Breast cancer is the second leading cause of cancer deaths among American women. Additionally, breast cancer rates in the United States today are among the highest in the world. In 1999 in the U.S., an estimated 175,000 new cases of invasive breast cancer are projected to be diagnosed, while mortality rates are projected to be 43,300.¹ Today, the lifetime risk of developing breast cancer has risen to one in every eight women, and among minority and low-income women, breast cancer mortality rates are increasing.² Furthermore, although male breast cancer is rare, accounting for less than 1% of all breast carcinomas, approximately 1,300 men will be diagnosed with breast cancer in the United States in 1999. Four hundred of these men will die of the disease.

The Department of Defense (DOD) Breast Cancer Research Program (BCRP) was established in fiscal year 1992 (FY92) by Joint Appropriations Bill 102-328, which provided $25M for research on breast cancer screening and diagnosis for military women and family members.

In 1993, grassroots advocates influenced public policy that led to a FY93 $210M Congressional appropriation to the DOD budget for peer-reviewed breast cancer research. An additional $30M was appropriated by Congress for FY94. Congressional appropriations have continued through FY99 (refer to Table B-1, Appendix B). In total, for FY92-99, Congress has appropriated $870.1M for the DOD BCRP.

At the inception of the BCRP, the U.S. Army Medical Research and Materiel Command (USAMRMC) sought the advice of the National Academy of Sciences to develop a sound investment strategy for the Congressional appropriations. A National Academy of Sciences Institute of Medicine (IOM) committee thoroughly studied the major considerations and in 1993 issued a report, Strategies for Managing the Breast Cancer Research Program: A Report to the U.S. Army Medical Research and Development Command. In response to the IOM report, the DOD developed an investment strategy that reflected the committee’s recommendations.

The overall goal of the BCRP is to challenge the scientific community to design innovative research that will foster new directions for, address neglected issues in, and bring new investigators into the field of breast cancer research. From its inception, the central theme of the BCRP has been innovation. The program’s areas of emphasis have been developed after consultation with renown scientists and clinicians and the IOM committee, to avoid overlap of programs, and to target underrepresented avenues of research and novel applications of existing technologies.

In FY92-99, Congress appropriated $870.1M for peer-reviewed breast cancer research. Table B-1 in Appendix B summarizes the directions from Congress for the BCRP appropriations, the program’s withholds and management costs, and the investment strategy executed by the program. Prior to receipt of funds by the office of the Congressionally Directed Medical Research Programs (CDMRP), Congress and the DOD withhold funds for designated initiatives. In addition, the CDMRP sets aside funds for program development, scientific peer review, programmatic review, and the administration of grants/contracts through the entire period of performance (up to 7 years). The investment strategy executed is consistent with Congressional language and reflects the program’s vision.

The vision of the BCRP has remained consistent since its conception: to eradicate breast cancer. The program’s mission is to foster new directions, address neglected issues, and bring new investigators into the field of breast cancer research. Scientific ventures that represent underinvestigated avenues of research or novel applications of existing technologies are highly sought. In addition, research that addresses the needs of minority, low-income, rural, and other underrepresented and/or medically underserved populations is encouraged.

——FY93-97 Programs

One of the unique features of the CDMRP is its ability to maintain flexibility. This is particularly evident in its investment strategy and funding history. For each FY, the BCRP adjusts its investment strategy to meet the needs of the research community. For instance, in FY93/94, the BCRP applied the recommendations of the IOM and focused on traditional research, infrastructure, and training (see Appendix A). In FY95, 21 special mammography projects were funded under the research and infrastructure award categories in response to Congressional directives. In turn, the FY96 BCRP de-emphasized traditional awards to fund innovative Idea Awards and Clinical Translational Research (CTR) Awards.

As a Congressionally directed program, the BCRP responds to priorities established in the Congressional language for each year’s allocation. The Congressional appropriation for FY97 included $100M to continue the BCRP, with an additional $6M earmarked for the development of a computer-based decision support system. Eight Computer-Based Decision Support Systems Awards were funded. Furthermore, in FY97, a $2.3M appropriation earmarked for research on calcium signaling/cancer cell proliferation was received after the BCRP Program Announcement (PA) was released. Scientifically meritorious proposals submitted in response to the PA more than satisfied the intent of this appropriation. Proposals were classified and reviewed as calcium signaling/cancer cell proliferation during peer and programmatic review and 15 proposals were funded. In addition, the President of the United States directed that $20M of the FY97 funds be spent on molecular and medical genetics. The program exceeded this goal by funding 111 ($26,749,600) research proposals in this research area.

