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A Review of the Department of Defense's Program for Breast Cancer Research (1997)

Chapter: 5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles

« Previous: 4 U.S. Army Breast Cancer Research Program
Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×

5
The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles

Since 1993 the Army's Breast Cancer Research Program (BCRP) has allocated almost $500 million to research, training, and infrastructure. In FY 1993/1994, Congress appropriated a total of $240 million for the program ($210 million for FY 1993 and $30 million for FY 1994), there were 2,641 grant submissions to the program, and 444 awards were made. The FY 1995 appropriation was $150 million and included two congressionally mandated programs: $20 million for mammography/breast imaging and $15 million for breast cancer centers. There were 2,209 FY 1995 grant proposals submitted and 287 awards made. For FY 1996 $75 million was appropriated for the BCRP, and $112.5 million has been allocated for FY 1997.

The first three sections of this chapter describe the portfolio of research funded by the BCRP during the FY 1993/1994 and FY 1995 award cycles. The final section examines how the portfolio of funded research compares to the research areas formulated and recommended by the 1993 IOM report.

RESEARCH PROJECTS

During the FY 1993/1994 funding cycle, the U.S. Army Medical Research and Development Command (later named the U.S. Army Medical Research and Materiel Command [USAMRMC]) followed closely the IOM 1993 report recommendations for the distribution of BCRP funds (IOM, 1993). Figure 5-1 compares the IOM's recommendation for the research projects by award mechanism with the actual distribution of awards for FY 1993/1994 and FY 1995. Of the total program expenditures of $218.8 million in FY 1993/1994,

Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×

FIGURE 5-1. Research projects by funding mechanism (amount in percentage).

approximately 78% of the funds ($170.9 million) went to research projects and the remaining funds ($47.9 million) went for training and infrastructure enhancement. The funded research projects can be further subdivided into New Investigator Awards (NIAs) with 11.4% of the research funds, IDEA grants with 4.5% of the research funds, and more traditional Other Investigator-Initiated Awards (OIAs) garnering 84.1%. In FY 1995, of the $86 million specified for funding research projects a greater proportion was directed toward IDEA grants (12%) while a proportionately smaller amount was directed to more traditional OIA grants (76%). NIAs stayed constant with approximately 12% of research funds (USAMRMC, 1997).

In FY 1996 the USAMRMC dramatically shifted funding toward IDEA awards. Of the $75 million total allocation in 1996, 53% was allocated for IDEA grants. This is over five times the amount awarded for IDEA grants in 1993/1994, and almost nine times more than originally recommended for this type of award by the IOM in 1993. NIAs and OIAs had been eliminated.

During 1996, 20% of funds (approximately $15 million) were allocated for Research with Translational Potential (RTP) awards. These multidisciplinary projects should produce practical applications in prevention, detection, and

Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×

treatment of breast cancer from new findings in genetics, cellular and molecular biology, and other basic science research areas.

In FY 1993/1994, the distribution of awards by funding mechanism was proportional to the numbers of proposals received for each type of award. As shown in Figure 5-2, the proportion of research proposals receiving a scientific merit score of 2.9 or better (with a score of 1.0 indicating the highest scientific merit and a score of 5 indicating no merit) was approximately equal among funding mechanisms. A somewhat larger proportion of IDEA proposals scoring in the fundable range were recommended for awards.

A greater proportion of the proposals received in 1995 were IDEA applications (33%) compared to 1993/1994 (20%) despite the fact that the BCRP was appropriated less money in 1995 than in 1993/1994 (see Figure 5-3). Similarly, a greater number of IDEAs were recommended for funding in 1995 (38%) compared to 1993/1994 (21%). IDEAs were favored over NIAs and OIAs in both cycles (Figures 5-2 and 5-3). It is particularly noteworthy that IDEA proposals as a group received the lowest percentages for merit scores of 2.9 or better but the highest percentages for award recommendations in both cycles. To meet programmatic goals, some proposals with relatively high technical merit scores were not recommended for funding, while some with lower technical merit scores were. The USAMRMC reported to the 1997 IOM

FIGURE 5-2. Number of research proposals by funding mechanism, FY 1993/1994.

Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×

FIGURE 5-3. Number of research proposals by funding mechanisms, 1995.

committee, however, that the IP's funding priority recommendations were in agreement with those of the scientific review panels 90%–95% of the time (USAMRMC, 1997).

Consistent with the 1993 IOM committee recommendations, the BCRP has funded a wide variety of research. The distribution of research projects by subject areas and disciplines for the 1993/1994 funding cycle is presented in Table 5-1.

Among subject areas/disciplines, an approximately equal proportion of proposals received was ultimately recommended for awards, but health care delivery and epidemiology scored highest with 16% of applications recommended for funding. In the 1995 funding cycle the distribution of awards across subject areas and disciplines was similar to that in FY 1993/1994, except for radiology which included set-aside funds for mammography research (Table 5-2).

