A Review of the Department of Defense's Program for Breast Cancer Research (1997) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-16
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Breast cancer occurs when the epithelial cells of the breast begin to grow and divide uncontrollably, although there is some controversy as to what stage of this process is officially termed cancer. What causes the cascade of events that converts a normal breast cell into a malignant cell is unknown, but it is generally thought to involve a complex interaction of inherited genetic, hormonal, dietary, and environmental factors causing multiple new genetic changes in the involved cells.
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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~.
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The IOM issued the report Strategies for Managing the Breast Cancer Research Program: A Report to the U.S. Army Medical Research and Development Command (IOM, 19934.
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The committee used these information sources and called upon its collective expertise to assess the Army's BCRP and develop its recommendations. FINDINGS The Army's Breast Cancer Research Program Operation The Army's BCRP has evolved over the last 5 years from a small research program pursuing interservice research on breast cancer screening and diagnosis into an organization pursuing a broad-based, competitively awarded research portfolio covering all areas of breast cancer research with approximately $500 million appropriated by Congress over the 4-year period.
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The Breast Cancer Research Program Portfolio As recommended by the report Strategies for Managing the Breast Cancer Research Program: A Report to the U.S. Army Medical Research and Development Command (IOM, 1993)
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There are other institutes and centers within NIH that also fund breast cancer research, either directly or indirectly. The NCI dedicated $308.7 million to breast cancer research in FY 1995, approximately 16% of its total budget exclusive of funding for AIDS research.
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Federal Government Department of Defense USAMRMC BCRP Other DOD expenditures Department of Health and Human Services National Cancer Institute Other National Institutes of Health Centers National Action Plan on Breast Cancer Other federal government State Governments California Breast Cancer Research Program Private Foundations American Cancer Society Susan G Komen Foundation $75,000 (FY 1996)
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that appear to be responsible for a significant fraction of inherited breast cancer as well as some ovarian cancer. But extensive epidemiological studies, spanning decades, have demonstrated that the etiology of breast cancer is extremely complex, involving multiple endogenous and exogenous risk factors.
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Moreover, the program fills a unique niche among public and private funding sources for cancer research. It is not duplicative of other programs and is a promising vehicle for forging new ideas and scientific breakthroughs in the nation's fight against breast cancer.
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Despite differing views on the committee regarding the need for a group to oversee the work of the IP and the BCRP in general, the majority of this committee agreed to recommend the establishment of a relatively small permanent oversight group that would be responsible for quality assurance and program evaluation activities. This group would include scientists and clinicians experienced in directing research programs, widely respected leaders in cancer research, as well as a consumer representative.
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.. RECOMMENDATIONS FOR FUTURE RESEARCH DIRECTIONS The 1993 IOM report identified six questions on the causation, prevention, screening, detection, diagnosis, and optimal treatment of and recovery from breast cancer that were to be used as a framework for breast cancer research.
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The challenge to epidemiology is to move beyond examination of traditional risk factors to basic and applied investigations using genetic information to assess both risk and prognosis factors. Knowledge of the genes involved in the complex cascade of events leading to tumor development and progression will not, by itself, tell us how best to intervene in the process.
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Finally, there is a need to update periodically systematic reviews of these trials. Furthermore, since 1993, women with breast cancer have had increasing influence in discussions relating to the direction and content of breast cancer research and they will continue to do so.
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Studies regarding ethnic, cultural, and personal differences in health beliefs and health care seeking behavior will yield important information for those providing care and setting policy. Also necessary is accurate, reliable, unbiased information on direct and indirect costs associated with genetic testing, prevention strategies, screening and diagnostic techniques, or a given treatment; such information is a critical component of realistic health care planning and delivery.
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