——FY98 Program

The $135M FY98 Congressional appropriation to the BCRP constituted a significant increase from the FY96 and FY97 Congressional appropriations (i.e, $75M and $108.3M appropriations, respectively). Given this increase, the BCRP Integration Panel (IP) recommended that the program particularly emphasize Idea Awards. In this manner, the program would continue to evolve as a unique funding agency that complements funding strategies of other agencies such as the National Institutes of Health. As a result of this recommendation, a record 240 Idea Awards were funded for a total budget of $76.7M. Tables V-1 and V-2 reflect the funding summaries, in terms of dollars and number of awards, for the FY92-98 BCRP.

Also in FY98, a new award mechanism, Academic Awards (see Table A-1, Appendix A), was successfully launched while Institutional Training Grant Awards were reintroduced into the training/recruitment award category (see Table A-2, Appendix A). In response to the FY98 PA, a total of 1,322 proposals were received and 403 (30%) were funded.

——FY99 Program

Congress has continued to support the DOD BCRP; in FY99, Congress appropriated $135M for peer-reviewed breast cancer research. In addition, $1.8M was received as a result of the Stamp Out Breast Cancer Act that will be used to fund approximately seven Idea Award proposals received in response to the 3 March 1999 PA.³

As described in the FY99 BCRP PA, several new award mechanisms were launched: CTR-CDAs, Collaborative CTR (C-CTR) Awards, CTR Fellowship Awards, Historically Black Colleges and Universities/Minority Institutions (HBCU/MI) Focused Training Awards, and HBCU/MI Partnership Training Awards. On 2 June 1999, 1,281 proposals were received. Scientific peer review was conducted August/September 1999 and programmatic review will take place in November 1999. Approximately 400 awards are anticipated. Investigators will be notified of their funding status in December 1999, and award negotiations will be completed no later than 30 September 2000.

——FY00 Program Plans

The Joint Conference Committee Report 106-371 specifies $175M for peer-reviewed breast cancer research. Vision setting for the FY00 program will occur in January 2000. At that time, an investment strategy will be developed, taking into account Congressional language, recommendations from scientific and advocacy groups, and gaps in research funding.

——Clinical Translational Research

The ultimate goal of the BCRP is to revolutionize breast cancer patient care by translating research outcomes into all aspects of breast cancer prevention, detection, diagnosis, treatment, quality of life, and ultimately, eradication. Given recent advances in the field, the BCRP foresaw an unprecedented opportunity to bring well-developed ideas to fruition on behalf of women with breast cancer. Since FY96, the BCRP has supported clinical translational research. These awards provide funding for initial clinical studies, a juncture at which it is often difficult to obtain funding. Applicants to this award category must have preliminary data to support the feasibility of their hypotheses and approaches, along with a plan to conduct a clinical trial or study during the course of the award.

——Outreach to HBCU/MI and Minorities

Due to the disparity in morbidity and mortality rates in breast cancer patients living in many socio-economically and medically underserved communities, the BCRP has increased its efforts to attract grants from investigators at HBCU/MI and proposals that study special populations.

For instance, the BCRP recently launched two new award categories: the HBCU/MI Focused Training Awards and the HBCU/MI Partnership Training Awards. The purpose of the former award mechanism is to enable investigators of HBCU/MI to collaborate, train, and acquire the knowledge and experience needed to prepare and submit a high-quality proposal for breast cancer research. The purpose of the latter award mechanism is to support collaborations between an applicant HBCU/MI and a collaborating institution with established investigators in breast cancer research for the purpose of developing a training program to increase the number of HBCU/MI investigators focused on breast cancer research. These awards will be funded out of the HBCU/MI set-aside, which is approximately $6M in FY99.

Since the inception of the BCRP, 1,806 proposals have been awarded with FY92-98 funds totaling approximately $629.1M. The following products have been reported by investigators and represent a measure of the program’s success: over 2,300 publications in scientific journals, 1,800 presentations at professional meetings, and 30 patent/license applications. Other program accomplishments and outcomes are described below.

