The CBCRP’s Strategy for Allocating Research Funds

The CBCRP’s Breast Cancer Research Council and staff set the priorities for allocating the Program’s research funds. The following ten criteria are used by the Breast Cancer Research Council to set priorities.

To ensure that the CBCRP fulfills all of the criteria, the Council devised a two-part funding strategy, the Special Research Initiatives and Core Funding.

Special Research Initiatives

Investigate Crucial, Neglected Questions
The CBCRP is investing 30 percent of its research funds in the Program’s Special Research Initiatives. The initiatives utilize California’s diverse populations and extensive research infrastructure to focus on challenging questions that have thwarted traditional research approaches. The initiatives investigate two interconnected research areas:

In April 2008, the ten groundbreaking initiatives were announced to the media and the public. Three are concerned with environmental links to breast cancer:

Three initiatives investigate the reasons why some groups of women are more likely to get or die from breast cancer, based on characteristics that include geographic location, race, and ethnicity:

Four Special Research Initiatives investigate intersections of multiple factors that impact breast cancer:

If one of these pilot studies yields promising results, a larger study will be funded in 2010 at up to $6 million in total costs.

The CBCRP launched the Special Research Initiatives in 2005 because the Program’s previous efforts to increase research addressing these questions had not led to enough progress. California is an ideal laboratory for these under-researched questions. The state has varied geography, heavily industrialized areas, and a large agricultural area. It has a mix of urban, suburban, small town, and rural communities. The state’s population is ethnically and racially diverse. California also has communities with some of the highest rates of breast cancer in the nation.

The initiatives are the result of a thoughtful, thorough planning process that included analyzing years of nationwide and CBCRP-funded breast cancer research, and collecting feedback from breast cancer advocates, researchers, healthcare providers, policy makers, other funders, and the public.

To select the research that will lead to the most progress against breast cancer, the Program followed a carefully-crafted, two-year, publiclyaccessible strategy development process. A steering committee of researchers and advocates from across the nation guided this process of developing strategy. The members of this committee include:

The CBCRP’s director, Marion H.E. Kavanaugh- Lynch, also serves on the steering committee.

A major step in selecting the topics to be studied under the CBCRP’s Special Research Initiatives was the drafting of a review of previous research into the impact of the environment on breast cancer and the reasons why some groups of women bear a greater burden of the disease. This document, titled “Identifying Gaps in Breast Cancer Research,” runs to hundreds of pages, considers the results of thousands of research studies, summarizes the latest thinking on these questions, and makes recommendations for research to be pursued. “Identifying Gaps in Breast Cancer Research” is available to the public on the CBCRP Web site. A panel of science advisors, composed of experts from California and across the nation, reviewed and shaped “Identifying Gaps in Breast Cancer Research.” A list of the science advisors, staff, and consultants who wrote and shaped “Identifying Gaps in Breast Cancer Research” is found in Appendix A.

The CBCRP also gathered ideas for research to be conducted under the Special Research Initiatives from a variety of sources. Town hall stakeholder meetings, teleconferences, online brainstorming, and a session at the CBCRP’s most recent symposium all encouraged the California public and breast cancer experts to submit ideas. Those who participated in this process were later able to rate the ideas submitted. Participants included women affected by breast cancer, investigators, clinicians, government officials, and interested members of the public across California and the nation.

During 2008, a 33-member strategy team of scientists, advocates, and clinicians from California and across the nation made specific recommendations for the ten research initiatives. The strategy team members are listed in Appendix B.

As a result of the CBCRP’s leadership in research into the role of the environment in breast cancer, the Program’s director, Marion H.E. Kavanaugh- Lynch, has been appointed to the nine-member California Environmental Contaminant Biomonitoring Program Scientific Guidance Panel. The panel assists the Department of Health Services and California Environmental Protections Agency by providing scientific peer reviews and making recommendations regarding the design and implementation of the California Environmental Contaminant Biomonitoring Program.

Core Funding

After setting aside 30 percent of CBCRP research funds for the Special Research Initiatives, the CBCRP dedicates the remaining 70 percent to challenging investigators to use the funds to maximum effect. During its fifteen-year history, the CBCRP has developed and fine-tuned a funding strategy designed to stimulate innovative research.

