The Most Lethal Cancers Get Shortchanged by Federal Funding, Study Shows

Highly lethal cancers received disproportionately less federal funding compared with other cancers that have better survival odds, according to a study by researchers at the National Cancer Institute.

An analysis of nine types of cancer showed that small-cell lung cancer (SCLC) and pancreatic cancer had the highest mortality-to-incidence ratios (MIRs) but received less funding per death during fiscal year 2025 than breast cancer and prostate cancer, which had the two lowest MIRs. Funding per death averaged $2,818 for SCLC and $8,945 for pancreatic cancer as compared with $69,800 and $126,992 for breast and prostate cancer, respectively. Liver cancer and non-small cell lung cancer (NSCLC) had the third and fourth highest MIRs and received $10,447 and $1,754 per death, respectively.

The findings suggest that the framework for prioritizing federal funding for cancer should integrate measures such as mortality and survival, in addition to incidence, which has been a principal influence, reported Chirayu Mohindroo, MD, and Anish Thomas, MD, MBBS, of the National Cancer Institute, in a research letter in JAMA Network Open.

“These findings indicate that cancers with the highest lethality receive disproportionately lower levels of federal research support,” they wrote. “Prioritizing these cancers could help direct limited resources toward diseases with the greatest potential to reduce suffering, particularly as outcomes continue to improve for less lethal malignant neoplasms.”

“Current funding patterns reflect historical progress in specific cancer types,” they added. “Cancers with limited advocacy or philanthropic support may depend largely on federal funding, magnifying the effects of funding imbalances, while industry investment, which often tracks incidence rather than lethality, may further reinforce these patterns. Although this misalignment has been recognized for more than a decade, our findings indicate that funding patterns remain largely unchanged.”

The study shines a light on the “critical funding disparities that disproportionately affect the most lethal cancers,” said Suneel Kamath, MD, of the Cleveland Clinic. He recently reported a study of federal funding for 12 types of cancer over a 10-year period. The largest allocations per death went to cervical cancer, breast cancer, and melanoma, which were as much as 10 times higher than per-death spending on lung, colorectal, pancreas, liver, and uterine cancers.

“Pancreatic cancer has been in the news a lot recently due to major advances in KRAS inhibitors and vaccines for adjuvant therapy,” Kamath told MedPage Today. “This is all, of course, great news, but we have to wonder, could we have gotten here 10 years ago with better funding? I think the answer is yes. We could be much further along for a number of other deadly diseases like colorectal cancer, lung cancer, and liver cancers, too.”

Kamath quibbled with some of the findings and methodology, such as singling out SCLC when NSCLC was far more common and received a smaller per-death allocation of federal dollars ($1,754 vs $2,818). Additionally, his own study showed that gastrointestinal cancers are underfunded “across the board.” The authors’ mortality estimates, which they calculated with their own methodology, differed for some cancers in comparison to estimates from the Surveillance, Epidemiology, and End Results (SEER) database. Nonetheless, “their basic conclusions are the same.”

“In the end, we need to evolve beyond an advocacy-based federal appropriation strategy,” said Kamath. “Currently, cancers with the most advocates and dollars to lobby lawmakers get the most funding. What we need instead is a system that delineates relevant criteria (e.g., incidence, mortality, cost, number of young people affected, degree of morbidity/disability, impact on quality of life), then calculates the impact of individual cancers on our society and then appropriates funding accordingly.”

“The dead cannot advocate for themselves, but more funding in the right diseases might have kept them alive longer in the first place,” he added.

Mohindroo and Thomas analyzed cancer incidence and 5-year survival using data from the SEER registries for 2015-2021 and the North American Association of Central Cancer Registries’ Cancer in North American Explorer for 2022. They extracted NIH funding data for 2025 from public reports. They also calculated funding per incident case, per estimated death, and MIRs.

The results showed that breast cancer (272,361), prostate cancer (248,541), and lung cancer (SCLC and NSCLC combined, 211,115) had the highest incidences. Estimated 5-year survival ranged from 9.1% for SCLC and 13.3% for pancreatic cancer to 91.7% for breast cancer and 97.9% for prostate cancer.

Breast cancer received the most NIH funding (~$1.6 billion), followed by prostate cancer ($663 million). SCLC received the least funding ($63 million), followed by stomach cancer ($105 million), NSCLC ($227 million), liver cancer ($291 million), ovarian cancer ($420 million), and pancreatic cancer ($440 million).

Estimated deaths ranged from 5,219 for prostate cancer to 129,161 for NSCLC. Colorectal cancer accounted for 49,576 deaths and pancreatic cancer for 49,211. An estimated 22,240 patients died of SCLC. SCLC had the highest MIR (0.909), followed by pancreatic cancer (0.867), liver cancer (0.780), and NSCLC (0.692). MIRs for breast and prostate cancer were 0.083 and 0.021, respectively.

NSCLC had the lowest average funding per death, followed by SCLC, stomach cancer (6,175), and pancreatic cancer.