——Infrastructure

The 1993 IOM Report noted that: "Research in breast cancer is impeded by the inadequate access to resources that are appropriate for sharing—including tumor samples, cell lines, animal models, DNA probes, follow-up data on women diagnosed with breast cancer, information about ongoing clinical trials, and economic data to evaluate the cost of care." In response to these needs, in 1994, the CDMRP funded 28 competitive awards in these areas to support tissue and/or cultured cell banks and generation of new cell lines (12 awards), development and dispersement of transgenic animals (2 awards), and development and enhancement of institutional resources, databases, and/or registries (14 awards).

These comprehensive resources have already facilitated progress in breast cancer research and they are expected to continue to play a significant role in the battle against breast cancer. At this time, over 50 publications have resulted from the use of specimens from these repositories. Among the most important reports supported by these awards are landmark studies of telomerase (e.g., Science 266:2011-2015, 1994) and description of cell lines established from a donor with BRCA1 mutation (Cancer Res 58:3237-3242, 1998). The 28 infrastructure awards were made to geographically dispersed institutions to ensure appropriate sampling of the population, assist in sample distribution, and aid in the advertisement of the repositories. Access to many of these resources has been enhanced by use of the World Wide Web. Five tissue banks, one transgenic resource, and four registries/databases have Internet sites. This program also contributed to the successful acquisition of further funding through the National Cancer Institute, including a Breast Cancer SPORE and Cancer Genetics Network grant at Duke University, and selection of Fox Chase Cancer Center as a site for the Cooperative Family Registry for Breast Cancer Studies.

The BCRP has also supported the development of several cancer centers. The FY93/94 BCRP funded the Center of Excellence in Breast Cancer. The FY95 BCRP supported three geographically dispersed breast cancer centers: the California Pacific Medical Center at the University of California at San Francisco, Lombardi Cancer Center at Georgetown University, and Robert H. Lurie Cancer Center at Northwestern University.

To further enhance the infrastructure needed in the field of breast cancer research, the FY97 BCRP supported proposals that addressed the development of information systems. The outcomes of these awards will enable patients to better understand their diagnoses, treatment options, and risks associated with treatment through the use of a computer-aided information system.

Additionally, in FY99 the BCRP recognized the need to develop new methods for executing clinical trials. The Collaborative-Clinical Translational Research Awards category was developed to support the infrastructure necessary to develop models to perform clinical trials to expedite the testing of new agents or technologies to accelerate the eradication of breast cancer.

——Training

A significant investment has been made to stimulate talented new investigators, as well as superb established investigators currently working in other fields. For instance, the FY93/94 BCRP established predoctoral training programs at 14 institutions, to which at least 30 trainees have been recruited. The FY93-98 BCRP awarded individual fellowships to 257 predoctoral trainees and 237 postdoctoral trainees. The FY93-98 BCRP also has funded 115 CDAs and 8 Sabbaticals for established investigators to focus on breast cancer research. The FY98 BCRP supported the initiation of 9 new training programs for pre- and postdoctoral students in breast cancer research. Finally, the FY99 program continued with the theme of training, and several training award mechanisms were offered, including Institutional Training Grants, Postdoctoral Traineeships, Predoctoral Traineeships, and two HBCU/MI Training Awards, HBCU/MI Partnership Training Awards and HBCU/MI Focused Training Awards.

——Era of Hope

The DOD Era of Hope meeting, held 31 October - 4 November 1997, was a significant BCRP milestone for the dissemination of research results. This meeting provided scientists who have lacked opportunities to interact across disciplines the means to share ideas leading to potential collaborative efforts and novel approaches to tackle difficult breast cancer research problems. FY92-95 BCRP grant recipients attended, presenting their research advances and sharing the progress of fellow scientists in breast cancer prevention, detection, diagnosis, treatment, and quality of life.

The meeting had several unifying themes. Day 1 focused on the "frontiers" of prevention and detection of breast cancer, highlighting the major opportunities for research progress. Day 2 focused on a better understanding of the molecular and cellular pathogenesis of breast cancer with an emphasis on the development of new and improved strategies to prevent and treat both hereditary and nonhereditary breast cancer. Day 3 focused on the most advanced and up-to-date treatments and future treatment possibilities with an emphasis on quality of life for the patient, family, and significant other. Day 4 focused on the future by addressing issues of funding; capacity building, ethnic diversity, and outreach; and the training of young investigators to be leaders in the fight against breast cancer.

