Background, Award Process and 1999 Award Summary
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Background
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Cycle V Research Funding Goals
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Scientific Review
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Basis for Funding
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Summary of Funded Research
The California Breast Cancer Research Program (BCRP) is pleased to present the Cycle V grant awardees. In this Chapter, a history of the BCRP, its mission, and an overview of funding is presented. In the following Chapters, the research project abstracts are organized by the individual breast cancer 'Priority Issues' developed by the BCRP. We welcome your interest as Californians concerned about breast cancer.
Breast Cancer Act
In 1993, the California Legislature recognized the need to respond to the tragic toll that breast cancer was taking on the people of California. With the passage of the Breast Cancer Act and enabling legislation (AB 1055 and AB 478), a three-pronged approach to reducing the impact of breast cancer in California was established. The legislation created the BCRP and the Breast Cancer Early Detection Program (BCEDP) and funded these programs with the revenue from an increase in the State tobacco tax (effective January 1, 1994). Forty-five per cent of the tax revenue is allocated to fund research on the cause, cure, treatment, early detection, and prevention of breast cancer through the BCRP, administered by the University of California; fifty per cent is allocated to fund breast cancer early detection services for uninsured and underinsured women through the BCEDP, administered by the State Department of Health Services; and the remaining five per cent is allocated to the California Cancer Registry, which collects and compiles statewide data on cancer rates, survival, and deaths in California.
Breast Cancer Tax Check-Off Contributions
The California Breast Cancer Research Program also receives funds directly from California tax-payers who opt to make donations on their state income tax returns (line 52). These funds were allocated to BCRP beginning this year, and are used to increase the number of grants the Program awards. The three new grants supported by these contributions are listed at the end of this Chapter.
Breast Cancer Research Program
The mission of the California Breast Cancer Research Program is to reduce the impact of breast cancer in California by supporting research on breast cancer and facilitating the dissemination of research findings and their translation into public health practice. From its conception, the Program has been a partnership between all Californians concerned about breast cancer. Legislators, breast cancer advocates, academic and biotechnology scientists, clinicians, and University of California officials worked together to draft the enabling legislation. Representatives of these same constituencies serve to advise the Program on research priorities and grant funding; similarly diverse groups are convened to review grant applications. Research grants are awarded to scientists across the state working in public and private universities, research institutes, hospitals and medical centers, community agencies and biotechnology companies. The BCRP also encourages research partnerships and collaborations. The Program has created innovative initiatives to ensure that funds are directed towards research that is meaningful to Californians and that will result in rapid implementation to make a difference for patients. One of these initiatives, the Community Research Collaboration, funds teams of community groups/agencies and experienced scientists to explore issues of concern to the community. Another initiative, the Translational Research Collaboration, funds teams of scientists from different disciplines and institutions to explore new ideas and translate them to practice. Thus, new research ideas are brought quickly from the bench to the bedside, from the research setting to the community. These initiatives are among the new portfolio of grants funded July 1, 1999.
Breast Cancer Research Council
The overall objectives, strategies, and priorities of the BCRP are developed by the Breast Cancer Research Council. The Council consists of 15 members. As shown in the listing in Chapter 10, the Council includes representatives from a variety of California breast cancer 'communities'- including survivor/advocacy groups, scientist/clinicians, non-profit health organizations, private industry, breast cancer medical specialists, and the Breast Cancer Early Detection Program. Council members are appointed by the University of California, based upon recommendations from the Council and the community. The Council is charged with developing the strategic objectives and priorities of the Program, actively participating in its overall management, and making final recommendations on grant funding based on the research priorities and the scientific merit of the proposals as determined by peer review committees.
Research Funding Goals for 1999 - Cycle V
The BCRP's goals are consistent with its broad mandate to reduce the human and economic costs of breast cancer in California. The Program is committed to funding research that is innovative, complementary to research funded by other agencies, and responsive to the concerns of the breast cancer constituency in California. Each year, the Breast Cancer Research Council uses input from stakeholders in the Program (breast cancer advocates, health care providers, and research scientists from academia and industry), information on the changing funding priorities of federal and local funding agencies, and the experience gained from previous BCRP funding cycles to revise the priorities and funding mechanisms for the new funding cycle. Recent changes reflect a desire to: 1) challenge the research community to propose more innovative approaches to the problems of breast cancer, including fostering collaborations among traditional research institutions and community groups; and 2) provide strong support for "translational" research, i.e., work whose results can be moved rapidly into practical application, whether through grass-roots organizations or mainstream healthcare providers. Eight priorities were adopted for Cycle V (see sidebar).
