Stopping Cancer Before It Starts, A Hill Briefing for Congressional Staffers

On April 5 Friends of Cancer Research hosted a town hall style meeting on cancer prevention and early detection for congressional staffers entitled “Stopping Cancer Before It Starts: Issues on Cancer Prevention for Policy Makers.” Conducted in partnership with the American Association for Cancer Research (AACR), the event was held in the Rayburn House Office Building and drew over 70 people.  The discussion panel featured Anna Barker, Ph.D. (NCI), Gary Gordon, M.D. Ph.D. (Abbott Labs), Amy Muhlberg, Ph.D. (Senate HELP committee), Bill Nelson, M.D., Ph.D. (Sidney Kimmel Cancer Center at Johns Hopkins), Tom Sellers, Ph.D. (H. Lee Moffitt Cancer Center and Research Institute), and was moderated by Susan Dentzer of the NewsHour with Jim Lehrer.  [Click for full article.]

The discussion began with Dr. Sellers providing scientific background on the topic, explaining that “cancer” is actually many different diseases that begins with genetic mutations and progresses for years before it is actually detected.  If the genetic changes are detected early enough, there is more time on the ‘front end’ to intervene and halt the disease process before it turns into a full blown and fast growing tumor.  Thanks in large part to recent advancements in biomedical research, the opportunities to use cutting edge science to detect and target cancer treatments at the early stages of the disease process are expanding rapidly. One promising technology is the use of biomarkers, which are detectable biological signals that can indicate the existence of conditions such as cancer.  Dr. Barker stated that biomarkers are the future of early detection and subsequent treatment, much like high blood pressure or high cholesterol can indicate increased risk for heart disease.  She predicted that over time an incredible array of biomarkers for different diseases could eventually be discovered. 

Dr. Gordon and Dr. Nelson described what new opportunities in biomarker research currently are being  pursued both by private companies and academic institutions around the country.  

Dr. Muhlberg offered insight as to how the use of biomarkers could revolutionize the FDA. Not only would biomarkers provide new targets for treatment, she explained, but they would identify people who are at greater risk for being afflicted by cancer and at higher risk for potential side effects from various treatment options. 

From biomarkers, the conversation lead to a discussion about chemoprevention. Susan Dentzer pointed out that this term was not chemotherapy, which is often used as treatment for already diagnosed cancer, but rather a treatment used preemptively before the cancer develops. 

Dr. Gordon articulated that the development of such treatments is difficult due to current patent laws surrounding drug development.  Because it is so expensive and takes so many years for companies to successfully develop new drugs, it is difficult to attract a sufficient level of  business capital for the research and development of preventive agents.  The current economic model for drug development would make it very difficult to ever make even a modest return on the investment.   

Dr. Barker pointed out that preventative drugs are still being developed and tested due to their potential benefit to millions of people.  She pointed to a recent study in which Celebrex prevented the redevelopment of colon polyps (a biomarker, which is a precursor for colon cancer) by nearly 45% as compared to patients who did not receive treatment.  This study addressed the previous concerns with Celebrex regarding cardiovascular risks.  It found that while patients who were determined to be at high risk for the development of heart disease showed an increase of cardiovascular related side effects, those patients at low risk for heart disease showed no increase of cardiovascular events associated with Celebrex treatment. 

The discussion over Celebrex sparked a discussion amongst the panelists about the importance of risk versus benefit assessment when treating diseases like cancer.  Dr. Muhlberg described how the FDA would face these challenges, specifically addressing the idea being proposed by some that the FDA add an office devoted solely to drug safety.  She felt that patients would be better served if both the risks associated with prescription drugs and the benefits they generate continued to be assessed together.  Dr. Nelson agreed that this is an important consideration as new preventative treatments emerge, such as a vaccine to the human papillonavirus (HPV), which is the primary cause for cervical cancer.  Several panelists reiterated that all drugs have risks and benefits.  If the balance between the two tips too far, too few products will get out into the market – and this could include products that the public wants and needs, like drugs that prevent cancer.  Panelists agreed that the implementation of the FDA’s Critical Path initiative would bring much needed enhancements to the agency across a number of areas including the assessment of risks and benefits.

In addition to discussing new emerging technologies and treatments, panelists also discussed barriers to continued advancements in the fields of chemoprevention and early detection.  Dr. Sellers explained that the reductions in federal funds for research was discouraging young and emerging scientists.  This situation could lead to the loss of a new generation of innovative researchers, which are often the ones who push the envelope of scientific advancement.  Dr. Barker depicted another barrier -- the flow of information.  As she explained, the National Cancer Institute is “receiving a tsunami of new information…the challenge will be processing such information into knowledge quickly.”  She went on to describe that without a renewed focus on energizing and resourcing the FDA, it will have little choice but to continue using increasingly outdated tools for assessing cutting edge treatments. 

Moderator Susan Dentzer explained that institutions like NCI, and the broader public/private research community, face an enormous challenge in managing the sheer volume of information that is going to be flowing in the years ahead.  Funding is needed not only for research, but to manage the research findings.  We must find answers to how the new information is going to be assembled, shared, and disseminated amongst those who can exploit it and turn it into further breakthroughs that translate directly to patients.  Such comments sparked questions from the audience about the public’s perception about the current funding levels for cancer research, particularly in light of the administration’s budget proposal to reduce federal funding for cancer research and programs by $40 million in 2007.  Dr. Muhlberg pointed out that the budget for fiscal year 2007 was far from finalized and that many lawmakers are aware of the important need to keep the current research progression moving forward.

As Susan Dentzer concluded, the potential benefits of curbing disease and mortality are enormous – not just for individuals, but for the economy, leaving little reason not to move forward as fast as possible.