Participation by breast cancer survivors and consumer advocates, a hallmark of the CDMRP peer and programmatic review process, was yet another integral part of the Era of Hope meeting. In fact, the spirit of cooperation among scientists, survivors, and consumer advocates was one of the most striking aspects of this first public meeting of the BCRP. The strong partnership that has evolved between these two groups was demonstrated as they served as co-chairs and co-speakers in every session.

Over 50 representatives from the media attended the meeting and described it with words such as "tremendous" and "unique and powerfully innovative." Approximately 175 articles covering the Era of Hope meeting and the DOD BCRP grant recipients’ research advances were printed, with a total readership of over 82,250,000. In addition, coverage in trade and women’s magazines began in February/March 1998, and 245 television and radio broadcasts disseminated information throughout the duration of the Era of Hope meeting.

This meeting achieved many goals, including the demonstration of the successful public-private government partnership, the exchange of information among scientists from diverse disciplines and consumer advocates, and dissemination of the research results from DOD-funded research. The success of the Era of Hope has prompted the BCRP to hold a similar multidisciplinary meeting showcasing funded DOD projects. The Second Era of Hope is scheduled to take place 8-12 June 2000 in Atlanta, Georgia.

——Scientific Achievements

The following summaries of breast cancer research projects represent a small portion of the scientific achievements within the BCRP-funded portfolio.

Oncogenes. Researchers funded by the BCRP are identifying oncogenes (i.e., cancer-causing genes) that are involved in the initiation and progression of cancer, with the hopes of localizing and eliminating developing breast tumors. One such oncogene that has been identified so far is the HER-2/neu gene. HER-2/neu encodes a growth factor receptor found on the membrane of tumor cells. Alteration of the HER-2/neu gene has been shown to correlate with poor prognosis in patients whose tumors contain it. Therefore, it is a logical target for the development of new therapeutic approaches for breast cancer. A study at the University of California, Los Angeles has determined that the HER-2/neu overexpression in human breast cells results in very aggressive biologic behavior. These changes included increased DNA synthesis rates, increased in vitro growth rates, and increased tumorigenicity in vivo. The principal investigator (PI) also demonstrated that HER-2/neu overexpression is directly associated with the development of an estrogen-independent, estrogen receptor-negative, tamoxifen-resistant phenotype. Antibodies directed against the cellular domain of the receptor had selective growth inhibitory effects on cells overexpressing the HER-2/neu receptor. One of the most important outcomes of this research is the development of Herceptin, a breast cancer therapeutic agent based on an anti-HER-2/neu antibody.

Matrix Metalloproteases. BCRP-funded researchers are searching for ways to stop tumors from metastasizing (i.e., spreading past their initial site) by studying matrix metalloproteases, molecules that break down the extracellular matrix and allow cancer cells to metastasize. A study at Vanderbilt University is focusing on an epithelial-specific matrix metalloproteinase called matrilysin. Matrilysin mRNA has been found in both normal-appearing and malignant epithelium of human breast cancers. In addition, the matrilysin protein is expressed in approximately 40% of human breast cancer specimens. The PI of this study generated transgenic mice expressing human matrilysin and then crossed these mice with transgenics carrying the c-neu protooncogene (which develop tumors). In these mice, the PI found that the expression of matrilysin accelerated the development of neu initiated tumors but did not affect the growth rate of the tumors or metastasis. These results suggest matrilysin may play a role in early stage tumor development and not in later-stage tumor invasion and metastasis.

Angiogenesis. Researchers funded by the BCRP are targeting the process of angiogenesis (i.e., the process by which new blood vessels grow into a tumor and allow for its growth), with the overall goal of killing existing breast tumors and stopping them from metastasizing. A cytokine that has been shown to have angiogenic properties is interleukin-8 (IL-8). A study at the University of Connecticut is attempting to determine if the local expression of IL-8 by tumor cells can promote tumor growth and metastasis by promoting neovascularization. So far, the PI of the study has found that IL-8 is present in human breast cancer specimens, and that human breast cancer cells can produce this factor. IL-8 was also induced by the injury factors interleukin-1 (IL-1) and tumor necrosis factor in estrogen-independent breast cancer cells. In the next step, the investigator will block IL-8 with antibodies to try to reduce tumor growth.

