietary patterns. Basic, translational, and clinical studies are supported to understand the interplay between nutrition and the microbiome, the underlying mechanisms implicated in cancer prevention, and the interplay of genetics background, epigenetics, gene expression, environmental exposures, obesity, exercise and dietary intake. One current focus is on the role of probiotics and prebiotics found in food or food components, their interaction with members of the gut, mouth, and skin microbiota, and their role in carcinogenesis and metabolism. Other areas include research to assess the effect of diet and nutrition in a tissue-specific manner by cataloging changes in transcriptome (coding and noncoding) and signaling networks through interagency collaboration and investigator-initiated grants, as well as to explore dietary influences on circulating exosomes and their cargo as biomarkers and in cancer prevention strategies.

Biostatistical Methods, Modeling, and Collaborative Support

DCP plans and conducts studies in biostatistical and epidemiological methodologies and mathematical modeling of processes relevant to cancer prevention. The IDATA project, as an example, looks at measurement error inherent in diet and physical activity assessment tools, which hinders research to assess the associations among diet, physical activity, and health outcomes. Given the high penetrance of internet and mobile devices in the population and the availability of motion-sensing devices for monitoring physical activity, web-enabled instruments that can be accessed remotely and repeatedly administered are increasingly a practical and economical approach for measuring diet and physical activity exposures in health studies. Other collaborations focus on cancer epidemiology, prevention, screening, and diagnosis.