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The CBCRP's Strategy for Allocating Research Funds

The Grant-Making Process

Each year, the California Breast Cancer Research Program funds California investigators' research into the disease. These research projects may be completed during that year, but typically they run for more than a year.

The CBCRP's 16-member Breast Cancer Research Council decides which research projects to fund. The members of the council are listed in the “California Breast Cancer Research Program Council (2009)” section of this annual report. The council bases its decisions on recommendations from expert committees who review all research applications for scientific merit. To minimize conflicts of interest, review committees are composed of experts from outside California. These experts include scientists highly knowledgeable about the broad topic of the applications they consider. Each review committee also has advocate reviewers. These are women and men active in breast cancer advocacy organizations, many of them also living with the disease. The committees use a review process based on established practice at the federal government's National Institutes of Health. The members of the CBCRP's review committees for 2009 are listed in Appendix A of this annual report. During 2009, the CBCRP reduced the cost of this review process, which allowed the Program to allocate nearly $600,000 more for research.

To use the CBCRP's research dollars in ways that will most quickly lead to the prevention and cure of breast cancer, the CBCRP has developed and fine tuned its funding strategy. The Program's current strategy is summarized in this section, as is the the priority-setting process that will inform the CBCRP’s future funding strategy for the next five years.

Current Funding Strategy: Priority Issues

The subject of each research project the CBCRP funds must fall under one of the Program’s Priority Issue areas:

The Community Impact of Breast Cancer
Etiology and Prevention
Biology of the Breast Cell
Detection, Prognosis, and Treatment

Current Funding Strategy: Special Research Initiatives

The CBCRP is investing 30 percent of its research funds in the Program’s Special Research Initiatives. The initiatives investigate two research areas that have not received enough attention, but that hold great promise against breast cancer:

Why are some groups of women—based on characteristics such as their ethnic group, race, or where they work or live—more likely to get, or die from, breast cancer?
What is the role of the environment in this disease?

Funds are being targeted to research that will most quickly lead to major breakthroughs. The studies funded have been designed not only to increase knowledge, but also to create solutions that will move toward the goal of ending the suffering caused by breast cancer.

To build on the most current findings, the CBCRP commissioned a review of previous research into the environmental links to breast cancer and the reasons why some groups of women bear a greater burden of the disease. A draft of this extensive scientific review, Identifying Gaps in Breast Cancer Research, is posted on the CBCRP web site.

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.

During 2009, the CBCRP funded research studies under eight of the Program's Special Research Initiatives:

Chemicals Policy and Breast Cancer. California's government is developing a new policy for the use of chemicals in the state. The policy could lead to better regulations to protect Californians from chemicals that cause breast cancer. However, science does not have all the answers about which chemicals those are. To make breast cancer prevention part of the new chemicals policy, the CBCRP is funding studies to figure out how best to test chemicals for their potential to cause breast cancer.
Demographic Questions for California Breast Cancer Research. The state of California collects data about who gets breast cancer. The CBCRP is funding research into the best way to improve this data. Improving the data can empower researchers better understand why some groups of women are more likely to get, or die from, the disease. Improving the data could also lead to recommendations for ways to lighten the burden on groups of women who suffer disproportionately from breast cancer.
Understanding Racial and Ethnic Differences in Stage-Specific Breast Cancer Survival. Women from some racial and ethnic groups are less likely to survive breast cancer than others, even when they are diagnosed at the same stage and with the same kind of cancer. To discover why, the CBCRP is funding studies with the goal of decreasing breast cancer deaths among racial and ethnic groups with the highest death rates. These studies leverage resources found only in California: diverse ethnic and racial groups, plus expert researchers conducting ongoing investigations of breast cancer among a number of those groups.
Biological/Ecological Models of Breast Cancer Causation and Prevention. Up until now, scientists have too often studied only one possible cause of breast cancer at a time. A different approach will be needed to make progress in uncovering the environment's role in breast cancer and in understanding why some groups of women bear a greater burden of the disease. For this reason, the CBCRP is funding research into better tools to investigate—all at once—many factors that may be involved in breast cancer.
The Environmental Causes of Breast Cancer Across Generations. In the first-ever "womb to breast cancer" study in women, rather than in lab animals, the CBCRP is finding out if women exposed to certain chemicals while they were developing in the womb are more likely to get breast cancer. The study is based on growing scientific evidence that women who were exposed to toxic chemicals at critical periods in their lives are more likely to get breast cancer years later.
Environmental Exposures and Breast Cancer Across a Large, Diverse Cohort of Women. To truly see the environment's role in breast cancer, researchers need to study a large diverse population of women over time, and collect information about the women's environments, lifestyles, racial and ethnic backgrounds, immigration histories, sexual orientations, genes, health histories, etc. The CBCRP is funding research that leverages over ten years of data collected by the ongoing California Teachers Study to discover the role of specific chemicals in breast cancer.
New Statistical Models to Address Disease Complexity. It takes complex math to evaluate the impact of many complex causes leading to breast cancer. New, more powerful computers and software make this complex math possible. The CBCRP is funding research teams to develop new statistical methods that will allow researchers to better measure the many factors that act in combination with each other across a woman's life span, increasing or lowering her risk of getting breast cancer.