Environmental Carcinogens. Epidemiological studies have shown that a variety of external factors can influence the development of cancers such as cancer of the breast. Therefore, BCRP-funded researchers are attempting to significantly reduce the incidence of breast cancer by searching for environmental causes of the disease. A study at the National Institute for Occupational Safety and Health seeks to determine if women who are occupationally exposed to ethylene oxide (ETO) or polychlorinated biphenyls (PCBs) have an increased risk of breast cancer. ETO is a direct alkylating agent that promotes mammary tumors in mice. ETO has been used as a chemical intermediate in the manufacture of ethylene glycol and since the 1950s, it has been used to sterilize medical supplies. PCBs are a group of chemicals suspected to be carcinogenic to the breast due to their lipophilic and estrogenic activities. They were used widely in the electrical industry due to their high stability, dielectric properties, and resistance to oxidation, and were produced commercially from 1929 to 1977. Two large cohorts were used: one included 9,929 women with exposure to ETO and the other included over 13,000 women exposed to PCBs. All women were exposed in the commercial sterilization industry. The ETO cohort included women from 14 medical supply manufacturers. The average year of first exposure was 1970. The PCB cohort includes women from 3 capacitor manufacturing facilities. Cancer incidence for both cohorts is mainly determined through the use of questionnaires. Each cohort represents the largest and best defined female study cohort in the U.S. for its respective exposure. The PI is currently in the process of analyzing data gathered in this study.

Quality of Life. Since an estimated 175,000 women will be diagnosed and living with breast cancer in 1999, researchers funded by the BCRP are searching for ways to improve the quality of their lives. Fatigue is recognized as a significant and long-lasting effect of cancer treatment that influences quality of life. A study at the University of Utah is testing the direct and/or indirect effects of exercise on fatigue and quality of life in breast cancer patients. Seventy-eight women with breast cancer were entered in the study. All subjects followed an 8-week, home-based exercise program. The PI first examined the relationship of exercise to quality of life in 31 subjects and found that the effect of exercise was strongly influenced by fatigue and accounted for 71% of the variance in quality of life. The PI then examined the pattern of fatigue over the first three cycles of chemotherapy in 68 subjects. Results indicated a curvilinear relationship between fatigue and duration of exercise; as the number of minutes of exercise increased, fatigue declined. This research indicates that exercise is important to help maintain functional ability, reduce fatigue, and improve quality of life during breast cancer treatment.

——Idea Award Successes

Idea Awards were intended to stimulate and reward speculative but especially promising and creative ideas, and were designed for scientists without sufficient pilot data to apply for traditional (e.g., R01-type) grants. The following examples of Idea Awards illustrate the impact of this award mechanism and the spectrum of awards that cover prevention, detection, diagnosis, treatment, and the basic biology of breast cancer.

Vaccine Development. An Idea Award to the University of California, San Francisco has generated a new vaccine targeted against ductal carcinoma in situ (DCIS), a malignant, non-invasive lesion that can develop into an invasive breast cancer. The vaccine is being tested on mice that develop spontaneous mammary tumors that overexpress the HER-2/neu protein, a marker for aggressive breast cancer in women that is also expressed in DCIS. Mice treated with the vaccine show a markedly decreased rate of tumor development when compared to that of control animals. Work from this funding effort suggests that a vaccine can be generated for the prevention of tumor formation in women at risk for the development of HER-2/neu expressing tumors.

Imaging. Investigators at Thomas Jefferson University have developed a novel imaging technique that combines two-dimensional (2-D) and novel three-dimensional (3-D) digital mammographic images for analysis of breast calcifications. Compared to conventional film screen mammography, this technique has greater resolution. A retrospective study of 44 cases suggested that the application of 2-D and 3-D images would have resulted in a 41% reduction in benign biopsies. Ultimately, this technique may help reduce the number of unnecessary breast biopsies.