A comparison of Tables 5-1 and 5-2 can be interpreted to show that as many or more proposals in underrepresented subject areas appear to have been received during the FY 1995 funding cycle as were received during the FY

Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×

1993/1994 funding cycle. Table 5-1, however, is not directly comparable to Table 5-2 because the former includes only research proposals, whereas the latter combines proposals for research and recruitment/training. Furthermore, some of the subject areas/disciplines used to sort proposals had changed from the FY 1993/1994 funding cycle to the FY 1995 cycle. Finally, during the 1995 funding cycle, the subject area/discipline of the proposal was designated by the investigator, whereas the subject areas/disciplines of proposals received during the FY 1993/1994 funding cycle were designated by the contractor, SAIC.

INFRASTRUCTURE ENHANCEMENT

The 1993 IOM report recommended that up to $21 million be allocated to enhance the infrastructure needed to carry out breast cancer research, and identified seven areas in which the BCRP funds could be used to shore up the research infrastructure. The 1993 IOM committee believed that these enhancements would help ensure that breast cancer researchers have access to the research tools they need.

During the 1993/1994 funding cycle, the BCRP spent $23.3 million (11% of funds) on infrastructure enhancements, very nearly the amount recommended by the 1993 IOM committee. The allocations of funding among each type of infrastructure enhancement, however, were markedly different from what the IOM recommended (see Table 5-3).

The BCRP awarded substantially less than what the IOM recommended for the development and enhancement of breast cancer registries, and substantially more for tissue banks and other shared resources. (Some of the tissue bank proposals recommended for funding also had registry components.)

During the FY 1995 and FY 1996 funding cycles, no funds were set aside for infrastructure enhancements. The IP recommended against allocating any funds because relatively few scientifically meritorious infrastructure research proposals were received during the FY 1993/1994 funding cycle, and because the breast cancer infrastructure was perceived as currently solidly funded (USAMRMC, 1996c).

TRAINING AND RECRUITMENT

The BCRP has supported training at different levels (Table 5-4). The purpose of the training and recruitment awards is to bring new investigators into breast cancer research and to entice researchers from other fields to focus their efforts on breast cancer.

Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×

TABLE 5-1. Distribution of Research Proposals by Subject Area or Discipline, Fiscal Year 1993/1994

Subject Area/Disciplinea

No. of Proposals Received

No. of Awards Recommended by IP

Cell biology

475

60 (13%)

Detection

354

26 (7%)

Clinical sciences

157

15 (10%)

Chemotherapy

183

10 (5%)

Endocrinology

130

15 (12%)

Epidemiology

151

24 (16%)

Psychosocial sciences

120

16 (13%)

Health care delivery

62

10 (16%)

Immunology

127

17 (13%)

Molecular biology

443

49 (11%)

Total

2,202

242 (11%)

a The 1993/1994 proposals were sorted into subject areas and disciplines by the Integration Panel contractor.

SOURCE: USAMRMC, 1996c.

TABLE 5-2. Distribution of Research and Recruitment/Training Proposals by Subject Area or Discipline, Fiscal Year 1995

Subject Area/Discipline

No. of Proposals Received

No. of Proposals Scoring 2.9 or Better

No. of Awards Recommended by IPa

Alternative medicine

5

4 (80%)

1 (20%)

Behavioral/social sciences

106

51 (48%)

11 (10%)

Cell biology

214

157 (73%)

31 (14%)

Clinical/experimental therapeutics

333

224 (67%)

35 (11%)

Endocrinology

184

122 (66%)

26 (14%)

Epidemiology

148

87 (59%)

26 (18%)

Health care delivery

62

39 (63%)

9 (15%)

Immunological sciences

124

59 (48%)

7 (6%)

Molecular biology

258

201 (78%)

40 (16%)

Molecular genetics

147

98 (67%)

16 (11%)

Pathobiology

257

150 (58%)

43 (17%)

Radiation

182

90 (49%)

14 (8%)

Radiological sciences

44

22 (50%)

9 (20%)

Total Proposals

2,064

1,304 (63%)

268 (13%)

a Proposals scoring 2.9 or higher.

SOURCE: USAMRMC, 1996c.

Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×

TABLE 5-3. Funding for Infrastructure Enhancement and Distribution of Proposals and Awards, Fiscal Year 1993/1994

Category

1993 IOM Recommendation ($million)

1993/1994 BCRP Funding ($million)

No. of Proposals Received

No. of

Proposals Scoring 2.9 or Better

No. of Awards Recommended by IPa,b

Total funding

≤$21

$23.3

127

53

24

tissue banks

2

7.2

28

18

12

mouse husbandry

1

1.5

3

2

2

information systems

3

5.6

26

8

3

cancer registries

12

3.8

49

20

3

shared resources

3

5.2

21

5

4

a Proposals scoring 2.9 or better.

b The Breast Cancer Research Program funded four infrastructure enhancement proposals with ratings above 2.9-two registries, one information system, and one shared resource.

SOURCE: USAMRMC, 1996c.

Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×

The 1993 IOM report recommended that up to $27 million be set aside for training and recruitment and divided among six training initiatives. The report further recommended that $4 million be allocated to fund up to 10 predoctoral training programs to bring together doctoral students from different disciplines with a common interest in breast cancer research. The committee also recommended that $3 million be spent on individual predoctoral fellowships to attract talented graduate students to breast cancer research and that $6 million be allocated for postdoctoral fellowships to allow fellows either to extend ongoing research related to breast cancer or broaden the scope of their research to include work relevant to breast cancer.

During the 1993/1994 funding cycle, $19.7 million (9% of funds for awards) was awarded by the BCRP for training and recruitment. This included $4.8 million for predoctoral training programs, $2.1 million for predoctoral fellowships, and $6.5 million for postdoctoral fellowships.

The IOM recommended that the BCRP allocate from $2.5 to $5 million for up to 50 ''instant sabbaticals" to allow mid-career investigators to receive training or explore new aspects of research relevant to breast cancer. However, only six sabbaticals were awarded, for a total of $570,000, because there were very few applications (USAMRMC, 1996c). BCRP management believed the lack of interest in the sabbaticals was a result of the timing of the announcement—late in the summer, after most academic faculty had finalized their plans for the upcoming academic year.

Funding of $8 million was recommended (IOM, 1993) for up to 40 career development awards, to be given to junior faculty to conduct research relevant to breast cancer, and to allow them to accumulate the experience and data needed for them to compete for traditional research awards. During the 1993/1994 funding cycle, 34 career development awards were funded for a total of $5.7 million.

The IOM (1993) also recommended that up to $1 million be set aside for interdisciplinary meetings to bring together investigators from different fields to discuss breast-cancer-related research. The IOM reasoned that such meetings would help foster interactions among investigators with diverse perspectives and expertise which could facilitate serendipitous collaborations and catalyze the development of creative and innovative approaches to breast cancer eradication. However, no money was allocated in FY 1993/1994 for interdisciplinary meetings; the IP reasoned that NIH and other agencies that fund breast cancer research provide sufficient funding for interdisciplinary meetings.

Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×

TABLE 5-4. Funding for Training and Recruitment, Fiscal Year 1993/1994

Category

1993 IOM Recommendations

1993/1994 Funding Cycle

1995 Funding Cycle

Predoctoral training programs

10 programs—$4 million

17 programs—$4.8 million

? programs—$122,000

Predoctoral fellowships

Up to 50 fellows—$3 million

35 fellows—$2.1 million

36 fellows—$3.0 million

Postdoctoral fellowships

Up to 50 fellows—$6 million

49 fellows—$6.5 million

35 fellows—$4.1 million

Special sabbaticals

Up to 50 sabbaticals—$2.5 million-$5 million

6 sabbaticals—$570,000

No sabbaticals funded

Career development awards

Up to 40 awards—$8 million

34 awards—$5.7 million

18 awards—$3.5 million

Interdisciplinary meetings

Up to $1 million

No meetings funded

No meetings funded

 

SOURCE: IOM, 1993; USAMRMC, 1996c.

Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×

The BCRP recommended a smaller proportion of predoctoral training program proposals with scientific merit scores in the fundable range for funding than it did other types of training and recruitment proposals, as evident from the data in Table 5-5.

With regard to subject matter, the BCRP supported a broad portfolio of training and recruitment awards in FY 1993/1994 as recommended in the 1993 IOM report. Table 5-6 provides information about training and recruitment proposals received and the number of awards recommended by topic for funding during this funding cycle.

Overall, 38% of training and recruitment grants were funded. The proportion of training and recruitment proposals in epidemiology, psychosocial sciences, and health care delivery significantly exceeded this proportion, with 13% of proposals received and 15% of the funded portfolio. On the other hand, cell and tissue biology, molecular biology, and immunology represented 65% of all training grants received and funded, while clinical and chemotherapy proposals were 9% of those received and 6% of those funded. Because of the small numbers of proposals received in certain areas, the IP recommended that, for FY 1995, special emphasis be directed toward increasing the number of training and recruitment proposals in the areas of psychosocial sciences, epidemiology, and clinical research.

The 1995 BAA stated that up to $14.7 million of the $150 million appropriation for the BCRP would be allocated toward training and recruitment (USAMRMC, 1995b). Although the proportion of funds allocated for training remained nearly the same between FY 1993/1994 and FY 1995, the total amount declined in the 1995 funding cycle, commensurate with the reduced congressional allocation for the BCRP for FY 1995. The BCRP spent $10.8 million on training and recruitment, divided among individual predoctoral fellowships, postdoctoral fellowships, and career development awards (see Table 5-7).

