WASHINGTON (NYTIMES) - President Joe Biden unveiled a plan on Wednesday (Feb 2) to reduce the death rate from cancer by at least 50 per cent over the next 25 years - an ambitious new goal, he said, to "supercharge" the cancer "moonshot" programme he initiated and presided over five years ago as vice-president.
Biden, joined by his wife, Jill Biden, and Vice-President Kamala Harris, also announced a campaign to urge Americans to undergo screenings that were missed during the coronavirus pandemic. And he said he would create a new "cancer Cabinet" to centre the fight against cancer inside the White House.
"Let there be no doubt," the president declared during a White House ceremony attended by roughly 100 people, including patients, doctors, caregivers, researchers and members of Congress. "Now that I am president, this is a presidential White House priority - period."
But despite the grand ambitions of the moonshot, cancer experts expressed doubt that it would be possible to so profoundly reduce the age-adjusted death rate, which accounts for expectations that older people are more likely to grow ill and die.
More screenings are not the answer - the only cancers for which screening has indisputably lowered the death rate are colon and cervical. Death rates for other cancers, like breast, have fallen, but a large part of the drop, if not all of it, is because of improved treatment, said Donald A. Berry, a biostatistician at the University of Texas MD Anderson Cancer Centre who has spent decades studying these issues.
"Everybody loves early detection, but it comes with harms," he said - principally, the harm of finding and treating tumours that do not need to be treated because they are innocuous. "The harms we know, but the benefits of screening are very uncertain," he said.
If the age-adjusted cancer death rate were to plunge by 50 per cent, it would have to be because cancers were being cured. Some treatments, like a drug that treats chronic myelogenous leukaemia, have slashed death rates for that disease, but such marked effects in cancer are few and far between.
The president has a deep personal interest in cancer research; in 2015, his son Beau died of glioblastoma, an aggressive brain cancer. The next year, president Barack Obama called on Biden in his State of the Union address to lead the moonshot programme, with a goal of making "a decade's worth of advances in cancer prevention, diagnosis and treatment" in five years.
At the time, Congress authorised US$1.8 billion (S$2.4 billion) over seven years; roughly US$400 million of that money has yet to be allocated. The National Cancer Institute, which oversees the initiative, says it has already spent US$1 billion on more than 240 research projects.
Senior administration officials, speaking on condition of anonymity, said on Tuesday evening that the White House would not be announcing any new funding commitments, but insisted that there would be "robust funding going forward."
Biden called on Congress to appropriate money to create a health research initiative modelled on the Pentagon's Defence Advanced Research Projects Agency, known as Darpa.
The White House billed the event as a fresh push by the president to "reignite" the moonshot programme and "end cancer as we know it."
Specifically, Biden set a goal of cutting the age-adjusted death rate by more than half over the next 25 years. But there were few specifics about how that goal would be achieved.
"These are audacious goals, and I have no doubt there will be mechanisms to achieve them," said Ellen V. Sigal, the founder of Friends of Cancer Research, which works to support cancer research and deliver new therapies to patients, who was briefed on the plan.
Biden has already named Danielle Carnival, who worked on the moonshot programme during the Obama administration, to help oversee the new version of the effort. Now, the president said, the "cancer Cabinet" will coordinate the work of multiple government agencies.
The White House says more than 9.5 million cancer screenings were missed in the United States as a result of the pandemic. Biden is calling on the cancer institute, a branch of the National Institutes of Health, to coordinate with cancer treatment centres to offer screenings around the country, and to develop a programme to fast-track the development of tests that can detect multiple types of cancer at once.
The new blood tests that are said to detect all cancers are still unproven and there are currently no plans to do the sort of very large studies that could determine if they actually prevent deaths and are not harming people with unnecessary treatment. But companies interested in them were thrilled with Biden's announcement.
"Making early cancer detection more affordable and accessible, especially for traditionally underserved groups, is the next leap forward in reducing cancer death rates," Francis deSouza, the chief executive of Illumina, a medical device company, said in a statement.
Yet, one Wall Street analyst who specialises in biotechnology and pharmaceuticals said that the time, money and effort might be better spent on initiatives to prevent cancer, like reducing smoking and rates of obesity. The Centres for Disease Control and Prevention says being obese increases a person's risk of cancer. And reducing smoking is a proven way to cut the cancer death rate.
"This moonshot is 100 per cent hype; this is the absolute wrong way to do this," said the analyst, Stephen Brozak, the president of WBB Securities.
Presidents since Richard Nixon have sought to tackle cancer, of which there are more than 100 types of disease that can vary in how they grow, spread and respond to treatment.
The cancer institute estimates that nearly 40 per cent of men and women will be diagnosed with some type of cancer at some point during their lifetimes. The American Cancer Society estimates there will be 1.9 million new cases of cancer in the United States this year, and more than 609,000 cancer deaths.
Most experts no longer talk of "curing" cancer; that language is far too simplistic, and the White House is not using it. But officials say it is possible to make substantial progress in the fight against cancer through early diagnosis and improved treatments.
There have been great strides in cancer research, treatment and prevention in the five years since the original moonshot programme was announced. Targeted therapies are helping cancer patients live longer. Doctors can now detect some cancers through a simple blood draw. More refined colonoscopies are preventing more colon cancers.
"The original moonshot demonstrated that it was possible to compress a decade's worth of progress into a few short years," Sigal said, adding, "We can't afford to not make that opportunity a reality again."