Estrogen Studies. Several studies funded by the BCRP will examine the role of estrogen and estrogen signaling in breast cancer. For example, funded scientists at the University of Southern California School of Medicine examined the effects of the two main pathways that process estrogen. Estrogen is often processed by one of two pathways; one yields biologically active substances while the other does not. It has been suggested that women who process estrogen via the biologically active pathway may be at a higher risk of breast cancer. It is anticipated that work from this funding effort will yield insights into the effects of estrogen processing on breast cancer risk in women with and without family histories of breast cancer.

Investigators at Michigan State University have identified several novel compounds that inhibit the estrogen receptor (ER) by a mechanism distinct from that of classical antiestrogens (e.g., tamoxifen). Five of these agents specifically and consistently interfered with an ER function in a dose-dependent manner. Since several of these compounds appear to be targeted to parts of the ER that are not involved in steroid hormone binding, they may allow for the development of new drugs that can inhibit ERs that do not respond to conventional antiestrogens. These drugs could potentially be used to treat hormone-dependent breast cancer.

Dietary Factors. Studies performed at Rockefeller University showed that some naturally occurring chemicals influence the changes in breast cancer tumor cells. In cancer, the balance between the number of cells multiplying and dying has been disrupted so that the number of cells multiplying is not counterbalanced by an equal number of cells dying. This project examined three naturally occurring phytochemicals (including a soy compound) and was able to demonstrate their ability to adjust the ratio between cells dying/multiplying in a breast cancer cell model. Results from this project provide support for the role of dietary factors in breast cancer and suggest a means to test dietary factors to see if they play a role in breast cancer.

DNA Study. An Idea Award to Northeastern University has supported the development of a new technology that may be used to identify changes in DNA. This technology uses a dye to label DNA adducts, compounds that are important because they may play a role in initiating breast cancer. Early results from this technique are promising and may eventually result in a new marker/method to screen breast cancer specimens.

Mitogen-activated Protein Kinase. Research at the University of Texas Southwestern Medical Center suggests that particular cell signaling pathways (i.e., mitogen-activated protein kinase (MAPK) pathways) are activated in breast cancer cell lines. Work from this funding effort shows that MAPKs may play a role in the pathogenesis of breast cancer. Studies are ongoing to correlate MAPK activity with tumor grade and other parameters. These results may have a future role in the diagnosis, prognosis, and treatment of breast cancer.

P-glycoprotein. Research performed at the University of Texas at Galveston suggests that the 3-D structure of P-glycoprotein (Pgp) may be important in adenosine triphosphate (ATP) hydrolysis and drug transport. Pgp is a membrane transporter that is responsible for multidrug resistance in cancer cells and appears to use energy from ATP hydrolysis to pump drugs out of a cell. Data from this funding effort suggest that changes in Pgp 3-D structure affect ATP hydrolysis and drug transport and therefore, may be important in patients developing resistance to chemotherapeutic drugs.

Chair, Frances M. Visco, Esq.: Breast cancer survivor. Attorney; President and Member of the Board of Directors of National Breast Cancer Coalition (NBCC); Member of the President’s Cancer Panel; Co-chair of the National Action Plan on Breast Cancer; Member National Cancer Policy Board. Discipline(s): Consumer.

Chair Emeritus, Anna D. Barker, Ph.D.: President and Chief Executive Officer, BIO-NOVA, Inc.; Chair of the Public Education Committee and the Corporate Support Development Subcommittee of the American Association for Cancer Research. Ph.D. in Immunology/Microbiology. Disciplines(s): Experimental Therapeutics and Immunology/Immunotherapy.

Daniel Acosta, Jr., Ph.D.: Dean, College of Pharmacy, University of Cincinnati. Ph.D. in Pharmacology/Toxicology. Vice President-Elect of the Society of Toxicology. Discipline(s): Cellular and Molecular Toxicology/Cell Culture Techniques.

John M. Boone, Ph.D.: Professor, Department of Radiology, University of California, Davis. Ph.D. in Radiological Sciences. Board-certified in Diagnostic Radiological Physics; Editorial Board member for Medical Physics. Discipline(s): Mammography/Physics of Medical Imaging.

