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• Cancer in 2023

In this section, you will learn:

• In the United States, the overall cancer death rate has been steadily declining since the 1990s, with the reductions between 1991 and 2020 translating into more than 3.8 million cancer deaths avoided.
• The decline in overall U.S. cancer death rates is driven by steady declines in mortality from cancers of the breast, colon and rectum, lung, and prostate.
• More than 18 million cancer survivors were living in the United States as of January 1, 2022.
• Progress has not been uniform against all cancer types or all subtypes and stages of a given cancer type.
• There are stark inequities in the cancer burden among many sociodemographic groups within the United States; these inequities occur across the cancer continuum and are driven largely by social factors.
• The economic burden of cancer both on individuals and the U.S. health care system is expected to rise in the coming decades, highlighting the urgent need for more research to accelerate the pace of progress against cancer.

Research: Driving Progress Against Cancer

Cancer: an ongoing public health challenge, inequities in the burden of cancer in the united states, variable progress against different types of cancer and stages of diagnosis, the growing population burden of cancer, the global burden of cancer, funding cancer research: a vital investment.

Research is the backbone of progress against cancer because it is the driving force behind every breakthrough that enhances survival and quality of life and every new policy or program designed to improve public health. Discoveries across the major areas of cancer research, including basic, clinical, translational, and population sciences, provide the foundation for advances in cancer prevention, detection, diagnosis, treatment, and survivorship.

Every clinical advance as well as every policy that spurs progress against cancer is the culmination of a complex process that requires collaboration over the course of many years among numerous different stakeholders committed to fundamentally changing the face of this devastating disease (see Sidebar 1 ).

The remarkable advances being made against cancer—in particular, improvements in prevention, early detection, and treatment—are resulting in a steady decline in U.S. cancer death rates year after year. In fact, the age-adjusted overall cancer death rate has fallen by 33 percent between 1991 and 2020, a reduction that translates into averting an estimated 3.8 million deaths from cancer ( 2 ) Siegel RL, et al. (2023) CA Cancer J Clin, 73: 17. [LINK NOT AVAILABLE] . The reduction in overall U.S. cancer mortality rate is driven largely by the decline in lung cancer death rate, the pace of which has accelerated in recent years because of reduction in smoking and advances in early detection and treatment (see Figure 1 ). Reduction in death rates for melanoma, colorectal cancer, prostate cancer, and female breast cancer has also contributed to overall progress against U.S. cancer mortality ( 2 ) Siegel RL, et al. (2023) CA Cancer J Clin, 73: 17. [LINK NOT AVAILABLE] .

Research-driven advances in treatment are reflected in the steady declines in death rates for melanoma, leukemia, and kidney cancer ( 2 ) Siegel RL, et al. (2023) CA Cancer J Clin, 73: 17. [LINK NOT AVAILABLE] . The death rate for chronic myeloid leukemia (CML), a cancer of the blood and bone marrow, for instance, has declined by 70 percent between 1975 and 2020 ( 5 ) Surveillance, Epidemiology, and End Results (SEER) Program. Accessed: July 5, 2023. . This progress can be attributed to groundbreaking basic research discoveries from the 1960s through 1980s that identified the mechanistic underpinnings of the disease and propelled the development of a cascade of new treatments for CML (see Sidebar 6 ) ( 6 ) Howlader N, et al. (2023) Cancer Epidemiol Biomarkers Prev, 32: 744. [LINK NOT AVAILABLE] .

Among children (14 years or younger) and adolescents (15 to 19 years), overall cancer death rates have declined by 70 percent and 64 percent, respectively, between 1970 and 2020, driven largely by improvements in treatment ( 2 ) Siegel RL, et al. (2023) CA Cancer J Clin, 73: 17. [LINK NOT AVAILABLE] .

Among the major advances made across the clinical cancer care continuum from August 1, 2022, to July 31, 2023, are 14 new anticancer therapeutics approved for use by FDA (see Table 3 ). During this period, FDA also approved new uses for 12 previously approved anticancer therapeutics (see Table 3 , p. 77), two agents to improve quality of life for patients with cancer undergoing active treatment, two new imaging agents to help visualize cancerous cells during surgery (see Visualizing Lung Cancers More Precisely During Surgery and Imaging Prostate Cancer More Clearly ) and several artificial intelligence-based tools to improve detection and diagnosis of cancers (see Sidebar 24 ). Collectively, advances such as these are helping increase the number of children and adults who live longer and fuller lives after a cancer diagnosis. As of January 1, 2022, the most recent date for which such estimate is available, more than 18 million individuals with a history of cancer were alive in the United States ( 7 ) Miller KD, et al. (2022) CA Cancer J Clin, 0: 1. [LINK NOT AVAILABLE] . Recent studies indicate that the number of U.S. individuals living despite being diagnosed with metastatic disease has increased since the 1990s and this number is estimated to grow considerably in the coming years ( 8 ) Gallicchio L, et al. (2022) J Natl Cancer Inst, 114: 1476. [LINK NOT AVAILABLE] . This increase is attributable to the advances in treatments that are available for patients with metastatic cancers.

Although incredible progress has been made against cancer, it continues to be an enormous public health challenge in the United States and around the world (see Sidebar 4 ). In the United States alone, an estimated 1,958,310 new cases of cancer will be diagnosed in 2023 and 609,820 people will die from the disease (see Table 1 ). Men have a higher incidence of many cancer types, including bladder, colon, and brain cancer compared to women and ongoing research is evaluating the role of a range of biological factors including genetics, epigenetics, metabolism, and immunity in mediating these differences.

