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  • How to Make Something Out of Nothing

    By Groesbeck Parham, MD
    Komen-funded researcher working in Lusaka, Zambia

    Over the past 30 years I’ve had the privilege of working as a gynecologic cancer surgeon in sub-Saharan Africa in the field of women’s cancer prevention and treatment.

    For the last 10 of those years I’ve lived full-time in Zambia, where I’ve worked side by side with some remarkable African clinicians as we sought to build a national cervical cancer prevention program in a country where healthcare resources are unimaginably low, compared to those with which I was accustomed in the U.S.

    There were days when it seemed desperate. Then there were times when our supplies and funds were relatively abundant and we dreamed big dreams.

    Looking back, it seems that we were the architects of our own successes and failures. It reminds me of the contrasting ideas of the Spirit of Lack and the Spirit of Abundance.

    We would feel the Spirit of Lack creeping in, as we thought: “You don’t have enough to get the job done, so why even try”; “It’s too difficult to do under these circumstances thus you will fail”; “Nobody else really cares”; “What makes you think you can innovate and try something that’s never been tried before, and be successful at it?”

    The Spirit of Abundance, on the other hand, encouraged us: “If you put your nose to the grindstone and do the best you can, it will eventually happen.”

    Our determination pushed us. We were not interested in giving up, and so, we chose to focus on the abundance.

    We were able to build an innovative program that has screened over 250,000 Zambian women for cervical cancer for the first time in their lives, and prevented countless numbers of unnecessary deaths.

    Prior to our work, only 10,000 women had ever been screened for cervical cancer in Zambia between 1964 and 2005. The Zambian government is now leading efforts to expand this program across the nation.

    As we now take on the task of breast cancer control we again hear similar sounds coming across our eardrums:

    “Breast cancer is a very complex disease and can’t be managed in a country with low resources”;

    “The cost of treating breast cancer is too expensive for poor economies to afford”;

    And just as before, we refused to listen to the negativity. We made the decision to disrupt the many barriers to breast cancer early detection and treatment in Zambia, and as usual the resources began to flow, this time in the form of a series of Susan G. Komen-funded initiatives.

    The first was support for the formation of an umbrella organization (Cancer Prevention Alliance of Zambia – CAPRAZ) to bring together all pre-existing breast and cervical cancer advocacy groups in Zambia, to amplify and expand breast cancer awareness opportunities and prevent redundancy.

    Second, Komen funding made it possible for cervical cancer screening nurses to be trained to perform clinical breast examinations on women attending their clinics.

    Komen funds also helped to train radiographers and general surgeons to perform breast ultrasound and ultrasound-guided core biopsy of palpable breast masses, while also improving the breast cancer care skills of these healthcare providers.

    Critical to the success of these efforts have been Zambian trainees with an eagerness to learn, as well as a superb breast cancer surgeon, Dr. Ronda Henry-Tillman from the University of Arkansas, who had an uncanny ability to effectively and compassionately communicate and educate both in the clinic and the operating room.

    Today CAPRAZ is active, and breast cancer care is expanding and improving. Cervical cancer prevention nurses are performing clinical breast examinations on all women within the target age range. Women found to have palpable breast masses or other complaints (bloody nipple discharge, breast pain, etc.) are referred to two newly formed breast specialty clinics that provide diagnostic ultrasound and ultrasound-guided core needle biopsy of breast masses. Two general surgeons are incrementally learning how to provide modern, high quality, breast cancer surgical care.

    In fact, since the Komen-funded training programs ended in January 2015, over 3,000 women have undergone clinical breast examinations by nurses, 122 referred for breast ultrasound and 62 biopsied. Of the women that were biopsied, 11 breast cancers were identified.

    One of the most remarkable successes is the sizes of the breast masses found in women diagnosed with cancer – generally between 2 and 5 cm. In comparison, women who visit the national cancer center have tumors that are very large – between 10-15 cm.

    We are the fortunate recipients of another Komen grant that will allow us to build on our past accomplishments. We plan to test whether combining all the services we now offer into a single visit, will impact the survival of those with cancer by decreasing delays in diagnosis and treatment.