TABLE 5-5. Distribution of Proposals and Recommended Awards for Training and Recruitment, Fiscal Year 1993/1994

Category

No. of Proposals

No. of Proposals Scoring 2.9 or Better

No. of Awards Recommended by IPa

Total awards

349

199 (57%)

134 (38%)

Predoctoral training programs

38

25 (66%)

11 (29%)

Predoctoral fellowships

64

38 (59%)

29 (45%)

Postdoctoral fellowships

142

86 (61%)

52 (37%)

Special sabbaticals

19

8 (42%)

7 (37%)

Career development awards

83

41 (49%)

35 (42%)

 

SOURCE: USAMRMC, 1996c.

Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×

TABLE 5-6. Distribution of Training and Recruitment Awards Among Subject Areas/Disciplines, Fiscal Year 1993/1994

Subject Area/Disciplinea

No. of Proposals Received

No. of Awards Recommended by IPb

Total training and recruitment awards

349

134 (38%)

Cell and tissue biology

110

43 (39%)

Detection

25

10 (49%)

Clinical research

14

3 (21%)

Chemotherapy

18

5 (28%)

Endocrinology

19

4 (21%)

Epidemiology

20

8 (40%)

Psychosocial

18

7 (39%)

Health care delivery

8

5 (63%)

Immunology

16

6 (38%)

Molecular biology

101

43 (43%)

a For the 1993/1994 funding cycle, the subject area/disciplines represented by proposals were determined by the Science Applications International Corporation.

b Proposals scoring 2.9 or better.

SOURCE: USAMRMC, 1996c.

TABLE 5-7. Distribution of Training and Recruitment Proposals by Funding Mechanisms, Fiscal Year 1995

Category

No. of Proposals

No. of Proposals Scoring 2.9 or Better

No. of Awards Recommended by IP

Total proposals

378

261 (69%)

99 (26%)

Predoctoral fellowship

116

82 (71%)

41 (35%)

Postdoctoral fellowship

149

105(70%)

39 (26%)

Career development awards

113

74 (65%)

19 (17%)

 

SOURCE: USAMRMC, 1996c.

Special sabbaticals were not offered during the 1995 funding cycle, in part because of the lack of sufficient proposals during 1993/1994 (USAMRMC, 1996c). No funds were allocated for new predoctoral training programs or interdisciplinary meetings in 1995, and predoctoral training programs were dropped because of their "questionable value" (USAMRMC, 1996c). By awarding funds directly to meritorious individuals rather than to institutional programs, the BCRP can more directly assess the individuals being recruited into the program.

Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×

Breast Cancer Centers and Mammography/Breast Imaging Projects

The 1995 appropriation included $20 million earmarked for mammography studies and $15 million earmarked for breast cancer centers (Committee on Appropriations, 1994b). The language accompanying the appropriation indicated that Congress was primarily interested in investing this money in studies of digital mammography (Committee on Appropriations, 1994a). However, the IP recommended that other types of breast cancer detection research also be considered for funding from the allocation.

During the 1995 funding cycle, 70 mammography demonstration project proposals were received, of which 32 fell within the fundable range (scientific merit scores of 2.9 or better). Of these, 8 mammography demonstration projects were funded, for a total of $11.4 million. In addition, 6 OIAs and 8 IDEAs were recommended for funding from the set-aside mammography allocation at $4.2 million. The purpose of the mammography and breast imaging demonstration projects was to improve and verify the accuracy of breast imaging in institutional and community environments. Breast cancer center funds were directed toward developing patient-centered care in breast cancer centers and increasing access of breast cancer patients to clinical trials of new cancer therapies. In 1995, 11 proposals for breast cancer centers were received, of which 6 had scientific merit scores in the fundable range (scientific peer review score of 2.9 or better), and 3 breast cancer centers were funded for a total of $12.9 million. The small number of submitted proposals for breast cancer centers may have been a result of the requirement that the center be located at a single site.

Historically Black Colleges and Universities/Minority Institutions

To promote submissions from minority applicants, 5 percent of BCRP funds were set aside for historically black colleges and universities/minority institutions (HBCU/MIs) and small, disadvantaged businesses (SDBs), consistent with established U.S. Army policy (USAMRMC, 1996c). Nevertheless, proposals from HBCU/MIs and SDBs had to meet established standards for scientific acceptability or the set-aside would revert to the general funding pool. Table 5-8 outlines the number of proposals and awards for HBCU/MIs and SDBs.

Opportunities for Minorities and Women

The IOM (1993) recommended that the BCRP create opportunities for women and minorities who are traditionally underfunded. In the 1995 funding

Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×

cycle there was a substantial increase of awards to minority principal investigators. The number of awards to female principal investigators also increased, despite an overall decrease in funds for the BCRP from the previous funding cycle. Proposals with female and/or minority principal investigators appear as likely or more likely to receive scores of 2.9 or better, and to be recommended for awards. Tables 5-9 and 5-10 outline the distribution of awards for minorities and women for FY 1993/1994 and FY 1995, respectively.

