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1. Executive Summary 7
2. Summary 9
Research Themes 11
Research Priorities 12
continued...
1.
2.
7. Call to Action 65
Overview 65
Collaborating for Success 65
CBCRA’s Commitment 66
Turning Strategy into Action 66
Appendices 69
Appendix A – CBCRA Board of Directors (2007-2009) 69
Appendix B – Detailed Breakdown of Funding by CSO Code 71
Appendix C – Definition of Key Terms 75
Figures and Tables
Figure 1: Cancer Research Investment by Cancer Site 20
Figure 2: Breast Cancer Investment by CSO Category 21
Figure 3: Breast Cancer Research Investment by Funding Mechanism and CSO Category 22
Figure 4: Process Overview – Developing the National Framework 23
Table 1: Summary Statistics for Breast Cancer in Females, Canada - 2009 (estimates) 19
Table 2: Summary of Data Gathered from Key Stakeholders Prior to the National Summit 25
Table 3: List of “State of the Science” Papers – May 2008 26
Table 4: Summary of Consolidated Findings from Stakeholder Input – Prior to the National Summit, May 2008 27
Table 5: Distribution of 2007 Breast Cancer Research Investment by CSO Code 70
3.
4.
FOREWORD FROM CO-CHAIRS
Canada is at the forefront of international efforts across many areas of breast cancer research. Our expertise and
technical capabilities are highlighted by an ever-increasing number of significant discoveries by Canadian cancer
researchers.
From a strategic standpoint, it became clear to many of us in the breast cancer community that to take full advantage
of this country’s outstanding research talent and capabilities, a more co-ordinated national approach to breast cancer
research is required. Without the guidance of a high-level plan there is a risk that research will occur in silos and that
resources will not be used for maximum effectiveness.
The National Breast Cancer Research Framework – the first initiative of its kind for breast cancer research in the world –
provides such an approach.
The National Framework presented here is the product of a broad-based, comprehensive and collaborative process.
It reflects the input of funders, breast cancer survivors, researchers and clinicians from across the country and, looking
ahead, offers a coherent vision of the most promising areas for breast cancer research. We encourage stakeholders to
become familiar with the research priorities identified within the National Framework, and funders to collaborate on
funding decisions based on those priorities.
As co-chairs and active researchers, we have full confidence in the process used for developing the National Framework.
We are also enthusiastic about the direction it sets for breast cancer research in this country and have high expectations
for the positive outcomes resulting from more focused research activity.
We urge Canada’s breast cancer research community to fully support the National Framework and its recommendations.
By harnessing our strengths and working more effectively together, we can maximize the benefits of Canadian breast
cancer research.
Eva Grunfeld MSc, MD, DPhil, CCFP Morag Park PhD, FRSC
Co-Chair, National Framework Working Group Co-Chair, National Framework Working Group
Director, Knowledge Translation Research Scientific Director
Health Services Research Program CIHR Institute of Cancer Research
Cancer Care Ontario Member, CBCRA Board of Directors
and the Ontario Institute for Cancer Research Montreal, Quebec
Toronto, Ontario
5.
Part Two: National Framework Working Group Members
Dr. Eva Grunfeld (Co-Chair) Dr. Thomas Hack
Director, Knowledge Translation Research Associate Professor, Faculties of Medicine, Nursing, and
Health Services Research Program Graduate Studies, University of Manitoba
Cancer Care Ontario and the Ontario Institute for Clinical Psychologist, CancerCare Manitoba
Cancer Research Member, CBCRA Research Advisory Committee
Health services, survivorship Psychosocial interventions for cancer patients
Staff Support
Nicola Lewis, CBCRA Executive Director
Dr. Pascale Macgregor, CBCRA Research Program Director
Dr. Jane Cooke-Lauder, Bataleur Enterprises Inc. (consultant)
Investment in breast cancer research has supported the development of considerable Canadian research talent and
capabilities and has fostered many breakthrough discoveries. However, to maximize Canada’s contribution to breast
cancer research, now and in the future, there is a need for more effective use of resources, increased collaboration and
agreement on a set of national research priorities.
To address this need, the Canadian Breast Cancer Research Alliance (CBCRA) established a broad-based consultation
process to develop a strategic framework for the funding of breast cancer research in Canada.
The resulting National Framework for Breast Cancer Research (National Framework) is a Roadmap for Research. It
identifies existing and emerging research priorities, encourages collaboration among funders and articulates a call to
action aimed at all members of the Canadian breast cancer community.
1. Defines strategic research priorities, covers all aspects of the breast cancer research system and includes areas
that could be relevant to other cancer sites;
2. Establishes a streamlined approach for achieving and measuring high levels of scientific rigour and research
impact;
3. Is forward looking and acknowledges the importance of both short-term and longer-term initiatives.
C. Personalized Medicine
1
Canadian Cancer Society’s Steering Committee: Canadian Cancer Statistics 2009. Toronto: Canadian Cancer Society, 2009.
www.cancer.ca/statistics.
Cancer Control, 14. HEALTH-CARE ISSUES – Analysis of the financial and health-care delivery issues facing breast
Survivorship, cancer patients across the cancer continuum
and Outcomes 15. KNOWLEDGE TRANSLATION AND BEST PRACTICES – Interventions to improve knowledge
Research translation and disseminate best practices in breast cancer across the cancer continuum
16. LINK WITH CLINICAL DATA – Developing mechanisms to link clinical trial data with
administrative health databases for studies on long-term outcomes and late effects
Scientific Model 17. ANIMAL MODELS – Developing new animal and cellular models to study response to
Systems therapeutics and mimic human breast cancer development
In assessing the funding needs for the National Framework’s 17 research priorities, a continuation of balanced support
Successful implementation of all aspects of the National Framework will require additional funding for breast cancer
research as well as some additional investment in infrastructure and capacity development across Canada’s research
system.
2. Breast cancer research funders across Canada are asked to adopt a set of guiding principles2 and to mobilize support
for both foundational research and the identified priorities.
3. Policy and practice influencers are asked to apply existing research findings to policy and practice as they relate to
breast cancer, cancer and chronic disease, and to engage with researchers and academics to shape future studies
aligned with policy development.
4. Industry (e.g., pharmaceutical companies, biotechnology companies, software developers, equipment manufacturers)
is encouraged to participate in new collaborative opportunities.
5. Provincial and hospital foundations are asked to allocate 10 per cent of their funds to these national priorities.
6. Donors are encouraged to familiarize themselves with the National Framework and to request that the organizations
receiving their support embrace these priorities and recommendations.
CBCRA is committed to leading the implementation of the National Framework, and to ensuring it is monitored, updated
and evaluated. As part of this commitment, CBCRA will also facilitate the development of a network of funders aligned
with the National Framework, fostering new collaborations aimed at ensuring the most effective use of resources.
2. SUMMARY
The good news is that over the past fifteen years, investment in breast cancer research has seen a twenty-fold increase.
This has led to the development of significant research talent and contributed to breakthrough discoveries. The
opportunity exists to maximize Canada’s contribution to tackling breast cancer globally by leveraging and co-ordinating
current, leading edge, internationally recognized projects. However, to achieve this level of global impact, funders will
need to collaborate more effectively in setting priorities, deploying resources and promoting their strengths.
2
For a listing of these principles see Discussion section in Chapter 6 Identifying the Research Priorities: pg 62.
3
Canadian Cancer Statistics 2009 by the Canadian Cancer Society, Statistics Canada, Provincial/Territorial Cancer Registries and the
Public Health Agency of Canada. Available at www.cancer.ca.
4
Ibid.
Chapter 2: Summary 9.
Members of the Canadian Breast Cancer Research Alliance5 (Avon Foundation for Women – Canada, Canadian Breast
Cancer Foundation, Canadian Breast Cancer Network, Canadian Cancer Society, Canadian Institutes of Health Research,
Health Canada and the Public Health Agency of Canada) determined the need to capitalize on the growth of Canadian
research talent, the widening interest in strategic research investment and the burgeoning knowledge about breast
cancer to undertake an inclusive process to develop a national breast cancer research strategic framework that would
guide all funders of breast cancer research in Canada.
Extensive discussions involving funders, breast cancer patients and survivors, and researchers from across Canada and
internationally, led to the development of the National Framework presented in this document.6
The opportunity is clear: to identify existing and emerging research priorities, areas that maximize Canada’s comparative
advantages and represent the best fit of Canadian initiatives within a larger set of provincial/territorial, regional, national
and international initiatives, and to articulate a call to action. The National Framework builds on foundational elements
already in place. The goal is to harness the existing momentum to increase levels of research impact while using
resources more effectively. By articulating what is most important, the National Framework challenges the breast cancer
community to step forward and act on these agreed priorities.
1. It is strategic in terms of defining priorities and putting in place an updating and monitoring process.8 However,
it is not a strategic plan in the sense that it does not prescribe requirements for any one organization.
2. It provides a balanced portfolio of options, covering all aspects and elements of the breast cancer research
system. Further, some of the priorities identified within the National Framework related to early pillar research
such as genomics and gene-related studies will likely provide insights that will be relevant to other cancer sites.
3. It establishes the groundwork for achieving and measuring high levels of scientific rigour and research impact in
a streamlined manner.
4. It is forward looking, acknowledging the importance of short-term as well as longer-term initiatives. The National
Framework identifies different issues and different approaches to research, recognizing that they will result in
actionable findings over different time periods – and that all are important for a robust research system.
5
Brief overview of the Alliance is provided in Chapter 3: Rationale for the National Framework: pg 17.
6
For more detail see Chapter 5 Approach and Methodology: pg 23.
7
For more detail see Chapter 7 Call to Action: pg 65.
8
Ibid.
In addition, it selects a small number of overarching and cross-cutting themes as well as a longer set of refined research
priorities, spanning the cancer continuum. These have been chosen through a rigorous, scientific and inclusive process.
The objective is that, if funded, any of these research areas will benefit Canadians and improve Canada’s global
competitiveness.
9
For more detail see Chapter 6 Identifying the Research Priorities: pg 33.
CSO
Research Priority11 Description
Category
Cancer is a disease of the genes. This research priority will focus on
1. GENETICS – The identifying the gene-altering changes underlying cancer initiation and
genetic and epigenetic progression. A better understanding of the role played by genetic and
basis of breast cancer epigenetic changes implicated in breast cancer and the discovery of
development new breast cancer susceptibility genes could lead to better strategies for
cancer prevention and treatment.
Cancer initiation is thought to result from alterations to the molecular
2. INITIATION – machinery regulating the normal functioning of cells. This research
Deciphering the priority will study these alterations and the factors influencing them,
molecular pathways and the consequences of these alterations on breast cancer initiation.
Biology
implicated in breast The results of this research could be highly clinically relevant through
cancer initiation the identification of molecular pathways that could be targeted by new
therapeutic interventions to block cancer initiation.
3. METASTASIS –
Understanding the Metastatic breast cancer results in mortality from the disease and is still
cause of metastatic poorly understood. Therefore, gaining a better understanding of the
breast cancer process of invasion of cancer cells throughout the body is critical and
and identifying should result in the development of new strategies for treatment of
new avenues for metastatic breast cancer.
interventions
4. BREAST CANCER
RISK – The influence
of lifestyle and Research in this priority area will attempt to identify modifiable risk factors
environmental implicated in the development of breast cancer. This could lead to the
factors on the risk of development of new prevention strategies and interventions.
developing breast
cancer
Certain genes or hormonal factors have been linked to the development
5. BREAST CANCER
of breast cancer in some groups of individuals. This research priority
CAUSES I – The
Etiology explores this link in more detail, and could lead to the development of
genetics and hormonal
new interventions or treatments to reduce the risk of breast cancer in
causes of breast cancer
certain populations.
The interaction of genes with lifestyle factors (gene-environment
6. BREAST CANCER
interaction) could play an important role in breast cancer risk. Research
CAUSES II –
in this priority area will study the interaction of different factors, such as
Understanding the
genetic predisposition or exposure to a certain environment on the risk
interplay of multicausal
of developing breast cancer. The results of this research could have an
factors: genetics and
important impact in the development of new breast cancer prevention
environment
interventions.
7. PREVENTION
(INTERVENTIONS) –
Interventions to study Specific factors continue to be identified as influencing the risk
the influence of lifestyle of developing breast cancer, particularly in some subpopulations.
Prevention
and environmental Research in this priority area will aim to develop new population-based
factors on the risk of interventions that could be introduced to reduce breast cancer incidence.
developing breast
cancer
10
For more detail on the Common Scientific Outline and priority setting process see Chapter 3 Approach and Methodology: pg 17.
