Determining whether broad implementation of a cancer screening test across the population can decrease deaths from the screened cancer and provide benefits that outweigh the potential risks of undergoing the test requires extensive research and careful analysis of the data generated. Independent groups of experts rigorously evaluate data indicating whether cancer screening tests meet these two criteria before putting forth recommendations about the use of the tests.
Not all groups of experts give the same weighting to all the benefits and potential risks, which can result in differences in recommendations from distinct groups. These differences highlight the areas in which more research is needed. Evidence-based cancer screening recommendations are only one consideration when a person makes decisions about which cancers he or she should be screened for and when. A person's own unique risks for developing each type of cancer, his or her tolerance of the potential risks of a screening test, and whether the test is covered by his or her health insurance are also important considerations.
Therefore, every individual should consult with his or her health care practitioners to develop a cancer prevention and early detection plan tailored to his or her situation. As we develop and implement new strategies that pair increased molecular understanding of cancer development with knowledge of an individual's unique cancer risk profile, we will move closer to a new era of precision cancer prevention and early detection.
The hard work of individuals throughout the biomedical research cycle constantly powers the translation of discoveries to advances across the clinical cancer care continuum. These advances are improving survival and quality of life for people around the world. As a result of research advances, the FDA approved 13 new therapeutics for treating certain types of cancer, one new cancer screening test, one new diagnostic test, two new diagnostic imaging agents, and a new medical device in the 12 months leading up to July 31, During this time, the FDA also approved new uses for 11 previously approved anticancer therapeutics.
Four of the new anticancer therapeutics approved by the FDA target specific molecules involved in cancer and are referred to as molecularly targeted therapeutics. They are part of the precision medicine revolution in cancer care that is improving the lives of patients like Ginger Tam p. Another four of the new anticancer therapeutics are immunotherapeutics that are yielding remarkable and durable patient responses, as highlighted in the report by the experiences of Dave Maddison and Bob Ribbans p. Importantly, immunotherapeutics have been shown to benefit patients with an increasingly diverse array of types of cancer.
For example, one immunotherapeutic, nivolumab Opdivo , was approved by the FDA for use as a treatment for three different types of cancer in just 6 months. Research-fueled advances in cancer detection, diagnosis, and treatment are helping more and more people to survive longer and lead fuller lives after a cancer diagnosis.
Despite this progress, cancer survivors often face serious and persistent adverse outcomes, including physical, emotional, psychosocial, and financial challenges as a result of their disease and treatment. Palliative care, given alongside cancer treatment and through the balance of life, is one approach that can improve quality of life for patients and survivors. Much more research is needed, however, to identify new and better ways to help cancer survivors meet the numerous challenges that they face.
Research is the foundation on which progress against cancer is made. Cancer genomics research, which has been central to the precision medicine revolution, is one area in which the pace of progress is expected to accelerate in the future. This type of research promises to dramatically increase the number of potential targets for the development of novel molecularly targeted anticancer therapeutics and to identify markers that determine which patients are most likely to respond to a particular treatment. As our knowledge of cancer biology grows, it is becoming increasingly clear that we cannot study cancer in isolation.
We need to know more about the whole person in which the cancer has developed. This knowledge is particularly vital for powering progress in the emerging area of precision cancer prevention. Federal investments in the NIH, NCI, and FDA have powered extraordinary progress against cancer by catalyzing scientific discovery and facilitating the translation of these discoveries into advances across the continuum of clinical cancer care.
However, there are many challenges to overcome if we are to dramatically accelerate the pace of progress in cancer prevention, detection, diagnosis, and treatment.
First, we must continue to increase our understanding of the biology of cancer and to develop new approaches to translating this knowledge into health care advances that will save lives. To do this, we must ensure that robust, sustained, and predictable federal funding is provided for biomedical research, cancer research, and regulatory science. We must also provide strong support for cross-cutting initiatives like the National Cancer Moonshot Initiative and the Precision Medicine Initiative.
Only by investing in research talent, tools, and infrastructure; supporting regulatory science initiatives; and increasing patient involvement in precision medicine initiatives, will we be able to accelerate the pace of progress and realize our goal of preventing and curing cancer. Late last year, as the fiscal year FY appropriations bill was being finalized, a bipartisan majority of members of Congress called for a significant funding increase for the NIH.
