Excerpts from the 12th edition of the annual AACR Cancer Progress Report (https://cancerprogressreport.aacr.org/progress/) to U.S. Congress and the public highlight how medical research continues to extend and improve lives by accelerating advances in cancer prevention, detection, diagnosis, and treatment. Current challenges are described, and a call to action is issued.

Despite the major strides, cancer continues to pose a significant threat in the United States and worldwide. This is underscored by the sobering reality that in the United States alone, an estimated 609,000 lives will be lost to cancer in 2022. This number is predicted to increase considerably in the coming decades because cancer is largely a disease of aging, and the segment of the U.S. population ages 65 and older is growing.

Cancer can strike anyone—regardless of age, race, ethnicity, ancestry, socioeconomic status, sexual orientation, gender identity, location, or political affiliation. As highlighted in the AACR Cancer Disparities Progress Report 2022 (ref. 1; https://cancerprogressreport.aacr.org/disparities/), advances against cancer have not benefited everyone equally; racial and ethnic minorities and certain underserved populations shoulder a disproportionate burden of cancer. This is unacceptable. As a scientific organization focused on preventing and curing all cancers, diversity, equity, and inclusion are at the core of our work. The American Association for Cancer Research (AACR) is fiercely committed to understanding and addressing the biological and systemic roots of cancer disparities and to ensuring that health equity through research, policy, and advocacy is a national priority.

In February 2022, U.S. President Joseph R. Biden Jr announced a reignition of the Cancer Moonshot. The reignited Cancer Moonshot will provide an important framework to help improve cancer prevention strategies, increase cancer screenings and early detection, reduce cancer disparities, and propel new lifesaving cures for patients with cancer. Therefore, the AACR urges Congress to continue to support robust, sustained, and predictable annual growth of the NIH and NCI budgets and to provide consistent and sufficient annual funding for the Cancer Moonshot, the FDA, and the Centers for Disease Control and Prevention (CDC). These actions will transform cancer care, increase survivorship, and bring lifesaving cures to the millions of people whose lives are touched by cancer.

The remarkable progress being made against cancer—in particular, improvements in reducing smoking rates and developments in early detection and treatment—is resulting in cancer death rates falling steadily and the number of people who survive a cancer diagnosis to rise. In fact, the age-adjusted overall cancer death rate has declined by 32% between 1991 and 2019 in the United States, a reduction that translates into nearly 3.5 million cancer deaths avoided (2). Among children and adolescents with cancer, overall death rates have declined by more than half between 1970 and 2019, largely due to advances in treatment (2). In addition, in the past 3 years, the number of adults and children living in the United States with a history of cancer rose by more than a million, exceeding an estimated 18 million on January 1, 2022 (3).

The steady decline in the overall cancer death rate can be attributed mainly to the unprecedented progress against lung, colorectal, breast, and prostate cancers, the four most common cancer types in the United States. During the past three decades, age-adjusted death rates from lung, female breast, and colorectal cancers have decreased by 44%, 42%, and 53%, respectively (4). Furthermore, there have been significant developments against previously intractable cancers, such as melanoma, the deadliest form of skin cancer, fueled by a range of innovative new therapeutics that have moved rapidly from the bench to the clinic and received approval by the FDA. Collectively, these advances have led to the increase in 5-year relative survival rate for all cancers combined from 49% in the mid-1970s to nearly 70% from 2011 to 2017, which are the most recent data available (2).

Although we have made incredible progress against cancers, this group of devastating diseases continues to be an enormous public health challenge in the United States and around the world. In the United States alone, it is predicted that 1,918,030 new cases of cancer will be diagnosed in 2022 and that 609,360 people will die from the disease (ref. 2; see Fig. 1). These estimates do not account for the consequences of COVID-19, which has proven to have an adverse impact across the spectrum of cancer research and patient care, including significant declines in cancer screening and diagnosis, as detailed in the AACR Report on the Impact of COVID-19 on Cancer Research and Patient Care (https://cancerprogressreport.aacr.org/covid/; ref. 5). In addition, data from the past two years have clearly shown the heightened risks of SARS-CoV-2 infection and severe COVID-19 among patients with cancer, albeit COVID-19–related mortality among this population has decreased over time (5, 6). Ongoing research will uncover the long-term effects of COVID-19 on cancer outcomes (7).

