30 Years of Cancer Treatment: What Has Changed and What Challenges Remain?

Extraordinary advances in cancer research and treatment in recent years continue to save millions of lives, yet cancer remains a public health problem that has not been fully solved.

The American Association for Cancer Research’s (AACR) 2024 Cancer Progress Report celebrates these achievements while emphasizing that major challenges must be overcome to achieve further progress.

Remarkable Advances in Treatment

The AACR’s comprehensive report, published this year in its 14th edition and comprising 216 pages, highlights “tremendous” progress in cancer treatment, prevention, and early detection. In particular, advances in early detection and treatment have enabled cancers to be found earlier and millions of lives to be saved. The report states that the cancer death rate in the United States fell by 33% between 1991 and 2021, preventing approximately 4.1 million cancer deaths over that period.

Major progress has also been made in childhood cancers. Over the past 20 years, the overall cancer death rate among children and adolescents has fallen by 24%. The 5-year survival rate after a cancer diagnosis in children in the United States rose from 58% in the mid-1970s to 85% in 2013-2019. This progress was made possible by developing new targeted drugs through decoding cancer genetics.

• Related topic: An Important Message for World Cancer Day, 4 February 2024: Inequalities Come to the Fore as the Cancer Burden Rises

Newly Approved Cancer Drugs and Diagnostic Tools

In fiscal year 2023-2024, the US Food and Drug Administration (FDA) approved 15 entirely new cancer treatments, as well as, for previously approved drugs, 15 new indications and a new imaging tool. Artificial intelligence (AI)-assisted early cancer detection and diagnostic tools are also revolutionizing healthcare. These new technologies make cancer diagnosis more sophisticated and enable a better understanding of tumors at the cellular level.

Two new molecularly targeted treatments for children were also approved during this period: tovorafenib for certain types of brain tumors, and repotrectinib for various cancers with NTRK gene fusions. In addition, eflornithine was approved to reduce recurrence risk in children with high-risk neuroblastoma.

Major Challenges to Progress

Despite all this progress, major challenges remain in the fight against cancer. More than 20 million new cancer cases worldwide in 2022 and more than 2 million new cases in the United States in 2024, with over 611,000 deaths, are expected. The incidence (frequency) of some cancers is rising. In particular, vaccine-preventable cancers associated with human papillomavirus (HPV) and cases of cervical cancer in young adults are increasing. The report shows that cervical cancer incidence among women aged 30-34 rose by 2.5% annually between 2012-2019.

Even more concerning is the limited awareness and low uptake of HPV vaccination. In 2022, only 38.6% of children and adolescents aged 9-17 in the United States had received at least one HPV vaccine dose. Although its effectiveness is established, more effort is needed to expand vaccination.

The report also notes an increase among adults under 50 in early-onset cancer among adults. Rates of breast, colorectal, and certain other cancers are rising in young adults.

Preventable risk factors also contribute substantially to cancer; 40% of all cases are associated with preventable factors such as smoking, excess weight, and alcohol. Excessive alcohol consumption is known to increase the risk of six different cancers.

Financial Challenges in Cancer Treatment

Cancer patients face difficulties that are not only health-related but also financial. The report finds that more than 40% of patients diagnosed with cancer use up all their savings during the first two years of treatment. Among adult survivors of childhood cancer, 20.7% struggle to pay medical bills, while 14.1% cannot afford medical care.

Worldwide, the global economic burden of cancer over 2020-2050 is expected to reach 25.2 trillion dollars. Containing costs and expanding patient support programs are therefore also critically important.

Steps Ahead: More Investment, More Progress

Despite these challenges, we are in an era of “unprecedented opportunities” in cancer research. Exciting developments in cancer research and patient care are expected in the coming period. However, sustaining this progress requires research funding to continue at a robust level.

The AACR calls on Congress and other stakeholders to act to ensure that, for fiscal year 2025, the NIH budget is at least 51.3 billion dollars and the NCI budget 7.934 billion dollars. In addition, funding is requested for the Cancer Moonshot program through 2026, amounting to 3.6 billion dollars. These investments will enable further progress in cancer treatment, increase cancer survival rates, and maintain US leadership in scientific research.

The AACR’s 2024 report celebrates major strides against cancer while highlighting gaps and needs. If the necessary steps are taken, there is hope of making substantial progress toward one day winning the battle to prevent and treat cancer.