Breast Cancer Group Recommends Return Of Funds, in Attempt To Limit its Focus

WASHINGTON--In an extraordinary decision, the steering committeeof the National Action Plan on Breast Cancer (NAPBC) voted toreject nearly the entire $14.75 million that Congress providedit for use in fiscal year 1997.

The group decided that some $4.3 million left over from fiscal1996 was nearly enough to cover its operations for the currentfiscal year, which began Oct. 1, 1996. Therefore, the steeringcommittee chose in a 13 to 0 vote (with 4 abstentions) to retainonly $750,000 of its appropriated funds and asked that the remaining$14 million go to the National Cancer Institute (NCI) to supportresearch on breast cancer.

Four committee members abstained from voting, including cochairSusan J. Blumenthal, MD, MPA, a deputy assistant secretary forhealth at HHS, and three committee members from the NCI.

The vote indicated the strong desire of a large majority of thesteering committee to keep the plan focused on a limited numberof areas. The vote now goes as a recommendation to the HHS secretary,who will decide whether to shift the money to NCI or use it elsewhere.

"The idea of the NAPBC was to jump-start areas of breastcancer research that were not receiving enough attention,"Frances M. Visco, JD, president, National Breast Cancer Coalition,and co-chair of the NAPBC, told Oncology News International afterthe vote. "We don't need to be out there doing everything."

Different Visions

The committee also voted to ask the HHS secretary to reaffirmsupport for the NAPBC operating plan, as formulated by the steeringcommittee. As with the vote to reject the government funds, thisvote stemmed from a long-standing clash of visions over the group'sscope of activities--whether it should expand, as is consistentwith the strategy of the plan, "to coordinate actions . .. to advance knowledge, research, policy, and services,"or remain focused on a few specific breast cancer issues, as manyof the scientists from the NIH and the non-government breast canceradvocates on the panel desire.

It is a debate that has dogged committee discussions since thesteering committee's inception nearly 3 years ago a number ofmembers noted during the meeting. There was general agreementexpressed that the NAPBC's major purpose is to highlight areasin great need of more extensive action and to help get this actionrolling.

However, there was disagreement as to whether the steering committeewas to be a short-lived group that would address only the high-priorityissues already being considered by its six working groups andthen go out of business, or whether it was to continue spotlightingareas of concern over a period of time, given that there is stillmuch to do in the fight against this disease.

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NAPBC: Origins and Future

The NAPBC grew out of an October, 1993, White House meeting inwhich Frances M. Visco, JD, president of the National Breast CancerCoalition and now an NAPBC cochair, and some 200 other breastcancer advocates presented the President with a petition containing2.6 million names.

That petition sought a national strategy to defeat breast cancer.In response, 2 months later, HHS secretary Donna Shalala conveneda broad-based meeting of scientists, advocates, government officials,and industry executives, and asked them to devise a way to proceed.

Attendees initially identified 92 potential recommendations, whichwere reduced to 20 priorities, six of which became the currentfocus of the action plan.

Rather than serve as an advisory committee, this body--referredto frequently as a "public-private partnership"--wasgiven the power to make recommendations about what the plan shoulddo.

Now, however, members question whether the steering committeeis truly setting the agenda through its recommendations, or whetherHHS officials view it as just another advisory committee