Although the mortality and incidence rates of cancer in the United States have been declining in recent years, the overall number of cancer cases and deaths is still increasing. About two million Americans are diagnosed with cancer every year, and more than 600,000 die from it. The primary risk factor is aging.

Researchers have never known more about the formation, growth, and spread of cancer than they do now. Cancer research has yielded extraordinary advances in understanding the biological mechanisms underlying why people are susceptible to cancer and why it grows. Translating this knowledge into the development of new treatments tailored to improve patient outcomes is known as precision medicine or precision oncology.

So far, precision medicine has focused mainly on developing new treatments for advanced cancers, when the chances of a complete cure are low. But if cancer is caught early, before it has spread, the possibility of a cure is significantly higher. These observations suggest that new approaches to improve cancer detection and treat cancer sooner have the potential to substantively improve outcomes for people with cancer.

The benefits of detecting and treating cancer earlier have already been demonstrated by screening colonoscopies for colon cancer and Pap smears for cervical cancer. These tests have been shown to stop cancer before it starts by detecting precancerous changes.

The same concept holds true for most other solid tumors: When tumors are found at an early stage, people have the best outcomes.

Using Molecular Tools to Develop Better Approaches

The tests that are currently used for early cancer detection and prevention are not very sensitive or specific. Because of this, in some cases they lead to a high number of false positive results. In other cases, they may miss the cancer.

Many of the methods for early detection have not evolved at the same pace as our understanding of cancer, making them technologically out of date. Emerging molecular approaches may allow doctors to screen people for cancer that can’t be detected with existing measures.

We aim to better identify who is at a high risk of developing cancer so that we can provide them with potentially life-saving measures.

Several well-characterized factors trigger the formation of mutations that can lead to cancer. These include the following:

• an inherited risk for cancer (often linked with an inherited deficiency in DNA repair)
• environmental exposures, such as UV light, smoking, and chemicals
• inflammation
• infection
• aging

Approaches led by PIP will target these factors using a two-step process: identifying what constitutes a high risk and conducting research to benefit high-risk people. This research will include ways to minimize the formation of cancer or to stop cancer at an early stage. Once assembled, these groups of high-risk people will provide the basis for discovery, translation, and research on preventing cancer. Underpinning this project is a robust molecular genomics platform that includes somatic, germline, and cell-free DNA tests.