What’s Next For President Biden’s Cancer Moonshot?

In an area of political polarization in Washington, D.C., the Biden administration’s Cancer Moonshot has drawn bipartisan support. In the U.S. last year, nearly two million Americans were diagnosed with cancer and more than 600,000 died, according to American Cancer Institute estimates. Approximately 10 million people died from cancer around the world in 2022.

President Joe Biden himself experienced the loss of an immediate family member in 2015 with the death of his son Beau. With then President Obama’s backing, Vice President Biden led the first Cancer Moonshot in 2016. After his election in 2020, he “reignited” the program in February 2022 as president with the headline goal of reducing the death rate from cancer by at least 50% over the next 25 years.

How much progress has been made? A lot, Dr. Danielle Carnival, Deputy Assistant to the President for the Cancer Moonshot, said in a recent interview. (Click here for a related interview last year.) Edited excerpts follow.

Forbes: How has the Moonshot been progressing?

Carnival: When we spoke last year, we had formed the cancer cabinet. We had two top-line goals of reducing the death rate from cancer by at least 50% over the next 25 years, and improving the experience of people including caregivers and families living with and surviving cancer.

We have since set priorities enabling us to be very clear about what is progress. One is to close the cancer screening gap that was exacerbated during the early years of the Covid-19 pandemic. But we also are working to close an equity and access gap existing for decades prior to Covid-19. We have also worked to address cancer from environmental and toxic exposure, and to decrease the impact of preventable cancer — think smoking cessation, nutrition, and HPV vaccinations. Colonoscopies have been a good one there because they not only detect cancer, but can remove precancerous lesions.

We’ve packed what people think traditionally is innovation into one – to drive progress from research to patients and communities. With these big goals, government agencies and departments can dig into them, get very specific about what that looks like for them, and push out a lot of progress.

Also, what I’m most excited about is how we’ve re-ignited not only the government side of the Cancer Moonshot, but that action and drive in the advocacy, patient, research and care provider communities that we had in 2016. Then, people said, “This is the vision, and we want to run and be bigger, better, faster, stronger, more collaborative.” And we’ve really reignited that. We’ve seen that over the last year. That’s come through in many different ways.

Forbes: Let’s zero in on progress with cancer from environmental exposures. What progress has been made there?

Carnival: The PACT Act — a once-in-a-generation, huge investment in our veterans, their access to care, and benefits for their caregivers and survivors — will have a huge impact not only on providing health benefits for those who are presumed to have cancer or other disease because of their service, but, through a huge investment from DoD and VA in particular, in understanding the linkage between those exposures and the diseases including cancer.

The EPA through implementation of the bipartisan infrastructure law— another huge signature piece of legislative progress in the last year — is not just building roads and bridges, as many people think. It also provides billions of dollars to clean up toxic Superfund sites which we know are impacting people’s health and have a connection to cancer. Funds are also replacing water lines and pipes, so all communities have access to clean water and can take a regulatory approach to reduce PFAS, the so-called “forever chemicals.”

When we last spoke, we were talking about a really broad agenda to deliver two bold goals. And now that we’ve broken it down, there are really big steps that we’ve taken. President Biden earlier this year signed an executive order on environmental justice that is directly connected to the Cancer Moonshot and reducing the impact of preventable cancers, especially in communities of color and underserved communities that we know have higher exposure — through jobs and through where they live — to some of these chemicals that will have an impact on their health outcomes broadly but specifically in cancer.

Forbes: How have you tried to expand screening?

Carnival: From the Federal side, we created a brand new program at HRSA, the Health Resources and Services Administration. So far, they’ve put out $11 million, but it’s a program that we’re looking to grow. There is a really novel connection between federally qualified health centers serving some people living in poverty and then connecting them to NCI-designated comprehensive cancer centers so that they’re getting access to life- saving cancer screenings and early detection services along with navigation. If they have a positive result, they’re now connected to excellent care, a pipeline to get that diagnosis, and a way to get that cancer addressed.

The Centers for Disease Control and Prevention has issued more than $200 million in grants as part of a greater than $1 billion commitment. These went to every state, many U.S. territories and tribal organizations – and directly to local providers and community organizations who know how to reach folks with cancer screening.

This wasn’t just about access to cancer screenings. CMS announced a national coverage determination, expanding coverage for lung cancer screenings with low dose CTs to improve health outcomes for people with lung cancer. CDC and the tri-agencies of HHS, Labor and Treasury also improved access to colon cancer screenings. You may remember that with these new stool-based tests, if people were getting a positive indication, the colonoscopy was then a diagnostic, not a screening, and there was a lot more cost for the patient. And we’ve closed those gaps so that you don’t pay more after a positive test at home, because those tests are great at showing us where to target resources and who is most at risk.

Then the last thing I’ll mention with screening is NCI launching a large national trial on these multi-cancer detection tests. There’s a lot of hope behind these. What NCI wanted to do was give a level playing field across the country that targeted a diverse set of populations to test as many of the technologies as possible against each other to really understand where we’re seeing benefit. The biggest hope is in detecting cancers that we don’t have good tools for now, and especially those without symptoms such as pancreatic and ovarian cancer.

Forbes: Has there been any progress in expanding trials, treatments and data sharing in rural areas?

