NCI Director Explains His Leadership Philosophy and Plans

BETHESDA, Maryland—During his first formal meeting with the National Cancer Advisory Board (NCAB), Andrew C. von Eschenbach, MD, spelled out his leadership philosophy, his intended directions as the new director of the National Cancer Institute (NCI), and several areas in which he plans to take rapid action.

The former researcher and clinician at M.D. Anderson Cancer Center left little doubt that he would be a strong leader and participate in the national cancer effort beyond the traditional role of the NCI director.

"I look forward to complementing what has gone on before by focusing on the continued development of new knowledge and the translation of that knowledge into more effective interventions that can be directly applied to patients," he told NCAB members.

He added that he would work actively to assure that new interventions "are applied to the populations at risk and that they are available equally and equitably to all individuals."

Dr. von Eschenbach, who spent 25 years at M.D. Anderson, was sworn in as the NCI’s 12th director on Jan. 10. He succeeded Richard D. Klausner, who resigned in September after more than 6 years in the post.

Two Conditions

The new NCI director said he accepted the post on two conditions. First, he wanted to continue to practice medicine, something, he said, that was both welcomed and encouraged at the Department of Health and Human Services and the White House.

"I will do that in a very specialized fashion," he said. "I will devote myself only to the issue of prostate cancer from the perspective of early detection, diagnosis, and consultation, as well as being involved in some of the investigation protocol development."

Second, Dr. von Eschenbach said that he wanted to continue to participate in such groups as the National Dialogue on Cancer, which consists of 150 cancer organizations. He said he felt it was extremely important that the head of NCI devote a great deal of energy to networking with other groups involved in the cancer effort, "not only within the federal community, but at the state level and with nongovernmental organizations and survivor groups."

Importance of Proteomics

Dr. von Eschenbach said that the work of NCI will increasingly lie in the post-genomic field of proteomics  and the interaction of cancer cells and their micro- and macroenvironments.

"There is an enormous amount of discovery that yet needs to occur. There is a critically important need for us to maintain our investment in investigator-initiated research," he said. "But I think that we have also reached the point where we can now begin to extrapolate knowledge that is already within our grasp and begin to effectively translate that into interventions that will directly benefit patients."

Mammography Guidelines Crisis

Within days of taking office, NCI and Dr. von Eschenbach had to confront the widely reported decision by an advisory board to the online database PDQ to rescind its support of mammography for women in their 40s.

Although funded by NCI, PDQ is an independent cancer information source for health care providers and the public. NCI quickly reaffirmed its own guidelines urging mammograms for women 40 to 49 every 1 or 2 years. But Dr. von Eschenbach told NCAB that he had taken several other steps as well.

He has asked the Institute of Medicine, a part of the National Academy of Sciences, to have its National Cancer Policy Board periodically review, on behalf of NCI, the scientific data emerging from mammography studies.

"We will not reconvene our own panels, but will depend on the IOM’s expert, independent process," Dr. von Eschenbach said. He emphasized that the Institute was looking beyond standard mammography to newer strategies for early detection of breast cancer.

"We have a major commitment to the digital mammography vs standard mammography trial," the NCI director said. "We will continue to accelerate and emphasize other mechanisms for the early detection of breast cancer so that we are providing to patients at risk not only guidance but also increased opportunity to obtain mammograms. That is an ongoing part of our agenda."

Three Areas to Review

Dr. von Eschenbach also listed three specific areas at NCI that he plans to review and take action on soon.

Reorganization. His focus for change is on the NCI director’s office and the effects of changes being ordered by HHS Secretary Tommy Thompson as he strives to consolidate his authority over the diverse agencies and institutes within the department. Secretary Thompson wants to create what he calls "one HHS."

"The department is looking at many of the functions that currently exist within various institutes and how to pull those functions into the department itself," Dr. von Eschenbach said. "Some of those functions relate to facilities, public relations, and personnel."

Public communications. "There are issues of clarification with regard to very important parts of the mission of the office," Dr. von Eschenbach said. "On the one hand, there is very effective, state-of-the-art education and communications with regard to the cancer community and patients." However, he added, "there are issues that relate to the press office and our ability to be responsive to the media with regard to things like mammography." He said that he had formed a small group of individuals with expertise in communications to advise him on how to proceed.

Cancer centers, SPOREs, and training. Dr. von Eschenbach noted that these areas have benefited significantly from the NCI budget increases of recent years, and he regards them as extremely important in carrying forward the Institute’s mission.

"These are critically important effector arms of the translational piece," he said. "So the centers, SPOREs [Specialized Programs of Research Excellence], and the training area will be a very high priority and a very close focus for me and the organization in the very near future."

The NCI director also pledged his support to the Institute’s intramural research program and cited the improvements in it after severe criticism from two review committees in the mid-1990s.

Lessons Learned

Dr. von Eschenbach said two lessons he learned during his career as a cancer surgeon have shaped his spirit of leadership. First, early in his career, he realized that he would never cure patients by himself and the best treatment would require a multidisciplinary approach. Second, one cannot solve a problem without fundamentally understanding it, and thus, discovery and research are ultimately the key to any successful intervention.

"Those lessons are the lessons I want to bring to the role of director of the NCI," he told NCAB. "Collaborative integration and a multidisciplinary approach is the most effective way the NCI can functionally contribute. It will be my goal every day to foster those collaborations, to bring together the multiple talents that exist, both within the organization and outside, in an effective, integrated fashion."