NIH News Update
NATIONAL INSTITUTES OF HEALTH
National Cancer Institute

For Response to Inquiries
Thursday, January 29, 1998

NCI Press Office
(301) 496-6641


Questions and Answers
About Advances, Opportunities and Investment in Cancer Research

1. What have been the major advances in cancer research in the past 25 years?

The past several decades have seen remarkable advances against cancer. In fact, thanks to research, the cancer mortality rates are declining. In 1996, the National Cancer Institute (NCI) reported a drop of 2.6 percent between 1991 to 1995. This drop includes major cancers, such as lung, prostate, and testicular cancers in men, breast cancer in women, and colorectal cancer.

Cancer continues to be a tremendous burden on Americans, but cancer research has made possible dramatic improvements in survival over the last 25 years. For example:

In treatment, major advances have been made in the development of biological therapies, including interferons, interleukins, and vaccines to stimulate the patient's immune system to fight cancer; factors that help the patient's immune system recover more quickly from the effects of cancer drugs; less radical surgery for breast, prostate and bone cancers; and improved drug treatments for common cancers like breast and colorectal cancers.

The most important advance in the last 25 years has been our understanding of the fundamental biology of cancer. All cancers arise as the result of the slow accumulation of changes in one of the trillions of cells in the body, in the instructions that guide the behavior of the cell. Scientists now know a tremendous amount about how genes can stimulate and suppress growth of cells. Building on this advance in understanding, the NCI has identified unprecedented cancer research opportunities which will use science and technology to read the true nature of the cancer cell and find ways to apply that knowledge to prevention, detection, diagnosis, and treatment.

2. Why is it important to learn about genes and how they are related to cancer and other diseases?

Because cancer is fundamentally a genetic disease, the most direct and ultimately the most effective approach to preventing, detecting, diagnosing, and treating cancer is to learn the properties of the responsible genes. Recent advances in the understanding of human genetics have provided an important new opportunity to identify cancer genes. This approach unlocks vast potential to expand our knowledge of the origins of cancer, to develop new ways to detect a tumor in an early stage, and to identify new targets for cancer therapies.

3. What advances have been made in the fight against childhood cancers?

Cancer research has made dramatic improvements in survival of childhood cancers over the past 25 years. Mortality rates have declined 57 percent since the early 1970s. Five-year survival rates for all sites are 72 percent today.

Improvements have come with the use of chemotherapy, along with transplantation of bone marrow or blood stem cells. Cures for lymphoma have stemmed from high-dose, multidrug chemotherapy regimens which attack both tumors and microscopic cancer cells that have spread throughout the body. In the treatment of solid tumors, improvements have come with the use of combination therapies, such as chemotherapy before or after surgery or radiation therapy. Special emphasis has been placed on preserving the quality of life for childhood cancer patients. Limb-sparing surgery for many sarcomas has had major impact, as has the development of drugs to protect key organs from damage caused by cancer drugs.

4. How serious are cancers of the colon and rectum, and are we making any progress in combating them?

Cancers of the colon and rectum are common cancers in both men and women and represent the second leading cause of cancer death in Americans each year. Fortunately, during the past 20 years, the death rate from colorectal cancer has dropped significantly.

Through sustained and innovative research, scientists have made dramatic advances in preventing, detecting, and treating this dreaded form of cancer. They have discovered four important genes which can lead to the development of certain types of colon cancer. Meanwhile, new testing procedures have improved our ability to detect early warning signs of this cancer, which is critical to treating it effectively. On the treatment front, doctors have found new drugs and surgical procedures that are improving both the cure rate and the quality of life of those who have been treated.

With continued advances in imaging and computer technologies, clinical studies, genetics research, and other developments, scientists are continually improving the tools needed to diagnose and treat colorectal cancer.

