Clearly an entity the size of OCF has limited impact on cancer itself when you consider the dollars we contribute to it. But consider how little a percentage our disease is getting from the big money sources we have been discussing. Small incidence diseases like oral cancer do not fare well given the existing model. OCF cannot look at long-term research goals. We cannot consider esoteric research that MAY have an application in a decade or two. We specifically look for areas where we believe that by co funding with others (often university based researchers, and the NCI) we can bring an answer to the population that we serve, and to future people who might be a part of it rapidly.
This means that ideas such as salivary diagnostics; which is likely to contribute significantly in the near term as it nears a commercial application, allowing the identification of high risk individuals from a very large population. These individuals can then be put on accelerated screening protocols to catch their disease at the earliest possible moment. Tissue auto-fluorescence, a science which has already yielded commercial devices since OCF co-funded the research (done in cervical cancer), for the early discovery of suspect tissues that may be difficult to see with the naked eye during dental examinations, has drawn our attention and donor dollars. Devices now in the market, are having an impact on early discovery when combined with a conventional visual and tactile screening.
Both these recipients of OCF funding share two important components. They facilitate the early discovery of at risk individuals or those with existing disease at stages when treatment related morbidity will be lower and there is an opportunity for greater survival, and their impact could be brought to bear on the disease in a very short period of time from the research world to public application. HPV research which has been a focus of OCF’s financial support for more than a decade, has yielded peer reviewed published science that has identified; the at risk demographics, the transmission mechanisms, the early signs and symptoms, a definitive test for separating this new and distinct etiology/cause from the historic tobacco related cause, and now identifying therapeutic targets for interfering with the viruses ability to convert cells to malignancy. OCF spent three years attending the vaccine meetings at the CDC to argue for a change in the rules that excluded young boys from being vaccinated. Surprisingly, none of the big non profits wanted to wage that battle with an organization as powerful as the CDC. Only one other small charity (related to another cancer caused by the virus) joined us in this fight. We eventually won this battle and boys who are vectors of the virus to women, and who get the majority of the oropharyngeal cancers, can now be vaccinated. The HPV research which the foundation has co-funded for many years, has expanded our understanding of HPV since 2001.
The foundation’s spending on research is highly targeted. With the limited dollars that an organization of our size can apply, we fund only ideas with immediate applications, and which can be brought to bear on the problem in a relatively short period of time.
Other, perhaps more important use of donor funding.
The foundation believes that in all cancers, and in oral cancer specifically, that early discovery/detection and prevention are the areas that will ultimately save the most lives. Of course if you have never even heard of a disease (the case for oral cancer in the US), how can you possibly avoid the risk factors which you obviously also do not know about, or recognize the early signs and symptoms that might allow self-discovery, and very early staging? We know that stage one oral cancer patients have less treatment related morbidity, they have fewer long-term quality of life issues, and they have better survival rates. We know that stage four cancer patients fare far worse in these same areas. Our goal, the place in which OCF can have the maximum impact for the dollars spent, is less on some research science of unknown outcome, or which might take years to bring to fruition, but in prevention and early discovery.
Besides their very low spending on oral cancer, when you look at the NCI’s budget, it is more of the same. Approximately 2 billion dollars were requested for BASIC cancer research into the mechanisms and causes of cancer. Another 1.3 billion was requested for treatment. Cancer prevention and control gets an ask of approximately 250 million. The irony of all this is that in the very same budget report the NCI states, “Much of the progress against cancer in the recent decades has stemmed from the successes in the areas of prevention and control.” Prevention is more impactful than cure. When you consider the financial return on investment, let alone the human toll, there is just no comparison. We have these opportunities in oral cancer. Tobacco, which historically has led the deadly numbers, is finally declining in the US, but it is far from eradicated as a source of cancer, and oral cancers specifically. Tobacco cessation information work can have profound impact on the oral cancer numbers in the future. HPV, the rapidly escalating driver in cancers of the back of the mouth (oropharynx) can be curbed in future generations through existing vaccine use. But we need to invest in public awareness, tools to facilitate tobacco cessation and education, and education related to the HPV virus and opportunity for vaccination to eliminate the viral cause in the next generation.
All this, while providing the most obvious route to reducing the incidence and impact of oral cancer, is far less “sexy” and attractive to donors than “research” which they believe will be the Holy Grail of the solutions. One requires a breakthrough idea, and years of high dollar investment (outside of OCF’s capabilities), with many paths taken proving unproductive in its incremental movement to a potential “silver bullet” that eradicates oral cancer. The other is available today and can have immediate impact, contributing to a steady decline in the incidence and mortality numbers.
OCF will continue to invest in research as the opportunities arise, particularly when we can interest co funders to join us in a particular project that meets our stated criteria. Those expenditures will be proportionate to opportunity, and co exist with the impact that we can have through more public health related spending.