Executive Summary
During 2008, the California Breast Cancer Research Program (CBCRP) funded 52 new single- and multiple year research projects that will advance scientific knowledge about breast cancer. With these new awards, we are investing almost $14 million at 24 California institutions. These pages list the studies funded this year, the studies in progress, and summaries of 56 studies funded in previous years that were completed during 2008.
Designed to push breast cancer research in new, creative directions, the CBCRP is funded primarily by a California state tax on tobacco. Since 1993, the CBCRP has provided nearly $195 million in research funds.
The need is urgent. Every two hours, on average, a California woman dies of breast cancer. More than 275,000 Californians are living with the disease, and over 21,000 more will be diagnosed this year. Over the past three decades, some progress has been made. Between 1988 and 2005, the breast cancer death rate in California dropped by 29 percent. While some argue that this is the result of earlier detection, there has been no significant drop in diagnosis of cancers that have spread to other parts of the body. Thus, it is more likely that the lower death rate is due to improvements in treatment, or to more women receiving appropriate treatment.
The rate at which California women get breast cancer, after climbing steeply from 1973-1988 and staying near the 1988 rate for more than a decade, has dropped by eight percent. While some attribute this to a drop in detecting breast tumors because women are receiving fewer mammograms, others observe that even women who receive mammograms are being diagnosed with breast cancer at a lower rate. This leads many researchers to believe that the current decrease in breast cancer cases is due to fewer women receiving hormone replacement therapy. This welcome decrease in breast cancer underscores the need to move beyond just stopping a harmful medical intervention; research is needed to find out why so many women still get breast cancer and to develop positive interventions that prevent the disease.
Breast cancer activists have played a leading role in the CBCRP from the beginning. They helped write and pass the statewide legislation that created the Program in 1993.
Women with breast cancer and survivors of the disease are involved in all levels of the CBCRP’s decision making, including decisions about which projects get funded. With input from these advocates, the CBCRP has established a record for funding cutting-edge studies and jump-starting new areas of research. The Program’s goal is to fund the projects that will lead most rapidly to the end of the breast cancer epidemic.
This report has been prepared by the University of California pursuant to Article 1 of Chapter 2 of Part 1 of Division 103 of the California Health and Safety Code, Section 104145; and the Revenue and Taxation Code Sections 30461-30462.1 and 18791-18796 amended by AB-28 Oct. 11, 2008. The following required reporting elements will be addressed in this report:
- The number and dollar amounts of research grants, including the amount allocated to indirect costs. The CBCRP awarded almost $14 million for 52 single- and multiple-year research projects at 24 California institutions in 2008. A complete list of newly funded grants can be found in Table 2.
- The institutions and campuses receiving grant awards. All funded grants are listed with the recipient institutions in Table 2 (page V) and in the Research Funding and Results section of this report (pages 18–42).
- The subject of research grants.
All of the investigator-initiated grants funded by
the CBCRP involve key questions in one or more
of the following research areas:
- Basic Biology of the Breast (normal breast biology and breast cancer pathogenesis)
- Breast Cancer Causes and Prevention
- Earlier Detection, Diagnosis, and Treatment of Breast Cancer
- Community Impact of Breast Cancer (Sociocultural behavioral studies and health policy)
The CBCRP is also devoting 30 percent of program funding to its Special Research Initiatives, which is a program-initiated endeavor to significantly advance understanding of factors that can contribute to breast cancer prevention. The Initiatives fund investigations into three of the most challenging and under-researched areas: the environmental links to breast cancer; ethnic, racial, and other disparities in breast cancer incidence and survival; and the combination of these and other factors that impact breast cancer.
- The relationship between federal and state funding for breast cancer research. The CBCRP takes several steps to avoid duplication of funding at the individual grant level and in the Program’s research priorities. We identify and attempt to fill important gaps in knowledge about breast cancer. We review priorities yearly in light of changes in the research field, successes and failures of previous funding initiatives, and the results of previous funding. Additionally, as founding members of the International Cancer Research Portfolio and participating members of the Collaborative Summit on Breast Cancer Research, we are able to ensure that CBCRP funding complements rather than duplicates grants bestowed by other funding organizations.
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
- Comparisons with portfolios and programmatic goals of other funding agencies
- In-house evaluations of the efficacy of CBCRP grant mechanisms and topic areas in fulfilling program goals
- The relationship between each project and the overall strategy of the research program. The following ten criteria are used to set overall programmatic research priorities and calls for applications.
