Federal funding for breast cancer research should focus on prevention and understanding how environmental factors influence risk rather than on diagnosis and cure, according to a federal commission report.

More federal investment is needed "to explore compelling themes, such as mechanisms underlying breast cancer subtypes and breast density, epigenetic alterations ... that occur over the life course, and gene/environment interactions," wrote the Interagency Breast Cancer and Environmental Research Coordinating Committee in a report released Tuesday.

While recognizing the link between breast cancer risk and family history, the committee said "most breast cancers, however, occur in people with no family history, so environmental factors -- broadly defined -- must play a major role in the etiology of the disease."

With breast cancer accounting for more cancer diagnoses than any other kind and about 14% of all cancer deaths annually, Congress passed the Breast Cancer and Environmental Research Act in 2008 that established the committee and tasked it with looking at existing research and finding knowledge gaps that can be eliminated. Tuesday's report, 2 years in the making, was the result.

The 27-member committee urged "transforming how research is conducted" and "intensifying the study of chemical and physical factors."

The report writers recommended that those who hold the purse strings "plan strategically across federal agencies. Engage public stakeholders. Train transdisciplinary researchers," noting that scientists are currently limited in their approaches to studying breast cancer.

The committee defined the "environment" broadly as lifestyle and behavior, such as alcohol and exercise; chemical agents like pesticides, pollutants, products and medications; physical agents like diagnostic and other radiation; and, the influence of society and culture on breast cancer. Breast development should be studied to facilitate prevention, the report said.

It recommended studying the environment of underserved populations, where black women show the highest breast-cancer death rates although they have a lower incidence rate than white women. Black women are more likely to be diagnosed before age 40 with late-stage cancer, and are more likely to be diagnosed with more aggressive tumors.

Research that discovers what instigates breast cancer could serve as the foundation for new governmental policies that reduce negative environmental factors. Regulatory agencies could better deal with controlling exposures and modifying social and lifestyle factors linked to breast cancer, the report suggested.

Research that can assess several risk factors that occur simultaneously should be stepped up, and study protocols should be streamlined so scientists can understand and test their hypotheses more quickly. Funding should be allocated for those studies, the report recommended.

The National Institutes of Health spent almost $2.4 billion on breast cancer research in fiscal years 2008 to 2010: About 83% percent was administered by the National Cancer Institute (NCI), 5% by the National Institute of Environmental Health Sciences, and 2% or less by others, the report said. The NCI reported spending $631.2 million in FY 2010 on breast cancer research. Breast cancer research receives more funding from the National Cancer Institute (NCI) above all other cancer research.

"Prevention is the key to reducing the emotional, physical, and financial burden of breast cancer," wrote the committee. "By urgently pursuing research, research translation, and communication on the role of the environment in breast cancer, we have the potential to prevent a substantial number of new cases of this disease in the 21st century."

However, the committee nodded to the numerous voices in the debate about how to better approach breast cancer. "Prevention does not come easily. The issues must be discussed widely, broadly, often, and vigorously to inform science, public health practice, and policy."