Executive Summary
In June of 1995, a little over a year after its formation, the California Breast Cancer Research Program distributed $19,167,354 to 78 breast cancer researchers throughout the state. Located in 22 California institutions, these researchers are among the leaders in California's effort to reduce the economic and human cost of breast cancer. Because of this program, the research dollars devoted to the fight against breast cancer in California were increased by 35%, from $55,938,045 to $75,105,399, sustaining and augmenting established laboratories and research groups with new projects, and bringing new researchers with cutting edge ideas into the field. The focus of these 78 projects range from finding new, better methods of detecting breast cancer while it is in its most curable stage, to identifying potential causes of breast cancer in the environment, and to bettering our understanding of how these agents bring on the disease. Lastly, and most hopefully, some of these projects look at how we might best reduce the risk of breast cancer, and eventually prevent its occurrence.
Understanding why some women develop breast cancer, and others do not, will provide clues about both risk and prevention. For example, one study is exploring the possibility that individual susceptibility to breast cancer may be related to how one's body handles certain environmental chemicals. One such class of chemicals (called PAHs) is found throughout the environment. They are continuously inhaled and ingested by all of us and are known to cause cancer, but only after they are converted by the body to an active cancer-causing form. How rapidly one's body converts PAHs to this active form and how rapidly PAHs are removed from the body are influenced by both one's genes and one's environment. The funded study will examine, in both normal and cancerous breast tissue, the amount of enzymes in the body that activates the PAHs into the toxic form, and another enzyme that detoxifies it, and enables the body to remove it. If it is found that the amount of PAH-activating and detoxifying enzymes in breast tissue represents a risk factor for breast cancer, this will not only provide a method for identifying women with increased susceptibility and the potential for taking measures to reduce their risk, but also shed light on one possible cancer pathway in the body.
Several studies are exploring different ways to boost the body's immune system to prevent any breast cancer cells that form from developing into an invasive cancer. In two studies, different protein fragments are being designed in the laboratory. These fragments will start two specific types of immune reactions to molecules that are on the surface of breast cancer cells and attack and destroy them. In one study, antibody-like molecules are being engineered which can search out and hopefully “stick” to breast cancer cells. If so, these can then be attached to radiation-emitting drugs which will destroy the targeted cancer cells when the antibody-like molecules “stick” to them. Another study is targeting another molecule that is found in some breast cancer cells with natural antibodies attached to a radiation-emitting drug to have the same effect.
Until we learn to prevent breast cancer, it is best to detect it as early as possible, before it has spread and become very difficult to cure. While X-ray mammography is still the “gold standard” for finding small tumors, it has a number of disadvantages, for example its use of ionizing radiation and finding “suspicious” areas in the breast that 70% of the time are not cancer' but which require surgical procedures, or additional tests to know for certain. CBCRP funded seven projects to either improve this X-ray early detection technology (by better use of computers instead of film to image the breast; improving the sensitivity of the imager so that the levels of radiation can be reduced while improving the image) or to develop and improve other, non-ionizing detectors. In the latter group are ultrasound and optical detectors. One other study will develop new radiopharmaceuticals that can be coupled with other nonX-ray detectors to more accurately find the smallest tumors possible.
Other efforts to develop techniques to better detect breast cancer earlier include the exploration of newly-discovered markers for breast cancer, and testing the technique of aspirating breast fluid through the nipple and examining the cells found in this fluid for abnormalities.
How people cope with their cancer and fear of cancer is as important as the technical and medical aspects of treating the disease. Thus, other studies are examining the effect of culture, race/ethnicity, stress and support, and other breast-related medical experiences such as false-positive mammograms and benign breast disorders on women's decisions to pursue routine breast cancer detection procedures. This includes studies among Hispanic, African American, Filipino, and Vietnamese women as well as women in general at higher risk of breast cancer. All of these will contribute to the state's ability to respond to the needs of California women, all of whom are “at risk” of developing breast cancer.
The 22 different institutions in the state receiving awards included independent research institutions (e.g., California Public Health Foundation), medical centers (e.g., California Pacific Medical Center), for-profit biotechnology firms (e.g., Geron Corporation), federal laboratories (e.g., Lawrence Berkeley National Laboratory), and private (Stanford) and public (University of California campuses) universities. This diversity reflects both the commitment of the CBCRP to involve the best researchers that California has to offer, and one of the objectives of the breast cancer advocacy community to widen the sources of ideas for research into this disease.
Oversight and development of strategic objectives and Program priorities is formally provided by the Breast Cancer Research Council, which consists of members representing a broad range of relevant scientific expertise, clinical and biotechnology knowledge, and community advocacy perspectives. One of the Council's first steps to establish the priorities for the Program was to convene a National Advisory Meeting. A wide range of breast cancer experts were brought together with the Council to solicit input and discuss the issues most critical for the Program to focus on. As a result of this meeting, the Breast Cancer Research Program broadened the range of breast cancer research being performed in this state by placing at a higher priority issues which receive less funding from federal agencies, especially prevention, etiology, and earlier detection (including social and behavioral aspects).
The California Breast Cancer Research Program was established in 1993, when the California Legislature passed, and the Governor signed, the Breast Cancer Act and enabling legislation. The Program is funded with a portion of the revenue from an increase in the State tobacco tax, resulting in approximately $14 million per year devoted to breast cancer research. By continuing to direct state funds towards important topics in breast cancer that are less well-supported by federal research dollars, and that are of particular importance to the people of this state, the CBCRP promises to accelerate progress in reducing the human and economic costs of breast cancer in the state.
