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This year, the twentieth since the National Cancer Act, was passed, has

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been marked by high scientific achievement for the National Cancer Program.

Research on gene therapies is progressing, resulting in new ways of

intervening against cancer.

Studies assessing the cancer risk posed by

nuclear facilities have been conducted.

New drugs to treat cancer patients

have been developed and new prevention strategies using vitamin derivatives

have proven effective.

A high level of sophistication in recombinant DNA

technology has been achieved and much of the biotechnology industry in the

United States has emerged from basic science Investigations in these areas.

One measure of the success of the National Cancer Act is that there are over

six million cancer survivors in the United States today. Despite these and

many other successes, the priority placed on cancer research by the National

Cancer Act is as needed today as it was in 1971 when the National Cancer

Program was founded.

There will be over a million new cases of cancer and a

half million people will die of cancer in the United States this year.


Americans who could benefit from the findings of this research do not

currently have access to state-of-the-art prevention, early diagnosis and


The National Cancer Institute also has an important role in AIDS research

and works closely with the National Institute of Allergy and Infectious

Diseases and other Federal agencies.

NCI scientists have made vital

contributions using basic biomedical research to study the pathogenesis and

natural history of Human Immunodeficiency Virus (HIV) infection, AIDS drug development, and vaccine development. The NCI intramural program is one of

the most important centers in the world for developing new therapies for

children with AIDS.

A new challenge is now on the horizon:

as people with

AIDS are surviving longer, the incidence of AIDS-related cancers is

increasing, and NCI is working to meet this challenge.

Cancer is the second leading cause of death among women in the United States, with more than 150,000 women expected to die of lung, breast, and colon cancers and cancers of the reproductive tract in 1991. Women

participate in every phase of NCI research and NCI strives for proportional representation of women in all clinical trials. Research on cancers that

affect the survival of women is an exceedingly high NCI priority.

Major progress has been made in reducing deaths from childhood cancers--a reduction of 36 percent between 1973 and 1987.

Almost two-thirds of children

with cancer now survive to the 5-year "cure" point.

There also has been

important progress in preventing or treating many common cancers in adults as well, particularly in people under age 65 where, for instance, the death rate

for colorectal cancer has fallen by approximately 15 percent in the last 20


The death rate for ovarian cancer has fallen by approximately 25

percent, about the same for stomach cancer, by 30 percent for bladder cancer,

and by nearly 40 percent for cancer of the cervix.

There has been less progress in reducing the death rate from the common

solid tumors in patients aged 65 and over.

There are disproportionate rates

of cancer mortality in some minority groups as well as in poor and underserved groups. Ironically, as technology for prevention, diagnosis and treatment improves, the groups without access to the technology appear to suffer even


In recognition of this, NCI has begun and will continue in 1992 to

develop new research and outreach programs to reach women, minority group

members, older individuals and other underserved groups.

The NCI cancer centers provide a resource within their geographic area

for interdisciplinary cancer research and for state-of-the-art diagnosis,

treatment, rehabilitation, prevention and control of cancer.

In 1992, the

comprehensive cancer centers will continue to emphasize community service and

outreach activities.

In addition, the centers are emerging as a potent

national resource for study of and state-of-the-art treatment for the rapidly

increasing number of AIDS-related cancers as well.

NCI's ability to transfer technology effectively rests on programs such

as the cancer centers, the clinical Cooperative Groups and the Community

Clinical Oncology Program (CCOP).

The CCOP is a network of community cancer

specialists, primary care physicians, and other health care professionals who

conduct both clinical treatment research and cancer prevention and control

research studies in the areas of early detection and screening,

chemoprevention, smoking, patient management, continuing care, and rehabilitation. The current program involves over 300 hospitals and 2,100

physicians. Approximately 5,000 patients per year are entered onto treatment

clinical trials through the CCOP alone, which represents about one-third of the annual Phase III accrual to NCI -approved randomized clinical trials.

New treatments continue to be developed.

NCI scientists and colleagues

from the National Heart, Lung and Blood Institute have conducted a number of

gene treatment studies.

Last year, gene transfer research successfully traced tire activity of reinfused genes. Last September, a related study introduced gene therapy for an extremely rare, inherited immune system disorder caused by

the absence of the enzyme adenosine deaminase (ADA).

The first patient, a 4

year old girl, has received monthly transfusions of gene-corrected white blood

cells, and preliminary results suggest that her immune function has improved.

We are now at the point of inserting genes for specific tumor-fighting

substances such as tumor necrosis factor into patients' genes.

The first two

patients were treated on January 29, 1991.

NCI - supported scientists are continuing to unravel the genetic mysteries

of the cancer cell and as a result, important new theories of how cancer

evolves from the normal cell are emerging.

