Quest post by Mitch Dowsett, Ph.D., F. Med. Sci., Head of the Academic Department of Biochemistry at the Royal Marsden Hospital, Professor of Biochemical Endocrinology, and Head of the Center for Molecular Pathology at the Royal Marsden Hospital and Institute of Cancer Research in London, England
As a teenager, I was fascinated by the genetic code, and I still find it astonishing that the immense complexity of living things is derived through a chemical code based on just four small molecules. Learning about the genetic code in my mid-teens established my interest in pursuing a career in life sciences. As a result of this interest. I earned a Bachelor of Science degree in Zoology (Imperial College, London), taking as many biochemical and genetic courses as possible, and went on to undertake a Ph.D. in health research.
I’ve always wanted there to be a direct clinical connection to my research, hoping that it will have an impact on patient care. As time has gone on I have tried to focus increasingly on issues that are rated by clinicians as having particularly high importance for the management of their patients.
I began studying breast cancer during my postgraduate fellowship at the Institute of Cancer Research (ICR), where I studied the very debilitating bone breakdown caused by breast cancer metastases. It was here, nearly 40 years ago, that I started a clinical research collaboration with Professor Trevor Powles and colleagues at the Royal Marsden Hospital.
In 1979, after three years’ training in clinical biochemistry, I won a Senior Biochemist post to undertake steroid hormone analyses at Chelsea Hospital for Women (CHW). This career-defining piece of good fortune allowed me to begin working with an extraordinary team of medical oncologists: Adrian Harris, Charles Coombes, Trevor Powles (again) and Ian Smith, the last of these being my very close collaborator since that time. Years later, Powles and Smith became the UK’s only other Brinker Award winners.
We set up steroid assays at CHW to study the activity of a complex drug called aminoglutethimide which was known to be effective in breast cancer We demonstrated that this effectiveness was because it inhibited aromatase, an enzyme responsible for a key step in synthesizing estrogens, thus validating this enzyme as a therapeutic target. Our CHW steroid assays were critical for the clinical development of the first specific aromatase inhibitor (AI) used in breast cancer, 4-hydroxyandrostenedione, undertaken with my colleagues Charles Coombes and Angela Brodie, and later anastrozole and letrozole, third-generation AIs.
In 1988, upon moving to the Royal Marsden Hospital, Per Eystein Lonning and I developed an assay to measure whole-body aromatization that became a benchmark for pharmacological comparisons.
In the 1990s, good fortune featured again when Professor Michael Baum joined the Royal Marsden. Together we initiated the ATAC (Arimidex, Tamoxifen Alone or in Combination) trial that established aromatase inhibition as more effective adjuvant endocrine treatment for postmenopausal women than tamoxifen.
I have been privileged to lead the AI Overview Group, a global collaboration that has shown that AIs lead to improvements in survival from breast cancer beyond the substantial gains achieved with tamoxifen.
More recently, in collaboration with Jack Cuzick and many others, we studied tumor samples from ATAC to identify markers that could help identify patients with ER-positive primary breast cancer who could avoid chemotherapy, and in doing so created a simple but effective new index, IHC4, that can help guide decisions about breast cancer treatment.
It astonished me that the ATAC trial needed to recruit >9,000 women with breast cancer to find if an AI was better than tamoxifen. I was therefore very keen to collaborate with Ian Smith on presurgical studies which validated that early changes in the proliferation marker Ki67 could be used to compare the relative efficacy of endocrine agents, a finding which has allowed for more rapid evaluation of new drugs.
We also found that Ki67 levels in the tumor during AI treatment might help predict the likelihood of a patient’s breast cancer recurring. Based on this finding, we created the POETIC (PeriOperative Endocrine Treatment for Individualised Care) trial which enrolled nearly 4,500 patients at over 120 UK hospitals. I believe the trial provides the best opportunity to understand the extraordinarily complex issue of resistance to endocrine treatment and how to select treatments to reverse that resistance, and ultimately could improve the personalized management of ER-positive breast cancer.
Mine is a story of a patient-focused scientific curiosity, good fortune and great collaborations. So many others have contributed to my career and my receiving the 2014 Brinker Award for Clinical Research that this blog could easily have been exhausted by simply listing them. I am grateful for the support of many funders over the years, and would also like to thank the countless patients who have trusted and joined with us in helping to reduce the toll from breast cancer.
Learn more about our other 2014 Brinker Awardee, Dr. Joan Brugge – Komen Brinker Award winner for Scientific Distinction in Basic Science
Blog by Managing Director, Strategic Partnerships and Programs, Kim Sabelko, Ph.D.
