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). 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). Funding Cancer Research: A Vital Investment 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). 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). 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). 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). 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 Global Burden of Cancer Cancer is a major public health challenge worldwide, as reflected by the rising number of new diagnoses and deaths around the globe. The disparate burden of cancer based on the human development index (HDI) of a country (a composite measure of social and economic development that accounts for income per capita, average years of education, and life expectancy at birth) highlights key barriers to achieving global health equity. Examples included here offer a broad view of the global burden of cancer. Tracheal, bronchus, and lung cancers are the leading causes of cancer deaths (34). Breast cancer is the leading cause of cancer-related deaths among women (41). Diagnoses and deaths from colorectal cancer more than doubled over the past three decades (51). Liver cancer is among the top five causes of cancer death in 90 countries; the number of new cases per year is predicted to increase by 55 percent between 2020 and 2040 (52). Six percent of new cervical cancer cases in 2018 were diagnosed in women living with HIV and five percent were attributable to the HIV infection. Eighty-five percent of women with cervical cancer and HIV live in sub-Saharan Africa (53). SIDEBAR 4 40 60 0 20 80 100 120 INCREASE IN ESTIMATED NEW CANCER CASES BETWEEN 2020 AND 2040 Percent (%) Very High HDI Countries Medium HDI Countries High HDI Countries Low HDI Countries 32% 56% 64% 95% Source: (30). AACR Cancer Progress Report 2023 Cancer in 2023 22
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