We are probably all aware that the Trump Administration has slashed medical research funding across the board, cancer definitely included.
What you may not be aware of is that the Senate passed a budget this week giving NOAA, NASA and the National Science Foundation more funds than the White House requested. (The House passed the bill last week.) Although, the timing of National Institutes of Health (NIH) funding remains under negotiation, Congress has rejected cuts here, as well.
Other good news: a federal appeals court ruled last week that the Trump Administration did not have the authority to cut NIH funding last February! (An appeal is self-evident.)
I’m probably more interested in NIH research than most of you. I have stage 4 or distant breast cancer. Originally diagnosed as a regional disease (stage 3c) in spring 2017, I found myself upstaged seven years later.
It’s medical research that has let me live almost two years since diagnosis, thriving with a very targeted form of treatment. Thank you, National Cancer Act of 1971.
But I get a little grumpy when I see headlines like these: Cancer survival rates reach record high and US hits new milestone in cancer survival rates. That’s because “survival” doesn’t mean what you think it means, unless you or someone you know has had cancer. “Survival” means you’re still alive five years after initial diagnosis.
Neither does “cancer,” for that matter.
Those headlines that set my teeth on edge aren’t entirely the fault of the American Cancer Society: they want us to know that we are making progress regarding cancers in the aggregate. (The overall cancer risk is 1-in-2 for US men and 1-in-3 for US women.)
Five-year survival rates range widely depending on the type of cancer. Our family has also been touched by stage 4 pancreatic cancer (the aggressive kind); my mother-in-law lived less than four months after diagnosis.
Look. “Cancer” is an extremely heterogeneous disease. Not only are there different cancers associated with different organs, there is often more than one cancer type per organ. Plus cancer tumors are found at different stages of growth. There’s one thing they have in common: unrestrained cellular growth.
Breast cancer is the most common cancer affecting women.
The most common form of breast cancer in women, ductal, is confined to the breast duct (stage 0) and is thus “non-invasive.” Invasive ductal carcinoma may be local, having escaped the duct but not the breast; be regional, having grown larger and invaded adjacent lymph nodes; or distant, affecting another organ of the body (stage 4 or metastatic).
But there are also invasive lobular and inflammatory breast cancers. There’s breast cancer associated with the BRCA gene. There are triple negative and HER2-positivecancers, which are defined by less common biological characteristics.
Heterogeneous disease, single location.
The incidence of breast cancer in women (percentage of breast cancer diagnoses) has not changed dramatically since the 2005-2014 average, as these charts from the National Cancer Institute show.
Earlier detection and advances in treatment mean more people live five years after diagnosis today than 40 years ago. But how much longer? That’s not an easily obtained statistic because tracking stops at five years. Also, understand that about 1-in-3 women diagnosed with invasive breast cancer will experience metastatic (stage 4) disease. Of women with metastatic disease, only about 1-in-3 will live 5+ years after diagnosis.
Breast cancer may be the most common cancer for women but it’s not the most fatal type of cancer.
There has been tremendous improvement in five-year survival for men and women whose cancers were extremely fatal during the mid-1990s. For example, survival rates for myeloma, a bone marrow cancer, almost doubled from 32% to 62%. Lung cancer survival rates have also almost doubled, from 15% to 28%, but some of that improvement comes from a reduced incidence of smoking in the population (from about 40% in the 1970s to 22% in 1995 to 15% in 2020).
There may not be a lot of us, percentage-wise, but we women living with metastatic breast cancer would also like more research focus on life after that five-year survival period. We’re a small part of the breast cancer population, but unfortunately our numbers are growing. In 2004, the incidence of metastatic cancer at diagnosis was 6.4 per 100,000. In 2023, it was 8.3.
All of us want to see treatments progress from cut (surgery), burn (radiation) and poison (chemotherapy). Research in targeted therapies is a rich promise, but research requires investment.
That’s why I urge you to ask your senators to support boosting NIH research funding with grant timing following the historical pattern. Then thank them if they do. Don’t know how? Head here: https://www.congress.gov/contact-us !
