Sunday, September 30, 2012

Keep the Pink Where It Belongs

It's that time of year again. Oh, how I hate it. I have only had one thing go "viral" in my online life, and that is the photo I made of Ralphie from A Christmas Story dressed in his hideous pink bunny costume with the caption, "It's Here: Welcome to Pink Hell Month." Rather than a photo I think I can finally put it into proper words. It is my greatest wish that people outside of the breast cancer world will now understand.

A dear friend of mine was just diagnosed with advanced stage lung cancer. It has spread to her eyes. She is facing quite an ordeal. At first they weren't sure if the primary cancer was lung or breast cancer. The biopsy revealed the origin and her treatment plan is forming. She has been receiving love, concern, flowers and genuine support from friends and family from all over. Her disease is being taken quite seriously. People are actually thinking about what they can do to support her. Because she does not have breast cancer, she is being spared the easy-way-out form of support.

She is not being demeaned or compartmentalized into a pink box. Not a single polyester  ribbon has crossed her threshold. No one has given her a pink baseball cap with a "cute" saying on it. No one has told her that they bought an extra six-pack roll of toilet paper because it is "supporting the pink." Throughout this entire hell on earth she is living, no one has taken away her dignity.

Just like when a man gets diagnosed with cancer, people are offering her true, meaningful, thoughtful support.

Breast cancer is no less a cancer than other cancers. It spreads. It takes away body parts. Its treatments are harsh. And it never seems to let you alone. What is it about breasts that make it a less serious disease? Is it because you can say "boobies" and "ta ta's" like a sixth grade playground sniggering joke?

In our bodies it is no joke. Our immune system knows only the assault. Just as lung, prostate, testicular, liver, skin or any other type of cancer, the malignant cells rapidly divide, mutate, spread, seek and destroy healthy cells.  So, just like lung, prostate, testicular, liver, skin or any other type of cancer, don't diminish us with the easy way out: a cheap piece of fabric tied to a mass marketing plan orchestrated by a major corporation hijacking our disease. Why? Because that translates into the care we get; the research allocated and the way you make us feel when we already feel like hell. We want a cure. We want better treatments. We want to retain our person-hood. It is not easy to do that when you are being treated like a child playing Pretty, Pretty Pink Princess.

If my words have not convinced you, perhaps this quiz will.
All three of the following slides are actual microscopic views of cancer cells. Which one is the breast cancer?



One of these is breast, one is lung, and one is prostate. Interestingly, they are all pink on the pathologist's slide. Here is my wish for this October:  Let's keep the pink in the lab. Where it belongs. And may God help the researchers finally find a way to save us.

(slide 1 is breast, slide 2 is lung and slide 3 is prostate)

Thursday, September 27, 2012

Prior Chest Radiation Patients Require MRI's

If you have had prior chest radiation for breast cancer or another type of cancer, it is important to get screened with breast MRIs as well as mammography to help identify new cancers that may be caused by the prior radiation.

Abstract

 

BACKGROUND:

Recommendation for breast magnetic resonance imaging (MRI) screening for women with a prior history of chest radiation is currently based on expert opinion, because existing data are very scant. The objective of this study was to evaluate added cancer yield of screening breast MRI in this population.

 

METHODS:

A retrospective review identified 98 women with a prior history of chest radiation therapy who had screening mammography and screening MRI performed at the authors' institution between January 2004 and July 2010. Medical records of these patients and results of 558 screening studies (296 mammograms and 262 MRI) were reviewed. Sensitivity, specificity, positive predictive value, negative predictive value, and added cancer yield were calculated.

 

 

RESULTS:

Malignancy was diagnosed in 13 patients, invasive cancer was diagnosed in 10 patients, and ductal carcinomas in situ was diagnosed in 3 patients. The median latency from completion of radiation to detection of the breast cancer was 18 years (range, 8-37 years). Of the 13 cancers, 12 (92%) were detected by MRI, and 9 (69%) by mammography. For mammography, the sensitivity, specificity, positive predictive value, and negative predictive value were 69%, 98%, 82%, and 95%, respectively; and, for MRI, these values were 92%, 94%, 71%, and 99%, respectively. In 4 of 98 patients, cancer was diagnosed on MRI only, resulting in an incremental cancer detection rate of 4.1% (95% confidence interval, 1.6%-10%).