Unfortunately, many population groups in the United States experience a disproportionately high rate of cancer incidence and death attributable largely to socioeconomic disadvantages. It should also be noted that current estimates of cancer burden do not reflect the adverse impact of COVID-19, which caused serious declines in screening, early detection, and new cancer diagnoses, and which continues to take a toll on cancer care especially among the medically underserved populations ( 9 ) American Association for Cancer Research. AACR Report on the Impact of COVID-19 on Cancer Research and Patient Care. Accessed: June 30, 2022. ( 10 ) Berrian J, et al. (2023) Cancer Med, 12: 7381. [LINK NOT AVAILABLE] ( 11 ) Zhao J, et al. (2023) JCO Oncol Pract: OP2200522. [LINK NOT AVAILABLE] . Ongoing monitoring of cancer-related population-based data is warranted to assess the long-term consequences of COVID-19 on cancer burden in the United States.

While we are making unprecedented advances against cancer, the grim reality is that these advances have not benefited everyone equally. Because of a long history of structural inequities and systemic injustices in the United States, certain segments of the population continue to shoulder a disproportionate burden of adverse health conditions, including cancer.

Cancer disparities are one of the most pressing public health challenges in the United States. The National Cancer Institute (NCI) defines cancer disparities as adverse differences in cancer, such as number of new cases, number of deaths, cancer-related health complications, survivorship and quality of life after cancer treatment, screening rates, and stage at diagnosis that exist among certain population groups (see Sidebar 2 ).

As outlined in the AACR Cancer Disparities Progress Report 2022 ( 13 ) American Association for Cancer Research. AACR Cancer Disparities Progress Report 2022. Accessed: June 30, 2023. , racial and ethnic minorities and other medically underserved U.S. populations shoulder a disproportionately higher burden of cancer (see Sidebar 3 ).

Individuals who are Black have the highest death rates and lowest survival rates of any racial or ethnic group in the U.S. for most cancers, largely driven by structural and systemic inequities ( 14 ) American Cancer Society. Cancer Facts and Figures for African Americans 2019-2021. Accessed: July 28, 2023. . While the disparity in the overall cancer death rate between Black and White populations has narrowed by half over the last two decades, Black individuals still had a 12 percent higher overall cancer death rate compared to White individuals, and the highest death rate from cancer among all U.S. racial or ethnic groups in 2020 ( 5 ) Surveillance, Epidemiology, and End Results (SEER) Program. Accessed: July 5, 2023. . American Indian and Alaska Native (AIAN) individuals are a culturally and geographically diverse U.S. population group who experience a disproportionally high prevalence of several chronic illnesses, including many cancers, largely because of barriers to quality health care ( 15 ) Kratzer TB, et al. (2023) CA Cancer J Clin, 73: 120. [LINK NOT AVAILABLE] . Cancer is the leading cause of death in the U.S. Hispanic population, the second largest racial or ethnic group in the continental United States and Hawaii, whereas heart disease is the leading cause of death in the non- Hispanic White population ( 16 ) Miller KD, et al. (2021) CA Cancer J Clin, 71: 466. [LINK NOT AVAILABLE] .

Researchers are increasingly recognizing the heterogeneity in cancer burden among individuals within each of the major racial or ethnic minority groups ( 13 ) American Association for Cancer Research. AACR Cancer Disparities Progress Report 2022. Accessed: June 30, 2023. . As one example, the U.S. Asian population has ancestry in numerous countries of origin and the Native Hawaiian or other Pacific Islander (NHOPI) population comprises more than 25 diverse subgroups with distinct variations in historical backgrounds, languages, and cultural traditions. Striking disparities in cancer death rates between NHOPI and Asian individuals have been identified since national death certificates included a new racial classification system which separated NHOPI individuals from Asian individuals, two populations that are frequently aggregated in cancer epidemiological data ( 17 ) Haque AT, et al. (2023) J Natl Cancer Inst. [LINK NOT AVAILABLE] . These findings highlight the vital importance of disaggregated cancer data to fully understand cancer disparities and develop effective strategies for achieving health equity.

In addition to racial or ethnic minorities, many other segments of the U.S. population shoulder a disproportionate burden of cancer (see Sidebar 2 ). These include residents in rural areas that lack access to cutting-edge cancer treatments and/or state-of-the-art health care facilities, sexual and gender minorities who experience bias and discrimination in health care settings, and low-income households where there is persistent poverty, and limited access to healthy food or the needed health care. It should be noted that patients with intersectional identities often experience multilevel barriers to cancer care that adversely impact screening, diagnosis, treatment, and survivorship. As one example, recent data have shown that Black and AIAN populations living in rural areas experience greater poverty and lack of access to quality care, which expose them to greater risk of experiencing poor cancer outcomes ( 22 ) Zahnd WE, et al. (2021) Int J Environ Res Public Health, 18. [LINK NOT AVAILABLE] .

Root causes of cancer disparities are multidimensional and multifactorial. Researchers have developed many models to understand and address health inequities. A key component of these models is the framework of social determinants of health (SDOH). According to NCI, SDOH are the social, economic, and physical conditions in the places where people are born and where they live, learn, work, play, and grow older that can affect their health, well-being, and quality of life (see Figure 2 ). It is increasingly evident that structural racism and systemic injustices are key adverse social factors, creating conditions that perpetuate health inequities, including cancer disparities, for racial or ethnic minorities and other medically underserved populations ( 23 ) Alnajar A, et al. (2023) JAMA Netw Open, 6: e234261. [LINK NOT AVAILABLE] ( 24 ) Hoskins KF, et al. (2023) JAMA Oncol, 9: 536. [LINK NOT AVAILABLE] ( 25 ) Zhang L, et al. (2023) JAMA Oncol, 9: 122. [LINK NOT AVAILABLE] ( 26 ) Vince RA, Jr., et al. (2023) JAMA Netw Open, 6: e2250416. [LINK NOT AVAILABLE] .

