Five years ago, scientists and research advocates never thought that one of its most valuable allies in the war againsŠt breast cancer would turn out to be the US Department of Defense (DOD).

Since 1992, however, the DOD has spent nearly $500 million on breast cancer research, and it is second only to the National Cancer Institute in funding studies on the disease that strikes some 200,000 women a year.

A new report by the Institute of Medicine says that the DOD's Breast Cancer Research Program has grown to fill a unique niche among breast cancer research supporters. Because it encourages new ideas and holds promise for scientific breakthroughs in the fight against cancer, the report recommends continuing the program with more stable funding and ways to monitor its success.

UCSF surgeon Laura Esserman, who directs the UCSF Breast Care Center, could not agree more. The DOD funds two clinical studies in which she is a co-researcher -- one testing a vaccine for women with advanced breast cancer and another exploring how MRI can best be applied to diagnosing and treating the disease. Its money also has provided the backbone for a "one-stop" patient-focused breast care center.

Last year, UCSF and the California Pacific Medical Center received a $4.3 million DOD grant to start and study the Bay Area Breast Care Center where a team of experts -- including radiologists, surgeons, pathologists and cancer specialists -- work together on the same unit. The team approach has been used widely, from making treatment decisions and measuring quality and cost of care to developing educational programs and devising projects to study alternative mind-body and spiritually oriented psychotherapy methods. The center could serve as a national model if the study does prove that single-site integrated programs offer advantages to the patient over decentralized systems, says Esserman.

The IOM report recommends more of these kinds of studies. Research into genetic, cellular and molecular events involved in breast cancer have garnered more than half the DOD funds awarded so far. Those studies should continue. However, the reports says more funding should now be steered toward research on how genetic risks interact with environmental or non-genetic risk factors; how to translate knowledge of genetic and cellular roots of breast cancer into improved detection, diagnosis, prevention, treatment and follow-up care; how risk, disease, treatment and ongoing care affect the psychosocial and clinical outcomes of breast cancer patients and their families; and how to ensure that all women have access to high-quality, cost-effective care.

The roots of the DOD Breast Cancer Research Program go back only to 1992, when Congress appropriated $25 million for research on the screening and diagnosis of breast cancer for women in the military and dependents. But a strong lobbying effort by women's health advocates in 1993 worked in getting Congress to raise the appropriation to $210 million and to stipulate that the money be used to support a peer-reviewed competitive grants program aimed at reducing the incidence of breast cancer, increasing survival rates, and improving the quality of life for those with the disease. Part of what makes the DOD program unique, says the IOM report, is its inclusion of breast cancer survivors and other consumer advocates as voting members of the scientific panels that review grant proposals and set broad program goals.

Unlike the NCI, which awards grants based on the best science, the DOD money goes to scientists who show their research is specifically aimed at breast cancer, says Esserman. In the first five years, she says, the panels have set a clear tone. "They look for innovativeness and research that has a true translational focus."

The programs, she says, encourages scientists from different fields to work together. It has attracted to breast cancer research some of the most "creative scientists -- those not afraid to go out on a limb with their work," says Esserman.

By Andy Evangelista

1st appeared 8/18/97