Federal and State Funding for Breast Cancer Research
“This is one of the most important contributions of [CBCRP]… to fund projects at a very early stage to promote innovation and to permit breakthroughs from the established or faltering current protocols. The breast cancer field will benefit greatly from the Program.”
Funding
Funding for breast cancer research in the U.S. is available through a variety of sources:
- federal agencies (National Institutes of Health, Department of Defense), which receive funding through Congress from the national budget and from voluntary purchase of more expensive postage stamps;
- national voluntary health organizations (American Cancer Society, Komen Foundation, etc.), which receive funding through charitable contributions from individuals, events, corporations and foundations;
- regional non-profit organizations (Entertainment Industry Foundation, The Wellness Foundation, etc.), which also receive funding through charitable contributions from individuals, events, corporations and foundations;
- state agencies (New Jersey Commission on Cancer, Massachusetts Department of Public Health, etc.) who receive funding primarily from state general funds and voluntary charitable donations from individuals on state income tax returns.
The California Breast Cancer Research Program is unique in its funding sources. The large majority of CBCRP funds comes from a portion of the revenue from a two-cent State tax on cigarettes. Thus, these funds do not come from the State's General Fund, nor are they dependent on voluntary charitable contributions. They are, however, dependent on the consumption of cigarettes in California—a declining and temporary source. CBCRP also receives funding through charitable contributions from two sources: voluntary donations by individuals on the California state income tax return, and individual contributions sent directly to the Program.
Research Priorities
One of CBCRP's mandates is to “fund innovative and creative research, with a special emphasis on research that complements, rather than duplicates, the research funded by the federal government.’ CBCRP fulfills this mandate in three ways:
- by identifying gaps in the priority issues and award types funded by the federal government, and developing specific priority issues and award types for CBCRP that address these gaps;
- by having expert reviewers from across the U.S. review grant applications for the innovativeness and uniqueness of each research topic; and
- by reviewing each application chosen for funding for overlap with existing and pending funding from other agencies.
Identifying Gaps
The federal government funds most health-related research through the National Institutes of Health. The vast majority of research grants funded by NIH are chosen not because they address a particular disease or problem that NIH has identified as important, but rather are chosen based on the scientific merit of projects that lie in the interest of the applicant. In the NIH view, “capitalizing on scientific opportunity depends, in part, on individual scientists designing specific research projects they believe have the greatest significance and offer the best chance of producing important knowledge. Therefore, the NIH places great reliance on investigatorinitiated research.” “Only a small percentage of funds is spent on research generated in response” to specific priority issues established by NIH. The majority of the NIH budget supports the “best” research grant proposals regardless of specific applicability to prevention and treatment of a disease.
In contrast, all CBCRP funds are directed to specific priority issues developed and selected by the Breast Cancer Research Council. The Council collects information from a variety of sources to inform its priority-setting process:
- opinions of national breast cancer experts;
- opinions of California stakeholders, including advocates and activists, health care providers, public health practitioners, community leaders, biotechnology scientists, and academic researchers;
- current literature on breast cancer and current gaps in knowledge
Thus, the Council attempts to identify and fill important gaps in knowledge about breast cancer that are not being addressed by other agencies. The CBCRP priority issues are reviewed and adjusted each year in light of changes in the field, successes and failures of previous initiatives, and results of previous funding cycles.
An indication that CBCRP has succeeded in identifying such gaps was provided by the 1998 publication of the NIH's “Charting the Course: Priorities for Breast Cancer Research.” This report, written by an external group of national experts in breast cancer, identified and prioritized the scientific opportunities and needs that must be addressed to continue and accelerate progress in preventing and treating breast cancer over the next decade. Of thirteen critical gaps in federal funding identified by this group of experts, CBCRP had already identified and chosen for funding the following eight:
- biology of the normal breast
- better model systems for pre-cancer and cancer
- biology of pre-cancer
- biomarkers
- translational research partnerships
- patient and survivor needs and concerns
- multidisciplinary training
- seed money for innovative, higher-risk ideas
Of the remaining five areas identified by NIH as critical to progress over the next decade, three involved national policy and infrastructure, and only two were research topics that CBCRP had not already identified.
It is expected that NIH will begin to offer funding in some of these critical areas over the coming years. As these areas receive more support from federal agencies, CBCRP will adjust its priorities and fill new gaps to complement federal funding.
Identifying Innovation and Impact
Over the past three years, CBCRP has developed, tested and phased in a scoring system that allows our expert reviewers to better differentiate applications that are especially innovative and that have the most potential impact on breast cancer. This has improved the Program's ability to emphasize innovation and creativity in the research it funds.
In the past, the majority of research funders, including CBCRP and the National Institutes of Health, have used a scoring method in which a single overall score for scientific merit is given to each application. With this method, an application that contained an idea that was not particularly novel, but an excellent research plan to test the idea, could receive the same score as an application that contained a very creative idea, but a flawed research plan. CBCRP developed a scoring method that could distinguish these two applications. In the new scoring method, every application is scored separately for innovation, impact, approach, and feasibility. These separate scores are used by the Council to arrive at funding recommendations.
Review for Overlap
As a final step to ensuring that CBCRP's funds support research that does not duplicate federal funding, all grants recommended for funding are carefully reviewed by both external scientific reviewers and staff scientists for overlap with current and pending federal grants. If any overlap is identified before funding, or during the period of the BCRP grant, the overlapping grant (or portion thereof) is not funded.
