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 us when we decide which research to fund. Every three years, the Breast Cancer Research Council sets the priorities for research funding. These priorities, which are reviewed yearly and re-set every three years, are based on the Council's expert judgment of what critical research we 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 by carefully collecting data; soliciting input from advocates, scientists, and clinicians; reviewing progress of research funded in the past and identifying priority topics that need more research. We fund priority topics first. During 2002, our priority topics were Health Policy and Health Services; Racial and Ethnic Differences in Breast Cancer; Sociocultural, Behavioral, and Psychological Issues Relevant to Breast Cancer; Prevention and Risk Reduction; and the Biology of the Normal Breast. After we funded all the research proposals meeting our high standards for scientific merit and innovation in these areas, we used the remaining funds to make grants for studies in more established research areas. These include Etiology, Earlier Detection, Innovative Treatments, and Pathogenesis.

One of our high-priority research areas—Racial and Ethnic Differences in Breast Cancer—was new in 2001. We added this new category of research funding to meet an urgent need. Women from different ethnic groups have different rates of breast cancer, different results from treatment, and different death rates. There may be important differences in the biology of the disease. Research into these questions can help reduce inequality among women with breast cancer and among those at risk for the disease in the future. It may also uncover important information about the disease itself, pointing toward new methods of prevention and treatment, or even cure. Yet insufficient research is being done on these questions. California, with its many diverse ethnic groups, provides one of the best resources in the nation, or the world, for this type of research. The CBCRP is therefore in an ideal position to push this area of scientific inquiry forward.

Outreach Efforts to Expand Underserved Research Areas

Even when we make under-researched areas a priority, scientists may not submit enough promising proposals for research in these areas. That's why we make extra efforts to build up new areas of research. For example, we have encouraged 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 the 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. Was it possible that we had funded all researchers who were 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, so we took further action.

The CBCRP did outreach to find more potential researchers. We gave feedback and advice to 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 the Community Research Collaboration Award process more user-friendly. We also created a supplement award for CBCRP-funded Community Research Collaboration teams to mentor either new scientific researchers or community groups in community-based research.

During this outreach process, 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, we seek out opportunities to publish articles about community- based research, and make the researchers we fund aware of these opportunities. During 2002, the Journal of General Internal Medicine announced a special issue on research done by collaborations of community organizations and scientists. We alerted our Community Research Collaboration teams, making sure the teams had access to the editors and were encouraged to submit articles. Publication of this research could 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. Our goal is to move other breast cancer funding agencies toward this innovative area of research.

Influencing the Research System Nationwide

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. Nonprofit organizations and for-profit corporations also fund breast cancer research. Although we are largest funding source in California for breast cancer research, 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 Innovative Development and Exploratory Awards (IDEA), 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 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 enzymes play in the spread of breast tumors to other parts of the body. Our funding led to grants from the NIH, the Susan Komen Foundation, and funding from private industry to develop this line of research.

To get creative new research going through our IDEAs, we also encourage and train researchers in California to submit exciting new ideas. In addition, we train scientific experts from outside California, who review research proposals submitted to the program for scientific merit, to use criteria that result in funding for promising new research concepts. We developed a new scoring system to help reviewers read proposals with a perspective toward rewarding high-risk, high-reward research.

Enlarging the Pool of Breast Cancer Researchers

Another of our major goals is to increase the number of talented scientists engaged in breast cancer research. Prior to 2002, we had several awards to meet this goal, including Postdoctoral Awards, New Investigator Awards, and Training Program Awards. Recent evaluations of the Postdoctoral and New Investigator Awards yielded the suggestion that we make grants to talented scientists earlier in their careers. This led us, during 2002, to develop three new types of awards. Dissertation awards fund masters' and doctoral students' dissertation research into breast cancer. Diversity Supplements allow scientists we fund to hire and mentor promising graduate or undergraduate students who face economic or social barriers to pursuing a career in breast cancer research. Mentored Scholar Awards fund new researchers who are not yet ready to become independent investigators for work under an experienced mentor. Career Enrichment awards allow established researchers to gain valuable training in a new breast-cancer-focused research discipline, and Community Supplements enable community members to better understand how they would engage in participatory research with scientists

Two Criteria: Priority Issues and Award Types

Every research project funded by the CBCRP must fit into two separate sets of categories, the Priority Issues and the Award Types. The CBCRP's Priority Issues are broad, to allow us to have an impact across a wide spectrum of breast cancer research. Our Award Types, 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.