An additional initiative will be funded in the future:

An Integrated Approach to Understanding Behavioral, Social, and Physical Environment Factors and Breast Cancer among Immigrants. Why does moving to the U.S. raise a woman's chances of getting breast cancer? The CBCRP will fund studies among California immigrant communities to answer this important question.

Special Research Initiatives Award Types
Unlike the procedure used with other CBCRP-funded research studies, and the majority of scientific research funded in the nation today, the scientists involved in the Special Research Initiatives are not selecting the topics to be studied. Using this method of selecting topics has not led to enough good research into the environment's role in breast cancer and the reasons some groups of women bear a greater burden of the disease. 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. The CBCRP used this process to select topics to be studied. California researchers were then invited to participate through the three following types of award:

Requests for Qualifications: The CBCRP developed specific research questions to be answered. The Program then invited California researchers to submit their qualifications for answering these questions. Grants were awarded to researchers identified as most qualified.
Program Directed Awards: The CBCRP identified and funded crucial research projects that leverage California resources.
Requests For Proposals: The CBCRP identified a relatively narrow area for research, and then invited researchers to propose topics to investigate within those areas.

The table below shows Special Research Initiatives funded in 2009 by Award Type.

Table 3: Special Research Initiative Award Types

Award Type	Initiatives
Requests for Qualifications	Chemicals Policy and Breast Cancer Demographic Questions for California Breast Cancer Research Understanding Racial and Ethnic Differences in Stage-Specific Breast Cancer Survival Biological/Ecological Models of Breast Cancer Causation and Prevention
Program Directed Awards	Environmental Causes of Breast Cancer Across Generations Environmental Exposures and Breast Cancer Among a Large, Diverse Cohort of Women
Requests for Proposals	New Statistical Models to Address Disease Complexity

The table below presents statistics of the nine Special Research Initiatives projects in 2009.

Table 4: Special Research Initiative Funded in 2009

Initiative	CBCRP Priority Issues Area	Number of Projects	Amount
Chemicals Policy and Breast Cancer	Community Impact of Breast Cancer	1	$159,334
Demographic Questions for California Breast Cancer Research	Community Impact of Breast Cancer	1	$430,988
Understanding Racial and Ethnic Differences in Stage-Specific Breast Cancer Survival	Community Impact of Breast Cancer	1	$322,541
Biological/Ecological Models of Breast Cancer Causation and Prevention	Etiology and Prevention	1	$229,732
Environmental Causes of Breast Cancer Across Generations	Etiology and Prevention	1	$5,000,000
Environmental Exposures and Breast Cancer Among a Large, Diverse Cohort of Women	Etiology and Prevention	1	$132,203
New Statistical Models to Address Disease Complexity	Etiology and Prevention Community Impact of Breast Cancer	2 1	$627,420 $442,631
Totals		9	$7,344,849

Special Research Initiatives Result in the CBCRP Providing Statewide and National Environmental Leadership

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 Protection Agency by providing scientific peer reviews and making recommendations regarding the design and implementation of the California Environmental Contaminant Biomonitoring Program. Dr. Kavanaugh-Lynch also serves on the oversight committee of the Breast Cancer and Environment Research Centers (BCERC). BCERC is a network of four national centers, created by the federal National Institute of Environmental Health Sciences and the National Cancer Institute. The network supports research into the impact of prenatal-to-adult environmental exposures that may predispose a woman to breast cancer.

