BETHESDA, Md--The National Cancer Institute should increase
funding for studies aimed at understanding the fundamental biology of
breast cancer and increase emphasis in a dozen other areas, an
outside panel concluded after a sweeping review of the
Institutes basic, clinical, and population-based breast cancer research.
"In reviewing the research portfolio of the NCI, it was clear
that most of the funding was going into the initiation and
progression of breast cancer and relatively little to the basic
biology," said Harold Moses, MD, director, Vanderbilt University
Cancer Center. Dr. Moses was co-chair of the Breast Cancer Progress
Review Group with Nancy Davidson, MD, associate professor of
oncology, Johns Hopkins Oncology Center.
NCI asked the 30-member group to identify the scientific needs and
opportunities critical to hastening progress against breast cancer
and to develop an action plan, using the current NCI research program
as a baseline. It released the report at a meeting of the National
Cancer Advisory Board (NCAB).
Most breast cancers cannot be attributed to any of the known risk
factors, the panel noted. It suggested two goals for etiologic
research for the next decade: Identify and validate the risk factors
that can be modified to reduce breast cancer risk, and develop a
better understanding of how various genetic and environmental factors
interact to affect the risk of breast cancer.
In the prevention area, the group saw a strong need for better animal
and human models of precancerous breast biology and for biomarkers
that can replace the development or lack of development of breast
cancer as a measure of a prevention interventions success.
The committee also called for "determining the potential of
newer imaging technologies to detect and diagnose breast disease
better than physical examination and conventional mammography, and
developing new serum and tissue-related methods to better diagnose
clinically significant breast disease and better predict clinical outcome."
Treatment research would be aided substantially by performing more
multi-disciplinary studies; establishing a separate NCI study section
to fund clinical trials; and ensuring that routine costs of patients
in clinical trials are reimbursed.
Thirteen Overarching Issues
The panel assigned equal priority to 13 overarching issues "in
which greater emphasis is now imperative" to ensure major
progress against breast cancer in the next 5 to 10 years.
Increase basic research on the biology and developmental genetics of
the normal mammary gland.
Develop better model systems for breast cancer, including animal
models and cell culture models.
Increase research on the genetics and biology of precancerous lesions
and their progression to invasive, metastatic cancers.
Identify key biomarkers and surrogate endpoints for epidemiologic
studies and prevention and therapy trials.
Enhance funding for and ensure investigator access to new
technologies. "Though costly, these tools are now indispensable
to progress in breast cancer research, and strategies must be
implemented to increase access to them," the report said.
Facilitate novel therapeutic approaches in academic centers and via
public/private partnerships. "It is critical that the NCI lead
the effort to forge academic/industry/NCI partnerships for drug
development," the report said. Such collaboration "could
greatly facilitate development of new drugs for breast cancer
prevention and treatment."
Modify and enhance support for prevention and therapy clinical trials.
Assure that all basic and clinical research and communication
efforts reflect and address patient and survivor needs and concerns.
Increase the focus on and support for basic and applied
research into behavioral mechanisms and decision-making relevant to
cancer prevention, detection, and treatment. The panel noted a gap in
understanding patient behavior related to issues such as genetic
testing, prevention, screening, utilization, treatment, and
preferences for palliative care. "This is a major effort that
needs to be undertaken," Dr. Davidson said.
Expand training opportunities and support for researchers, especially
for multidisciplinary training and attracting new research talent.
Promote multidisciplinary research and communication.
Develop mechanisms to support innovation and enhance support for
specific areas of research. New options are needed to support
important investigations not served by the current system, the panel
said. Seed money should be provided for innovative, higher risk
ideas, and funding of such work should be outside the existing
peer-reviewed, investigator-initiated research project grant mechanism.
Address informed consent and confidentiality issues. "Current
consent procedures are so cumbersome that they impede crucial
research . . . and may discourage participation by clinicians and
patients," the panel concluded.