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By identifying the specific priorities listed above, the Council encouraged researchers to develop and explore innovative and risky concepts in areas that are most important in the fight against breast cancer. Innovative Developmental and Exploratory Awards (IDEAs) allow researchers to explore new concepts that could lead to breakthroughs in these areas. Two award types are designed to stimulate and support collaborative research - one for collaborations between experienced research scientists and community members/agencies (the Community Research Collaboration (CRC) Award), and one for collaborations between research scientists in different fields and institutions (the Translational Research Collaboration (TRC) Award). Both types of awards were designed to offer a one-year Pilot Award to foster the development of teams and their projects, and larger 3-year awards for full projects.
The relentless rate of deaths due to breast cancer over the last several decades has prompted BCRP to provide for the training of new investigators - the human resources needed to ensure progress in the fight against breast cancer. Through three award types, BCRP endeavors to attract new investigators to breast cancer research. Postdoctoral Fellowship Awards, New Investigator Awards, and Training Program Awards allow researchers early in their careers to receive research training in breast cancer issues. Together, these awards bring new minds into the fight against breast cancer, and ensure the human resources required to eradicate the disease.
The Council identified three specific topics that they felt were (1) especially important to making progress in breast cancer research; and (2) not well supported by other research funding agencies. They set aside $1.0-$1.5 million for each of the topics:
- Socio-cultural, Behavioral and Psychological Aspects of Breast Cancer - This Request for Applications encouraged qualitative and quantitative research into sociocultural, behavioral and psychological issues affecting women with respect to the risk or occurrence of breast cancer.
- Biology of the Normal Breast – This Request for Applications encouraged studies aimed at achieving a greater knowledge of the normal breast, through all stages of development and change, in order to better understand anomalous changes that may lead to cancer.
- Breast Cancer Prevention, Risk Identification and Risk Reduction – This Request for Applications encouraged research that will enable more effective and appropriate prevention interventions by increasing our knowledge of modifiable breast cancer risk factors.
Through these combined efforts of exploring new concepts and building on existing knowledge, the resulting improvements in prevention, detection and cure of breast cancer will advance the day when we can say with confidence that breast cancer is no longer a threat to the people of California.
Scientific Review
The BCRP procedure for scientific review of applications is modeled on the National Institutes of Health procedure, with modifications adopted to: (1) emphasize the inclusion of representatives from all stakeholders involved in the eradication of breast cancer; and (2) foster funding of highly innovative research.
The BCRP staff assembles review committees, comprised of breast cancer patient advocates and researchers expert in the areas of the applications received. Reviewers are drawn from outside California in order to avoid both the occurrence and the appearance of conflicts of interest.
Scientific reviewers include prominent breast cancer researchers, biotechnology scientists, oncologists, surgeons, nurses, public health practitioners, and scientists with expertise in different fields, and are selected on the basis of their demonstrated knowledge in specific breast cancer-related disciplines. BCRP draws qualified individuals from as diverse a range of organizations as possible. Quality of research, professional service, and other scientific achievements and honors are considered in selecting members, as is the overall balance of perspectives on the review committee. Scientific reviewers are identified through numerous means, including rosters of NIH study sections, literature searches for publications in the appropriate research area, and recommendations from Council members, other reviewers and other researchers in the area. Advocate reviewers are selected from recommendations made by breast cancer advocacy organizations and Council members.
Reviewers prepare written evaluations of proposals and meet in committees (i.e., study sections) to discuss and score all applications. Applicants are provided with written summaries of the reviewers' evaluations. Confidentiality is maintained in all aspects of the review process, and selected information is released only on funded projects.
Applications are evaluated and voted on by the Committees for the following scientific merit score components:
Scientific merit score components:
- Innovativeness
- Impact
- Approach
- Feasibility
- Career Development (new investigator and postdoctoral fellowships)
These scores are the basis for the initial ranking of applications by award type within each Committee.
