From the Director's Desk
The drop in funding revenue has created an expanding chasm between critical issues that must be addressed and our ability to address them.
The Funding Gap
In the past 13 years, we’ve had tremendous
success in building a responsive,
innovative, and results-oriented
breast cancer research agenda for
California, but I’m afraid that we must
find a way to stabilize our declining
funding or risk losing our momentum
against the disease.
Our funding revenue has dropped nearly 12 percent in the last six years. Current estimates indicate that our funding will further decline at a rate of 5 percent per year. Cigarette tax revenue, which accounts for most of the California Breast Cancer Research Program’s funding, has been declining thanks to successful anti-smoking and cessation campaigns, increases in cigarette prices, and cigarette tax evasion. Our other major funding source, voluntary contributions through the Tax Check-off program on California income tax form Series 540, has declined 10 percent per year for the last two years.
This drop in revenue has created a funding gap, an expanding chasm between the critical issues that must be addressed and our ability to address them.
Achieving a Vision
One of the strengths of the California
Breast Cancer Research Program is that
we are able to adapt quickly to changes
in priorities and needs. In 2004, following
an intense, three-year evaluation
process, our advisory council recommended
three important changes: to
reduce our award types to those that
provided the greatest potential impact;
to design a new award type that
establishes clear guidelines for translation
and supports research that is on a
critical path for practical application;
and to set aside a portion of our funding
to develop the road map to studying
the effects of environment and lifestyle
on breast cancer and the reasons why
some women suffer more from the
disease.
A cornerstone in the structure of the CBCRP is our commitment to innovation. We realize that truly innovative ideas often begin as theories that require a tremendous amount of development, exploration, and supporting data before results can be clearly identified. To launch these explorations, we’re willing to fund high risk, high reward projects that the federal funding agencies are too afraid to touch. In 12 years, we have funded 141 of these innovative, exploratory, developmental awards (IDEAs), which allowed experienced researchers to develop enough data to allow them to pursue additional funding elsewhere. Some of our most compelling research results have come from these IDEAs, like Dr. Kristen Kulp’s discovery that Essiac tea, which was used by many women as an alternative chemopreventive medicine, actually promoted tumor growth. Dr. Bruce Tromberg received funding from the CBCRP to pursue a novel non-invasive detection method. With the data from our seed funding, Dr. Tromberg obtained further funding from the NIH, and he has developed a laser-based scanner that may detect breast cancer with more accuracy in younger women and women with denser breast tissue.
The CBCRP has also led the way in encouraging collaboration, particularly between researchers and community. In 12 years of funding, we have supported the formation of 86 collaborative teams, including 54 projects that linked community organizations with experienced scientists to study questions of particular importance. Many of those collaborative teams have produced pilot data that allowed them to receive larger awards from both the CBCRP and other funding organizations. One such team is Jeff Belkora (UCSF) and Sara O’Donnell (Mendocino Cancer Resource Center), whose collaborations have developed and expanded decision support services for women in rural areas.
The Downside of Success
Since its inception, the CBCRP has
successfully piqued the interest of researchers.
We receive hundreds of grant
applications each year, and each year
we fund only the projects that meet our
high standards in both scientific rigor
and programmatic appropriateness.
In the past we’ve been able to offer
funding to as many as 34 percent of the
applications we receive, but in the past
five years, that rate has fallen to approximately
20-25 percent. This means
that a significant number of applications
engender strong scientific and
programmatic interest, but there simply
isn’t enough money to fund them. We
put them on a “pay-if” waiting list and
offer funding only if money becomes
available, like when a grant recipient
turns down CBCRP funding. In the past four years alone, over $13
million of “pay-if” grants
have gone unfunded.
We have also made great strides in encouraging advocacy involvement in every level of our program, including participation in conducting research. We have informed community groups about the opportunity for research funds and provided technical assistance in putting projects together. As a consequence, we have seen a sharp rise in community-based participatory research for the past several years. These teams of concerned community groups and experienced researchers study problems directly affecting their community. Outcomes from these projects often move directly into practice within that community and often migrate to other similar populations. New teams typically start out with pilot grants, which allow for development of the research team and the acquisition of preliminary data. Full research projects are resource-intensive, but really get into the heart of the community’s question. Information and dissemination awards, implemented in 2005, help these teams move the research results from theory into actual practice. We have enabled several outstanding community-research teams to get started, but under our current funding levels, we are already limited in our ability to fund them beyond their pilot studies. As our funding resources continue to erode, so will our ability to fulfill the translational promise of these awards.
Research that will be applied to critical
questions in breast cancer prevention,
treatment and management is
sorely needed, and is indeed one of
the central reasons for the existence of
the CBCRP. This year we are launching
our translational research award,
which has been carefully designed to
address the critical path to practical
application. We received 52 letters of
intent, indicating high interest for this
type of research. Those letters were
reviewed by our advisory council, and
ten researchers have been invited to
submit full applications in February.
While we have yet to make funding
considerations, we anticipate that we
can afford to fund only one translation
project. This means that many good,
immediately applicable ideas will be
left on the table.
At current levels of funding, we are only able to fund a fraction of the incredible, scientifically meritorious ideas presented by these brilliant researchers. As our funding resources diminish, we will have to decline funding for even more good ideas. The concept of losing the cure for cancer for want of funding is haunting.
An Infrastructure at Risk
Ours is not the only breast cancer
research funding program to face
declining revenue. The Department
of Defense’s Breast Cancer Research
Program, which must argue yearly for
its funding, recently saw its budget
slashed by over 16 percent. Representatives
from the National Cancer Institute
have also announced declining funding
rates for breast cancer research.
A stable infrastructure is important if we are to continue to make progress against breast cancer. As we face declining funding, we know that we won’t be able to support the meritorious projects at the same rate as we have before. This challenge imperils California’s ability to produce groundbreaking research and our ability to make an impact against breast cancer. Without the financial support provided by research grants, the best and brightest researchers may be forced to leave the state, or worse, leave breast cancer research altogether.
There is an enormous demand for answers to the causes and prevention of breast cancer. We are dedicated to pursuing those answers, and we have identified the best ways to put our resources to the best use, but unless we close our funding gap, too many important projects will never get off the ground.
With a View to the Future
Californians declined to pass
Proposition 86 in the recent elections,
which would have tripled our
funding revenue. As an alternative,
we are focusing on other revenue
sources, such as the Tax Check-off
Program, donations through the
United Way, and individual contributions
from our Community Partners.
To increase Californians’ awareness of the Tax Check-off’s easy and taxdeductible method of contributing to breast cancer research, we have joined with the other tax check-off organizations on the state’s income tax Form 540 to launch a combined marketing campaign. We will continue to explore other methods of fundraising for and increasing awareness of the California Breast Cancer Research Program.
Despite our shrinking funds, we will continue to invest in the best ideas that move us closer to our goal of eliminating breast cancer. But we must rely on you, our stakeholders, for your continued support and involvement. Visit our website (www.CABreastCancer.org): learn about our research projects, develop your research questions, and support our research program with your donation. Together, we can move closer to the day when breast cancer is eliminated from our bodies and our lexicon.
Marion H. E. Kavanaugh-Lynch, M.D., M.P.H.,
Director of the CBCRP
