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The following article gives a
brief background on how CCRA was created. It is also
available in
PDF format.
Cancer Control in the 21st Century
The Challenges
Cancer is caused by a
combination of genetic, environmental, and lifestyle
factors and is the disease that Canadians fear the
most. One in three Canadians will develop cancer
during their lifetime and approximately half will
die of their disease. Because the majority of cancer
is age dependent, and Canada's demographic wave of
baby-boomers will shortly be over 60 years of age,
the annual incidence of cancer in Canada is expected
to rise by approximately 75% over the next 20 years.
This dramatic increase in cancer burden will place
an intolerable strain on the health system and will
generate increased social and economic pressures for
enhanced cancer control.
Over the last 20-30
years, billions of dollars worldwide have been
invested in cancer research. This research has
resulted in an overall cure rate of 50% and evidence
to suggest that roughly 30% of cancer could be
prevented by changes in diet and lifestyle. There
have been outstanding achievements in the treatment
and cure of childhood cancer, certain adult cancers
such as testicular cancer and, through early
diagnosis and prevention, cervical cancer. However
this is not the success rate that one might have
hoped for after decades of research and major
financial investment. Part of the challenge lies in
the complexity of the disease and gaps in our
understanding of cancer at the molecular level.
However, this is now rapidly changing as cancer
research has reached a crossroads at which the
increasing demand for improved cancer control will
intersect with an explosion in our understanding of
the disease process brought about by the recent
revolution in molecular biology and genomics. In
short, there has never been a more opportunistic
time to capitalize on recent discoveries in research
to revolutionize our approach to cancer control.
Such a turning point
is long overdue and has created a sense of urgency
and excitement in the cancer research community. New
research discoveries need to be applied rapidly in
the clinic, so that patients will immediately
benefit from the products of this new science. This
type of 'translational cancer research' requires
national coordination among Canada's researchers,
research institutions and research funding agencies.
No single centre or funding body can achieve the
desired results in an acceptable timeframe. Other
countries with similar demographics and economies
have already recognized this fact. For example, the
UK has established a national cancer control
strategy underpinned by major financial investment
from their national government. Canada also needs to
move quickly to capitalize on our unique health care
system and our internationally recognized excellence
in cancer research to take advantage of this
unprecedented opportunity to revolutionize cancer
control and provide Canadians with the first class
health care that they expect.
In an ideal world,
cancer would be a preventable disease. However,
there are still many unknowns about the factors and
combinations of factors that result in malignancy.
Even the risk factors that have been identified,
such as cigarette smoking, have not yet resulted in
the eradication of smoking in Canada. Canada needs a
coordinated approach to enable an in-depth analysis
of the risk factors leading to the development of
chronic diseases, including cancer, and to provide a
strong evidence base for interventions to reduce
risk and lower disease incidence.
Early cancer
diagnosis is the key to successful treatment and
outcome. The challenge is to develop screening
techniques with the sensitivity and specificity to
detect small tumours in the early stages of
malignant transformation. These same techniques are
also invaluable for monitoring tumour regression or
recurrence in response to treatment. The benefits of
this science would be reflected in decreased rates
of invasive cancer, decreased mortality and lowered
economic and emotional costs.
Cancer therapy
generally consists of radiation and/or chemotherapy,
both of which can have severe side effects and a
negative impact on quality of life. Current
chemotherapy drugs lack specificity and can be
extremely toxic to normal tissues, resulting in
extensive tissue damage and long term side effects
for the patient. Response to chemotherapy is often
variable and unpredictable. Mechanisms to enable
patient stratification are required so that only
those subsets of patients likely to respond to a
particular chemotherapy regime receive that
treatment, and those unresponsive are spared the
side effects of unnecessary treatment and can be
offered alternatives where they exist. New, highly
specific, anti-cancer drugs and drug combinations
are needed that are both more effective and do not
have the extensive side effects of current
treatments. Such targeted drugs would also result in
increased cost effectiveness as a result of more
precise patient diagnosis and stratification.
The Opportunities
Canadians expect the
best health care available and also access to the
latest treatments that research and technology can
provide. Canadian cancer researchers are among the
best in the world and have a strong history of
collaboration and information sharing. The Canadian
health care system is also among the best in the
world and its integration and capacity for
flexibility makes it ideally suited for uptake and
application of new knowledge and discoveries.
In recent years,
there has been an accelerated understanding of cell
structure and function based on rapid advances in
genomics, including the sequencing of the human
genome and the development of new techniques to
study the genetic structure of life. Researchers can
now analyze cells in minute detail, down to the
level of individual genes, and are beginning to
discover the function and products of many of the
genes that are important to human health. This new
science creates the possibility of individualized
cancer treatments. In less than 10 years it could be
common practice for cancer patients to have their
tumour analyzed to obtain a genetic and molecular
profile and then match the profile to a drug known
to be effective against that particular tumour. In
some cases this new treatment will effect a cure
and, in others, cancer will become a manageable
disease. This dramatically different way of treating
cancer will have a significant impact on health care
delivery models and will reduce disease burden both
for the individual and the system. Already research
studies show that by using the new techniques
available, it is possible to discriminate between
patients who will respond to a specific
chemotherapeutic agent and those who will not.