    We look forward to the challenges and the positive messages from the Spirit of Abundance. After all, it appears that it’s the key to making something out of nothing.

     

     

     

  • Q&A with Martine J. Piccart, M.D., Ph.D., Winner of the 2015 Brinker Award for Scientific Distinction in Clinical Research

    Martine J. Piccart

    Martine J. Piccart, M.D., Ph.D., Winner of the 2015 Brinker Award for Scientific Distinction in Clinical Research

    In the quest for personalized medicine, scientists have been studying why some breast cancers respond to certain therapies and others don’t. Dr. Martine Piccart, the recipient of this year’s prestigious Brinker Award for Scientific Distinction in Clinical Research, has been coordinating international clinical trials and other collaborations, thriving for real impact on better treatments and outcomes for breast cancer patients. But it hasn’t always been easy. We recently had a chance to chat with Dr. Piccart and learn more about what motivates her in her work.

    1.    How could your research help individuals facing breast cancer today and in years to come?

    In the past, the clinical trial work done through Breast International Group (BIG), a group of international scientists who participate in global collaborations to make significant advances in breast cancer research and contribute to the faster development of better treatments, focused primarily on conducting trials in early breast cancer in the adjuvant setting. Several of those trials are now considered to be landmark, contributing to significant breakthroughs, and paving the way toward more personalized treatment of the disease.

    Indeed, BIG trials are helping many patients today: HERA has already contributed to a major breakthrough in treating HER2-positive breast cancer; BIG 1-98 put aromatase inhibitors on the map; and SOFT changed how we treat young women with breast cancer. Another trial that can potentially improve the quality of life of many patients is MINDACT,  the results of which will help determine which specific women within a population of breast cancer patients may not need chemotherapy.

    Finally, a few years ago, BIG decided to expand its efforts to cover research in advanced (metastatic) breast cancer. We launched AURORA in 2014, an ambitious molecular screening research program aimed at understanding the drivers of breast cancer metastasis, and defining which tumors respond to treatment. Metastatic and primary breast cancer tissue specimens will be collected and analyzed for the first time on an international scale. By uncovering the molecular mechanisms underlying metastasis, we expect to be able to develop more personalized treatments for our patients in the future.

    2.    What made you decide to focus your research on clinical trials testing new therapeutic agents and incorporating translational research?

    Women whose cancer is not responding to current therapies badly need innovative compounds with new mechanisms of action and smart combinations. New drug development remains challenging but is incredibly exciting today, given our much-improved understanding of the molecular basis of the disease. Translational research is vital for the future, because it provides the link between the discoveries in the laboratory (basic science research) and their application for the benefit of patients (clinical research). It has already succeeded in expanding our medical knowledge and bringing many discoveries to the clinic. Translational Research is our biggest hope for decreasing over- and undertreatment of our patients due to the current “one size fits all” approach.

    3.    What was the biggest challenge that you had to overcome in your career?

    It hasn’t always been easy to keep a healthy balance between family and work. With a husband and three daughters, we have often had to come up with creative solutions. I have a fantastic husband who’s supported me throughout my entire career and who’s given me the room, opportunity and motivation to pursue a career in oncology. However, what I found more challenging was establishing myself in a predominantly male professional environment. You have to prove yourself every step along the way. When I was appointed president of ESMO (European Society for Medical Oncology), I was the first women to hold this position. And this was only a few years ago. Women still have a long way to go, but perceptions are slowly changing, and I’m positive that my daughters won’t encounter as many obstacles along the way.

    4.    What, in your opinion, is the most recent progress in breast cancer research that patients should be aware of?

    Personalized medicine has made significant progress with key discoveries in the field of breast cancer treatment – namely with the development of endocrine therapies and anti-HER2 therapies. With the great work of basic and translational scientists, we have a better understanding today of the molecular mechanisms that drive resistance to these very effective “targeted” therapies, and we are witnessing the development of new agents able to delay endocrine resistance and resistance to the anti-HER2 agent trastuzumab. These agents allow better control of advanced disease and are now being tested in early breast cancer as well, where they are expected to successfully treat the disease.