Figure 1.

Estimated incidence (A) and mortality (B) for selected cancers in the United States in 2022. In A, cancers contributing to <2% of the estimated new cases in 2022 include (clockwise) brain and central nervous system (CNS); gallbladder and other biliary/digestive organs; soft tissue (including heart); small intestine; testis; anal; other nonepithelial skin; bones and joints; eye and orbit; and penis and other genital. In B, cancers contributing to <2% of the estimated cancer-associated deaths in 2022 include (clockwise): gallbladder and other biliary/digestive organs; melanoma (skin); soft tissue (including heart); other nonepithelial skin; thyroid and other endocrine; bones and joints; small intestine; anal; penis and other genital; testis; and eye and orbit. Adapted from Table 1 in the AACR Cancer Progress Report 2022 and ref. 2.

Figure 1.

Estimated incidence (A) and mortality (B) for selected cancers in the United States in 2022. In A, cancers contributing to <2% of the estimated new cases in 2022 include (clockwise) brain and central nervous system (CNS); gallbladder and other biliary/digestive organs; soft tissue (including heart); small intestine; testis; anal; other nonepithelial skin; bones and joints; eye and orbit; and penis and other genital. In B, cancers contributing to <2% of the estimated cancer-associated deaths in 2022 include (clockwise): gallbladder and other biliary/digestive organs; melanoma (skin); soft tissue (including heart); other nonepithelial skin; thyroid and other endocrine; bones and joints; small intestine; anal; penis and other genital; testis; and eye and orbit. Adapted from Table 1 in the AACR Cancer Progress Report 2022 and ref. 2.

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Variable Progress among Stages at Diagnosis and Types of Cancer

Progress against cancer has not been uniform for all stages of a given type of disease (https://seer.cancer.gov/statistics-network/explorer/application.html; ref. 8). This issue is illustrated by the fact that the 5-year relative survival rates for U.S. patients vary widely depending on the stage at diagnosis. As one example, among women with breast cancer and people with colorectal cancer, those whose cancer is confined to the breast or to the colon or rectum have 5-year relative survival rates of 99% and 92%, respectively, whereas those whose cancer has spread to a distant site have 5-year relative survival rates of 30% and 16%, respectively.

An additional challenge that we face is the uneven progress against various cancer types. For example, the overall 5-year relative survival rates of nearly 91% for women with breast cancer and 97% for men with prostate cancer stand in stark contrast to the overall 5-year relative survival rates of 21% for people with liver cancer and less than 12% for those with pancreatic cancer. Although some of these differences could be attributed to early detection of breast and prostate cancers through population-level screening, disparities in 5-year relative survival rates hold true for patients with these four cancer types even when their diseases are diagnosed at an advanced stage. The 5-year relative survival rates of greater than 30% for advanced-stage female breast and male prostate cancers are significantly higher than the 5-year relative survival rates of less than 5% for those with advanced-stage liver or pancreatic cancer.

Developing new and effective tests for the early detection of more types of cancer could help address the challenges of variable progress against different types of cancer. This is partly because patients diagnosed when cancer is at an early stage, before it has spread to other parts of the body, have a much higher likelihood of long-term survival than those diagnosed when the disease has spread to distant sites, an occurrence known as metastasis.

Among children ages 1 to 14 years, cancer is the second leading cause of death, and the most diagnosed cancers are leukemia and brain tumors (2). Thanks to extraordinary advances in treatments for childhood leukemia, the age-adjusted mortality rate from the disease has almost halved in the past two decades. Unfortunately, mortality rates from childhood brain and other central nervous system tumors have essentially remained unchanged.