Considering that a significant proportion of the U.S. population is affected by cancer disparities, it is important that public health experts intensify efforts designed to improve the understanding and mitigation of these inequities. Only with new insights obtained through innovative and inclusive research, such as basic research using biospecimens from diverse populations, clinical studies involving participants from all sociodemographic backgrounds, and health care delivery research that is representative of everyone in the communities, will we be able to develop and implement interventions that eventually eliminate cancers for all populations.

Among the current challenges in cancer science and medicine is the uneven progress against different cancer types and different stages of a given cancer type.

These challenges are illustrated by the fact that the 5-year relative survival rates for U.S. patients vary widely depending on both the type of cancer diagnosed and the stage at diagnosis ( 5 ) Surveillance, Epidemiology, and End Results (SEER) Program. Accessed: July 5, 2023. . For example, the overall 5-year relative survival rates of 94 percent for patients with melanoma and 97 percent for patients with prostate cancer stand in stark contrast to the overall 5-year relative survival rates of 23 percent for those with liver cancer and 13 percent for those with pancreatic cancer. In addition, among women with breast cancer and men with prostate cancer, those whose cancer is confined to the breast, or to the prostate, have 5-year relative survival rates of 99 percent and 100 percent, respectively, while those whose cancer has metastasized have 5-year relative survival rates of 31 percent and 34 percent, respectively ( 5 ) Surveillance, Epidemiology, and End Results (SEER) Program. Accessed: July 5, 2023. .

Variable progress among different cancer types can be partly attributed to the availability of novel cutting-edge therapeutic options, or lack thereof, that have moved rapidly from the laboratory to the clinic and are now available to patients. As one example, between January 1, 2011, and July 31, 2023, the U.S. Food and Drug Administration (FDA) approved five immunotherapeutics and six molecularly targeted therapeutics for use alone or in combination for the treatment of patients with metastatic melanoma, a previously intractable cancer. Thanks to these innovative new therapeutics, melanoma mortality rates have declined rapidly between 2011 and 2020 by about five percent per year in adults younger than age 50 and three percent per year in those 50 and older ( 28 ) American Cancer Society. Cancer Facts and Figures. Accessed: July 5, 2023. . In contrast, progress has been slow for patients with glioblastoma multiforme (GBM), an aggressive form of brain tumor (see Tackling Difficult-to-Treat Cancers ). Since the approval of the chemotherapeutic temozolomide nearly 25 years ago, no new anticancer agents have shown promise in improving overall survival. Consequently, the 5-year relative survival rate for patients with GBM remains at a dismal seven percent ( 29 ) Ostrom QT, et al. (2022) Neuro Oncol, 24: v1. [LINK NOT AVAILABLE] .

Developing new and effective methods for early detection of more cancer types could help address the challenge of variable progress between types of cancer because the likelihood of cure is much higher when cancer is diagnosed at an early stage while it is confined to its original location than when it has spread to distant sites. Additionally, intensive research into the molecular underpinnings of cancer initiation and progression is vital in order to improve future therapeutic options for currently hard-to-treat diseases (see Tackling Difficult-to-Treat Cancers ).

The public health challenges posed by cancer are predicted to grow considerably in the coming decades unless we develop and implement more effective strategies for cancer prevention, early detection, and treatment ( 30 ) International Agency for Research on Cancer. Global Cancer Observatory. Accessed: July 31, 2023. . In the United States alone, the number of new cancer cases diagnosed each year is expected to reach nearly 2.3 million by 2040 ( 30 ) International Agency for Research on Cancer. Global Cancer Observatory. Accessed: July 31, 2023. . This is because cancer is primarily a disease of aging; 57 percent of diagnoses occur among those 65 and older ( 28 ) American Cancer Society. Cancer Facts and Figures. Accessed: July 5, 2023. , and this segment of the U.S. population is expected to grow from 54.1 million in 2019 to nearly 81 million in 2040 ( 31 ) U.S. Department of Health and Human Services. Administration for Community Living. 2020 Profile of Older Americans. Accessed: Jul 6, 2023. .

Also contributing to the projected increase in the number of U.S. cancer cases are the high rates of obesity and physical inactivity and the continued use of cigarettes by 11.5 percent of adults ( 32 ) Cornelius ME, et al. (2023) MMWR Morb Mortal Wkly Rep, 72: 475. [LINK NOT AVAILABLE] . However, it should be noted that a significant proportion of lung cancers (16 percent in women and 10 percent in men) are diagnosed in individuals without a history of smoking ( 33 ) Siegel DA, et al. (2021) JAMA Oncol, 7: 302. [LINK NOT AVAILABLE] and there is a need for more research to determine whether the incidence rate of lung cancer among those without a history of smoking is increasing ( 34 ) Pelosof L, et al. (2017) J Natl Cancer Inst, 109. [LINK NOT AVAILABLE] . Identification of risk factors, characterization of disease, and development of evidence-based early detection and treatments are critical needs to lower the burden of lung cancer in the population of patients who do not have a history of smoking.

While overall cancer incidence in the United States has stabilized in recent years, the incidence of certain cancer types such as pancreatic cancer and uterine cancer ( 5 ) Surveillance, Epidemiology, and End Results (SEER) Program. Accessed: July 5, 2023. is steadily increasing. Additionally, many recent studies have reported an increase in the incidence of colorectal cancer among individuals younger than 50 years, a phenomenon referred to as early-onset cancer ( 35 ) Siegel RL, et al. (2023) CA Cancer J Clin, 73: 233. [LINK NOT AVAILABLE] ( 36 ) Giannakis M, et al. (2023) Science, 379: 1088. [LINK NOT AVAILABLE] . According to a recent report, between 2011 and 2019, the colorectal cancer incidence rate increased by 1.9 percent per year in people younger than 50 years ( 35 ) Siegel RL, et al. (2023) CA Cancer J Clin, 73: 233. [LINK NOT AVAILABLE] . Many of the early-onset colorectal cancer cases are diagnosed at an advanced stage. Between 2010 and 2019, among 20- to 49-year- old individuals, incidence of advanced-stage colorectal cancer increased by about three percent per year ( 35 ) Siegel RL, et al. (2023) CA Cancer J Clin, 73: 233. [LINK NOT AVAILABLE] .