11
Additional information on each of these Priorities is included in Chapter 6 Identifying the Research Priorities (pg 33) under the following
headings: Current Funding Levels; Current Research Activity; Possible Research Questions; Proposed Investment Requirements;
Readiness to Initiate Research, Timing of Impact, Uniqueness to Breast Cancer and System Support Requirements.
12. Chapter 2: Summary
CSO
Research Priority11 Description
Category
8. DETECTION – Better This research priority will focus on the development of new approaches
approaches to to breast cancer screening and on the discovery of new tools leading
early detection and to more accurate diagnoses and to more personalized treatment of the
diagnosis disease.
9. BIOMARKERS I –
Development
and evaluation of Research in this priority will lead to the discovery and validation of new
Early
new biomarkers biomarkers. New diagnostic biomarkers will provide critical information for
Detection,
(including biomarkers more accurate disease characterization. Predictive biomarkers will forecast
Diagnosis
for diagnosis) and patient response to therapy and could lead to the development of new
and
the optimization treatment targets.
Prognosis
of treatments for
individual patients
10. BIOMARKERS II – Following the discovery of new biomarkers, clinical trials will be required
Clinical setting/ to assess their use in a clinical setting, particularly for some specific
clinical trials to assess subtypes of breast cancer. The results of these trials will have an important
clinical sensitivity and impact on the development of new personalized therapeutic strategies
specificity of new by providing predictive information on response to therapy for specific
biomarkers groups of breast cancer patients.
11. NEW TREATMENTS –
Discovery and More specific and effective therapies are required for breast cancer
development of new patients. This research priority area will focus on the development of
treatments for breast better treatments, particularly for some specific subtypes of breast cancer.
cancer
Treatment
Following the discovery of new promising therapies, clinical trials and
12. CLINICAL TRIALS – related companion studies test these new agents on breast cancer
Clinical trials of new patients. Clinical testing and applications of new breast cancer therapies
promising therapies and the assessment of side effects, toxicity and pharmacodynamics is a
critical step in the implementation of these therapies.
What can be concluded is that of the 17 priorities,13 one priority was identified as not needing additional funding at this
time and 14 required enabling or additional funding. This provides clear evidence that many of the identified priorities
are already receiving attention and therefore, some of the current research expenditure of $46.8M is already being
applied in an aligned, strategic manner. The remaining two priorities were identified as needing new funding.14 Further,
four priorities contained elements requiring both new and additional funding.15 Therefore, the National Framework
demonstrates a relatively good mix of support to ongoing initiatives while drawing attention to approximately one-third
of the proposed priorities which do not currently receive funding.
Successful implementation of all aspects of the National Framework will require additional funding of breast cancer
research in Canada, but radical change is not required. Some resources can likely be shifted as investment is freed up
from current research priorities or moved from areas that may not have lived up to earlier promise. Additional investments
may also be required in infrastructure across the research system.
1. All members of the breast cancer research community are invited to become familiar with the National Framework
document and to work together to achieve the ultimate outcome: a world where no person need fear breast cancer.
2. Breast cancer research funders across Canada are asked to adopt a set of guiding principles17 and to mobilize
support for both foundational research and the identified priorities.
12
A full listing is available in Chapter 6 Identifying the Research Priorities: pg 33.
13
For more detail see Chapter 6 Identifying the Research Priorities: pg 33.
14
[1] Etiology: Understanding the interplay of multicausal factors; genetics and environment and [2] Early Detection, Diagnosis and
Prognosis; Clinical setting/clinical trials to assess clinical sensitivity and specificity of new biomarkers.
15
[1] Biology: The genetic and epigenetic basis of breast cancer development; [2] Biology: Understanding the cause of metastatic breast
cancer and identifying new avenues for interventions; [3] Early Detection, Diagnosis and Prognosis: Development and evaluation of new
biomarkers (including biomarkers for diagnosis) and the optimization of treatments for individual patients; and [4] Treatment: Clinical
trials of new promising therapies.
16
For more detail see Discussion section in Chapter 6 Identifying the Research Priorities: pg 62 and Chapter 7 Call to Action: pg 65.
17
For a listing of these principles see Discussion section in Chapter 6 Identifying the Research Priorities: pg 62.
5. Provincial and hospital foundations are asked to allocate 10 per cent of their funds to these national priorities.
6. Donors are encouraged to familiarize themselves with the National Framework and to request that the
organizations receiving their support embrace these priorities and recommendations.
CBCRA has committed to playing a leading role in supporting the implementation of the National Framework, as well
as to its ongoing monitoring, evaluation and updating. To that end, CBCRA will itself adopt two priority themes for
implementation as part of Phase IV of the Alliance (2010-2015). In addition, CBCRA will support the development of a
network of funders wanting to embrace the recommendations of the National Framework and to work together in new
ways to prevent and/or mitigate the effects of breast cancer, reduce recurrence and, when not curable, transform breast
cancer from a killer into a chronic disease.
Against this backdrop, the CBCRA Board of Directors,19 prior to entering a new phase of the partnership, embarked
upon a strategic review. The Alliance, a cross-sectoral partnership representing public, private, non-profit and breast
cancer survivor organizations,20 is committed to finding ways to prevent breast cancer, improve survival rates and the
lives of those affected by the disease. Since its inception in 1993, as a recognized leader in breast cancer research in
Canada, CBCRA has awarded more than $197M to 583 breast cancer research initiatives covering a broad range of
topic areas. However, CBCRA’s most recent external expert review panel (Sutcliffe et al, 2007),21 while applauding the
success achieved by the Alliance, also challenged it to become more strategic and proactive in shaping the breast cancer
research landscape.
In September 2007, the Board took action on these review findings and initiated the development of a national
framework for breast cancer research. A working group22 was formed, chaired by Drs. Phil Branton (Scientific Director,
CIHR Institute of Cancer Research at the time) and Moira Stilwell (member, National Board of Directors, Canadian Breast
Cancer Foundation at the time and medical oncologist), and charged with the planning and hosting of a National Breast
Cancer Research Summit as the first major milestone in the development of this National Framework.
1. A roadmap to guide the efforts of all members of the breast cancer community in moving breast cancer research
forward: generating new knowledge and encouraging further exploration by building on findings and adopting
new knowledge into policy and practice settings.
2. Inclusive in that it recognizes – and leverages – the foundational elements of the breast cancer research system
that are already in place (such as capacity, infrastructure, partnerships, state of the science globally).
3. Strategic in that it identifies existing and emerging research priorities, areas that build on Canada’s comparative
advantage while representing the best fit of Canadian initiatives within a larger set of provincial/territorial,
regional, national and international initiatives.
4. A call to action.
It is NOT a traditional strategic plan with goals, objectives and timelines for a specific organization or sector. However,
it is similar to a strategic plan in that its adoption and implementation will be monitored and it will remain dynamic:
continuing to shape and be shaped by ongoing discoveries and new knowledge in all aspects of breast cancer research.
18
Canadian Cancer Society’s Steering Committee: Canadian Cancer Statistics 2009. Toronto: Canadian Cancer Society, 2009.
www.cancer.ca/statistics
19
Membership included in Appendix A.
20
The Alliance is funded by both Members and Friends. Current Members include: Avon Foundation for Women – Canada, Canadian
Breast Cancer Foundation, Canadian Breast Cancer Network, Canadian Cancer Society, Canadian Institutes of Health Research, Health
Canada and the Public Health Agency of Canada. Current Friends of CBCRA include: Breast Cancer Society of Canada, The Cancer
Research Society, CURE Foundation.
21
Membership of the External Expert Review Team: Dr. Simon Sutcliffe, Chair (Vancouver), Dr. Carole Cass (Calgary), Prof. Lesley
Fallowfield (Brighton, U.K.), Dr. Tom Kean (Washington), Support – Dr. Judy Birdsell.
22
Membership included under Listing of Working Groups: pg 5.
Stakeholders23 indicate the need for a national framework that is forward looking and strategic, building on Canada’s
existing strengths. They describe a framework focused on impact to maximize chances of breakthrough research
discoveries by addressing unique opportunities. The framework they want must also be relevant, feasible and
demonstrate scientific excellence. Stakeholders also suggested that the framework be sensitive to international, national
and regional issues and initiatives, and demonstrate flexibility by offering opportunities for cross-sectoral funder
collaboration.
More relevant and timely research, as well as improved efficiencies in the research process, will be achieved through
funders working together. The development of the National Framework is expected to encourage greater co-operation
and co-ordination among the many breast cancer funding and research organizations across Canada to address areas
of research priority. The National Framework will attempt to improve communication and support joint planning efforts
among breast cancer research funding agencies. In addition, it will help meet donor expectations for the most efficient
use of funds.24
A tangible and immediate benefit of the National Framework to stakeholders is providing strategic information to
funding organizations which lessens their need for environmental scanning and initial priority setting during their
planning processes. The National Framework provides a starting set of scientifically rigorous options for strategic
consideration by funders. By applying their own strategic requirements and values to this broad set of priorities, funders
can identify their preferred research areas, resulting in significant savings of time and resources.
The approach and methodology behind the development of the National Framework follow, leading to the outline of the
proposed breast cancer research priorities, the assumptions underpinning these priorities, a suggestion as to how they
can be clustered, and a discussion of what is and is not part of the National Framework. The report ends with a call to
action which includes CBCRA’s commitment to make the National Framework a dynamic and valuable strategic resource
to funders across Canada. Footnotes are provided throughout the text to identify sources, some of which are included in
the appendices but the majority of which are available, as identified, on the CBCRA website (www.breast.cancer.ca).
23
Proceedings from the National Breast Cancer Research Summit. Mapping the Future. Toronto: May 26-27, 2008. Available on CBCRA
website at www.breast.cancer.ca/pdf/summit_app/mtf-proceedings.pdf.
24
Data from web-survey conducted in early 2008 as reported in Breast Cancer Research Priorities: A survey of survivors and others
involved in breast cancer. Brian Rush and Nancy Dubois. May 2008. Available on CBCRA website at
www.breast.cancer.ca/pdf/Survey_of_Survivors_and_Others.pdf
Impact on Canadians
In 2009, it is estimated that 22,700 women and 180 men will be diagnosed with breast cancer. An estimated 5,400
women and 50 men will die of the disease.28 This is a daunting picture. While incidence and mortality rates have
continued to decline in all age groups, probably due to the uptake of screening mammography, a drop in usage of
Hormone Replacement Therapy (HRT) and the adoption of more effective adjuvant therapies, many questions remain
unresolved.
In every adult age group, breast cancer is the most common female cancer, accounting for more than 30% of all new
diagnoses in women aged 20-49 and 50-69. Breast cancer represents 20% of all new cancer diagnoses among older
women.29 It is the leading cancer cause of death in young women, and ranks second and third, respectively, in older
ages. One Canadian woman out of every nine is expected to develop breast cancer during her lifetime. Of those who
develop breast cancer, one in four will die of the disease.
Table 1: Summary Statistics for Breast Cancer in Females, Canada – 2009 (estimates)30
25
Health Canada. Report on the National Forum on Breast Cancer. Ottawa: Minister of Supply and Services Canada. Catalogue
H39/305/994E, 1994.
26
Canadian Cancer Research Alliance: Cancer Research Investment in Canada, 2007: The Canadian Cancer Research Alliance’s Survey of
Government and Voluntary Sector Investment in Cancer Research in 2007. Toronto: CCRA, 2009.
27
Canadian Cancer Society’s Steering Committee: Canadian Cancer Statistics 2009. Toronto: Canadian Cancer Society, 2009.
www.cancer.ca/statistics.
28
Ibid.
29
Ibid.
30
Ibid.
The CCRA report states that an estimated $403M was invested in cancer research in 2007. More than half (51%) of this amount
is invested in non-site-specific cancer. Of the remaining 49%, breast cancer accounts for the greatest share of the site-specific
investment at 14% ($54.6M).33 Trends over the last four years suggest that breast cancer research funding has increased at a faster
rate than for other cancer-specific sites. The following chart depicts research investment across non site-specific and site-specific cancers.
COLORECTAL $13.6M
LEUKEMIA $23.7M
LUNG $13.8M
PROSTATE $17.2M
NON-SPECIFIC/ALL SITES $205.2M
31
Data for this section has been provided by CCRA’s most recent survey of Government and Voluntary Sector Investment in Cancer
Research (2007). CCRA has adopted the Common Scientific Outline (CSO) to organize and report on the data. Canadian Cancer Research
Alliance: Cancer Research Investment in Canada, 2007: The Canadian Cancer Research Alliance’s Survey of Government and Voluntary
Sector Investment in Cancer Research in 2007. Toronto: CCRA, 2009.
32
The amount of this funding is not available but is thought to be significant: for example, in 2007, provincial cancer and hospital
foundations received some $42.7M from the Weekend to End Breast Cancer.
