The Cancer Moonshot: Overview and Issues

The Cancer Moonshot: Overview and Issues

September 29, 2023
The Cancer Moonshot: Overview and Issues
Cancer was the second-leading cause of death in the United
detection. Rates of new cancer cases (incidence) among
States in 2021. For decades, Congress has maintained a
adults have decreased overall in the same period, though
sustained interest in reducing cancer mortality, particularly
certain cancer types have seen increases. Some research
by funding cancer research at the National Institutes of
shows that delayed detection and treatment of cancer during
Health (NIH). In 2016, the 21st Century Cures Act (Cures
the Coronavirus Disease 2019 (COVID-19) pandemic may
Act; P.L. 114-255) authorized appropriations for the Cancer
affect cancer outcomes.
Moonshot initiative at NIH, which expires at the end of
FY2023. President Biden previously signaled that
There are disparities in cancer rates in the United States.
reauthorization of the program is a priority. Congress has
For example, black people have overall higher death rates
not considered any bills to reauthorize the Cancer
from cancer compared with all other racial/ethnic groups,
Moonshot program.
though rates vary by cancer type. As another example,
some research has found that cancer mortality is
The Cancer Moonshot was originally established in 2016 as
significantly higher in the lowest-income counties
a biomedical research program with the broad goal of
compared with the highest income counties. Cancer
making a decade’s worth of scientific progress in
disparities may owe to differences in access to care;
preventing and treating cancer in just five years. In 2022,
environmental conditions; health literacy; and other
President Biden announced a “reignited” Cancer Moonshot
behavioral, life experience, or genetic differences.
effort. This new Biden Administration Cancer Moonshot
would also incorporate other health policy strategies, such
21st Century Cures Act Cancer
as promoting access to cancer care and screening, in
Moonshot Program
addition to biomedical research. The Biden Administration
further announced programs and actions under the Cancer
Authorization
Moonshot in September 2023. If Congress considers
The Cures Act (P.L. 114-255; §1001), enacted in December
reauthorization or other Cancer Moonshot-related
2016, involved a unique funding mechanism for the Cancer
legislation, policymakers might consider what priorities, if
Moonshot initiative. The Cures Act transferred funds into
any, to establish for the Cancer Moonshot initiative, and
an NIH Innovation Account and authorized those funds to
specifically to what extent the program should support
be appropriated at various levels in specific fiscal years for
biomedical research compared with other health programs.
four Innovation Projects, including the Cancer Moonshot
initiative. Those funds were not available for obligation
Background on Cancer
until appropriated each fiscal year. When appropriations are
Cancer refers to a group of diseases characterized by the
enacted—up to the authorized amount each fiscal year—
abnormal growth of cells in the body, which can invade and
those appropriations are subtracted from any cost estimate
damage surrounding tissues and organs. There are many
for the purpose of enforcing the discretionary spending
different types of cancer, including breast, lung, colon, and
limits. In effect, appropriations to the NIH Innovation
prostate cancer, among others. Treatment for cancer may
Account as authorized by the Cures Act are not subject to
include surgery, radiation therapy, chemotherapy,
discretionary spending limits. The Cures Act authorized a
immunotherapy, or a combination of these approaches,
total of $1.8 billion for the Cancer Moonshot from FY2017
depending on the type and stage of the cancer as well as the
through FY2023. Congress has fully appropriated the
overall health of the patient. Cancer can sometimes be
authorized funding. Should Congress continue to
detected in early stages through screening, which can, in
appropriate funding for the Moonshot after the Cures Act
some cases, improve outcomes from treatment. The exact
authorization expires, these appropriations would be subject
causes of cancer are not fully understood, but factors that
to the discretionary spending limits.
can increase the risk of developing cancer include genetics;
lifestyle factors, such as smoking or a poor diet; exposure to
Implementation
certain chemicals or radiation; and infections.
In 2016, NIH’s National Cancer Institute (NCI) convened a
Blue Ribbon Panel of outside experts to advise on cancer
Among adults, the overall death rate from all cancer types
moonshot goals, which made recommendations for the
decreased from 2015 to 2019 by 2.3% per year (on average)
moonshot research to focus broadly on improving cancer
for men and 1.9% per year (average) for women from 2015
data and research platforms, improving treatments and
to 2019. Death rates vary by cancer type, having decreased
addressing side effects, expanding cancer prevention, and
significantly for lung cancer and melanoma—some of the
intensifying research on the drivers of pediatric cancer.
most common cancer types. Experts attribute declining
cancer mortality to preventive behaviors (e.g., declines in
With the Cures Act moonshot funding, NCI has invested in
smoking tobacco), new treatments, and enhanced early
research resources and platforms aimed at making it easier
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The Cancer Moonshot: Overview and Issues
to study cancer in all its types and forms. For example, NCI
unclear the extent to which some of these programs are
has invested in platforms for aggregating data across
“new,” or reflect ongoing agency activities.
studies. NCI has also funded the Human Tumor Atlas