Understanding the reasons behind rising cases of early-onset colorectal cancer is an area of intensive research. To reduce the burden of early-onset colorectal cancer, the United States Preventive Services Taskforce (USPSTF) and many professional societies have modified their screening guidelines to recommend starting colorectal cancer screening at an earlier age (see Guidelines for Cancer Screening ). Researchers are also evaluating new and improved strategies including genetic testing and other approaches for prevention and early detection of colorectal cancer in the younger population ( 37 ) Sinicrope FA (2022) N Engl J Med, 386: 1547. [LINK NOT AVAILABLE] .

Another cancer for which U.S. incidence rate has been rising is cervical cancer ( 39 ) Francoeur AA, et al. (2022) Int J Gynecol Cancer. [LINK NOT AVAILABLE] ( 40 ) Shahmoradi Z, et al. (2022) JAMA, 328: 2267. [LINK NOT AVAILABLE] . According to a recent analysis, the rate of advanced cervical cancer (that has spread to the bladder or rectum at diagnosis) increased by 1.3 percent per year from 2001 to 2018 ( 39 ) Francoeur AA, et al. (2022) Int J Gynecol Cancer. [LINK NOT AVAILABLE] . A second report showed that, among U.S. women ages 30 to 34 years, overall cervical cancer incidence increased by 2.5 percent per year between 2012 and 2019 ( 40 ) Shahmoradi Z, et al. (2022) JAMA, 328: 2267. [LINK NOT AVAILABLE] . Considering that nearly all cervical cancers are caused by infection with human papillomavirus (HPV) and that HPV vaccination (see Prevent and Eliminate Infection from Cancer-causing Pathogens ) and cervical cancer screening are extremely effective in reducing the burden of the disease, these data emphasize the importance of public health measures to boost cervical cancer prevention and early detection in the United States (see Screening for Early Detection ).

Beyond the United States, cancer is an ongoing global challenge (see Sidebar 4 ). According to a recent analysis, there were an estimated 17.2 million new cancer cases (excluding nonmelanoma skin cancer) and 10 million cancer deaths globally, in 2019 ( 41 ) Global Burden of Disease Cancer C, et al. (2022) JAMA Oncol, 8: 420. [LINK NOT AVAILABLE] . The study evaluated cancer burden in terms of cancer-related deaths, as well as disability-adjusted life years (DALYs) and years of life lost (YLLs), which are two measures of cancer morbidity. Researchers found that among the 22 groups of diseases and injuries analyzed, cancer was second only to cardiovascular disease in the number of deaths, DALYs, and YLLs ( 41 ) Global Burden of Disease Cancer C, et al. (2022) JAMA Oncol, 8: 420. [LINK NOT AVAILABLE] . The five leading causes of cancer-related morbidity among men and women combined were cancers of the lung, colon and rectum, stomach, breast, and liver.

There is a stark disparity in the cancer burden among countries with different levels of socioeconomic development. Researchers use various metrics such as human development index (HDI) or sociodemographic index (SDI), which are composite measures of social and economic development, to identify where countries or geographic areas fall on the spectrum of development. SDI quantification considers income per capita, average years of education, and total fertility rate for citizens younger than 25 ( 42 ) Institute for Health Metrics and Evaluation. Socio-demographic Index (SDI). Accessed: July 5, 2023. ; HDI measurement considers income per capita, average years of education, and life expectancy at birth ( 43 ) United Nations. Human Development Index. Accessed: July 5, 2023. . While age-adjusted cancer incidence and mortality rates are declining in countries with high SDI, both rates are still trending upward in lower SDI countries ( 41 ) Global Burden of Disease Cancer C, et al. (2022) JAMA Oncol, 8: 420. [LINK NOT AVAILABLE] . Based on a recent estimate, between 2010 and 2019, countries with the lowest SDI experienced the largest percent increase in the numbers of cancer cases and deaths ( 41 ) Global Burden of Disease Cancer C, et al. (2022) JAMA Oncol, 8: 420. [LINK NOT AVAILABLE] .

Considering the growth and aging of the global population and the negative impact of recent global crises such as the COVID-19 pandemic on cancer research and patient care ( 45 ) United Nations. Ageing. Accessed: July 6, 2023. , researchers caution that the burden of cancer worldwide may rise significantly in the coming decades. One area in which progress is urgently needed is the establishment of population-based cancer registries in all countries because the collection of high-quality cancer surveillance data is essential for developing effective national cancer control plans. Notably, only one in five low- and middle-income countries has the necessary data to drive policy and reduce the burden and suffering due to cancer, according to the International Agency for Research on Cancer ( 46 ) Editorial (2014) Lancet, 383: 1946. [LINK NOT AVAILABLE] .

Another emerging concern among public health experts is the dramatic rise since the 1990s in the incidence of early-onset cancers, including cancers of the breast, colon, esophagus, kidney, liver, and pancreas, among others, around the world ( 47 ) Ugai T, et al. (2022) Nat Rev Clin Oncol, 19: 656. [LINK NOT AVAILABLE] . While improvements in early detection may be attributable, in part, to this rising cancer incidence, researchers hypothesize that early life exposures to certain cancer risk factors (see Reducing the Risk of Cancer Development ), including diets rich in highly processed foods, alcohol, sedentary lifestyle, obesity, environmental carcinogens, and an unfavorable microbiome, many of which have become more prevalent in recent decades, are playing a role in the increased incidence of early-onset cancers ( 47 ) Ugai T, et al. (2022) Nat Rev Clin Oncol, 19: 656. [LINK NOT AVAILABLE] . Notably, 44 percent of cancer deaths worldwide are caused by modifiable risk factors, such as smoking and drinking alcohol ( 48 ) GBD 2019 Cancer Risk Factors Collaborators. (2022) Lancet, 400:563 [LINK NOT AVAILABLE] .