33
This total investment figure includes all reported projects with breast cancer weightings in excess of 1% which is the CCRA standard. Else-
where in this report, a total figure of $47M is used. This figure reflects the CBCRA standard of including only breast cancer research project
with a weighting of more than 50%.
The overall pattern of breast cancer research investment across the research spectrum mirrors the overall pattern for
all cancers with the majority of research investment going to biology and treatment. Differences noted include more
investment for breast cancer research in the area of early detection, diagnosis and prognosis, and slightly reduced
investment in biology and treatment as compared to all cancers.
As with all cancers, the largest investment category is biology ($19M for breast cancer), followed by treatment ($9.6M
for breast cancer). Prevention receives the smallest amount of research investment for breast cancer and cancer overall
($0.61M for breast cancer). It should be noted that the CSO classification system defines prevention quite narrowly:
research that might typically be referenced as prevention is included in the etiology category. This is obviously a limiting
factor when interpreting the distribution of research investment according to this classification system.
In reviewing breast cancer investment in greater detail, the following chart shows the allocation of investment by CSO category.
EARLY DETECTION,
DIAGNOSIS &
PROGNOSIS $7.2M
ETIOLOGY
(causes of cancer)
$4.7M
TREATMENT $9.7M
BIOLOGY $19.1M
CANCER CONTROL,
SURVIVORSHIP
& OUTCOMES $4.9M
A profile of the funding mechanisms to which investment dollars are allocated, as shown in the figure below, reveals that
operating grants34 are by far the most common mechanism for breast cancer research, accounting for $38M (81%) of the
$47M total investment. For all cancers, the dollar amount spent on operating grants is $210.4M (52% of total).
34
Definitions of the different funding mechanisms are included in Appendix C.
$15,000,000
$3,750,000
35
Definition used for research system: The funding mechanisms, partnerships, infrastructure requirements, key processes (such as
planning and surveillance) and human resources to support a world-class research enterprise.
Overview
A multi-tiered, multi-stakeholder approach was adopted to consult, identify and define research priorities and the
elements of a National Framework. It was developed in two parts – Part One included the data gathering necessary to
inform the National Summit and the input received from that forum. Part Two included the refinement of the research
priorities based on the views expressed at the Summit, further data gathering and expert scientific input.
The schematic below depicts the different stages in the development of the National Framework, from the
recommendations stemming from the review of CBCRA by the external expert panel and the support of the CBCRA
Board, to the completion of the National Framework document.
2010 2010
Summit Planning
2008 Working Group 2008
CBCRA Board
engagement/new vision
The Common Scientific Outline (CSO) was adopted as the organizing framework to classify the stakeholder data and to
shape national breast cancer research priorities.36 It was chosen because it is the system currently used by the majority of
national and international research granting agencies.
This chapter presents an overview of the process undertaken to develop the National Framework. The proposed research
priorities are presented in Chapter 6.
36
The Common Scientific Outline is a classification system organized around seven broad areas of scientific interest in cancer research,
developed by the International Cancer Research Portfolio, a joint initiative of International Cancer Research Partners as
defined at www.cancerportfolio.org/cso.jsp.
Other national agencies that classify research by CSO include CCSRI, CBCF, CIHR and members of CCRA. Internationally, such organiza-
tions as the Wellcome Trust, Medical Research Council, Cancer Research UK and the Breast Cancer Campaign use the CSO classification
as do the American Cancer Society, Susan G. Komen, the National Cancer Institute and the Department of Defense in the U.S.
In addition to identifying research priorities, information was collected about the critical infrastructural and resource
requirements that enable the pursuit of world-class research. These findings are provided at the end of this section.
• Breast Cancer Campaign’s breast cancer gap analysis and the identification of translational research priority areas (U.K.);37
• International web-based consultation on priorities for translational breast cancer research (Top Ten Project or the
St. Gallen Research Priorities);38
• California Breast Cancer Research Program’s process to identify research priorities relevant to the role played in
breast cancer by the environment and health disparities;39
• U.S. Department of Defense congressionally-directed medical research investment in breast cancer. This is a
highly flexible program, with a vision that is adapted annually and a focus on addressing research gaps through
innovative proposals;40
• A Collaborative Summit on Breast Cancer Research hosted in Virginia, U.S., by key funding agencies including
the Avon Foundation, the Breast Cancer Research Foundation and Susan G. Komen for the Cure. This meeting
was attended by approximately 100 invited participants from across the system, including the private sector.
The conference participants identified several key action items, such as the establishment of a National Breast
Cancer Planning Committee and a commitment to demonstrating more transparency in sharing information and
reporting to the public.41
37
http://breast-cancer-research.com/content/10/2/R26.
38
http://www.toptenresearch.org/#.
39
http://www.cbcrp.org/sri/
40
http://cdmrp.army.mil/bcrp/default.htm
41
http://www.fnih.org/index.php?option=com_content&task=view&id=445&Itemid=551.
45
Breast Cancer Research Priorities: A survey of organizations funding breast cancer research in Canada and related key informant
interviews. Brian Rush and Nancy Dubois. May 2008. Available on CBCRA website at www.breast.cancer.ca/pdf/Survey_of_Funders.pdf.
46
Papers available as part of the advance reading materials for the National Summit at www.nationalframework.ca.
Table 4: Summary of Consolidated Findings from Stakeholder Input – Prior to the National
Summit, May 2008
Listing of
CSO
Prioritized CSO Code Examples of Identified Research Issues/Questions Stakeholders
Category Prioritizing this Code
1. 1.4 Cancer • Early detection of metastasis disease, if oligometastatic Researchers: SRAW,
Biology progression and disease is treatable with curable intent NCIC Summit
metastasis • Does the ability to metastasize develop during
growth at the primary site? Survivors
• Tumour dormancy
Funders
• Risk/prevention of recurrence; why recurrence
after five years?
• Finding new ways to ensure that cancer that
spreads to other parts of the body is found early
2. 2.1 Exogenous factors • Exposure to risk factors: biomarkers of exposure to risk Researchers: SRAW,
Etiology in the origin and cause factors (environment) through long-term cohort studies NCIC Summit
of cancer • How does the food we eat, body weight and
exercise relate to the risk of breast cancer? Survivors
• Why is breast cancer among young/pre-
Policy-makers
menopausal women increasing?
• What are the key causes of breast cancer generally Funders
across the population and within certain cultural groups?
• Lifestyle influence on breast cancer: How do Researchers: SRAW,
nutrition/lifestyle/natural remedies influence NCIC Summit, CBCF
cancer formation, cancer progression and BC/Yukon Region 2020:
3.1 Interventions effectiveness of therapy at the molecular level,
to prevent cancer: The Future Without
including in subpopulations? Breast Cancer Report
personal behaviours • Exposure to risk factors: What biomarkers of
3. that affect cancer risk exposure to risk factors (environment) could be Survivors
Prevention identified through long-term cohort studies?
3.2 Nutritional science Policy-makers
• What insights could be gained through clinical
in cancer prevention
prevention trials in genetically high risk women?
• What are the significant behavioural interventions Funders (Prevention
3.3 Chemoprevention a current priority with
to reduce risk?
• What population-based interventions can be environmental causes seen
introduced to reduce breast cancer incidence? as an emerging priority)
continued...
47
Ibid.
The following research priority areas were identified for possible inclusion in the National Framework:
• Early diagnosis/Detection: put in place an inexpensive, universal screening tool like a blood test, a “fingerprint
of high risk”. Follow up results, if needed, with a more targeted and expensive test. Importance of imaging
leveraging off the current One Millimetre Cancer Challenge program; research into improving screening
compliance; enhance understanding of molecular basis of early disease.
• Etiology/Prevention/Risk reduction: cancer cannot be prevented without knowing its cause, so focus on cancer
genome: determining this can be used as a prescription for prevention; focus on the types of breast cancer
occurring in young women; learn more about implications of breast density; find new ways to combat the
challenge of changing behaviours around certain areas; growth factors/estrogen: how can exposure to estrogen/
growth factors be reduced and lifestyle modulated; include children in the cohort and take advantage of the data
gathered by the cohort.
• Treatment: personalized medicine – reduced toxicity; biological research into metastatic disease; prevention and
treatment of recurrence; understanding of the the role of cancer stem cells; addressing specific issues like triple
negative breast cancer; improving translational science.
• Supportive/Palliative/Psychosocial: is this a cancer or breast cancer issue? What is unique to breast cancer and
should be included within the priorities – perhaps the focus on young women?
• Health services: access to care and to clinical trials – understand the barriers to turning research findings into
action; challenge of timely care.
• Knowledge translation: how to turn results into change; modelling of barriers to the application of knowledge
into practice; moving to evidence-informed practice.
A significant outcome of the National Summit was affirmation of CBCRA’s leadership role in the continued development
of a national breast cancer research framework.
Several separate analyses were also conducted by CCRA using its database, to further define breast cancer research
funding by CSO category and code.
NFWG met three times as a group in October and November 2008. Given the complexity and level of detail required,
the process also included a series of small group teleconference calls or one-on-one telephone interviews with working
group members. These meetings focused specifically on the research theme(s) relevant to the scientific expertise of
each working group member, allowing for meaningful engagement. This process generated a more in-depth discussion
between group members, facilitating a careful review of the material and proposed research priorities.50 Consensus
on the list of research priorities was achieved and validated at the final meeting of NFWG, held on January 20, 2009.
NFWG then went a step further with the list of individual priorities, relaxing the CSO framework to cluster priorities into
research themes. Finally, NFWG reviewed the list of research system gaps and challenges generated at the National
Summit, refining the list to include system gaps relevant to the identified priorities. These system gaps are included in
the descriptions of each research priority in Chapter 6.
50
Between December 3 and 18, 2008, nine small group meetings and five one-on-one interviews were held with NFWG members and
CBCRA’s Executive Director and Research Program Director. The majority of NFWG members participated in more than one meeting
addressing several thematic research areas. The results of these in-depth meetings were tabulated for the fourth teleconference
meeting of NFWG.
Overview
This chapter showcases the work of the National Framework Working Group in finalizing the National Framework,
building on the findings from Part One, including the proposals developed at the National Summit.
It begins by acknowledging the foundational system elements that need to be maintained if breast cancer research is
to thrive in Canada. It goes on to present the research priorities, first individually and then clustered as priority research
themes. Each research priority is described in terms of a number of elements reflecting the criteria used in selecting and
assessing them. The chapter concludes with a summary of the required research system changes and a discussion of the
possible funding and other ramifications arising from the National Framework.
In discussions around setting priorities for future research, it was explicitly acknowledged that the foundational elements
need to continue to ensure the sustainability of future breast cancer research. Most of these underlying elements are not
exclusive to breast cancer research. However, the challenge from a funding standpoint lies in trying to determine the
relative level to invest in such foundational mechanisms as:
1. Investigator-initiated grants across the spectrum of breast cancer research; i.e., there is a need for robust open
competitions beyond the priorities and strategic research identified by funders.
2. Clinical trials infrastructures including not only cancer treatment centres but national or other groups outside of
industry.
3. Platforms for innovation: examples might include biomarker development, molecular imaging and cohort studies.
While the total investment in non-industry-funded clinical trials is known, the portion that is breast cancer specific is not
available at this time. Similarly, while funding levels of operating grants by CCRA survey participants are known, those
related to targeted competitions are not tracked. However, a trend toward more targeted research is clearly evident, with
the scientific community expressing a view that the optimal investment ratio between investigator-initiated research and
targeted research is in the range of 70:30.
Enable: Some funding is currently directed to research within this CSO code, but additional funding is required.
Sustain: Funding currently in place that needs to be continued.
The most recent CCRA data identifies that only 2.8% of total funding to breast cancer research is dedicated to this area
of research, primarily through operating grant programs (79%).53
No current or emerging initiatives specifically for breast cancer were identified in Canada or internationally. Identified
cancer-wide initiatives include: the Ontario Institute for Cancer Research Stem Cell Project (GENESIS) and the California
Institute for Regenerative Medicine/CIHR ICR collaboration on cancer stem cell research.
Internationally, for breast cancer specifically, the National Cancer Institute (NCI) has funded an RFA on the biology
of breast pre-malignancies, up to $4.5M (2008-2010). In Australia, the Priority-driven Collaborative Cancer Research
Scheme (PdCCRS) receives about $10M of funding from Cancer Australia and the National Breast Cancer Foundation
(NBCF). Projects are in place investigating all cancers in the EU, Sweden and the U.S.
