Our Strategy for Funding Research

What use of our research dollars will do the most to end the human suffering caused by breast cancer? This question guides the California Breast Cancer Research Program when we decide which research to fund. We answer it by applying our research dollars to meet two broad goals: funding the most creative new research ideas, and moving the larger world of breast cancer research toward innovation. Each year, the Breast Cancer Research Council sets the priorities for research funding. These priorities are based on the Council's judgment of what critical research the CBCRP can add to move most rapidly to the prevention and cure of breast cancer.

Funding Creative New Research Ideas

We encourage research in new directions in several ways. One is by earmarking funds for subjects we know need more research. During 2001, we set aside up to $5.5 million for new research in Health Policy and Health Services; Racial and Ethnic Differences in Breast Cancer; Sociocultural, Behavioral, and Psychological Issues Relevant to Breast Cancer; and the Biology of the Normal Breast.

However, the CBCRP has found that even when we identify under-researched areas and make research funds available, we can't always fund the type of research we'd like to see. We still don't receive enough proposals for research that meet our high standards for scientific merit and innovation. That's why we make extra efforts to build up new areas of research. A case in point is our efforts to encourage the women most affected by breast cancer to become more active in doing research.

In 1997, we launched a new grant, our Community Research Collaboration Award. It funds research by teams composed of research scientists and members of communities affected by breast cancer. The members of communities have typically been women involved in breast cancer advocacy organizations, community clinics, or organizations serving minority women. The research teams pursue research questions of interest to both the scientists and the community members.

The first year we funded Community Research Collaborations, we received few proposals. The second and third years, we received a healthy number of proposals, but in the fourth year, the number of proposals dropped. We had funded everyone who was ready to do this type of community research. We could have just stopped there, but we wanted to encourage the women most affected by breast cancer to do more research, and so we took further action.

The CBCRP did outreach to find more potential researchers. We worked with research teams whose proposals hadn't been strong enough, and helped them improve the design of their studies so we could fund them in the future. We interviewed research teams we'd already funded and used their suggestions to make our Community Research Collaboration Award process more user-friendly.

In our outreach, we discovered a barrier that kept some scientists from doing research in collaboration with women affected by breast cancer. Collaborating with a community organization isn't always a career-enhancing move for a research scientist. Sharing decision-making with members of a community organization takes a lot of time, and the resulting research is less likely to get published in a scientific journal. Fewer publications can mean the research scientist has less chance of getting promotions or tenure.

To change this situation, the CBCRP is attempting to publish articles about our own experience with Community Research Collaborations in scientific journals and other publications. We want to pave the way, so the community-based researchers we fund will also be able to get their research published. What's more, we want to inspire the larger research world and community organizations to think seriously about making it possible for the women most affected by breast cancer to actively do research on the disease. We hope this will move other breast cancer funding agencies toward this innovative area of research.

Moving Other Breast Cancer Funding Agencies toward Innovation

The CBCRP is part of a much larger research system. The federal government funds breast cancer research through the National Cancer Institute and the Department of Defense. Non-profit organizations and for-profit corporations also fund breast cancer research. Although we are the largest funding source for breast cancer research in our state, our funds make up only a small part of the funds granted through the larger system. We try to influence this larger research system to go in new, creative directions.

An example is our funding for research that has a high potential for scientific payoff-and also a high potential for failure. When the CBCRP began funding breast cancer research in the mid-1990s, less than 10% of research proposals submitted to the nation's funding agencies were getting funded. This led the people who decided what got funded— panels of research experts—to look for proposals that seemed most likely to succeed. Research scientists had to have done a significant portion of the research, and have strong preliminary data, before they could even get a grant. This made it hard for anyone to get funding in order to try out a high-risk idea; however, high-risk ideas are often the source of scientific breakthroughs.

That's why we started our IDEA Awards, grants specifically designed to encourage scientists to investigate high-risk questions. If the research succeeds, the researcher may well be able to get another research funding agency to fund the next step. For example, the CBCRP gave Robert Debs, M.D., an IDEA Award in 1997 to investigate gene therapy for breast cancer. When the idea showed promise, he was able to get funding from the federal government's National Institutes of Health (NIH) to pursue the research on a much larger scale. Alex Strongin, Ph.D., received a grant from the CBCRP in 1996 to study the role of enzymes in breast tumors developing the ability to spread to other parts of the body. The CBCRP award led to grants from the NIH, the Susan Komen Foundtion, and funding from private industry to develop this line of research.

To get creative new research going through our IDEA Awards, we've also needed to influence the larger research world. We had to encourage and train researchers in California to submit exciting new ideas. In addition, we had to train scientific experts from outside California, who review our research proposals for scientific merit, to identify promising new research concepts. We developed a new scoring system to help reviewers read proposals with a perspective toward rewarding high-risk research.

