Beyond the Headlines:
Hype vs. Hope in Breast Cancer Research and Management in the News
Report of BCRF's 2011 Symposium and Scientific Retreat
On October 26, more than 800 guests joined moderator Denise Grady, The New York Times Health and Science Reporter, at the Waldorf=Astoria for the 2011 Breast Cancer Research Foundation Symposium in separating real hope from hype in recent news about breast cancer advances. The Symposium panel, reflecting the diversity of BCRF-funded investigations, was comprised of Nancy Davidson, MD (University of Pittsburgh), Laura Esserman, MD, MBA (University of California, San Francisco), Charles M. Perou, PhD (University of North Carolina, Chapel Hill), Neal Rosen, MD, PhD (Memorial Sloan-Kettering Cancer Center), and George W. Sledge, Jr., MD (Indiana University School of Medicine).
BCRF Scientific Director Larry Norton, MD (MSKCC), introduced the proceedings and acknowledged that Denise Grady's expert guidance would help to reconcile the seemingly contradictory information from mass media versus scientific sources. "Performing surgery" on the panelists' responses to her questions, Grady led a dynamic conversation among panelists and the audience.
With over 230,000 new cases of invasive breast cancer diagnosed in the US each year, Grady opened the discussion asking about means of breast cancer prevention in addition to extreme ones such as prophylactic surgery.
"The simple answer is 'Yes,'" answered Dr. Davidson, who also pointed out the availability of over a decade's worth of data from preclinical and clinical studies on breast cancer prevention and risk assessment. Currently, there are two FDA-approved drugs for prevention: tamoxifen and raloxifene. Exemestane, a third drug commonly used in cancer treatment, was reported in June 2011 to reduce risk of recurrence by about 50 percent in a group of high-risk women, a rate comparable to the two approved interventions.
Addressing the issue of breast cancer risk, Dr. Davidson mentioned tools such as the Gail Breast Cancer Risk Assessment Model as ways for individuals to calculate risk of breast cancer based on body mass index, family history of cancer, and BRCA status. Dr. Esserman encouraged the development of a more comprehensive assessment tool that takes into account lifestyle factors, such as hormone replacement usage and alcohol consumption.
Using cardiology as an example, the panelists pointed out the success achieved in heart disease prevention through educating patients about blood pressure and cholesterol. Dr. Sledge also noted the urgently needed training of generalists on options for breast cancer prevention, just as cholesterol-lowering drugs are frequently prescribed by primary care physicians as well as by cardiologists.
Grady then began to unravel the relationship between the breast cancer subtypes and targeted therapies. Dr. Perou, recognized for his research which led to the identification of these subtypes, answered that when the biology of cancer tumors is better understood, then these diseases become more "predictable." In turn, this knowledge can lead to finding genes or cellular processes that drive cancer growth so that new clinical interventions can be developed.
Dr. Rosen elaborated by explaining that "targeted therapies" is a short-hand term for drugs that were developed to counteract or intervene with cellular changes caused by a particular genetic mutation or a specific cellular process that is driving the growth of cancer. He used the example of the ALK gene inhibitor in lung cancer treatment. In breast cancer, the PI3kinase pathway is frequently activated by HER2 and estrogen receptors; as a result, specific drugs and diagnostic tools have been developed.
In terms of diagnostic tools that can determine the aggressiveness and prognosis of breast cancers, Dr. Perou spoke of several genetic tests that have already been developed. He explained that scientists are now beginning to create tools that can detect specific genetic mutations, not just genes, to determine prognosis and, more importantly, what targeted therapy(ies) may be most effective.