CONCLUSIONS:

The current results indicated that MRI is a useful adjunct modality for screening high-risk women who have a prior history of chest radiation therapy, resulting in a 4.1% (4 of 98 women) added cancer detection rate. The authors concluded that both MRI and mammography should be used to screen women in this high-risk group. Cancer 2012. © 2012 American Cancer Society.

Wednesday, September 26, 2012

Breast Cancer Further Demystified Exposes Importance of Before Forty Initiative


Breast cancer has been further demystified genetically, which will lead to better, more targeted treatments. The take home message is clear: More work needs to be done on the  genomic front lines of breast cancer research.

Important to note: The findings clearly indicate that triple negative breast cancer is found in young women, particularly African-American women. Our Before Forty Initiative has been fighting for four years to promote this fact. Please read more about how you can help Here.

From the New York Times:

Study Divides Breast Cancer Into Four Distinct Types

In findings that are fundamentally reshaping the scientific understanding of breast cancer, researchers have identified four genetically distinct types of the cancer. And within those types, they found hallmark genetic changes that are driving many cancers. 


These discoveries, published online on Sunday in the journal Nature, are expected to lead to new treatments with drugs already approved for cancers in other parts of the body and new ideas for more precise treatments aimed at genetic aberrations that now have no known treatment. 


The study is the first comprehensive genetic analysis of breast cancer, which kills more than 35,000 women a year in the United States. The new paper, and several smaller recent studies, are electrifying the field. 


“This is the road map for how we might cure breast cancer in the future,” said Dr. Matthew Ellis of Washington University, a researcher for the study. 


Researchers and patient advocates caution that it will still take years to translate the new insights into transformative new treatments. Even within the four major types of breast cancer, individual tumors appear to be driven by their own sets of genetic changes. A wide variety of drugs will most likely need to be developed to tailor medicines to individual tumors.
“There are a lot of steps that turn basic science into clinically meaningful results,” said Karuna Jaggar, executive director of Breast Cancer Action, an advocacy group. “It is the ‘stay tuned’ story.”
The study is part of a large federal project, the Cancer Genome Atlas, to build maps of genetic changes in common cancers. Reports on similar studies of lung and colon cancer have been published recently. The breast cancer study was based on an analysis of tumors from 825 patients. 


“There has never been a breast cancer genomics project on this scale,” said the atlas’s program director, Brad Ozenberger of the National Institutes of Health


The investigators identified at least 40 genetic alterations that might be attacked by drugs. Many of them are already being developed for other types of cancer that have the same mutations. “We now have a good view of what goes wrong in breast cancer,” said Joe Gray, a genetic expert at Oregon Health & Science University, who was not involved in the study. “We haven’t had that before.” 


The study focused on the most common types of breast cancer that are thought to arise in the milk duct. It concentrated on early breast cancers that had not yet spread to other parts of the body in order to find genetic changes that could be attacked, stopping a cancer before it metastasized. 


The study’s biggest surprise involved a particularly deadly breast cancer whose tumor cells resemble basal cells of the skin and sweat glands, which are in the deepest layer of the skin. These breast cells form a scaffolding for milk duct cells. This type of cancer is often called triple negative and accounts for a small percentage of breast cancer. 
 But researchers found that this cancer was entirely different from the other types of breast cancer and much more resembles ovarian cancer and a type of lung cancer. 


“It’s incredible,” said Dr. James Ingle of the Mayo Clinic, one of the study’s 348 authors, of the ovarian cancer connection. “It raises the possibility that there may be a common cause."


There are immediate therapeutic implications. The study gives a biologic reason to try some routine treatments for ovarian cancer instead of a common class of drugs used in breast cancer known as anthracyclines. Anthracyclines, Dr. Ellis said, “are the drugs most breast cancer patients dread because they are associated with heart damage and leukemia.” 


A new type of drug, PARP inhibitors, that seems to help squelch ovarian cancers, should also be tried in basal-like breast cancer, Dr. Ellis said. 


Basal-like cancers are most prevalent in younger women, in African-Americans and in women with breast cancer genes BRCA1 and BRCA2. 



Two other types of breast cancer, accounting for most cases of the disease, arise from the luminal cells that line milk ducts. These cancers have proteins on their surfaces that grab estrogen, fueling their growth. Just about everyone with estrogen-fueled cancer gets the same treatment. Some do well. Others do not. 