    5.    What would you predict will be the next big breakthrough for breast cancer patients?

    I believe that the practice of oncology is entering a ‘revolution’ rather than undergoing an ‘evolution.’  Although we’ve been talking about personalized breast cancer treatment for several years, we’re just now on the verge of taking a giant leap from dream to reality. Increasingly sophisticated technologies will continue to help us to further dissect breast cancer into the individual molecular aberrations driving the disease. We see a growing number of biomarkers being identified and tested for their potential with targeted therapies. Along with these new molecularly directed therapies, we are likely to witness the birth of a new treatment modality – namely immunotherapy – which may play an important role for certain breast cancer subtypes. Essential for the success of these new approaches are innovative clinical trials. Driving this highly innovative research forward is a high priority for BIG, its group members, and its partners around the world – whom I sincerely thank for their great support over the years.

    6.    What does receiving the Brinker Award for Scientific Distinction in Clinical Research mean to you?

    I am of course extremely honored to be granted such a prestigious award. Today, as BIG co-founder and chair, much of my energy is devoted to building a strong international network of academic groups and their centres that is committed to ‘driving’ the breast cancer clinical and translational research agenda. This international nonprofit organization was founded just over 15 years ago, and today unites 56 academic research groups from around the world, leading more than 40 trials to date. Our approach through BIG comes at a crunch time for clinical research, and it will allow for better screening of more patients, and the selection of specific subpopulations of patients, in which we will be able to test and tailor new drugs. I hope to use this model to change our approach to clinical trials in cancer, with the benefit of patients in mind.

  • Q&A with Myles Brown, M.D., Winner of the 2015 Brinker Award for Scientific Distinction in Basic Science

    In the quest for better patient outcomes, scientists have been studying why some breast cancers stop responding to therapies and develop resistance.  Dr. Myles Brown, the recipient of this year’s prestigious Brinker Award for Scientific Distinction in Basic Science, has been studying the role of hormones in breast cancer treatment, and his years of successful accomplishments started with one patient. We recently had a chance to chat with Dr. Brown and learn more about what motivates him in his work.

    Myles Brown, M.D., Winner of the 2015 Brinker Award for Scientific Distinction in Basic Science

    1.    What made you decide to focus your research on steroid hormones and their receptors in breast cancer?

    When I was a first-year oncology fellow in 1986 I cared for a young woman, Anne V., who had ER+ breast cancer that had recurred in the skin of her chest wall. I started her on tamoxifen and could see the tumors in her skin regress over a period of only a few months. The gene for ER had just been cloned and for me this was a visible example of the efficacy of a molecularly targeted therapy. Despite having a complete clinical response in her skin, Anne’s breast cancer recurred a year later, and she eventually died of her disease. My entire career since has been focused on understanding why patients like Anne initially respond to endocrine therapy only to become resistant.

    2.    How could your research help individuals facing breast cancer today and in years to come?

    Our work is focused on understanding what makes most breast cancers depend on steroid hormones such as estrogen. Drugs that block estrogen’s ability to bind its receptor such as tamoxifen and fulvestrant or ones that block the production of estrogen such as anastrozole, letrozole and exemestane are among the most effective and least toxic therapies we have for breast cancer. While these drugs work for many women with estrogen receptor-positive (ER+) breast cancer, there are still too many women who die from ER+ disease. We are defining the reasons why some tumors fail to respond to these treatments and are developing new approaches to overcome endocrine resistance including new combination therapies and new ER-targeted drugs.

    3.    What was the biggest challenge that you had to overcome in your career?

    Starting out in my career I was investigating how tamoxifen worked and how it was able to block estrogen action in the breast, yet mimic estrogen action in other organs such as the uterus and bone. In my initial grants I proposed that this difference might be due to proteins we called coactivators that would interact physically with ER and might be differentially expressed in various tissues. My first application to the NIH that proposed cloning these coactivators was not well received to say the least. Fortunately for me the ACS and Komen were willing to take a risk on me early in my career. These early non-government grants were crucial to my ability to build a successful research program.