Each core funding research project must fall under one of the CBCRP’s Priority Issue areas:

Each core funding research project must also qualify as one of the CBCRP types of awards:

Core Funding by Priority Issue and by Award Type
Below, two tables present statistics on the 42 projects funded during 2008 by Priority Issue and by Award Type.

Influencing the Research System Nationwide

One goal underlying the CBCRP’s funding strategy is the leveraging of Program funds to influence the research system nationwide. The CBCRP is part of a much larger research system. The federal government funds breast cancer research through agencies like the National Cancer Institute and the Department of Defense. Nonprofit organizations and for-profit corporations also fund breast cancer research. Although the CBCRP is the largest state funding source for breast cancer research in California, these funds make up only a small part of the funds granted through the larger system. The CBCRP tries to influence this larger research system to move in new, creative directions.

An example is the CBCRP’s Innovative, Developmental, and Exploratory Awards (IDEAs). These awards were specifically designed to fund 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 1995, less than 10 percent of research proposals submitted to the nation’s funding agencies were successful. 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. The CBCRP’s IDEAs meet a need by funding creative new research approaches.

If the research funded by an IDEA succeeds, the researcher may well be able to get another research funding agency to fund the next step. For example, John Boone, Ph.D., and Karen Lindfors, M.D., of the University of California, Davis, received a CBCRP IDEA award that allowed them to build the first dedicated computerized tomography (CT) breast scanner. CT scanners are a special type of x-ray machine that produce threedimensional pictures. In contrast, mammogram x-rays produce a two-dimensional picture and may not show a tumor obscured by other breast tissue. Standard mammography detects tumors at an average size of about 11 millimeters in diameter, about the size of a garbanzo bean (or chick pea). Breast CT aims to detect tumors at an average diameter of 5 millimeters, about the size of a small pea. The smaller a tumor is when it is discovered, the more treatment options a woman has—and the better her odds of surviving breast cancer. CBCRP funding allowed the researchers to solve problems that included lowering the previously unacceptably high radiation dose involved in breast CT scanning. As a result, Boone and Lindfors have received $6 million from the National Institutes of Health to further develop their CT scanner, which is currently being tested in clinical trials.

The CBCRP uses additional methods to get creative new research going. These include encouraging researchers in California to submit exciting new ideas. The CBCRP also developed a new scoring system to help reviewers read proposals with a perspective toward rewarding high-risk research. In addition, the Program’s Special Research Initiatives are a multi-year effort to stimulate new research in previously underinvestigated areas that have a high potential to lead to breakthroughs in breast cancer causes and prevention.

Enlarging the Pool of Breast Cancer Researchers

Another major goal of the CBCRP is to increase the number of talented scientists engaged in breast cancer research. Some of the Program’s grants have allowed investigators to specialize in, or concentrate much of their efforts on, breast cancer research. For example, Anastasia Kralli, Ph.D., of the Scripps Research Institute, has been interested in investigating mechanisms of action of estrogen-related receptors in the muscle and central nervous system. CBCRP funding has encouraged her to expand her investigations to include breast cancer. Using her 2006 CBCRP IDEA grant, Dr. Kralli was able to demonstrate that when the activity of these proteins is selectively increased in breast tumor cells, it keeps these cells from growing and forming tumors. Dr. Kralli’s findings also suggest that compounds based on parts of the molecular structure of estrogen-related receptors could be used to treat breast cancer.

Leveraging Funds for Promising Research

An additional goal of the CBCRP’s research strategy is encouraging and inspiring other research funding agencies to support cuttingedge research. For example, in 2008, the Avon Foundation, which funds breast cancer research nationwide, joined the CBCRP in supporting the Program’s ground-breaking Special Research Initiatives. The foundation, long a funder of breast cancer research, agreed that not enough has been done in the areas of environmental links to breast cancer and the reasons why some groups of women bear a greater burden of the disease. The Avon Foundation awarded the CBCRP a $500,000 grant earmarked for three of the ten CBCRP Special Research Initiatives. Two of the initiatives support research exploring environmental exposures and breast cancer among large and diverse groups of women at several points through their life. The third project will combine data from multiple California studies to explore answers to why people from different racial and ethnic groups have different survival outcomes, despite being diagnosed with breast cancer at the same stage.