Scientific Scope

The National Cancer Institute Division of Cancer Prevention (DCP) is devoted to research on cancer prevention, interception, screening and early detection, and symptom science. To accomplish this, DCP provides funding and administrative support to clinical, population science, and laboratory researchers, community and multidisciplinary teams, and collaborative scientific networks.

DCP supports research for developing and validating new ways to prevent cancer and cancer-related deaths and reduce the burden of cancer and cancer therapies. This includes the creation and use of interventions that prevent carcinogenesis or intercept the carcinogenesis process before invasive cancer develops, as well as discovering and validating early detection biomarkers, developing screening technologies to find precancerous changes in tissues or identifying cancer when it can be successfully treated. DCP also supports research to manage or prevent symptoms caused by cancer and cancer treatment through understanding the cause of these debilitating side effects, improving methods of measuring their incidence, and creating new symptom relief interventions.

DCP supports bench-to-bedside research from basic research and preclinical development to clinical trials that demonstrate safety and efficacy/clinical utility. DCP supports effectiveness research, especially for high-risk populations. Developing a diverse, trans-disciplinary workforce is critical to reducing the population burden of cancer.

Cancer Early Detection Biomarker Development and Screening

DCP supports early detection and screening discovery, validation, and development to reduce cancer incidence and mortality, including:

• Morphology such as cytology for cervical cancer,
• Markers/biomarkers of precancer and cancer such as human papillomavirus (HPV) for cervical cancer, prostate specific antigen (PSA) for prostate, and fecal blood for colorectal cancer; and
• Imaging such as mammography for breast cancer and low-dose CT for lung cancer.

Screening for cervical, breast, lung, and colon cancers have proven effective for preventing and controlling cancer and are recommended by the U.S. Preventive Services Task Force (USPSTF). DCP-supported research has contributed to the evidence supporting their use and to limiting PSA testing. USPSTF recommends screening for hepatitis B and C, the leading liver cancer risk factors. Improved screening opportunities exist for these cancers by increasing their effectiveness and reducing their harms.

DCP is committed to identifying cancers that have no proven screening methods, such as the highly lethal pancreatic cancer. This includes supporting the discovery and validation of biomarkers for early cancer detection, and the development and evaluation of multi-cancer detection tests.

Intervention Development for Cancer Prevention

DCP supports research on the causes of and risk factors for cancer to translate these findings into new cancer prevention and interception strategies. This includes increasing knowledge of how internal and external factors contribute to cancer risk.

Internal factors – such as genetics, immunity and inflammation, hormones, and microbiome – are associated with cancer risk. External risk factors include infections (oncogenic viral and bacterial) and environmental carcinogens – such as smoke, air pollution, toxic waste, and radiation.

Elevated cancer risk can result from mutations and other inheritable factors. Non-biological factors like social determinants of health (SDH) also can elevate risk. People with elevated risk are more likely to develop cancer, and therefore more likely to benefit from a prevention intervention than people with average or low risk.

Cancer preventive agent discovery and development requires translation of risk factors into preventive interventions. This includes in vitro and in vivo studies cell lines to evaluate efficacy, toxicity, and biomarkers. Immunoprevention studies involve pathogenic vaccines and vaccines that target cancer-associated antigens along with studying adjuvants or immunomodulators to decrease immunosuppression.

Human studies and clinical trials focus on evaluating interventions to prevent or intercept pre-cancerous lesions; the pre-malignant progression to invasive cancer; recurrence of precancerous lesions; and the acquisition of or progression to cancer from carcinogenic infectious agents. Research involves reducing individual risk associated with genetic and non-genetic cancer-predisposing conditions.

Once ready these interventions move into early phase trials that evaluate components of diet; FDA-approved and investigational drugs; small molecules, vaccines, immunomodulators, biologics, biomarkers; and medical devices. Other research includes procedures such as risk-reducing surgery (e.g., mastectomy, removal of ovaries and fallopian tubes, etc.) and non-surgical ablative techniques directed at cancer biomarker modulation, cancer incidence and cancer risk reduction.

Precision Cancer Prevention

Precision cancer prevention – the use of biological data to identify those at risk of cancer and to inform targeted interventions, converges DCP’s investment in biomarkers for screening and early detection and preventive agents. Recent achievements include the Cancer Moonshot^SM, the Pre-Cancer Atlas and the IOTN-Immunoprevention projects.

Symptom Science and Management

Intervention and strategies to prevent or lessen the symptoms of cancer or cancer treatment is another focus of our research. Improved symptom management impacts cancer survivors’ quality of life and allows completion of therapy that would otherwise be too toxic. This improves the likelihood that a person will survive longer, perhaps to receive the next-in-line therapy that is currently unavailable. Research spans:

• Defining basic mechanisms of cancer treatment-related toxicities and symptoms;
• Characterizing symptoms and chronic toxicities from cancer treatment in the clinic;
• Developing, verifying, and validating endpoints for assessing symptoms and chronic toxicities in symptom management clinical trials.

Creating a precision medicine model for symptom management and care (“precision symptom management”) in which knowledge of the person and disease informs how symptoms are prevented and treated, is the end goal.

DCP has a grant portfolio in quality of life, symptom science, and toxicity mitigation. Studies of symptom management and quality of life have been part of the NCI Community Oncology Research Program for decades.

Workforce Training

DCP has a longstanding commitment to training, education, and workforce development, starting with establishing the Cancer Prevention Fellowship Program (CPFP) in 1987. Through 35 years, CPFP has trained hundreds of scientists and clinicians, many of whom have taken on national and international leadership positions in academia, industry, and other settings. CPFP alumni (>300) across the country are in leadership positions at cancer centers, universities, government agencies, research firms, foundations, and policy organizations.