December is a month of celebration for many reasons, but for us at Susan G. Komen, it’s also the month that we present our marquee scientific awards – The Brinker Awards for Scientific Distinction. These awards, now in their 22nd year, celebrate the clinicians and scientists who are making the most significant advances in breast cancer research and clinical medicine.
Brinker Laureates are the shining stars of the breast cancer world. Past recipients include V. Craig Jordan, O.B.E, Ph.D.,D.Sc., F.Med.Sci., who transformed a failed contraceptive into tamoxifen, a breast cancer treatment that has saved millions of lives, and Mary-Claire King, Ph.D., who identified the BRCA1 and BRCA2 gene mutations that may predispose women to breast cancer – giving women the opportunity to take steps to prevent the disease. King’s work has also earned her the prestigious Lasker Award, and opened up the area of genetic research for breast cancer scientists.
This year, Komen is proud to present the Brinker Awards for Basic Science and Clinical Research, respectively, to Joan S. Brugge, Ph.D., of Harvard Medical School, for her work helping us to understand how normal breast cells become cancerous and how cancer cells respond to therapy, and Mitch Dowsett, Ph.D., F.Med.Sci. of the Royal Marsden Hospital in London, for transforming our understanding of ER-positive breast cancers and using that information to improve the efficacy of treatments and prevention for patients. Read the full press release here.
Brugge and Dowsett will be honored at the December San Antonio Breast Cancer Symposium (SABCS), a gathering of thousands of the world’s leading breast cancer scientists, clinicians and advocates. But they are not the only honors given this fall. Komen, in partnership with the American Association for Cancer Research (AACR) presents two additional awards to honor the best and brightest in breast cancer research.
These include the 2014 AACR Distinguished Lectureship on the Science of Health Disparities award, given to John Carpten, Ph.D., on November 9. Dr. Carpten is a Komen grantee who has pioneered novel technologies to study cancer genes and is passionate about learning why cancer incidence and mortality are higher for some minority populations. Carpten is deputy director of the Translational Genomics Research Institute (TGen) in Phoenix
Another Komen grantee, Yibin Kang, Ph.D., of Princeton, will be presented with the 2014 AACR Award for Outstanding Investigator for Breast Cancer Research, funded by Komen, given annually to an investigator younger than 40. Dr. Kang is being recognized for his pioneering work in breast cancer metastasis, the spread of breast cancer that is responsible for nearly 90 percent of all breast cancer deaths.
Throughout the year we also partner with AACR (and other organizations) to offer Scholar-In-Training Awards to promising early career breast cancer researchers who are presenting their research findings at premier international cancer research conferences.
All of these awards are intended to recognize research excellence and also tie to Komen’s priorities in key areas: understanding metastasis; ending disparities in outcomes for minority populations, development of personalized treatments and prevention. We also have committed to investing in the next generation of breast cancer researchers, by both funding, and recognizing, the work of early career scientists and clinicians.
As the year comes to a close, it is a time for those of us at Susan G. Komen to reflect on the past, to remember those we have lost and to acknowledge the triumphs of survivors and research breakthroughs along the way. It is also a time for us to have hope, to look forward to the next breakthroughs and to acknowledge the work of these researchers who have dedicated their lives to furthering our mission to end breast cancer, forever.
Please join us in congratulating our 2014 award winners!
American Association on Health and Disability (AAHD): Project Accessibility: Removing Barriers for Women with Disabilities
Earlier this year, the Susan G. Komen Breast Care Helpline received a call from a woman in need of a mammogram. Her request was among the nearly 14,000 people who call us each year seeking information about breast cancer as well as those in need of resources that may help them overcome any number of barriers to care, such as financial constraints, family responsibilities or a lack of transportation.
But this caller’s situation was even more unique. She had no insurance, uses a wheelchair and needed to find a place in her community with wheelchair-accessible mammography equipment.
Fortunately, we were able to provide her with resources that could help.
For the past five years, Komen has been working with the American Association on Health and Disability (AAHD) to address, and remove, barriers to screening and treatment for women with disabilities.
In 2009, Komen and AAHD launched Project Accessibility: Removing Barriers for Women with Disabilities, which aimed to improve access to care for women living with disabilities in our nation’s capital. Project Accessibility staff visited 60 community mammography screening facilities in the D.C. Metro area to provide on-site facility accessibility assessments, technical assistance and project materials.
