by Barbara A. Brenner
It seems like hardly a day goes by when there isn’t a story in the news about the supposedly horrifying fact that federal funding is being cut for medical research. A January 29 article in USA Today noted the alarm being raised throughout the cancer industry about proposed reductions in the National Cancer Institute (NCI) budget.1 Men’s Health magazine recently ran an article warning of the cures that would never be found because of cuts in medical research funding.2 And a letter to the editor in the New York Times from a medical professor claimed that the decline in cancer research funding at the NCI proves that “breast cancer is simply not an administration priority anymore.”3
All of these fears of looming disaster fail to recognize that the NCI is just one of many funders of cancer research. Because many entities are involved in funding breast cancer and other cancer research—not only many different federal agencies, but state governments, private nonprofit organizations and foundations, and pharmaceutical companies—no one knows how much is being spent in the United States on breast cancer research, or cancer research in general. So, what the NCI budget cuts will mean for the future of breast cancer research is impossible to predict.
While budget cuts are always difficult, they can also serve as an opportunity to refocus. The NCI can use this challenge as an opportunity to figure out where its investments are paying off, where they’re not, and where additional funding might result in important returns to people with and at risk for cancer.
One example of an area that the NCI could and should take a fresh look at is its focus on pills for the prevention of breast cancer. As implied in the USA Today article, researchers who are committed to this approach to prevention believe that the postponement of the STELLAR trial—testing raloxifene against Arimidex in women who have not had breast cancer—was for budgetary reasons. But, according to a March 2, 2007 article in the Cancer Letter, published a week before the USA Today article ran, the NCI director put the trial on indefinite hold.4 In doing so, John Niederhuber said he would encourage the NCI executive committee to look more broadly at the issue of breast cancer prevention.
We hope that a broader look will involve innovative strategies for understanding what in the external environment triggers the development or aggressiveness of breast cancer. Given our commitment to this kind of research effort, and for reasons related to the dangers of giving powerful pills to people to prevent diseases like breast cancer, we have long opposed giving pills to women who have not had breast cancer to reduce their risk of getting the disease.5 In light of the emerging information about the hard time that many breast cancer patients are having on aromatase inhibitors like Arimidex, we are hopeful that the NCI is seeing the light about a trial in which recruitment would likely prove difficult if not impossible.6 The budget challenge is all the more reason to look for new approaches.
It’s not only in the prevention arena that the NCI has an opportunity here. Despite all the money that has been spent on breast cancer research since funding began to rise in the early 1990s, the key questions in breast cancer remain, tragically, unanswered. BCA’s Answers Wanted campaign lays out those questions—related to overtreatment, better treatments for metastatic disease, tools for understanding environmental triggers, and ways to address the disparate impact of breast cancer on diverse communities—and proposes an approach for getting answers to them.
While what we are asking for may seem like pie in the sky, keep in mind that the progress that has been made in breast cancer in recent times—from the lumpectomy option, to sentinel node biopsy, to more targeted therapies—has come about because people just like you demanded it and the research community listened.
The NCI budget crisis in fact is an opportunity to make your voice heard in reframing how breast cancer research questions are posed and answers to them are sought. To find out how you can get involved, visit www.bcaction.org/answerswanted.
1 Liz Szabo, “Proposal Would Cut Cancer Institute Budget Again,” USA Today, January 29, 2007.
2 Bob Drury, “The Battle For Your Health,” Men’s Health, April 2007.
3 Gerald Denis, “Cancer Research Funds,” New York Times, March 12, 2007.
4 Kristen Goldberg, “NCI Director Halts STELLAR Trial, Seeks ‘Brilliant’ Ideas to Prevent Breast Cancer,” Cancer Letter, March 2, 2007.
5 See BCA’s policy on pills for prevention, online at www.bcaction.org/bcapolicies.
6 See BCA’s AI Report, “Side Effects Revealed: Women’s Experiences With Aromatase Inhibitors.”