Including Minority Women in Research

In all the research studies the CBCRP funds that have women or human tissues as subjects, we make it a practice to include minority women. In addition, some of the studies we fund are focused solely on minority women. We also make it a practice to include low-income women, lesbians, older women and other groups who don't have equal access to health care and are often left out of research. California is a very diverse state, with many different ethnic groups, immigrant groups, and a mix of urban and rural dwellers. Some of the research the CBCRP funds takes advantage of this diversity. A number of the studies we fund-such as research with Samoan American or Hmong American women-could only be done in our state.

Our Research Categories

Every piece of research we fund must fit into two separate sets of categories: our Priority Subject Areas and our Types of Awards. The CBCRP's Subject Areas are broad, which allows us to have an impact across a wide spectrum of breast cancer research. Our Types of Awards, which include the IDEA and Community Research Collaborations discussed above, are narrowly targeted. The narrow targeting is designed to jump-start under-funded areas of research, encourage creative new thinking, and bring new investigators into the fight against breast cancer.

Priority Subject Areas:

Award Types:

On the following pages, we explain our eight Priority Subject Areas and provide statistics on the 66 projects we funded in 2001 by subject. Then we explain our Award Types and provide statistics on the 66 projects by award type.

Priority Subject Areas

The Starting Point
The Biology of the Normal Breast

Understanding the biology of the normal breast may provide important clues about how tumors develop and point to ways to prevent or stop breast cancer. Relatively little research has been done on normal breast structure and physiology, so the CBCRP makes it a priority to expand knowledge in this area. We encourage investigations that include normal breast development, how different types of breast cells interact, and the process of normal breast cells becoming pre-cancerous. We also encourage the development of cell lines and animal models that reflect human breast development more closely that those currently in use.

Biology of the Normal Breast
Number of projects funded in 2001: 7
Funds awarded: $1,847,959
Percentage of total projects funded: 11%
Percentage of total funds awarded: 10%

Types of awards: 3 Postdoctoral Fellowship Awards, 2 New Investigator Awards, 2 Targeted Awards.

Improving the Chances for a Cure
Earlier Detection

Since there is still no effective way to prevent breast cancer, early detection remains the best line of defense. Present methods of detection are far from perfect. Mammograms miss some tumors, falsely indicate cancer in some cases, and expose women to ionizing radiation. Low-income and minority women are also less likely to have their cancer detected early, when treatment is most likely to succeed. The CBCRP concentrates funding for detection in areas not well addressed by other funding agencies. These include new detection technology, potential new detection methods (such as blood or urine tests) that may detect cancer earlier than methods now in use, and ways to improve detection for women for whom current technology is less accurate, including women under 50.

Earlier Detection
Number of projects funded in 2001: 9
Funds awarded: $2,338,830
Percentage of total projects funded: 13%
Percentage of total funds awarded: 12%

Types of Awards: 2 Innovative Developmental and Exploratory (IDEA) Awards, 3 STEP Awards, 1 Postdoctoral Fellowship Award, 2 Translational Research Collaboration (TRC) Awards, 1 Community Research Collaboration (CRC) Award.

Finding the Causes
Etiology

Discovering the causes of breast cancer can lead to strategies to prevent, treat, or cure it. The CBCRP emphasizes research in areas that haven't received enough study, including possible environmental causes, environment-gene interactions, as-yetundiscovered genes that affect breast cancer risk, and finding the biological basis behind factors-such as early pregnancy or socio-economic status-that affect risk. We encourage research into the possible causal role of lifestyle, hormones, and nutrition. We also fund studies into the biological mechanisms that could account for some women being at higher- or lower-risk for breast cancer; for example, studies into the biological mechanisms behind the increased risk for women with higher estrogen levels.

Etiology
Number of projects funded in 2001: 4
Funds awarded: $2,842,467
Percentage of total projects funded: 6%
Percentage of total funds awarded: 15%

Types of awards: 1 STEP Award, 3 Targeted Awards.

Serving Women's Needs
Health Policy and Health Services

In California, as in the nation and in the world, inequality increases the suffering breast cancer causes. Low-income women and women from some minority groups have less access to early detection, are less likely to get treatment, are less likely to survive, or all three. We encourage more study on how to address the often lethal problem of unequal access to the best in prevention, detection, and treatment. We also encourage more work on ethical and legal issues surrounding breast cancer and on finding the most effective and supportive ways to deliver health care. In addition, we encourage research into new ways to deliver breast cancer care.

Health Policy and Health Services
Number of projects funded in 2001: 5
Funds awarded: $3,526,106
Percentage of total projects funded: 7%
Percentage of total funds awarded: 19%

Types of awards: 2 Community Research Collaboration Awards, 3 Targeted Awards.

