What Is Required for Continued
Progress Against Cancer?
Unquestionably, we stand at a defining moment in our Nation’s
ability to conquer cancer. The explosion of new knowledge and the
exciting technological advances, along with our ever-increasing
understanding of how to apply them, are providing innovative ways
to reduce the global burden of cancer. Novel strategies for making
further strides in cancer prevention, detection, diagnosis and
treatment are now on the horizon. Despite these opportunities,
there are many challenges that must be overcome if we are to
make a quantum leap forward in our mission to prevent and cure
First and foremost, we must continue to pursue a comprehensive
understanding of the biology of cancer at all stages—the root
causes of its initiation, growth and metastasis—and at all scales,
from molecules to cells to humans. We need the complete picture
of what occurs within cancer cells at the level of genetics and
epigenetics, as well as an understanding of the contributions of
other cells in the tumor and its microenvironment. Beyond studying
these in isolation, an integrated assessment—generated by the
approach known as systems biology—of the tumor and the
patient’s response to the tumor is essential to fully understand and
contextualize the cancer’s causes, prognosis, vulnerabilities and
responses to treatments.
With this comprehensive knowledge in hand, we can build better
tools for, and be smarter in, our approaches to preventing,
detecting, diagnosing and treating cancer. This vision will require a
great deal of innovation, effort and collaboration from all those who
care about saving lives from cancer and it will require adequate
funding from the federal government and other sources to meet the
challenges ahead. We must continue to push forward together, or
we risk losing more people like seven-year-old Evan Lindberg, to
this dreadful disease.
It is through research that we advance our understanding of the
biological factors involved in cancer. But how we conduct research
matters, and increased efforts in strategic areas are necessary to
achieve a more efficient cancer research enterprise. Gaining a
comprehensive picture of cancer will require new tools, new
analytics, new ways of thinking and new ways of working together.
These areas, which are described below, span the continuum from
improvements in fundamental research to performing clinical
American Association for Cancer Research
Children’s National Medical
• Is a member of the Children’s
Oncology Group (COG) Phase I
• Assesses and/or cares for more than
360,000 patients each year.
• Assesses and cares for about
225 newly diagnosed cancer patients
• Provided more than $100 million in
Community Benefit services in 2011.
research using our healthcare delivery system as a natural
laboratory in which research can continue in everyday patient-clinician interactions.
Improved Biospecimen Collection and
Biospecimens, such as samples of tumors that have been removed
from cancer patients, are the backbone of cancer research. A great
deal of the current understanding of cancer biology comes from
studying the differences between tumor tissue and healthy tissue,
between primary tumors and metastases and among different
types of tumors. In this way, researchers are able to identify
weaknesses to be exploited to potentially kill cancer cells.
Many research questions do not require direct access to patients
and can be studied using the patients’ donated biospecimens. If a
repository of samples, sometimes referred to as a “biobank” or a
“biorepository,” is available to researchers, then hundreds or even
thousands of samples can be tested quite rapidly. The utility of
research on archival tissue is highlighted by the fact that this
strategy has already led to a number of scientific discoveries,
including the identification of HCV and the determination that HIV
originates from a precursor Simian immunodeficiency virus (SIV),
among others. The examination of biospecimens from clinical trial
participants is also a promising means to identify drug resistance
mechanisms, the knowledge of which can lead to the development
of new drugs to overcome such resistance.