Since the establishment of the Division of Cancer Control and Population Sciences (DCCPS) 20 years ago, the scientific experts in the division have been working closely with our funded investigators to make significant strides in advancing cancer control and population sciences research. In particular, molecular epidemiology, survivorship, health disparities, and outcomes research are among the fields that have shown remarkable progress as a result of NCI’s support for the population sciences. Many of our signature programs have been expanded substantially, including the Surveillance, Epidemiology, and End Results (SEER) Program, which initially covered 13% of the US population and now gathers data on approximately 28% of the population; with the current recompetition, we are aiming to increase that percentage even further. Our interagency and public-private partnerships now number in the dozens, and we have led advances in transdisciplinary science through initiatives such as the Transdisciplinary Tobacco Use Research Centers (TTURC), the Centers of Excellence in Cancer Communication Research (CECCR), the Transdisciplinary Research in Energetics and Cancer (TREC) centers, and the Centers for Population Health and Health Disparities (CPHHD). The division has also been infused with a greater diversity in research disciplines, complementing our public health and behavioral scientists with physicians, nurses, geographers, pharmacologists, geneticists, and informaticists.
As stewards of the trust and investment given to us, we’ve relied on continuous input from our extramural community. Key reports, such as National Academy of Medicine reports, the recent Blue Ribbon Panel Report, President’s Cancer Panel reports, NCI strategic plans, and a 2016 report to the NCI Board of Scientific Advisors on tobacco control research priorities, have all provided direction. We have also proactively engaged our research community by convening working groups and through a number of webinars and workshops.
Most recently, we have completed efforts to revitalize and reposition DCCPS for continued success in the coming decade. We have built a structure and appointed program leadership to better enable us to answer pivotal questions shaping our nation’s cancer control strategy. Going forward, we can now focus on responding to current and emerging challenges. Some of these challenges include the impact of changes in health care; establishing validity of new omics technologies; understanding the mechanisms through which obesity, nutrition, and physical activity influence cancer risk and prognosis; enhancing treatment data in SEER; reducing tobacco use in low-income populations; and addressing disparities in cancer control in rural areas of the United States.
Based on the expert advice we have received, we have identified those research priorities on which we will dedicate our most immediate, robust efforts. In this edition of our annual Overview and Highlights, we briefly describe those priorities and how we believe we can make the greatest impact in reducing the cancer burden in each of those areas.
To our research community and partners, we hope this publication will provide insight into areas of joint interest and collaboration. We are grateful for your expertise, dedication, and enthusiasm in helping us to identify these key priorities. And, we encourage you to continue to share your perspectives as we work together in support of the critical science needed to inform those policies and programs aimed at preventing, detecting, and treating cancer.
Robert T. Croyle, Ph.D.
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In this Overview and Highlights, DCCPS features division-wide priority areas that are responsive to NIH and NCI priorities and provide immense opportunities for advancement. However, DCCPS is not focusing on these priorities to the exclusion of other important areas of work. The division continues to invest in research across the cancer control continuum. Most of the grants we fund are investigator-initiated, not in response to a specific funding opportunity announcement. Potential grant applicants are encouraged to contact one of our program directors, whose contact information can be found on our website (https://cancercontrol.cancer.gov/).
For each priority below, we include examples of DCCPS initiatives and activities that illustrate ways in which the division is addressing these areas.
Tobacco use is still the leading cause of preventable death in the US. Despite half a century of progress in tobacco control and prevention, the devastating health and economic effects of tobacco use continue. In order to bring this epidemic to an end, innovative research is needed to address a myriad of factors, including a changing population of users, evolving patterns of initiation and use, new and modified tobacco products, and a complex and changing policy environment. We must implement what we already know, while not being “limited” by past strategies in tobacco control, and support cross-cutting research that accelerates progress in behavioral science relevant to tobacco use; treatment development and delivery; policy, system, and environmental changes; and public health interventions.
In the United States, rates of preventable and detectable cancers are falling for the general population, but, for some cancers, minority communities are still suffering at disproportionate rates. NCI’s research priorities in the area of cancer disparities encompass the entire cancer control continuum, from identifying and understanding the role of biology in disparities, to cancer prevention, treatment, and survivorship. A variety of research efforts is needed to better understand and address the disparities that exist in cancer incidence, treatment access, and outcomes. In addition, research is needed to improve methodologies and selection of appropriate research sample sizes that will allow for generalization of findings to racial and ethnic subpopulations across the US.