The genetic analysis divided these cancers into two distinct types. Patients with luminal A cancer had good prognoses while those with luminal B did not, suggesting that perhaps patients with the first kind of tumor might do well with just hormonal therapy to block estrogen from spurring their cancers while those with the second kind might do better with chemotherapy in addition to hormonal therapy. 


In some cases, genetic aberrations were so strongly associated with one or the other luminal subtype that they appeared to be the actual cause of the cancer, said Dr. Charles Perou of the University of North Carolina, who is the lead author of the study. And he called that “a stunning finding.”
“We are really getting at the roots of these cancers,” he said. 


After basal-like cancers, and luminal A and B cancers, the fourth type of breast cancer is what the researchers called HER2-enriched. Breast cancers often have extra copies of a gene, HER2, that drives their growth. A drug, Herceptin, can block the gene and has changed the prognosis for these patients from one of the worst in breast cancer to one of the best. 


Yet although Herceptin is approved for every breast cancer patient whose tumor makes too much HER2, the new analysis finds that not all of these tumors are alike. The HER2-enriched should respond readily to Herceptin; the other type might not. 


The only way to know is to do a clinical trial, and one is already being planned. Herceptin is expensive and can occasionally damage the heart. “We absolutely only want to give it to patients who can benefit,” Dr. Perou said. 


For now, despite the tantalizing possibilities, patients will have to wait for clinical trials to see whether drugs that block the genetic aberrations can stop the cancers. And it could be a vast undertaking to get all the drug testing done. Because there are so many different ways a breast cancer cell can go awry, there may have to be dozens of drug studies, each focusing on a different genetic change. 


One of Dr. Ellis’s patients, Elizabeth Stark, 48, has a basal-type breast cancer. She has gone through three rounds of chemotherapy, surgery and radiation over the past four years. Her disease is stable now and Dr. Stark, a biochemist at Pfizer, says she knows it will take time for the explosion of genetic data to produce new treatments that might help her. 


“In 10 years it will be different,” she said, adding emphatically, “I know I will be here in 10 years.”

Saturday, September 22, 2012

MD Anderson to the Rescue. Thank you.



UT MD Anderson Cancer Center Launches Unprecedented Moon Shots Program 

Effort sets new bar for eradicating cancer; Goal to significantly increase patient survival during the next decade 

HOUSTON — The University of Texas MD Anderson Cancer Center announces the launch of the Moon Shots Program, an unprecedented effort to dramatically accelerate the pace of converting scientific discoveries into clinical advances that reduce cancer deaths. 


Even as the number of cancer survivors in the US is expected to reach an estimated 11.3 million by 2015, according to the American Cancer Society, cancer remains one of the most destructive and vexing diseases. An estimated 100 million people worldwide are expected to lose their lives to cancer in this decade alone. The disease’s devastation to humanity now exceeds that of cardiovascular disease, tuberculosis, HIV and malaria – combined. 


The Moon Shots Program is built upon a “disruptive paradigm” that brings together the best attributes of both academia and industry by creating cross-functional professional teams working in a goal-oriented, milestone-driven manner to convert knowledge into tests, devices, drugs and policies that can benefit patients as quickly as possible. 


The Moon Shots Program takes its inspiration from President John Kennedy’s famous 1962 speech, made 50 years ago this month at Rice University, just a mile from the main MD Anderson campus. “We choose to go to the moon in this decade ... because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win,” Kennedy said. 


“Generations later, the Moon Shots Program signals our confidence that the path to curing cancer is in clearer sight than at any other time in history,” said Ronald A. DePinho, M.D., MD Anderson’s president. “Humanity urgently needs bold action to defeat cancer. I believe that we have many of the tools we need to pick the fight of the 21st century. Let’s focus our energies on approaching cancer comprehensively and systematically, with the precision of an engineer, always asking ... ‘What can we do to directly impact patients?’” 


The inaugural moon shots
The program, initially targeting eight cancers, will bring together sizable multidisciplinary groups of MD Anderson researchers and clinicians to mount comprehensive attacks on:
  • acute myeloid leukemia/myelodysplastic syndrome;
  • chronic lymphocytic leukemia;
  • melanoma;
  • lung cancer;
  • prostate cancer, and
  •  triple-negative breast and ovarian cancers – two cancers linked at the molecular level. 


    Six moon shot teams, representing these eight cancers, were selected based on rigorous criteria that assess not only the current state of scientific knowledge of the disease across the entire cancer care continuum from prevention to survivorship, but also the strength and breadth of the assembled teams and the potential for near-term measurable success in terms of cancer mortality. 


