Looking to the Future
In this section you will learn:
The more we know about the biology of cancer and the individual in whom it occurs, the more precisely we are able to prevent, detect, diagnose, and treat cancer.
“Big data” sharing initiatives will fuel a new era of cancer discoveries.
Through research, some of the significant cancer health disparities that exists today can be eliminated tomorrow.
We have made some significant advances against cancer, with many more people living longer and fuller lives after a cancer diagnosis than ever before. Despite these advances, cancer continues to be an enormous public health challenge in the United States and worldwide (see sidebar on Cancer: A Global Challenge). In fact, it is predicted that 600,920 people in the United States will die from some type of cancer in 2017 (2) (see Table 2). However, many researchers, including the 2017–2018 AACR President, Michael A. Caligiuri, MD, are extremely hopeful about the future and are confident that through research we will power more advances against cancer.
Fueling a New Era of Cancer Discoveries Harnessing Big Data
As we move into the era of precision cancer medicine it is clear that a greater understanding of the molecular underpinnings of cancer will drive future progress in prevention, early detection, and treatment of the disease. Comprehensive molecular assessment of tumors will continue to uncover additional therapeutic targets that are altered in cancer. Minimally invasive tools such as liquid biopsies, which are being studied extensively, have the potential to advance early detection, diagnosis, and treatment by identifying markers of disease, therapeutic response, resistance, and recurrence (see sidebar on Moving toward Minimally Invasive Testing). However, to achieve the full potential of precision medicine, the molecular profile of a patient’s cancer will need to be considered along with other factors, including the patient’s genome, epigenome, microbiome, metabolome, lifestyle, and environmental exposures, which are emerging as important influences on cancer initiation, development, and progression.
To deepen our understanding of the many factors that influence cancer development and progression, we need to first generate and gather real world data, including patient history, diagnostics, genetic tests, treatment decisions, and measured and patient-reported outcomes from large numbers of cancer patients. Using these data sets we could harness, and analyze patients’ information to answer many of cancer’s most elusive questions in real time. For example, physicians may be able to match existing FDA-approved molecularly targeted therapeutics to novel cancer types, as well as identify subgroups of patients who are most or least likely to benefit from aggressive cytotoxic chemotherapies. One way to accelerate the pace at which we gather patient-derived information is through data sharing across health care organizations throughout the United States and abroad.
Approaches such as these will require cross-discipline collaboration among those working in basic, clinical, and translational sciences, biostatistics, epidemiology, mathematics, bioinformatics, and computational biology, among other disciplines. Extracting knowledge from large and complex data sets will also require unique processing applications, and concerted efforts from all sectors of the biomedical research community will be required to overcome the current technical as well as regulatory and ethical barriers to effective data sharing.
Several cancer organizations as well as multi-institutional teams have already launched a number of initiatives to catalyze data sharing (see Table 6). A few examples of these cross-institutional projects are NCI Genomic Data Commons; BRCA Exchange (see sidebar on Interpreting Genetic Tests); ASCO CancerLinQ; Oncology Research Information Exchange Network (ORIEN); and AACR Project Genomics, Evidence, Neoplasia, Information, Exchange (GENIE) (207). Continued advances in technological innovations as well as regulatory policy initiatives will be critical to overcome current barriers to data sharing and create a framework for a global data ecosystem that will accelerate discoveries and benefit patient care.
Greater Effort to Reduce Cancer Health Disparities
Unquestionably, advances across the spectrum of research have spurred great progress in cancer prevention, detection, diagnosis, treatment, and, in some cases, cure. However, certain groups of individuals in the United States—in particular, racial and ethnic minorities and people of lower socioeconomic status—experience a notably higher incidence of some types of cancer and/or have significantly poorer outcomes (see Disparities in Progress for Distinct Population Groups).
Through research, we have gained some knowledge about the factors that contribute to U.S. cancer health disparities (see sidebar on Why Do Cancer Health Disparities Exist?). However we have also learned that there are many of these factors and that they are interrelated, which makes them difficult to isolate and study individually.
To accelerate the pace of progress in this area, it is vital that all stakeholders, including researchers, cancer survivors, and health care providers, come together to ensure that research advances benefit all populations and patients regardless of race, ethnicity, age, gender identity, sexual orientation, socioeconomic status, or the communities in which they live. A recently published position statement from four leading cancer organizations—the AACR, the ACS, ASCO, and the NCI—provides specific recommendations for improving the way that disparities research is conducted and disseminated, and highlights one important effort to move the field forward (see sidebar on Charting the Future of Cancer Health Disparities Research) (208).
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