CBCRP Priority Issues:

Award Types:

On the following pages, we explain our nine Priority Issues and provide statistics on the 67 projects funded in 2002 by Priority Issue. Then we explain our Award Types, and again, provide statistics on the 67 newly-funded projects, this time by Award Type.

Priority Issues

The Starting Point

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. Yet 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 precancerous. We also encourage the development of cell lines and animal models that reflect human breast development more closely than those currently in use.

Biology of the Normal Breast

Number of projects funded in 2002: 11
Funds awarded: $3,076,254
Percentage of total projects funded: 16%
Percentage of total funds awarded: 21%
Types of awards: 1 Translational Research Collaboration, 2 Targeted Awards, 1 New Investigator Award, 3 Postdoctoral Fellowship Awards, 1 Dissertation Award, 1 IDEA, 2 STEP Awards.

Improving 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 methods for identifying women at high risk for breast cancer.

Earlier Detection

Number of projects funded in 2002: 2
Funds awarded: $855,959
Percentage of total projects funded: 3%
Percentage of total funds awarded: 6%
Types of Awards 2 Translational Research Collaborations.

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-yet-undiscovered genes that affect breast cancer risk, and finding the biological basis behind factors—such as early pregnancy or socioeconomic status—that affect risk.

Etiology

Number of projects funded in 2002: 3
Funds awarded: $389,696
Percentage of total projects funded: 4%
Percentage of total funds awarded: 3%
Types of awards: 1 Training Program Award, 2 Dissertation Awards.

Better Serving Women's Needs

Health Policy and Health Services

How can breast cancer treatment, prevention, and detection be organized to better serve women? The CBCRP funds investigations into this under-researched question. We encourage research on methods for improving the health and quality of life for women with breast cancer, on more effective and efficient ways to organize care, on issues facing women who survive the disease, and issues confronting women at the end of life. We encourage more work on ethical and legal issues surrounding breast cancer. In addition, we encourage investigations into the cost and efficiency of breast cancer care, into the economic and social costs of the disease in California, and into ways to reduce unequal access to prevention and care.

Health Policy and Health Services

Number of projects funded in 2002: 2
Funds awarded: $432,055
Percentage of total projects funded: 3%
Percentage of total funds awarded: 3%
Types of awards: 1 Community Research Collaboration Award, 1 New Investigator Award.

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 methods for tailoring drug treatment to individuals, investigations of alternative medicine and nutrition, and new ways to evaluate a tumor's danger. We also encourage research that evaluates new, unconventional treatments and develops methods to better manage the side effects of current treatments.

Innovative Treatments

Number of projects funded in 2002: 10
Funds awarded: $2,293,421
Percentage of total projects funded: 15%
Percentage of total funds awarded: 15%
Types of awards: 1 Community Research Collaboration, 2 IDEAs, 5 STEP Awards, 2 Dissertation Awards.

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, with hundreds of promising leads discarded. 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 2002: 30
Funds awarded: $6,079,554
Percentage of total projects funded: 45%
Percentage of total funds awarded: 41%
Types of awards: 1 Translational Research Collaboration, 3 New Investigator Awards, 9 Postdoctoral Fellowship Awards, 4 Dissertation Awards, 3 IDEAs, 10 STEP Awards.

