On the 60th anniversary of John F Kennedy’s moonshot speech, US President Joe Biden channelled his predecessor, vowing to continue his administration’s efforts to “end cancer as we know it”.
The president was travelling to Boston on Monday to draw attention to a new federally backed study that seeks evidence for using blood tests to screen against multiple cancers.
This is a potential game-changer in diagnostic testing to dramatically improve the early detection of cancers. He also planned other announcements meant to better the lives of those suffering from cancer.
His speech at the John F. Kennedy Presidential Library and Museum comes as Biden seeks to rally the nation around developing treatments and therapeutics for the pervasive diseases that the Centers for Disease Control and Prevention rank as the second-highest killer of people in the US after heart disease.
In Europe, cancer rates are even higher, with an estimated 280 deaths per 100,000 on the continent in 2018 — compared to 189 per 100,000 in the US over the same period — according to the International Agency for Research on Cancer.
Biden hopes to move the US closer to the goal he set in February of cutting domestic cancer fatalities by 50% over the next 25 years and dramatically improving the lives of caregivers and those suffering from cancer.
Biden’s grief as parent as driving force in eradicating illness
Danielle Carnival, the White House cancer moonshot coordinator, told AP that the administration sees huge potential in the commencement of the blood diagnostic study on identifying and treating cancers.
“One of the most promising technologies has been the development of blood tests that offer the promise of detecting multiple cancers in a single blood test and really imagining the impact that could have on our ability to detect cancer early and in a more equitable way,” Carnival said.
“We think the best way to get us to the place where those are realized is to really test out the technologies we have today and see what works and what really has an impact on extending lives.”
In 2022, the American Cancer Society estimates, 1.9 million new cancer cases will be diagnosed, and 609,360 people will die of cancer diseases.
The issue is personal to Biden, who lost his adult son Beau in 2015 to brain cancer. After Beau’s death, Congress passed the 21st Century Cures Act, which dedicated $1.8 billion over seven years for cancer research and was signed into law in 2016 by President Barack Obama.
Obama designated Biden, then vice president, to run “mission control” on directing the cancer funds in recognition of Biden’s grief as a parent and desire to do something about it.
Biden wrote in his memoir Promise Me, Dad that he chose not to run for president in 2016 primarily because of Beau’s death.
Despite Biden’s attempts to hark back to Kennedy and his space program, the current initiative lacks that same level of budgetary support.
The Apollo program garnered massive public investment — more than $20 billion, or more than $220bn (€217.4bn) in 2022 adjusted for inflation. Biden’s “moonshot” effort is far more modest and reliant on private sector investment.
Still, Biden has tried to maintain momentum for investments in public health research, including championing the Advanced Research Projects Agency for Health, modelled after similar research and development initiatives benefiting the Pentagon and intelligence community.
On Monday, Biden announced Dr Renee Wegrzyn as the inaugural director of ARPA-H, which has been given the task of studying treatments and potential cures for cancers, Alzheimer’s, diabetes and other diseases.
He also announced a new National Cancer Institute scholars’ program to provide resources to early-career scientists studying treatments and cures for cancer.
In Boston, Biden also spoke at Logan International Airport to highlight spending from last year’s bipartisan infrastructure law.
“We risk losing our edge as a nation to China, and the rest of the world is catching up,” he said. “That stops now, with investments like we’re celebrating here today.”
Possibilities, challenges both enormous
Scientists now understand that cancer is not a single disease but hundreds of diseases that respond differently to different treatments.
Some cancers have biomarkers that can be targeted by existing drugs that will slow a tumour’s growth. Many more targets await discovery.
“How do we learn what therapies are effective in which subtypes of disease? That to me is oceanic,” said Donald A. Berry, a biostatistician at the University of Texas M D Anderson Cancer Centre. “The possibilities are enormous. The challenges are enormous.”
Despite the challenges, he’s optimistic about cutting the cancer death rate in half over the next 25 years.
“We can get to that 50% goal by slowing the disease sufficiently across the various cancers without curing anybody,” Berry said. “If I were to bet on whether we will achieve this 50% reduction, I would bet yes.”
Even without new breakthroughs, progress can be made by making care more equitable, said Dr Crystal Denlinger, chief scientific officer for the National Comprehensive Cancer Network, a group of elite cancer centres.
And any effort to reduce the cancer death rate will need to focus on the biggest cancer killer, which is lung cancer. Mostly attributable to smoking, lung cancer now causes more cancer deaths than any other cancer. Of the 1,670 daily cancer deaths in the United States, more than 350 are from lung cancer.
Lung cancer screening is helping. The American Cancer Society says such screening helped drive down the cancer death rate by 32% from its peak in 1991 to 2019, the most recent year for which numbers are available.
But only 5% of eligible patients are being screened for lung cancer.
“It’s tragic,” said Dr Roy Herbst, a lung specialist at Yale Cancer Center.
“The moonshot is going to have to be a social fix as well as a scientific and medical fix,” Herbst said. “We’re going to have to find a way that screening becomes easier, that it’s fully covered, that we have more screening facilities.”
Dr Michael Hassett of Dana-Farber Cancer Institute in Boston said Biden’s goal to reduce cancer deaths could be met by following two parallel paths: one of discovery and the other making sure as many people as possible are reaping the advantages of existing therapies and preventive approaches.
“If we can address both aspects, both challenges, major advances are possible,” Hassett said.
In breast cancer, for example, many women who could benefit from a hormone-blocking pill either never start the therapy or stop taking it before the recommended five years, Hassett’s research has found.
“Those are big gaps,” Hassett said. “That’s a treatment that’s effective. But if many people aren’t taking that medication or if they’re taking it but stopping it before concluding the course of therapy, then the benefits that the medicine could offer aren’t realised.”
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