Thomas G. Burish, Ph.D.: Provost, Professor of Psychology and Medicine, Vanderbilt University; Member, Board of Directors of the American Cancer Society (ACS); Member, External Scientific Advisory Committee of Cancer Research Center of Hawaii. Discipline(s): Psychosocial and Behavioral Oncology.

Victoria L. Champion, D.N.Sc.: Associate Dean for Research and Professor, Indiana University School of Nursing; Associate Director of Clinical Research, Indiana University Hospital; Director of Mary Margaret Walther Cancer Care Program, and Director of Cancer Control for Indiana University Cancer Center. Discipline(s): Nursing/Psychology.

Deborah E. Collyar: President, Patient Advocates in Research. Breast Cancer advocate and survivor. Director, Clinical Trials Information Project and Advocacy Core Program Leader of the San Francisco Specialized Program of Research Excellence Translational Research Program. Discipline(s): Consumer.

Kunio Doi, Ph.D.: Ralph W. Gerard Professor of Biological Sciences; Professor, Department of Radiology, and Director, Kurt Rossman Laboratories for Radiologic Image Research, The University of Chicago, Illinois. Ph.D. in Applied Physics. Discipline(s): Imaging Physics.

Ronald B. Herberman, M.D.: Director, University of Pittsburgh Cancer Institute; Associate Vice Chancellor for Research, Health Sciences, University of Pittsburgh. Discipline(s): Immunology/Clinical Trials/Psychoneuroimmunology.

M. Carolina Hinestrosa: Co-Founder and Director of Programs, Nueva Vida, the first Spanish-language support and telephone resource program for breast cancer in the Washington, DC area, located at the Washington Cancer Institute. Development Director of Prevención, Inc., producers of Spanish-language radio, television and print programs on health promotion and disease prevention. Invited workshop leader at the First World Conference on Breast Cancer Advocacy, Brussels, 1997; Board Member of the NBCC. Discipline(s): Consumer.

Gabriel N. Hortobagyi, M.D.: Professor of Medicine, Nellie B. Connally Chair in Breast Cancer Research, and Chair, Department of Breast Medical Oncology, The University of Texas M.D. Anderson Cancer Center (MDACC), Houston. Discipline(s): Medical Oncology/Experimental Therapeutics/Clinical Trials.

Lovell A. Jones, Ph.D.: Professor and Director, Experimental Gynecology-Endocrinology, Head, Breast Cancer Nutrition Group, and Professor of Biochemistry and Molecular Biology, The University of Texas MDACC, Houston. Ph.D in Zoology. Cofounder and Cochair of the Intercultural Cancer Council, the largest national multicultural coalition in the United States. Discipline(s): Tumor Biology/Endocrinology.

Fredi Kronenberg, Ph.D.: Director, The Richard and Hinda Rosenthal Center for Complementary and Alternative Medicine; Associate Professor of Clinical Physiology in Rehabilitation Medicine, Columbia University, College of Physicians and Surgeons; Cofounder and Member of the Board of Directors, North American Menopause Society; Advisor to the National Institutes of Health Office of Alternative Medicine. Ph.D. in Physiology and Behavior. Discipline(s): Menopause/Reproductive Physiology/Thermoregulatory Physiology/ Alternative Medicine.

Edison Liu, Ph.D.: Director, Division of Clinical Sciences, NCI, Bethesda, Maryland. On the editorial boards or associate editor of several journals. Received several honors, including the 1996 Brinker International Award for Breast Cancer Research. Research interests are in molecular epidemiology. Discipline(s): Internal Medicine/Hematology/Oncology/Molecular Biology.

Lynn M. Matrisian, Ph.D.: Professor and Vice-Chair, Department of Cell Biology, Vanderbilt University School of Medicine and Director of Education, Vanderbilt Cancer Center. Ph.D. in Molecular Biology. Discipline(s): Cell Biology/Molecular Pathogenesis.

Louanner Peters, M.S.: Chief Executive Officer of Heritage Telecommunications. M.S. in Social Work. Member of the DC Congressional Affairs Advisory Group. Legislative Affairs Coordinator for Breast Cancer Resource Committee. Discipline(s): Consumer.

Lori J. Pierce, M.D.: Associate Professor, Research Investigator, and Director, Clinical Division, Department of Radiation Oncology, University of Michigan School of Medicine. Member of numerous professional organizations, including the Radiation Therapy Oncology Group, Southwestern Oncology Group, and ASCO. Discipline(s): Radiation Oncology/Translational Research.

