Report of the President and Director
(prepared in 2002)

Fred Hutchinson Cancer Research Center has reached its 27th year. Although young compared to our peer institutions, we have achieved a stage of considerable maturity. With 2,800 employees, 200 faculty and an annual research budget of about $250 million, we have become the largest institution in receipt of research funding from the National Cancer Institute and, among free-standing nonprofit research institutions, we are No. 1 in total National Institutes of Health funding. We have nearly completed building our new Public Health Sciences building at Southeast Lake Union and soon, all of our scientists will be working together on one campus.

Although we train students and treat patients, we are primarily a medical-research institution. Each of the center's four divisions, Basic Sciences, Human Biology, Clinical Research and Public Health Sciences, are world leaders and have many seminal contributions to their credit. We are also heavily involved in collaborations within the community, particularly in the Seattle Cancer Care Alliance and the Fred Hutchinson/University of Washington Cancer Consortium, which also involves Children's Hospital and Regional Medical Center. We partner with health-care organizations around the region to promote participation in clinical and prevention trials, which are essential to developing better ways to prevent, diagnose and treat cancer.

An institution of our stature has a responsibility to take leadership for the cancer problem. Our mission, "to eliminate cancer and related diseases as causes of human suffering and death" may appear to be an unrealistic idea in view of the fact that cancer survival has improved only marginally in the last 20 years. There are isolated success stories like childhood leukemia, and testicular and cervical cancer, in which dramatic improvements have been achieved. Fred Hutchinson contributed its own success, the development of bone-marrow and stem-cell transplantation, which now cures tens of thousands of cancer patients worldwide each year who otherwise would have died. But we cannot escape the fact that the major U.S. cancers - breast, prostate, colon and lung - have shown very little improvement.

Most of the current research on cancer therapy emphasizes late-stage disease. Biologists study late-stage cancer to identify pathways for therapeutics. New therapeutics are first tested in clinical trials with patients with late-stage disease. Yet the survival from late-stage, disseminated cancer, for all of the prevalent cancers, has shown almost no improvement in 20 years. In contrast, survival for breast, colon and prostate cancer for patients detected with localized, early stage disease is 85-95 percent over five years and remains high at 10 years. These patients are cured - usually by surgery alone.

Is there another path we should be taking? The implication is obvious. We should work to detect cancer earlier, when it can be cured by standard procedures. Many have recognized this fact for years. However, the technologies to develop sensitive and highly specific molecular markers for early cancer detection are just now becoming available. Technologies arising from our knowledge of the human genome sequence now permit a direct approach to finding such markers. These technologies require more development. But I believe, along with many of my colleagues, that this is time for an all-out effort to develop markers for early detection of cancer. If successful, dramatic improvements in cancer survival would occur quickly.

If this goal can be achieved, the whole health-care enterprise will reorient its approach to the cancer patient. Screening for cancer will be as universally available as tests for blood cholesterol. Most cancers will be detected early and eliminated. The surviving patients will constitute a high-risk group either because their genetics or their history predisposed them to the cancer they experienced. These survivors will have the opportunity to enroll in high-risk clinics where they can be monitored periodically for recurrence of their cancer, and they will be prime candidates for chemoprevention of cancer.

This scenario will also reorient our fundamental study of the biology of cancer. Rather than trying to understand the molecular changes in late-stage disease for the treatment of advanced cancer, we will need to understand the earliest biological events in the progression to cancer so that we can develop chemoprevention drugs to target the emergence of disease.

Fred Hutchinson is in a strong position to bring about these changes in the understanding, diagnosis and treatment of early-stage cancer. Our public-health scientists are leaders in designing and executing the large population trials necessary to validate biomarkers for early detection. Our clinical-research scientists are leaders in immunotherapy that may be applicable to high-risk prevention strategies for patients with a previous cancer. Our basic and human-biology scientists are investigating many animal and human cancers to reveal the earliest changes in cells that lead to cancer.

No one has the right to predict the future. But a research institution has to bet on its best guess of the future. A future of early cancer detection seems realistic to us, and one that this highly capable institution should make every effort to bring to reality.

Dr. Lee Hartwell
President and Director