Disparities in Progress for Certain Population Groups

Cancer health disparities are one of the most pressing public health challenges in the United States. NCI defines cancer health disparities as adverse differences in cancer such as number of new cases, number of deaths, cancer-related health complications, survivorship and quality of life after cancer treatment, screening rates, and stage at diagnosis that exist among certain population groups (9).

As outlined in the AACR Cancer Disparities Progress Report 2022, racial and ethnic minorities and other medically underserved U.S. populations shoulder a disproportionately higher burden of cancer (1). As one example, the U.S. Black population has long experienced cancer health disparities. In 1990, the overall cancer death rates for Black people were 33% higher than for white people (8). There has been some progress in recent years as evidenced by the narrowing of the gap in cancer death rates between the Black and white populations to 13% in 2019, a 60% decline since 1990 (10). However, even in 2019, overall cancer death rates were higher among Black men and women compared with all other U.S. racial and ethnic groups (10).

Sexual and gender minorities (SGM) are another U.S. population that experiences cancer health disparities. According to a new report, gay men are more likely than heterosexual men to report lifetime diagnoses of cancers, and gay men and lesbian women are more frequently unable to afford many types of health care services compared with heterosexual men and women (11). Unfortunately, there are limited data on the epidemiology of cancer incidence and outcomes among SGM individuals, making it difficult to evaluate the true burden of cancer in this underserved population. It is imperative that researchers collect disaggregated data by sexual orientation and gender identity, as well as within sexual minority groups (e.g., gay vs. bisexual) and gender minority groups (e.g., transgender vs. nonbinary), to accurately capture cancer epidemiology in these heterogeneous populations (9).

Research has identified complex and interrelated factors, often referred to as the social determinants of health, including socioeconomic, cultural, behavioral, environmental, and clinical factors that contribute to cancer health disparities. It is increasingly evident that structural racism and systemic injustices cause adverse differences in social determinants of health, creating conditions that perpetuate health inequities, including cancer health disparities.

One of the drivers of cancer health disparities is the general health of a population group. For instance, individuals with underlying health conditions, such as diabetes, or those infected with certain pathogens, such as human immunodeficiency virus (HIV), experience a greater burden of cancer. It should be noted that individuals with intersectional identities often experience multilevel barriers to optimal health care that adversely impact cancer incidence and outcomes. As one example, among individuals living with HIV, those who are from racially and ethnically minoritized populations may experience worse cancer health disparities (12) than those who are not. Understanding the biological drivers of cancer health disparities in marginalized populations with intersectional identities is an area of active investigation (12).

Considering that a significant proportion of the U.S. population is affected by cancer health disparities, it is important that public health experts intensify research efforts designed to improve our understanding and mitigation of these disparities. Only with new insights obtained through innovative research, including basic science using biospecimens from diverse populations, clinical trials involving participants from all sociodemographic backgrounds, and health care delivery research, will we develop and implement interventions that may eventually eliminate cancer for all populations.

The Growing Burden of Cancer

The public health challenge posed by cancer is predicted to grow considerably in the coming decades unless we develop and implement more effective strategies for cancer prevention, early detection, and treatment. In the United States alone, the number of new cancer cases diagnosed each year is expected to reach nearly 2.3 million by 2040 (https://gco.iarc.fr/today). This is largely because cancer is primarily a disease of aging: 80% of U.S. cancer diagnoses occur among those who are 55 or older, 57% of diagnoses occur among those 65 and older (2), and this segment of the U.S. population is expected to grow from 54.1 million in 2019 to nearly 81 million in 2040 (13). Also contributing to the projected increase in the number of U.S. cancer cases are high rates of obesity and physical inactivity, which are both linked to some common types of cancer, and the continued use of tobacco products among certain U.S. populations.