    4.    What, in your opinion, is the most recent progress in breast cancer research that patients should be aware of?

    Patients need to be aware of the progress in personalizing breast cancer treatments based on the specific breast cancer subtype and specific genetic alterations present in the tumor. There are new drugs and drug combinations in development targeting many of these changes. It is important to be able to sample a patient’s tumor when it no longer responds to a given therapy in order to find the resistance mechanisms and potential vulnerabilities present in that tumor. This can now be done for most patients using radiographically guided needle biopsies and modern high throughput gene sequencing. On the horizon are so-called liquid biopsies in which DNA either from circulating tumor cells or free tumor DNA can be purified from the blood and sequenced. If this technology proves reliable, it should be possible to genetically profile a patient’s tumor repeatedly over the course of therapy.

    5.    What would you predict will be the next big breakthrough for breast cancer patients?

    There continues to be very considerable progress in the development of targeted therapies based on the specific sensitivities of the different breast cancer subtypes, defined both by the genes they express and the mutations they harbor. It is likely that novel combinations of these therapies will be shown to be active in the advanced disease setting and given the very strong adjuvant paradigm in breast cancer, will be tested there where the field has consistently made progress in curing increasing numbers of women.

    Curing women with metastatic breast cancer will continue to be a challenge for this approach, however, because of the high level of heterogeneity present at this stage of the disease. Given the successes in metastatic melanoma, non-small cell lung cancer and other cancer types, a breakthrough in immunotherapy would have the potential to cure breast cancer patients with advanced disease. Figuring out how to prompt the immune system to attack breast cancer and how immunotherapy might be combined with targeted therapy will be the challenge of the coming decade.

    6.    What does receiving the Brinker Award for Scientific Distinction in Basic Science mean to you?

    It is extremely gratifying to be recognized by one’s colleagues and to join the ranks of other members of the steroid receptor field who have won the award in the past, including Craig Jordan, Marc Lippman, Angela Brodie, Bert O’Malley, Elwood Jensen, Evan Simpson, Geoffrey Greene and Benita Katzenellenbogen. I have had the extreme good fortune to have had wonderful mentors, collaborators and trainees over my career. Without them, none of my work would have been possible.

  • We Have Flowers

    Post by Judy Salerno

    The following blog appeared in The Huffington Post on November 24, 2015.

    I’ve heard it said, “Fall down seven times; get up eight.”

    Resiliency is a defining factor of our humanity – the ability to overcome and push forward. We may stumble, but we get back up, not taking “no” for an answer, especially when we know we have something important to offer the world.

    I have seen it firsthand so many times this year. My role at Susan G. Komen takes me around the world – literally. In fact, a week ago I was in Guangzhou, China, meeting with our partners to discuss new ways of combating breast cancer in the world’s most populous country, and today, I write this from Marrakech, Morocco. But it was as I traveled from Guangzhou to Hong Kong that I learned about the tragic events that had taken place in Paris.

    The world watched as people fueled by hate attacked individuals enjoying a beautiful Parisian evening, intent on destroying our collective sense of happiness, safety and peace.

    But through the chaos, one thing was undeniable: good people are everywhere you look. In the midst of devastation there were flowers, offering hope for a better tomorrow.

    There were many heroes that night (and many since), from those who opened their doors as people ran from explosions, to the French emergency responders who tended to the victims.

    Reflecting on their selfless behavior gave me a profound appreciation for all the heroes in life. Those everyday champions who put others first, committing their lives to something bigger than themselves in hopes of a better future for everyone.

    Men and women serving on active duty. Volunteers collecting food and clothing for the less fortunate. Scientists unlocking the mysteries of cancer. These are heroes who, each and every day, are fighting for all of us.

    Sometimes it just takes one inspired individual to change the world. Such was the case with the widely used breast cancer drug tamoxifen (originally created as a contraceptive). For all its therapeutic potential, the drug was nearly thrown in the garbage after proving to be an ineffective contraceptive in humans. That is, until Komen Scholar Dr. V. Craig Jordan (just a young man at the time) fought for the opportunity to continue testing the drug, but for a different reason – treating breast cancer. A reason that now offers hope to thousands of women diagnosed with breast cancer each year.