FUNDING FOR PROGRAM ADMINISTRATION

Funds for program administration cover review of scientific merit and program relevance; review of human use, animal use, and environmental/safety protocols; and up to four years of grant/contract performance monitoring (including site visits). During the 1993/1994 funding cycle, 7% of funds allocated to the BCRP went to management (USAMRMC, 1997); this was well below the target management budget of 10% of allocated funds. Just under 90% of administrative expenditures went to contractors providing peer review and programmatic support. About 4.6% of administrative expenses supported Army personnel and administration, and 5.5% were spent on maintenance, supplies, and equipment.

TABLE 5-8. Numbers of HBCU/MI and SDB Proposals by Category of Award, Fiscal Year 1993/1994

Category of Awards

No. of Proposals Received

No. of Proposals Scoring 2.9 or Better (fundable range)

No. of Proposals Funded

Research (HBCU/MIs)

17

4

2 (both OIAs)

Infrastructure (SDBs)

10

4

2 (1 tissue bank, 1 information system)

Training and recruitment (HBCU/MIs)

3

1

1 (postdoctoral fellowship)

NOTE: HBCU/MI = historically black colleges and universities/minority institutions; SDB = small, disadvantaged business; OIA = other investigator-initiated research.

SOURCE: USAMRMC, 1996c.

Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×

TABLE 5-9. Designation of Minority Status and Gender for Research Awards, Fiscal Year 1993/1994

Designationa

No. of Proposals Received

No. of Proposals Scoring 2.9 or Better

No. of Proposals Recommended for Award

Female investigator

96

95 (99%)

67 (70%)

Minority investigator

38

36 (95%)

17 (48%)

Female minority investigator

18

18 (100%)

16 (89%)

a Designation of gender and minority status were optional items for inclusion on proposal submissions.

SOURCE: USAMRMC, 1996c.

TABLE 5-10. Designation of Minority Status and Gender, All Awards, Fiscal Year 1995

Designationa

No. of Proposals Received

No. of Proposals Scoring 2.9 or Better

No. of Awards Recommended

Female investigator

701

457 (65%)

110 (17%)

Minority investigator

569

330 (58%)

64 (11%)

Female minority investigator

178

113 (63%)

30 (17%)

a The 1995 figures include both research proposals and training and recruitment proposals. Therefore, this table is not comparable with the table for FY 1993/1994.

SOURCE: USAMRMC, 1996c.

For the 1995 funding cycle, 5.9% of allocated funds went toward program management (USAMRMC, 1997). The proportion of program management expenses going to the peer review contractor decreased and the proportion going toward personnel and administration increased. The expense for the latter that year included the travel expenses for the members of the scientific peer review committees. The proportion of funds for maintenance, supplies, and equipment also decreased from the 1993/1994 funding cycle because most of the costs for purchasing equipment were incurred upon initiation of the program.

DISTRIBUTION OF AWARDS AMONG RESEARCH AREAS

Part of the USAMRMC's charge to IOM is to examine how the portfolio of research that was funded by the BCRP compares to the recommendations of the

Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×

1993 IOM committee as outlined in their report (1993). The 1993 IOM committee concluded that rather than targeting funds to specific disciplinary areas, the best way to ensure that the most promising research is funded is instead to create a framework for a broad portfolio of breast cancer research that would allow the best ideas to emerge from all disciplines (IOM, 1993). The 1993 IOM report identified six fundamental questions related to the causation, prevention, detection, diagnosis, and treatment of breast cancer, and recommended that research projects funded under the program be directed toward answering one or more of these questions. (The six fundamental questions are listed in Chapter 4.)

The report also recommended that the funds not be restricted to proposals that deal solely or directly with breast cancer, but that funds be allocated to support the best proposals, as long as that work is relevant to at least one of the fundamental questions that the committee identified (IOM, 1993). The report noted that many of the discoveries that have benefited breast cancer patients have come about as a result of research that did not address breast cancer directly. In this spirit, the 1993 BAA stated that the six questions were intended to be "illustrative" of the types of research that would be funded under the program, and that "any promising research area that is relevant to breast cancer will be considered." A similar statement appeared in the overview section of the BCRP's 1995 BAA (USAMRMC, 1995b).

It should be noted that the USAMRMC presented the IOM's fundamental questions in a slightly modified form. To ensure that men with breast cancer were not excluded from consideration, the language of the BAA was made gender-neutral. The fundamental question relating to epidemiology was reworded to include all types of epidemiological research—not only molecular epidemiology research, but also more traditional epidemiological research, including epidemiological studies to investigate the role of endogenous and exogenous risk factors in the development of breast cancer.

To determine how well the BCRP portfolio was addressing the IOM-identified (1993) fundamental questions, the 1997 IOM committee examined the abstracts and award lists of projects recommended for funding in the 1993/1994 and 1995 cycles. Studies on genetic changes usually include research on the molecular and cellular consequences of these changes. Therefore, projects addressing questions 1 and 2 were combined in the analysis of the grants funded. A separate category for nonmolecular epidemiological studies was added (see Table 5-11).

