in NCI and added to the mission of the Institute research on the continuing care of patients with cancer and their families. In 1993, the NIH Revitalization Act (P.L. 103–43) required that the Institute intensify and expand its research on breast and women's cancers and prostate cancer. It also required a set-aside for cancer control activities.

Progress Reports

The U.S. Congress had given NCI special consideration since the beginning of the War on Cancer, as evidenced by increased levels of funding and authority. In 1993, however, the nation, through its elected representatives in the House and the Senate, appeared to be unhappy with the progress of the War, although it was impressed by the breakthroughs in molecular biology.

Progress Report 1

In 1993 the Institute prepared a report on the progress that had taken place between 1982 and 1992 in the scientific understanding of cancer (National Cancer Institute, 1993). Six expert panels provided evidence of substantial progress in a variety of areas. Perhaps the most fundamental progress, according to this report, was in understanding of the multistep process of genetic changes by which cancer is initiated and promoted. Cancer had come to be recognized as a genetic disease or a category of diseases caused by the accumulation of mutations. Most of the mutations are somatic and occur only in an individual's cancer cells, but about 1 percent of all cancers are associated with a hereditary syndrome, and individuals with these hereditary syndromes carry the mutation in every cell of their body (Fearon, 1997). Advances in biotechnology had enabled scientists to identify normal genes that stimulate cell proliferation. These genes undergo mutation as a result of exposure to carcinogens, and the disruption in their function results in abnormal cell growth. In addition to these genes, which are called oncogenes, suppressor genes suppress the growth of tumors. Mutation or damage to these genes also causes abnormal growth.

Much of the new knowledge about the prevention, diagnosis, and treatment of cancer had resulted from the study of cells at the genetic level and had become possible through the use of new technologies such as the polymerase chain reaction. New technologies included nuclear magnetic resonance imaging and computer modeling. In addition, the ability to identify genetic markers had contributed to the ability to detect inherited susceptibility to cancer, and some marker genes such as the BRCA1 gene had been identified.

Progress in the detection of cancer had been affected by new or improved



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