The NCI’s “provocative questions” project: the current 24 questions


A key initiative introduced by Dr. Harold Varmus after he took his current position of Director of the National Cancer Institute (NCI) here in the USA was the “provocative questions” project. His idea was that we should try to identify a small number of really focused questions about cancer and base research funding around seeking answers to these questions.

A lot of thought and discussion — from all over the cancer research spectrum — has gone into this initiative over the past couple of years. The 24 questions currently identified as drivers for future research funding in cancer are listed in detail on the NCI web site.

It should be recognized immediately that none of these questions is specific to prostate cancer (or to any other specific form of cancer either). One of the core premises of the project was that the really provocative questions were not questions that were specific to particular types of cancer. Dr. Varmus was always very clear that the questions should drive research that might turn out to be applicable across the entire cancer spectrum. However, many of the final 24 questions are highly relevant to why men get prostate cancer, how it could potentially be prevented, and what we should try to do about it at specific times in the course of the clinical condition once it has been diagnosed.

We suggest to our readers that they look through the entire 24 questions. It only takes about 10 minutes or so to do this. The home page for the provocative questions project states that:

The provocative questions project is intended to assemble a list of important but non-obvious questions that will stimulate the NCI’s research communities to use laboratory, clinical, and population sciences in especially effective and imaginative ways.

It includes a brief video in which Dr. Varmus about the project, and in that video he encourages the continued participation of all interested individuals who wish to propose new provocative questions or to comment on the questions that have currently been selected as research drivers.

Just to give you a flavor of the breadth of the questions and their potential relevance to prostate cancer, here are abbreviated versions of just three of the questions:

  • Why do some animals with long lifetimes (e.g., sea turtles) apparently get cancers only very rarely?
  • Can we develop imaging techniques to reliably identify tumors that are (say) about five to 10 cancer cells in size (≤ 1 cubic millimeter) as opposed the current minimum of about 100 cancer cells in size?
  • Can we predictably determine the clinical significance of finding cells from a primary tumor at a secondary site?

For each of the 24 questions listed, in addition to the question itself, the web site gives some background to the importance of the question, a discussion of the feasibility of research on this specific question, and some commentary on the implications of successfully being able to answer the question itself.

You want to propose your own provocative question? Go to the community dialog pages on the web site … but remember … your question can’t be about prostate cancer; it should be about something “bigger” that has relevance to prostate cancer … and you will find that literally hundreds of potentially provocative questions have already been posed, so do a little research before you just throw another question on the heap!

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