A portion of the BCRP allocation was congressionally earmarked for infrastructure development and mammography/breast imaging studies. The committee placed awards on mammography/breast imaging in a separate category (category M). The FY 1993/1994 funds allocated for infrastructure (i.e., tissue banks, mouse husbandry, information systems, registries, and shared

Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×

resources) were also placed in a separate category (category I). The committee then assigned each of the research and recruitment/training grants recommended for funding during the FY 1993/1994 and FY 1995 award cycles to the research area to which it is primarily related (see Tables 5-12a,b and 5-13a,b). The committee constructed the tables based on awards lists made available by the Army that in turn were based on the IP recommendations for funding. The actual award amounts may differ slightly after the negotiations between the awarding unit and the investigators' institutions are completed.

The committee found that the questions posed in the 1993 IOM report, as modified by the USAMRMC in the BAA, were sufficiently broad, and that all grants awarded during the FY 1993/1994 and FY 1995 funding cycles could be assigned to one of these categories (Tables 5-12a and 5-13a). In the 1993/1994 funding cycle, over half the funds ($120 million) were awarded for projects related to the basic genetic, cellular, and molecular research questions; less than 5% (about $10 million) was spent on studies to explain risk factors at the cellular and molecular level, and 3% went toward support of more standard epidemiological studies. In FY 1995, fewer dollars were directed toward basic research ($49 million) and epidemiological studies (over $4 million), but the amount awarded for studies of mechanisms of risk factors remained about the same as FY 1993/1994, despite a reduction in the congressional allocation for the BCRP program of almost 40 percent.

Despite the lower levels of BCRP funds in FY 1995 (but reflective of the change in program priorities), nearly the same amount was spent in the 1995 funding cycle for research on breast cancer detection, diagnosis, and treatment—areas of high translational potential—as was spent in FY 1993/1994. Substantially more money was awarded to studies of mammography and other imaging techniques in the 1995 funding cycle compared to 1993/1994; this was a result of a special congressional set-aside of BCRP funds for digital mammography demonstration projects. Funding of studies relating to delivery of health services and psychosocial impact was at almost the same level in FY 1995 as in FY 1993/1994; in addition, three special breast cancer centers were funded in FY 1995. Conversely, during the 1995 funding cycle, there were no awards for predoctoral training programs or for enhancement of breast cancer research infrastructure.

Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×

TABLE 5-11. Fundamental Areas of Breast Cancer Research

Research Area

Abbreviation

Basic genetic, cellular, and molecular studies relevant to the origin and progression of breast cancer

B (Basic)

Risk factors, endogenous and exogenous: Studies of their molecular mechanisms

R (Risk factors)

Epidemiological studies of risk factors, progression, and outcome

E (Epidemiology)

Detection, diagnosis, prevention, treatment: Clinical studies (excluding imaging studies)

D (Detection)

Mammography: Studies of effectiveness and innovation in breast cancer imaging technology, including databases

M (Mammography)

Psychosocial: studies of psychosocial factors, quality of life, and clinical outcomes

P (Psychosocial)

Health care delivery: Studies of effectiveness and innovation in providing diagnosis, treatment, and followup care

H (Health care delivery)

Infrastructure: tissue or DNA banks, registries/databases regarding regional screening and outcome; establishment of cell lines and animal models

I (Infrastructure)

For both the 1993/1994 and 1995 funding cycles, the distribution of grants among research subject areas for NIAs, IDEA grants, and OIAs were similar, with the largest proportion of research grants directed toward investigations of genetic alterations and cellular and molecular changes in breast cancer. During the 1993/1994 funding cycle, most research awards were directed at the first of the five research areas—genetic alterations and cellular and molecular functions in breast cancer. This distribution mirrored the distribution of grant applications received, with the largest proportion in the areas of genetics and cellular and molecular biology (Tables 5-12a, b). During the 1995 funding cycle, the largest proportion of research awards and funding went into the same basic research area (Tables 5-13a, b), followed by research awards for translating findings in genetics and molecular and cellular biology into new methods of breast cancer prevention, detection, and treatment.

The remainder of the funded research awards in FY 1993/1994 and FY 1995 appeared to be distributed approximately equally among the other important research subject areas identified by the IOM—that is, explorations of endogenous and exogenous risk factors and their relationship to processes occurring at the cellular and molecular level; studies of psychological, social,

Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×

and cultural factors and their relationship to breast cancer prevention and treatment; and healthcare delivery and effectiveness research.

In FY 1993/1994 research and training grants, only 3.8% of funded projects focused on minority and other traditionally underserved populations. However, in FY 1995, despite the reduced level of funding available, 9.6% of funded research proposals focused on underserved populations and concerned issues such as genetics, health care seeking behavior, health care delivery/access to care, health promotion and education, and epidemiology.

