Bottleneck Issues in Breast Cancer Research
Brainstorming Session on Breast Cancer & the Environment
Kenneth Olden asked workshop participants to identify "bottleneck" issues that may hinder rapid progress in the field of breast cancer research. The following items were mentioned:
- Lack of clinical researchers and research volunteers
Richard Santen pointed out that clinical studies and clinical trials are inhibited by a lack of clinical investigators and a lack of patients willing to participate in clinical trials (approximately 5% of patients volunteer to enter clinical trials). Efforts to stimulate clinical research have been initiated, but the problem still exists. This is compounded by inadequacies or difficulties associated with patient registries, tissue procurement and informed consent procedures. More effort is needed to promote clinical research and resolve these issues. Patient advocacy groups might be able to work with scientists on some of these problems.
- Poor characterization of food supply and nutrition
Peter Greenwald (NCI) indicated that the influence of nutrition on breast cancer risk is poorly understood and understudied. It may be necessary to undertake agricultural studies to understand how the food supply is changing.
- Access to diverse institutions
Peter Greenwald also indicated that progress in decreasing breast cancer incidence might require access to institutions and public entities that are outside of the breast cancer research community.
- Success rate in peer-review
Frances Visco, Nancy Krieger, Walter Willet, Leslie Bernstein, Carl Barrett (NCI) and others expressed concern about the success rate for funding breast cancer research. In particular, it can be difficult to obtain funding for interdisciplinary studies and large scale and/or long-term epidemiological studies. Thus, the existing peer-review system may be a barrier to success in future breast cancer research programs
- Non-modifiable risk factors
Walter Willet pointed out that reproductive history has a very strong influence on breast cancer risk. However, it is also a factor that is difficult to control or manipulate in order to lower cancer risk. Similarly, obesity is a strong risk factor for breast and is a general problem in the overall population. Obesity can be considered a general "environmental" or "societal" problem that influences health status.