Current Funding Strategy: 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 sixteen-year history, the CBCRP has used this type of funding to stimulate innovative research.

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

Community Research Collaboration (CRC) award: Brings community organizations—such as breast cancer advocacy organizations, community clinics, or organizations serving under-represented women—together with experienced scientists to investigate breast cancer problems that are important to that community, using culturally-appropriate research methods. Pilot CRC awards are funded up to 18 months and up to $150,000 in direct costs. Full CRC awards are funded up to three years for up to $600,000 in direct costs.
Innovative Developmental and Exploratory Award (IDEA): Funds promising high-risk/ high-reward research to “road test” innovative concepts. Applicants must show how their project is part of a step-by-step research process that will lead to practical applications, such as breast cancer diagnosis, treatment, or prevention. IDEAs are funded for up to 18 months and up to $100,000—and for studies using animals or humans, $150,000—in direct costs.
IDEA–competitive renewal: Allows recently-funded recipients of CBCRP IDEA grants to compete for additional funding, if the project has succeeded in meeting key milestones in a research process that will lead to practical applications. IDEA-competitive renewal awards are available for up to two years and up to $200,000—and for studies using animals or humans, $250,000—in direct costs.
Postdoctoral Fellowship award: Funds advanced training under a breast cancer mentor. Total postdoctoral tenure (prior training plus new CBCRP funding) is limited to five years, and the maximum award duration is three years at $45,000 per year.
Dissertation award: Supports the completion of dissertation research by masters or doctoral degree candidates. Dissertations are funded up to $38,000 per year for up to two years.
Joining Forces Conference award: Supports a conference, symposium, retreat, or other meeting to link breast cancer researchers, non-breast cancer investigators, and community members for the purpose of stimulating new ideas and collaborations.
Translational Research award: Funds research that will take basic science findings quickly toward treatment, diagnosis, prevention or another application that can directly impact breast cancer, either in a medical clinic setting or through a public health measure.

Each Core Funding research project must also qualify within one of the CBCRP's four Priority Issue areas, which are listed in the Table below.

Core Funding by Priority Issue and by Award Type

Below, two tables present statistics on the 44 Core Funding projects funded during 2009 by Priority Issue and by Award Type.

Table 5. Core Funding Awarded in 2009 by Priority Issue

	Number of Projects	Amount	Percentage of Total Core Funding
Community Impact of Breast Cancer	7	$1,155,143	13.5%
Etiology and Prevention	3	$1,149,190	25.0%
Detection, Prognosis and Treatment	15	$2,222,312	25.8%
Biology of the Breast Cell	19	$3,072,049	35.7%
Totals	44	$8,598,739	100%

Table 6. Core Funding Awarded in 2009 by Award Type

Award Type	Number of Projects	Amount	Percentage of Total Core Funding
Dissertation	8	$604,247	7.0%
Postdoctoral Fellowship	9	$809,996	9.4%
Innovative Developmental and Exploratory (IDEA)	19	$3,901,192	45.3%
IDEA-Competitive Renewal	2	$602,500	7.1%
Community Research Collaboration (CRC)	2	$672,614	7.8%
Joining Forces Conference Award	2	$50,000	0.6%
Translational Research Award	2	$1,958,190	22.8%
Totals	44	$8,598,739	100%

Current Funding Strategy: Ten Programmatic Funding Goals

The following ten goals are used to set overall programmatic research priorities and calls for applications.

California Specific: Fund research that utilizes resources particular to California and/or addresses a breast cancer need that is specific but not necessarily unique to the burden of breast cancer in California
Career Development: Fund research that helps recruit, retain, and develop high-quality California-based investigators who engage in breast cancer research
Collaboration: Fund research that uses multidisciplinary approaches and helps fosters collaboration among California scientists, clinicians, advocates, community members, patients, survivors, and others
Disparities: Fund research that addresses disparities, inequalities and/or underserved populations in California
Innovation: Fund innovative research (i.e., new drugs, new strategies, new paradigms, new applications of tested strategies in new populations and contexts)
Non-duplicative: Fund research that complements, builds on, and/or feeds into, but does not duplicate, other research programs
Outcome Driven: Fund research that will improve public health outcomes (e.g. preventing breast cancer, detection of breast cancer, effective treatments and quality of life)
Policy: Fund research and evaluation that will have policy implications for breast cancer in California
Responsive: Fund research that is responsive to the perceived breast cancer research needs, opportunities, and expectations of the CBCRP as identified by scientists and the public in California
Translation: Fund research that is on a critical path for practical application and leads to more effective products, technologies, interventions, or policies and their application/ delivery to Californians

The following figure illustrates how the CBCRP's current types of awards address the Program's goals.