To ensure equitable progress against cancer worldwide, it is imperative that the global medical research community work together and shares best practices to implement newer and more effective strategies that incorporate local needs and knowledge into tailored national cancer control plans. Public health experts have identified several priorities based on present and future needs of low resource countries, including reducing the burden of advanced cancers; improving access, affordability, and outcomes of treatment; utilizing value-based care; fostering implementation research; and leveraging technology to improve cancer control ( 49 ) Pramesh CS, et al. (2022) Nat Med, 28: 649. [LINK NOT AVAILABLE] . The urgent need for robust worldwide investments in medical research is emphasized by recent findings that estimated the cumulative global economic burden of cancer to be at an enormous $25.2 trillion over the next 30 years ( 50 ) Chen S, et al. (2023) JAMA Oncol, 9: 465. [LINK NOT AVAILABLE] .

Cancer exerts an immense toll, both because of the number of lives it affects each year and its significant economic impact. The direct medical costs of cancer care are one measure of the financial impact of cancer, and in the United States alone, these costs were estimated to be nearly $209 billion in 2020, the last year for which these data are currently available ( 28 ) American Cancer Society. Cancer Facts and Figures. Accessed: July 5, 2023. . Unfortunately, these numbers stand in stark contrast to the NCI budget of $6 billion for the same year. Notably, the direct medical costs do not include the indirect costs of lost productivity due to cancer-related morbidity and mortality, which are also extremely high. As one example, the costs of lost productivity for U.S. adolescent and young adult patients with cancer (age 15 to 39) diagnosed in 2019 were an estimated $18 billion over their lifetime ( 54 ) Parsons SK, et al. (2023) J Clin Oncol, 41: 3260. [LINK NOT AVAILABLE] .

Patients with cancer shoulder a large amount of economic burden associated with cancer care. In 2019, in the United States, patients with cancer lost nearly $5 billion due to time costs— value of time that patients spend traveling to and from health care, waiting for care, and receiving care—and paid an estimated $16.2 billion in out-of-pocket costs for cancer care ( 55 ) Kuehn BM (2021) JAMA, 326: 2251. [LINK NOT AVAILABLE] .

With the number of cancer cases projected to increase in the coming decades, it is likely that both the direct and indirect costs will also escalate. According to a recent report the economic burden of cancer in the United States will reach $5.3 trillion over the next three decades ( 50 ) Chen S, et al. (2023) JAMA Oncol, 9: 465. [LINK NOT AVAILABLE] . The rising personal and economic burden of cancer underscores the urgent need for more research so that we can accelerate the pace of progress and curb the increasing burden of this disease.

Recent advances in cancer prevention, detection, and treatment, many of which are highlighted in this report, were made as a direct result of the cumulative efforts of researchers across the spectrum of cancer science and medicine. Much of their work, as well as that of FDA and CDC, is supported by funds from the federal government. Public sector funding from NIH and NCI contributes significantly to the development of novel anticancer drugs including molecularly targeted therapeutics and immunotherapeutics (see Advances in Treatment with Molecularly Targeted Therapy ) and Immunotherapy: Pushing the Frontier of Cancer Medicine ) ( 56 ) Nayak RK, et al. (2021) JAMA Intern Med, 181: 1522. [LINK NOT AVAILABLE] ( 57 ) Galkina Cleary E, et al. (2023) JAMA Health Forum, 4: e230511. [LINK NOT AVAILABLE] . The rapid pace of approval of these cutting-edge treatments, many of which were evaluated in NCI-funded clinical trials, has transformed the treatment landscape and dramatically improved patient outcomes. A recent study that evaluated the population-level impact of NCI-funded clinical research concluded that over the past 40 years, patients with cancer in the United States gained 14 million years of additional life because of these trials ( 60 ) Shiels MS, et al. (2023) Cancer Discov, 13: 1084. [LINK NOT AVAILABLE] . Collectively, these findings highlight the importance of federal investments in medical research in saving and extending lives and driving progress against cancer.

The consecutive increases for the NIH budget in the last seven fiscal years have helped maintain the momentum of progress against cancer and other diseases (see Investments in Research Fuel a Healthier Future ). Additionally, NIH research grants help sustain the U.S. economy. In Fiscal Year (FY) 2022, the $36.68 billion awarded to researchers in the 50 U.S. states and the District of Columbia supported more than 568,000 jobs and nearly $97 billion in economic activity ( 59 ) United for Medical Research. NIH’s Role in Sustaining the U.S. Economy. Accessed: August 1, 2023. .

NCI’s current success rate of 14.1 percent in FY 2021 has created a grant funding crisis and has left potentially lifesaving cancer science and medicine unfunded. There are also serious concerns that early-stage scientists and those from underrepresented racial or ethnic backgrounds might choose other career paths instead of academic research, which will impede progress against cancer.

If Congress lowers the NCI budget, it will force the Institute to reduce pay lines to even lower levels. Such actions will result in highly meritorious grants being unfunded and make it harder for the next generation of scientists to build promising careers in cancer research.

