Cancer research funding is a complex and multifaceted issue, and the notion of whether it is underfunded or unequally distributed is not as straightforward as it may seem. While the total amount invested in cancer research has grown over the years, the distribution of these funds is a critical aspect that demands attention. In this article, I will delve into the various factors that contribute to the uneven distribution of cancer research funding and explore the implications of this imbalance. I will also offer my personal perspective on how we can work towards a more equitable funding model.
The Unequal Distribution of Cancer Research Funding
Cancer research funding is not simply a matter of the total amount invested; it is about where that money goes and whose needs it reflects. The distribution of funds is shaped by a myriad of factors, including scientific opportunity, public policy, commercial interest, advocacy, infrastructure, and historical priorities. This complex interplay of factors results in an uneven distribution of funding across different cancer types, countries, treatment approaches, research phases, and patient populations.
Funding Imbalances Across Cancer Types
The unequal distribution of funding extends beyond differences in the amount of money assigned to each cancer type. Analyses comparing research investment with incidence, mortality, and years of life lost have repeatedly identified bladder, esophageal, liver, lung, oral, pancreatic, stomach, and uterine cancers as receiving relatively limited support in relation to their disease burden. Breast cancer, prostate cancer, and leukemia, by contrast, often receive higher levels of funding relative to these measures.
This imbalance has significant implications for the entire research landscape. Cancer types receiving less investment generally have fewer funded studies, smaller research networks, and fewer clinical trials, potentially slowing the development of new diagnostic approaches and treatments. Limited funding can also make it more difficult to attract investigators and build the infrastructure needed to conduct large, practice-changing studies.
Geographic Concentration and LMIC Underinvestment
Cancer research funding is concentrated in a small number of wealthy countries. Between 2016 and 2023, public and philanthropic organizations provided approximately $51.4 billion through nearly 108,000 cancer research awards. High-income countries accounted for around 97% of this investment, while low-income countries received less than 0.1%, equivalent to only about $8.4 million.
This distribution does not reflect the geographic burden of cancer. LMICs account for a substantial proportion of global cancer deaths and disability, yet only a small share of research funding is directed toward cancer priorities in these settings. Important questions involving affordable treatment, late diagnosis, access to care, resource-adapted therapies, and implementation of existing evidence therefore remain insufficiently studied.
The Modality Divide: Drugs, Surgery, and Radiotherapy
Cancer research funding is unevenly distributed not only across cancer types but also across treatment modalities. Within treatment-focused research, considerably more funding is directed toward cancer drugs than toward surgery or radiotherapy.
A global analysis of public and philanthropic cancer research funding between 2016 and 2020 found that drug-treatment research received approximately $4.6 billion, representing 19.6% of total investment. By comparison, radiotherapy research received about $0.7 billion, or 2.8%, while surgery research received only $0.3 billion, equivalent to 1.4%.
This disparity does not necessarily mean that drug research receives too much support. Rather, it indicates that surgery and radiotherapy research receive comparatively limited investment despite their established roles in cancer care. A more balanced research portfolio would support innovation across all major treatment modalities instead of concentrating resources primarily on interventions with stronger commercial sponsorship.
Imbalances Across Research Phases and Domains
Cancer research funding is distributed unevenly across both stages of research and areas of scientific focus. Most public and philanthropic investment is directed toward preclinical laboratory research, while clinical trials, public-health research, survivorship, and implementation-focused studies receive considerably smaller shares.
Between 2016 and 2020, preclinical research received approximately 73.5% of global cancer research funding, equivalent to around $18 billion. By comparison, phase 1–4 clinical trials received only 7.4%, or approximately $1.8 billion, while public-health research accounted for 9.4%, or about $2.3 billion.
Racial, Ethnic, and Advocacy-Related Funding Disparities
Cancer research funding is shaped not only by disease burden but also by public visibility, fundraising capacity, and the strength of patient advocacy. As a result, cancers that disproportionately affect racial and ethnic minority populations—or lack well-established advocacy organizations can receive less support.
US analyses show that funding is more closely associated with cancer incidence than with mortality or years of life lost. Colorectal, liver, lung, pancreatic, uterine, and other gynecologic cancers have been identified among those receiving relatively limited support despite their substantial burden, including among Black populations.
Changes in Funding Priorities Over Time
Cancer research funding has not increased steadily. Global public and philanthropic investment fell from approximately $6.6 billion in 2016 to $2.9 billion in 2020, with the sharpest decline occurring between 2019 and 2020.
Funding priorities have also shifted. Between 2006 and 2018, treatment and early detection gained a larger share of investment, while cancer biology and etiology declined proportionally. Prevention, survivorship, cancer control, and outcomes research remained relatively unchanged.
Policy Decisions and Their Impact on Research Investment
Policy decisions can influence how much cancer research is funded, which projects receive support, and whether long-term studies can continue without interruption. Public investment, regulatory policies, reimbursement systems, and partnerships between government, academia, and industry all shape the cancer research environment.
Recent US policy debates demonstrate how funding levels alone do not provide the full picture. Although the NIH received a $415 million budget increase for fiscal year 2026, the NCI funded 334 fewer grants in 2025, a decline of 21% from the previous year. Delayed reviews, workforce reductions, administrative requirements, and changes in how multiyear grants are funded were identified as contributing factors.
Building a More Equitable Cancer Research Funding Model
A more equitable funding model would align research investment with disease burden, unmet need, and disparities rather than relying mainly on visibility, advocacy strength, or commercial potential. Funding decisions could give greater weight to mortality, years of life lost, incidence, and the burden carried by underserved populations.
Dedicated support is also needed for neglected areas such as prevention, surgery, radiotherapy, survivorship, public health, and implementation research. Greater investment in LMIC-led research is equally important. Funding local research centers, trial networks, and investigator training would help countries study the cancers and treatment challenges most relevant to their populations.
Transparency should also improve. Public reporting could show whether funding, trials, and research output reflect mortality, geographic need, and health disparities. The aim is not to reduce support for well-funded cancers, but to ensure that highly lethal cancers, neglected treatment areas, and underrepresented populations receive investment that better reflects their needs.