This area was identified as needing new and more investment to encourage research (initiate and enable) through
mechanisms such as a broad competition directed to breast and other cancer tumour-initiating cells. This competition
would include the opportunity for the funding of small teams and specific targeted initiatives, such as the impact of
chromosomal instability on breast cancer development. An amount of $5-10M over five years was proposed for each of
the suggested funding mechanisms, for a total of $20M.
53
The CCRA data does not distinguish between investigator-initiated research and targeted research. Thus, the percentage provided
includes grants from both types of competitions.
1. Readiness to Initiate Research: As there is significant researcher expertise and capacity in Canada and Genome
Canada has invested in substantial infrastructure, this area has a high degree of readiness to initiate research.
2. Timing of Impact: Research is likely to have a medium-term impact (five to 10 years) on patient health and the
health system.
3. Uniqueness to Breast Cancer: The nature of the results (e.g., which gene) will determine whether they are unique
to breast cancer.
Specific areas where improvements or changes are required to the research system to enable success include:
The CCRA report determined that 15.4% of total breast cancer funding is currently targeted to this area of research,
primarily through operating grants (73%) and personnel awards (16%).
One initiative identified within Canada specifically for breast cancer, was for research awards from the Translation
Acceleration Grants for Breast Cancer Control program (a $6.6M CBCRA/CIHR program to be completed in 2009). The
OICR GENESIS program is applicable to breast cancer. The Terry Fox Research Institute’s (TFRI) project grants may also
be applicable.
Internationally, for breast cancer specifically, NCI has funded an RFA on the biology of breast pre-malignancies, up to
$4.5M (2008-2010). In Australia, the PdCCRS receives funding of about $10M from Cancer Australia and NBCF. For
cancer generally, several initiatives were identified from the EU, Finland and from NCI in the U.S.
• What are the effects of hormones and growth factors and their receptors in breast cancer development?
• How are normal control mechanisms (e.g., senescence) bypassed during tumour initiation?
• What is the clinical relevance of novel breast cancer stem cell biomarkers?
This area was determined to require additional investment (enable) given that the CBCRA/CIHR TAGS projects are
funded only until 2009. An amount of $22M has been proposed to finance a portfolio of funding mechanisms over the
next five years. These include a specific RFA on Translation Acceleration Grants (team grants) for $5-7M over three to five
years; encouragement of operating grants in this area (e.g., by funding the top grants through a priority announcement)
for $2M annually; and launching an open competition for small teams (two or three Principal Investigators) and existing
teams for $2-3M per year.
Other Characteristics
1. Readiness to Initiate Research: Given the current international excellence, this area has a high degree of
readiness to initiate research.
2. Timing of Impact: Research is likely to have a short-term, as well as a medium- to longer-term impact (5+ years)
on patient health and the health system.
3. Uniqueness to Breast Cancer: Research results will represent a combination of insights, some of which will be
unique to breast cancer.
Specific areas where improvements are required to the research system to enable success include:
• Tissue banks: Infrastructure to collect high quality samples from all patients, with access to appropriate and
annotated clinical material;
• Access to and management of tissue microarrays and similar methods/data sets, and their associated patient
databases;
• Capacity building and training to integrate systems biology and bioinformatics (e.g., student and post-doc
fellowships, networks with leading centres for internships);
• Career system for retaining bioinformaticians.
3. Understanding the cause of metastatic breast cancer and identifying new avenues for
interventions (linked to CSO code 1.4)
Metastatic breast cancer results in mortality and is still poorly understood. Therefore, gaining a better understanding
of the process of invasion of cancer cells throughout the body is critical and should result in the development of new
strategies for treatment of metastatic breast cancer.
The most recent CCRA data identifies that approximately 19.5% of total breast cancer research funding is dedicated to
this area of research, primarily through operating grant programs (84.2%).
Current and emerging breast cancer specific projects include CBCRA’s New Approaches to Metastatic Disease in Breast
Cancer, in partnership with CBCF and the Cancer Research Society (CRS), for $7M total (2005-2010) and the CBCRA/
CIHR-funded Translation Acceleration Grants for $6.6M total (2005-2009). Addressing all cancers are the OICR Cancer
Stem Cell Project ($17M for three years) and a planned CIHR cross-institute RFA addressing, among other areas, the
tumour microenvironment.
Internationally, for breast cancer specifically, NCI has funded an RFA on the biology of breast pre-malignancies, up to
$4.5M (2008-2010). In Australia, the PdCCRS receives funding of about $10M from Cancer Australia and NBCF. For
cancer generally, several initiatives were identified from the EU, Belgium and from NCI in the U.S.
• Does the ability to metastasize develop during growth at the primary tumour site?
• What are the mechanisms of tumour dormancy and reactivation?
• What is the basis for homing to different tissues?
This area was identified as needing new and additional investment to encourage research (initiate and enable). While
some areas have received funding, key questions in other areas are not currently funded.
Researchers determined a need for approximately $20M over the next five years to fund two specific initiatives:
encouraging operating grants in this area (funding top grants through priority announcement) ($5M over three to five
years) and a specific RFA (team grant) on metastatic mechanisms in breast cancer ($15M over three to five years).
Other Characteristics
1. Readiness to Initiate Research: With its current level of activity, this area has a reasonable degree of readiness to
initiate research.
2. Timing of Impact: Research is likely to have a short-term, immediate and longer-term impact (5+ years) on
patient health and the health system.
3. Uniqueness to Breast Cancer: Research results will not be unique to breast cancer.
Specific areas where improvements are required to the research system to facilitate success include:
• Tissue banks: Infrastructure to collect high quality, annotated clinical material samples (including metastases and live
cancer stem cells) from all patients;
The most recent CCRA data shows that about 2.1% of total breast cancer research funding is dedicated to this area of
research, primarily through operating grant programs (84%).
CBCRA funded 10 projects in an Etiology/Primary Prevention research program for $9.25M. These projects ended
in 2006. Two major emerging initiatives are focusing on all cancers: the CCS Prevention Initiative which addresses
modifiable risk factors and conditions in cancer prevention and the National Cohort Study of 300,000 participants,
funded for $100M by the Canadian Partnership for Tomorrow Project (CPAC, OICR, Alberta and CARTaGENE).
Internationally, for breast cancer only, a U.S.-based foundation, Susan G. Komen for the Cure, is funding a few studies
(ductal carcinoma in situ [DCIS], experimental model systems, identification and validation of biomarkers, and the
development of environmental research methods). NCI is co-ordinating two other studies.
Several international studies are taking place for all cancers: in France, Germany, the U.K. and the U.S., as well as by a
group from the U.K., France, Hong Kong and the Netherlands. These projects are researching the link between cancer
and diet, physical activity and weight management.
• Which lifestyle and environmental factors offer the greatest potential for influencing risk?
• What are the key causes of breast cancer generally across the population and within certain cultural groups?
• Why is breast cancer among young/pre-menopausal women increasing?
• What is the interrelationship between obesity and the risk of breast cancer?
It was decided that this area requires an ongoing investment similar to its current funding level (sustain). Several funders
(as outlined above) have already selected significant initiatives that will include breast cancer requirements. Therefore
the proposed approach is to partner with agencies such as CPAC on its Canadian Partnership for Tomorrow Project to
monitor progress within the National Cohort Study, and to identify which findings are relevant to breast cancer. This
process will help to identify breast cancer-specific projects on an as-needed basis.
1. Readiness to Initiate Research: With its current level of activity this area has a high degree of readiness to initiate
research.
2. Timing of Impact: Research is likely to have a medium- to longer-term impact (5+ years) on patient health and
the health system due to the anticipated length of time required to complete the cohort recruitment.
3. Uniqueness to Breast Cancer: Research results will represent a combination of insights, some of which will be
unique to breast cancer.
No specific areas requiring improvements were found. However, once the cohort recruitment is completed, additional
funding will be needed for questioning the cohort findings. Funding at a later date could support the ability to carry out
targeted sequencing and research on new animal models.
5. The genetics and hormonal causes of breast cancer (linked to CSO code 2.2)
Certain genes or hormonal factors have been linked to the development of breast cancer in some groups
of individuals. This research priority explores this link in more detail, and could lead to the development of new
interventions or treatments to reduce the risk of breast cancer in certain populations.
The most recent CCRA data shows that approximately 6.4% of total breast cancer research funding is dedicated to this
area, through a combination of operating grant programs (74.2%) and personnel awards (18.8%).
No current or emerging breast cancer specific initiatives have been identified. Two major emerging initiatives are
focusing on all cancers: the CCS Prevention Initiative which addresses modifiable risk factors and conditions in cancer
prevention and the National Cohort Study of 300,000 participants, funded for $100M by the Canadian Partnership for
Tomorrow Project (CPAC, OICR, Alberta and CARTaGENE).
Internationally, for breast cancer only, NCI has funded the Cancer Genetic Markers of Susceptibility Initiative (CGEMS).
An international Breast Cancer Family Registry Project (BCFRP), currently in Phase 3, is being developed. Cancer Care
Ontario is a member of this initiative. Many international studies are underway, focusing on all cancers. A $20M study
involving specimens from approximately 500 patients is taking place in the EU, France, Finland, the U.K. and the U.S., as
well as with two international consortia. OICR is a member of this group. The international HapMap Project is developing
a haplotype map of the human genome at a cost of $100M, with Genome Canada as a member.
• What is the role played by certain genes or factors (sex steroid hormones, obesity and inflammation markers,
molecular markers of disease occurrence, etc.) in familial and sporadic breast cancer biology?
• What are specific polymorphisms and specific genes that will influence breast cancer risk in specific populations?
It was decided that this area needs more investment to encourage research (enable) since, with the exception of the
National Cohort Study, which is not breast cancer specific, no other initiatives specific to breast cancer are in place.
Researchers indicate that this area of research requires about $9M in investment over the next five years. This amount
would be used for targeted RFAs such as the Translation Acceleration Grants addressing the deciphering of molecular
pathways implicated in cancer initiation ($5-7M over three to five years – the same RFA listed under CSO Code 1.3),
developing Canadian involvement in international cohorts ($1-2M over two years) and ongoing partnering with the
Canadian Partnership for Tomorrow Project to ensure breast cancer-specific data is collected and made available.
Other Characteristics
1. Readiness to Initiate Research: With the current level of activity this area has a high degree of readiness to initiate
research.
2. Timing of Impact: Research is likely to have a medium- to longer-term impact (5+ years) on patient health and
the health system.
3. Uniqueness to Breast Cancer: Research results will be a combination of insights, some of which will be unique to
breast cancer.
Specific areas where improvements or changes are required to the research system to facilitate success include:
• Once recruitment for the cohort is completed, additional funding will be needed to include specific questions of
the cohort study. Funding needed at a later date could support the following:
o Access to cohort materials;
o Ability for targeted sequencing;
o Development of new animal models;
o Technology for functional validation (e.g., RNAi) of genes discovered through cohort studies.
The most recent CCRA data shows that approximately 1.5% of total breast cancer research funding is dedicated to this
area of research, primarily through operating grant programs (88.8%).
No current or emerging breast cancer-specific initiatives have been found. The CCS Prevention Initiative addresses all
cancers, focusing on modifiable risk factors and conditions in cancer prevention. However it is not clear at this time
whether research in this area will be funded or whether such research would be specific to breast cancer.
Internationally, studies exploring all cancers are taking place: in the EU, Germany and the U.S.
• What are the key causes of breast cancer generally across the population and within certain cultural subgroups?
• In BRCA1/2-linked cancers, is there an additional impact of environmental factors, including diet, on the risk of developing
breast cancer?
• What is the interaction of genetic and environmental factors in breast cancer?
This area was determined to require investment (initiate), as no current or emerging breast cancer research programs
were identified in Canada.
Over the next five years, this area of research will require about $7.5M for two special RFAs. One will evaluate gene-
environment interactions in the etiology of breast cancer (with special consideration to polymorphisms). The other will
build on the findings of genome sequencing and environmental research to explore the environmental interactions and
biological implications of the genome sequencing. The requirement for the full $7.5M is conditional on the genome
sequencing project yielding important data that would justify further exploration.
Other Characteristics
Specific areas where improvements are required to the research system to enable success include:
7. Interventions to study the influence of lifestyle and environmental factors on the risk
of developing breast cancer (linked to CSO code 3.1)
Specific factors continue to be identified as influencing the risk of developing breast cancer, particularly in some
subpopulations. Research in this priority area will aim to develop new population-based interventions that could be
introduced to reduce breast cancer incidence.
The most recent CCRA data reveals that less than 1% of total breast cancer research funding is dedicated to this field,
primarily through operating grant programs (75.8%) and personnel awards (24.2%).
