Sustaining Progress in Cancer Research: Precision Medicine and More

One very encouraging proposal in President Obama's recent State of the Union is the commitment to greater federal investment in biomedical research, including precision medicine and genomics research.

Although specific details of the president's plan have yet to be released, additional funding in biomedical research holds significant promise for new and effective treatments and prevention approaches for cancer and a host of chronic conditions.

It also is a welcome change from the recent declines -- in real, spendable dollars -- in federal research budgets, which, of course, includes cancer science.

Federal cancer research funding, which grew significantly after our national "War on Cancer," initiated by President Nixon in the 1970s, has remained relatively flat in recent years, leading to reductions of about 25 percent for the National Cancer Institute (NCI) in the past decade. This reduction has translated into $10 billion fewer dollars for cancer research since 2003. (See NCI's budget analysis here.)

This reduction, if allowed to continue, has troubling implications from both a scientific and public health perspective. Some question whether research investments have yielded results in our war on cancer. The realities are that cancer death rates have declined by 22 percent between 1990 and 2011, according to NCI, with the American Cancer Society reporting that 1.5 million cancer deaths have been avoided in the past two decades.

These declines are attributable in large part to almost exponential progress in molecular biology and genomics that have enhanced our understanding of how cancer develops and spreads. This has led to more-effective (and often less-toxic) cancer treatments, and ushered in the era of precision medicine - where we've moved away from a "one-size-fits-all" approach to cancer treatment and instead are developing approaches tailored to individuals.

The pace of this research has led to striking changes in breast cancer treatment. In just one generation, we have moved from approaching breast cancer as one disease with one standard set of treatments, to a time when we know that breast cancer is a family of diseases, each with different characteristics -- and each requiring tailored and often individualized approaches. Better treatments and more treatment options have followed, as has science-based knowledge of risk reduction and the role of early detection and early treatment.

As a result, breast cancer death rates have declined by 35 percent since 1990.

As our population gets older - many more cancers occur in later life - there is an even greater need to build on the progress of cancer research, which is best achieved with leadership and investment from the federal government, and continued investment by philanthropic organizations and industry.

The return on this investment, economically and socially, is significant. In a Jan. 13 article in JAMA, NIH Director Francis Collins notes that the U.S. government's $3.8 billion initial investment in the Human Genome Project "has resulted in nearly $1 trillion in economic growth -- a 178-fold return on investment." He also noted a 140-fold return on investment on NIH's $250 million investment in the Women's Health Initiative's estrogen plus progestin clinical trials.

Investment today ensures continuity in cancer research for tomorrow. Early-career researchers have been especially disadvantaged by tightened federal budgets. With fewer dollars available to new scientists, many have been forced to leave biomedical research all together, in search of greater financial and career stability.

Nonprofit funders like Susan G. Komen and others work hard to fill the gaps left by these declines. Komen, as the largest nonprofit funder of breast cancer research outside of the U.S. government, invested half of its research portfolio in 2014 to early-career researchers and we hope to do more this coming year. But philanthropic organizations alone cannot fill the gap left by declining federal dollars: only a renewed federal commitment of significant proportions can assure the promise of the next generation of cancer researchers and, indeed, of cancer research itself.

President Obama said he wants "the country that eliminated polio and mapped the human genome to lead a new era of medicine -- one that delivers the right treatment at the right time." We agree, and will work with others toward a renewed federal commitment to biomedical research to achieve this goal.