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Vol. 03 Issue 4, Fall 1998

Partnering to Improve Outcomes: Opportunities for Collaboration in Government Sponsored Programs
The Ribbon 

Sponsored by the Federal Coordinating Committee on Breast Cancer (FCCBC)
in the U.S. Public Health Service's Office on Women's Health
September 28, 1998

An Interview with Wanda K. Jones, Dr. P.H., Deputy Assistant Secretary for Health (Women's Health) and Susan Wood, Ph.D., Acting Deputy Director and Assistant Director for Policy, U.S. Public Health Service's Office on Women's Health

The FCCBC was established in 1994 to provide a forum for the coordination and exchange of information on breast cancer programs and initiatives across the agencies of the Federal government, and to foster transagency collaborations to fight the disease. Is this the first conference of this type sponsored by the group, and did it meet its objectives?

WKJ: Yes, it was the first conference of its type. The group meets regularly, since 1994, but of course it is hard in one- or two-hour meetings to share at the level and depth that was achieved in this day-long conference. It was a very significant event, bringing participants together to highlight their efforts, as well as the challenges they face.

We achieved the major objective of facilitating dialogue, and we think that many opportunities for partnerships were created. We think folks found oppor-tunities by hearing from others and seeing other projects demonstrated. We weren't expecting duplication, but rather synergy; people came together and talked about opportunities to work together; how projects might "add on this" and "complement that." These relationships are always difficult because of funding, but any partnering begins with talking.

SW: I saw new partnerships being formed. It was a very successful conference. Another outcome was to learn from previous experiences that people have had in partnerships; to pull together information on what barriers there are, such as institutional barriers across government, and into private sector. Likewise, we wanted to pull together information on what facilitates partnerships. By the end we got a clear idea, and we will disseminate this information so that participants may learn how to be successful at partnering and not hit the same barriers. We are putting together these proceedings and will disseminate them through our department, the government, the FCCBC, and conference participants.

BCERF works on understanding risk and working toward risk reduction; what progress do you see being made on breast cancer risk reduction from your national perspective, and what more do you think should be done?

WKJ: Progress is incremental. Breast cancer, as other cancers, is proving itself to be a multifactorial disease, and there are no easy solutions. We have a lot of work to do to identify and clarify the role of risk factors, such as in the area of environment.

SW: We don't even know what many of the risk factors are, and which will be preventable. The National Action Plan on Breast Cancer is a national-level project addressing some possible risk factors, such as radiation. At the Partnering to Improve Outcomes conference, one of the partnerships described was a conference cosponsored by the National Action Plan on Breast Cancer, the National Cancer Institute, the Komen Foundation and the American Cancer Society. It addressed the relationship between physical activity and breast cancer, and provides an example of how we might set up something similar at this level on other possible risk factors. Also, as a one-time "supplement program," the FCCBC funded over 20 special projects, many of which addressed possible risk factors. These were cross-agency projects, many targeted at underserved populations from Native Americans to persons with disabilities. As demonstration projects, these could be replicated.

BCERF grew out of the concern in New York State that environmental chemicals may have the ability to influence breast cancer risk. Do you have some thoughts on coordinating research and outreach efforts on issues of women and the environment?

WKJ: One of the greatest uncharted opportunities for us in women's health is to pay attention to environmental concerns that women have. This is very complex research topic; for example, a woman may have grown up in an area with one mix of exposures, maybe in the country, then move to the city, and work in an office environment with an entirely different set of exposures. We don't know which is more important, if they are important at all.

Some adverse effects of chemical exposures have been demonstrated. In some cases, there may be a modulating gene defect, or an enzyme for processing environmental pollutants that maybe doesn't work right. Or, even those with a "perfect set of genes" subjected to a serious and complex array of insults may develop cancer or an autoimmune disease. But we just don't know, we have very little about dosing and data from animal studies and it does not translate directly to humans. We have limited information from occupational studies, which are so often further limited by sex, age and other factors.

We need to move forward on better and more integrated approaches between genetic studies, the cancer bioassay, and exposure studies. We need to improve actual measurement, as many methods are not standardized. We have to improve risk assessment and address risk mitigation for women and for the public in general.

In terms of outreach, we need to get the message out about where the science is strong and where it is not. It is a challenging job to try to communicate about a complex issue where science seems to be moving at a snail's pace but really isn't - we are making progress.

Where is a good place to start on a local or state level for fostering partnerships to combat breast cancer?

SW: I would like readers to be aware of the Office of Woman's Health's ten regional coordinators across the U.S. They coordinate a comprehensive women's health agenda, and range as to where they may be found within a state government. To locate the women's health coordinator for a particular region, readers may call:
1-800-994-WOMAN, or look at the World Wide Web site (http://www.4woman.org/owh/office/coordinators.htm), for coordinator names, contact information and definitions of the ten regions. The work of these coordinators complements the other coordinating and collaborating projects of the Office on Women's Health.


The above two conferences were attended by BCERF Director June Fessenden MacDonald. Carol Devine, BCERF Education Project Leader, represented BCERF on a panel on "Public Perceptions, Risk Assessment,and Communication Issues" in a conference entitled Women's Health and The Environment: Innovations in Science and Policy, sponsored by the U.S. Public Health Service Office of Women's Health and the Society for Advancement of Women's Health Research, on September 10, 1998.


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