CBCRA, in collaboration with CIHR, supported Translation Acceleration Grants (three projects funded for $6.6M) which
are exclusive to breast cancer. Ongoing and emerging initiatives for all cancers include the CIHR Team Grants on physical
activity, mobility and health and the CCS Prevention Initiative: Modifying risk factors and conditions in cancer prevention
($3M).
Internationally, several studies are investigating all cancers: in France, Finland and the U.K., which is undertaking a
national prevention research initiative for £12M (2008-2013) and the U.S. (NCI – two targeted competitions in alcohol
and nutrigenics).
• What population-based interventions can be introduced to reduce breast cancer incidence (including for high
risk women)?
• What is the role of primary care in terms of primary prevention?
This field was defined as needing more investment to encourage research (enable), since CIHR has a targeted initiative
(not specific to breast cancer) as does CCS (Prevention Initiative). In addition, the CBCRA/CIHR TAGS grants will end in
2009.
Researchers indicate that this area of research requires approximately $20M in investment over the next five years to
support primary prevention trials in collaboration with partners and international agencies. This research is unlikely to be
exclusive to breast cancer.
Other Characteristics
1. Readiness to Initiate Research: This area has a high degree of readiness to initiate research. However, a lengthy
lead time is likely necessary to put all of the required elements in place, including multidisciplinary teams with
behavioural scientists and epidemiologists. Longer-term funding mechanisms will also be required.
One specific example for research system improvement is the development of a collaborative multicentre trial structure
for co-ordination of trials.
8. Better approaches to early detection and diagnosis (linked to CSO code 4.1)
This research priority will focus on the development of new approaches to breast cancer screening and on the
discovery of new tools leading to more accurate diagnoses and to more personalized treatment of the disease.
The most recent CCRA data shows that about 6.7% of total breast cancer research funding is dedicated to this field,
primarily through operating grant programs (90.3%).
Several OICR projects are investigating all cancers, including the “Selective Agents” project in partnership with TFRI and ICGC.
Internationally, for breast cancer specifically, the PdCCRS in Australia receives about $10M of funding from Cancer
Australia and NBCF. In the U.S., Susan G. Komen for the Cure has funded work related to DCIS, experimental model
systems, identification and validation of biomarkers, and the development of environmental research methods. Many
international studies are taking place for all cancers in the EU, Sweden, France, the U.K., and the U.S., as well as through
an international cancer biomarker consortium.
• Who to treat, who to screen, with what, and with what benefits and costs?
• Are there more practical alternatives to RCTs?
• Can we distinguish between DCIS that will progress to aggressive invasive cancer and that which will remain in situ?
• Are there new screening tools that could be implemented (blood or serum related)?
• What type of screening can be targeted to high-risk populations more effectively?
This area was identified as needing more funding to encourage research (enable) given the current level of investment.
Researchers indicate that this area of research requires approximately $6M in investment using flexible funding
mechanisms such as small pilot studies but avoiding too many small grants to multidisciplinary teams. Partnering across
sectors and geographic regions will be key.
Other Characteristics
1. Readiness to Initiate Research: This field has a high degree of readiness to initiate because existing technologies
are ready for evaluation, considerable Canadian expertise exists in imaging and there is strong infrastructure
capacity in place from past CFI funding.
2. Timing of Impact: Research is likely to have a short- to medium-term impact (immediate to five years) on patient
health and the health system. Its impact will be influenced, however, by the attitudes and policies of Health
Canada and the FDA.
3. Uniqueness to Breast Cancer: Research results will be unique to breast cancer.
Specific areas where improvements are required to the research system to enable success include:
• Support for approval of new agents through the Health Canada regulatory process;
• Improving tissue banks through a co-ordinated, systematic approach to specimen collection/annotation which
would be required from all patients. Easier access for researchers to appropriate and annotated clinical materials;
• Capacity development for personnel with interdisciplinary expertise (e.g., imaging combined with biochemistry;
clinician scientists);
• Salary support for clinician scientists to have protected time for research;
• Support for new technologies.
The most recent CCRA data reveals that approximately 4.6% of total breast cancer research funding is dedicated to this
field, primarily through operating grant programs (85%).
CBCRA has a planned RFA in predictive oncology. Other ongoing and emerging initiatives include the TFRI Biomarker
initiative (which includes a breast cancer node) and the OICR initiative which addresses all cancers.
This area was defined as needing new (evaluation of new biomarkers) as well as more (discovery of new biomarkers)
investment to encourage research (initiate and enable). New funding is required to enable Canadian breast cancer
researchers to validate targets or markers and initiate pre-clinical studies based on novel breast cancer targets.
Researchers indicate that this area of research requires approximately $12M in investment over the next five years
through a portfolio of different funding mechanisms. These options include companion studies to clinical trials
($100-500K per study with duration of one to three years); RFAs in specific areas (possibility of multi-institutional and
multidisciplinary projects at $5-10M per year); workshop support bringing experts from different disciplines together
to propose a larger-scale effort ($100K per workshop); retrospective studies “ready to act” on results of clinical
trials (included in RFA); and training support for methodology and statistical evaluation. Researchers emphasize the
importance of flexibility in the funding streams, avoiding too many small multidisciplinary teams, as well as the need to
link with pharma, Phase I clinical trials and other existing initiatives.
Other Characteristics
1. Readiness to Initiate Research: As the expertise is in place, this area has a high degree of readiness to initiate
research, although parts of the technology are still under development. Some concern has been expressed
regarding the recency of clinical trials with tissue samples, given that long-term outcomes are required to identify
prognostic and predictive markers.
2. Timing of Impact: Research is likely to have a medium-term impact (5+ years) on patient health and the health
system.
3. Uniqueness to Breast Cancer: Research results will not be unique to breast cancer.
Specific areas where improvements are required to the research system to enable success include:
10. Clinical setting/clinical trials to assess clinical sensitivity and specificity of new
biomarkers (linked to CSO code 4.3)
a. Subtypes of breast cancer
b. Predictive markers of response to therapy
Following the discovery of new biomarkers, clinical trials will be required to assess their use in a clinical setting,
particularly for some specific subtypes of breast cancer. The results of these trials will have an important impact on
the development of new personalized therapeutic strategies by providing predictive information on response to
therapy for specific groups of breast cancer patients.
The most recent CCRA data reveals that about 2.7% of total breast cancer research funding is dedicated to this field of
research, primarily through operating grant programs (91.3%).
No breast cancer specific funding has been identified. Ongoing and emerging initiatives for cancer as a whole include
the NCIC Clinical Trials Group (companion studies on clinical trials) and the OICR High Content Cancer Trials designed to
improve clinical trials, infrastructure and processes in Ontario.
Internationally, for breast cancer specifically, the PdCCRS in Australia receives about $10M of funding from Cancer
Australia and NBCF. In the U.S., several multisectoral funders including Susan G. Komen for the Cure and the Fred
Hutchinson Cancer Research Center have launched a global breast health initiative. International studies investigating all
cancers are taking place in the EU, in the U.K. and the U.S., as well as through an International Cancer Screening Network.
It was determined that this field needs new funding to encourage further research (initiate) given the limited number of
current projects specific to breast cancer that are testing new biomarkers.
Researchers indicate that this area of research requires approximately $15.5M over the next five years for two different
funding mechanisms: investigator-initiated operating grants ($1-2M per year) and companion studies to existing clinical
trials ($2-3M per year for clinical trials and $150K per year for three years for each study).
Other Characteristics
1. Readiness to Initiate Research: As the expertise is in place in specialized centres and current trials of the
predictive value of commercially available gene panels are already underway, this area has a high degree of
readiness to initiate research.
2. Timing of Impact: Research is likely to have a short- as well as a longer-term impact (immediate to 5+ years) on
patient health and the health system.
3. Uniqueness to Breast Cancer: Research results will be unique to breast cancer.
A specific area where improvements are required to the research system to enable success is in the qualitative and
quantitative evaluation of data. Requirements for improvement include:
More specific and effective therapies are required for breast cancer patients. This research priority area will focus on the
development of better treatments, particularly for some specific subtypes of breast cancer.
The most recent CCRA data reveals that approximately 13.0% of total breast cancer research funding is dedicated to this
area, primarily through operating grant programs (92.5%).
Current projects, specific to breast cancer, include CBCRA’s Predictive Oncology strategic initiative planned for launch in
2009 and the CBCRA/CIHR-funded Translation Acceleration Grants for $6.6M (2005-2009). Canadian initiatives such as
the Ontario Cancer Institute (OCI) Cancer Stem Cell Project, the TFRI pan-Canadian Biomarker Initiative in partnership
with CPAC and several OICR projects including the “Selective Agents” project in partnership with TFRI, the Immuno-and
Bio-therapies Project and ICGC are addressing all cancers.
Internationally, for breast cancer specifically, the PdCCRS in Australia receives about $10M of funding from Cancer
Australia and NBCF. Many international studies are taking place to investigate all cancers: in the EU, France, Finland,
Germany, Australia, South Africa and the U.S.
• What is the functional meaning of breast cancer subtypes and its implication for treatment?
• What targeted therapies can be developed?
This area was defined as requiring further investment to encourage research (enable). CBCRA’s Predictive Oncology
initiative, to be launched in 2009, will provide $5M of funding. A portfolio of mechanisms is proposed for approximately
$12M of funding over the next five years. Examples include:
Other Characteristics
1. Readiness to Initiate Research: In terms of building on new understandings of disease identified in biology
studies, this area has a high degree of readiness to initiate. However, partnerships with industry are required
to bring laboratory discoveries to clinical trials; therefore, overall this area is assessed as being in a low state of
readiness.
2. Timing of Impact: Research is likely to have a long-term impact (10+ years) on patient health and the health
system.
3. Uniqueness to Breast Cancer: Research results will be unique to breast cancer.
Specific areas where improvements are required to the research system to enable success include:
• Enhancing the capability of labs to be clinical trials-oriented; e.g., improve their ability to process and store
samples, extract DNA, conduct microarray analysis and genomic assessments;
• Developing an appropriate national patient consent process to facilitate tissue banking;
• Developing and acquiring technology for tissue diagnostics;
• Developing rapid throughput models for testing large numbers of agents;
• Developing pre-clinical models for therapy evaluation;
• Working with industry to facilitate an appropriate level of involvement.
12. Clinical trials of new promising therapies (linked to CSO code 5.4)
Following the discovery of new promising therapies, clinical trials and related companion studies test these new
agents on breast cancer patients. Clinical testing and applications of new breast cancer therapies and the
assessment of side effects, toxicity and pharmacodynamics is a critical step in the implementation of these therapies.
The most recent CCRA data shows that about 1.4% of total breast cancer research funding is committed to this field,
primarily through operating grant programs (88.4%). Funding for the NCIC Clinical Trials Group is included in this breast
cancer breakdown. Examples include:
• A Phase II Study of a Second Generation Clustering Antisense Oligonucleotide (OGX-011) in combination with
Docetaxel in Advanced Breast Cancer;
• A Phase III Study of Regional Radiation Therapy in Early Breast Cancer.
Several CCS-funded clinical trials specific to breast cancer are currently underway. Canadian initiatives such as the TFRI
pan-Canadian Biomarker Initiative (in partnership with CPAC) and OICR project, including the Immuno- and Bio-therapies
Project and the High Content Cancer Trials, are investigating all cancers.
Internationally, for breast cancer specifically, the PdCCRS in Australia receives about $10M of funding from Cancer
Australia and NBCF. Several international studies are taking place: in Finland, Germany and Australia.
• Do promising new agents have an impact on breast cancer (Phase I to Phase III)?
• What new therapies can be tailored to different subpopulations of breast cancer patients?
Given the significant number of large clinical trials already in place, this area needs new and increased funding to
encourage (initiate and enable) the launch of companion studies. This research would focus on existing clinical trials as
well as investigator-initiated operating grants. Specifically, a portfolio of mechanisms is proposed for approximately $5M
over the next five years. Examples include:
Other Characteristics
1. Readiness to Initiate Research: As the current infrastructure is in place, funded predominantly by the
pharmaceutical industry and CCS, this field has a high degree of readiness to initiate research.
2. Timing of Impact: Research is likely to have a short-, medium- and long-term impact (i.e., immediate and 10+
years) on patient health and the health system.
3. Uniqueness to Breast Cancer: Research results will be unique to breast cancer.
Specific areas where improvements are required to the research system to achieve success include:
• Capacity training in emerging areas of expertise, including functional imaging biopsies (e.g., PET, MRI) and trial
design;
• Increased links/partnerships with industry and co-operatives;
• Mechanisms to enable multiple partnerships with pharma in a single project;
• Administrative and research staff support for clinical trials.