Progress has been made toward reducing cancer incidence in the United States: New cancer cases have declined 10% from their peak in 1992 to 2019, the year for which the most recent data are reported. However, overall cancer incidence has been rising among the U.S. adolescent and young adult population (ages 15–39), which has seen nearly a 20% increase in cancer incidence from 2000 to 2019 (8). In addition, the incidence of certain cancer types is steadily increasing, specifically among people younger than 50. As one example, many recent studies have reported an increase in the incidence of early-onset colorectal cancer among those ages 49 and younger (14, 15). The reasons behind rising cases of early-onset colorectal cancers are not completely understood but are presumed to be multifactorial, including contributions of modifiable lifestyle factors such as unhealthy diet and physical inactivity as well as use of antibiotics and other factors that alter the gut microbiome. To reduce the burden of early-onset colorectal cancer, many professional societies have modified their screening guidelines to recommend starting colorectal cancer screening at an earlier age. Additionally, researchers are evaluating new and improved strategies including genetic testing and others for the prevention and early detection of colorectal cancer in the younger population (14).

The Global Challenge of Cancer

Beyond the United States, cancer is an ongoing global challenge. According to a new analysis, there were an estimated 17.2 million new cancer cases (excluding nonmelanoma skin cancer) and 10 million cancer deaths globally, in 2019 (16). The study evaluated cancer burden from 204 countries and territories as indicated by cancer-related deaths, as well as disability-adjusted life years (DALY) and years of life lost (YLL), which are two measures of cancer morbidity. Researchers found that among the 22 groups of diseases and injuries analyzed, cancer was second only to cardiovascular disease in the number of deaths, DALYs, and YLLs (16). The five leading causes of cancer-related morbidity among men and women combined were lung cancer, colorectal cancer, stomach cancer, breast cancer, and liver cancer.

The study also indicated that, although there were increases in the absolute numbers of both global cancer deaths and new cases from 2010 to 2019, the age-standardized mortality and incidence rates decreased by 6% and 1%, respectively (16). These trends, however, precede the setbacks in cancer care and outcomes that have been caused by the COVID-19 pandemic. Global health experts are also concerned about the consequences of the ongoing wars that have displaced populations, further destroying health care systems, disrupting social services, and increasing risk of infectious disease transmission (17). Considering the devastating impact of these global crises on the entire continuum of cancer research and patient care, as well as the growth of the global population ages 65 and older (18), researchers caution that the burden of cancer worldwide may rise significantly in the coming decades.

Another concern among global public health experts is that, although age-standardized mortality and incidence rates are declining overall, the reduction in rates appears to be driven by countries with a higher sociodemographic index (SDI)—a composite measure of the social and economic development of a country that considers income per capita, average years of education, and total fertility rate for people younger than 25. The data indicate that age-standardized cancer incidence and mortality rates are increasing in countries with lower SDI (19).

To ensure that progress against cancer is equitable worldwide, it is imperative that the global medical research community work together and share best practices to implement newer and more 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 (19).

Cancer exerts an immense toll 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, they were estimated to be $183 billion in 2015, the last year for which these data are currently available; this cost is projected to increase to $246 billion by 2030 (2). These numbers do not include the indirect costs of lost productivity due to cancer-related morbidity and mortality, which are also extremely high. Notably, cancer patients in the United States shouldered an economic burden of $21 billion in 2019 from out-of-pocket costs and other related expenses, which is nearly 3.5 times the amount of approximately $6 billion in NCI funding for cancer research in the same year (20).

With the number of cancer cases projected to increase in the coming decades, we can be certain that both direct and indirect costs will also escalate. The rising personal and economic burden of cancer underscores the urgent need for more research so that we can accelerate the pace of progress against cancer.