A pattern begins in the second year, and we have seized the opportunity this year to begin a pattern of increases for the NIH. The AACR is supportive of Senator Blunt's statement and action in his role as Subcommittee Chairman, especially because of the unprecedented scientific opportunities that exist today to improve the way we prevent, detect, diagnose, and treat cancer. Robust, sustained, and predictable investments in medical research, coupled with comparable funding increases for the FDA, will accelerate progress against cancer at this critical time in the cancer field.
This timely initiative has galvanized the cancer community and sparked a renewed dialogue on how we can speed the pace of progress for the benefit of all patients with cancer. Working together, we can capitalize on this unique moment in cancer research to harness the extraordinary knowledge obtained through past federal investments like the Human Genome Project, and allow for the translation of this information into strategies to prevent, detect, and treat cancer and a myriad of other diseases.
Readjust the discretionary budget caps for FY and beyond, which would allow our nation's policymakers to continue to provide robust, sustained, and predictable funding increases for the NIH, NCI, and FDA in future years. By taking such actions, we will improve our nation's health, sustain our leadership in cancer research and biomedical science, and spur our innovation-based economy.
- AACR CANCER PROGRESS REPORT 2016 STEERING COMMITTEE!
- The Lords of Seduction.
- Invisible Men: Life in Baseballs Negro Leagues.
- Borrowed Time;
- The Penelope Peters Effect?
- The Yosemite.
In the United States, the overall cancer death rate is decreasing, and the number of cancer survivors is increasing. The reduction in the U. In , , people are expected to die from some form of cancer in the United States, making it the second most common cause of death. Research improves survival and quality of life for people around the world because it powers the development of new and better ways to prevent, detect, diagnose, treat, and cure some of the many diseases we call cancer.
Each clinical and legislative advance against cancer is the culmination of many years of hard work by individuals from all segments of the biomedical research community see sidebar on The Biomedical Research Community: Powering Progress Together , p. Among the most prominent clinical advances against cancer are the new medical products approved for use by the U.
Bringing a new medical product from initial research discovery through development, approval by regulatory agencies, and then into the clinic is a complex, multifaceted process see Biomedical Research , p. During this period, the FDA also approved new uses for 11 previously approved anticancer therapeutics. Clinical advances such as those listed in Table 1 see p. In fact, the age-adjusted U. In addition, the U. The research that powers the significant advances that have been and continue to be made against cancer is made possible by investments from governments, philanthropic individuals and organizations, and the private sector the world over.
Although we have made tremendous progress against cancer, this collection of diseases continues to be an enormous public health challenge worldwide, accounting for one in every seven deaths that occur around the world 6 see Figure 1. In the United States alone, it is predicted that , people will die from some form of cancer in , making it the second most common cause of death after heart disease 3. One of the challenges we face is that advances have not been uniform for all forms of cancer see Table 3 , p.
For example, while the incidence rates for many of the most commonly diagnosed cancers in the United States—including breast, colorectal, lung, and prostate cancer—have been declining for more than a decade, those for other forms of cancer—most notably kidney, liver, and pancreatic cancer, as well as melanoma and childhood cancer—have been increasing 2.
Overall 5-year relative survival rates for U. Overall 5-year relative survival rates for women with invasive breast cancer and men with prostate cancer are 89 percent and 99 percent, respectively, while those for U. Another challenge is that advances have not been uniform for all patients diagnosed with a given form of cancer. Five-year relative survival rates vary with stage at diagnosis and among different segments of the population see sidebar on What Are Cancer Health Disparities?
Cancer Health Disparities , p. Of concern is the fact that the devastating toll of cancer is predicted to increase significantly unless more effective strategies for cancer prevention, early detection, and treatment are developed. This is largely because cancer is primarily a disease of aging 9 , and the segment of the world population age 65 and older is expected to almost double by , rising from million in to 1.
During this period, the number of global cancer cases is anticipated to increase dramatically, reaching 24 million in 8. Also contributing to the projected increase in the number of cancer cases are high rates of tobacco use, obesity, infection, and physical inactivity, which are linked to some common types of cancer 6. Thus, it is imperative that we work with the global biomedical research community to address cancer incidence and mortality and power more progress against cancer.