Research in cancer survivorship covers the range of research domains from basic biomedical (e.g., to understand
the underlying mechanisms leading to late effects of treatment modalities); clinical (e.g., to test interventions
to ameliorate late effects; health service interventions to improve the quality of survivorship care; randomized
trials to improve the evidentiary basis for elements of follow-up care during survivorship); and population studies
(e.g., to understand the impact of public health interventions to improve lifestyle factors on the outcomes for
cancer survivors).
Research in quality of life could lead to the development of new interventions for improving the quality of life of
breast cancer patients across the course of the disease, and promoting psychological adjustment to the diagnosis
of breast cancer and to treatment effects.
The most recent CCRA data reveals that approximately 4.5% of total breast cancer research funding is dedicated to this
area, primarily through operating grant programs (77.6%), personnel awards and related support grants (22.4%).
Current breast cancer projects were defined as follows: CBCRA Quality of Life/Survivorship for $2.1M (2006-2010) and
CBCRA/CBCF Special Research Competition on Psychosocial Aspects of Breast Cancer for $2.4M (2009-2014). CIHR
catalyst grants focused on biomedical and clinical approaches to improving quality of life for cancer survivors (one-year
grant, 2009-2010). The Sociobehavioural Cancer Research Network (SCRN), initiated by the Centre for Behavioural
Research and Program Evaluation (CBRPE) on behalf of CCS, conducts related research addressing all cancers.
Internationally, a Norwegian study on physical and mental health in breast cancer patients has been underway since
2007. This $2.9M (U.S. dollars) research has been sponsored by the Norwegian Cancer Society and Foreningen for
Brystkreftopererte. Many international studies are taking place for all cancers: in Australia, New Zealand, France, Finland,
Germany, the U.K. and the U.S.
• Which interventions best improve the quality of life of breast cancer patients during the course of the disease,
including survivors living after primary treatment?
• What is the influence of attitudes and beliefs on compliance to breast cancer treatment?
• How do we influence general health prevention behaviours?
• What are effective behavioural tests to lower lifestyle risk after cancer treatment?
This area was identified as needing more investment to encourage research (enable). Currently underway is the CBCRA/
CBCF Special Research Competition on Psychosocial Aspects of Breast Cancer for $2.4M (2009-2014). In addition, CPAC,
Other Characteristics
1. Readiness to Initiate Research: This area has a medium/high degree of readiness to initiate research.
2. Timing of Impact: Due to the need to develop outcome measures and the challenge of translating findings into
policy and practice, research findings are likely to have a medium-term impact (5+ years) on patient health and
the health system.
3. Uniqueness to Breast Cancer: Research results may not be unique to breast cancer.
Specific areas where improvements are needed for the research system to achieve success include:
• Improving cancer centres by funding mechanisms to develop and test creative interventions including clinical
trials in the community;
• Enhancing laboratory equipment for exercise physiology and dietary testing in cancer centres and community venues;
• Providing funding for support staff for intervention trials and to gather data in community-based practice. Salary
support to allow clinician scientists to have protected research time;
• Developing administrative databases linked to population-based trials;
• Increasing research capacity, particularly for young investigators.
14. Analysis of the financial and health-care delivery issues facing breast cancer
patients across the cancer continuum (linked to CSO code 6.4)
This area of research examines quality of care, access to care (including timeliness and equity), and factors
associated with variations in quality and access. Studies examine the health system requirements to provide
optimum quality of care throughout the cancer continuum (from health system requirements to improved
screening, reduced wait times for diagnosis, and improved end-of-life care). This research also studies patients’
preferences and needs through the cancer continuum.
In addition, individuals affected by breast cancer and their family/caregivers face economic challenges. Research
in this area could focus on the financial implications of a breast cancer diagnosis; it could include an evaluation
of the long-term economic and employment implications for breast cancer patients and their families. The results
of this research could have an important impact on the development of new health services and care delivery policies.
The most recent CCRA data shows that only 1.8% of total breast cancer research funding is directed to this field,
primarily through operating grant programs (84%).
SCRN, initiated by CBRPE on behalf of CCS, conducts related research addressing all cancers. Other current and
emerging Canadian initiatives include the CIHR NET grants: Access to Quality Cancer Care for $10M (2007-2012); the
CCS Centre for Health Economics, Services, Policy and Ethics Research in Cancer Control (HESPE) and the OICR/CCO
Health Services Research Program. These studies analyze the benefits, risks and costs of existing and new interventions
to improve knowledge and policies for the delivery of cancer services.
Internationally, two Australian breast cancer projects were funded from 2005-2009 by Cancer Australia and NBCF. In
the U.S., Susan G. Komen for the Cure has funded community projects, community-academic partnership programs,
investigator-initiated research, promise grants and training in disparities research. Internationally, for all cancers, studies
are taking place in Australia, the U.K. and the U.S.
Although resources exist for research on all cancers in this area, no studies specifically for breast cancer are underway.
Therefore, more funding to encourage research is recommended (enable). The preferred funding mechanism is operating
grants.
A collective funding envelope of $18M is proposed to devote to all work defined in this category of cancer control,
survivorship and outcomes research.
Other Characteristics
1. Readiness to Initiate Research: This area has a high degree of readiness to initiate research.
2. Timing of Impact: Research findings will potentially affect patient health and the health system in the short term
(i.e., immediately).
3. Uniqueness to Breast Cancer: Research results may not be unique to breast cancer.
Specific areas where improvements are required for the research system to enable success include providing capacity
training in emerging areas of expertise; e.g., for health-care economists.
The most recent CCRA data reveals that 0.4% of total breast cancer research funding is directed at this area of research.
This amount is split fairly evenly between personnel awards (48.2%) and operating grant programs (49%).
HESPE, CPAC’s Cancer Journey Action Group (through the program “Role of psychosocial education in delivering quality
care to cancer patients”) and OICR/CCO Knowledge Translation Research Network conduct related research dedicated
to all cancers.
Internationally, several studies investigating all cancers are being conducted in France and the U.S.
• What knowledge translation applications are effective within the breast cancer context?
• How can we improve the application of research findings into policy and practice across the breast cancer
continuum?
This area was identified as needing more investment to encourage research (enable). Currently underway is the CBCRA/
CBCF Special Research Competition on Psychosocial Aspects of Breast Cancer for $2.4M (2009-2014). In addition, CPAC,
CCS and CIHR are planning other initiatives targeting this area. Grants for multidisciplinary teams including policy-makers
and other stakeholders are the preferred funding mechanism.
A collective funding envelope of $18M is suggested to devote to all research defined in this category of cancer control,
survivorship and outcomes research.
Other Characteristics
1. Readiness to Initiate Research: This area may have a high degree of readiness to initiate research, depending on
the type of KT science required.
2. Timing of Impact: Research findings have the ability to influence patient health and the health system in the short
term (i.e., immediately).
3. Uniqueness to Breast Cancer: Research results may not be unique to breast cancer.
Specific areas where improvements are required to the research system to facilitate success include mechanisms to
encourage greater involvement of partners, such as the community and policy-makers.
Linking data collected during clinical trials with administrative health databases enables long-term studies on
survivorship and quality of life issues related to breast cancer treatment. This form of linkage is potentially
powerful because data from clinical trials (where patients have been randomly assigned to treatments and where
the precise treatment regimens are known) may be linked with administrative health databases providing
information about long-term outcomes. For example, a clinical trial conducted in 1990, if linked with
administrative health databases running to 2005, could provide 15-year, patient-specific information on outcomes
compared to population controls. Research in this area will provide critical information for the development of
future therapeutic strategies and better understanding of late effects of treatments.
The most recent CCRA data shows that less than 0.10% of total breast cancer research funding is devoted to this area
primarily through operating grant programs (76%).
Canadian current and emerging programs include the HESPE, OICR/CCO Health Services Research Program and CPAC’s
initiative to improve capture of cancer disease stages in registries.
Internationally, several substantial studies are being conducted for all cancers. These include: the NCRI Informatics
Initiative, the National Cancer Research Network and National Cancer Intelligence Network in the U.K.; the Cancer
Biomedical Informatics Grid (caBIG), the NCI Community Networks and NCI Community Cancer Centers Program in the
U.S.; and the Seventh Research Framework Programme (FP7) in the EU designed to optimize the use of cancer registries
for 29 cancer research purposes.
• What are the long-term effects (e.g., cognitive functioning, fatigue, obesity) related to different treatment
regimens (chemotherapy, radiation therapy, surgery)?
Although resources exist in this area on all cancers, none is specific to breast cancer. Therefore, this area was defined as
needing research funding to encourage breast cancer studies (enable). The preferred support mechanisms are operating
grants combined with contract funding to support the development of position papers related to, for example, privacy and
logistical issues.
A collective funding envelope of $18M is suggested, directed to all research in this category of cancer control,
survivorship and outcomes research.
Other Characteristics
1. Readiness to Initiate Research: This area has a high degree of readiness to initiate research. However, privacy
policy requirements are a constraint.
Specific areas where improvements are needed for the research system to achieve success include improved access to
administrative health databases, improved cancer staging in cancer registries and the provision of capacity training in
emerging areas of expertise; e.g., programmers, statisticians and health informatics.
17. Developing new animal and cellular models to study response to therapeutics
and mimic human breast cancer development (linked to CSO code 7.1)
New animal and cellular models are required to study specific subtypes of breast cancer and their response to
treatment as well as breast cancer development and invasion.
The most recent CCRA data indicates that about 1.1% of total breast cancer research funding is directed to this field,
solely through operating grant programs (100%).
Two breast cancer projects are currently funded through CBCRA’s New Approaches to Metastatic Disease in Breast
Cancer, in partnership with CBCF and CRS, for $7M (2005-2010). An RFA competition dealing with bioinformatics and all
cancers is expected to be launched by CIHR in 2009.
Internationally, Susan G. Komen for the Cure has been funding (since 2007), research studying DCIS, experimental model
systems, identification and validation of biomarkers and the development of environmental research methods in breast
cancer. Several studies funded by NCI relating to all cancers include:
• Cancer Intervention and Surveillance Modeling Network (CISNET, Division of Cancer Control and Population
Sciences) for approx $2.7M per year over five years (2005-2011);
• Mouse Models of Human Cancers Consortium (MMHCC) for $18M over five years (2003-2008);
• Which animal and tissue culture models best represent specific aspects of breast cancer?
• Using sophisticated model systems, can new mechanisms of breast cancer development be identified?
• How can animal models be used to determine whether specific subtypes of breast cancer are differentially
affected by therapeutics?
This area was recognized as needing new and additional funding to encourage research (initiate and enable) through
programs such as the creation of a breast cancer model network/consortium (similar to the mouse model consortium in
the U.S.), an RFA on model systems for breast cancer, and seed funding for research on other animal models. In addition,
IDEA or catalyst grants could support further research on the integration of several animal model systems and humans.
In recognition of the expense associated with mouse modelling a proposed $7.5M would be required over a five-year
period (approximately $1.5M per team per year). If single investigator operating grants were awarded they would
need to be larger than those currently available: approximately $250K per year per grant. Suggested seed funding is
approximately $200K per project.
Other Characteristics
1. Readiness to Initiate Research: As a result of technological advances, this area has a high degree of readiness
to initiate research. However, for optimal results, sustained support over time is required, as the impact of any
research is dependent on discoveries in other areas.
2. Timing of Impact: Research is likely to have more of a medium- to long-term impact (5+ years) on patient health
and the health system.
3. Uniqueness to Breast Cancer: Research results will be unique to breast cancer.
• Funding for:
o Operating costs of animal facilities;
o Accessibility to repositories of mouse embryos;
o Inventory of investigators working on different animal models;
o Development of a consortium for collaboration and networking.
NFWG developed a short list of overarching research themes with the potential to maintain Canada’s world-class status
or to extend it to new areas of significant promise where there is a good fit with the country’s existing strengths.
Five of these themes include many of the already identified 17 research priorities, with many of them spanning more
than one CSO category. The sixth, Knowledge Translation, is different and is presented as a required component within
all of the research themes. Several of these areas have already been identified by various stakeholders throughout the
consultation process undertaken by CBCRA, as described below.
Congenital and acquired genetic defects are responsible for cancer development. Prevention strategies would be
advanced with a better understanding of the genetic defects responsible for cancer development, their causes and
the mechanisms through which external factors promote genetic alterations. For example, one developing area of
research that shows promise is based on correlations between Body Mass Index and the risk of breast cancer. There are
also emerging discoveries linking metabolism to cancer (not specific to breast cancer). Essentially, this research theme
includes studies on cellular, biological, lifestyle factors; e.g., obesity or other risk factors and their influence on the risk of
developing breast cancer.
This is considered a high priority research area because of its potential impact in preventing breast cancer. However, it is
also one of the more high-risk priorities with respect to success in the near term.