Therefore, it is imperative that in the years ahead, Congress continues to provide sustained, robust, and predictable increases in investments in the federal agencies that are vital for fueling progress against cancer, in particular, NIH, NCI, FDA, and CDC (see AACR Call to Action ). Such investments will help the medical research community sustain the momentum of scientific and technological innovation and accelerate the pace of progress against cancer to achieve the President’s Cancer Moonshot goal of reducing U.S. cancer death rate by 50 percent by the year 2047.

• A Message from AACR
• Executive Summary
• A Snapshot of a Year in Progress
• Understanding the Path to Cancer Development
• Reducing the Risk of Cancer Development
• Screening for Early Detection
• Advancing the Frontiers of Cancer Science and Medicine
• Spotlight on Immunotherapy: Pushing the Frontier of Cancer Medicine
• Perspective: Looking to the Future of Immunology
• Supporting Cancer Patients and Survivors
• Envisioning the Future of Cancer Science and Medicine
• Advancing the Future of Cancer Research and Care Through Evidence-based Policies
• AACR Call to Action
• AACR President’s Vision: Future of Cancer Research and Care
• AACR Cancer Progress Report 2023: Steering Committee

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World Cancer Report: Cancer Research for Cancer Prevention

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Questions and answers, download pdf, what is the iarc world cancer report .

The new IARC World Cancer Report is the product of a collaboration between leading international scientists that describes multiple aspects of cancer research for cancer prevention. Starting with the latest trends in cancer incidence and mortality worldwide, this publication provides wide-ranging insights into cancer prevention based on the known causes of cancer, factors that determine how cancer develops, and the behaviour of different tumour types, and presents a broad scope of interventions to reduce the cancer burden from a global perspective. The scientific disciplines covered include descriptive epidemiology (the distribution of disease, and specifically cancer, within particular populations), cancer etiology (including infections, chemicals, radiation, metabolism and nutrition, and genetic factors), cellular and molecular biology, toxicology and pathology, behavioural and social sciences, public health, biostatistics, and informatics. Wild CP, Weiderpass E, Stewart BW, editors (2020). World Cancer Report: Cancer Research for Cancer Prevention. Lyon, France: International Agency for Research on Cancer. Available from: http://publications.iarc.fr/586 .

Who is this publication for?

World Cancer Report: Cancer Research for Cancer Prevention features the latest research from across multiple disciplines. It is aimed primarily at cancer researchers, academia, health professionals, and policy-makers, but this expert report remains accessible to a wider audience, including the general public, civil society, and the private sector.

What is the objective of the report?

The IARC World Cancer Report is the most comprehensive overview of relevant research yet available. This latest publication is part of a well-established series . Produced about every 5 years, World Cancer Report provides the latest evidence on cancer prevention and serves as an authoritative reference in the cancer research community. The volume editors of this new World Cancer Report are IARC Director Dr Elisabete Weiderpass, former IARC Director Dr Christopher P. Wild , and Professor Bernard W. Stewart of the University of New South Wales, Sydney, Australia.

What does the latest World Cancer Report include?

Based on how cancer is distributed worldwide, and differences between and within particular countries, this new assessment offers a comprehensive overview of the global cancer burden as a starting point for documenting all known options for cancer prevention through the latest research. The publication documents the causes of cancer, discussing infectious agents, alcohol consumption, metabolism and nutrition, physical activity, sedentary behaviour, and obesity as well as dietary carcinogens, occupational exposure, and the contamination of air, water, and soil, among other topics. The biological processes that affect cancer development are also presented, with a focus on sporadic cancer, genomics and susceptibility, gene–environment interactions, and DNA repair, as well as inflammation and its pivotal role in cancer pathogenesis, to name but a few. A full section is devoted to multiple chapters on the inequalities that affect the distribution of cancer within communities, clearly illustrating that in both high-income countries and low- and middle-income countries, there are groups of people in every community who are at a major disadvantage with respect to risk of cancer. Options for prevention include avoiding exposure to carcinogens, for example by smoking cessation, as well as vaccination, screening, monitoring those at high genetic risk, using therapeutics to reduce cancer risk, and emerging molecular technology for early diagnosis.

What’s new in this World Cancer Report ?

