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139th National Cancer Advisory Board

(Byers et al., Cancer 2006;107(2):396-405). Additionally, the projected decrease in breast, male lung, and colon cancers is tracking at 50 percent. Prevention and early detection are more important than treatment in these successes, and more can be achieved by increased participation. Collaboration and synchronization with stakeholders (e.g., other Cancer Centers, state care providers, professional organizations, pharmaceutical and biotechnology companies, patient advocacy groups, and government agencies) remains important. This exercise has succeeded in energizing the directors of NCI-designated Cancer Centers to collaborate in research and dissemination of best practices, and to advocate aggressively for increased public awareness and governmental funding.

Regarding prevention, there is a need for uniform dissemination and an educated and motivated public. Because cancer is a disease that starts as a premalignant clone of cells and progresses, early interventions should be effective. In addition, endorsement of the recommendations of the National Cancer Policy Board should be a priority. Immediate strategies address the importance of acting on risk factors that reflect lifestyle (e.g., tobacco use, obesity, physical inactivity, and diet), as well as intervention by health care providers (e.g., colonoscopy, mammography, PSA, Pap smear, vaccination, chemoprevention, and smoking abatement). Approaches to the long-term resolution include: clinical trials to discover molecular targets for early detection of high-risk and precancerous lesions and identification of targets for chemopreventive therapy; chemoprevention clinical trials (i.e., risk-based interventions); clinical research in behavioral sciences; and the need for databases and powerful informatics to establish risk profiles for individuals and for high-risk populations. Other issues to take into consideration with prevention are the length and cost of clinical studies, the epidemic of childhood obesity, disparities in provision of and payment for health care, and the thought that scientific knowledge does not guarantee clinical implementation.

Cancer clearly is more curable when it is detected early. Research results will come in faster if the focus is on high-risk populations: cancer survivors, genetic predisposition, environmental exposure, and family history. The technology involved in early detection includes genomics, proteomics, and immunohistochemistry; X-ray and MRI imaging; molecular imaging; and informatics and computational biology. Immediate strategies involve partnering with: (1) government agencies and providers to expand the clinical use of validated screening methods; (2) advocacy groups to pursue payment from Centers for Medicare and Medicaid Services (CMS), insurance, and health plans; (3) state public health departments and health care providers to disseminate information on health benefits and on points of access; and (4) other Cancer Centers to share tissue resources and advance technology platforms. The report identifies several long-term strategies, including collaboration in large-scale clinical trials to discover and validate biomarkers and the application of new technologies in genomics, proteomics, immunohistochemistry, and molecular imaging. It also is important to continue fundamental, basic research on genetic and molecular abnormalities in cancer. Finally, it was recommended that, through the NCI and governmental agencies, a standardized electronic database of medical and scientific information and patient medical records be created.

Systemic treatment is contributing significantly to the decrease in the mortality rate in breast cancer and probably in other common solid tumors. Recent advances in targeted therapy are not yet reflected in encouraging mortality statistics. There is an urgency to make progress in cancers refractory to current therapeutic approaches, but obstacles to collaboration and coordination must be overcome. One of the immediate strategies to address treatment in the short term is to work with the NCI as Cancer Center directors to activate the Clinical Trials Working Group (CTWG)’s recommendations to improve NCI’s role in supporting innovative clinical research. Additionally, top priority should be placed on training, recruiting, and supporting clinical investigators, and redundancy in clinical research should be reduced by a more effective sharing of services, technologies, and tissue specimens. Further collaboration between government agencies, industry, and Cancer Centers across the spectrum of clinical

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