Six of the 17 priorities identified by NFWG will focus on research questions in this theme. They are:
Some aspects of this theme were also identified in the themes and priorities of three international consultation studies
and in the consultation of breast cancer survivors undertaken prior to the National Summit.54
This research theme includes studies on early detection of breast cancer, including non-mammography-based tools.
It will also investigate more effective ways to distinguish between what is breast cancer and what is not, to reduce
overdiagnosis. It will also look at linking 3-D imaging to disease and microenvironment. Modern screening modalities,
while associated with a reduction in breast cancer mortality, still miss clinically significant disease in some populations.
Detection of smaller lesions is likely to be associated with detection of clinically irrelevant lesions. The use of more
sensitive detection strategies must be balanced against an understanding of which detected lesions progress to clinically
significant disease, and over what time period.
Advance reading materials for the National Summit are available at www.nationalframework.ca.
54
This theme was not identified in the themes and priorities of the three international consultation studies. However, it was
mentioned in the consultation with breast cancer survivors undertaken prior to the National Summit.55
C. Personalized Medicine
Breast cancer describes a heterogeneous group of diseases with differing prognoses and therapeutic responsiveness.
Improved tumour classification and understanding of biologic behaviour is needed to define specific treatments that are
more effective and less toxic. Overtreatment should be avoided.
This research area includes systemic approaches to biomarker validation and gene targets, genomic screens, companion
studies with treatment links to identify biomarkers predictive of response to treatment, treatment of recurrent breast
cancer and decision-making tools for treatment of primary disease.
There is a general consensus that outcomes will be improved by optimizing and/or matching therapies to the precise
molecular characteristics of the cancer and by mapping therapy to the specific defects. This is because patients present
with many subtypes of disease and respond differently to therapy. Accounting for the patient’s personal tumour “life
history” is also expected to improve treatment efficacy.
This area cuts through several disciplines and could potentially result in significant research advances. For example, one
outcome could be a better use of health-care resources. Combined with earlier detection and diagnosis, studies could
also lead to reduced mortality/morbidity.
Nine of the 17 research priorities identified by NFWG will address research questions in this theme. They are:
Ibid.
55
Metastatic breast cancer ultimately kills patients with breast cancer. This research theme includes markers and predictors
of breast cancer progression/metastasis, understanding how to block metastatic pathways, the identification of which
lesions will progress to invasive cancer and prediction and prevention of breast cancer recurrence.
A recognized knowledge gap exists in metastatic disease research. For example, understanding which lesions progress to
life-threatening disease, and under what circumstances, will allow treatment to be planned accordingly. Prevention of breast
cancer spread would have a major impact on mortality, reduce the occurrence of relapse and increase the chances of cure.
Six of the 17 research priorities identified by NFWG will address research questions in this theme. They are:
In addition, this theme was identified in the themes and priorities of two of the three international consultation studies;
the Top 10 Translational Priorities (St. Gallen) and the U.K. Gap analysis. It was also recognized in the consultation of
breast cancer survivors undertaken prior to the National Summit.57
This research theme includes the psychosocial aspects of breast cancer, including interventions to improve the quality of
life of breast cancer patients throughout the course of the disease and health-care delivery to breast cancer patients. This
theme also encompasses biomedical and clinical approaches to access, survivorship and quality of life issues for breast
cancer patients (e.g., late effects).
The following five of the 17 research priorities identified by NFWG will address research questions in this theme.
Ibid.
56
Ibid.
57
Analysis of the financial and health-care delivery issues facing breast cancer patients across the cancer
14
continuum
Developing mechanisms to link clinical trial data with administrative health databases for studies on
16
long-term outcomes and late effects
In addition, this theme was recognized in the themes and priorities of one of the three international consultation studies:
the U.K. Gap analysis, and in the consultation of breast cancer survivors undertaken prior to the National Summit.58
• Tissue banks – the need for a co-ordinated systematic approach to specimen collection/annotation (fresh and
frozen tissues, blood, live stem cells, breast cancer subtypes); access to appropriate and annotated clinical
materials; and a national consenting process to facilitate tissue banking;
• Capacity training in emerging areas of expertise, especially interdisciplinary expertise, bioinformatics, and biostatistics;
• Infrastructure support – specifically administrative and research staff support, and protected time for clinician
scientists;
• Enhanced partnerships among different stakeholders – funders, industry, community members and policy-makers;
• Development of multidisciplinary, multisectoral and possibly international networks and consortia (tumour-
initiating cells, animal model systems, population health/genetics).
Ibid.
58
Ibid.
59
Introduction
A new approach was taken in creating this National Framework: no comparable exercises have been undertaken in any
jurisdiction. Consensus was achieved on a broad set of priorities that span the breast cancer continuum. Several logistical
challenges were addressed: from compiling large amounts of background information into a succinct usable format, to
assembling a group of committed experts on a regular basis, to developing consensus within a limited time period on
specifics from a large amount of detailed information. In addition, the perspectives of all different disciplines needed to
be considered both individually and across the research spectrum.
From the outset, there was recognition of the need to retain the current foundational elements of breast cancer research.
For Canada to contribute world-class breast cancer research to a global society, it is important to fund the appropriate
balance of targeted and curiosity-driven (investigator-initiated) research and to provide sufficient capacity with a well-
resourced infrastructure. The challenge is that the right way to determine the optimum blend of investment is currently
unknown. Therefore, the research and funder communities need to continually ensure that the vitality of such critical core
elements as investigator-initiated grant competitions, clinical trials infrastructure, and platforms for innovation, including
biomarker development and molecular imaging, is maintained.
The National Framework provides a set of research priorities to inform more targeted research granting. This movement
toward targeted research granting is in keeping with the identified social trend of increased accountability of science to
society. It recognizes that knowledge has to be both scientifically and socially robust.60 Autonomous and self-directed
research is being balanced with more targeted research in areas defined typically by a multidisciplinary mix of scientists,
practitioners, policy-makers and other key stakeholders.
All of the breast cancer research priorities have been established in an inclusive manner using the Common Scientific
Outline and represent the full cancer continuum. This is in response to the expressed preferences of National Summit
participants for a balanced portfolio of research priorities. These priorities focus on outcomes, and are forward looking
while building on existing strengths. They are sensitive to the national and international research context and represent
scientific excellence. Each of the selected priorities, as well as the group as a whole, meets these criteria and – if funded
– will make a significant contribution to preventing or eradicating breast cancer, reducing its recurrence or, when it is not
curable, turning breast cancer from a killer into a chronic disease.
In addition, NFWG applied such criteria as whether the findings would be unique to breast cancer, how long it would likely
take for research findings to have an impact on patient health and the health system, and how ready the research community
is to undertake the studies. The application of these screening criteria – or others, such as adopting a target group (e.g.,
young women) is not intended to characterize priorities as “better” or “more worthy”. Rather, the information is supplied to
help funders find the best fit, matching strategic direction and other preferences with the appropriate research priority. For
example, a funder who is particularly interested in improving quality of life and demonstrating short-term impact might select
studies that investigate interventions to improve the quality of life of those with breast cancer throughout the course of the
disease.
In the same vein, NFWG undertook some preliminary funding analyses to provide order-of-magnitude guidance to funders
over a five-year period (2010-2015). Funders should validate the financial numbers provided with the proposed mechanisms,
using a group of relevant experts as part of the due diligence process when developing a research request. Final funding
60
Nowotny H, et al (2001) Re-thinking Science Knowledge and the Public in an Age of Uncertainty – quoted in Alison Kitson and Mark
Bisby’s background paper: Speeding up the Spread, sponsored by the Alberta Heritage Foundation for Medical Research, June 2008.
All of these discussions about research priorities took place in accordance with the CSO. NFWG then stepped outside
this framework and created six priority research themes, five of which include more than one of the identified priorities.
These themes represent a high degree of correlation with the preferences of survivors and participants at the National
Summit. Funders may find it advantageous to select a theme as the focus of their granting efforts if they want to enter
into a multi-year/multi-initiative commitment with the goal of making an impact in a particular area. For example, funders
interested in responding to survivor requests for less toxic and more personalized treatments for young women might be
interested in adopting the theme related to personalized medicine. Those who wish to adopt a strong patient-focused
approach might be interested in the Psychosocial, Survivorship and Health Services theme.
Guiding Principles
To foster the optimal return on research investment for funders and to keep moving the body of knowledge forward,
NFWG proposed a set of guiding principles for funding excellent high-impact research. Their advice to funders includes
the following:
• Avoid duplicating research already underway when setting up local studies. Be familiar with research results in
the area of interest and leverage existing research findings. Fund researchers to come together to help identify
and define high-leverage research questions;
• Explore possible linkages with global partners or funding collaboration with existing global cohorts;
• Embed knowledge translation approaches within the research whenever it makes sense;
• Integrate research and service delivery whenever possible, ensuring that the health-care system will support the
research; e.g., by having sufficient protected clinician scientist time and salary support for administrative staff in
clinical trials groups;
• Adopt a broad perspective across research disciplines, recognizing that multidisciplinary teams take time and
require funding to learn to work well together;
• Fund appropriate evaluation studies; e.g., the rapid assessment of a new technology.
However, to succeed in conducting the type of world-class research recognized in the National Framework, changes will
be required. These include improvements to the way that tissue bank specimens are collected and annotated, access to
clinical materials in tissue banks and the linkage of administrative health databases. Other needed improvements include
capacity development in high demand, complex areas like bioinformatics and biostatistics, an improved co-operative
environment across sectors and the development of more multidisciplinary networks and consortia. Infrastructure support
to provide clinician scientists with protected time and appropriate levels of administrative and research staff support is
also needed. Support and funding is required for the provision of an appropriate infrastructure and system to enable new
and novel research.
Overview
The priorities have been established. The challenging but rewarding work of taking action lies ahead. This chapter
discusses the benefits of collaborating and why an expectation has been created that breast cancer research funders
will be responsive and continue to support the foundational elements while adopting research priorities that fit their
strategic direction and values. It also outlines the commitment made by CBCRA to promote the adoption of the National
Framework and monitor progress. This section concludes by articulating some specific action items in the form of a call
to action directed to all members of the breast cancer research community.
Funders of breast cancer research indicated before and during the Summit their interest in working together more
effectively. They recognize the benefit of jointly tackling projects that they could not accomplish alone. They want to
avoid duplicating the work of others. They are also interested in being part of a uniquely Canadian initiative that will lead
to better distribution of resources and optimal return on research investment. They want to associate themselves with
an exciting, ambitious agenda. They want a lead partner for cohesive joint efforts. And they want to use their funds in a
value-added way. They are looking for clear accountability, shared ownership and ongoing evaluation of research efforts.
They are also interested in gaining access to a high quality, national peer review process.61
Funders also understand that successful collaboration needs more clarity and definition of expectations, roles and
processes. For example, pooling funds to support a priority is different from dividing up a priority and asking individual
funders to support different elements. Both approaches could potentially succeed but they require different approaches,
different roles and offer different risks. Similarly, partnering with one or two others to fund individual breast cancer
research priorities differs from joining a larger group that creates and monitors the implementation of the National
Framework. Examples of the different types of collaborative partnerships are provided below.
CBCRA represents one kind of collaboration where the funding partners pool resources and jointly agree on which priorities
to fund. In addition, funding partners may choose to further support specific priorities that are closely aligned with their
individual goals.
A second example is the funding of investigator-initiated grants. A common peer review process is used to assess research
excellence. Different organizations fund the highest rated research proposals, starting at the top of the list, according to
agreed criteria such as a specific focus on breast cancer and the geographic location of the researcher. Resources are not
pooled, but efficiency is gained by using only one peer review process, requiring only one application submission. This allows
funders to choose the most appropriate way to use their investment.
Another scenario is different funding organizations focusing on parts of a larger research theme, but fairly autonomously. For
example, in the area of cancer survivorship, CPAC’s focus is on investigating and identifying current projects that address
survivorship issues with special attention to underserved populations. In contrast, CIHR is targeting biomedical issues. The
Centre for Behavioural Research and Program Evaluation, funded by CCS, targets the evaluation of quality of life/survivorship
programs and population health-level interventions.
A hypothetical third example involves three or four national organizations interested in funding capacity building combining
their efforts to obtain administrative efficiencies. They might identify critical gaps and necessary skills, and agree on their
preferred focus areas. They would then each set up their own career ladder and award structures based on the best fit with
their strategy and resources.
Funding Priorities
The CBCRA Board has declared that in addition to funding high-impact research, the Alliance’s role over the next five
years (Phase IV) will be to enable the successful implementation of the National Framework. CBCRA will encourage
adoption of all the priorities and recommendations of the National Framework by all breast cancer research funders in
Canada. In pursuit of this goal, CBCRA will apply a range of strategies including hosting forums to maintain interaction
among funders and using its pooled research funds to attract other funders, working with them to find common interests
and developing new structures and funding mechanisms.