Cancer exerts an immense global toll that is felt not only through the number of lives it affects each year, but also through its significant economic impact. With the number of cancer cases projected to increase substantially in the next few decades, it is anticipated that the economic burden will rise, too. The increasing personal and economic burden of cancer underscores the urgent need for more research so that we can accelerate the pace of progress against cancer. Recent advances, some of which are highlighted in this report, were made as a direct result of the cumulative efforts of researchers from across the spectrum of research disciplines.
Much of their work, as well as the federal regulatory agency that ensures the safety and efficacy of medical device and therapeutic advances—the FDA—is supported by funds from the federal government. Cancer is not one disease; it is a collection of diseases characterized by the uncontrolled growth of cells. Many cancers are progressive in nature, providing distinct points for medical intervention to prevent cancer, detect it early, or treat progressive disease.
The most advanced stage of cancer, metastatic disease, accounts for most cancer-related deaths. Changes in the genetic material in a normal cell underpin cancer initiation and development in most cases. The more we know about the interplay among the individual factors influencing cancer biology, the more precisely we can prevent and treat cancer.
Research has taught us that cancer is a complex disease. In fact, it is not just one disease but rather a collection of many diseases that arise when the processes that control the multiplication and life span of normal cells go awry. In adults, cell multiplication is a very tightly controlled process that occurs primarily only to replace cells that die due to exposure to various external factors or as a result of normal wear and tear.
If the processes that control the multiplication and life span of normal cells go awry, the cells start multiplying uncontrollably, fail to die when they should, and begin to accumulate. In body organs and tissues, the accumulating cells form a tumor mass, whereas in the blood or bone marrow, they crowd out the normal cells.
Over time, some cancer cells within the tumor mass gain the ability to invade local tissues. Some also gain the ability to spread or metastasize to distant sites. The progressive nature of cancer provides distinct sites for medical intervention to prevent cancer, detect it early, or treat progressive disease. In general, the further a cancer has progressed, the harder it is to stop the chain of events that leads to the emergence of metastatic disease, which is the cause of most deaths from solid tumors.
Changes, or mutations, in the genetic material of a normal cell are the primary cause of cancer initiation. Over time, additional mutations are acquired by cells within a growing tumor mass, and this drives cancer progression. The number of cells within a growing tumor that carry a given mutation depends on when the mutation was acquired during tumor growth.
Thus, even within the same tumor, different cancer cells may have different genetic changes. In general, the more genetically heterogeneous a tumor is, the harder it is to effectively treat. Not all mutations acquired by a cell contribute to cancer initiation and development. In fact, the identity, order, and speed at which a cell acquires genetic mutations determine whether a given cancer will develop and, if a cancer does develop, the length of time it takes to happen.
Numerous interrelated factors influence mutation acquisition and determine the overall risk that a person will develop a particular type of cancer see sidebar on Why Did I Get This Cancer? The accumulation of mutations in the genetic material of a cell over time is the predominant cause of cancer initiation and progression see sidebar on Genetic and Epigenetic Control of Cell Function , p.
A genetic mutation is a change in the type or order of the four deoxyribonucleic acid DNA units, called bases, that make up the genetic material of a cell. The order, or sequence, of DNA bases is a key determinant of what proteins are produced by a cell and how much of each protein is produced. Many different types of mutation contribute to cancer initiation and development, primarily by altering the amount or function of certain proteins see sidebar on Genetic Mutations , p. In addition to genetic mutations, most cancer cells also have profound epigenetic abnormalities, compared with normal cells of the same tissue.
In many cases, epigenetic alterations and genetic mutations work together to promote cancer development. Although genetic mutations are permanent, some epigenetic abnormalities appear to be reversible, and harnessing this discovery for therapeutic purposes is an area of intensive investigation.
Genetic mutations that disrupt the orderly processes controlling the multiplication and life span of normal cells are the main cause of cancer initiation and development. However, interactions between cancer cells and their environment—known as the tumor microenvironment—as well as interactions with systemic factors, also have an important role in cancer development see sidebar on Cancer Growth: Local and Global Influences. In fact, cancer cells often exploit tumor microenvironment components to promote their multiplication and survival.
Research has powered an explosion in our understanding of the individual factors inside and outside a cell that cause cancer initiation, development, and progression. It is also beginning to provide us with a picture of how these factors work together and are influenced by each person's unique biological characteristics.