Most of the funds for recruitment and training in FY 1993/1994 and FY 1995, like the research grants, were directed toward studies of genetic alterations and cellular and molecular functions in breast cancer. As discussed above, the six fundamental research questions, as originally formulated by the 1993 IOM committee, did not encompass standard or classical epidemiology. The 1993 IOM report emphasized the need for molecular epidemiology studies, that is, studies that related epidemiological findings to changes occurring at the genetic, molecular, and cellular levels. The IP recommended modifying the fundamental questions to include standard epidemiological research. For FY 1993/1994, there were 12 awards for epidemiology research and one training grant for classical epidemiological research (i.e., epidemiological research that was not cellular or molecular epidemiology [Table 5-12a]). For 1995, there were 14 research awards and two training grants related to classical epidemiological research (Table 5-13a).

Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×

TABLE 5-12a. Number of Funded Grants, U.S. Army Breast Cancer Research Program, Fiscal Year 1993/1994

 

Funding Mechanisma,b

Content

OIA

NIA

IDEA

CDA

PTP

PREF

POST

SS

BANK

HUSB

INFO

REG

SHAR

Total No. (%)

Basic

120

24

26

25

3

29

36

2

 

1

 

 

 

266 (59.2%)

Risk Factors

10

2

7

2

 

 

3

 

 

 

 

 

 

24 (5.4%)

Epidemiology

9

1

2

2

 

 

 

1

 

 

 

 

 

15 (3.3%)

Detection

21

4

7

2

1

 

2

1

 

 

 

 

 

38 (8.5%)

Mammography

10

1

5

1

 

6

4

 

 

 

2

 

1

30 (6.7%)

Psychosocial

9

1

3

2

 

 

1

1

 

 

 

 

 

17 (3.8%)

Health Care Delivery

13

1

4

 

 

 

1

1

 

 

1

 

 

21 (4.7%)

Infrastructure

 

 

 

 

 

 

 

 

12

1

1

5

4

23 (5.1%)

Training

 

 

 

 

13

 

2

 

 

 

 

 

 

15 (3.3%)

TOTAL

192

34

54

34

17

35

49

6

12

2

4

5

5

449

 

42.8%

7.6%

12.0%

7.6%

13.8%

7.8%

10.9%

1.3%

2.7%

0.5%

0.9%

1.1%

1.1%

 

a OIA = Other Investigator-Initiated Awards; NIA = New Investigator Awards; IDEA = Innovative DEvelopmental and Exploratory Awards, CDA = Career Development Awards; PTP = Predoctoral Training Programs; PREF = Predoctoral Fellowships; POST = Postdoctoral F SS = Special Sabbaticals; BANK = Tumor Sample, Breast Tissue, and Cell Line Repositories; HUSB = Transgenic Mouse Husbandry; INFO = Information Systems; REG = Enhancement of Existing Cancer Registries; New Registries of High Risk Individuals; SHAR = Other Innovative Shared Resources.

b Five awards were split into two separate awards because they had been assigned two funding mechanisms by the Army: four OIA/CDA and one NIA/CDA were split into four OIA, one NIA, and five CDA awards.

SOURCE: USAMRMC, 1995a, 1995d.

Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×

TABLE 5-12b. Amounts of Funded Grants, U.S. Army Breast Cancer Research Program, Fiscal Year 1993/1994 ($ millions)

 

Funding Mechanisma,b

Content

OIA

NIA

IDEA

CDA

PTP

PREF

POST

SS

BANK

HUSB

INFO

REG

SHAR

Total No. (%)c

Basic

91.7

13.3

3.8

4.9

0.19

1.8

4.1

0.19

 

0.51

 

 

 

120.5 (56.5%)

Risk Factors

7.6

0.68

0.89

0.36

 

 

0.36

 

 

 

 

 

 

9.9 (4.7%)

Epidemiology

5.0

0.62

0.30

0.39

 

 

 

0.10

 

 

 

 

 

6.4 (3.0%)

Detection

15.0

2.2

1.0

0.40

0.02

 

0.30

0.10

 

 

 

 

 

19.1 (9.0%)

Mammography

6.1

0.59

0.75

0.20

 

0.35

0.54

 

 

 

2.1

 

1.2

11.8 (5.5%)

Psychosocial

7.8

0.60

0.44

0.40

 

 

0.08

0.09

 

 

 

 

 

9.4 (4.4%)

Health Care

9.7

0.60

0.58

 

 

 

0.14

0.09

 

 

0.70

 

 

11.8 (5.5%)

Delivery

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Infrastructure

 

 

 

 

 

 

 

 

7.2

1.0

2.8

3.7

4.1

18.8 (8.8%)

Training

 

 

 

 

4.6

 

0.94

 

 

 

 

 

 

5.5 (2.6%)

TOTAL

142.8

18.6

7.8

6.7

4.8

2.2

6.4

0.6

7.2

1.5

5.6

3.7

5.2

213.2

 

67.0%

8.74%

3.6%

3.1%

2.3%

1.0%

3.0%

0.3%

3.4%

0.7%

2.6%

1.8%

2.5%

 

a OIA = Other Investigator-Initiated Awards; NIA = New Investigator Awards; IDEA = Innovative Developmental and Exploratory Awards; CDA = Career Development Awards; PTP = Predoctoral Training Programs; PREF = Predoctoral Fellowships; POST = Postdoctoral F SS = Special Sabbaticals; BANK = Tumor Sample, Breast Tissue, and Cell Line Repositories; HUSB = Transgenic Mouse Husbandry; INFO = Information Systems; REG = Enhancement of Existing Cancer Registries; New Registries of High Risk Individuals; SHAR = Other

b Five awards were split into two separate awards because they had been assigned two funding mechanisms by the Army: four OIA/CDA and one NIA/CDA were split into four OIA, one NIA, and five CDA awards.

