Former NCI director: Obesity-related cancers, ‘pandemic hangover’ are major challenges
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SAN FRANCISCO — The newly reignited Cancer Moonshot is centered on the goal to reduce cancer deaths by 50% over the next 25 years.
The oncology community must overcome several formidable challenges if that objective will be met, according to former NCI director Norman E. "Ned" Sharpless, MD.
“Cancer mortality is declining everywhere in the United States in a fairly robust way over the past 3 decades, on the order of a 1.5% decline per year,” Sharpless said during a keynote address at ASCO Genitourinary Cancers Symposium. “That’s about a 30% decline over the last 25 years. That is pretty good ... but if you want to [achieve] the president’s goal of 50% over the next 25 years, that’s really hard.”
During his address, Sharpless identified several major hurdles that the oncology community will face as it strives to accelerate the reduction in cancer mortality over the next quarter-century.
‘Pandemic hangover’
The American Cancer Society issues an annual report that highlights trends in cancer incidence and mortality.
The most recent report — released in January — showed a 33% reduction in cancer mortality in the United States since 1991.
However, the data used in these reports typically is about 2.5 years old.
That means the effects of the COVID-19 pandemic are only beginning to reveal themselves, Sharpless said.
He cited the estimated 1.5% decline in cancer mortality in 2020 compared with 2019.
“The last several years, [the annual decline] had been over 2% — somewhere in the range of 2.2% to 2.3% — so 1.5% is not good relative to the last few years,” said Sharpless, professor of medicine, cancer policy and innovation at UNC School of Medicine and member of UNC Lineberger Comprehensive Cancer Center. “I’m worried that is the beginning of the so-called ‘pandemic hangover.’”
During the first year of the pandemic, cancer screenings declined sharply and many individuals postponed medical appointments. Evidence already suggests rising rates of late-stage cancer diagnoses, leading to widespread concern about the impact that will have on outcomes.
“We’re just starting to see 2020’s effect now. I’ll be looking for even worse [figures] next year and the year after,” Sharpless said. “We estimate that the hangover could last as long as a decade, but the main effect could be 3 years or so. That could drive down our progress in cancer mortality for the next few years.”
Obesity-related cancers
Sharpless cited statistics that show sharp declines in age-adjusted cancer mortality between 1994 and 2019.
The figures showed notable reductions in per 100,000 people in lung cancer (58.6 vs. 33.2), female breast cancer (30.9 vs. 19.5) and prostate cancer (38.8 vs. 18.6).
However, age-adjusted mortality rates for several obesity-related cancers increased during the same period. These included pancreatic cancer (10.6 vs. 11.1), liver cancer (4.2 vs. 6.7) and uterus cancer (4.2 vs. 5.1).
“The obesity epidemic in the United States is something we’re really going to have to deal with if we want to meet the president’s goal [of] ending cancer as we know it,” Sharpless said. “We’ll have to make progress in cancers like pancreatic cancer, where there hasn’t been a lot of progress.”
‘A real Moonshot’
During a Cancer Moonshot relaunch event in February 2022, President Joe Biden touted the effort as a new “national purpose.”
That statement — along with a commitment to expand cancer research and provide necessary funding — is reassuring, Sharpless said.
NCI appropriations have increased over the past 7 fiscal years, climbing from $4.95 billion during the 2015 fiscal year to $6.91 billion during the 2022 fiscal year. The 2023 fiscal year is estimated to be at $7.3 billion.
The first Cancer Moonshot provided $1.8 billion over 7 years through the 21st Century Cures Act, set to expire this year.
The next cash infusion to accelerate cancer research must be significantly larger to address issues like low pay lines and spiraling research costs, Sharpless said.
“The first Moonshot really wasn’t transformative in terms of funding with $1.8 billion over 7 years. That’s a low-Earth orbit. That is not a real Moonshot,” Sharpless said. “The first Moonshot was a laudable, great thing that I think did some really important stuff, but it was under-resourced for the goal at hand.
“The next Moonshot needs to acknowledge that cancer is a very expensive and difficult problem, and we’re not going to solve it on the cheap,” Sharpless added. “We’re hoping to see billions of dollars over the next 7 to 10 years for cancer research. That would be a real Moonshot in my opinion.”