This knowledge is the essence of precision medicine, as well as the more nascent strategy of precision prevention see Figure 2.shayan-ozero.com.ua/language/296.php
AACR Cancer Progress Report | Clinical Cancer Research
As we develop an even more comprehensive, whole-patient understanding of the way in which cancer starts, progresses, and results in sickness, we can expect to see an acceleration in the pace of progress in precision medicine and prevention for cancer see Anticipating Future Progress , p. About 20 percent of U. Many cases of skin cancer could be prevented by protecting the skin from ultraviolet radiation from the sun and indoor tanning devices. The number of U. Exposure to environmental cancer risk factors remains a challenge for certain segments of the U.
Factors that increase the chance of developing cancer are referred to as cancer risk factors. These factors directly or indirectly increase the chance that a cell will acquire a genetic mutation and therefore increase the chance that a cell will become cancerous see sidebar on Why Did I Get This Cancer?
Decades of research have led to the identification of numerous cancer risk factors see Figure 3 , p. Many of the risk factors that have the biggest impact on cancer incidence are avoidable see Figure 3 , p. For example, many cases of cancer could be prevented either by individuals modifying their behaviors or through the development and implementation of new public education and policy initiatives that encourage individuals to avoid cancer risk factors or protect people from cancer risk factors in the workplace or environment.
In fact, a recent study suggests that between 40 percent and 60 percent of cancer cases among white Americans could be prevented if each person did not smoke, limited alcohol consumption, maintained a healthy weight, and undertook regular physical activity These lifestyle behaviors also increase risk for cancer in other U.
Many cancer risk factors are also risk factors for other chronic diseases, such as cardiovascular disease, respiratory diseases, and diabetes. Therefore, reducing or eliminating exposure to these factors through behavior modification or public education and policy initiative implementation has the potential to reduce the burden of both cancer and other diseases.
In the United States, many of the greatest reductions in cancer morbidity and mortality have been achieved through the implementation of effective public education and policy initiatives. For example, major public education and policy initiatives to combat cigarette smoking have been credited with preventing almost , deaths from lung cancer from to The researchers concluded, however, that this figure represented just 32 percent of the lung cancer deaths that could have been prevented during that period if tobacco control strategies had completely eliminated cigarette smoking Clearly, a great deal more research and more resources are needed to understand why some individuals continue to engage in risky behaviors despite current public education and policy initiatives, and how best to help these individuals eliminate or reduce their risk of some cancers.
One recent study suggested that the way that public education messages are framed can dramatically influence whether or not an individual modifies his or her behavior because it showed that dieting individuals who saw a message focusing on the negative aspects of unhealthy food actually increased their consumption of unhealthy foods Smoking tobacco exposes a person to toxicants that can cause genetic mutations, increasing his or her risk of developing not only lung cancer, but also 17 other types of cancer see Figure 4 , p. It is responsible for one in every three cases of cancer diagnosed in the United States each year Therefore, one of the most effective ways a person can lower his or her risk of developing cancer, as well as other smoking-related conditions such as cardiovascular, metabolic, and lung diseases, is to avoid or eliminate tobacco use.
Since the relationship between tobacco use and cancer was first brought to the public's attention in 37 , the development and implementation of major public education and policy initiatives have driven down cigarette smoking rates among U. In addition, the most recent data show declining use of cigarettes among high school students: We have made tremendous progress reducing the public health burden of tobacco use, with researchers estimating that more than 8 million smoking-related deaths were prevented in the United States from to as a result of declines in cigarette smoking rates The reductions in cigarette smoking rates have not been evenly distributed among all segments of the population, as defined by race, ethnicity, educational level, socioeconomic status, and place of residence Moreover, use of emerging tobacco products, such as electronic cigarettes e-cigarettes and water pipes, among high school students is increasing rapidly.
Given that tobacco use and addiction mostly begin during youth and young adulthood, more research into the health consequences of using e-cigarettes and water pipes is urgently needed In particular, we need to fully understand whether e-cigarettes have value as cigarette-smoking cessation aids and how they affect use of other tobacco products by smokers and nonsmokers see sidebar on E-cigarettes: We also need more research into the health consequences of smoking marijuana; for example, there is concern it could cause cancer because it involves the burning of an organic material, much like tobacco smoking.