The impact of cancer on the global community can now be defined with greater precision than ever before. The causes of cancer are now better understood in terms of both the precise biological changes induced by causative agents and the characteristics of exposed people who prove to be susceptible to cancer development. This is the broad background against which both biological and sociological variables determine the distribution of cancer and, in many instances, its potential prevention. Factors determining cancer development and prevention The causes of cancer vary markedly in their character and impact. Cancer is just one of the diseases caused by tobacco smoking, but lung cancer and other cancer types caused by smoking are among the most lethal of such diseases. Millions of people are infected with human papillomavirus (HPV), Helicobacter pylori , or hepatitis B virus or hepatitis C virus, and are thus at risk of developing cervical cancer, stomach cancer, and liver cancer, respectively. Complex biological processes, including DNA repair, the occurrence of overweight or obesity, and the consequences of inflammation, are crucial determinants of cancer development. These processes are delineated in the new World Cancer Report . Although much is known about cancer causation, for many tumour types few, if any, relevant carcinogens have been identified. This applies to, for example, brain cancer and prostate cancer. For lung cancer, a broad spectrum of causes are known, beginning with active smoking and extending to second-hand smoke, certain occupations, and atmospheric pollution. Despite this, some individual cases of lung cancer have no evident cause. Such tumours, along with most cases of brain cancer and prostate cancer, are often described as sporadic. Another exciting first for the new World Cancer Report is a discussion of sporadic cancer and the biological principles that are thought to underpin the development of such cancer. Biological processes are common to all people, but the distribution of cancer in all countries is subject to socioeconomic differences. For the first time, inequalities as a determinant of cancer incidence and mortality are specifically addressed in a separate section of the new World Cancer Report . Previous World Cancer Reports described the disproportionately increasing burden of cancer in low- and middle-income countries, and this trend clearly persists. However, in all countries, irrespective of income grouping, sections of the communities are disadvantaged both in relation to circumstances of risk and with respect to prevention and treatment services. In the new World Cancer Report , separate chapters evaluate inequalities that affect cancer incidence in Africa, China, Europe, India, and the USA. Increasing options for cancer prevention Cancer prevention is often identified with community campaigns, such as those to promote smoking avoidance or cessation, to ensure that exposure to asbestos does not occur in the workplace and elsewhere, to prevent particular infections, and, particularly for fair-skinned people, to avoid deliberate sun exposure without sun protection. All these ways of preventing cancer remain relevant; they are proven to reduce cancer incidence, and research continues to demonstrate their efficacy. However, cancer prevention involves a far greater range of initiatives than avoiding exposure to known carcinogens. Perhaps the most effective means of cancer prevention, and one that has the prospect of eliminating one tumour type completely, is vaccination against human papillomavirus (HPV), which is the cause of cervical cancer. Vaccination against hepatitis B and C viruses also has a proven impact on the incidence of liver cancer in certain communities. The single greatest challenge to cancer prevention identified in the new World Cancer Report is overweight or obesity. Although the prevalence of overweight or obesity is readily identified with populations in high-income countries, this condition is now evident in many regions of the world. Multiple tumour types, including colorectal cancer and breast cancer, are attributable, at least in part, to overweight or obesity. The biological mechanisms by which overweight or obesity increases the risk of various tumour types are not yet fully explained. Altering community behaviour to reduce the prevalence of overweight or obesity is recognized as a means of preventing not only certain types of cancer but also other chronic diseases such as type 2 diabetes. For sporadic cancers in different organs (i.e. cancers for which no recognized exposure accounts for tumour development), options for prevention are emerging and are being evaluated by researchers. For multiple tumour types, World Cancer Report discusses population-based screening for detection of cancer at an early stage or of preconditions leading to cancer development. One chapter describes early diagnosis on the basis of tumour DNA detected in blood, and another describes how individual susceptibility to tumorigenesis may be determined using genomic data.

What is the difference between the WHO Report on Cancer and the IARC World Cancer Report ?

In May 2017, the cancer resolution ( WHA70.12 ) adopted at the Seventieth World Health Assembly requested WHO, in collaboration with IARC, to produce a comprehensive global report providing evidence-based public health- and policy-oriented guidance on cancer for WHO Member States. The outcome of this charge is the WHO Report on Cancer: Setting priorities, investing wisely and providing care for all . The WHO report complements the IARC World Cancer Report by synthesizing evidence to translate the latest knowledge into actionable policies to support governments to prevent and control cancer globally. These two complementary publications, launched jointly by WHO and IARC, will each contribute to an increased awareness, both professionally and in the wider community, of the lives affected by cancer, and what may be done, is being done, and should be done to decrease the impact of this disease.

What are the key messages in the IARC World Cancer Report ?

Cancer is the second most common cause of death worldwide, and the burden of cancer is increasing in all countries. This poses a rapidly growing threat to individuals, health systems, and economies globally. Countries must accelerate their multisectoral, evidence-based, and resource-appropriate responses now to avoid 7 million cancer deaths over the next decade. The cancer burden is predicted to nearly double over the next decade in low- and middle-income countries. If no additional action is taken, there will be millions of additional premature deaths from cancer over the next decade, and we will fail to achieve the United Nations Sustainable Development Goals target (Target 3.4) to reduce the total premature mortality from noncommunicable diseases, including cancer, by one third by 2030. The global cancer burden is expected to reach 29 million new cancer cases per year by 2040, a 62% increase on the estimated 18.1 million cancers in 2018. The increases in the cancer incidence burden will affect all countries, but the predicted increases will be proportionately greatest in low-income countries, due to known infectious agents, chemicals including tobacco, and obesity. World Cancer Report documents how the cancer burden continues to grow and emphasizes the need for urgent implementation of efficient prevention strategies to curb the disease. For cervical cancer, lung cancer, and most other cancer types, the relative incidence is greatest among those at socioeconomic disadvantage, particularly including ethnic and racial minorities and Indigenous populations. Cancer inequalities reflect the cultures and environments in which people are born, live, and work and the uneven application of preventive measures, both between and within countries. Vaccination and screening are effective for some cancer types but are differentially available. Most genomic data are from studies in individuals of European ancestry. In the future, the characterization of individual susceptibility to cancer and the closer identification of those at risk will enable precision cancer prevention.

Dr Elisabete Weiderpass, IARC Director, presents World Cancer Report: Cancer Research for Cancer Prevention

Professor bernard stewart presents world cancer report: cancer research for cancer prevention.

Published in section: Featured News

Publication date: 4 February, 2020, 6:50

Direct link: https://www.iarc.who.int/featured-news/new-world-cancer-report/

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• Evidence Gaps in Cancer Survivorship Care: A Report From the 2019 National Cancer Institute Cancer Survivorship Workshop ,  Journal of the National Cancer Institute  (2021)
• Disparities and Barriers to Pediatric Cancer Survivorship Care , Agency for Healthcare Research and Quality (2021)
• Childhood Cancer and Functional Impacts Across the Care Continuum ,  National Academies of Sciences, Engineering and Medicine  (2020)
• Follow-Up Care for Breast and Colorectal Cancer Across the Globe: Survey Findings From 27 Countries , Journal of Clinical Oncology Global Oncology  (2020)
• Developing a Quality of Cancer Survivorship Care Framework: Implications for Clinical Care, Research, and Policy ,  Journal of the National Cancer Institute  (2019)
• Survivorship Science at the NIH: Lessons Learned From Grants Funded in Fiscal Year 2016 , Journal of the National Cancer Institute (2019)
• Models of Care for Survivors of Childhood Cancer From Across the Globe: Advancing Survivorship Care in the Next Decade , Journal of Clinical Oncology (2018)
• Going Beyond Being Lost in Transition: A Decade of Progress in Cancer Survivorship , Journal of Clinical Oncology (2017) – co-authored by Dr. Julia Rowland, a look back at the 2006 IOM Report
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Adverse Event Signal Detection Using Patients’ Concerns in Pharmaceutical Care Records: Evaluation of Deep Learning Models

