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1 [1] (September 29, 2023)

handle is hein.crs/govenac0001 and id is 1 raw text is: Congressional Research Service Informing the IegisIative debate since 1914 September 29, 2023 The Cancer Moonshot: Overview and Issues Cancer was the second-leading cause of death in the United States in 2021. For decades, Congress has maintained a sustained interest in reducing cancer mortality, particularly by funding cancer research at the National Institutes of Health (NIH). In 2016, the 21st Century Cures Act (Cures Act; P.L. 114-255) authorized appropriations for the Cancer Moonshot initiative at NIH, which expires at the end of FY2023. President Biden previously signaled that reauthorization of the program is a priority. Congress has not considered any bills to reauthorize the Cancer Moonshot program. The Cancer Moonshot was originally established in 2016 as a biomedical research program with the broad goal of making a decade's worth of scientific progress in preventing and treating cancer in just five years. In 2022, President Biden announced a reignited Cancer Moonshot effort. This new Biden Administration Cancer Moonshot would also incorporate other health policy strategies, such as promoting access to cancer care and screening, in addition to biomedical research. The Biden Administration further announced programs and actions under the Cancer Moonshot in September 2023. If Congress considers reauthorization or other Cancer Moonshot-related legislation, policymakers might consider what priorities, if any, to establish for the Cancer Moonshot initiative, and specifically to what extent the program should support biomedical research compared with other health programs. Background on Cancer Cancer refers to a group of diseases characterized by the abnormal growth of cells in the body, which can invade and damage surrounding tissues and organs. There are many different types of cancer, including breast, lung, colon, and prostate cancer, among others. Treatment for cancer may include surgery, radiation therapy, chemotherapy, immunotherapy, or a combination of these approaches, depending on the type and stage of the cancer as well as the overall health of the patient. Cancer can sometimes be detected in early stages through screening, which can, in some cases, improve outcomes from treatment. The exact causes of cancer are not fully understood, but factors that can increase the risk of developing cancer include genetics; lifestyle factors, such as smoking or a poor diet; exposure to certain chemicals or radiation; and infections. Among adults, the overall death rate from all cancer types decreased from 2015 to 2019 by 2.3% per year (on average) for men and 1.9% per year (average) for women from 2015 to 2019. Death rates vary by cancer type, having decreased significantly for lung cancer and melanoma-some of the most common cancer types. Experts attribute declining cancer mortality to preventive behaviors (e.g., declines in smoking tobacco), new treatments, and enhanced early detection. Rates of new cancer cases (incidence) among adults have decreased overall in the same period, though certain cancer types have seen increases. Some research shows that delayed detection and treatment of cancer during the Coronavirus Disease 2019 (COVID-19) pandemic may affect cancer outcomes. There are disparities in cancer rates in the United States. For example, black people have overall higher death rates from cancer compared with all other racial/ethnic groups, though rates vary by cancer type. As another example, some research has found that cancer mortality is significantly higher in the lowest-income counties compared with the highest income counties. Cancer disparities may owe to differences in access to care; environmental conditions; health literacy; and other behavioral, life experience, or genetic differences. 2 Century Cures Act Cancer Moonshot Programn Authorization The Cures Act (P.L. 114-255; §1001), enacted in December 2016, involved a unique funding mechanism for the Cancer Moonshot initiative. The Cures Act transferred funds into an NIH Innovation Account and authorized those funds to be appropriated at various levels in specific fiscal years for four Innovation Projects, including the Cancer Moonshot initiative. Those funds were not available for obligation until appropriated each fiscal year. When appropriations are enacted-up to the authorized amount each fiscal year- those appropriations are subtracted from any cost estimate for the purpose of enforcing the discretionary spending limits. In effect, appropriations to the NIH Innovation Account as authorized by the Cures Act are not subject to discretionary spending limits. The Cures Act authorized a total of $1.8 billion for the Cancer Moonshot from FY2017 through FY2023. Congress has fully appropriated the authorized funding. Should Congress continue to appropriate funding for the Moonshot after the Cures Act authorization expires, these appropriations would be subject to the discretionary spending limits. Im plmen tation In 2016, NIH's National Cancer Institute (NCI) convened a Blue Ribbon Panel of outside experts to advise on cancer moonshot goals, which made recommendations for the moonshot research to focus broadly on improving cancer data and research platforms, improving treatments and addressing side effects, expanding cancer prevention, and intensifying research on the drivers of pediatric cancer. With the Cures Act moonshot funding, NCI has invested in research resources and platforms aimed at making it easier

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