5. What are some of the advances made and opportunities in prostate cancer research?

The recent upsurge in NIH-supported research on prostate cancer includes several notable breakthroughs in our basic understanding of the disease:

Recent advances that have been made for prostate cancer include: 1) improved radiation therapy--the emergence of computer-enhanced imaging techniques to better focus the beam of radiation onto the tumor, away from healthy tissue; 2) new treatment options--blocking hormones that make prostate cancer grow and destroying the tumor by freezing; and 3) quality of life--doctors can now remove the prostate and reduce the chances that the surgery will cause other health problems.

Many opportunities for research exist. Opportunities that are being investigated are whether to screen men for prostate cancer; determining which men will be helped by having the cancer detected early; and which treatments will be best for the different stages of the disease. Evaluation of drugs that could lead to better ways to control or even prevent the disease is another opportunity. In the area of genetics, scientists are searching for genes linked to prostate cancer so that they may: 1) pinpoint the exact causes of cancer; and 2) develop tests for those who want to know if they were born with an altered gene increasing their chances of developing prostate cancer. Finally, opportunities lie in determining who will or will not benefit from specific treatments and which treatments are best in which situations.

NCI's Prostate Cancer Progress Review Group, made up of hundreds of individuals with expertise and interest in prostate cancer, is evaluating where we are and creating a vision for a national agenda for prostate cancer research. This first-ever systematic look at prostate cancer research by the NCI will enable us to guide our research investment towards accelerating progress and reducing the burden of prostate cancer.

6. What advances have been made in the fight against lung cancer?

Death rates from lung cancer, the largest single cause of cancer death in the United States, have been going down since 1991. Hard to detect and difficult to treat, it is responsible for one of every four cancer deaths in this country. Continued efforts to reduce the use of tobacco products, the major cause of lung cancer, have reduced the number of adults in the United States who smoke cigarettes. The detection and treatment of lung cancer has improved somewhat over the last 20 years, leading to an increase in the one-year and five-year survival rates. These advances include combining chemotherapy with radiation therapy resulting in some benefit for many patients with locally advanced lung cancer and development of new chemotherapy drugs which have improved response rates in tests of each agent alone. Researchers are also finding ways to enhance the quality of life of lung cancer patients by easing the shortness of breath and lowering the risk of pneumonia.

7. What are the current advances for improved breast cancer detection and treatment?

Detection and treatment have improved for women with breast cancer. Improved detection has resulted through screening techniques that use better imaging technologies, such as ultrasound and computed tomography, that may spare some women surgical biopsy. Thus, women today are more likely to be diagnosed when the breast cancer is small and restricted to the breast. Improved treatment options include less radical surgery as a replacement for mastectomy for women with early stage cancer. In addition, improved chemotherapy and hormonal therapy have improved overall survival for many breast cancer patients.

8. Are there any techniques under way to improve early breast cancer detection and treatment?

Several new breast cancer early detection and treatment techniques are in the research stage. Researchers hope to improve early detection with techniques such as magnetic resonance imaging (MRI), positron emission tomography (PET), and laser beam scanning. Treatment options under study include high-dose chemotherapy with bone marrow or stem cell transplantation and biological therapies such as the HER2/neu antibody.

9. Is the cancer death rate falling?

The Nation's death rate from cancer fell between 1991 and 1995--the first sustained decline since records started being kept in the 1930s. The cancers that have shown the most significant drop in mortality include colon and rectal, breast, prostate, and lung (in men) cancers. The overall cancer death rate in the United States declined 2.6 percent, falling 4.3 percent in men and 1.1 percent in women. Thanks to remarkable advances in cancer prevention, detection, diagnosis and treatment, 10,000 to 15,000 men, women, and children with cancer who may not have survived 10 years ago now have a real chance at living long, full, and productive lives.

The death rates are going down, and the rate of new cases being diagnosed has slowed, but a large number of cancer patients are still entering the health care system and need specialized medical care. Because cancer is a disease of the aging process, the Medicare population is significantly affected. Cancer continues to take an unacceptable toll on American lives.

For more information about cancer visit NCI's web site for patients, public and the mass media at http://rex.nci.nih.gov or NCI's main web site at http://www.nci.nih.gov