effective oncologic medical products. Additionally, as tobacco products, including electronic cigarettes, remain the leading preventable cause of cancer, recent FDA efforts through its Center for Tobacco Products seek to reduce the use of these products. The Centers for Disease Control and Prevention (CDC) is another federal agency that plays an important role in driving progress against cancer. The agency’s Division of Cancer Prevention and Control (DCPC) works with state, local, territorial, and tribal health entities to develop and implement effective cancer prevention and screening practices. Key CDC cancer initiatives include programs to support early detection of breast, cervical, and colorectal cancer, as well as support for central cancer registries that are vital to data collection on cancer. The Biden administration remains committed to “ending cancer as we know it.” In February 2022, the administration relaunched the Cancer Moonshot, a whole-of-government initiative that aims to reduce the cancer death rate in the U.S. by 50 percent by 2047 (748). To help achieve the goals of the Cancer Moonshot, the National Cancer Plan lays out eight goals to accelerate progress against cancer (309). Funding support for medical research and the many cancer programs at NIH, NCI, FDA, and CDC remains critical, but the June 2023 agreement to raise the debt ceiling is making the prospect of increased appropriations for these agencies in FY 2024 very challenging. To ensure that federal agencies can advance progress against cancer, the medical research community must continue to advocate before Congress the importance of supporting robust, sustained, and predictable investments, most especially for the medical research supported by NIH. Investments in Research Fuel a Healthier Future Remarkable advances in medical research have led to significant improvements in cancer prevention and reductions in cancer mortality. Investments in cancer research have resulted in a 33 percent decrease in cancer deaths since 1991, preventing an estimated 3.8 million deaths. This progress is a result of NIH and NCI investments in research that developed stateof-the-art anticancer therapies and more effective screening tools to detect cancers at the earliest possible stage, as well as initiatives through FDA and CDC to raise public awareness of the importance of cancer prevention and cancer screenings. As a result of these efforts, there are now more than 18 million cancer survivors living in the United States (see Supporting Cancer Patients and Survivors, p. 132). Continued federal investments are needed to further the progress against cancer. Beginning in FY 2005, a decade of stalled funding at NIH caused budgets to be eroded by inflation (see Figure 22, p. 154). As a result, NIH’s purchasing power—the amount that each dollar invested can buy—was reduced by nearly 25 percent compared to the previous decade. This had a devastating impact on the ability of NIH to adequately fund research and meet the needs of the medical research community. The current political climate surrounding appropriations and NIH funding has once more created an uncertain environment for this necessary research. The FY 2024 Presidential Budget Request includes $48.6 billion in discretionary and mandatory resources for NIH, an overall increase of $811 million from FY 2023 (749). Within this budget, $7.8 billion (an increase of $503 million) was proposed for NCI (750); $2.5 billion was requested for ARPA-H (an increase of $1 billion); and $716 million for the reauthorization of the Cancer Moonshot through FY 2026. Major steps towards a cancer-free future for all can be achieved with these supplementary investments, as well as other FY 2024 allocations. A proposed $394.5 million investment is slated for CDC’s Division of Cancer Prevention and Control (DCPC) programs. The National Comprehensive Cancer Control Program, including the Cancer Genomics program, intends to increase the number of individuals who are appropriately referred to genetic counseling and testing; the National Breast and Cervical Cancer Early Detection Programs to enhance breast and cervical cancer screening and diagnostic services for uninsured and underinsured American women, addressing inequity in cancer prevention efforts; and the Colorectal Cancer Control Program to increase colorectal cancer screening rates among people ages 45 to 75. The Division works with state and local governments, community organizations, and health care providers to promote cancer prevention and early detection. These collaborations include funding for central cancer registries; comprehensive cancer control, which includes state, tribal, local, and territorial organizations; the National Breast and Cervical Cancer Early Detection Program; and initiatives focused on colorectal, skin, prostate, and ovarian cancer, as well as HPV-associated cancers (751). While Congress has made decisive commitments to medical research over the last eight fiscal years, a now strained budget is leading to a more uncertain future for medical research. Investments have been proposed to expand opportunities in medical research, cancer prevention, and cancer treatment. But the risk of not passing President Biden’s FY 2024 Budget, which is already below the One Voice Against Cancer (OVAC) budget provided to Congress, threatens the future funding of NIH, NCI, and other institutions. The need for increased funding, as opposed to flat funding, comes directly from the NCI’s budget projections, with their Professional Judgment Budget detailing the need for a $2.7 billion increase. Flat funding can set a precedent for lower funding in the future because future budget requests will have to be built from the FY 2024’s final budget. Additionally, if funding is kept at the same rate as FY 2023, it will not meet or address new costs AACR Cancer Progress Report 2023 153 Advancing the Future of Cancer Research and Patient Care Through the Adoption of Evidence-Based Policies
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