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REPORT of the NIH INSTITUTES and CENTERS National Cancer Institute REPORT OF THE NIH INSTITUTES AND CENTERS National Cancer Institute Executive Summary advances include the finding that mutations in the PALB2 gene raise the risk of breast cancer in women by almost as Cancer remains one of the most challenging areas of much as mutations in BRCA1 and BRCA2. In addition to medicine. In the United States, one in three women will raising the risk of breast and ovarian cancer, BRCA gene develop cancer within their lifetime, and one in five women mutations may contribute to lung tumor risk. A mutated will die of their disease, which means that in 2015, an version of the BRCA2 gene was found to raise the risk estimated 277,280 women will die from cancer in this of getting any type of lung cancer by 85 percent. Daily country. The most commonly diagnosed cancers among aspirin use was shown to reduce ovarian cancer risk by 20 American women include breast, colorectal, and lung percent. Additional studies are needed to explore the risks cancers. Together, these cancers account for about half of and benefits for this potential chemopreventive agent and the estimated new cancer cases in this population. These to identify the mechanism by which aspirin may reduce same three cancers are also the leading causes of cancer ovarian cancer risk. In reducing cervical cancer risk, data deaths in women. Although breast cancer is the most from the NCI Costa Rica Trial showed that less than the commonly diagnosed cancer among women, lung cancer is standard three-dose regimen of the HPV vaccine may be the leading cause of cancer death in women. protective against HPV infection. A noninvasive DNA Despite these statistics, there is good news in the fight test is being evaluated that could have clinical impact for against cancer. Since the early 1990s, overall death rates from screening underserved populations in the United States and cancer have continued to decrease in both men and women. for millions of women in poor, underdeveloped countries. Among women, cancer death rates decreased an average of NCI is also advancing basic and translational research 1.4 percent per year from 2001 through 2010. In addition, related to women’s health and conducting population-based overall cancer incidence rates among women stabilized studies aimed at identifying risk factors for poor outcomes. from 2001 through 2010. In spite of these important In addition, NCI remains dedicated to expediting the gains, improvement has not been equal in all cancers, dissemination of research advances, new knowledge, and which underscores the need for additional research. Also, beneficial interventions to the scientific community and improvements have not been equal among all populations. diverse public audiences via numerous resources related to Minority and underserved women are burdened by increased women’s health. Additional information on women’s health rates of cancer incidence and mortality. issues related to cancer can be found on NCI’s award- As this report highlights, real progress is being made in winning Web site: http://www.cancer.gov. cancer prevention, early detection, and treatment, which has helped to reduce cancer incidence and mortality. Introduction Decreases in colorectal cancer incidence rates, cervical cancer deaths, and mortality for other cancers can be The American Cancer Society (ACS) estimates that 277,280 attributed respectively to increases in screening (which women in the United States will die from cancer in 2015. can detect and remove precancerous colon polyps), early Breast, colorectal, and lung cancers are the most commonly detection (including improvements in primary prevention, diagnosed cancers among American women, collectively such as the human papillomavirus [HPV] vaccine), and accounting for approximately half of the estimated new improved treatment strategies (such as combination cancer cases in this population. Breast cancer is the most therapy, targeted drugs, and genetic testing particularly in common, accounting for 29 percent of all new cases, while breast and colon cancers). lung cancer accounts for 13 percent and colorectal cancer accounts for 8 percent. These three cancers are also the Over the past 2 years, National Cancer Institute (NCI)­ leading causes of cancer deaths in women. supported researchers made major strides in a variety of cancers that affect women. Some of the most promising 70 Report of the NIH Advisory Committee on Research on Women’s Health | Fiscal Years 2013–2014 Overall cancer incidence rates among women stabilized the cause, diagnosis, prevention, and treatment of cancer, from 2001 through 2010. When averaged across this as well as rehabilitation and continuing care for patients period, breast cancer incidence rates declined 1.0 