In the United States, rates of preventable and detectable cancers are falling for the general population, but, for some cancers, minority communities are still suffering at disproportionate rates.
Evidence has shown that rural communities in the United States face disadvantages compared with urban areas, including higher poverty rates, lower educational attainment, and lack of access to health services. Populations living in rural areas have higher average death rates for all cancer sites combined, compared to populations in urban counties. Additionally, rural counties have higher incidence and death rates for cancers associated with smoking (e.g., lung and laryngeal cancers) and higher rates of incidence of cancers that can be prevented by screening (i.e., colorectal and cervical cancers).
Some of the higher incidence and mortality rates for cancer can be attributed to barriers in accessing health services in rural areas. Research has also shown that some of these cancer disparities relate to financial barriers (e.g., no insurance or insufficient insurance coverage), transportation issues, and lack of preventive and screening services. There are also rural-urban differences in health behaviors that are associated with cancer, including higher rates of tobacco use, alcohol consumption, and obesity, and less physical activity, less-frequent adoption of sun safety measures, and lower HPV vaccination rates in rural compared to urban areas.
Currently, DCCPS has few funded projects focused specifically on rural populations. This long-standing public health challenge calls for sustained support for research along the entire cancer control continuum. We also need to better understand the various definitions of the term “rural” and their uses in health research – and specifically for cancer control. Focused research initiatives would provide the groundwork to develop and implement cancer control programs that are sustainable in these communities across the United States. In recognition of this need and to inform NCI’s efforts to better address cancer disparities in rural communities, DCCPS staff are working closely with our agency partners and a wide variety of experts to analyze the current evidence and scale up our research efforts in rural cancer control.
The Surveillance, Epidemiology, and End Results (SEER) Program has been supporting research on the diagnosis, treatment, and outcomes of cancer since 1973. SEER’s timely, complete, and accurate surveillance data, statistical methodologies and tools, and surveillance infrastructure all support cancer research in changing health care, technology, and scientific environments.
In 2014, the President’s Cancer Panel released a report calling for a coordinated effort to increase the rates of vaccinations against human papillomavirus (HPV). The report, Accelerating HPV Vaccine Uptake: Urgency for Action to Prevent Cancer, calls increasing the rate of HPV vaccinations one of the most profound opportunities in cancer prevention today. The two HPV vaccines – Cervarix and Gardasil – both prevent the two types of HPV (HPV16 and HPV18) that cause 70% of all cervical cancers. Despite this, only 33% of adolescent girls and less than 7% of boys in the US have completed the recommended dose schedule of either vaccine. DCCPS is pursuing areas of research that could potentially lead to higher vaccination rates.
Despite the significant advances in cancer research over the past decade, many patients with cancer do not receive optimum care. In addition, the economic burden associated with cancer is staggering, with costs expected to only increase as the population ages and more expensive screening, diagnostic, and therapeutic strategies are adopted as standards of care. The complexity of research on the quality and economic impact of cancer care requires more comprehensive sources of meaningful data and scientifically sound methods to enhance the linkages of traditional databases and cancer registries. Moreover, outcomes research must increasingly consider not only traditional biomedical endpoints, such as survival and disease-free survival, but also patient-reported outcomes that reflect the perspective of the individual with cancer.
There are already an estimated 15.5 million cancer survivors in the United States, and that number is projected to increase to 20.3 million by 2026. These exponential increases underscore the growing need to better understand and improve survivorship care and the survivorship experience, including possible physical and financial changes, risks of persistent or late-occurring effects – and interventions to prevent or mitigate them – the psychosocial needs of cancer survivors and their caregivers, the role of physical activity, and the need to develop and integrate effective and efficient models of care.
Over the past few decades, the incidence of obesity has risen markedly in the United States and in many other countries around the world. The obesity epidemic has substantial implications for cancer research and cancer control, given that obesity is associated with increased risks of developing cancer at many sites. In recent years, researchers have been focusing on energy balance, or the integrated effects of diet, physical activity, and genetics on growth and body weight over an individual’s lifetime, and on how those factors may influence cancer risk. Further interdisciplinary research is needed to refine our understanding of the associations between obesity and specific cancers, the mechanisms underlying these associations and their potential reversibility, and to support behavioral research to help overcome obesity at the individual and population levels.
Changes in the health and scientific landscape are posing many important new demands on behavioral research.