A number of new tobacco control policy initiatives have been recently announced in the United States, the most prominent of which is the decision by the FDA to extend its regulatory oversight to all tobacco products, including e-cigarettes, cigars, pipe tobacco, and hookah tobacco see sidebar on Enhancing Tobacco Control Through FDA Regulation. In addition, a growing number of cities, counties, and states, most recently California, have passed legislation raising the minimum age of sale of tobacco products to 21 This is important because nearly everyone who buys cigarettes for U.
Being overweight or obese as an adult increases a person's risk for 14 types of cancer see Figure 6 , p. Therefore, it is extremely concerning that in the United States, 71 percent of adults age 20 or over are overweight or obese 52 , 32 percent of youth ages 2 to 19 are overweight or obese 52 , and more than half of U.
The importance of following guidelines for leisure time physical activity is highlighted by a recent study showing that increasing levels of leisure time aerobic physical activity decreased risk for developing 13 types of cancer For 10 of these cancers, this held true regardless of body mass index BMI , the most common measure of whether or not a person is underweight, normal weight, overweight, or obese. Several steps to promote physical activity for all segments of the U.
National Physical Activity Plan 57, Nevertheless, concerted efforts by individuals, families, communities, schools, workplaces, institutions, health care professionals, media, industry, government, and multinational bodies are required to implement any strategy to promote the maintenance of a healthy weight and the participation in regular physical activity. In addition, intensive efforts by all stakeholders are needed if we are to increase the number of people who consume a balanced diet, such as that recommended by the U. Department of Health and Human Services and the U.
Department of Agriculture in the — Dietary Guidelines for Americans One recent policy initiative to help people make better informed food choices and meet the new dietary guidelines is the FDA decision to change the regulatory requirements for the information that manufacturers must provide on nutrition facts labels on food packaging, including the new requirement for information about how much sugar has been added to the food product More research is needed, however, to better understand the effect on cancer risk of exposure to these cancer risk factors at various stages of life.
For example, recent data suggest that increased body weight during childhood and adolescence may increase risk for colorectal cancer later in life 62, 63 , while eating plenty of fruit during adolescence may decrease risk for breast cancer in later life 64 , although more research is required to confirm these findings. For most of the nearly 5 million patients with skin cancer who are treated each year in the United States, their disease was caused by genetic mutations arising as a result of exposure to ultraviolet UV light from the sun, sunlamps, tanning beds, and tanning booths In fact, it is estimated that exposure to UV radiation, primarily from the sun, causes as many as 90 percent of U.
About 8 percent of cases are attributable to indoor tanning Thus, one of the most effective ways a person can reduce his or her risk of skin cancer is by practicing sun-safe habits and not using UV indoor tanning devices see sidebar on Ways to Protect Your Skin. Despite the knowledge that the three main types of skin cancer—basal cell carcinoma, squamous cell carcinoma, and melanoma—can be prevented, fewer than 15 percent of men and 30 percent of women use sunscreen regularly on their faces and other exposed skin when outside for more than 1 hour 67 , and one in three adults in the United States reports experiencing at least one sunburn in the past 12 months In addition, 6 percent of U.
The most recent data show that use of indoor UV tanning devices has declined among high school students, from 13 percent in to 7 percent in , although more needs to be done to reduce this number even further 53, Continued exposures to UV radiation have fueled a rise in melanoma incidence rates over the past 3 decades 3 , and researchers anticipate that the number of new U. Thus, it is vital that individuals, families, communities, schools, workplaces, institutions, health care professionals, media, industry, government, and multinational bodies work together to develop and implement more effective policy changes and public education campaigns to reduce exposure to UV radiation.
One policy change currently being considered by the FDA is a ban on the use of indoor UV tanning devices by individuals younger than age 18 see sidebar on Indoor Tanning Legislation , p. This measure could be particularly effective at reducing exposure to UV radiation given that recent research showed that placing age restrictions on the use of indoor UV tanning devices reduces the use of these devices by female high school students Persistent infection with a number of pathogens—bacteria, viruses, and parasites that cause disease—increases a person's risk for several types of cancer see Table 4 It is estimated to have been responsible for about 2 million of the Therefore, individuals can significantly lower their risk for certain types of cancer by protecting themselves from infection with cancer-associated pathogens or by obtaining treatment, if available, to eliminate an infection see sidebar on Preventing or Eliminating Infection With the Four Main Cancer-causing Pathogens.
