Cancers with the highest lethality receive disproportionately lower levels of U.S. National Institutes of Health (NIH) research support, according to a study published April 20 in JAMA Network Open. 

Researchers at the National Cancer Institute in Bethesda, MD, found that on a per estimated death basis, NIH funding was $69,800 for breast cancer and $126,992 for prostate cancer, compared to $2,818 for small cell lung cancer and $8,945 for pancreatic cancer, despite strikingly lower survival rates. 

“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,” wrote authors Chirayu Mohindroo, MD, and Anish Thomas, MD. 

Both cancer outcomes and the distribution of federal research funding across cancer types continue to evolve, and assessing how current funding aligns with contemporary measures of disease burden may help identify gaps, the pair wrote. 

To that end, the authors analyzed national cancer registry data on incidence and five-year survival alongside NIH funding across nine major cancer types. They pulled incidence and survival data in national patient registries between 2015 and 2022, while fiscal year 2025 NIH funding data were extracted from public NIH portfolio reports. The team calculated funding per incident case, per estimated death, and mortality-to-incidence ratios (MIRs) for each cancer type.  

According to the analysis, small cell lung cancer and pancreatic cancer carried MIRs above 0.85 (meaning 85% of diagnoses resulted in death), yet received only $62 million and $440 million in NIH funding. Breast cancer received $1.58 billion and prostate cancer received $663 million, despite five-year survival rates of 91.7% and 97.9%. 

“These findings indicate that cancers with the highest lethality receive disproportionately lower levels of federal research support,” Mohindroo and Thomas wrote. 

The authors noted that current funding patterns reflect historical therapeutic breakthroughs, long-standing research infrastructure, and sustained advocacy-driven investment in certain cancer types. Cancers with limited advocacy or philanthropic support may depend largely on federal funding, magnifying the effects of imbalances, they added. 

"Although this misalignment has been recognized for more than a decade, our findings indicate that funding patterns remain largely unchanged," they wrote. 

The findings underscore the need for 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, Mohindroo and Thomas concluded. 

The full research letter can be found here.