Biden’s Cancer Moonshot should focus on prevention, not a cure

“Let’s end cancer as we know it,” President Biden told Americans during last week’s State of the Union address. Earlier this year, Biden rebooted the Cancer Moonshot program he started in 2017 to cure the disease that took the life of his son Beau and kills 600,000 Americans a year–a rate second only to heart disease.

The initial program was granted $1.8 billion in funding over a seven-year period toward cancer research (which some argue is not that much money), and it has a new audacious goal of halving cancer deaths by 2047. The plan outlines several target areas, including improving immunotherapies, advancing childhood cancer research, mapping tumors, expanding existing cancer prevention and detection to a wider swath of Americas, and creating a framework for collecting and sharing cancer data.

So far, the National Cancer Institute has spent $1 billion of the funding on projects related to Biden’s Cancer Moonshot. But is the program focused on the right things?

Famed oncologist and cancer researcher Siddhartha Mukherjee says we should add a few more research areas to the list. Mukherjee, who is working on a new book about cellular immunity, recently cofounded a company called Faeth Therapeutics that is developing cancer drugs in tandem with nutrition plans that cut tumors off from the nutrients they need to grow. He spoke with Fast Company about Biden’s Cancer Moonshot and how he thinks we should approach the fight against cancer.

Biden’s research initiatives put emphasis on mapping tumors, investing in immunotherapy, addressing drug resistance, getting people more access, and broadly building a more collaborative open-data approach to research. I’m curious what you think of these focus areas.

I think, very broadly speaking, changing the trajectory on cancer is a pyramid. The pyramid begins at the bottom, as all pyramids do, with prevention. I’m talking about primary prevention; that is, making people have less cancer. We have identified major risk factors for cancer. These include some of them that were known before, such as smoking, alcohol, infections with some viruses, such as human papillomavirus [HPV], and—perhaps very relevant to the United States—obesity. So, the bottom of the triangle, which is the widest edge of the pyramid, is, of course, to prevent or to mitigate these risk factors.

The second layer is early detection, so-called secondary prevention. We have incredible new technologies to achieve early detection of cancer, which far outpace the older technologies. So, the older technologies are mammography, pap screening, colonoscopy, et cetera. We have new technologies, including looking at DNA shed by cancer cells and figuring out whether someone has cancer.

Then finally, we come to treatment, and there are multiple new drugs and immunotherapies. I think that those are important focus areas, but I would broaden the cancer surveillance and early-detection projects. The bigger question that lies behind all of this is, as a global or national policy, is: Should we focus on the bottom of pyramid, which is prevention and early detection? The prevention concerns are extremely important, because we need to understand: What is it? What are the factors? To what extent is it genetic versus metabolic versus an environmental phenomenon that sets you up to get cancer? I would urge us to think about this as a national project.

What are some of the questions you think cancer prevention researchers need to answer?

One is: What are the physiological states in the body that make you prone to cancer? What are the genetic predispositions that make you prone to cancer? What are the environmental predispositions, behavioral and otherwise, that make you prone to cancer? With the advanced tools that we have right now, including lots of data and data management, I think these are solvable problems—but they need to be solved.

Why is it that a 35-year-old woman has invasive breast cancer? You need to ask how much of it was genetic, how much of it was environmental exposure, or behavioral changes. How much of it was or is related to her physiological state?

The second series of questions follow metabolic state, and this is what [my company] Faeth is trying to do. To try to metabolically profile people and say, “You’re at a higher risk or lower risk of developing cancer,” and thereby developing new cancer drugs. From this very deep data-mining process—which was not possible 10 years ago, or 20 years ago—you now have this question: How do we make the behavioral changes or modifications that are required so that these X or Y aims are achieved? That’s a behavioral modification question, which is different from the first one—which is to identify what the problem is—and both are, I think, extremely important.

What kinds of data do you need to start answering these questions?

I think we need a much, much deeper analysis of the availability of many nutrients that cancer cells use [to thrive], like amino acids and precursors of amino acids and precursors of DNA synthesis, et cetera.

How do we change the metabolics so that people don’t get cancers? It’s a huge question and really needs a kind of consortium of thinkers. Are we eating the wrong things? Are we doing the wrong things? Same with early detection: Do cancer cells, when they arise early in their progression, secrete or use or change the metabolic profile of an individual such that we can identify those people who are at high risk or already have stage one cancer?

And then finally moving onto treatment: If you have cancer, it’s established, we’re treating you: Can we use our understanding of metabolics to treat the cancer? As we’ve shown, at least in animals, insulin is a major player in all this. Others have shown that there are other players, such as precursors of amino acids. So, we are trying each and every one of these as potential ways to prevent, detect, and treat cancer.

The Cancer Moonshot outlines, as one of its priorities, more opportunities to share data. In particular, it references the National Cancer Institute’s Cancer Research Data Commons. What opportunity do you see in that?

It would be great to have an open-source way to collect data. I think particularly now that we know more and more about metabolic parameters that affect cancer, that would be wonderful.