- California Specific: Fund research that utilizes resources particular to California and/or addresses a breast cancer need that is specific but not necessarily unique to the burden of breast cancer in California
- Career Development: Fund research that helps recruit, retain, and develop high-quality California-based investigators who engage in breast cancer research
- Collaboration: Fund research that uses multidisciplinary approaches and helps fosters collaboration among California scientists, clinicians, advocates, community members, patients, survivors and others
- Disparities: Fund research that addresses disparities, inequalities and/or underserved populations in California
- Innovation: Fund innovative research (i.e., new drugs, new strategies, new paradigms, new applications of tested strategies in new populations and contexts)
- Non-duplicative: Fund research that complements, builds on, and/or feeds into, but does not duplicate, other research programs
- Outcome Driven: Fund research that will improve public health outcomes (e.g. preventing breast cancer, detection of breast cancer, effective treatments and quality of life)
- Policy: Fund research and evaluation that will have policy implications for breast cancer in California
- Responsive: Fund research that is responsive to the perceived breast cancer research needs, opportunities and expectations of the CBCRP as identified by scientists and the public in California
- Translation: Fund research that is on a critical path for practical application and leads to more effective products, technologies, interventions, or policies and their application/ delivery to Californians
The review of each individual grant application is also designed to ensure that the grants funded by the CBCRP have both high scientific merit and programmatic interest. Each individual application is evaluated by our scientific review committees for specific aspects of scientific merit including, but not limited to, impact on breast cancer, innovation, feasibility, and approach. All applications of sufficient scientific merit undergo a programmatic review by our advisory Breast Cancer Research Council for responsiveness to program priorities, including whether it’s an underfunded research area, integrates advocacy issues, and is an underfunded research question.
- A summary of research findings including discussion of promising new areas. Summaries of all of research grants completed in 2008 are included in the body of this report. Listed below are just a few of the findings:
- Roshan Bastani, Ph.D., and Beth Glenn, Ph.D., at the University of California, Los Angeles, and Zul Surani, B.S., at the South Asian Cancer Foundation, Mission Hills, assessed the needs of South Asian women with breast cancer, a segment of the California population that is growing but is rarely studied. Their study highlighted the need for intervention programs that use religious and community networks, promote healthy lifestyles, address the important role of spirituality in the breast cancer experience, and tackle the social stigma that surrounds South Asian breast cancer survivors. See page 20.
- Yoshiko Umezawa, M.H.S., at the University of California, Los Angeles, investigated the role that social and religious support plays in helping minority women cope with their diagnosis. One of her findings was that Latinas and African American women were more likely to rely on social and religious support than white women. This study could help improve breast cancer patients’ quality of life and help healthcare providers develop more culturally sensitive partnerships with their patients. See page 21.
- Koie Chin, M.D., Ph.D., at the University of California, San Francisco, compared breast tumor tissue from African Americans to white women to see if they could identify genomic variations that could account for the 20 percent poorer prognosis observed in African Americans. An analysis of gene expression identified more than 40 genes that were turned on at a higher level in the African American women’s tumors than in the white women’s tumors. See page 23.
- Peggy Reynolds, Ph.D., at the Northern California Cancer Center, Union City, used data from the U.S. census and the California Cancer Registry to investigate whether they could identify birth characteristics that would be predictive of breast cancer risk in young women. Dr. Reynolds and her colleagues found, among other things, that maternal age and paternal age were the strongest predictors of breast cancer risk, and that women who were born post-term (42 weeks or later) had a significantly reduced risk of breast cancer. See page 26.
- Christina Clarke Dur, Ph.D., at the Northern California Cancer Center, Union City, tested the “hygiene hypothesis”, which is the theory that living in a sanitized environment hampers the development of a healthy immune system, thus weakening the immune response against tumors, increasing estrogen production, or both. Her preliminary analysis showed that certain markers of a weaker immune system were associated with an increased risk of postmenopausal breast cancer. See page 28.
- Sean McAllister, Ph.D., at the California Pacific Medical Center Research Institute, San Francisco, and colleagues used a mouse model to investigate whether cannabidiol, a non-psychotropic component of the Cannabis sativa (marijuana) plant, could be used to treat breast cancer. They found that it was able to inhibit cancer growth and decrease production of a protein that is believed to make breast cancer more aggressive. See page 31.
- Konstantin Stoletov, Ph.D., at the Scripps Research Institute, La Jolla, studied role of a metastatic gene called RhoC in metastasis by growing human cancer cells that RhoC in see-through Zebrafish and directly observing how tumors grow, invade, and develop new blood vessels. They found that RhoC causes the tumor cell to develop specific features that allow it to penetrate the blood vessel. See page 38.
- Inclusion of women and minorities in research studies.
Forty-four percent (19 of 43) of the grants and initiatives that the CBCRP awarded in 2008 studied either women or tissues from women, while the remaining 58 percent were laboratory studies that did not directly involve women or tissues from women.
Of the 19 grants and initiatives that involved women or tissues from women, 79 percent (15) collected new information from and about women.
Out of the 15 studies that included women:
- Eighty-seven percent, (13) grants include minority women in the study.
- Forty-seven percent, (7) are focused on minority women.
- Sixty percent, (9) are focused on underserved women.
The CBCRP’s activities, goals, and progress during 2008 are described in this report, along with the challenges that must be confronted in order to decrease the economic burden and human suffering caused by breast cancer in California.
