Relationship between Federal and State Funding for Breast Cancer Research

The California Breast Cancer Research Program is distinct from research programs funded by the federal government in both the CBCRP’s sources of funding and in the types of research funded.

The CBCRP’s Source of Funding: Unique Among the Nation’s Breast Cancer Research Agencies

The primary source of funding for the CBCRP is a 45 percent share of revenue from a two-cent State tax on cigarettes. This source of funding is unique among agencies that fund breast cancer research across the nation.
In contrast, funding for breast cancer research at other programs in the U.S. comes from a variety of different sources:

The California Breast Cancer Research Program’s primary source of funds, a State cigarette tax, is declining and temporary. Measures were proposed in the California State Legislature that would have directly or indirectly decreased funding for the CBCRP. Similar measures may be proposed, and may pass, in the future.

The CBCRP also receives funding from the income tax checkoff program, which allows individuals to make voluntary donations on state income tax returns. This was a result of legislation passed by the California State Legislature that authorized donations for five years. In 2007, AB28, a bill authored by Assembly Member Jared Huffman, became law, providing individuals the opportunity to make donations to the CBCRP via voluntary tax contributions through 2012.

To increase these sources of revenue, the CBCRP conducts a public outreach and fundraising effort, the Community Partners Program. This effort, begun in 2002, has led to an increase in donations to the CBCRP from individuals, businesses, and foundations. The CBCRP’s Community Partners Program is discussed more fully in the section of this report titled “Increasing Funding for and Awareness of Breast Cancer Research.”

Types of Research Funded by the CBCRP: Complementing, Not Duplicating, Federal Efforts

The CBCRP has a deep commitment to using the funds provided by the State of California in the most efficient and cost-effective manner, and to adhering to the Program’s mandate as defined by the California Legislature. One of the 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.” The CBCRP fulfills this mandate in four ways:

  1. By funding breast cancer research areas that could have a major impact on breast cancer—including leading to prevention and cure—that are not getting sufficient attention from the federal government;

  2. By having expert reviewers from across the U.S. review grant applications for their innovation and impact;

  3. Before funding a grant application, reviewing it for overlap with current and pending funding from other agencies;

  4. By taking leadership in reducing barriers and waste in state, federal, and international breast cancer research funding.

These four ways of assuring that CBCRP-funded research does not duplicate federally-funded research are each discussed in more detail below.

Funding Promising Areas of Research That Have Not Received Sufficient Attention

The federal government’s method for funding research has led to some promising areas of breast cancer research being under-funded. The federal government funds most health-related research through the National Institutes of Health (NIH). The primary basis on which the NIH chooses grants for funding is their scientific merit, not their relevance to a particular disease. As a result, most research proposals submitted to the NIH address scientific questions in which the investigators have theoretical and empirical interest, even though there may be no clear relevance to particular diseases.

Only a small percentage of NIH funds go to research in issues the NIH has identified as particularly important to specified diseases (i.e., Requests for Applications). The majority of NIH funds support the most scientifically meritorious research, regardless of the applicability of the research to breast cancer or any other disease.
In contrast, a fundamental priority for the CBCRP is to fund scientifically meritorious research that will speed progress in preventing and curing breast cancer specifically. The CBCRP’s Breast Cancer Research Council sets the Program’s funding priorities, taking into account:

The council attempts to identify important research questions that could lead to breakthroughs and that have not received sufficient attention. The CBCRP is conducting program-initiated research to fill a significant gap in breast cancer research. The CBCRP will address three overlapping research questions that California is uniquely positioned to address through program initiated research. They are the environment's role in breast cancer, the reasons for the unequal burden of breast cancer among various populations of women, and breast cancer prevention. More information on these projects may be found in two previous sections of this report, “The CBCRP's Strategy for Allocating Research Funds,” and "Answering Urgent, Neglected Questions: Program Initiated Research."

Choosing Research for Innovation and Impact

To allow the Program’s expert reviewers to differentiate applications that are especially innovative and that have the most potential impact on breast cancer, the CBCRP created its own scoring system. The scoring system has improved the Program’s ability to choose the most innovative and creative research for funding.

In the past, the majority of research funding agencies, including the NIH, scored funding proposals with a single score based solely on scientific merit. With this method, an application with an excellent research plan to test an idea that wasn’t particularly novel could receive the same score as an application with a flawed research plan to test a novel idea. The CBCRP’s scoring method, based on the recommendations of an NIH Advisory Committee, can distinguish these two applications. The CBCRP scores applications separately for innovation, impact, approach, and feasibility. The separate scores are then used to inform  funding decisions. For example, under the CBCRP’s “impact” criterion, researchers are required to describe the steps necessary to turn their research into products, technologies, or interventions that will have an impact on breast cancer, and describe where their study fits into this critical path. Since the CBCRP developed its pioneering scoring system, the NIH has also abandoned the single scientific merit score and developed a system that   rates specific application qualities such as innovation and significance.

Reviewing Grant Proposals for Overlap with Federal Funding

As a final step to ensure that CBCRP-funded research doesn’t duplicate federally-funded research, breast cancer science experts in other states and Program staff scientists review all grants recommended for funding for overlap with current and pending federal grants. If overlap with federal funding is found, the overlapping grant (or portion of the grant) is not funded.

Taking Leadership to Reduce Duplication and Waste In Federal, State, and International Funding

The CBCRP is part of an international effort to reduce duplication and waste in research toward the goal of ending breast cancer. This effort, the International Cancer Research Portfolio (ICRP), includes 50 of the largest government and charitable research funding agencies in the U.S., United Kingdom, Canada, and the Netherlands. The organizations that make up the ICRP are working to speed progress by increasing communication and avoiding duplication among agencies that fund breast cancer research.

One way the ICRP pursues these goals is through a research classification system to encourage agencies to report their funding in an accessible and meaningful way. The ICRP Web site (www.cancerportfolio.org) includes research abstracts from more than 15,000 current and past research projects. The online database is searchable by cancer type, scientific area, funding organization, and other criteria. The Web site allows scientists to identify possible collaborators, plan their research based on current research, and facilitates dialogues among cancer researchers. Access to information about ongoing research also aids research funding organizations in strategic planning. In addition, the Web site is a useful tool for other groups. Policy makers may use the database during the formulation of new health care and service delivery policies. Healthcare professionals, patients, survivors, and advocates may review the current status of funded research.

The CBCRP and the Program’s ICRP partners further coordinate efforts by inviting representatives from the other organizations to attend their scientific meetings and review in person their funded research.

The ICRP has also taken international coordination to a higher level. It published the results of an evaluation of the career development funding trends in the U.S., U.K., and Canada. The evaluation found that providing funds for recent Ph.D. or M.D. graduates to conduct breast cancer research enabled a large majority of these researchers to stay in breast cancer research and to leverage additional funding for their investigations. The ICRP also conducted and published the results of an online survey of its member organizations on strategies for peer review. Peer review is the process of a funding agency having research proposals reviewed by scientific experts, with the goal of selecting the best research to be funded. The survey identified several successful methods for costs savings in the peer review process,  In the future, the ICRP will publish a review of cancer research funding patterns in the U.S., U.K., and Canada that will point to gaps in research and make recommendations for research priorities to fill those gaps.