Search for a Cure
Innovative Treatments

Rather than fund more studies on new combinations of standard chemotherapy, the CBCRP puts our research dollars into novel medical approaches that hold potential to improve treatment or even point toward a cure. These include new therapies based on blocking breast cancer's ability to hijack blood vessels and investigations of alternative medicine and nutritional factors. We encourage research to evaluate non-conventional alternative treatments and to develop methods to better manage the side effects of current treatments.

Innovative Treatments
Number of projects funded in 2001: 14
Funds awarded: $3,031,380
Percentage of total projects funded: 21%
Percentage of total funds awarded: 16%

Types of awards: 1 Innovative Developmental and Exploratory (IDEA) Award, 8 STEP Awards, 2 New Investigator Awards, 2 Postdoctoral Fellowship Awards, 1 Translational Research Collaboration (TRC) Award.

Understanding the Disease
Pathogenesis

Using the tools of molecular biology, scientists can discover the gene and protein interactions that make breast cancer cells grow and spread. These discoveries may lead to new treatments, they may be dead ends, or their implications for breast cancer may only become apparent after further discoveries. The process of turning a discovery on the molecular, gene, or cell level into a treatment can take 10-15 years and hundreds of millions of dollars. Other funding agencies adequately support this type of large scale research. To encourage scientists to try for breakthroughs, the CBCRP is willing to fund completely new paradigms and novel approaches.

Pathogenesis
Number of projects funded in 2001: 21
Funds awarded: $3,502,288
Percentage of total projects funded: 32%
Percentage of total funds awarded: 19%

Types of awards: 4 Innovative Developmental and Exploratory (IDEA) Awards, 2 STEP Awards 5 New Investigator Awards, 10 Postdoctoral Fellowship Awards.

Ending the Danger of Breast Cancer Prevention and Risk Reduction

According to current science, only about one in ten cases of breast cancer is due to inherited abnormal genes. The other nine are caused by environment and lifestyle, or by interactions between genes, environment, and lifestyle. So changing our environment or lifestyle has great potential to prevent cancer; however, the question is, which changes? The CBCRP funds research into promising areas, including diet, potential vaccines, and safer alternatives to environmental substances already known to cause breast cancer. Although we were only able to fund one Prevention study during 2001, we are actively encouraging researchers to submit more proposals in this area.

Prevention and Risk Reduction
Number of projects funded in 2001: 1
Funds awarded: $185,642
Percentage of total projects funded: 2%
Percentage of total funds awarded: 1%

Type of award: Innovative Developmental and Exploratory (IDEA) Award

The Human Side
Sociocultural, Behavioral and Psychological Issues

California women with breast cancer, and those at high risk, get treatment or don't get treatment, make decisions or miss their chance to make them, and cope with the disease-all in a social and cultural context. This context has great impact on well-being and even survival. So the CBCRP encourages research on the human side of the disease, including studies on enhancing quality of life for women with breast cancer, on improving doctor-patient interaction, and on non-medical factors leading to long-term survival. We also fund studies on how to increase the number of women with breast cancer taking part in the testing of promising treatments.

Sociocultural, Behavioral, and Psychological Issues
Number of projects funded in 2001: 5
Funds awarded: $1,484,179
Percentage of total projects funded: 8%
Percentage of total funds awarded: 8%

Types of awards: 3 Community Research Collaboration (CRC) Awards, 1 New Investigator Award, 1 Scientific Perspectives Research Collaboration (SPRC) Award.

Award Types

Collaboration Awards

To encourage thinking outside traditional research modes, we offer four types of awards to bring together new combinations of researchers. Two awards-the Scientific Perspectives Research Collaboration (SPRC) Awards and the Joining Forces Conference Award-are designed to bring talented researchers from other scientific disciplines into breast cancer research. All collaboration awards except the Conference Award offer one-year grants to explore innovative ideas and three-year grants to pursue promising full projects.

Scientific Perspectives Research Collaboration (SPRC) Awards

To spark creative new approaches to overcoming breast cancer, this award encourages researchers from other disciplines to team up with breast cancer researchers. The projects apply tools, insights, and ideas from another field of study to breast cancer.

Scientific Perspectives Research Collaboration (SPRC) Awards
Number of projects funded in 2001: 1
Funds awarded: $129,000
Percentage of total projects funded: 2 %
Percentage of total funds awarded: ‹1%

Subject area: Sociocultural, Behavioral, and Psychological Issues.

Community Research Collaboration (CRC) Awards

We believe communities should take an active part in research about themselves, so this award brings community organizations-such as breast cancer advocacy organizations, community clinics, or organizations serving minority women-together with experienced scientists. The teams investigate breast cancer problems that are important to that community, using culturally-appropriate research methods. This award allows women most affected by breast cancer to enrich the breast cancer research process with new expertise and ideas.