In addition, some types of grant applications are evaluated and considered for their:
- Multidisciplinary approach: the incorporation of investigators and ideas from different fields of study to approach a problem in a new way.
- Translational potential: the potential of the research to be used in areas which result in clinical applications and/or have direct and immediate impact on the prevention or treatment of breast cancer.
- Focus on underserved populations: the potential of the work to reduce disparities in breast cancer incidence, morbidity, mortality or health care access among underserved California populations and communities.
Applications are analyzed by the Review Committees and Program staff for (i) compliance with regulations covering the use of human and animal subjects, (ii) overlap with other funding support, (iii) eligibility of the principal investigators, and (iv) issues related to distribution of research overhead (indirect costs).
The Review Committee rosters and a description of the different roles of committee members are shown on pages 119-132.
Basis for Funding
The Program provides the Review Committee scoring and written evaluations to the Breast Cancer Research Council. The basis for funding recommendations by the Council include: (1) the scientific merit rankings, innovativeness and potential impact of the proposed research, as judged by the Review Committees; (2) the specificity and relevance to the priority areas identified by the Council; and (3) the balance of number and quality of applications across award types, priority areas and research topics.
The University of California approved the Council's recommendations in awarding these grants.
Summary of Funded Research
In 1999, BCRP awarded more than $16 million in 62 grants to investigators at 26 California institutions and organizations. Award recipients include community agencies (e.g., Women's Cancer Resource Center), independent research institutes (e.g., The Scripps Research Institute), medical centers (e.g., Cedars-Sinai), federal laboratories (e.g., Lawrence Livermore National Laboratory), and universities both public (University of California campuses) and private (e.g., Stanford University). A listing of funded institutions is provided in Chapter 7.
Awards commenced on July 1, 1999. These included:
- 7 grants to expand our knowledge of the biology of the normal breast;
- 5 grants to investigate factors that increase the risk of breast cancer, including 2 grants to explore ways to reduce the risk of breast cancer;
- 19 grants to further understand how breast cancer develops;
- 11 grants to develop new treatments for breast cancer;
- 12 grants exploring socio-cultural, behavioral, and psychological aspects of breast cancer;
- 4 grants to teams of community members/organizations and research scientists focused on issues identified by, and important to, communities in the state;
- 1 grant to a cross-disciplinary team of research scientists focused on bringing results of scientific research into practical application;
- 18 grants to new investigators in breast cancer and postdoctoral fellows to establish their careers in areas that will make an impact in breast cancer;
- 6 fully developed research grants in areas that have been identified as relatively under-funded, but important to advance our knowledge of breast cancer;
- 33 grants to explore new, innovative concepts that may open up new avenues for breast cancer research and new options for prevention, detection and treatment of breast cancer.
In this funding cycle, the BCRP is using donations received from the supported by the California State income tax return check-off (line 52) to fund three grants. The grant titles, principal investigators, and recipient institutions are:
Breast Cancer Survivorship: Partner's Role in Recovery
Beth E. Meyerowitz, Ph.D.
University of Southern California- Department of Psychology
Breast Cancer Prevention by a Dominant Negative ER Variant
Vicki Davis, Ph.D.
Cedars-Sinai Medical Center
Do Community Cancer Groups Enhance Well-Being?
Matthew J. Cordova, Ph.D.
Stanford University- School of Medicine
With these 62 new awards, the California Breast Cancer Research Program has now invested more than $75 million in breast cancer research since 1994. This investment supports research projects and training of both beginning and experienced scientists and supports efforts in laboratories, clinics and communities. It is perhaps still too early to draw conclusions about the research funded in the previous five years, but it is not too early to recognize that California is once again leading the country as it develops new models for research. The funds that the state of California has invested provide critical leverage in developing new scientific infrastructure and networks crucial for a comprehensive approach to eradicating breast cancer.
In the following sections, an overview of grant funding is presented by BCRP priority issue, and the individual project titles, principal investigator(s), institutions, and abstracts are provided. The abstracts are organized by the award type described earlier in this Chapter.
