Biden's Cancer Moonshot and how innovation and collaboration can close the cancer care gap

Over the last 20 years, cancer death rates in the US have fallen by 27%, yet nearly 600,000 still die from cancer, making it the second leading cause of death in the US. This week, the Biden-Harris Administration announced a relaunch of the country’s Cancer Moonshot project, which aims to reduce the cancer death rate by at least 50% by 2047 and improve the experience of people and their families living with and surviving cancer.

There are over 200 different types of cancer, each of which can set a patient off on a long and arduous journey. For many patients, families, and caregivers, where you live determines the type of journey you experience. In contrast to previous initiatives, the new Cancer Moonshot project does not shy away from cancer’s unequal toll across vulnerable communities, a reality that must be addressed within the US and abroad. As the US invests in new technologies to reduce cancer mortality, questions of access should remain at the forefront.

Building on progress made during the previous Cancer Moonshot initiative, technological innovation in cancer prevention, diagnosis, and treatment will continue to drive down mortality and improve patient outcomes.

When diagnosed early, cancer patients are more likely to respond well to treatment and avoid delays in care. Unfortunately, cancer cells have a variety of ways to hide and avoid detection. Scientists are identifying new biomarkers – molecules indicating cancer – and developing easier and cheaper diagnostics. A new trial is underway to try out a home-testing “Prostate Screening Box” designed to diagnosis aggressive prostate cancer using a urine sample. Finding new non-invasive ways to detect cancer and removing barriers, such as traveling to a doctor’s office, will be valuable in diagnosing cancer sooner.

Advancing precision medicine is a key objective for the relaunched Cancer Moonshot. Pairing the right treatment to the right patient relies on understanding the intricacies of a person’s particular cancer. DNA sequencing has become a standard procedure in precision medicine and can help doctors customize an effective treatment regime. Entire human genomes can now be sequenced in roughly five hours, foreshadowing a future when rare cancer-causing mutations may be quickly spotted in order to prepare a custom therapy.

Customization is part of the appeal for developing mRNA vaccines for cancer. The same technology behind mRNA vaccines for COVID-19 is being applied to treat cancers by teaching immune cells to specifically locate and destroy cancerous cells. Similarly, chimeric antigen receptor (CAR) T cell therapy uses engineered immune cells to selectively attack cancer cells. While CAR-T therapy has been around for several years, research is expanding their use into a wider range of cancer types.

Artificial intelligence (AI) is impacting nearly every facet of healthcare, and cancer is no exception. By training computers to detect patterns among thousands of ultrasound images, researchers are using AI to identify malignant breast cancer. Rather than replacing doctors, AI may soon become valuable assistants improving the speed and accuracy of diagnoses.

The theme of World Cancer Day 2022 is “Close the Care Gap,” a call to improve patient access to timely, effective, and affordable cancer prevention, diagnosis, and treatment services. The Cancer Moonshot project aims to address inequities within the US by improving access to cancer screening through at-home screening programmes and mobile screening services. While the US addresses the domestic care gap, the looming global cancer crisis is a gap that continues to widen.

Cancer is the leading cause of death worldwide, accounting for nearly one in six deaths. In 2020, approximately 10 million people died from cancer, 70% of whom lived in lower- and middle-income countries (LMICs). While impressive technological advancements in cancer diagnosis and treatment have saved countless lives, applying these tools in low-resource settings is impaired by systemic problems across drug procurement, workforce development, and policy.

International and cross-sector public-private partnerships are vital to strengthening healthcare infrastructure and building clinical oncology capacity in LMICs. For example, BIO Ventures for Global Health’s African Access Initiative (AAI) accelerates access to cancer treatment by facilitating agreements between pharmaceutical companies and health ministries to lower costs of medicines. AAI is also addressing workforce limitations by training pathologists across Africa to improve their cancer diagnosis capacity. The demand for African pathologists to make quick and accurate diagnoses is rising since the average number of pathologists per citizen in Africa is roughly 1 in 1 million, a ratio that is 50-fold lower than the US.

Standardization is an effective way to promote the use of evidence-based care across diverse settings, from rural clinics to urban hospitals. The National Comprehensive Cancer Network recently released Harmonized Guidelines for Sub-Saharan Africa to guide clinical decision-making and offer pragmatic approaches to improve the availability of effective treatment options.

Information is likely to be an effective yet underutilized tool in turning the tide on rising cancer cases in LMICs. The World Health Organization estimates that around “one-third of deaths from cancer are due to tobacco use, high body mass index, alcohol consumption, low fruit and vegetable intake, and lack of physical activity.” Roughly 80% of the current 1.1 billion smokers live in LMICs. Only seven of these countries have active cessation policies designed to discourage smoking, meaning that lung cancer may remain the common cause of cancer death worldwide for the foreseeable future. Encouraging healthy lifestyles is an immediate step that countries can take to close the global care gap.