Malcom C. Pike, Ph.D.: Flora L. Thornton Chairman and Professor of Preventive Medicine, University of Southern California School of Medicine. Ph.D. in Mathematical Statistics. Served on several national organizations, including Member, Board of Scientific Counselors and Council, National Institute of Environmental Health Sciences, Division of Biometry and Risk Assessment. Discipline(s): Mathematical Statistics/Epidemiology of Cancers.

Andrew D. Seidman, M.D.: Assistant Professor of Medicine, Cornell University Medical College, and Assistant Attending Physician, Breast Cancer Medicine Service, Memorial Hospital. Member of Taxol Breast Cancer Advisory Board and Board of Directors, American Society of Breast Disease. Discipline(s): Medical Oncology.

Susan M. Shinagawa: Executive Administrator, Blood and Marrow Transplantation Program, University of California, San Diego (currently on medical leave). Holds numerous state and national appointments and positions, including California Department of Health Services Breast and Cervical Cancer Advisory Council, Association of Asian Pacific Community Health Organization’s Breast and Cervical Cancer Advisory Committee, The Breast Cancer Fund’s Board of Directors, Intercultural Cancer Council’s Steering Committee, and consultant to the Asian and Pacific Islander American Health Forum. Discipline(s): Consumer.

Dennis Slamon, M.D., Ph.D.: Executive Vice-Chair for the Department of Medicine, Professor of Medicine, and Chief of the Division of Hematology-Oncology, University of California at Los Angeles School of Medicine; Director of Clinical Research, Jonsson Comprehensive Cancer Center, University of California at Los Angeles. Ph.D. in Cell Biology. Discipline(s): Medical Oncology/Cell Biology.

David B. Thomas, M.D., Dr.P.H.: Head, Program in Epidemiology, Fred Hutchinson Cancer Research Center; Professor, Department of Epidemiology, School of Public Health and Community Medicine, University of Washington. Discipline(s): Epidemiology/Environmental Carcinogenesis.

Nicole Urban, Sc.D.: Member, Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, and Associate Professor, Department of Health Services, School of Public Health and Community Medicine, University of Washington. Sc.D. in Health Services Administration and Biostatistics. Member of the NCI Breast Cancer Surveillance Consortium, Society for Clinical Trials, and American Society for Preventive Oncology. Discipline(s): Biostatistics/Preventive Oncology.

Patricia Barr, Esq.: Barr, Sternberg and Moss, P.C. Discipline(s): Consumer.

Angela M. Brodie, Ph.D.: University of Maryland at Baltimore, Department of Pharmacology. Discipline(s): Pathobiology/Radiation Sciences.

Christine Brunswick: American Bar Association, Section of Taxation. Discipline(s): Consumer.

Graham Casey, Ph.D.: Department of Cancer Biology, Cleveland Clinic Research Institute, Cleveland Clinic Foundation. Discipline(s): Molecular Biology.

Joe W. Gray, Ph.D.: University of California, San Francisco. Discipline(s): Molecular Biology/Molecular Genetics/Translational Research.

Bettye Green, R.N.: African American Women in Touch. Discipline(s): Consumer.

Peter A. Jones, Ph.D.: University of Southern California, Norris Comprehensive Cancer Center. Discipline(s): Molecular Biology/Molecular Genetics/Medical Genetics.

Edward A. Levine, M.D: Wake Forest University, Department of Surgery. Discipline(s): Medical Oncology/Surgical Oncology/Translational Research.

Ngina Lythcott, Dr. P.H.: Discipline(s): Clinical Experimental Therapeutics/Behavioral and Social Sciences/Health Care Delivery/Alternative Medicine/ Epidemiology.

Jerry W. Shay, Ph.D.: University of Texas Southwestern Medical Center. Discipline(s): Cell Biology/Molecular Biology/Translational Research.

Vernon K. Sondak, M.D.: University of Michigan Medical Center. Discipline(s): Immunology/Surgical Oncology/Translational Research.

Patricia S. Steeg, Ph.D.: National Cancer Institute, National Institutes of Health, Laboratory of Pathology. Discipline(s): Pathobiology/Radiation Sciences.