As it is for many of us, cancer is personal for President Biden. In his State of the Union address this month, he renewed our nation’s commitment to end cancer as we know it.
He plans to start by cutting the cancer death rate in half and by improving the lives of people with cancer, cancer survivors, and their families. These are lofty goals, but for the renewed Cancer Moonshot to succeed, we’ll need to commit to effective prevention strategies, especially through a healthful plant-based diet and human-specific research—research that reliably models patient tissue and microenvironments, advances precision medicine, and addresses health disparities.
Indeed, cancer prevention is a stated priority for the renewed Cancer Moonshot, but only vaccines and environmental exposures are highlighted. This scope is shortsighted. The most powerful cancer prevention tools may already be at our fingertips: forks, knives, and spoons. Limiting carcinogenic foods and increasing the intake of foods that lower cancer risk can be the difference between a diagnosis and a crisis averted. Red and processed meats raise colorectal cancer risk; dairy products increase prostate cancer risk; soy intake and a low-fat diet both increase survival in women with breast cancer; and dietary fiber protects against colorectal cancer. The World Cancer Research Fund/American Institute for Cancer Research recommends eating a diet high in all types of plant foods, including whole grains, vegetables, fruit, and beans. The renewed Cancer Moonshot should therefore focus its prevention efforts on nutrition by promoting healthy plant-based diets and diverting processed meats—classified as Group 1 carcinogens by the World Health Organization—from ending up on the nation’s plates.
Effective medical research builds trust in our scientific institutions and underpins everything from the implementation of dietary recommendations to advancing cancer diagnostics and therapeutics, to addressing inequities in cancer outcomes. For this reason, it’s crucial that the renewed Cancer Moonshot make investments in human-specific, nonanimal research. The original Cancer Moonshot resulted in millions of dollars in animal research through programs like PDXNet. PDXNet coordinates the development of patient-derived xenografts, where human cancer cells are grafted into mice and used to test potential therapies. But xenografts, just like other animal experiments, cannot replicate the human microenvironment or human metabolism, resulting in unpredictable differences in drug efficacy and toxicity outcomes. They are also expensive and time-consuming, and they lack the large-scale testing capabilities common to 21st century methods.
In his address, Biden expressed the need to turn cancers from death sentences into treatable diseases. By the end of its seven-year term next year, the original Cancer Moonshot will have spent $1.8 billion, but thus far it hasn't achieved a single successful clinical trial. Instead of throwing good money after bad, the renewed Cancer Moonshot should focus on human-specific approaches. We need modern, 3D, in vitro approaches like tumor chips and cancer organoids. These hold key advantages over xenografts and other animal-based systems: more accurate modeling of human biology within a shorter time frame and with lower resource and ethical burdens. We need to invest in efforts to incorporate what we’ve learned from the Human Tumor Atlas Network into realistic models of human drug response. And we need computational methods to integrate all that we know about human population variability so we can predict what will work for each patient.
Finally, human-focused cancer research must be a key component of addressing inequities, another stated priority for the renewed Cancer Moonshot. Research can provide a deep understanding of factors that impact cancer outcomes, including the effects of racism on health and barriers to participation in clinical trials, which then inform systemic solutions. Cancer research and other programs involving racialized and marginalized communities must be conducted with great care, however. Community engagement through the Cancer Moonshot should be built upon co-leadership and reciprocity to avoid and redress extractive and exploitative medical practices of the future, present, and past.
If Biden’s renewed Cancer Moonshot is going to bring about the transformation needed in research and prevention to cut the cancer death rate in half, it must focus on the most effective strategies. We can achieve these goals if we empower Americans with agency over cancer prevention through nutrition, if we advance human-specific research, and if we center on communities in the most need of care.