Why Cancer Mortality Doesn’t Match Money: A Critical Review of Cancer Research Funding Disparities

Introduction: Challenging the Status Quo in Cancer Research Funding

Cancer research funding reaches billions annually, yet this money often flows to areas based on marketability rather than public health impact. Why do cancers like breast and prostate receive high funding, while high-mortality cancers like pancreatic and liver struggle? For instance, the 2020 Oncology Market Outlook reports $3.5 billion and $2.7 billion in funding for breast and prostate cancers, compared to only $400 million and $300 million for pancreatic and liver cancers, respectively (International Agency for Research on Cancer, 2020; Al Hadidi, Zaid, & Ali, 2019). This disparity reveals a system driven by commercial and institutional biases rather than the goal of reducing the actual burden of disease. It’s time to question—and change—how we fund cancer research.

Funding Allocation Disparities: Profit Over Public Health

Cancers with well-established markets receive a disproportionate share of research funding. Breast and prostate cancers are consistently funded due to advocacy and high profitability. Meanwhile, pancreatic and liver cancers, with some of the lowest survival rates (around 11% for pancreatic and 20% for liver) (American Association for Cancer Research [AACR], 2024), receive a fraction of that funding. Studies show the influence of profit over need in these funding decisions, with public attention and market potential taking priority. Additionally, recent data from Haghighat et al. (2024) highlights significant discrepancies in average annual NCI funding from 2014–2018, showing that breast cancer funding substantially outpaces pancreatic cancer despite its lower mortality rate.

Influence of Advocacy and Public Perception: The "Pink Ribbon" Effect

Public perception, shaped by strong advocacy campaigns like the Pink Ribbon for Breast Cancer, heavily influences funding allocation. Cancers with well-funded advocacy networks receive more attention, leading to increased financial support. Conversely, cancers lacking widespread awareness, such as liver and pancreatic cancer, struggle to garner funding.

The AACR Cancer Disparities Progress Report underscores that cancers disproportionately affecting underserved communities receive less funding and support (AACR, 2024). This "Pink Ribbon Effect" demonstrates how public sentiment steers funding, with high-profile cancers benefiting from sustained advocacy while others remain underfunded.

Institutional and Geographic Biases in Cancer Funding

Funding is not only biased towards specific cancers; it also remains concentrated within elite institutions. Studies show that a significant percentage of ASCO and NCI grants go to top-tier research centers, often in major cities, creating a feedback loop of privilege that limits smaller institutions.

Further analysis reveals that 60% of ASCO's total funding goes to the top 10% of research institutions, leading to geographic inequities and limiting diverse research perspectives (Al Hadidi, Zaid, & Ali, 2019). Figure 2 (data extracted from NIH RePORTER) shows how top institutions like MD Anderson and UCSF dominate funding distribution. Additionally, the supplementary figure by state highlights the geographic concentration, indicating that certain states, particularly California, New York, and Massachusetts, receive the bulk of funding, while others are comparatively neglected.

Market-Driven Funding Models: Limiting Innovation

A profit-driven funding model marginalizes high-risk, high-reward research essential for breakthrough discoveries. CAR-T therapy, a groundbreaking treatment, was initially considered high-risk and only supported by niche funding. Current NCI and CDMRP reports show that only 10-15% of public and nonprofit funds go towards high-risk research, favoring lower-risk projects that ensure returns (Haghighat et al., 2023).

Innovation requires high-risk investment, yet the funding system discourages support for transformative projects. To genuinely advance cancer treatment, we must prioritize high-reward research, even if it carries uncertainty.

Global and Socioeconomic Inequities in Funding Allocation

Funding disparities extend globally. The International Agency for Research on Cancer (IARC) report indicates that high-income countries receive most cancer research funding. In contrast, low-income regions with high cancer burdens are underrepresented. African nations facing increasing liver and cervical cancer rates, for example, receive less than 5% of global cancer research funds (International Agency for Research on Cancer, 2020). This geographic imbalance not only limits research diversity but also prevents us from understanding how various populations worldwide experience and respond to cancer.

A socioeconomic bias also permeates U.S.-based cancer research. A recent study by Al Hadidi et al. (2019) shows that cancers with a higher incidence among Black populations, such as multiple myeloma, are significantly underfunded compared to cancers affecting broader demographics. This lack of diversity in funding allocation compounds health inequities, limiting effective treatment options for underserved populations.

Recommendations for a More Equitable and Impact-Driven Funding Model

1- Reprioritize Funding by Impact: Allocate resources to high-mortality, underrepresented cancers. Funding decisions should reflect the impact on public health, not just incidence or profitability.

2- Support High-Risk, High-Reward Research: Establish funds for high-risk, high-reward projects. Breakthroughs often require time and investment beyond commercial timelines, making it essential to support transformative research through dedicated grants.

3- Increase Access for Emerging Research Institutions: Smaller research centers should have access to more funding. Increasing diversity in research perspectives can accelerate innovation and bring new solutions to the forefront.

Conclusion: A Call for Real Change in Cancer Research Funding

Cancer research should be a bold investment in human health, not just a profitable one. Yet, under the current system, institutional favoritism and financial priorities drive funding, often at the expense of patients with less common or commercially viable cancers. True progress demands challenging this status quo, prioritizing funding based on impact rather than market appeal, and embracing innovation even when it doesn’t promise immediate returns.

With these changes, we can move closer to a world where cancer research addresses the true needs of all patients, offering hope and solutions for the future.