Ending the Danger of Breast Cancer

Prevention

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 and environment and lifestyle, so changing women's 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 ways to monitor substances in the environment that may cause breast cancer. We also encourage studies on tests that can predict the likelihood of a woman getting breast cancer or measure if attempts at prevention are reducing her risk.

Prevention

Number of projects funded in 2002: 5
Funds awarded: $1,187,573
Percentage of total projects funded: 7%
Percentage of total funds awarded: 8%
Type of award: 1 Scientific Perspectives Research Collaboration, 1 Targeted Award, 1 Postdoctoral Fellowship Award, 1 Dissertation Award, 1 STEP Award.

Eliminating Disparity

Racial and Ethnic Differences

Women from different ethnic groups have different rates of breast cancer, different results from treatment, and different death rates. There may be important differences in the biology of the disease. Research into these questions can help reduce inequality among women with breast cancer and among those at risk for the disease in the future. It may also uncover important information about breast cancer that could point to new methods of prevention and treatment, or even a cure. California, with its many diverse ethnic groups, provides one of the best resources in the nation, or the world, for this type of research. This Priority Issue is new for 2002.

Racial and Ethnic Differences

Number of projects funded in 2002: 2
Funds awarded: $289,563
Percentage of total projects funded: 3%
Percentage of total funds awarded: 2%
Types of awards: 1 IDEA, 1 STEP 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 wellbeing and even survival. 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 public perceptions of the disease. We also fund studies on how to increase the number of women with breast cancer taking part in the testing of promising treatments, and on issues women face when they survive breast cancer, or as it ends their lives.

Sociocultural, Behavioral, and Psychological Issues

Number of projects funded in 2002: 2
Funds awarded: $205,028
Percentage of total projects funded: 3%
Percentage of total funds awarded: 1%
Types of awards: 1 Dissertation Award, 1 IDEA.

Award Types

Collaboration Awards

To encourage thinking outside traditional research modes, we offer four types of award to bring together new combinations of researchers. Two awards—the Scientific Perspectives Research Collaboration (SPRC) Award 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 grants for up to three years 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 2002: 1 Funds awarded: $100,000 Percentage of total projects funded: 1% Percentage of total funds awarded: 1% Priority Issue: Prevention and Risk Reduction.

Community Research Collaboration (CRC) Awards

We believe communities should take an active part in research about themselves. 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 2002: 2
Funds awarded: $266,889
Percentage of total projects funded: 3%
Percentage of total funds awarded: 2%
Priority Issues: 1 Health Policy and Health Services, 1 Innovative Treatments.

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. The TRC 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 or comparable health application.

Translational Research Collaboration (TRC) Awards

Number of projects funded in 2002: 4
Funds awarded: $1,512,755
Percentage of total projects funded: 6%
Percentage of total funds awarded: 10%
Priority Issues: 1 Biology of the Normal Breast, 2 Earlier Detection, 1 Pathogenesis.

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 other fields, the Conference Award is aimed at kindling new research across disciplines.

Joining Forces Conference Award

Number of awards made in 2002: None, but the CBCRP hopes to fund more conferences of this type and is actively encouraging the submission of proposals for 2003.

Topic-Targeted Awards

Each year, the CBCRP selects under-researched areas that are crucial to progress against breast cancer and makes a special effort to encourage more research in these areas. In 2002, $1.5 million was set aside to encourage creative research in each of the following areas:

Topic-Targeted Awards (RFAs)

Number of projects funded in 2002: 3
Funds awarded: $2,282,399
Percentage of total projects funded: 4%
Percentage of total funds awarded: 15%
Priority Issues: 2 Biology of the Normal Breast, 1 Prevention and Risk Reduction.

Career Development Awards

By investing in training for researchers early in their careers, we increase the pool of scientific talent working to end breast cancer. This year, we added two new types of awards, Dissertation Awards and Mentored Scholar Awards. Both awards are designed to encourage promising future scientists to enter the breast cancer field early in their careers.