Collectively, the panelists expressed optimism about the direction of current clinical treatment and prevention, which seeks to combine therapies to maximize benefits to patients but limit negative side effects. The panelists also explored the scientific basis of how factors such as post-menopausal weight gain, exercise, and alcohol consumption could influence one's breast cancer risk. They drew from the expertise of BCRF investigators in attendance, such as Patricia Ganz, MD (University of California, Los Angeles) and Pamela Goodwin, MD (Mount Sinai Hospital, University of Toronto), who study the effects of obesity and weight loss on the prevention of breast cancer recurrence. The panelists also noted that even though there is widespread focus on environmental factors, such as ubiquitous use of plastic and presence of hormones in meat, there has not been definitive scientific proof linking such factors to breast cancer development.
Grady ended the Symposium by asking each panelist to express the one question he or she would like to be answered in the short-term. All focused on the need for additional and more effective tools for breast cancer diagnosis, prognosis, and treatment. Thanking Denise Grady and the panelists for sharing their expertise and their passion for breast cancer research, BCRF Scientific Advisory Committee Chairman Clifford Hudis, MD (MSKCC), closed the 2011 Symposium with an animated question and answer session. The eagerness of the audience's questions and their heartfelt comments demonstrated how the breast cancer story is one that permeates too many lives.
2011 SCIENTIFIC RETREAT
The afternoon preceding the Symposium, 147 BCRF-funded investigators gathered at Memorial Sloan-Kettering Cancer Center for their highly anticipated annual "retreat" at which new research findings on particular topics and new ideas for collaboration are presented and discussed. For the 2011 event, underwritten for the tenth year by BCRF Advisory Board member by Muriel Siebert, paired experts "debated" specific topics. Organized by BCRF's Scientific Advisors at their strategic planning meeting in August, the panels initiated conversations among grantees on controversial topics intended to stimulate new research inquiries and collaborations.
After welcoming the grantees, Dr. Norton highlighted the hot issues to be debated. The first session focused on cancer stem cells in terms of what they are and what they mean in breast cancer care. Max Wicha, MD (University of Michigan), presented on how cancer stem cells impact the effectiveness of trastuzumab (Herceptin®) for women with primary or metastatic breast cancer that has an excess of HER2 proteins (a.k.a. HER2+ breast cancer). Kornelia Polyak, PhD (Dana-Farber Cancer Institute), posited that the heterogeneity of cancer cells within one tumor and the tumor microenvironment may be the main factors limiting the effectiveness of breast cancer therapies. BCRF Executive Board of Scientific Advisors member, Gabriel Hortobagyi, MD, FACP (University of Texas MD Anderson Cancer Center), moderated a lively discussion.
Addressing the issue of breast cancer prevention, a member of BCRF's Executive Board of Scientific Advisors, Peter Greenwald, MD, Dr.PH (National Cancer Institute), led the portion of the program that deliberated on lifestyle and/or medicinal approaches. First presenter, Graham A. Colditz, MD, Dr.PH (Washington University School of Medicine), shared findings from his extensive studies highlighting the importance of adolescent lifestyle (diet and exercise) in breast cancer development in later life. Carol J. Fabian, MD (University of Kansas Medical Center), spoke about her current research examining the possible use of "nutriceuticals," defined as "vitamin, food, or food component used for medicinal purposes" as prevention agents for women at high-risk of developing breast cancer.
The third session, moderated by Dr. Hudis, zeroed in on the topic of obesity in relation to breast cancer. Walter C. Willett, MD, Dr.PH (Harvard School of Public Health), directed the audience's attention towards the impact of weight loss and weight gain on breast cancer risk in post-menopausal women. Andrew J. Dannenberg, MD (Weill Cornell Medical College), delved into the biological basis linking obesity, inflammation, and breast cancer formation.
BCRF investigators were also treated to a presentation with a provocative title of "Why don't we get more cancer?" by the 2011 Jill Rose Award recipient, Mina J. Bissell, PhD (Lawrence Berkeley National Laboratory), internationally recognized for her seminal research examining the role of tumor microenvironment in cancer development. Dr. Bissell ended her talk by encouraging young investigators and "passionate old" alike to pursue their research interests.