Cancer research in the United States does not rely on an institution or funding flow - it is a complex ecosystem composed of interdependent parts: academia, pharmaceutical companies, biotech startups, federal agencies, and private foundations. As a cancer biologist who has worked in these departments for the past three decades, I have witnessed first-hand how each piece supports other departments.

When one staggers, the entire system becomes vulnerable.

The United States has long led cancer research. It costs more cancer research than any other country, with the National Cancer Institute alone at $7.2 billion a year. This continued public investment has helped drive a sharp decline in cancer mortality since the National Cancer Act of 1971, which has dropped by 34% since 1991. Over the past five years, the Food and Drug Administration has approved more than 100 new cancer drugs, and the United States has brought more cancer drugs to the global market.

But this legacy is under threat. Funding delays, political shifts and instability across the sector create an environment in which basic research on the fundamentals of cancer biology is working to maintain traction while the drug development pipeline shows signs of stress.

These damages go far beyond uncertainty and have practical consequences. Early career scientists facing unstable funding and limited work prospects may leave academics altogether. Intermediate researchers usually spend more time pursuing scarce funds rather than conducting research. Disrupted research budgets and transfer policy priorities can reveal years of cooperation. I, along with many other researchers, believe that these setbacks will slow progress, break the training pipeline and draw expertise from key research areas, which will ultimately hurt patients waiting for new treatment.

The foundation of 50 years of federal investment

The modern era of cancer research in the United States began with the signing of the National Cancer Act of 1971. The law has dramatically expanded the National Cancer Institute, an institution within the National Institutes of Health that focuses on cancer research and education. NCI lays the foundation for a strong national cancer science infrastructure, from early research in the laboratory to large-scale clinical trials, and supports training for a generation of cancer researchers.

This federal support has led to progress leading to higher survival rates and converting certain cancers into manageable chronic or curable conditions. Advances in screening, diagnostic and targeted therapies and patients who benefit from it are attributed to decades of NIH support.

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But federal funds have been vulnerable to political headwinds. In-depth cuts to biomedical science budgets during the first Trump administration could undermine progress made under 2016 initiatives such as the Cancer Moon. Despite strong bipartisan opposition in Congress, the cuts are justified by cuts in overall spending. Legislators eventually rejected the government's proposal and instead increased the NIH funding. In 2022, the Biden administration is committed to restarting the Cancer Moonlight.

This uncertainty has intensified in 2025 as the second Trump administration cuts or cancels many NIH grants. Labs relying on these awards suddenly faced a funding cliff, forcing them to give up their staff altogether, pause the experiment or shutters. The delay in communications from the Department of Health and Human Services has delayed new NIH grant reviews and funding decisions, putting many promising research recommendations already at risk.

Charity support is strong - but limited

Although federal agencies remain a backbone of cancer research funding, charities provide important support for breakthroughs, especially for new ideas and more risky projects.

Groups such as the American Cancer Society have built on the foundations of cancer and the large hospitals to fill important gaps, often providing funding for pilot studies or supporting early researchers before receiving federal grants. By supporting bold ideas and providing seed funding, they help initiate innovative research that may later attract large-scale support from NIH.

Without bureaucratic restrictions from federal agencies, philanthropy is more flexible and flexible. It can support work in emerging fields such as immunotherapy and precision oncology more quickly. For example, the American Cancer Society grant process usually takes four months, while the NIH grant review process takes an average of eight months.

But charitable funds are small and are usually disease-specific. Many of the foundations are created around specific causes, such as the treatments that advance pancreatic, breast cancer, or pediatric cancer. The urgency of their impact allows them to fund bold approaches that federal funders consider too preliminary or speculative. Their donations also fluctuate. For example, the American Cancer Society awarded nearly $60 million in 2020 research grants compared to 2019.

Although private foundations are important partners in cancer research, they cannot replace the size and consistency of federal funding. It is estimated that the total charitable funding in the United States is for cancer research estimates, which are distributed in billions of dollars each year, among hundreds of organizations. By contrast, the federal government usually contributes about five to eight times more to cancer research every year than philanthropy.

Industry innovation and its priorities

Private sector innovation is essential to convert discovery into treatment. In 2021, nearly 80% of the approximately $57 billion spent on cancer drugs in the United States comes from pharmaceutical companies and biotech companies. Many of the treatments used in oncology today, including immunotherapy and targeted therapies, are collaborations between academic labs and industry partners.

However, business priorities are not always aligned with public health needs. The company naturally focuses on areas with rich financial returns: common cancers, projects that qualify for rapid regulatory approval, and high-priced drugs. Rare cancers, pediatric cancers, and basic sciences often receive less attention.

The industry is also full of uncertainty. Rising R&D costs, tough regulatory requirements and investor caution create a challenging environment to bring new drugs to market. Over the past year, several biotech startups have been struggling with new drugs in the lab before they can conduct clinical trials.

Without federal or charity to compensate for this slack, these findings may never attract patients who need them.

System under pressure

The cancer will not go away. As the U.S. population ages, the burden of cancer in society will only increase. Differences in treatment visits and outcomes persist in racial, income and geography. And factors such as environmental exposure and infectious diseases continue to intersect with new and complex ways of cancer risk.

Addressing these challenges requires a strong, stable and well-coordinated research system. But the system is responding. The National Cancer Institute’s grant line or funding cutoff remains highly competitive. Early career researchers face unstable job prospects. The lab is losing technicians and postdoctoral researchers in high-paying roles in industry or burnout. and patients, especially those who wish to participate in clinical trials, face delays, disruptions and reduced options.

This is not only a funding issue. This is a coordination issue between the federal government, academia and industry. At present, there is no long-term policy solution that ensures sustained federal investment, promotes collaboration between academia and industry, or makes room for philanthropy to drive innovation, not just fill in the gaps.

I think that to make the United States a global leader in cancer research, it will require funding to successful models: a balanced ecosystem of public funding, private investment and nonprofit support. Until recently, this meant providing predictable long-term budgets to enable labs to plan for the future; inspiring partnerships that would find shifts from benches to bedside without compromising academic freedom; and providing a career path to support young scientists so that they would not leave the court. and create mechanisms for equity to ensure research includes and benefits from all communities.

Cancer research and science have come a long way, and from 1991 to 2022, the United States saved about 4.5 million lives from cancer. Today, thanks to decades of discovery, thousands of researchers have discovered that patients have lived longer and better for decades. But science is not a good intention. It requires college. It requires charity. It requires industry. It requires vision. It requires ongoing federal support.