Cancer morbidity and mortality are greatly influenced by behaviors such as tobacco use, physical activity, vaccination, and sun exposure, and by psychological and behavioral processes including stress, cognition, emotion, and communication. Changes in the health and scientific landscape are posing many important new demands on behavioral research. Fortunately, new data sources, technological innovations, and methodologies have created novel ways to address the changing paradigm in health behavior research, offering the opportunity to adopt a multilevel approach to understanding behavior and the downstream effects of behavior on cancer incidence, progression, and quality of life.
DCCPS conducts and supports research that examines the role of various screening modalities in preventive health care. Transdisciplinary research in cancer screening has helped us to better understand how to improve the screening process, including recruitment, diagnosis, and referral for treatment. However, effective messaging is still needed to reach the unscreened, and barriers to health care access must be removed. Successful models are needed for coordinated, high-quality cancer screening and follow-up care that engages the patient and empowers them to complete needed care, from screening through treatment and long-term follow-up.
Spatial context is a key factor in health, as it can influence the risk of getting a disease, the ability to adopt a healthy lifestyle, and the ease of access to medical services for disease diagnosis and treatment and for preventive care. Geospatial data and tools, therefore, play an important role in cancer research by integrating data on exposure, neighborhood characteristics, and access to health services. Robust geographic information systems are critical to answering key questions about cancer incidence, morbidity, mortality, cancer-related health status, and health disparities in diverse regions and populations, as well as the impact of cancer control interventions on the cancer burden in the United States.
Health care delivery research at NCI is conceptualized as the study of cancer care, factors influencing care, and outcomes of care. Cancer care refers to medical services offered across the cancer continuum, such as screening individuals not known to have cancer; treating cancer patients; following cancer survivors for recurrence; and providing psychosocial support at the end of life for patients and their caregivers.
DCCPS staff help to support two NCI-wide initiatives focused on investigator-initiated technology development to address needs in cancer research: the Informatics Technologies for Cancer Research (ITCR) program and the Innovative Molecular Analysis Technologies (IMAT) program.
The development of innovative, validated methods is critical to risk factor assessment and for analyzing and interpreting epidemiologic, genetic, and other data. DCCPS staff guide science focused on the development, evaluation, and dissemination of high-quality risk factor metrics, methods, tools, technologies, and resources for use across the cancer research continuum, and the assessment of cancer-related risk factors in the population.
In addition to encouraging innovative scientific ideas for researchers through investigator-initiated applications and omnibus
solicitations, DCCPS develops and participates in NIH funding opportunities aimed at stimulating new directions in specific
research to examine, discover, and test methodologies to improve public health. The following are examples of recent
Funding Opportunity Announcements to encourage research projects in emerging or priority areas.
More information about funding opportunities can be found at cancercontrol.cancer.gov/funding.html.
DCCPS staff members are innovators in creating resources for the public and our research community. Visit our website for links to DCCPS-funded public-use data sets, as well as reporting and survey tools.
Researchers funded by DCCPS have advanced the science to improve public health for nearly two decades, and we celebrate their scientific advances and research accomplishments in cancer control and population sciences. Major programmatic areas include epidemiology and genomics research, behavioral research, health care delivery research, surveillance research, and survivorship research.
In fiscal year 2016, DCCPS funded 668 grants valued at more than $378 million, supporting work in the United States and internationally to reduce risk, incidence, and deaths from cancer, and to enhance quality of life for cancer survivors. While the majority of DCCPS funding is for investigator-initiated research project grants, the division also uses a variety of strategies to support and stimulate research such as multi-component specialized research centers and cancer epidemiology cohorts.
Learn more about the DCCPS grant portfolio and funding trends at maps.cancer.gov/overview/.
As a window into the many ways DCCPS provides return on investment, we highlight here just a few snapshots of progress from the past year.
DCCPS and the Centers for Disease Control and Prevention (CDC) colleagues have worked together on a wide range of efforts, often with other state or federal agencies and nonprofit organizations, to capitalize on shared strengths and resources. In FY 2016, NCI and CDC were working together on more than 40 collaborations.
The searchable Cancer Control Publications database includes more than 30,000 publications from research conducted by DCCPS staff, grantees, and contract investigators since 1998.
The DCCPS 2017 New Grantee Workshop brought together 33 new investigators who received their first R01 in 2016 and 2017 to help them successfully manage their grants and advance their careers.
The Behavioral Research Program hosted eight webinars on funding opportunities and data resources covering a wide variety of topics, attracting a total of 1,606 registrants. DCCPS programs host a number of free webinars throughout the year to support our grantee, research, and cancer control community.