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The Cancer Research Institute (CRI) iAtlas is an interactive web-based platform and set of analytic tools for studying interactions between tumors and the immune microenvironment. These tools allow researchers to explore associations among a variety of immune characterizations as well as with genomic and clinical phenotypes. The initial version of CRI iAtlas is based on an analysis performed by The Cancer Genome Atlas (TCGA) Research Network on the TCGA data set comprising over 10,000 tumor samples and 33 tumor samples (Thorsson et al.  Immunity , 2018). In this analysis, each tumor sample was scored for a variety of readouts for immune response, such as immune cell composition, adaptive cell receptor repertoire, neoantigen load, and expression of genes coding for immunomodulatory proteins. The web tool allows research to explore these data readouts, and the relation between them in TCGA tumor types and in overarching immune subtypes identified in the study. The CRI iAtlas is made possible through collaboration between the Cancer Research Institute, Sage Bionetworks, and the Institute for Systems Biology. Moreover, the CRI iAtlas Targets module can now probe IO agent information in both the CRI Immuno-Oncology Landscape and the newly updated CRI Cancer Cell Therapy Landscape by respective gene.

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Cancer research landmarks, resource report, cancer immunology, cancer metabolism and molecular mechanisms, translational cancer biology, cancer landscapes, journal archive, cancer research (1941-present; volumes 1-current), the american journal of cancer (1931-1940; volumes 15-40), the journal of cancer research (1916-1930); volumes 1-14), table of contents, molecular mechanism of fasting-mimicking diet in inhibiting colorectal cancer progression: implications for immune therapy and metabolic regulation, epigenetic regulators open the door to sclc plasticity, targeting wnt/β-catenin via modulating ezh2 function: a new chapter in the treatment of β-catenin mutant hepatocellular carcinoma, bcl-xl targeting to induce apoptosis and to eliminate chemotherapy-induced senescent tumor cells: from navitoclax to platelet-sparing bcl-xl protacs, aacr cancer centers alliance: fostering collaboration and innovation to advance lifesaving scientific discoveries for patients, targeting the rna-binding protein hur in cancer, biallelic dicer1 mutations in the gynecologic tract of mice drive lineage-specific development of dicer1 syndrome–associated cancer.

Generation of a Dicer1 mutant mouse model establishes the oncogenicity of missense mutations in the DICER1 RNase IIIb domain and provides a faithful model of DICER1 syndrome–associated cancer for further investigation.

Fasting-Mimicking Diet Drives Antitumor Immunity against Colorectal Cancer by Reducing IgA-Producing Cells

Metabolic reprogramming of B cells induced by fasting-mimicking diet suppresses IgA class switching and production to activate antitumor immunity and inhibit tumor growth.

Cross-talk between Myeloid and B Cells Shapes the Distinct Microenvironments of Primary and Secondary Liver Cancer

The immunomodulatory patterns of tumor-infiltrating B cells are distinct in primary and secondary liver cancer, with plasma cells mediating important physiologic processes that drive cancer progression.

Parkin Deficiency Suppresses Antigen Presentation to Promote Tumor Immune Evasion and Immunotherapy Resistance

Parkin prevents immune evasion by regulating tumor antigen processing and presentation through the PTEN/Akt network, which has important implications for immunotherapy treatments in patients with Parkin-deficient tumors.

Matrix Stiffness Triggers Lipid Metabolic Cross-talk between Tumor and Stromal Cells to Mediate Bevacizumab Resistance in Colorectal Cancer Liver Metastases

Extracellular matrix stiffening drives bevacizumab resistance by stimulating hepatic stellate cells to provide fuel for mCRC cells in the liver, indicating a potential metabolism-based therapeutic strategy for overcoming resistance.

The IGF2BP3–COPS7B Axis Facilitates mRNA Translation to Drive Colorectal Cancer Progression

Increased expression of COPS7B mediated by IGF2BP3 elevates the translational efficiency of genes enriched in mRNA translation and ribosome biogenesis pathways, promoting protein synthesis and driving progression in colorectal cancer.

Expressed Barcoding Enables High-Resolution Tracking of the Evolution of Drug Tolerance

The evolution and heterogeneity of EGFR inhibitor tolerance are identified in a large number of clones at enhanced cellular and temporal resolution using an expressed barcode technology coupled with single-cell RNA sequencing.

Targeting BCL6 in Gastrointestinal Stromal Tumor Promotes p53-Mediated Apoptosis to Enhance the Antitumor Activity of Imatinib

BCL6 drives resistance to imatinib by inhibiting p53-mediated apoptosis and can be targeted in combination with imatinib to synergistically suppress tumor growth, providing a therapeutic strategy for treating gastrointestinal stromal tumor.

DNA Methylation-Based Testing in Peripheral Blood Mononuclear Cells Enables Accurate and Early Detection of Colorectal Cancer

Development of a diagnostic model for early colorectal cancer based on epigenetic analysis of PBMCs supports the utility of altered DNA methylation in immune cells for cancer diagnosis.

Genetic Variants That Impact Alternative Polyadenylation in Cancer Represent Candidate Causal Risk Loci

Cancer risk is mediated by alternative polyadenylation quantitative trait loci, including the rs1020670-G variant that promotes alternative polyadenylation of DNM1L and increases colorectal cancer risk.

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