The National Cancer Act at 42: Reversing a Deadly Trend

By 1971, scientists had developed vaccines for measles and mumps and doctors had successfully transplanted lungs, hearts, kidneys and livers. But they hadn’t beaten cancer. Not even close. At the time, the chances of dying from cancer were rising – rapidly. The cancer death rate in the United States had climbed to 199 out of every 100,000 people in 1971, from 79 out of 100,000 in 1900.

“The act would quintuple the budget of the NCI by the end of the decade and provide the fuel for the revolution in molecular biology,” according to Vincent DeVita, M.D., American Cancer Society volunteer president. The National Cancer Act poured immense scientific energy into figuring out the inner workings of the cell, an area that previously had not received a lot of attention from cancer researchers.

The intense investment in basic science – understanding how both healthy and cancerous cells work – led to a fundamental shift in research to cure cancer. Scientists went from testing a variety of natural products to see if they could kill cancer cells to designing drugs to specifically block these cells from growing and spreading.

Major Strides Made Over Past 42 Years

With the scientific advancements that the NCA enabled, researchers began to tinker with what are now known as targeted therapies – drugs that target, or interfere with, specific molecules that play a role in tumor growth and progression. The first targeted cancer drug the FDA approved was rituximab (Rituxan), in 1997. Since that time, numerous such drugs have entered the market.

From the late 1970s to the end of the 20th century, scientists also made major improvements in areas of cancer prevention, diagnosis and treatment, including:

• developing screening tests for more types of cancers;
• creating better surgical and radiation techniques to more successfully and safely treat tumors;
• inventing new and more effective chemotherapy drugs;
• identifying more cancer risks – such as sun exposure, benzene, asbestos, and obesity.

These advancements – combined with major public awareness efforts including significant anti-smoking campaigns – began to reverse the trend of increasing cancer death rates in the U.S., with a decline occurring for the first time in 1992. And, this trend continues today. Cancer death rates decreased on average 1.8% per year among men and 1.4% per year among women from 2001 through 2010, according to the 2014 Annual Report to the Nation, produced by the American Cancer Society and other organizations.

The past 42 years of cancer research have also led to an explosion in new areas of opportunity for cancer treatment and prevention. “We can ask questions today that we couldn’t ask before,” says Michael Melner, Ph.D., Director of the Molecular Genetics and Biochemistry of Cancer extramural research program at the American Cancer Society.

Melner notes that in 1971, researchers didn’t even know how many genes there were in the human body or the sequence of the DNA that makes up genes. Now, scientists more clearly understand the answer to both, which is essential to figuring out cancer. Cancer can occur when there are mutations – or defects – in a gene; thus, knowing more about human genes means researchers can start to know more about all the ways in which they may mutate – and cause cancer.

The Future: Personalized Cancer Therapy, Immunotherapy, and So Much More

This enhanced knowledge of human cells and their genes is part of the reason 2 of today’s most promising emerging cancer treatments came about – personalized cancer therapy and immunotherapy.

Personalized cancer therapy is all about each individual’s genetic makeup. Increasingly, researchers can take a sample of a person’s tumor and test it to see which genetic defects are present, with the goal of helping to determine how to treat the cancer. And, scientists are working on making this type of testing and treatment easier, faster, and useful against more types of cancer.

For example, American Cancer Society-funded grantee Ross Cagan, Ph.D., director of the Center for Personalized Cancer Therapeutics at the Mount Sinai Hospital System Tisch Center Cancer Institute, is developing a way to quickly and correctly test which drugs will work best on a particular person’s cancer. Cagan takes tumor tissue from a patient and looks at all of the genes to find the mutations. He recreates the same mutations in fruit flies and tests different cancer drugs on the flies. When he finds a drug that works, he shares that information with his oncology colleagues at Mount Sinai, who may be able to use it to help treat the patient.

This model, which is still experimental, takes the trial and error out of testing many drugs on a human patient. Cagan is just one of many scientists finding success in looking for ways to use a person’s unique genetic data to treat his or her cancer.

Cancer immunotherapy, which Science Magazine just named the “2013 breakthrough of the year,” is a way to get the body’s own immune system to attack cancer. For the most part, the body’s immune system ignores cancer cells because they are similar to normal cells – and the immune system is built mainly to recognize and get rid of foreign elements, like viruses and bacteria. Immunotherapies help the immune system recognize and learn to attack cancer cells. But as Science Magazine notes: “There’s still a long way to go: Immunotherapies have only worked for a subset of those who’ve been treated, and they have only been tested in some types of cancer.” More research still needs to be done.

Other developing areas of cancer research include:

• investigating the role gut bacteria play in preventing – and fighting – some forms of cancer;
• creating drugs that get cancer cells to self-destruct;
• understanding better the connections between diet and exercise and cancer;
• addressing health disparities, such as the socioeconomic imbalance in certain cancer incidence and survival rates;
• uncovering better ways to manage the physical and emotional pain cancer patients deal with during and after treatment.

Curing Cancer Not as Simple as Putting a Man on the Moon

Both personalized cancer therapy and immunotherapy are made possible by advancements in science and in technology. For example, improvements in both the time it takes and the money it costs to sequence human genomes (the entire sequence of human DNA) have been necessary to allow for the type of work researchers like Cagan are doing.

Even as technology evolves, the work being done to understand the science of cancer continues. When Nixon signed the 1971 NCA into law 42 years ago, many scientists worried that the massive investment was sort of like putting the cart before the horse – a war to stop cancer before even knowing how to attack it. One well-known cancer scientist stated: "An all-out effort at this time would be like trying to land a man on the moon without knowing Newton’s laws of gravity."

Despite such reservations, the Act passed and has enabled significant investment in the types of foundational research that scientists knew was necessary. Indeed, because of this research, “we know today that cancer encompasses hundreds of diseases, so the “war” is now in fact being waged against hundreds of distinct enemies,” says William Phelps, Ph.D., director of the preclinical and translational cancer research grants program at the American Cancer Society. The Act “fueled the entire spectrum of research: social, clinical, and basic,” notes Otis Brawley, M.D., American Cancer Society chief medical officer – “giving scientists today a better understanding of what cancer is, what goes wrong in the cell to make it become cancerous and what causes cancer.”