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 Institute’s 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 intervention’s 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.
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Increase basic research on the biology and developmental genetics of the normal mammary gland.
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Develop better model systems for breast cancer, including animal models and cell culture models.
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Increase research on the genetics and biology of precancerous lesions and their progression to invasive, metastatic cancers.
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Identify key biomarkers and surrogate endpoints for epidemiologic studies and prevention and therapy trials.
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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.
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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."
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Modify and enhance support for prevention and therapy clinical trials.
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Assure that all basic and clinical research and communication efforts reflect and address patient and survivor needs and concerns.
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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.
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Expand training opportunities and support for researchers, especially for multidisciplinary training and attracting new research talent.
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Promote multidisciplinary research and communication.
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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.
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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.