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 from across the spectrum of cancer science and medicine. Much of their work, as well as that of FDA—the federal regulatory agency that assures the safety and efficacy of medical devices and therapeutic advances—is supported by funds from the federal government. The consecutive increases for the NIH budget in the last 7 fiscal years (FY) have helped maintain the momentum of progress. To keep up with the pace of scientific and technological innovation, however, it is imperative that Congress continue to provide sustained, robust, and predictable increases in investments in the federal agencies that are vital for fueling progress against cancer, in particular, the NIH, the NCI, the FDA, and the CDC, in the years ahead.

As cancer continues to be the second leading cause of death in the United States, there is an urgent need for more research to accelerate the pace of progress against cancer. Remarkable bipartisan, bicameral efforts in Congress have increased NIH funding by $14.9 billion, or roughly 49%, from FY 2015 to FY 2022. These significant investments make it possible for researchers to make groundbreaking advances against cancer and many other diseases.

The AACR deeply appreciates the commitment of Congress to expediting progress against cancer and other diseases through robust funding increases for the NIH, as well as support of the critical regulatory science work at the FDA and public health initiatives at the CDC. Therefore, the AACR encourages Congress and stakeholders committed to eradicating cancer to:

  • Continue to support robust, sustained, and predictable funding growth for the NIH and the NCI by providing increases to the FY 2023 base budget, including $49.1 billion in base budget authority for the NIH, representing an increase of $4.1 billion, and $7.766 billion for the NCI, which is an increase of $853 million and is consistent with the NCI director's Professional Judgment Budget.

  • Fully fund initiatives authorized in the 21st Century Cures Act, including the national Cancer Moonshot, and ensure that Moonshot funding supplements rather than supplants NIH funding in FY 2023.

  • Reauthorize the Childhood Cancer STAR Act and provide no less than $30 million for STAR Act implementation, as well as $50 million for the Childhood Cancer Data Initiative, which seeks to better understand cancer biology specific to pediatric patients and improve prevention, treatment, quality of life, and survivorship.

  • Invest in vital initiatives of the CDC Division of Cancer Prevention and Control by providing at least $462.6 million to support comprehensive cancer control, central cancer registries, and screening and public awareness programs for specific cancers.

  • Increase funding for the FDA's critical regulatory science initiatives that advance the development and regulation of oncology products by providing an increase of at least $318 million for a total of $3.653 billion in discretionary budget authority in FY 2023, as recommended in President Biden's budget.

  • Ensure that patients with cancer have equitable access to quality, affordable health care by expanding Medicaid and enacting the Accelerating Kids’ Access to Care Act, which would reduce barriers to care for children on Medicaid who receive specialist care from an out-of-state pediatric provider.

  • Increase participation and diversity of cancer clinical trials by reducing barriers for patient enrollment and encouraging diverse representation in clinical trials, as contained in the Diversifying Investigations Via Equitable Research Studies for Everyone Trials Act and the Diverse and Equitable Participation in Clinical Trials Act, respectively.

  • Encourage research institutions to recruit, support, and retain a robust cancer research workforce that reflects the diversity of our society, and support NCI initiatives, such as the NCI Equity and Inclusion Program, that strive to build a more inclusive and equitable workforce and markedly reduce cancer disparities.

  • Reduce cancer incidence and mortality by addressing nicotine addiction through expanded coverage of tobacco cessation services, removing flavored tobacco products including menthol from the market, and limiting nicotine concentration in tobacco products.

  • Expand tax policies to encourage philanthropic giving so that nonprofit cancer research organizations can continue to fund high-risk, high-reward research proposals and accelerate the discovery of new treatments and cures.

These investments and initiatives would fuel innovation and usher in a new era of cancer science, reduce cancer disparities, improve cancer prevention and detection, and bring lifesaving cures to millions of people whose lives are touched by cancer.