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 2002: 5
Funds awarded: $2,028,655
Percentage of total projects funded: 7%
Percentage of total funds awarded: 14%
Priority Issues: 1 Biology of the Normal Breast, 1 Health Policy and Health Services, 3 Pathogenesis.

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 2002: 13
Funds awarded: $1,092,544
Percentage of total projects funded: 19%
Percentage of total funds awarded: 7%
Priority Issues: 3 Biology of the Normal Breast, 9 Pathogenesis, 1 Prevention and Risk Reduction.

Mentored Scholar Awards

To encourage new researchers who are not yet ready to become independent investigators to work in breast cancer research, we fund research under a mentor. This type of award is new for 2002.

Mentored Scholar Awards

Number of projects funded in 2002: None, but the CBCRP is actively encouraging scientists to apply for this type of award in the future.

Dissertation Awards

To encourage talented students to pursue careers in breast cancer research, we fund dissertation research conducted by masters or doctoral candidates. The students work under a breast cancer research mentor. This Award is new for 2002.

Dissertation Awards

Number of projects funded in 2002: 11
Funds awarded: $551,729
Percentage of total projects funded: 16%
Percentage of total funds awarded: 4%
Priority Issues: 1 Biology of the Normal Breast, 2 Etiology, 2 Innovative Treatments, 4 Pathogenesis, 1 Prevention and Risk Reduction, 1 Sociocultural, Behavioral, and Psychological Issues.

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 2002: 1%
Funds awarded: $269,698
Percentage of total projects funded: 2%
Percentage of total funds awarded: 2%
Priority Issue: 1 Etiology.

Career Enrichment Awards

To encourage established scientists to pursue innovation, the CBCRP funds up to one year of research in a field important to breast cancer that is new to the researcher.

Career Enrichment Awards

Number of projects funded in 2002: None, but the CBCRP is actively encouraging scientists to apply for this type of award in the future.

Innovative Research Awards

Innovative Developmental and Exploratory Awards (IDEAs)

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

Innovative Developmental and Exploratory Awards (IDEAs)

Number of projects funded in 2002: 8
Funds awarded: $1,085,670
Percentage of total projects funded: 12%
Percentage of total funds awarded: 7%
Priority Issues: 1 Biology of the Normal Breast, 2 Innovative Treatments, 3 Pathogen-esis, 1 Racial and Ethnic Differences in Breast Cancer, 1 Sociocultural, Behavioral, and Psychological Issues.

STEP Awards

STEP Awards fund innovative developmental research into exceptionally promising topics. This allows research teams with some preliminary data to develop their research further, as a step toward getting funding from a major research agency for a full-scale study.

STEP Awards

Number of projects funded in 2002: 19
Funds awarded: $5,618,764
Percentage of total projects funded: 28%
Percentage of total funds awarded: 38%
Priority Issues: 2 Biology of the Normal Breast, 5 Innovative Treatments, 10 Pathogenesis, 1 Prevention and Risk Reduction, 1 Racial and Ethnic Differences in Breast Cancer.

Diversity Supplement and Community Research Collaboration Supplement Awards

To bring students who face economic or social barriers to entering a career in breast cancer research into the field, we offer Diversity Supplement Awards. These awards go to a scientist whose research project is already funded by the CBCRP to hire a promising student who might otherwise not have the opportunity. We also make Diversity Supplement Awards to CBCRP-funded collaborations between community organizations and scientific researchers, to allow them to bring new scientists and new community groups into their projects. Funding for both supplement awards comes from a portion of the donations made by California taxpayers on their state income tax returns.

Diversity Supplement Awards

Number of supplements funded in 2002: 6
Funds awarded: $199,900
Priority Issues: 1 Earlier Detection, 3 Health Policy and Health Services, 1 Pathogenesis, 1 Racial and Ethnic Differences in Breast Cancer.
Award Types: 2 Community Research Collaborations, 1 New Investigator Award, 3 Targeted Awards.