Network, which makes publicly available three-dimensional
Are the Cancer Moonshot Goals
models of the biological features of human cancer cases.
Achievable?
Both these “atlases” and the data resources can be analyzed
Researchers have explored how the Administration’s goal
with computational tools (like artificial intelligence tools)
to reduce cancer mortality rates by 50% over the next 25
to deepen the scientific understanding of cancer. NCI has
years could be achieved. The United States would have to
also funded research into new treatments and health care
sustain reductions in cancer mortality averaging 2.7% per
delivery practices, among other topics.
year. Progress in reducing mortality against lung,
colorectal, and breast cancers may need to be sustained, and
Outcomes
new strategies may be needed for prostate, liver, pancreatic,
In its first four years, Cancer Moonshot funding resulted in
and other cancers. Some of the reduction could come from
thousands of scientific publications, 49 clinical trials, and
prevention and early detection of new cancer cases.
over 30 patent filings. Still, the full impact of the initiative
Modifiable lifestyle factors, such as reduced smoking and
on cancer health outcomes remains unknown. A time lag
alcohol intake, diet, exercise, and certain vaccinations could
often exists between initial investments in research and new
play a significant role. In addition, many people do not get
medical innovations for patients. As an example, major
recommended cancer screenings (that could help detect and
investments in cancer research followed the National
treat cancer cases early) or adhere to recommended
Cancer Act of 1971 (P.L. 92-216). One analysis links the
treatments. There are significant racial and socioeconomic
early 1970s funding to new drugs approved by the U.S.
disparities in cancer screening rates and treatment access.
Food and Drug Administration (FDA) decades later after
Addressing such disparities could have a measurable impact
the science became established.
on overall cancer health outcomes.
Biden Administration “Reignited”
Still, researchers note that achieving the Cancer Moonshot
Cancer Moonshot
goals may require innovation, such as better screening tests,
In February 2022, President Biden announced the
preventive tools (e.g., cancer vaccines), treatments, and care
“reignited” Cancer Moonshot effort, with goals to cut the
practices. Although many therapies and innovations are in
U.S. death rate from cancer by 50% over the next 25 years
development, new cancer therapies have not always proven
and to improve the experience of patients and their families
“better.” For example, of the 161 FDA approvals for solid
living with cancer. The new effort is focused on increasing
cancer therapies since 2017, 35% were graded as delivering
cancer screening and early diagnosis; boosting prevention;
substantially meaningful clinical benefit.
addressing inequities; ensuring patients get the right
treatment; speeding progress against rare and childhood
Considerations for Congress
cancers; supporting patients, survivors, and caregivers; and
As mentioned, no bill to reauthorize the Cures Act Cancer
increasing research data sharing. In summary, the
Moonshot program has been introduced or considered. The
“reignited” moonshot has a much broader scope than the
Administration’s “reignited” Moonshot effort goes beyond
original 2016 Cancer Moonshot.
the research activities funded under the Cures Act
authorization. The Administration has also placed many of
In its FY2024 budget request, the Biden Administration
the new Moonshot research programs within ARPA-H, a
requested reauthorization of the Cures Act Cancer
new agency, rather than NCI, the lead for the original
Moonshot program through 2026, and $2.9 billion in
Moonshot effort. If Congress were to legislate on the
mandatory appropriations in 2025 and 2026. In addition, the
Cancer Moonshot effort, it faces many considerations and
FY2024 request included funding for programs tied to the
questions:
Cancer Moonshot across the Department of Health and
• Should a reauthorized Cancer Moonshot program focus
Human Services. As mentioned, no bill to reauthorize the
on a broad set of health strategies, as proposed, or
Cures Act funding has been introduced or considered this
continue placing its primary focus on research? For its
session. It remains to be seen if any of the FY2024 funding
research efforts, should the program be housed in NCI
will be provided.
or ARPA-H? Are there research areas that should be
prioritized?
In September 2023, the Biden Administration announced
programs as a part of the Cancer Moonshot effort. Several
• Some have argued that the “reignited” Cancer Moonshot
of the efforts involve the Advanced Research Projects
lacks a cohesive strategy and goals. Should Congress
Agency for Health (ARPA-H), a new agency first funded in
require the Administration to develop a more specific
2022 that is focused on taking risks and driving innovation
plan for achieving Moonshot goals?
in biomedical and health technology. The Biden
• Some stakeholders have argued that ARPA-H should
Administration has announced that ARPA-H is committing
focus on technologies rather than specific diseases. In
$240 million to cancer-related research and will invest in
addition, ARPA-H was designed to be “bottom-up” and
new data sharing platforms and a nationwide network for
led by its program managers. How does ARPA-H’s
clinical trials. The Administration also announced other
involvement in the President’s Cancer Moonshot affect
programs to reduce smoking and exposures to
the new agency’s role and purpose?
environmental carcinogens, and to increase screenings. It is
Kavya Sekar, Analyst in Health Policy
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The Cancer Moonshot: Overview and Issues

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