percent with cancer. NCI supports numerous research programs per year, though they did not change from 2006 through and projects that address cancers specific to or primarily 2010. However, there have been declines in other cancers affecting women, especially those cancers with high common among women. From 2006 through 2010, average incidence or mortality among women, as well as cancers incidence rates per year decreased for colorectal cancer, that affect both genders to a similar degree. This research 4.0 percent; ovarian cancer, 2.9 percent; lung cancer, 1.8 focuses on all stages of disease, from prevention through percent; and cervical cancer, 1.2 percent. Steady declines in cancer survivorship, and ranges from molecular and cancer incidence among women have also been observed for subcellular basic science experiments to population-based lymphoma and cancers of the brain, bladder, and stomach. studies and community-based interventions. In addition to the stabilization of the overall incidence rates NCI also is committed to disseminating research advances of cancer, overall death rates have continued to decrease to the scientific community and the public and has in both men and women since the early 1990s. From 2001 developed numerous resources related to women’s health. through 2010, cancer death rates in women decreased The award-winning NCI Web site, Cancer.gov (http:// an average of 1.4 percent per year. In the same period, www.cancer.gov), is a key Institute vehicle for disseminating average death rates per year declined for colorectal cancer, information to a diverse range of audiences; NCI also 2.9 percent; stomach cancer, 2.7 percent; breast cancer, provides a Spanish-language version of its Web site, 1.9 percent; cervical cancer, 1.7 percent; oral cavity and Cancer.gov en español (http://www.cancer.gov/espanol). pharynx cancer, 1.6 percent; ovarian cancer, 1.6 percent; NCI’s Cancer Information Service provides the latest, most leukemia, 1.3 percent; and lung cancer, 0.8 percent accurate information about cancer treatment, clinical trials, (Edwards et al., 2014). early detection, and prevention for cancer patients, their These data indicate real progress in cancer control. Primary families, and the public. U.S. residents can reach English- prevention, early detection, and improved treatment have or Spanish-speaking NCI information specialists by calling resulted in the vast majority of changes. Decreases in toll-free 1–800–4–CANCER (1–800–422–6237). An cervical cancer deaths primarily are due to early detection of instant-messaging service called LiveHelp is also available premalignant lesions, with incidence rates expected to drop on the NCI Web site. dramatically in the coming years due to improvements in Although far from comprehensive, the following pages primary prevention, including the human papillomavirus provide a representative sampling of the activities and (HPV) vaccine. The decrease in colorectal cancer incidence accomplishments of NCI relative to women’s health in rates largely reflects increases in screening, which can detect FY 2013 and FY 2014. Disease areas included in this and remove precancerous polyps. Decreases in mortality report are brain, breast, cervical, endometrial, lung, for many cancers, particularly breast and colon cancers, oropharyngeal, ovarian cancer, Burkitt lymphoma, and can be attributed to improved treatment strategies, such as AIDS-associated malignancies. combination therapy, targeted drugs, and genetic testing. Unfortunately, improvement has not been equal in all NCI Women’s Health Officer cancers. Incidence rates were steady or increased from 2001 through 2010 for two HPV-associated cancers (oropharynx The NCI Women’s Health Officer facilitates and anus). This underscores the need for additional communication across the Institute and promotes prevention efforts for HPV-associated cancers, including collaboration between NCI and other National Institutes efforts to increase vaccination coverage. Moreover, of Health (NIH) Institutes and Centers, Federal agencies, with many minority and underserved women burdened and nongovernmental organizations. The Women’s Health by increased rates of cancer incidence and mortality, Officer develops and disseminates reports and information improvements have not been equal among all populations. on NCI’s research and research progress on cancers in NCI conducts and supports research, training, health women and coordinates NCI’s responses to agency requests information dissemination, and other programs focused on for information. National Cancer Institute 71 Accomplishments and (sdNVP). Boltz et al. (2014) found the risk of virologic Activities failure on NVP-based combination antiretroviral therapy from NVP-resistant variants differs between sdNVP­ All Cancers
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