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ERA OF HOPE: TIME FOR ACTION
More than 1600 scientists, military personnel, advocates including CRAAB! Board member Wanda Burch and I, and others recently participated in the Fifth U.S. Department of Defense (DOD) Breast Cancer Research Program (BCRP) Meeting, the 2008 Era of Hope, in Baltimore.
In three plenary sessions, world-renowned scientists discussed risk and prevention, diagnosis, markers and individualized therapy. BCRP grant awardees presented research at 40 symposia, in 21 early morning sessions and on more than 1200 abstracts posters.
The four-day event drew enthusiastic applause for the tremendous strides BCRP has helped make happen in understanding the heterogeneity and complexity of this ancient disease, its initiation and progression, encompassing a wide spectrum of innovative and multidisciplinary research projects.
Because of the inclusion of breast cancer survivors in the research peer review decision making process, BCRP has become a model for other research programs. BCRP was a world pioneer, bringing breast cancer survivors to the scientific research grant review table as equal partners with scientists.
BCRP, through its funding and highly professional structure, attracts experienced as well as promising new scientists in an environment directed toward the eradication of breast cancer. It focuses on innovative, high-impact research and has integrated the perspectives of breast cancer survivors into all program aspects. It has received more than $2 billion in congressional appropriations since 1992, granting more than 5000 awards.
More than 10,000 publications have resulted from BCRP research; more than 11,000 abstracts have been published; over 400 patents and licensures have been issued.
This partnership of science, military and consumer advocate has eliminated forever the “ivory tower” and has given the advocate new power coupled with new responsibility.
I was honored to be among the early advocate reviewers (1995 and years following); I participated in the first Era of Hope in 1997 among others. Hence this report which I hope provides one breast cancer survivor’s view of then and now plus some highlights and comments. Because of the enormous volume of research presented simultaneously in various rooms, other observers would report differently.
To provide background on my perspective, at the 1995 review, a woman scientist, not knowing I was a “consumer” advocate criticized the BCRP policy for including us at the table. I replied that as a scientist she should reserve judgment until she had experienced the review process. She did change her mind.
At the 1997 Era of Hope, some of the plenary session presentations were still typed and shown in black and white via a slide projector. It was best to sit upfront to be able to read the screen. This time presentations were in full color with beautiful clear graphics projected on large screens. Although this comment may seem superficial, it reflects on the surface the advances and technological leaps that have been made in the actual scientific discovery process. At this point, the scientist has access to many tools and data information unavailable a decade ago.
History
BCRP, marking its 16th anniversary, was initiated as a result of the persistent grassroots campaign led by the National Breast Cancer Coalition (NBCC), Frances M. Visco Esq., its first and continuing president, and the breast cancer community who pushed for more breast cancer research federal funding. Because of its long history of biomedical research in diseases and other public health problems and its efficiency and experience in managing Congressionally-mandated programs, the U.S. Army Medical Research and Materiel Command (USAMRMC) was directed to manage BCRP. Congressional funding is allocated on a yearly basis. For more information please see http://cdmrp.army.mil./bcrp/era/default.htm See also NBCC at http://www.stopbreastcancer.org
In 1993, the National Academy of Sciences’ Institute of Medicine recommended BCRP’s management framework. Within that structure, advocates who have/have had breast cancer work side by side with scientists and management in the peer review process.
2008 Era of Hope Meeting
The Meeting offered a unique opportunity for participants to exchange ideas, learn more about the latest advances in fields other than their own, and identify promising new research directions. Advocates shared the podiums as co-chairs. To this observer there were no barriers to the information exchange among young and older scientists and advocates who dialoged with them at breaks and during sessions.
Causes/Prevention
As we know, this is a difficult challenge, not only in preventing the disease in the first place, but in stemming the metastatic cascade as cancer cells become more aggressive and resistant. At the 1997 Meeting, Dr. Malcolm C. Pike, Prof. of Preventive Medicine, Keck School of Medicine, Univ. of Southern Calif., Norris Comprehensive Cancer Center, discussed a healthy lifestyle – maintaining correct weight, eating nutritionally with emphasis on fruits and vegetables, and exercising. He cautioned that even those who followed all the rules could be subject to the disease.
Once again in 2008, the caveat that people who do all the right things still get breast cancer remains. However, the need for education about obesity, lack of exercise and alcohol consumption underscores CRAAB!’s risk reduction strategies.
Among BCRP Science Stars
Dennis Slamon, MD, PhD, chief, Division of Hematology/Oncology, UCLA Jonsson Comprehensive Cancer Center, pioneered in studies that led to the development and clinical use of the novel breast cancer drug called Herceptin for the treatment of Her-2/neu positive breast cancer. Dr. Slamon received funding from BCRP to study the effects of Her-2/neu overexpression and the impact of antibodies to Her-2/neu in normal and cancerous breast tissue. The July 8 issue of NCI Cancer Bulletin notes FDA approval that day of a genetic test that can help identify women with breast cancer who are candidates for the drug trastuzumab (Herceptin)
Graham Casey, PhD, Prof. of Preventive Medicine at the Univ. of Southern Calif., BCRP Integration Panel chair-emeritus, and Era of Hope Meeting technical planning committee co-chair, is known for his molecular genetics analysis of common human cancers.
