he ultimate goal of the National Cancer Institute (NCI) is to prevent or cure cancer. As we approach the 21st century, we have cause for celebration tempered by the knowledge that we still have much to do to achieve our goal. We celebrate a long-awaited turning point, the drop in the cancer death rate between 1991 and 1995, the first sustained drop of its kind since national record keeping was instituted in the 1930s. However, though our knowledge of cancer is ever increasing, we still do not fully understand the cause of cancer - an understanding that is the keystone of further progress. It is at this critical juncture of increasing knowledge and decreasing mortality that we must press forward with tremendous energy and increased resources to continue the NCI's vital and lifesaving work.

In order to achieve our goal, NCI envisions a three-pronged approach:
  1. Sustain at full measure the proven research programs that have enabled us to come this far.
  2. Seize extraordinary opportunities to further progress made possible by our previous research discoveries.
  3. Create and sustain mechanisms that will enable us to rapidly translate our findings from the laboratory into practical applications that will benefit everyone.

Sustain at full measure the proven research programs that have enabled us to come this far.

The heart of NCI's research efforts rest in its Infrastructure for Discovery. This is the underpinning for activities that encompass all aspects of cancer prevention, diagnosis, treatment, and control. Each year, the efforts of thousands of scientists in the extramural and intramural communities yield scientific advances in cancer biology, risk, interventions, and control (see Highlights of Progress). Our infrastructure supports basic, translational, and clinical cancer research, as well as investment in new research programs to address the needs of cancer patients and survivors, cancer centers, community-based clinical oncology programs and specialized programs of research excellence, training and education opportunities, and communicating research results to our constituents.

Seize extraordinary opportunities to further progress brought about by our previous successes.

In 1996, NCI began a process of looking critically at the field of cancer research and identifying areas of discovery with exceptional promise for achieving pivotal advances both in our knowledge of cancer and in benefits for patients and those at risk for cancer. We identified four Extraordinary Opportunities as being ripe for investment.

Cancer Genetics

Identify every major human gene predisposing to cancer; use the knowledge we gain as we identify these genes to help patients at risk; and deal with the psychosocial, ethical, and legal issues associated with inherited cancer susceptibility.

Preclinical Models of Cancer

Create animal models of human cancers; build the experimental foundation to use these models effectively; and develop the infrastructure and procedures needed to make these models available to all researchers.

Imaging Technologies

Discover and develop techniques that will further increase the precision, accuracy, and scope of imaging diagnosis; and integrate imaging further into the practice of clinical oncology.

Defining the Signatures of Cancer Cells: Detection and Diagnosis

Develop new methods for detecting tumors at their earliest stages, when the number of tumor cells is small and the chance for cure or control is greatest; establish methods for detecting changes in cells that accompany and determine the development of cancer to enable the generation of new prevention strategies and tools. Create a new approach to accurate diagnosis that will allow us to tailor therapy to each distinct cancer and target a new generation of therapeutics to the particular changes that occur in the development of each cancer.

Create and sustain mechanisms that will enable us to rapidly translate our findings from the laboratory into practical applications that will benefit everyone.

How will we convert our knowledge of cancer into advances in prevention and care on the scale that is needed to conquer cancer? To meet this challenge, we must have a research base that can bring the best of our developing knowledgeable - the best ideas, technologies, and people - to the problems of cancer prevention and care. Response to this challenge requires increased investment in seven key areas:

National Clinical Trials Program

We need to create a clinical trials program that can test the most new ideas about prevention, detection and treatment of cancer in the shortest possible time. We need to ensure that all people who wish to participate in a clinical trial are able to do so.

Investigator-Initiated Research

We need to fund the top 40 percent of research grants to ensure that excellent ideas have the chance to be tested, whether they are in basic, clinical, or population research, or the translational research that links them. We need to ensure that new investigators are attracted to cancer research.

Support for Clinical Investigators

We must create and maintain an environment that supports and encourages health care professionals who are involved in clinical research.

Cancer Centers: Restructuring and Expansion

The Cancer Centers program should grow over the next few years to include about 75 institutions and broaden its scope to include smaller organizational units that can respond efficiently to highly specialized areas of opportunity, and perform the translational research so critical to move from laboratory insights to clinical testing.

Informatics and Information Flow

We must develop a Cancer Informatics Infrastructure that will lower the barriers for patients, families, at-risk individuals, and physicians to learn about available clinical trials, and to create an infrastructure that facilitates information exchange among researchers, clinicians, and the public.

Studying Emerging Trends in Cancer

We must ensure that the Surveillance, Epidemiology, and End Results (SEER) database not only tracks accurately changes in cancer incidence and survival, but also contains information that will enable researchers to generate hypotheses and answer questions about the basis of observed changes in trends over time.

Training and Education

We must take steps now to ensure that some of the brightest, most creative young people from every segment of the American population enter the cancer research field. We must convince some of them that the field of translational research offers tremendous challenges and rewards.

In summary, because such a large commitment cannot be made without a full understanding of the infrastructure, programs, and research to be supported, the National Cancer Institute has prepared this document to provide a concise yet comprehensive view of NCI's Research Programs and Infrastructure for Discovery, our investment plan for Extraordinary Research Opportunities, and our plan to meet the future challenge of bringing discoveries to practical application for the benefit of people. The cancer research enterprise involves not only futuristic research but also exciting efforts that will soon yield results, as discussed in the "Immediate Opportunity" and "On the Cutting Edge" boxes throughout the document. Finally, "People's Stories" throughout the document remind us that the research we support, whether it yields outcomes immediately or in the future, is conducted with a single purpose: to help people with cancer, or who are at risk for cancer, and to remove the shadow of cancer from the lives of all Americans.

In order for the National Cancer Institute to sustain our current research investment, identify and invest in new research opportunities, and anticipate our future challenges and invest in them now, we request the following funding.


  1999 BYPASS BUDGET REQUEST

  1. Sustaining ongoing research programs:
    TOTAL: $2.58 billion


  2. Seizing extraordinary opportunities for further progress brought about by our previous successes:
    Cancer Genetics: $53.7 million
    Preclinical Models of Cancer: $29.3 million
    Imaging Technologies: $39.0 million
    Defining the Signatures of Cancer Cells: $63.5 million
    TOTAL: $185.5 million

  3. Creating and sustaining mechanisms that will enable us to rapidly translate our findings from the laboratory into practical applications:
    National Clinical Trials Program: $170.0 million
    Investigator-Initiated Research: $40.4 million
    Support for Clinical Investigators: $66.0 million
    Cancer Centers - Restructuring and Expansion: $70.0 million
    Informatics and Information Flow: $20.0 million
    Studying Emerging Trends in Cancer: $25.0 million
    Training and Education: $34.1 million
    TOTAL: $425.5 million

    GRAND TOTAL: $3.191 billion

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Cancer Research Investment | Infrastructure for Discovery | Extraordinary Opportunities
NCI's Challenge | Budget | Acknowledgements | People's Stories