On May 1, the House Appropriations Subcommittee on Defense examined Department of Defense (DoD) Congressionally Directed Medical Research Programs (CDMRPs), with particular attention to breast, ovarian, and prostate cancer research programs.
Director of the CDMRP, Colonel Janet Harris, discussed the history of the program: “The breast cancer advocacy community launched a grassroots effort in 1992 to raise public awareness on the need for increased funding for breast cancer research. In response, Congress appropriated $25 million in FY1992 for research in breast cancer screening and diagnosis for military women and family members.” In 1993, after an appropriation of $210 million for “extramural peer-reviewed breast cancer research,” the Office of the CDMRP was created within the U.S. Army Medical Research and Materiel Command (USAMRMC). “From the beginning, the mission of CDMRP has been to provide hope by promoting innovative research, recognizing untapped opportunities, creating partnerships, and guarding the public trust,” Col. Harris said. She emphasized the unique features of the CDMRP, including its leadership in integrating “consumers [disease survivors] into every aspect of program execution…This adds a perspective, passion, and sense of urgency that the human dimension is incorporated in the program policy, investment strategy, and research focus.”
Col. Harris described the oversight of the grant-making procedure, focusing on the evaluation of applications by a “two-tier review process, originally recommended by the Institute of Medicine.” She said the highest priority of the CDMRPs is to “encourage researchers to undertake innovative, high-impact research” that holds the greatest chance of eradicating breast, prostate, and ovarian cancer. The CDMRP also strives to “fill gaps” in existing research and to coordinate its activities with the National Cancer Institute to avoid duplicative studies.
Fran Visco, president of the National Breast Cancer Coalition, began by saying, “This is where hope is for women and their families.” Ms. Visco asked the subcommittee to appropriate $150 million in FY2008 for breast cancer research, an increase of $22.5 million over FY2007. She praised the Innovative Developmental and Exploratory Awards (IDEA) grants as “critical in the effort to respond to new discoveries and to encourage and support innovative, risk-taking research. The Concept Awards bring funding even earlier in the process of discovery. These grants have been instrumental in the development of promising breast cancer research.” Ms. Visco also noted that “90 percent of funds go directly to research grants. The flexibility of the program allows the Army to administer it in such a way as to maximize limited resources.” Besides the low administrative costs, the CDMRP also is notable for its transparency, she said. The program reports its research to the public every two years at a public meeting called the Era of Hope; “the transparency of the BCRP [breast cancer research program] allows scientists, consumers, and the American public to see the exceptional progress made in breast cancer research,” Ms. Visco said.
Beth Karlan, past president of the Society for Gynecological Oncologists and director of the Women’s Cancer Research Institute at Cedars-Sinai Medical Center in Los Angeles told the subcommittee about her experience as a grant recipient and participant in the grant review process. Dr. Karlan said that “from the perspective of a funded scientist and an evaluator of the program, I assure this subcommittee that your investment is making a difference.” She explained the difficulty in detecting ovarian cancer, telling the subcommittee that early tumors do not cause, or cause few, symptoms. Because ovarian cancer remains asymptomatic until it is advanced, “ovarian cancer causes more deaths than all the other cancers of the female reproductive tract combined, and is the fourth highest cause of cancer deaths among women.” Dr. Karlan said that the Society for Gynecological Oncologists is requesting $20 million in funding for the ovarian cancer research program (OCRP), $10 million above FY2007. These dollars can be “leveraged through partnerships and collaborations to yield even greater returns.” At current funding levels, the OCRP only can fund a small fraction of grant applicants; in FY2006, 588 pre-proposal submissions were received and only 15 percent of the proposals with a fundable score received a grant.
During questions, there was vigorous discussion of the DoD cancer research program’s accomplishments and the state-of-the-art research being conducted at leading medical institutions. Chair John Murtha (D-PA) was particularly interested in efforts to prevent, detect, and treat cancers medically, without surgical intervention. Dr. Karlan said that research is progressing toward cancer prevention through the use of vaccines; specifically, she noted the introduction of the Hepatitis B vaccine that protects against some forms of liver cancer, and the new HPV vaccine, which protects women and girls from some forms of cervical cancer.
There also was discussion about the relationship between nutrition and cancer. Reps. Marcy Kaptur (D-OH) and Jack Kingston (R-GA) serve on the House Agriculture Committee and were particularly interested in the role food processing might have in the incidence of cancer. The panel agreed that more studies were needed to reveal any definitive links between cancer and nutrition; however, all agreed that obesity seemed to influence the growth and treatment response of cancers.
Dr. H. Kim Lyerly, director of the Duke Comprehensive Cancer Center, and Dr. Donald Coffey, professor of clinical research at the Brady Urological Institute at Johns Hopkins University, also testified.