    Passion for others is also making an impact in Zambia – a country that overcame a health crisis with HIV/AIDS to then be stricken by cancer. In Lusaka, the country’s capital, Komen grantee Dr. Groesbeck Parham and his team have had doors shut in their faces for the last 10 years as they sought to introduce cervical cancer screenings to public health care. People gave countless reasons why it couldn’t be done (from limited infrastructure and resources to ample apathy), but in his own words, they “were not interested in giving up.” Today, they are saving lives, and now working to introduce breast cancer screening in the country as well.

    And sometimes, making a positive difference is much simpler, as it was with Daniel Fleetwood. I was astounded yet so encouraged by how even the smallest gesture – say, a tweet – can inspire a global effort to bring joy and serenity to someone’s final days (which, as the events in Paris remind us, sometimes arrive all too soon).

    I see the everyday heroes every time I meet a woman, man or family facing breast cancer. Parents determined to live to see children through milestones – weddings, graduations, first days of kindergarten. The men and women by their sides who fight with them, holding back their own fear to be strong for the ones they love. I see those with advanced forms of breast cancer who know that they may not survive this, but will use their experience for something greater, so that others may not have to go through what they are enduring. Their strength gives me strength, and I am thankful for it.

    So, as we approach the time of year many of us are giving thanks, my hope is that we not only appreciate the moments at hand but also the men and women who are creating a better future for which we can be thankful. We have seen what is possible when dedication and resiliency come together, and we know it will take nothing less if we want to take on life’s most challenging issues, like ending breast cancer, forever.

  • From Earth Mother to Survivor

    Guest Post By, Menopause The Musical Cast Member and Breast Cancer Survivor Megan Cavanaugh

    I’ve performed in Menopause The Musical for the last eleven years, and I’ve loved it. The current tour is special, and very near and dear to my heart; it’s the Survivor Tour, in partnership with Susan G. Komen – and I’m a survivor. 

    My life changed while I was on tour with Menopause The Musical in Springfield, Illinois. I got a phone call telling me that the result of my biopsy (from a routine mammogram) was “invasive carcinoma.” I left the tour and met with my surgeon, and she explained that given the size of the tumor, I was probably stage I ILC (Invasive Lobular Carcinoma). After an MRI, five more tumors were found.  I had a partial mastectomy and four lymph nodes removed, three of the four lymph nodes tested positive for cancer so I had seven more lymph nodes removed – which, thankfully, all came back negative. But those blasted three positive nodes meant I was going to have to endure chemotherapy. I was now stage II ILC.

    I had four chemotherapy sessions every three weeks, and lost all my hair, then thirty radiation treatments. The day after my last radiation treatment, I was on a flight to the east coast to attend my nephew’s wedding and join a new Menopause The Musical tour. I was bald and worried that I wouldn’t have the energy, but with the support of my spouse and the cast and crew I did it – followed by 48 more shows!

    I now am dealing with lymphodemia of the left breast. I also have to take Femara for five years. This drug inhibits the estrogen production in my body, as my cancer feeds on estrogen, but it also majorly increases hot flashes and night sweats. While traveling on tour I single­ handedly steam up the van windows near me and I have totally become my Earth Mother character ­ “Dripping and Dropping” (one of the parodies in Menopause The Musical to the classic Dusty Springfield song, “Wishing and Hoping”)!

    When I came back to tour I was bald and wearing a wig for the show. I was so uncomfortable and the producers said, “Don’t wear it.” So I went on stage with peach fuzz hair and I had women coming up to me at the end of the show telling me they were cancer survivors.

    Every person I know has been affected by cancer in some way, and I’m humbled and empowered to share my story of hope and strength if it can help one person. Breast cancer affects our bodies and can make us feel “less than” or not pretty – but LIVING beyond it is incredible and so empowering. You are beautiful with all your scars, and bald heads, and cancer does NOT define you, but it does change you. It has changed me – to be grateful for today. My sister Mary Cay, died from brain cancer and every day I miss her, however I am grateful for today.  My living through this has made me so much more alive­ living each day and loving my life. I’m so excited to share a tour of laughter and hope with you all, one show at a time.