    Each moon shot will receive an infusion of funds and other resources needed to work on ambitious and innovative projects prioritized for patient impact, ranging from basic and translational research to biomarker-driven novel clinical trials, to behavioral interventions and public policy initiatives. 


    The platforms make the program unique
    The institution-wide, high quality scientific and technical platforms will provide key infrastructure for the success of the Moon Shots Program. In the past, each investigator or group of investigators has developed their own infrastructure to support their research programs. Frequently they were under-funded and lacked the high level management and leadership required to ensure that they were of the highest caliber and in particular that they were able to adapt to the rapidly changing scientific and technological environment. The moon shot platforms will be designed and resourced to provide expertise that will support the efforts of all of moon shots teams. The platforms will provide a critical component to the success of each moon shot and of the overall Moon Shots Program. In particular, they will leverage the investment across the moon shots. 


    These platforms include: 

    Adaptive Learning in Genomic Medicine: A work flow that enables clinicians and researchers to integrate real-time patient clinical information and research genomic data, allowing understanding of the cancer genome and ultimately improving outcome.


     Big Data: The capture, storage and processing of huge amounts of information, much of it coming from Next Generation Sequencing machines (genome sequencing). 



    Cancer Control and Prevention: Community-based efforts in cancer prevention, screening, and early detection and survivorship to educate and achieve a measureable reduction in the cancer burden. Interventions in the areas of public policy, public education, professional education and evidence-based service delivery can make a measurable and lasting difference in our community, especially among those most vulnerable - the underserved.


    Center for Co-Clinical Trials: Uses mouse or cell models of human cancers to test new drugs or drug combinations and discover the subset of patients most likely to respond to the therapy. 


    Clinical Genomics: An infrastructure designed to bank and process tumor specimens for clinical tests that can guide medical decisions. 


    Diagnostics Development: The development of diagnostic tests for use in the clinic to guide targeted therapy. 

     Early Detection: Using imaging and proteomic technologies to discover markers that can identify patients with early-staged cancers.   

    Institute for Applied Cancer Science: Developing effective targeted cancer drugs.


    Institute for Personalized Cancer Therapy: An extensive infrastructure that analyzes genomic abnormalities in patient tumors to direct them to the best treatments and clinical trials. 


    Massive Data Analytics: A computer infrastructure that develops or uses computational algorithms to analyze large-scale patient and public data. 


    Patient Omics: Centralizing collection of patient biospecimens (tumor samples, blood, etc.) to profile genes and proteins (genomics, proteomics) and identify mutations that can guide personalized treatment decisions and predict therapy-related toxicity to improve overall patient outcomes. 


    Translational Research Continuum: A framework to facilitate efficient transition of a candidate drug from preclinical studies to early stages of human clinical trial testing so effective drugs can be developed in a shorter time and clinical trials can be quicker and cheaper with higher success rates.


    •  MD Anderson’s “Giant leap for mankind” 

      A year ago, when DePinho was named MD Anderson’s fourth president, he proposed the notion of a moon shot moment. “How can we envision what’s possible to reduce cancer mortality if we think boldly, adopt a more goal-oriented mentality, ignore the usual strictures on resources that encumber academic research and use the breakthrough technology available today?” he asked. Response from the faculty and staff took the form of initial moon shot proposals that targeted several major cancer types and involved large, integrated MD Anderson teams, sometimes numbering in the hundreds.


      Frank McCormick, Ph.D., director of the University of California, San Francisco Cancer Center and president of the American Association for Cancer Research, led the review panel of 25 internal and external experts that narrowed the field to the inaugural six moon shots.
  • “Nothing on the magnitude of the Moon Shots Program has been attempted by a single academic medical institution,” McCormick said. “Moon shots take MD Anderson’s deep bench of multidisciplinary research and patient care resources and offer a collective vision on moving cancer research forward.”
    McCormick added, “The process of bringing this amount of horsepower together in such a focused manner is not normally seen in academic medicine and is valuable in and of itself.”
“The Moon Shots Program holds the potential for a new approach to research that eventually can be applied to all cancers and even to other chronic diseases,” DePinho said. “History has taught us that if we put our minds to a task, the human spirit will prevail. We must do this – humanity is depending on all of us.”
For more information, including backgrounders on the inaugural moon shots, please visit www.cancermoonshots.org.