Federal Cancer Research Funding Misaligned With Mortality Burden

Cancers with the highest lethality receive disproportionately lower levels of federal research support, according to a research letter published today in JAMA Network Open.¹

Aligning Cancer Research Funding With Evolving Measures of Disease Burden

Cancer incidence and outcomes in the US continue to evolve alongside advances in screening, treatment, and prevention. At the same time, the distribution of federal research funding reflects a combination of scientific opportunity, historical investment, and advocacy-driven priorities.

The researchers emphasized that incidence alone does not fully capture disease burden because it does not account for how deadly a cancer is. Instead, measures such as mortality, 5-year survival, and mortality-to-incidence ratios (MIRs) provide a more complete picture of clinical urgency and unmet need. They evaluated how current federal cancer research funding aligns with these outcome-based metrics across major cancer types.

The investigators conducted a cross-sectional analysis using national cancer registry data and National Institutes of Health (NIH) funding levels. They obtained incidence and 5-year survival data from the Surveillance, Epidemiology, and End Results Program spanning 2015 through 2021 and from the North American Association of Central Cancer Registries’ Cancer in North America Explorer for 2022.

The researchers extracted NIH funding data for fiscal year 2025 from publicly available portfolio reports and estimated mortality by multiplying annual incident cases by the proportion of patients who did not survive to 5 years. They then calculated funding per incident case, funding per estimated death, and MIRs for each cancer type.

The analysis included 9 major cancer types in the US: colorectal, pancreatic, breast, prostate, ovarian, liver, and stomach cancers, as well as small cell lung cancer (SCLC) and non-SCLC (NSCLC). The researchers noted that these cancers were selected based on their substantial contribution to overall disease burden and demonstrated wide variation in incidence, survival, mortality, and research funding.

Research Surrounding Higher-Mortality Cancers Remains Underfunded

They found differences across cancer types in both clinical outcomes and funding allocation. Clinically, both lung cancers accounted for 151,401 deaths, which was the highest total among the cancers studied. They were followed by pancreatic cancer (n = 49,211), breast cancer (n = 22,606), and prostate cancer (n = 5219).

The researchers determined these patterns to be more pronounced using MIRs, as SCLC and pancreatic cancer had ratios exceeding 0.85, indicating that most diagnoses result in death. Conversely, breast and prostate cancers had ratios below 0.10, reflecting substantially higher survival rates.

However, funding levels did not track with these patterns of lethality. NIH research funding totaled $1.58 billion for breast cancer compared with $440 million for pancreatic cancer, $227 million for NSCLC, and just $62 million for SCLC.

On a per estimated death basis, breast cancer received approximately $69,800, and prostate cancer received $126,992. In contrast, pancreatic cancer received $8945 per estimated death, and SCLC received only $2818.² The researchers emphasized that these findings indicate that cancers with the highest mortality burdens receive substantially less funding relative to their lethality.¹

Researchers Call for a Composite Funding Framework

They concluded by acknowledging several limitations, including that the analysis relied on a single fiscal year of NIH funding data, which may not reflect longer-term funding trends. In addition, the study did not account for how funding is distributed across different research areas, such as basic science, translational research, or clinical trials. However, they expressed confidence in their findings, arguing for a more balanced framework for distributing federal cancer research funding.

“These findings support a composite framework for federal funding that integrates incidence with outcome-based measures such as mortality and survival, alongside consideration of nonfederal research investment from philanthropy and industry, to better align resources with areas of greatest clinical need,” the authors wrote.

References

1. Mohindroo C, Thomas A. Incidence, mortality, and federal research funding by cancer type in the US. JAMA Netw Open. 2026;9(4):e267837. doi:10.1001/jamanetworkopen.2026.7837
2. NIH RePORTER. NIH. Accessed April 20, 2026. https://reporter.nih.gov/