Cancers: A "Constellation" of Diseases

Harold Varmus, M.D., Director, National Cancer Institute (NCI)
Photo courtesy of TBD

NIH Research: A Q&A with Harold Varmus, M.D., Director, National Cancer Institute

Harold Varmus, M.D., is co-winner of a Nobel Prize for studies of the genetic basis of cancer. Among his leadership positions, he has served as President and Chief Executive Officer of Memorial Sloan-Kettering Cancer Center and Director of the National Institutes of Health (NIH) from 1993 to 1999. Dr. Varmus received early training in genetics and molecular biology at the National Cancer Institute (NCI) in the late 1960s. He has been Director of the NCI since July 2010. The year 2013 marks the 76th anniversary of the founding of the NCI—the world's largest organization solely dedicated to cancer research.

What would you say has been the biggest change in our understanding of cancer during the past few decades?

It is not, for example, a "war on cancer" as a single enemy. It is many different diseases with common themes that can cause different kinds of disorders in many of our organs.

In the last 40 years—the period of time in which I've been doing cancer research—we've come a long way. We've gone from really knowing nothing about how a normal cell became a cancer cell to being able to describe that process in exquisite genetic and molecular detail.
This transformation has been accompanied by gradual—and occasionally dramatic—improvements in the control of human cancer. In an increasing number of cancers, new concepts about the biology of cancer are driving changes in the ways we prevent, diagnose, and treat disease.

How does that new understanding affect how we think about cancer and cancer research?

What we've learned can be grouped into three categories. First, we've learned that cancer is not simply a single disease that affects many parts of the body. It is not, for example, a "war on cancer" as a single enemy. It is many different diseases with common themes that can cause different kinds of disorders in many of our organs. These include mutations in many different genes, changes in essen-tial cell functions, and unusual interactions with the cellular environment in which tumors grow. We need to study each of these areas separately.
Second, because we use so many methods to approach the disease, virtually every part of the scientific community is working to try to understand cancer and control it better. They are studying approaches to prevention, multiple methods to screen for early stages of cancer growth, more precise diagnostic tests, and better therapies.
And third, we've made progress using a variety of new techniques and science of many kinds. Progress in the control of cancer has required new knowledge from the many fields of research that the NCI supports.

As we begin 2013, what are some of the opportunities that you see in cancer research?

The National Cancer Institute is ready to take advantage of new and emerging scientific opportunities in cancer research. We can do this because we now understand that cancers are diseases caused by changes in a cell's genome—all of the biological information needed to build and maintain a living organism. We also have new tools for understanding cells at a molecular level. There are now new technologies for genomic analysis.
Progress in molecular biology has transformed our ability to understand the broken parts of a cancer cell. It also allows us to develop new and more precise therapeutic strategies.
In just the past few years, NCI-supported science has delivered a remarkable collection of genetic information about several types of cancers, a number of new targeted therapies for various cancers, compelling examples of successful therapies, persuasive evidence that radiographic screening can identify lung cancer early enough to reduce lung cancer mortality, and many new observations about how cancer cells arise, develop, behave, and interact in their micro-environment.

How has the work of NCI changed since the National Cancer Act was signed just over 40 years ago?

When the National Cancer Act was signed in 1971, the NCI Director was viewed as the leader of the National Cancer Program, heading the nation's efforts to combat cancer. We now recognize that efforts to control cancer and its effects—through science, medicine, and social programs—are so vast, conducted by so many people, and funded by so many organizations that leadership in any strict sense is not possible. Still, the NCI and its director have enormous potential to lead the nation's efforts through the NCI's "convening power"—the ability to bring people together from all sectors working on cancer and to think cooperatively about how to solve our most difficult problems.

Funding for many kinds of medical research—including cancers—has slowed in recent years and at a time when medical and technological opportunities are increasing.

This slowdown in funding has come, ironically, at a time of unmatched promise in the cancer sciences and at a time when the world of cancer research has expanded in talent, facilities, and ideas.
We must balance our knowledge about the public health burden of each cancer type against the knowledge that the sources of our greatest advances are difficult to predict and often emerge from unexpected places. Scientific opportunity, the richness of experimental ideas, and the talent of investigators must be taken into account, along with the toll taken by individual cancer types, if we are to spend our funds wisely and earn public trust.
For more information, please visit www.cancer.gov.

Winter 2013 Issue: Volume 7 Number 4 Page 2-3