Keynote speech: Progress with a purpose

Authors

  • Andrew C. von Eschenbach M.D.

    Corresponding author
    1. National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
    • National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Building 31, Room 10A19, 31 Center Drive, MSC 258, Bethesda, MD 20892-2590
    Search for more papers by this author
    • Fax: (301) 496-0846


  • Presented at Asian American Network for Cancer Awareness, Research, and Training (AANCART): Fifth Asian American Cancer Control Academy, Sacramento, California, October 22, 2004.

Abstract

The U.S. invigorated a campaign against cancer when the National Cancer Act of 1971 was signed into law. At that time, the nation pledged as a country to make the conquest of cancer a national cause. Much progress has been made in the more than 30 years since the National Cancer Act, and researchers have much work to do. To achieve the goal of eliminating suffering and death due to cancer, clinicians must define an integrated strategy of multiple interventions along the pathways that are capable of preventing, detecting, eliminating, and controlling cancers.

The United States invigorated a campaign against cancer when the National Cancer Act of 1971 was signed into law. We pledged as a country to make the conquest of cancer a national cause. Over the last three decades, the National Cancer Institute [NCI] has used its authorities and appropriations to foster an investment in cancer research that has seen a steady increase in research breakthroughs that have contributed to an increasing number of cancer patients surviving the disease–10 million today versus less than 3 million 3 decades ago.

I believe that the progress has been so great that today it is within our grasp to eliminate suffering and death due to cancer by the year 2015. As we approach cancer as a disease process, we can prevent more cancers, detect them early enough to easily and safely eliminate them, or control cancers such that some individuals will die with cancer but no one will ever die from cancer. We have much work to do before then; just in the year 2004 alone, more than 563,700 people were projected to die from cancer and 1.3 million new cases of cancer were projected to be diagnosed.

The promise of cancer research is now defined by our ability to investigate cancer at the genetic, cellular, and molecular levels. Through 3 decades of basic scientific discovery, we have been unraveling the genetic, molecular, and cellular mysteries about cancer. We know that cancer is not just one disease but an expression of multiple and unique aberrations of the normal life processes of growth, differentiation, and cell death. We also know that the processes that are involved, from normal to malignant to metastatic, define pathways of vulnerability enabling the design of interventions to preempt cancer's progression. To achieve our goal to eliminate suffering and death due to cancer, we must define an integrated strategy of multiple interventions along the pathways, that are capable of preventing, detecting, eliminating, and controlling cancers.

The commitment to our 2015 challenge goal is not just for some Americans or for certain types of cancers, such as breast and prostate cancers. We will eliminate the suffering and death due to all cancers for all Americans. Unfortunately, there are persistent gaps in cancer incidence and mortality that are defined by race and ethnicity, and Asian Americans face a heavy cancer burden in some areas. For example, lung cancer rates among Southeast Asians are 18% higher than for white Americans. In addition, cervical cancer rates are five times higher for Asian American women than white women and, overall, cancer has been the number-one killer of Asian-American women since 1980. Vietnamese men also have the highest liver cancer rates in this country for all racial and ethnic population groups. Different expressions of cancer may require different interventions. For example, new research findings on Asian-American dietary habits have provided the impetus for a campaign designed specifically for Asian Americans to encourage them to eat at least five servings of fruits and vegetables a day.

There are signs of progress. Asian Americans are experiencing the most rapid decreases in overall cancer incidence and mortality rates among the major ethnic groups. Still, there is more to accomplish and the members of the Asian American Network for Cancer Awareness, Research, and Training (AANCART) Academy are admirably prepared to take on the challenge. AANCART is one of 18 Special Populations Networks formed by the NCI to monitor cancer control in various underserved communities. As the first-ever national cancer awareness, research, and training infrastructure for Asian Americans, AANCART is uniquely qualified to address the cancer concerns of this community.

In many respects, the way in which AANCART has approached its work reflects two major shifts we must make in our thinking about cancer as we move toward 2015.

Our cancer centers have played a major role in advancing the cancer fight, from research to drug development to treatment. Since the establishment of the NCI-designated cancer centers in the early 1970s, the national cancer program has been enormously successful at ensuring that cancer progress is realized at the community level. However, with continued leadership from the cancer centers, it is the growing role of community oncologists–along with outreach and education programs–that will help us become even more effective in reaching all Americans with the information and interventions they need.

We must increase our emphasis on cancer prevention. Although exciting new therapies show promise in treating cancers and prolonging life, the best approach for long-term progress against cancer is in the area of mechanism-based prevention and the early detection of cancer, which is also a proven cost-effective strategy. Our focus must always be on doing all we can to predict and prevent cancer from occurring in the first place.

AANCART is striving to achieve both of these goals: more integration of progress at the community level and a greater emphasis on prevention. The response of the Asian-American community to the threat of cancer and the success of the recent AANCART Academy are to be commended. AANCART is an important example of how we all must work together to eliminate suffering and death due to cancer. Collaboration is the only way we will reach our goal.

Ancillary