Reaching cancer 'Moonshot' goals would be a giant leap for mankind
President Biden’s move to relaunch the White House’s Cancer Moonshot initiative is an important reminder that while we continue to lower cancer incidence and mortality rates, the nation’s cancer health care and research infrastructure still needs to make substantial inroads in eliminating racial and ethnic disparities.
Those disparities occur due to inadequate access to quality care, including cancer screening and clinical trials, as well as our lack of understanding of genetic and lifestyle factors that contribute to these clinical differences.
The original Moonshot dates to 2017, when the Obama administration and Congress agreed to spend an additional $1.8 billion to fund cancer research over seven years. Through 2020, the National Cancer Institute had invested $1.2 billion of that on 240 research projects, leaving $600 million earmarked through 2023.
The reignited Cancer Moonshot, noted in Biden’s State of the Union speech recently, aims to halve the cancer mortality rate in the next 25 years. If reached, nearly 300,000 American lives would be saved annually, allowing for greater focus on the Moonshot’s second major goal — improving quality of life for the millions who are surviving cancer. Doing so would end cancer as we know it today.
These new goals rolled out by the Biden administration in last few weeks are laudable. But there is much work to be done, including more funding over time.
Improving outreach and education are vital to involving minority and underserved populations in cancer prevention programs and early detection through various screening modalities. Providers like Northwell Health have been aggressive in publicizing the importance of preventive care like mammograms and colonoscopies at houses of worship, community centers, and through public events and awareness campaigns. We must work tirelessly to engage and connect with our neighbors.
A related challenge is diversifying clinical trial participants. It is well-established that enrollment in clinical trials improves outcomes. Researchers develop clinical standards of care, based on clinical trial results, derived largely from European American subjects, skewing results based solely on the distinct genetic and lifestyle factors characteristic of this population.
Major hurdles to such participation include lack of awareness, socioeconomic factors, communication issues and mistrust. We must engage with our community partners to educate minority and underserved populations about the benefits of cancer clinical trials — using the languages in which these individuals are most fluent.
More effective messaging could save thousands of lives annually, because in cancer, racial diversity is also genetic diversity. We now know that combinations of surgeries, drugs, and radiation treatments that work well for one racial group, might fail for others.
Notably, the Cancer Moonshot has catalyzed greater inter-institutional and transdisciplinary scientific collaboration. At Northwell, we’ve partnered with Cold Spring Harbor Laboratory to study the genetic drivers of certain cancers (such as breast, prostate, and colorectal cancers) that have a higher incidence and/or worse outcome in African Americans compared to European Americans. That will allow development of novel prevention and treatment strategies to reduce these disparities.
The Cancer Moonshot program should be commended for investing in, and shining a spotlight on reducing the cancer burden. National Cancer Institute director Dr. Norman Sharpless told the 2021 American Association for Cancer Research Annual Meeting, "The President did not say he wanted to end cancer as we know it for some people. The goal is to make this progress for all people, regardless of race, ethnicity, wealth, or access."
It’s time to roll up our sleeves.
This guest essay reflects the views of Richard Barakat, physician-in-chief and director of the Northwell Health Cancer Institute.