Although cancer rates are declining about 1% per year, cancer is the second leading cause of death in the United States, surpassed only by heart disease. In 2009, 567,614 people died from some form of cancer—1,555 people every day. We’ve been waging war on this disease for decades now. But we now have the tools to address many more questions.
How does aspirin protect against cancer? How does obesity increase the risk of cancer? What genetic, epigenetic, biologic, behavioral, or environmental factors enable some people with highly lethal cancers to survive beyond expectation?
These are just a few perplexing issues chosen as part of the Provocative Questions Initiative of the National Cancer Institute (NCI), one of the 27 Institutes and Centers that make up the NIH. The initiative identifies previously neglected questions or problems about cancer. By crowdsourcing the entire research community, NCI hoped to identify the most important questions—potentially creating game-changing advances in preventing, diagnosing, and treating all forms of cancer.
To select the most challenging and interesting questions, NCI held 16 day-long workshops at the NIH. They invited:
- Clinical and translational investigators
- Basic scientists
- Behavioral researchers
- Evolutionary biologists
- Drug developers
For those who couldn’t attend these workshops, NCI launched the Provocative Questions website for online submissions. Anyone in the world could submit a question or comment. The response was overwhelming, with hundreds of questions being submitted. NCI leadership selected the top 24, organized around four themes, and solicited grant applications that focus on them.
Questions were selected for a variety of reasons, including the opportunity to:
- Provide explanations for forgotten observations
- Address complicated issues that are easier to explain with new genomic technologies and computing power
- Explore questions based on new findings
NCI received 750 grant applications and funded 56 of them in the first round of competition in 2011. Total funds awarded totaled $21.5 million. NCI received a second round of applications in June, 2013. Answering each of these questions will expand our understanding of cancer biology in the near future.