SOURCE: USAMRMC, 1995a, 1995d.

Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×

TABLE 5-13a. Number of Funded Grants, U.S. Army Breast Cancer Research Program, Fiscal Year 1995a

 

Funding Mechanismb

Content

OIA

NIA

IDEA

CDA

PREF

POST

DEMO

Total

Basic

43

10

35

11

26

28

 

153 (52.9%)

Risk Factors

8

4

8

 

3

4

 

27 (9.3%)

Epidemiology

4

1

5

3

 

1

 

14 (4.8%)

Detection

17

2

8

2

2

1

 

32 (11.1%)

Mammography

10

 

12

1

1

1

8

33 (11.4%)

Psychosocial

7

 

1

 

2

 

 

10 (3.5%)

Health Care

9

2

6

1

2

 

 

20 (6.9%)

Delivery

 

 

 

 

 

 

 

 

Total

98

19

75

18

36

35

8

289

 

33.9%

6.6%

25.9%

6.2%

12.5%

12.1%

2.8%

100%

a The three funded cancer centers are not included in this table.

b OIA = Other Investigator-Initiated Awards; NIA = New Investigator Awards; IDEA = Innovative Developmental Exploratory Awards; CDA = Career Development Awards; PREF = Predoctoral Fellowships; POST = Postdoctoral Fellowships; DEMO = Demonstration Projects.

SOURCE: USAMRMC, 1996b, 1996d.

TABLE 5-13b. Amounts of Funded Grants, U.S. Army Breast Cancer Research Program, Fiscal Year 1995a

 

Funding Mechanismb ($ millions)

Content

OIA

NIA

IDEA

CDA

PREF

POST

DEMO

Total

Basic

29.9

5.5

5.9

2.1

2.4

3.3

 

49.1 (43.8%)

Risk Factors

6.1

2.1

1.2

 

0.18

0.48

 

10.0 (8.9%)

Epidemiology

3.1

0.06

0.74

0.60

 

0.08

 

4.6 (4.1%)

Detection

10.7

1.2

1.1

0.41

0.14

0.15

 

13.7 (12.2%)

Mammography

7.5

 

1.7

0.20

0.05

0.12

11.4

21.0 (18.7%)

Psychosocial

5.2

 

0.15

 

0.13

 

 

5.4 (4.8%)

Health Care

5.6

1.2

0.82

0.60

0.14

 

 

8.4 (7.5%)

Delivery

 

 

 

 

 

 

 

 

Total

68.0

10.0

11.6

3.9

3.0

4.1

11.4

112.1c

 

60.7%

8.9%

10.4%

3.5%

2.7%

3.7%

10.2%

 

a The three funded cancer centers are not included in this table.

b OIA = Other Investigator-Initiated Awards; NIA = New Investigator Awards; IDEA = Innovative Developmental Exploratory Awards; CDA = Career Development Awards; PREF = Predoctoral Fellowships; POST = Postdoctoral Fellowships; DEMO = Demonstration Projects.

c May not add to 100% because of rounding.

SOURCE: USAMRMC, 1996b, 1996d.

Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×
Page 65
Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×
Page 66
Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×
Page 67
Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×
Page 68
Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×
Page 69
Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×
Page 70
Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×
Page 71
Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×
Page 72
Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×
Page 73
Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×
Page 74
Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×
Page 75
Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×
Page 76
Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×
Page 77
Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×
Page 78
Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×
Page 79
Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×
Page 80
Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×
Page 81
Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×
Page 82
Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×
Page 83
Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×
Page 84
Suggested Citation:"5 The Funded Portfolio of the 1993/1994 and 1995 BCRP Award Cycles." Institute of Medicine. 1997. A Review of the Department of Defense's Program for Breast Cancer Research. Washington, DC: The National Academies Press. doi: 10.17226/5808.
×
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According to current statistical data, one in eight women will be diagnosed with breast cancer. The five-year survival rate for breast cancer patients has improved in recent years, but the overall mortality rates have changed little. In 1993 Congress allocated $210 million for breast cancer research as part of the Department of Defense budget. An Institute of Medicine (IOM) committee was convened at that time to advise the U.S. Army Medical Research and Development Command on strategies for managing a breast cancer research program. This book evaluates the program's management and achievements to date. Although it is too early to evaluate the program in terms of breakthrough results and new insights produced by the funded projects or investigators, this book documents the process used to select research proposals for funding and analyzes the portfolio of funded projects in terms of their responsiveness to the recommendations and fundamental questions articulated in the 1993 IOM report.

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