Driving New Approaches to Cancer Prevention and Early Detection

January 13, 2016, by Barry Kramer, M.D., M.P.H.

The following is the last in a series of posts from senior NCI scientists and leaders on NCI’s Annual Plan and Budget Proposal for Fiscal Year 2017, which was officially submitted to the President on September 17, 2015. The proposal provides an overview of NCI’s priorities and key initiatives and the institute’s funding request for the President to consider when formulating his own Fiscal Year (FY) 2017 budget proposal.

In this post, Barry Kramer, M.D., M.P.H., director of NCI’s Division of Cancer Prevention (DCP), discusses a new NCI-funded research effort intended to help guide treatment decisions for people diagnosed with cancer following a screening test.

Research into the prevention and early detection of cancer is entering a new era. With our greater understanding of how cancers develop and, far too often, flourish—and with the availability of powerful new technologies—our approach to preventing cancer, how we screen for it, and how we manage very early-stage disease is now more refined.

As a report published last week in Cancer Prevention Research illustrates, this evolution is rapid and broad ranging. Recent studies, for example, have demonstrated the potential of using a genomic classifier to identify early lung cancer and of using precision medicine approaches to reduce cancer risk in those at elevated risk.

As the Annual Plan and Budget Proposal for 2017 describes, NCI supports many promising avenues for prevention and early detection, including studies focused on extending the use of immune-based cancer therapies to prevent cancer in those at increased risk and studies to investigate whether aspirin and metformin, which are used safely and effectively to treat other conditions and are known to affect molecular pathways involved in cancer, may halt the development or progression of several types of cancer.

One particularly exciting NCI-led initiative that is forging new ground is the Consortium for Molecular Characterization of Screen-Detected Lesions. The consortium is a joint effort of DCP and NCI’s Division of Cancer Biology that will help to address an area of critical need: determining the risk of progression of early cancers detected by screening.

Identifying cancer at the earliest stages has long been a critical area of research. However, our success in achieving this goal has been uneven. Effective screening tests—where the established benefits outweigh the potential harms—are available for only a handful of cancers, and, in many cases, it’s still unclear whether screen-detected cancers (and those detected as a result of an unrelated medical exam) always need to be treated.

There is ample evidence in prostate cancer, for example, that routine screening has led to many cases of overdiagnosis and overtreatment—cases where people were diagnosed and treated for a cancer that likely never would have harmed them.

The focus of this new consortium will be to analyze the cellular and molecular makeup of precancerous lesions and screen-detected tumors (and of the cells and other components in their immediate surroundings, the “tumor microenvironment”) and identify features—such as mutated genes or the expression of specific proteins—that distinguish slow-growing cancers that may not need to be treated immediately, if at all, from those that are aggressive or likely to become aggressive and thus need immediate treatment.

The consortium was established in October 2015, when NCI awarded grants to support seven multidisciplinary research teams and a center that will coordinate the consortium’s efforts. Each research team will focus on one of four cancer types: lung, breast, prostate, or pancreatic.

Like much of cancer research today, advanced technologies and tools—such as powerful imaging modalities, single-cell analysis, and next-generation cancer models—will be a crucial part of the research done by consortium members. Each participating consortium research group will be composed of a multidisciplinary team with expertise in patient care, pathology, imaging, and genomics, among others.

And although each team will conduct its own research projects, the teams will share data and expertise and develop collaborative research projects.

This novel endeavor builds on NCI’s efforts to bring more precision to how we treat and control cancer. Every patient’s cancer may have its own unique molecular makeup and clinical presentation. Our job is to use the improved understanding of the biology of premalignancy and new technologies to not only reduce cancer risk, but to ensure that we are providing treatment only when it’s necessary and most likely to benefit patients.

I encourage you to leave a comment below with your thoughts and questions about cancer prevention. I also encourage you to read the FY 2017 Annual Plan and Budget Proposal.