In 1971, President Nixon signed the National Cancer Act as part of the War on Cancer. In honor of the act's 50th anniversary, Norman Sharpless, M.D., director of the National Cancer Institute (NCI), shares his thoughts on cancer research and treatment, and how both have changed over the past 50 years.

What was cancer like before the passage of the National Cancer Act?

In most cases, cancer was an automatic death sentence. I can think of one exception that offered real hope. In the 1950s, a group of science leaders found a cure for an especially terrible childhood leukemia. The survival rate increased from zero to more than 80%.

Why couldn't that dramatic change happen for all cancers? That kind of thinking led to support for the National Cancer Act. At the time, some people believed cancer was a medical problem that could be solved in about five years. It was simply a matter of finding the right drugs. But of course, cancer turned out to be a much harder problem.

Why is cancer so hard to solve?

We now understand that cancer is different between patients. In a way, cancers are like snowflakes. Each one is unique.

Cancer is not one disease or even 10, it's hundreds or thousands of diseases. Each cancer has its own treatment and approach. In the past, we tried the same ineffective cancer drugs over and over. Now we're starting to see real advances on specific cancers.

We're committed to President Biden's goal to end the tragedy of cancer that takes loved ones too soon. About 600,000 Americans die from cancer each year. So, we have a lot of work to do.

How does big data play a role?

We've moved away from traditional clinical trials. We no longer give drug A to 400 people and drug B to another 400 and compare outcomes. All 800 patients are different, and we can't treat them in a cookie-cutter way. We link lots of data sources, from lab reports to insurance claims. Analyzing large amounts of data helps us understand cancer in the real world. For example, treatments that work in big, urban hospitals may not work in areas with low access to care.

"Cancer is not one disease or even 10, it's hundreds or thousands of diseases. Each cancer has its own treatment and approach."

– Norman Sharpless, M.D.

How did COVID-19 affect cancer care and clinical trials?

COVID-19 caused major delays in treatment and surgeries. It drastically reduced screening tests like Pap smears and mammography. Yet I'm impressed with how the cancer world rallied to decrease the impact of the pandemic. That means getting patients into treatment quickly and making up missed tests.

Clinical trials are critical to advancing cancer research. NCI enrolls more than 35,000 participants annually. Participants benefit from access to new therapies. Increasing the diversity of our participants is a priority. This includes bringing trials to patients and making them more convenient.

Early in the pandemic, we had to learn how to use telemedicine for clinical trials. We obtained consent by phone. We mailed drugs. We found treatment closer to home. Patients, caregivers, and clinicians liked these changes. As we move forward, these lessons will help increase access to clinical trials and care.

What else can you tell us about cancer research today?

We're in a golden age. At NCI, we have more research ideas than we can fund. For example, myeloma has at least five new approaches to treatment. The challenge is to figure out how to use these techniques.

To make progress in cancer, we need to understand it. The incredible results we see in some cancers builds on decades of basic research. You cannot skip that step. Science is surprising and unpredictable. We don't know where the next breakthrough will come from.

Take metastatic melanoma, a great success story. It had a very low survival rate. It may have looked like nothing changed for decades. Then, all of a sudden, we gained new knowledge about the immune system. And within five years, scientists found a cure. That would have not happened without the prior 30 years of hard work.

While I've focused on NCI's work, progress against cancer is a National Institutes of Health-wide effort. For information about clinical trials, patients should talk to their doctor and visit ClinicalTrials.gov.

---

Listen to NCI's 50th anniversary podcast series on HealthCast

For a close-up look at past and present cancer research and innovation, listen to this special podcast miniseries: 50 Years of the National Cancer Act. Each podcast is about 30 minutes long, and topics include prevention, treatment, clinical trials, health disparities, and more. Listen on Spotify, Apple Podcasts, or wherever you get your podcasts.