The National Framework document will be kept current. Emerging trends and activities in the cancer and health research
environments will be tracked. Trends in breast cancer research funding, annually and longer term, will be reported with
assistance from CCRA/CPAC. CBCRA will regularly host forums with groups of experts – possibly by priority or by theme
– to ensure that new knowledge is shared and introduced into the National Framework document. The implications
of all the data will be reviewed by a committee of national and international experts for its impact on the research
priorities. Updates will be published featuring progress reports and success stories. CBCRA will also publish and promote
opportunities to increase efficiencies in the funding, management and delivery of world-class breast cancer research.
Commitment to Collaborate
In short, CBCRA will champion the adoption of the National Framework. It will actively encourage those interested
to become part of a network, sharing learning experiences in pursuit of more effective funding practices. CBCRA will
proactively seek funding partners in priority areas – both for its own initiatives and for other funders; e.g., “brokering”
collaborations. Finally, CBCRA plans to host a national biennial forum to facilitate continued discussion, in a networking
environment and to celebrate achievements.
1. All members of the breast cancer research community are invited to become familiar with the National Framework
document and to work together to achieve the ultimate outcome: a world where no person need fear breast
cancer;
2. Breast cancer research funders across Canada are asked to adopt a set of guiding principles and to mobilize
support for both foundational research and the identified research priorities;
3. Policy and practice influencers are asked to apply existing research findings to policy and practice areas as they
relate to breast cancer, cancer and chronic disease, and to engage with researchers and academics to shape
future studies aligned with policy development;
5. Provincial and hospital foundations are asked to allocate 10 per cent of their funds to these national priorities;
6. Donors are encouraged to familiarize themselves with the National Framework and to request that organizations
receiving their support embrace these priorities and recommendations.
62
Pharmaceutical companies involved in breast cancer research include: Abbott, Abraxis, Aegera Therapeutics, Amgen,
Angiochem, Antisoma Research, Ariad Pharmaceuticals, Array BioPharma, AstraZeneca, Aventis, AVEO Pharmaceuti-
cals, Bayer, Biomira Inc., Bionovo, BiPar Sciences, Boehringer Ingelheim Pharmaceuticals, Bristol Myers Squibb,
Celgene Corporation, Cell Therapeutics, Cephalon, Cytokinetics, Eisai Limited, Eli Lilly and Company, Fresenius Biotech
GmbH, Gem Pharmaceuticals, Genentech, Geron Corporation, GlaxoSmithKline, GPC Biotech, F. Hoffmann-La Roche,
ImClone Systems, Immutep S.A., Intarcia Therapeutics, Johnson & Johnson Pharmaceutical R&D, Ligand Pharmaceu-
ticals, Medarex, MediGene, MedImmune LLC, Merck Frosst, Novartis, Pfizer, Pharmacyclics, Pierre Fabre
Laboratories, Regeneron Pharmaceuticals, Sanofi Aventis, Sonus Pharmaceuticals.
As of February 1, 2009 NCIC was integrated into CCS and hence former NCIC members are also identified as representing CCS.
63
Appendix A 69.
Appendix B – Detailed Breakdown of Funding by CSO Code
As the aim of the National Framework is to establish actionable research priority areas, research investment within
each CSO category is shown by CSO code. The following table illustrates this breakdown and provides actual dollar
investment, the percentage contribution within the CSO category and the percentage contribution against total
investment. An analysis of this data provides the following insights:
• For breast cancer, two codes within the highest funded CSO category of Biology are the largest recipients of
funding, namely: 1.3 - Cancer initiation and 1.4 - Cancer progression and metastasis;
• The third highest funded code is 5.3 - Systemic therapies: discovery and development within the CSO category
Treatment;
• For All Cancers data, the highest funded CSO category is Biology. However, the highest proportion of funding is
code 1.1 - Normal functioning, followed by Systemic therapies in the CSO category Treatment;
• Across all CSO categories, breast cancer receives minimal funding for resources and infrastructure.
64
Canadian Cancer Research Alliance: Cancer Research Investment in Canada, 2007: The Canadian Cancer Research Alliance’s Survey of
Government and Voluntary Sector Investment in Cancer Research in 2007. Toronto: CCRA, 2009.
65
Only projects weighted at 100% breast cancer are included in the breast cancer breakdown.
70. Appendix B
Breast Cancer65 All Cancers
CSO
CSO Code
Category 2007 % Total % Category 2007 % Total % Category
Investment Investment Investment Investment Investment Investment
4.1 - Technology
development and/or marker $3,142,189 6.7 43.4 $18,457,387 4.59 42.55
discovery
4 - Early 4.2 - Technology and/
Detection, or marker evaluation with
Diagnosis $2,126,493 4.5 29.4 $7,918,762 1.97 18.25
respect to fundamental
and parameters of method
Prognosis
4.3 - Technology and/or
marker testing in a clinical $1,282,407 2.7 17.7 $5,285,889 1.31 12.18
setting
4.4 - Resources and
$693,441 1.5 9.6 $11,720,239 2.91 27.02
infrastructure
continued...
Appendix B 71.
Breast Cancer65 All Cancers
CSO
CSO Code
Category 2007 % Total % Category 2007 % Total % Category
Investment Investment Investment Investment Investment Investment
72. Appendix B
73.
74.
Appendix C – Definition of Key Terms
Angiogenesis:
Angiogenesis is a physiological process involving the growth of new blood vessels from pre-
existing vessels. It is a normal and vital process in growth and development; however, it is
also a fundamental step in the transition of tumours from a dormant state to a malignant one.
Bioinformatics:
Computational approaches to analyze, manage, and store biological data. Bioinformatics
involves the analysis of biological information, using computers and statistical techniques,
the science of developing and using computer databases and algorithms to accelerate and
improve biological research. Bioinformatics is used to analyze genomes and proteomes
and for three-dimensional modelling of biomolecules and biologic systems. Training in
informatics requires a background in molecular biology and computer science, including
database design and analytical and statistical approaches.
Biomarker:
A specific biochemical or other measurable parameter in the body with a feature that makes
it useful for measuring the progress of disease or the effects of treatment.
Biomedical:
Relating to the activities and applications of science to clinical medicine.
Biostatistics:
The application of statistical science to biology.
CBCF:
Canadian Breast Cancer Foundation.
CBCN:
Canadian Breast Cancer Network.
CBRPE:
Centre for Behavioural Research and Policy Evaluation.
CCO:
Cancer Care Ontario.
CCS:
Canadian Cancer Society.
CCSRI:
Canadian Cancer Society Research Institute (formerly National Cancer Institute of Canada).
Appendix C 75.
CFI funding:
The Canada Foundation for Innovation is an independent corporation created by the
Government of Canada to fund research infrastructure. CFI normally funds up to 40% of
a project’s infrastructure costs in partnership with eligible institutions. Funding partners
from the public, private, and voluntary sectors provide the rest of the funding.
Chemoprevention:
The use of drugs or other agents to reduce the chances of developing cancer or the
return of the disease.
CIHR:
Canadian Institutes of Health Research.
CIHR ICR:
Canadian Institutes of Health Research Institute for Cancer Research.
Cohort study:
A cohort (group of individuals who share a common characteristic) study is a form of
longitudinal study used in medicine and the social sciences. It is often used to study an
association between cause and disease.
Companion study:
A translational study based on validating targets in another model (e.g., preclinical) or
using tumour biopsies for other types of research.
CPAC:
Canadian Partnership Against Cancer.
CRS:
The Cancer Research Society.
DCIS:
Ductal carcinoma in situ. A very early form of breast cancer in the lining of the breast
ducts, also known as intraductal breast cancer or Stage 0 breast cancer.
Epidemiology:
The study of the patterns, causes, and control of disease in groups of people. When
applied to cancer, it may involve looking at how many people have cancer or develop
specific types of cancer. It also investigates which factors, such as genetics or personal
behaviour, play a role in the development of cancer.
Epigenetic changes:
Any changes in an organism caused by alterations in the action of genes are called
epigenetic changes. Epigenetic transformation refers to those processes that cause
normal cells to become tumour cells without the occurrence of any mutations.
Equipment/infrastructure grants:
Grants that cover in part or in full the costs of construction or major renovation of
research facilities, and/or the purchase, housing and installation of equipment, scientific
collections, computer software, information databases, and communication linkages used
primarily for conducting research.
76. Appendix C
Etiology:
The cause of disease or disorder.
Exogenous:
Originating from outside a system.
FDA:
The U.S. Food and Drug Administration is the federal agency responsible for ensuring
that foods are safe and nutritious. The FDA also regulates human and veterinary drugs,
biological products and medical devices.
Functional imaging:
A method of detection or measuring physiological changes within an organ or tissue by
using medical images.
Gene panels:
A group of genes relevant to a biological process (e.g., response to treatment) usually
identified through genomic profiling.
Genome sequencing:
The process of determining the order of DNA nucleotides or bases in a genome.
Genomic assessment:
Determination of genomic changes associated with a disease or a treatment.
Health informatics:
The interface of information science, computer science and health care.
HESPE:
Centre for Health Economics, Services, Policy and Ethics Research in Cancer Control.
ICGC:
International Cancer Genome Consortium.
IDEA grants:
A grant program which supports innovative, new research ideas that are speculative, but
have the potential for advancing scientific knowledge.
Investigator-initiated grant:
A type of research grant in which Principal Investigators (PIs) propose investigations of
curiosity-driven hypotheses.
Microarray:
A multiplex technology used in biology and medicine that uses an arrayed series of
thousands of microscopic spots of DNA sequences.
66
CIHR definition of KT may be found on CIHR’s website, at www.cihr-irsc.gc.ca/e/39033.html.
Appendix C 77.
Molecular imaging:
A discipline that combines molecular biology and in vivo imaging to visualize molecular
processes in living organisms without perturbing them. Molecular imaging often uses
biomarkers to obtain images from specific molecular pathways or other areas.
NBCF:
National Breast Cancer Foundation.
NCI:
National Cancer Institute.
NCIC:
National Cancer Institute of Canada; now known as the Canadian Cancer Society Research
Institute (CCSRI).
NCRI:
National Cancer Research Institute.
OICR:
Ontario Institute for Cancer Research.
Oligometastases:
Metastases that are limited in number and location and usually found in the brain, lung,
liver and bone.
Operating grants:
Grants that support all the direct costs involved in conducting specific research projects.
Operating grants typically cover salaries for laboratory staff and research assistants/
associates/trainees, costs of research equipment and supplies, and other specific
research-related expenses. Multicomponent projects (program projects), feasibility grants,
proof-of-principle grants, regional development grants, innovation grants and knowledge
translation grants are all included in this category.
PdCCRS:
Priority-driven Collaborative Cancer Research Scheme. A collaboration between Cancer
Australia and the National Breast Cancer Foundation (NBCF).
PHAC:
Public Health Agency of Canada.
PI:
Principal Investigator.
Pillar research:
CIHR categorizes health research into four broad pillars: Biomedical; Clinical; Health
services; and Social, cultural, environmental and population health. Many topics are
cross-cutting; that is, the same topic may be researched across all four pillars.
Polymorphisms:
Multiple versions (alleles) of a gene within a population, usually expressing different
phenotypes (observable characteristics).
RAC:
Research Advisory Committee of the Canadian Breast Cancer Research Alliance.
78. Appendix C
Randomized controlled trial (RCT):
A study in which individuals are randomly chosen to receive one of several clinical
interventions.
Research system:
The funding mechanisms, infrastructure requirements, key processes (such as planning and
surveillance) and human resources needed to support a world-class research enterprise.
RFA:
Request for Applications. A formal invitation for grant or co-operative agreement
applications. The applications are for specific objectives in well-defined scientific areas.
Salary awards:
See “Career awards”.
SCRN:
Sociobehavourial Cancer Research Network.
Systems biology:
A biology-based, interdisciplinary study field that focuses on the systematic investigation
of complex interactions in biological systems, viewing the organisms as an integrated and
interacting network of genes, proteins and biochemical reactions.
Targeted research:
A type of research grant in which the research topic is established by the funding agency
and PIs must submit proposals within prescribed parameters.
TFRI:
Terry Fox Research Institute.
Tissue banks:
A collection of biomedical specimens (blood, tissue, urine, etc.) stored under cryogenic
conditions, donated by volunteer patients or healthy individuals and often used for
biomedical research.
Tissue microarrays:
Paraffin blocks in which up to 1,000 separate tissue cores are assembled in array fashion
to allow multiplex histological analysis.
Appendix C 79.
80.