NCI’s Surveillance Epidemiology and End Results (SEER) Program and the American Society of Clinical Oncology (ASCO) announced a data sharing partnership to facilitate the exchange of information between SEER and ASCO’s CancerLinQ system. CancerLinQ is currently in use at nearly 90 academic institutions and community oncology practices nationwide.
The SEER Program develops the Did You Know? video series, in collaboration with NCI’s Office of Communications and Public Liaison, to highlight key topics and trends in cancer statistics. One of the most popular videos in the series, Human Papillomavirus (HPV), had more than 28,000 views as of FY 2016.
More than 1,000 peer-reviewed publications have resulted from the Transdisciplinary Research on Energetics and Cancer Centers initiative. TREC fosters collaboration across multiple disciplines and projects, from the biology, genomics, and genetics of energy balance to behavioral, sociocultural, and environmental influences upon nutrition, physical activity, weight, energetics, and cancer risk.
In 2016, the Surveillance Research Program estimates there were 15.5 million cancer survivors in the US, and 2.8 million adults in the US serving as a caregiver to another adult with cancer.
The NCI Facebook Live Event “Cancer Survivorship: The Importance of Research,” featuring experts and research from the Office of Cancer Survivorship, was NCI’s most successful Facebook event to date, with more than 300,000 viewers.
As of FY 2016, 360 peer-reviewed publications had used data from the Health Information National Trends Survey (HINTS), which monitors changes in the rapidly evolving fields of health communication and health information technology.
The searchable online registry of the National Collaborative on Childhood Obesity Research annotated and included 1,207 validation studies of measures of diet, weight, and their environmental determinants. DCCPS staff developed the registry.
According to the 2014–15 cycle of DCCPS’s longstanding tobacco survey, the Tobacco Use Supplement to the Current Population Survey (TUS-CPS), 86.5% of US household respondents had rules in place in their home restricting cigarette smoking. Similarly, 79.7% of respondents reported some form of ban on smoking in their workplace. These data became available in FY 2017.
Over a 7-month period in FY 2016, Smokefree.gov hosted more than 3 million web visits, which represented a 140% year-over-year increase compared to the same period in 2015. The Smokefree.gov initiative includes 15 smoking cessation and healthy lifestyle text message programs, reaching adult smokers and other audiences such as teens, pregnant women and new mothers, veterans, and Spanish speakers. All programs can be used in research studies, and individual- and aggregate-level data are available.
The new NCI/WHO monograph on the Economics of Tobacco and Tobacco Control reports that there are about 1.1 billion tobacco smokers aged 15 or older worldwide, and tobacco use burdens national economies with more than US $1 trillion in health care costs and lost productivity annually.
The current Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) central data repository includes detailed screening process data on more than 6 million people cared for in 3,650 facilities by more than 50 thousand physicians and their staff across a wide variety of health care systems.
DCCPS funds the Cancer Care Delivery Research (CCDR) component of the NCI Community Oncology Research Program (NCORP). NCORP comprises seven research bases and 46 community sites, 12 of which are designated as Minority/ Underserved Community Sites. CCDR generates evidence that can be used to improve clinical practice patterns as well as develop and test promising interventions within the health care delivery system.
The NCI Cohort Consortium has more than 7 million participants in 59 international cohorts.
Approximately 13,000 breast cancer cases and controls from 7 genetic data sets, some of which were made available for the first time, were shared for the NCI prize competition “Up For A Challenge (U4C) – Stimulating Innovation in Breast Cancer Genetic Epidemiology.” Leveraging these data, 15 entries (from 14 teams, including 88 individuals) were submitted that applied innovative approaches to discover novel genetic associations with breast cancer.
Nearly 500,000 people from African, Asian, European, and Hispanic populations were genotyped for a total of nearly 500,000 SNPs through the Genetic Associations and Mechanisms in Oncology (GAME-ON) and OncoArray initiatives. More than 200 new genetic variants were discovered across 5 common cancer types.
From March 2016 to March 2017, the extramural National Cancer Institute Data Access Committee (eNCI) received 932 projects requesting access to datasets under its purview, from 758 investigators. As of March 2017, the eNCI DAC oversaw 129 datasets available for controlled access in the database of Genotypes and Phenotypes (dbGaP).
The Research Tested Intervention Program (RTIPs) is a searchable database of more than 183 evidence-based cancer control interventions and program materials, spanning 12 topics of interest, for program planners and public health practitioners.