The purpose of this Notice is to inform potential applicants of the interest of the National Cancer Institute (NCI) in supporting implementation research related to cancer prevention and control in low- and middle-income countries (LMICs). This Notice also aligns with the Global Alliance for Chronic Diseases (GACD) 2020 Cancer Call.
Cancer is a leading cause of premature death worldwide. In 2018, an estimated 18.1 million new cancer cases were diagnosed and there were 9.6 million deaths from cancer. Predictions suggest that 30 million people will die from cancer each year by 2030, of whom 75% will be in low- and middle-income countries (LMICs). This increase may be attributed to the aging of societies, the 'epidemiologic transition' in many LMICs, the high prevalence of behaviors that increase the risk of developing cancer, as well as the socioeconomic inequalities that result in delayed diagnosis or care provision and poor-quality care in many LMIC settings.
It is estimated that 30-50% of all cancers are preventable. Specifically, one-third of global cancer deaths are attributable to behavioral risk factors, such as tobacco and alcohol use, low fruit and vegetable intake, obesity, and lack of physical activity. Tobacco use alone accounts for around 22% of the cancer mortality. Around 20-25% of cancer incidence in LMICs is attributable to chronic infections, including human papillomavirus (HPV), hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), Epstein Barr virus (EBV), human T-cell leukemia virus 1 (HTLV1), helicobacter pylori, and other pathogens. Increasingly, in LMICs, exposure of humans to environmental risk factors, such as air pollution, poses an increasing challenge to health. Within high-income countries, similar patterns are seen in populations experiencing health disparities and greater exposure to cancer risk factors.
A key challenge to reducing the global burden of cancer, particularly among people in LMICs and in other populations experiencing disparities, is the poor implementation of cancer prevention and control strategies that are known to work. Implementation of effective, evidence-based interventions has been central to cancer control in many high-income countries (HICs). Yet, in LMICs and other low-resource environments, such interventions are under-used or have limited impact because of implementation challenges that have yet to be identified, researched, and addressed.
NCI encourages applications that pursue innovative approaches to identifying, understanding, and developing strategies for overcoming barriers to the adoption, adaptation, integration, scale-up, and sustainability of evidence-based interventions, tools, policies, and guidelines in low-resource settings. The research projects on which these applications will be based should be focused on dissemination and implementation research for the primary and secondary prevention of cancer in LMICs and/or in populations facing conditions of vulnerability in HICs. The projects described in grant applications must be built on evidence-based interventions (including cost-effectiveness) for the respective population groups under defined contextual circumstances. For promising interventions, a limited validation period can be envisaged. However, the core of the research activities should focus on their implementation in real-life settings.
NCI is interested in proposed studies to adapt and scale-up the implementation of these interventions in accessible, affordable, and equitable ways in order to improve the prevention and early diagnosis of cancer in real-life settings. Interventions should meet conditions and requirements of the local health and social system context and address any other contextual factors identified as possible barriers.