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OUR MISSION: Making a difference for women with breast cancer anywhere in the world. This means somehow decreasing the rates at which women develop this disease and their chances of dying of the disease when they get it.   Patient frozen blood specimens start their long journey in a minus 70-degree F cannister from Khulna, Bangladesh to the United States. GUIDING PERSPECTIVES: Progress against breast cancer has been slow for the overwhelming majority of women. We need greater focus on patient-drive agendas and questions. Involving as many women in the world in getting answers is a major mechanism for moving forward faster. We need to be bolder in our thinking and work. Research is critical to moving forward wisely. FRAMING THE KINDS OF RESEARCH WE ALL NEED We can think broadly about three kinds of research: I. Efficacy research: Does "it" – the intervention –a pill or a test for example-really work? This kind of research is usually done in tightly controlled “ideal” circumstances. Problem: Just because something “works” doesn’t mean it can then be successfully used in the usual medical practice for “regular” people. II. Effectiveness research: Does the intervention work in usual clinical practice? Problem: How do we “make it happen” for most people if it does work in usual practice? III. Implementation research: How do we successfully bring the intervention to help all the people who need it? Sometimes we can combine efficacy and effectiveness research in one study. IBCRF work in evaluating the timing of surgical oophorectomy as adjuvant and metastatic therapies does this. IMPORTANT CHALLENGES IN FINDING GOOD INTERVENTIONS OR TREATMENTS Beyond efficacy – the determination that an intervention really works – the big issues are 1. Is the treatment practical—that is can it be given in most clinical practice settings in the world? 2. Are the “side effects” of the treatment limited? When chemotherapy treatments make people very sick, they questions whether” it is worth it”? When taking certain pills cause stomach pains or hot flashes, women don’t want to take them regularly. 3. In the intervention or treatment inexpensive? If a treatment is expensive, most of the people in the world who need it cannot get it.