Highlighted Scientific Opportunities in Cancer Research

Tackling the Emergence of Early-Onset Cancers in Young Adults

More young adults are developing cancer than ever before. Worldwide, the rate of cancer among people between the ages of 18 and 49, known as early-onset cancer, has climbed by almost 80% since the 1990s.

The roots of this change are poorly understood. While the trend is most notable in gastrointestinal, breast, and uterine cancers, the increase in diagnosis at younger ages has not been seen across all cancer types. The increase also varies significantly across different racial and ethnic groups, as well as by geographic location. We must identify the factors underlying the dramatic increase in early-onset cases to develop effective prevention strategies, optimize screening guidelines for early cancer detection, and eliminate inequities with shifting cancer demographics.

The increase in early-onset cancer is not explained by elevated screening rates and is unlikely to have a simple explanation. For example, researchers have linked certain genetic conditions, dietary habits, and obesity to colorectal cancer, but these risk factors do not fully explain the sharp rise in this cancer among young adults. To learn more about risk factors in this age group, researchers are also investigating the role of accelerated aging processes, pollution, and even microbes that live in the gut. Other studies seek to understand inequities in early-onset cancer, such as the higher rates of death from early-onset colorectal cancer seen among men who live in parts of the U.S. South.

Addressing this problem will require the full spectrum of the NCI-supported cancer research enterprise, from NCI’s Surveillance, Epidemiology, and End Results Program—which has been instrumental in tracking this emerging trend—to basic science studies on the biological effects of environmental exposures. With decades of sustained data collection and technology advances, researchers have more tools than ever before to study early-onset cancer. However, more research is needed to fully leverage these resources.

Data from large and diverse groups of people are essential, including information about lifetime environmental exposures and health history paired with preserved biological samples. Additionally, we need to create advanced computational programs capable of processing and analyzing the extensive and intricate data gathered from these studies.

NCI has already made great strides against cancer. With sustained funding, NCI is primed to develop interventions specific to early-onset cancers and the unique needs of this patient population. We must tackle early-onset cancers to better protect young people today and future generations from cancer at any age.

Approaching Cancer as a Disease That Affects the Entire Body

Cancer is a whole-body problem. We know that some of cancer’s most devastating effects are extreme weight loss, debilitating fatigue, pain, and accelerated aging, which is particularly concerning for childhood cancer survivors. Cancer can also affect healthy tissues and organs, allowing tumors to spread to other parts of the body. These whole-body effects of cancer can decrease quality of life, hinder a person from receiving effective treatments, and worsen outcomes for those living with the disease. If we hope to meet the National Cancer Plan goals to develop effective treatments and deliver optimal care, we must identify, understand, and overcome the systemic effects of cancer.

After decades of promoting collaborations and supporting progress in cancer biology research, NCI is poised to unite discrete research areas that contribute to our understanding of the effects of cancer on the entire body. We will continue to build on NCI-led basic science research by supporting teams that look at the systemic effects of cancer from multiple angles. For example, a deeper understanding of how healthy organs in the body interact and how those interactions differ in people with cancer is crucial. This will require the collection, integration, and advanced computational analysis of diverse types of data from specialized fields, as well as animal and engineered-tissue models that better reflect system-wide processes in the human body.

Not everyone who develops cancer will have the same set of symptoms and treatment responses, even those with the same type of cancer and those receiving the same treatments. Understanding these differences will require large studies with highly diverse groups of people and more advanced technologies that can probe for and detect cancer-related signals throughout the body.

The return on investment in this area of research is a clearer picture of how cancer communicates with and affects the entire body. This knowledge is critical to inform proactive, personalized treatment plans that address cancer and cancer-related symptoms and halt the spread of disease to other parts of the body—improving outcomes for all.

Alleviating Financial Toxicity for Cancer Survivors and Caregivers

Financial toxicity—the problems patients and their families experience because of medical expenses—can be a catastrophic effect of cancer for many people. About half of those diagnosed with cancer experience financial hardship, and some even skip their recommended treatments because of high costs. Yet, many questions remain about how to address this problem in a way that meets the unique needs of all people. Finding answers will require sustained support for NCI’s vast research networks combined with community involvement to engage every person. 

NCI has been instrumental in revealing and understanding the effects of financial hardship on cancer survivors and their families. For example, NCI-supported research found that nearly 75% of people with advanced colorectal cancer face financial problems, even if they have health insurance. Another NCI-funded study found that some people with breast cancer are more likely to make surgical decisions based on cost than the physical effects of their treatment options. 

NCI is committed to testing and implementing novel approaches to assess the impacts of public policies on financial hardship and to reduce the risks of financial toxicity. A recent NCI-supported study showed that people undergoing treatment for cancer and their caregivers who participated in a financial navigation program saved thousands of dollars, easing some of the financial burden. More research and engagement efforts are needed, however, to learn from our communities, especially the growing population of young cancer survivors who are at risk of employment disruption and who are more likely to be underinsured.

Imagine having the ability to incorporate effective screening for financial hardship into patient care and connecting cancer survivors and their families to financial resources that have been proven to help based on results from large studies. No family should have to forgo lifesaving interventions or make suboptimal treatment decisions to avoid financial ruin. Delivering optimal care includes preventing and treating cancer in a way that is sustainable for all people, without the burden of financial toxicity. 

Expanding the Utility of Cancer-Targeting Vaccines

Millions of people receive a cancer diagnosis each year, and millions more live with inherited conditions that put them at high risk of developing the disease. Interventions that can enhance a person’s immune response against cancer and decrease the burden of potentially life-altering surgeries or time-consuming, invasive surveillance are crucial. These are the goals of preventive and therapeutic cancer vaccines.

Cancer vaccines rely on a simple idea: By exposing the immune system to molecules found on the surface of cancer cells, the immune system is primed to identify and eliminate cancer.

We have seen that vaccines against cancer-causing viruses like HPV have been successful at preventing some cancers, and now vaccines against cancer itself have shown promise for those with genetic conditions that increase their risk of the disease. Preventive cancer vaccines are already being tested in first-of-their-kind clinical trials for people with an inherited condition called Lynch syndrome, which dramatically increases a person’s risk of developing colorectal and other cancers.

NCI-supported researchers are also designing cutting-edge therapeutic vaccines for those who already have cancer, including mRNA vaccines tailored to target a person’s cancer cells. In early clinical trials, researchers have shown that personalized vaccines—specifically for pancreatic cancer and melanoma—can effectively train the immune system to recognize tumor cells, reducing the risk that the cancer will return after surgery to remove it.

These advances lay the groundwork for additional progress, but more research is needed. For example, identifying molecules unique to cancer cells is critical to ensure that vaccines target cancer cells only. Finding ways to keep a cancer visible to and remembered by the immune system after vaccination is also a high priority for researchers. While mRNA vaccines have changed the speed and personalization of vaccine development, continuing to refine this technology for distribution in under-resourced communities and build upon other vaccination methods remains important.

Reaching these goals will require sustained investments. Researchers need models that accurately reflect the interactions between cancer and immune cells as well as its surrounding tissues; databases that catalog precancer and cancer cell characteristics; and support for multidisciplinary collaborations between experts in cancer biology and immune system function. But most importantly, investments to engage every community in this research are critical. Enrolling robust numbers of diverse participants in clinical trials will ensure that all people benefit from cancer vaccines.

Cancer vaccine research has shown potential for great progress in preventing cancer and developing effective treatments. Cancer vaccines may allow people at high risk of cancer to have a higher quality of life and live cancer free with fewer interventions, and those living with cancer may be able to better use the cancer-fighting power of their own immune systems to help eliminate the disease.