Improved screening, novel therapies and a focus on health equity can reduce cancer mortality by 50% in the next 25 years, but these must be underpinned by an investment in basic, translational and clinical research, along with open data.
In 2016, the Obama Administration in the United States launched the Cancer Moonshot to accelerate progress against cancer. The United States Congress signed into law the 21st Century Cures Act that same year, authorizing US$1.8 billion in funding for the Cancer Moonshot over seven years starting in 2017. Since then, the National Cancer Institute has invested those funds in more than 240 research projects and 70 programs in the cancer research priority areas recommended by an expert advisory Blue Ribbon Panel. Moonshot-supported research has significantly advanced the understanding of cancer and has improved the lives of patients, caregivers, survivors, families and communities afflicted by cancer. Research conducted since 2017 has advanced the field by contributing to the initial Moonshot goals: improving the understanding of cancer; fostering collaboration, data sharing and open access to publications; and addressing cancer disparities.
Credit: Eva Cornejo / Alamy Stock Vector
On 2 February 2022, President Joe Biden announced new efforts to extend the Cancer Moonshot1 to address bold but achievable new goals: to reduce cancer mortality by at least 50% in the next 25 years and improve the experience of people and their families living with and surviving cancer.
The Biden–Harris Administration described the opportunities for cancer research in seven areas (Box 1).
Box 1 Seven priorities for the Cancer Moonshot
Diagnose cancer sooner
Prevent cancer
Address inequities
Target the right treatments to the right patients
Speed progress against the most deadly and rare cancers
Support patients, caregivers and survivors
Learn from all patientsShow more
Disparities in cancer screening
During the COVID-19 pandemic, millions of people missed recommended cancer screenings. Even in the absence of a pandemic, cancer is often diagnosed too late, and many people lack access to existing, proven, effective ways to screen for cancer as the result of a complex constellation of variables at different levels from the individual to society. To successfully achieve a return to pre-pandemic levels of screening will require a multifaceted approach to reach people for whom earlier diagnosis could mean a dramatically improved quality of life.
There are large differences in access to cancer screening and prevention based on gender, race and ethnicity, region and socioeconomic status. Meaningful progress against cancer for all will mean addressing these disparities and the underlying factors that contribute to them. Several ongoing Cancer Moonshot studies are evaluating approaches to improve the uptake of proven cancer screening modalities where they are underutilized, including telehealth and direct community engagement.
Research to improve screening includes the American Indian Colorectal Cancer Screening Consortium, which has implemented a patient navigation program using community, clinician and patient input2; the Accelerated Control of Cervical Cancer program, where a deep learning algorithm was employed to analyze cervix images captured using smartphones, providing a low-cost, practical way to screen for cervical cancer, especially in low-resource settings3; and a trial assessing single-dose efficacy of the HPV vaccine to prevent cervical cancer4.
Lack of health insurance is a known barrier to cancer screening that Moonshot researchers are addressing through technological solutions. Under the Implementation Science Centers in Cancer Control Program (ICS3), researchers developed an insurance support tool integrated into electronic health records to help community health center staff guide patients in enrolling for health insurance. Findings suggested that the tool can help increase cancer screenings and preventive care5. In another study, researchers found that implementing a rideshare transportation intervention after colonoscopy may improve colonoscopy completion rates6. The model, if successful, could be applied broadly to improve colorectal cancer screening rates in safety-net health systems (where care and resources are provided to uninsured, Medicaid and other vulnerable patients) and settings where procedural sedation is administered.
Screening is especially important for people known to be at greater risk for cancer because of inherited syndromes. As part of the Moonshot, researchers are developing a strategy for detecting hereditary breast and ovarian cancer and Lynch syndromes in broader populations. Those found to have these syndromes will be included in the study, and their relatives will be enrolled in cascade screening. Findings will have important implications for determining how best to screen and monitor these patients over time.
Refractory cancers
Progress against different types of cancer has been made at different rates. There has been much progress in lung cancer, melanoma and childhood leukemias, but much less for the most refractory cancers, such as pancreatic cancer and solid tumors in children. Cancer Moonshot programs have led to progress in some of the deadliest and rarest cancers, including childhood cancers.
The Fusion Oncoproteins in Childhood Cancers (FusOnC2) Consortium, a diverse group of experts in cancer biology, proteomics, genomics, computational biology and pharmacology, discovered a previously unknown function in the EWS/FLI fusion protein that drives Ewing sarcoma, a rare cancer that occurs in bones or soft tissue around the bones, that may lead to novel therapies7. Another group identified TRIM8 as a regulator of EWS/FLI stability, which may provide new therapeutic targets8. A new genetic model of Ewing sarcoma in zebrafish helped define the role of the extracellular matrix in the growth of these tumors, which could also lead to novel therapies9.
Read More: https://www.nature.com/articles/s41591-022-01881-5