About 10 years ago it was discovered that a gene, located at the 13q14 position (on chromosome 13), was

missing in familial retinoblastoma, a rare childhood cancer of the eye.


protein produced by the gene at 13q14 is called RB.

The normal RB gene

appears to play a role in the suppression of cancer.

Abnormalities in the RB

gene and the RB protein have been found in acute lymphocytic leukemia,

osteosarcomas and in many of the common "adult" tumors such as lung and breast. Abnormalities in another suppressor gene, p53, have been detected in colorectal cancer and other common malignancies, including lung and breast


The Li-Fraumeni syndrome is characterized by multiple tumors and is

inherited within families. NCI-supported scientists have recently pinpointed an inherited mutation of p53 as the responsible factor for these multiple


Finding this critical gene may allow counseling of individuals with

this inherited syndrome, and increase the understanding of the mechanisms that result in the transformation of a normal cell into a malignant ceil.

NCI has an active drug development program for cancer and AIDS.


high capacity drug screen examines synthetic compounds and natural products

for activities against many human tumor cell lines and retroviruses such as

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A large number of the cancer drugs available today have been developed

through the support of the National Cancer Program. Currently, there is great interest in the compound taxol as it can kill ovarian and breast cancer cells.

Unfortunately, taxol is extracted from the bark of yew trees and stripping the

bark kills the tree.

However, so that clinical tests can go forward, NCI is

making production of taxol fron alternative renewable sources a priority. The development of taxol and clinical Investigations of taxol in combination with

other drugs will continue in 1992.

Prevention is the most effective way to eliminate a disease.

Studies in

chemoprevention point the way to the day when people at high risk for cancer

or those with premalignant conditions will be protected from getting cancer by

adding a vitamin supplement, a micronutrient or other chemopreventive agent to

their diets.

Recently, findings from chemoprevention studies have shown that

vitamin A-related compounds can prevent oral cancers and second primary head

and neck tumors.

A new prevention clinical trial will employ tamoxifen, an anti-estrogen

agent, as a breast cancer prevention agent.

Tamoxifen has the potential to

reduce the incidence of breast cancer by some 30 to 50 percent among

postmenopausal women.

NCI is planning a two to three year study to determine the feasibility of

conducting a full randomized dietary intervention trial to assess the impact

of a low fat diet on the prevention of cancer and cardiovascular disease among


A broad cross-section of women will be recruited to the feasibility

trial with special attention to women from poor and underserved minority

groups whose cancer mortality statistics are particularly high.

Tobacco use remains the single most deadly contributor to cancer

mortality rates.

NCI supports several large-scale smoking cessation studies:

the Community Intervention Trial for Smoking Cessation (COMMIT), and the

American Stop Smoking Intervention Study (ASSIST).

There is an intense effort to develop vaccines and vaccine-like

approaches to the prevention of cancer.

Vaccination is a classical tool to

prevent diseases caused by a virus, and since a number of cancers are linked

to a virus, vaccination is a promising strategy.

For instance, Epstein-Barr

virus and related viruses are detected in Burkitt's and other B cell

lymphomas, oral hairy leukoplakia, nasopharyngeal carcinoma, and AIDS-related

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virus, a risk factor for the development of liver cancer.


researchers have reported significant regressions of non-virus-caused malignant melanoma tumors using a vaccine-like approach to increase the

patient's immune response.

NCI has pioneered the rapid communication about advances in clinical


NCI disseminates important new clinical research results via

professional journals, PDQ, clinical announcements, press conferences, and

consensus development conferences.

The latest information about cancer

treatment and clinical trials is available via the NCI's Cancer Information


Over 500,000 patients, families and doctors received information via

the CIS toll-free 1-800-4-CANCER telephone number.

NCI also reaches the

public in novel ways, for instance, adding cancer education messages to rental

videos of popular films.

Last year, to extend information services abroad,

NCI installed a state-of-the-art system using a compact disk technology (CD

ROM) product at demonstration sites in three cancer research Institutes in

Eastern Europe.

In 1992, an additional 15 systems will be installed in

developing countries.

A number of NCI publications also are being provided

free of charge to key medical libraries and academic institutions in Poland,

Hungary, and the Soviet Union.

In conclusion, we have accrued understanding of the basic biology of

cancer, which in turn is pointing to effective prevention, diagnostic and

treatment strategies.

We must continue our progress and NCI stands ready to

fulfill that goal.

Mr. Chairman, the FY 1992 budget request for the National Cancer

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College of Literature, Science and the Arts (high honors)
School of Medicine (cum laude)

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National Cancer Institute, National Institutes of Health, Bethesda, MD


clinical Associate, Metabolism Branch
Investigator, Medicine Branch
Senior Investigator, Metabolism Branch
Associate Director, clinical Oncology Progran
Director, National Cancer Institute

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