cancer research program and investment strategy. As discussed in Chapter 1, in response, the IOM suggested that funds be allocated among three broad programmatic areas—infrastructure enhancement, training/recruitment, and investigator-initiated research—and that applications within these areas be evaluated using a two-tiered review system (IOM, 1993). The first tier of the review system would review applications for scientific merit and the second tier would make funding decisions regarding those applications on the basis of programmatic relevance. Following the IOM recommended investment strategy, the USAMRMC developed a Broad Agency Announcement (BAA), which was released in September 1993 to invite submission of proposals.

Congress extended the BCRP in FY 1994 with an additional $30 million appropriation, stating that "this funding should be used to continue the fiscal year 1992 and 1993 breast cancer research program in accordance with the standards outlined by the Institute of Medicine recommendations." The congressional report stated "the conferees agree that the Department (of Defense) should continue this important program in future budget requests" (Committee on Appropriations, 1993).

In 1995, Congress and the Secretary of the Army directed the USAMRMC to conduct another breast cancer research initiative, similar to the 1993/1994 program. The appropriation of $150 million for FY 1995, however, was associated with some changes in programmatic priorities—$20 million earmarked for research in mammography/breast imaging and $15 million for breast cancer centers, leaving $115 million to support other breast cancer research. The $20 million earmark for mammography was intended to take advantage of new applications of military technology that could facilitate automated mammography screening. The goal was to "improve and verify the accuracy of breast imaging in institutional and community environments" (USAMRMC, 1995b). The other earmark, $15 million for breast cancer centers, was designed to "support the development and enhancement of patient-centered care that incorporates strategies for increasing patient accession in clinical trials" (USAMRMC, 1995c) at three geographically dispersed centers. Based on these programmatic goals, a supplemental BAA (USAMRMC, 1995c) was released on June 15, 1995, inviting applications.

IOM PROGRAMMATIC VISION (1993)

The 1993 IOM committee sought to "provide investigators the opportunity to explore new approaches to understanding breast cancer and relieving or eliminating its toll on individuals and their families" (IOM, 1993). The recommended programmatic strategy was intended to provide guidance to the USAMRMC on how to bring new talent into the field and foster innovation in



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