During its first two years (i.e., FY 1993/1994), the program was established and managed according to both the spirit and letter of the 1993 IOM report. Those responsible for the organization and management of the program deserve special commendation for the ingenuity and resourcefulness that forged a structure and processes that are for the most part working well despite a series of limiting circumstances.
The peer review system was established in record time, although not without some difficulty. The IP is to be commended for recognizing weaknesses in the first year's procedure and recommending that the Army rebid the contract. United Information Systems (UIS) was selected.
In the third year of the program (FY 1995), two consumers (breast cancer survivors nominated by an advocacy group) were placed on each scientific peer review panel, an innovation now being evaluated. Meanwhile, testimony the committee heard from consumers and other peer review panel and IP members indicates that most observers have found the participation of consumers to be a very positive aspect of the BCRP peer review process, and one that may serve as a model for other peer review systems.
The additional years of funding that began with FY 1994 presented a considerable challenge to the leadership of the program because IOM (1993) did not specifically address the possibility of additional funds. The fact that the program is funded for only one year at a time has understandably hampered the ability of the program managers to plan for the longer-term. For example, it has prevented the establishment of standing primary review panels, resulting in lack of standardization of priority scores across the ad hoc panels. Year-to-year funding has also produced too short a time frame between the publication of the announcement of each grant cycle by a Broad Agency Announcement (BAA) and the deadline for grant applications, and exacted an unduly heavy toll in time and energy on those involved in the various stages of the process.
Based on abstracts of projects funded in the 1993/1994 and 1995 cycles, the committee determined that the portfolio covers science that is responsive to the range of six questions posed in the 1993 IOM report. The distribution of funds was such that the majority supported basic molecular and cellular biology of breast cancer with far less going to epidemiological, psychosocial, and health services research. No inherent bias was apparent, though, insofar as the number of funded proposals was proportionate to the number of applications received for each discipline. Reliable methods to measure the success of the BCRP investment are not yet in place. In addition, it was considered premature for this committee to evaluate the quality of the portfolio of funded projects, since most funded projects are not complete and progress reports were not available to the committee.
The committee is concerned about the wide range of, and sometimes conflicting, responsibilities currently placed on the IP as a result of the lack of