Community Research Collaboration (CRC) Awards
Number of projects funded in 2001: 6
Funds awarded: $2,775,621
Percentage of total projects funded: 9%
Percentage of total funds awarded: 14%

Subject areas: 2 Health Policy and Health Services, 4 Sociocultural, Behavioral, and Psychological Issues.

Translational Research Collaboration (TRC) Awards

Lab scientists may have already discovered the key to curing breast cancer and not even know it. That's a paradox of research. Basic scientists who make the discoveries need a laser-like focus on a specialty. They may not see the potential of their discovery, and they may not have the interest or knowledge to apply it. Turning a discovery into a way to detect, treat, or prevent cancer may need insights and expertise from several other fields, so this award generates creative research partnerships that might not otherwise occur. The goal is to move scientific discoveries as quickly as possible from the lab to the clinic.

Translational Research Collaboration (TRC) Awards
Number of projects funded in 2001: 3
Funds awarded: $773,458
Percentage of total projects funded: 5%
Percentage of total funds awarded: 4%

Subject areas: 2 Earlier Detection, 1 Innovative Treatments.

Joining Forces Conference Award

Creative thinkers working in fields far removed from breast cancer research may have concepts, methods, and discoveries that could lead to breakthroughs. By bringing breast cancer researchers into dialog with experts from another field, the Conference Award is aimed at kindling new research across disciplines.

Joining Forces Conference Award
Number of projects funded in 2001: None, but we hope to fund more conferences of this type and are actively encouraging the submission of proposals for next year.

Targeted Awards

Each year, the CBCRP selects under-researched areas that are crucial to progress against breast cancer, and we make a special effort to encourage more research in these areas. In 2001, $1 million to $1.5 million was set aside to encourage creative research in each of the following areas:

Targeted Awards
Number of projects funded in 2001: 8
Funds awarded: $5,760,935
Percentage of total projects funded: 12%
Percentage of total funds awarded: 31%

Subject areas: 2 Biology of the Normal Breast, 3 Etiology, 3 Health Policy and Health Services.

Training Awards

By investing in training for researchers early in their careers, we increase the pool of scientific talent working to end breast cancer.

New Investigator Awards

To launch careers in breast cancer research, we provide funding for new M.D.s, Ph.D.s, and other entry-level scientists to set up their own research programs.

New Investigator Awards
Number of projects funded in 2001: 10
Funds awarded: $2,889,338
Percentage of total projects funded: 15%
Percentage of total funds awarded: 15%

Subject areas: 2 Biology of the Normal Breast, 2 Innovative Treatments, 5 Pathogenesis, 1 Sociocultural, Behavioral and Psychological Issues.

Postdoctoral Fellowship Awards

To encourage new talent to enter the field, we fund advanced training for Ph.D.s under a breast cancer research mentor.

Postdoctoral Fellowship Awards
Number of projects funded in 2001: 16
Funds awarded: $1,356,800
Percentage of total projects funded: 24%
Percentage of total funds awarded: 7%

Subject areas: 3 Biology of the Normal Breast, 1 Earlier Detection, 2 Innovative Treatments, 10 Pathogenesis.

Training Program Awards

To increase the pool of excellent researchers working on breast cancer, we fund educational programs that train undergraduate or graduate students in disciplines important to breast cancer research.

Training Program Awards
Number of projects funded in 2001: None, however, we currently fund two training programs through 3-year grants made in previous years.

Innovative Research Awards

Innovative Developmental and Exploratory (IDEA) Awards

Our IDEA awards fund research with a high potential for scientific payoff, understanding that trying out new concepts also means a high risk of failure. IDEA Awards open new research channels in the wider world of breast cancer research, because researchers who receive start-up IDEA awards from the CBCRP can leverage them into larger grants from mainstream research funding agencies.

One-Year Innovative Developmental and Exploratory (IDEA) Awards
Number of projects funded in 2001: 8
Funds awarded: $973,617
Percentage of total projects funded: 12%
Percentage of total funds awarded: 5%

Subject areas: 2 Earlier Detection, 1 Innovative Treatments, 4 Pathogenesis, 1 Prevention and Risk Reduction.

STEP Awards

STEP Awards fund innovative developmental research in exceptionally promising topics. The research team needs to have some preliminary data in breast cancer, but not enough to get funding from a major research agency for a full-scale study.

STEP Awards
Number of projects funded in 2001: 14
Funds awarded: $4,100,024
Percentage of total projects funded: 21%
Percentage of total funds awarded: 22%

Subject areas: 3 Earlier Detection, 1 Etiology, 8 Innovative Treatments, 2 Pathogenesis.