Home > Publications > CBCRP Annual Reports — 2005 > Relationship between Federal and State Funding

Relationship between Federal and State Funding for Breast Cancer Research

The California Breast Cancer Research Program is distinct from research programs funded by the federal government in both the CBCRP’s source of funding and in the types of research funded.

Sources of Funding

Funding for breast cancer research in the U.S. is available from a variety of sources:

Federal Agencies (National Institutes of Health, Department of Defense) receive funding through Congress from the national budget and from voluntary purchase of more expensive postage stamps.
National Voluntary Health Organizations (such as the American Cancer Society, Komen Foundation) receive funding through charitable contributions from individuals, corporations, and foundations.
Regional Nonprofit Organizations (such as the Entertainment Industry Foundation, The Wellness Foundation) also receive funding through charitable contributions.
State Agencies (such as the New Jersey Commission on Cancer, Massachusetts Department of Public Health) receive funding from state general funds and voluntary donations on individual state income tax returns.

The California Breast Cancer Research Program is unique in its funding source. Rather than coming from the state general fund or solely voluntary donations, almost all of the Program’s funds come from a 45 percent share of revenue from a two-cent State tax on cigarettes. This source of funds is declining and temporary. In the past, measures were proposed in the California State Legislature that would have had the indirect effect of decreasing funding for the CBCRP by $5 million; similar measures may be proposed, and may pass, in the future.

The CBCRP also receives some funding from voluntary donations on individual state income tax returns and from individual contributions. To increase this source of revenue, the CBCRP conducts a public outreach and fundraising effort.

Since 2002, the CBCRP’s Community Partners Program has pursued two goals: increasing public awareness of the CBCRP and increasing voluntary donations through the Income Tax Check-Off Program and new sources.

The CBCRP is a participant organization in the Community Campaign of the United Way of California, which allows residents of the state to make donations at their place of work.

This year, the public demonstrated continued enthusiasm for the CBCRP’s research. Businesses, community groups, and individuals initiated their own efforts to provide funds for the Program’s research, without being solicited to do so. Eleven-year-old Sydney Low of Newport Beach reacted to the news that her favorite aunt had breast cancer by brainstorming with her Girl Scout troop. They decided to make pink ribbons, which they distributed at public events, collecting donations for the CBCRP. Jewelry maker Janet Bocciardi of Soquel teamed up with her breast cancer survivor friend Leann Proud to hold a benefit party where they sold jewelry, with the proceeds going to the CBCRP. Janet Bocciardi’s company, Honey from the Bee, also markets jewelry over the Internet, with the CBCRP receiving a portion of the price.

Businesses that made the CBCRP the beneficiary of their community or employee fundraising efforts included Acco Engineered Systems in San Leandro; Costco in Fremont, Livermore, San Bruno, San Leandro, and Redwood City; Farrallon Restaurant in San Francisco; and Wells Fargo Community Support Campaign in Princeton, NJ. Del Mar Middle School in Tiburon also raised funds for the CBCRP.

In addition, the public has also responded to the opportunity to make donations via the Program’s Web site, www.cbcrp.org.

During 2005, the CBCRP continued to do outreach to increase citizen contributions on their state income tax forms. Using the results of a focus group conducted previously, the CBCRP initiated an advertising campaign targeted to those most likely to make donations in this way. Advertisements with the slogan “Invest in a Cure for Breast Cancer,” which encouraged people to use their state income tax forms to make donations, appeared over public radio stations, on Bay Area Rapid Transit (BART), and over the Internet. Targeted advertising was also mailed to CBCRP and University of California contacts.

These efforts resulted in the California Breast Cancer Research Program amassing nearly $650,000 in contributions, the top beneficiary organization receiving donations through the state income tax check-off program.

A distinguished panel of Californians provides leadership to the Community Partners Program as members of the Community Partners Executive Team. The Executive Team is chaired by Sherry L. Lansing, Founder, Sherry Lansing Foundation, and Regent, University of California.

Unmet Need

Ensuring the CBCRP’s present funding sources and increasing funds from new sources are both necessary. Current funds are not sufficient to do all that needs to be done. The CBCRP is unable to make grants to meet the following needs:

Clinical Trials. In a clinical trial, some patients receive a promising new therapy and the outcome is compared to a group receiving standard therapy. Clinical trials are the way science discovers which treatments work. Currently, almost every child with cancer in the U.S. is treated through a clinical trial, compared to 3 percent of women with breast cancer. With California’s diverse population, statewide clinical trials here could lead to the discovery of information that could be discovered nowhere else.
Drug Development. Developing a new drug can take 10–15 years and cost hundreds of millions of dollars. Pharmaceutical companies select potential drugs most likely to be profitable; discoveries that are too risky or only have the potential to help a small population may never become treatments.
Long-term Studies. A 20- or 30-year study of California women and girls could reveal risk factors that lead to breast cancer and point to ways to prevent the disease.
Tissue Banks. Samples of tumors from California women, along with the women’s medical history, could provide answers to research questions now and in the future.
Services. The CBCRP provides funding for community-based organizations to test services for women with cancer, but once those services have been shown to help women with breast cancer cope or survive, the Program is unable to ensure that those services will be provided.
Collaborative Consortium with Biotechnology. One of the most promising areas to support new therapies and drug discovery is the potential collaboration between the CBCRP and biotechnology leaders in academia, industry, and government. Agenda-setting conferences could propel research into development.
Research Facilitation. The breast cancer research field is becoming increasingly complex, making liaisons between disparate disciplines all the more critical. An additional staff scientist would enable the CBCRP to increase the potential to coordinate programs with scientific and medical communities, and to pursue new research opportunities on both a short and long-term basis.
National Priority-Setting Conferences. As the largest state-funded research organization in the nation, the CBCRP carries a leadership role. The Program has the opportunity to attract experts from medicine, research, and science to take part in a series of “think tank” conferences to support new directions in breast cancer research. The conferences would also draw new researchers into this field.
Grant Proposals the CBCRP Does Not Fund. During 2005, the CBCRP turned down 148 grant applications that requested a total of $25,279,448. While some of these applications lacked merit, the majority contained good ideas. With technical assistance from the CBCRP, the majority of these applications could become good, creative projects that could help enlarge the scope of breast cancer research.