George Sledge Jr. MD, Ballve Lantero Prof. of Oncology, Indiana Cancer Pavilion, Univ. of Indiana, spoke about individualized therapy, the critical need to collect tissue appropriately with standardized regulations, carefully annotate tissue/tumor registries and obtain metastatic tissue. Dr. Sledge oversees the Center of Excellence for Individualization of Therapy for Breast Cancer study, funded by the BCRP. See http://www.homepages.indiana.edu/042304/text/health.shtml and also the advocate core at www.researchadvocacy.org .
Robert A. Weinberg PhD, a founding member of Whitehead Institute and MIT Biology Prof. focuses primarily on interactions between epithelial cells and stromal cells, (the two major types of cells found in mammalian tissue) that produce cancers and the processes by which these cells invade and metastasize.
Mauro Ferrari, PhD is founder of the field of biomedical micro/nanotechnology, especially as it pertains to drug delivery and other innovative therapeutic modalities. At Ohio State, his appointments include professorships in biomedical engineering, internal medicine, mechanical engineering and materials science. Nanotechnology is the development and engineering of devices so small they are measured on a molecular scale. Devices can be one hundred to ten thousand times smaller than human cells. .
Martin Tornai PhD, Assoc. Prof., Radiology Dept., Duke Univ. Medical Center and Dept. of Biomedical Engineering, Duke Univ. Pratt School of Engineering, co-chaired the Era of Hope symposium: Imaging Technology for the New Millennium. Dr. Tornai has worked with a team to develop a series of breast scanners that can improve radiologists’ ability to see small tumors while reducing radiation exposure and providing a 3-D image of the breast without requiring painful breast compression.
What’s Ahead
The Meeting demonstrated how far the scientific community, riding the crest of new technologies and major advances, has come. For the future, I would look for:
A better understanding of why some women develop metastasis, some many years after the initial event. What triggers a dormant cancer cell to come to life? How can that be stopped?
One of my conversations was with Marilie Gammon PhD, who was Principal Investigator of the Long Island Breast Cancer Study Project and was co-chair of the Era of Hope symposium: Environmental Impact and Gene Expression. Dr. Gammon is Prof. of Epidemiology, Univ. of NC at Chapel Hill, School of Public Health. She mentioned briefly a focus concerning supplements taken by women before diagnosis, during treatment and post treatment. As we know, supplements, other medications, alternative remedies and the like taken during treatment without the approval of the oncologist can contradict chemo treatment and could be dangerous.
In the future, I would look for a better understanding of the internal and external human environment from fetal development through the teenage years and investigations into factors that might lead to breast cancer in later years.
And I would hope for a vaccine.
Some Personal Observations
I was very sad for the loss from breast cancer of friends and acquaintances who participated in one or more previous Eras of Hope. I feel admiration for those who are living with recurrence, some too ill to attend this year and others present and looking so beautiful.
I remember well the late Yvonne Andejeski, MD, radiation oncologist who was Lieutenant Col., Medical Corps, and the manager of the BCRP in 1995. Later, she became NCI’s program director for the Consumers Advocates Active in Research and related Activities (CARRA). She asked me to be a founding member. Dr. Andejeski died after a long battle with breast cancer.
From a past Era of Hope, I hold in memory CRAAB!’s Dr. Pat Brown, commenting on Poster abstracts; I recall SHARE’s Carol Hochberg co-chairing an angiogenesis symposium and asking questions of the scientists who had received funding. For these brave women who are no longer with us and for ourselves, it is TIME FOR ACTION.
Resources: Era of Hope (EofH) DOD BCRP Program and Proceedings Books, Press Kit, consumer advocates folder; U.S Army Medical Research and Materiel Command brochures on BCRP and Congressionally-directed Research Programs; websites listed in this report plus institutional websites with information about Doctors Weinberg, Casey, Ferrari, Tornai; NCI’s www.cancer.gov; NCI Cancer Bulletin of 7/8/2008; Triangle Business Journal 3/28/2008 feature on Dr. Tornai; EoH conversations with Dr. Patricia Modrow, conference chair, CDMRP, USAMRMC; with Janet Harris, PhD, RN who was CDMRP director and is now Director of Clinical and Rehabilitative Medicine, USAMRMC; with Doctors Tornai, Ferrari, Gammon, EoH advocates both new and from other EoH; scientists who had attended previous EoH; scientists from around the USA, young scientists from as far away as Chengdu (site of China earthquake); my EoH notes and previous reports, previous conversations with Doctors Slamon and Gammon. |