Figure 1.
How research awards address program goals

Future Funding Strategy: The Next Five Years

The CBCRP is in the process of developing the funding strategy for grant-making for the next five years. The Program has a strong commitment to targeting research funds where they will be most effective toward ending the breast cancer epidemic. To fulfill this commitment, the CBCRP periodically engages in a thoughtful, data-driven process of setting priorities.

To get the data needed to set priorities, the CBCRP evaluates the types of grants the Program makes, to measure whether they meet specified goals. For example, two types of CBCRP awards—Dissertation awards and Post-doctoral Fellowship awards—have a goal of launching scientists into careers in breast cancer research, thus enlarging the pool of scientists working to end the disease. The CBCRP surveys former recipients of these awards to find out what percentage have continued to conduct breast cancer research. (For more on evaluations of CBCRP grants, see the section titled "Improving the CBCRP Through Evaluation" in this annual report.) Setting priorities through this data-driven process has led to the CBCRP improving some types of grants, discontinuing some types of grants, and developing new types of grants. For example, a previous priority-setting process led to the CBCRP setting aside 30 percent of its funds for the Special Research Initiatives—an effort to uncover the environment's role in breast cancer and the reasons why some groups of women bear a greater burden of the disease.

During 2010, the CBCRP council and staff will use a group decision-making process to identify and make decisions for the long term (5 years) and the short term (1 year) and incorporate these decisions into the CBCRP's funding of breast cancer research.

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.

Former CBCRP-Funded Researcher Receives Nobel Prize.

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, or even win a Nobel Prize. During 2009, Elizabeth Blackburn, a scientist who received an IDEA in 1996, was awarded the Nobel Prize for Physiology or Medicine. Dr. Blackburn, along with two other recipients, received the prize for discovering that telomeres, which are specialized DNA “caps” on the ends of chromosomes, protect chromosomes during cell division. The researchers then discovered the enzyme telomerase, which allows cells to continue to divide indefinitely. Most normal cells have little telomerase, but many breast cancers have high levels. In 1996, there was little evidence that telomeres could be targeted to breast cancer. But the CBCRP took a chance and funded Dr. Blackburn's project to explore ways to treat breast cancer cells by using their high telomerase content against them. With subsequent funding, Dr. Blackburn has further developed methods for using "toxic" RNA to trick breast cancer cells into destroying themselves with their own telomerase, without harming normal cells. Because of the chance that Dr. Blackburn and the CBCRP took, a new treatment for breast cancer is emerging. Although the CBCRP's IDEA grants will not always lead to a Nobel Prize, this example illustrates the importance of funding high-risk research.

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 under-investigated 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, Margaret Fuller, Ph.D., of Stanford University, is an expert in stem cell biology. A CBCRP grant is enabling her to apply findings about stem cells to breast cancer. Dr. Fuller's research project is concerned with the normal process where adult stem cells become specialized cells in the breast. She is testing the hypothesis that certain cell proteins involved in this process may also suppress tumors, and that not having enough of these proteins may allow tumors to get started. Her research, if successful, could lead to a genetic test that could identify women at high risk for 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 cutting edge research. For example, the Avon Foundation for Women, which funds breast cancer research nationwide, is joining the CBCRP in supporting the Program’s ground-breaking Special Research Initiatives. The foundation, long a funder of breast cancer research, agrees 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 for Women awarded the CBCRP a $500,000 grant earmarked for the CBCRP Special Research Initiatives.

In addition, receiving a CBCRP grant to conduct breast cancer research also allows scientists to leverage additional funding. For example, for every $1 the CBCRP invested in the Program's Innovative, Developmental and Exploratory awards (IDEAs), investigators have been able to leverage another $5 for breast cancer research.