Application of this knowledge to patient treatment
could spare unresponsive patients from unnecessary
drug treatment.
The pathway between
new discoveries in the laboratory and the
application of this new knowledge in the treatment
of patients is called translational research, often
referred to as 'bench to bedside'. In addition to
new drug development and the potential for
individualized therapy, there are now dramatically
improved imaging techniques with enhanced
specificity. These new techniques enable the
visualization of increasingly small tumour masses
and even pre-malignant lesions and will facilitate
early diagnosis, targeted therapy and continuous
disease monitoring.
The Path Forward
With all these
unparalleled advances in research, the challenge is
to accelerate the application of new knowledge into
real time patient treatment. Canada is uniquely
placed to take advantage of this new age science.
Canadian Cancer
Research Alliance
The formation of the
Canadian Strategy for Cancer Control (CSCC) in 1999
heralded a new beginning for cancer control in
Canada. With a mandate to address and coordinate all
aspects of cancer control including clinical
practice, human resources, prevention, balance,
research, standards, and surveillance, CSCC
established an action group in each of these
priority areas. The Research Action Group (R-AG) was
tasked with the challenge of providing a national
voice on key research issues, promoting the
integration of research with all aspects of cancer
control, and championing biotechnology and
translational research. It was quickly recognized
that in order to capitalize on Canadian research
strengths and opportunities, and focus them on
addressing the challenges in cancer control, a
nationally coordinated effort was essential. In
response, the Canadian Cancer Research Alliance (CCRA)
evolved from the R-AG. For the first time, CCRA
formally brings together all the major organizations
and agencies funding cancer research in Canada to
coordinate a united research response for cancer
control. Originally convened in December 2003, this
group has, through a process of consultation and
discussion, identified two major areas where the
greatest impact on cancer control can be realized.
They are:
Translational
Cancer Research
In order to fast
track the application of the outcomes of the
exciting new science that has happened in the last
decade, Canada needs to coordinate and strengthen
existing centres of excellence in multiple research
fields, including biology, engineering, mathematics,
information technology, physics and chemistry. There
is a standard chain of events during drug
development, often referred to as the 'drug
pipeline' and delays in this pipeline result in
delays in the availability of new drugs. Major
financial investment will be required to remove or
reduce some of the roadblocks along this pathway
through the creation of large scale national
networks that have the necessary core facilities,
equipment and human resources to rapidly screen,
validate and test potential new drugs. Creation of a
national tumour bank network in which tumour samples
are linked to patient outcome, a national cancer
registry, and an enhanced clinical trials network
would complete the process. The return on the
financial investment needed to support these
research platforms and networks would include
economic benefits resulting from the production, in
Canada, of more specific anti-cancer drugs, a
reduction in the morbidity caused by cancer
treatment, individualized cancer therapy and
ultimately, cancer cure.
A National Chronic
Disease Cohort
In order to
understand the causes and risk factors related to
cancer and design effective intervention strategies
at a population level, Canada needs a large national
cohort study. A 300,000 person cohort followed over
a 20-30 year period would enable researchers to
asses the impact of numerous environmental, social,
behavioural and biological factors on the risk of
developing a variety of chronic diseases, including
cancer. A cancer cohort, housed within a broader
chronic disease cohort, would provide a research
'laboratory' that would provide important new
insights into the factors that contribute to chronic
diseases. In addition to the completion of detailed
questionnaires, recruits to the cohort would donate
biological samples, such as blood, for future
biomarker and gene-environment studies. High
quality, repeated data and sample collection over
time would allow detailed studies of the impact of
and interaction between numerous determinants of
risk and would establish a strong evidence base for
intervention studies that might prevent the onset of
disease. The national repository of information
created would be made accessible to Canadian
researchers engaged in population studies, through
existing peer review mechanisms, and would provide a
vital source of information for generations to come.
The path forward is
clear and all the necessary components to make it
happen are in place. If Canadians are to derive the
maximum health, social and economic benefits from
the revolution in cancer research, the time for
major financial investment by federal and provincial
governments is now. The return on this investment
would be incalculable.
For further
information on this initiative, please contact:
Dr. Judith Bray
Assistant Director, ICR
160 Elgin Street, Room 97
Ottawa, ON K1A 0W9
Tel: (613) 954-7223
Fax: (613) 954-1800
Email:
jbray@cihr-irsc.gc.ca
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