The increasing likelihood of sequestration and the current climate of budget uncertainty have direct and possibly long-term impacts on cancer research at the Georgetown University Medical Center.

Georgetown University and the Georgetown University Medical Center (GUMC) are among the many universities that rely on federal grants to support research. 

"Grants are our bread and butter...It's how we get work done, how we support our graduate students," Rebecca B. Riggins, PhD., an assistant professor in the Department of Oncology and member of the Breast Cancer Program at the Lombardi Comprehensive Cancer Center at GUMC, said.

According to sequester documents from the White House, cuts to research grants could impact up to 12,000 scientists and students.

Georgetown anticipates that sequestration would result in an estimated $10 million reduction in expected grant funding through fiscal year 2017.

Howard J. Federoff, MD, PhD, executive vice president of Georgetown University Medical Center and executive dean at the School of Medicine, said he expects all federally funded grants and contracts to be impacted by sequestration.

Already the National Institute of Health (NIH) has instituted across the board 10 percent cuts on existing grants and that is largely in response to the continuing resolutions Congress keeps passing instead of new budgets.

The sequester, according to White House documents, would mean that NIH would make hundreds of fewer research awards, each of which accounts for seven research positions on average.

Riggins said that cuts to existing grants mean researchers have to narrow the scope of the question they try to answer. She said cutting an area of research on a contract she was working on meant letting go of a team member.

It also has significant implications for cancer research. Riggins said cuts are not always made based on the significance or importance of the work being done.

"We wish it were based on importance. Sometimes it is that things just cost too much," Riggins said.

As part of an NIH National Cancer Institute grant, Riggins had proposed using sample tissue from a breast cancer tumor to do next generation sequencing. By looking at genetic changes or mutations she hoped to understand why certain forms of very aggressive breast cancer do not respond to current treatments.

But the sequencing required expensive outsourcing to a biotechnology firm, so Riggins had to forgo that portion of her research.

One of the primary goals of her research is to use what she learns to refine how treatments are applied and to understand why some tumors are not responsive to therapy.

She can still do research to achieve parts of this goal, but then there's the issue of what happens when this round of grant money runs out.

Normally she would be putting together proposals to submit this summer and fall to continue her research or expand it.

But with the government's budget issues and the specter of sequestration, federal grants are less appealing.

"I have made applying for private foundation money my priority," said Riggins.

The downside to private funds is that they are often for very short periods of time—one year, instead of the standard four years one gets with a federal grant.

"You need that length of investment to figure out the problems and the questions that you propose to study," she said.

As each private grant deadline piles onto the next, Riggins said a some point it can feel like applying for grants is all you do.

And what about those ideas that had to get cut now. Could she revisit them in sunnier budgetary climates?

"Opportunities are lost when things have to sit on the shelf, when things have to sit on the shelves for months to years at a time," Riggins said.

Despite the gloomy outlook, in some ways, Georgetown is better positioned for cuts than other research centers. GUMC aligned itself on topics—cancer, neuroscience, health care for under-served populations, and global health—that tend to fare better when cuts come around, according to Federoff. 

According to Federoff, GUMC's financial plan "assumed there will be some loss in grant income." GUMC will try to manage with the cuts and to absorb them to the extent it can.

"The sky for us is not going to fall on March 1," Riggins said.

But that is not much of a consolation.

Between sequestration and flatline budgets, Riggins said, "there are lots of issues that could set us back for years at a time."