Although there are strategies available to eliminate, treat, or prevent infection with Helicobacter pylori , HBV, HCV, and HPV, it is clear that these strategies are not being used optimally. For example, even though the CDC recommends screening all U. Given that infection with HCV is estimated to be responsible for 22 percent of cases of hepatocellular carcinoma HCC —the most common form of liver cancer—in U. It is estimated that in the United States, more than 53, cases of cervical cancer and thousands of cases of other HPV-related cancers, including many anal, genital, and oral cancers, could be prevented if 80 percent of those for whom HPV vaccination is recommended—girls and boys at age 11 or 12—were to be vaccinated However, the most recent estimates from the CDC show that in , only 40 percent of girls ages 13 to 17 and 24 percent of boys of the same age had received the full course of three or more doses of an HPV vaccine This low coverage stands in stark contrast to three-dose HPV vaccine coverage in other countries 81, 83 see Figure 7.
Several steps to address the low HPV vaccine coverage in the United States were recently recommended by the National Vaccine Advisory Committee NVAC , a federal advisory committee that provides vaccine and immunization policy recommendations to the U. Department of Health and Human Services Among the objectives outlined by the NVAC was the development of comprehensive communication strategies for physicians to encourage HPV vaccination at every opportunity.
The need for these strategies is highlighted by recent data showing that many physicians recommend HPV vaccination inconsistently, behind schedule, or without urgency There are many other cancer risk factors in our environment, including environmental pollutants and occupational cancer-causing agents 87 see Figure 3 , p. It can be difficult for people to avoid or reduce their exposure to many of these factors. Therefore, it is imperative that policies are put in place to ensure that everyone lives and works in a safe and healthy environment.
In the United States, some policies that help protect people from known cancer risk factors have been in place for several decades. For example, there are numerous policies to help prevent exposure to asbestos, which can cause mesothelioma, an aggressive type of cancer for which there remain few treatment options There are also guidelines for reducing exposure to radon gas, which is released from rocks, soil, and building materials and is the second most common cause of lung cancer in the United States after cigarette smoking That said, compliance with these guidelines is not mandatory.
It is estimated that about one in every 15 U. As we learn more about environmental and occupational cancer risk factors and identify segments of the U. We also need to do more worldwide to limit exposure to well-established environmental and occupational cancer risk factors such as asbestos. One environmental pollutant that was recently classified by the International Agency for Research on Cancer IARC , an affiliate of the World Health Organization, as having the ability to cause cancer in humans, is outdoor air pollution Outdoor air pollution is a complex cancer risk factor because it is a mixture of pollutants that vary over space and time as a result of differences in climate and sources of outdoor air pollution.
We do know, however, the sources of much outdoor air pollution—emissions from motor vehicles, industrial processes, power generation, and the burning of solid fuels for domestic heating and cooking—and it is clear that new policy efforts to reduce the release of pollutants into the atmosphere are needed if we are to reduce the burden of cancer.
What’s New in Cancer Research?
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But over the years, our ability to test for the disease and treat it has greatly improved. Some are being cured. Your immune system hunts down and kills invaders like bacteria and viruses. It also seeks out and destroys cancers as they form. But cancer has developed ways to hide from your immune system. Immunotherapy helps your immune system attack the cancer.
This treatment works in several ways, including:. They seek and destroy foreign cells, including cancer. Healthy cells have proteins called checkpoints on their surface that let the fighters know they're friendly. Immunotherapy drugs called checkpoint inhibitors block checkpoints on cancer cells or T cells. These drugs help T cells find the cancer. Checkpoint inhibitors have been approved to treat several cancers, including bladder cancer, non-small cell lung cancer, melanoma, kidney cancer, head and neck cancer, and Hodgkin lymphoma.
Your immune system makes proteins called antibodies to help it spot invaders like bacteria and viruses. Each antibody seeks out another protein, called an antigen, on the surface of an invading cell. Monoclonal antibodies are designed in a lab to target antigens on cancer cells. Some help your immune system find the cancer. Others are attached to a toxic substance that kills the cancer.
Trastuzumab Herceptin blocks the protein HER2 on cancer cells or other nearby cells that help cancer cells grow and spread.