The past decade has been a time of both great optimism and frustration in breast cancer research. The optimism stems in part from the emerging insights into the basic genetic and biochemical mechanisms of breast cancer; the frustration stems from the fact that while systemic treatment of breast cancer continues to make advances, the progress is relatively slow. This slow progress may be a reflection of the natural history of the disease, or a reflection of the lack of knowledge required to specifically target newer therapies and lower the toxicity of treatment. Scientists agree that until the causes of breast cancer are understood, its prevention or eradication is unlikely.

CHARGE TO THE COMMITTEE

In late 1995 the U.S. Army Medical Research and Materiel Command (USAMRMC) asked the Institute of Medicine (IOM) to review the implementation and progress of the Breast Cancer Research Program (BCRP). Specifically, the IOM was asked to: (1) review the portfolio of breast cancer research that has been funded by the Army's BCRP as well as breast cancer research supported by other public and private funding agencies; (2) provide an analysis of the BCRP as it has been implemented in response to the IOM (1993) recommendations, specifically assessing program management and program achievement; and (3) provide recommendations delineating important areas of research for which current funding and programs are not yet in place or in which additional emphasis is needed.

To undertake the stated task, the IOM appointed a multidisciplinary committee consisting of 13 individuals, including experts in basic, clinical, and public health research; surgical, radiation, and medical oncology; genetics; sociology; epidemiology; nursing; obstetrics and gynecology; health services research; health administration; and law. One member was also a breast cancer survivor with formal ties to a breast cancer advocacy group.

THE ARMY'S BREAST CANCER RESEARCH PROGRAM

For fiscal year (FY) 1992, Congress appropriated initial funding of $25 million for breast cancer research in the Army's Research, Development, Test, and Evaluation program for the purpose of pursuing interservice research on breast cancer screening and diagnosis for military women and dependents of military men (Public Law 102-172). This marked the beginning of the Army's BCRP. In FY 1993, Congress included $210 million to support a peer-reviewed competitive grants program in breast cancer research in the Defense Appropriations Act (Public Law 102-396). The Army subsequently assigned these funds to its Medical Research and Materiel Command, which continues to administer the BCRP. This appropriation was largely the result of the successful



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