Since the CBCRP’s major source of funding, the state tobacco tax, is decreasing every year, the Program will not be able to meet these critical needs or continue to fund the broad range of projects it has funded in the past.

Types of Research Funded by the CBCRP: Research Priorities

One of the CBCRP’s mandates is to “fund innovative and creative research, with a special emphasis on research that complements, rather than duplicates, the research funded by the federal government.” The CBCRP fulfills this mandate in three ways:

By identifying gaps in the research funded by the federal government, and providing funding to fill those gaps
By having expert reviewers from across the U.S. review grant applications for their innovation and impact
Before funding a grant application, reviewing it for overlap with current and pending funding from other agencies

Filling Research Gaps

The federal government funds most health-related research through the National Institutes of Health. The NIH view is on “capitalizing…investigator-initiated research.” The primary basis on which the NIH chooses grants for funding is their scientific merit, not their relevance to a particular disease. As a result, most research proposals submitted to the NIH address scientific questions in which the investigators have theoretical and empirical interest even though there may be no clear relevance to particular diseases.

Only a small percentage of NIH funds go to research in issues the NIH has identified as particularly important to specified diseases (i.e., Requests for Applications). The majority of NIH funds support the most scientifically meritorious research regardless of the applicability of the research to particular diseases.

In contrast, a fundamental priority for the CBCRP is to fund research that will speed progress in preventing and curing breast cancer. The CBCRP’s Breast Cancer Research Council sets the Program’s funding priorities, taking into account:

Opinions from national breast cancer experts
Opinions from California advocates and activists, healthcare providers, public health practitioners, community leaders, biotechnology scientists, and academic researchers
Current literature on breast cancer and current gaps in knowledge

The council attempts to identify and fill important gaps in knowledge about breast cancer, and reviews priorities yearly in light of changes in the research field, successes and failures of previous funding initiatives, and the results of previous funding.

In 2005, the CBCRP launched a new five-year program initiative to fill a significant gap in breast cancer research. This initiative will address three overlapping research questions that California is uniquely positioned to address. They are the relationship between breast cancer and the environment, the reason for the unequal burden of breast cancer among various populations of women, and the influence of lifestyle on breast cancer. More information on this initiative may be found in a previous section of this report, “The CBCRP Strategy for Funding Research.”

Choosing Research for Innovation and Impact

The CBCRP created a scoring system, based on the recommendations of an NIH Advisory Committee, to allow the Program’s expert reviewers to differentiate applications that are especially innovative and that have the most potential impact on breast cancer. The scoring system has improved the Program’s ability to choose the most innovative and creative research for funding.

In the past, the majority of research funding agencies, including the CBCRP and the National Institutes of Health, scored funding proposals with a single score based solely on scientific merit. With this method, an application with an excellent research plan to test an idea that was not particularly novel could receive the same score as an application with a flawed research plan to test a novel idea. The CBCRP’s scoring method can distinguish these two applications. The CBCRP scores applications separately for innovation, impact, approach, and feasibility. The CBCRP’s advisory Breast Cancer Research Council uses these separate scores to inform their funding recommendations. During 2005, the CBCRP modified the “impact” criterion of the scoring system. Researchers are now required to describe the steps necessary to turn their research into products, technologies or interventions that will have an impact on breast cancer, and describe where their study fits into this critical path.

Reviewing Grant Proposals for Overlap with Federal Funding

As a final step to ensure that CBCRP-funded research doesn’t duplicate federally-funded research, breast cancer science experts in other states and Program staff scientists review all grants recommended for funding for overlap with current and pending federal grants. If overlap with federal funding is found, the overlapping grant (or portion of the grant) is not funded.

Taking Leadership to Coordinate Federal, State, and International Funding

The CBCRP is working to make it easier to avoid duplication among research funding agencies and to speed progress in breast cancer research by increasing communication among agencies that fund breast cancer research. One way the Program pursues these goals is by taking part in developing a research classification system to encourage agencies to report their funding in a way that is more accessible and meaningful to other agencies and the public.

The CBCRP has joined with eight other breast cancer funding organizations in the U.S. and United Kingdom to launch the International Cancer Research Portfolio (ICRP) Web site (www.cancerportfolio.org). This Web site includes research abstracts from more than 14,000 active research projects, and the online database is searchable by a variety of criteria. The Web site allows scientists to identify possible collaborators, plan their research based on current research, and facilitate dialogues among cancer researchers. Access to this information about ongoing research will also aid research funding organizations in strategic planning for future spending. In addition, the Web site is a useful tool for other groups. Policy makers may use the database during the formulation of new health care and service delivery policies. Healthcare professionals, patients, survivors, and advocates may review the current status of funded research.

The partners in this effort are dedicated to making current research information available to funding agencies and the public, and to promoting scientific collaboration.

To extend coordination further, the ICRP partners invite representatives from the other organizations to attend their scientific meetings and review in person the funded research.