In 2012, our two organizations expanded the program across the country, launching Project Accessibility USA. We jointly developed a free, online Breast Health Accessibility Resource Portal with materials to help Komen grantees around the globe improve their ability to care for women with disabilities. Of note: an “Accessibility Self-Assessment Guide for Mammography Facilities” was developed under this initiative, and it is available through the portal at this link.
Addressing the needs of women living with a disability is of key importance all year, but it’s of special significance today: the 22nd annual International Day of Persons with Disabilities. Observed on Dec. 3 each year, this day gives leading health organizations everywhere an opportunity to recognize shortcomings in accessibility to our healthcare system, and tools to improve services for the 15 percent of the global population currently living with a disability.
Through Project Accessibility USA, Komen and AAHD are changing the status quo for women with disabilities by working to ensure access to quality breast cancer care for all. We encourage all women with a disability to get the screenings recommended by their healthcare providers and to contact our Helpline at 1-877 GO KOMEN (1-877-465-6636) if they need additional information.
Post by Dr. Judy Salerno, President and CEO Susan G. Komen
I recently read that the Internet – the all-encompassing information, communication and networking tool that has taken over nearly every aspect of our daily lives – just turned 45. Comically, my kids would probably tell me that makes the Internet itself too old for a Twitter account or selfies.
Jokes aside, the Internet has been a tremendous force for good across the globe: connecting common causes; giving a voice to the everyman and everywoman; and, today especially, inspiring all of us to generously contribute to a better tomorrow.
Today marks the third annual #GivingTuesday, a global, online effort that aims to bring together charities, families, businesses and individuals who want to make an impact in their communities. We at Komen are pleased to again be participating in this important event, joining more than 10,000 organizations in more than 46 countries around the world.
Here’s how you can join in…
Everyone loves a good selfie, but today, take an #UNselfie! Show us what you’re doing for this international day of giving back by sharing it on Facebook, Twitter or Instagram along with the hashtag #UNselfie.
Then, give back! You are the most important part of #GivingTuesday. Join millions of people making a difference today, by donating and showing your support for Komen and other impactful organizations.
Guest blog by Lauren Davis, Susan G. Komen Community Grants Manager
Six years ago, a young woman, age 25, called my office in tears. She was uninsured, had no reliable source of income, and had noticed a lump of increased size as well as spontaneous nipple discharge in her right breast. Through the generous funding of the local Komen Affiliate in Philadelphia, she received an ultrasound, and after, a breast biopsy.
“Is it breast cancer?” she asked. “I have no family, and no one to support me. If I have breast cancer, I’ll have to stop working. And if I stop working, I will have no money for a bus pass. I have no insurance – how will I even pay for my care? What will happen to me?”
As a patient navigator, I was tasked with finding the answers to these difficult questions. But more importantly, I was charged with the responsibility to ensure that this patient received access to quality care and the tools necessary to fight a potential diagnosis of breast cancer, regardless of any external constraints.
By definition, patient navigation is a process by which an individual – a patient navigator – guides patients through and around the barriers in the complex cancer care system to ensure timely diagnosis and treatment. There are many different types of patient navigators, though, most common are clinical nurse navigators, social workers, and lay health advocates from within the community.
Often, patient navigators are the first line of defense in the fight against breast cancer. We personally guide patients into and through the mammography screening and diagnostic processes, and onward through treatment and survivorship, by scheduling appointments and ensuring compliance with recommended plans.
Along the way we offer individualized education, and provide assistance in “navigating” the murky waters of accessing the healthcare system. We break down financial, transportation, and childcare barriers. We provide guidance on securing necessary psychosocial support. And we work to prevent lapses in care because of differences in language or culture.
Recent evidence1 suggests that patient navigation has a substantial impact on improving breast cancer survival rates. Because of this, Susan G. Komen has supported this intervention as a means to ensure equitable access, quality care, and enhanced patient outcomes for all. Earlier this week, we announced the launch of a new patient navigation program which seeks to help women and men nationwide who may be facing this disease.
To many in need, patient navigators are a modern day superhero, fighting alongside any woman (or man) facing a breast cancer diagnosis.
Six years ago, that woman in need was facing breast cancer.
Realizing the magnitude of her situation, I took a deep breath and responded, “Whatever obstacle you face, we face together. We are in this fight to win. I have the tools, and you have the strength. Now let’s get down to work.”
(Follow-up: I am so thrilled to report that we were able to access medical assistance and appropriate care for this young woman, and she is now cancer-free, and happily married with two little boys!)
1 Freeman, H. Patient Navigation: A Community Centered Approach to Reducing Cancer Mortality. J Cancer Educ; 21(Suppl): S11-S14, 2006.