AACR Cancer Progress Report 2022 Steering Committee

Lisa M. Coussens, MD (hc), PhD

Chair

AACR President 2022–2023

Hildegard Lamfrom Endowed Chair in Basic Science

Professor and Chair, Department of Cell, Developmental & Cancer Biology

Associate Director for Basic Research, Knight Cancer Institute

Oregon Health & Science University

Portland, Oregon

Lourdes Baezconde-Garbanati, PhD, MPH

Associate Dean of Community Initiatives

Professor of Population and Public Health Sciences

Associate Director of Community Outreach and Engagement

Norris Comprehensive Cancer Center, Keck School of Medicine

University of Southern California

Los Angeles, California

Adam P. Dicker, MD, PhD, FASTRO, FASCO

Enterprise SVP, Professor & Chair, Department of Radiation Oncology

Director, Jefferson Center for Digital Health

Sidney Kimmel Medical College & Cancer Center

Thomas Jefferson University

Philadelphia, Pennsylvania

Margaret Foti, PhD, MD (hc)

Chief Executive Officer

American Association for Cancer Research

Philadelphia, Pennsylvania

Maryam Fouladi, MD, MSc, FRCP

Professor of Pediatrics, Ohio State University, College of Medicine

Co-Executive Director of Neuro-Oncology, Division of

Hematology/Oncology/BMT

Nationwide Children's Hospital

Columbus, Ohio

Jennifer Grandis, MD

Professor of Otolaryngology-Head and Neck Surgery

Associate Vice Chancellor for Clinical and Translational Research

Director, Clinical and Translational Science Institute (CTSI)

University of California San Francisco

San Francisco, California

Paul Jacobsen, PhD

Associate Director Healthcare Delivery Research Program

Division of Cancer Control and Population Sciences

National Cancer Institute

Bethesda, MD

Shivaani Kummar, MD, FACP

DeArmond Endowed Chair of Cancer Research Professor & Head, Medicine, Division of Hematology/Medical

Oncology, School of Medicine

Co-Director, Center for Experimental Therapeutics Knight

Cancer Institute

Oregon State Health & Science University

Portland, Oregon

Carlo C. Maley, PhD

Professor, School of Life Sciences

Associate Professor, Center for Evolution & Medicine

Associate Professor, Biodesign Center for Biocomputing, Security and Society

Associate Faculty, Biodesign Center for Mechanisms of Evolution

Arizona State University

Tempe, Arizona

Gilbert Omenn, MD, PhD

Harold T. Shapiro Distinguished University Professor

Director, Center for Computational Medicine and Bioinformatics

Professor of Computational Medicine & Bioinformatics

Professor of Molecular Medicine & Genetics

Professor of Human Genetics

Professor of Public Health, School of Public Health

University of Michigan Medical School

Ann Arbor, Michigan

Elizabeth Platz, ScD, MPH

Professor and Martin D. Abeloff, MD Scholar in Cancer Prevention

Department of Epidemiology

Johns Hopkins Bloomberg School of Public Health

Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

Baltimore, Maryland

Yu Shyr, PhD

Harold L. Moses Chair in Cancer Research

Chair, Department of Biostatistics

Director, Vanderbilt Center for Quantitative Sciences

Director, Vanderbilt Technologies for Advanced Genomics Analysis and Research Design

Professor of Biostatistics, Biomedical Informatics, and Health Policy

Vanderbilt University Medical Center

Nashville, Tennessee

Catherine Wu, MD

Professor of Medicine, Harvard Medical School

Lavine Family Chair, Preventative Cancer Therapies

Dana-Farber Cancer Institute, Harvard Cancer Center

Boston, Massachusetts

Timothy A. Yap, MD, PhD

Medical Director, Institute for Applied Cancer Science

Associate Professor, Department of Investigational Cancer Therapeutics (Phase I Program)

Department of Thoracic/Head and Neck Medical Oncology

Associate Director of Translational Research, Khalifa Institute for Personalized Cancer Therapy

The University of Texas MD Anderson Cancer Center

Houston, Texas

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