Carnival: There’s a shift from finding a “silver bullet” for a specific kind of cancer. That’s a really important part of the Cancer Moonshot. We’ve said from the beginning we don’t have all the tools we need to reach the goals that we’ve set. We need to drive progress in new ways to prevent, detect, and treat cancer. But we also need to make sure that the tools we have today, and those we develop along the way, reach all Americans.

You see this in the National Cancer Plan that NCI under Dr. Monica Bertagnolli just put out. This was a way of kind of solidifying how NCI is thinking about reaching the goal of ending cancer as we know it.

And so much of that is how can NCI position itself and then work with the rest of communities that have their fingers into all of the communities across the country to make sure that what we’re doing from research, through data and through care, is reaching more people.

Monica says it is now a principle at the National Cancer Institute that every American facing a cancer diagnosis should have the right to participate in research — whether that’s through a clinical trial, through participating in a data network or something else. We’re interested in updating the cancer research and care system for today’s fight rather than the one that started 51 years ago. We think one way to do that is through re-authorizing the National Cancer Act, and building into NCI’s DNA a feeling of moving out and building a national infrastructure community-connected NCI that shares research and reaches individuals.

The last thing I’ll say on this is we often talk about diversity in clinical trials. Yes, it’s an important first step. For the individuals who get access to that trial, it may be their best hope of surviving or extending their life.

But unless we then create a system where it’s not just that trial, but a sustainable connection between an NCI comprehensive cancer center, and through telehealth or an extended network where they’re being seen by a community oncologist, we’re not getting into the community. We’re serving some people better and we’re more knowledgeable about the science, but we’re not changing the system.

Forbes: How about progress with children’s cancers?

Carnival: It was called out from the beginning of the reignited Cancer Moonshot as a focus, along with all other rare cancers. NCI recently put out a paper saying to reach the 50% goal, you have to drive progress in the big cancers that impact a lot of people. But what Monica Bertagnolli, Liz Jaffee and I put out in an accompanying opinion piece was you actually can’t reach the goal without making progress beyond those.

We have not left out anyone in the ambition of what we’re setting for the Cancer Moonshot, specifically for childhood cancer. We brought back the Childhood Cancer Forum to the White House, which gathered dozens of advocates, researchers and clinicians. That made sure that they had a national stage, and resulted in the reauthorization of the STAR Act, an advocate, grassroots-driven piece of legislation that created better data systems and research infrastructure for childhood cancer.

NCI also recently brought together dozens of internal and external partners for the Childhood Cancer–Data Integration for Research, Education, Care, and Clinical Trials (CC-DIRECT), whose goal is threefold. One, it provides direct navigation and assistance to families facing a new childhood cancer diagnosis. It also allows them to opt in directly to research that includes trials and data. And it connects many more individuals facing a childhood cancer diagnosis to the NCI and broader research infrastructure in a way that we hope makes progress faster in understanding and treating childhood cancers, and helps that individual have a better pathway.

The last thing I’ll say is the progress we’re seeing from outside organizations and groups that really do great work. A lot of that has been in the childhood cancer space — whether it’s new data agreements and infrastructure, or collaborations. So much is driven by that because thankfully these are rare. They impact too many kids, but they’re still rare. We have to have that cross connection across centers and individual researchers. And we’ve seen a lot of that come forward as part of the Cancer Moonshot in the last year.

Forbes: Global health equity is a popular theme this year around the world. Is the Moonshot addressing that?

Carnival: While the goals for the Cancer Moonshot are very much domestic in focus, the ambitions have always extended far beyond the borders. Back in 2016, there was incredible work from NCI in partnering on research with more than a dozen centers across the world. We recognize that the burden of cancer falls heavily to lower- and middle-income countries where 80% of global cancer deaths occur. We hope to advance international work on equity by increasing access to prevention, screening, treatment, and care for families across the world. One specific way this happened is through the African Leaders Summit, which the president hosted last December; there was a spousal program with the First Lady focused on cancer.

As part of that event, there were new commitments from the Federal government and private sector that totaled about $300 million. We’re going to continue to build on that. We see our leadership as part of the Cancer Moonshot in two ways. Let’s expand the research collaboration we already have through NCI and the FDA’s Project Orbis, which on a regulatory basis is seeking partnerships with additional countries, so that we can move trials and regulatory approval forward faster.

And let’s, as the president often says, lead by the power of our example. Not just on the continent of Africa, but in many places around the world where we know the burden of cancer is so heavy. Let’s have conversations with other world leaders to join us in helping relieve the burden of cancer in less-resourced countries, like the European Union who already has a priority to combat cancer.

Forbes: How has the First Lady helped?

Carnival: She’s done listening and learning sessions across the country and the world, sitting with patients and talking about the impact that navigation services can have on the experience and outcomes. Because of her leadership we set a goal and started to make progress so that patient navigation services are a covered benefit for Americans facing cancer. That is all Dr. Biden.

And she is impatient for change here. The patient navigation community has done a ton of research on how it has a positive impact on patient and families, an impact on outcomes, and in many cases, decreases cost for the health system because patients are more satisfied and are being cared for on a more continuous basis. They don’t end up in the ER with treatment side effects. They have someone to call. She will continue to be a tireless champion for that work.

See related posts:

Why Fighting Cancer In Lower Income Countries Helps Progress In Rich Ones, Too

“Fundamentally Wrong”: Less Than 5% Of Cancer Patients Get Access To Clinical Trials

Forbes China, In Partnership With MSK, To Convene International Experts To Advance Fight Against Cancer

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