The latest discoveries related to breast cancer research, diagnosis and treatment will be presented by several of the nation's most highly esteemed breast cancer specialists at a day-long symposium at the University of California San Francisco, Thursday, April 30, from 9:00 a.m. to 5:15 p.m., at Cole Hall on the UCSF campus.
Researchers will present up-to-date results regarding new breast cancer diagnostic techniques; the genetics of breast cancer and what it means for prevention, diagnosis and treatment; and changing trends in breast cancer incidence and mortality, including the role of diet, hormones and environment. In addition, researchers and patient advocates will describe the increasingly important role that patient advocates are playing in developing research and treatment programs and in improving treatment outcomes for cancer patients.
The symposium is sponsored by the UCSF Cancer Center, directed by Frank McCormick, PhD, the David A. Wood Professor of Tumor Biology and Cancer Research. The goal of the UCSF Cancer Center is to become the first NCI-designated comprehensive cancer center in Northern California. UCSF expects to apply for the designation this year.
Speakers at the UCSF Cancer Center's day-long symposium include: Virginia Ernster, PhD, UCSF professor of epidemiology and biostatistics at UCSF, will provide an overview on the latest demographic trends in breast cancer incidence and mortality. Ernster also will discuss risk factors for breast cancer, including lifestyle, hormonal, and environmental factors; possible preventive strategies; and the pros and cons of mammography screening.
Ernster, who along with her colleagues has described an "epidemic of diagnosis" of a type of breast cancer called ductal carcinoma in situ, leads a large National Cancer Institute (NCI)-funded project to establish a computerized population-based mammography registry for San Francisco that will be linked to other registries and used to develop a better understanding of mammography practices and outcomes.
Laura Esserman, MD, MBA, director of the Breast Care Center at UCSF and assistant professor of surgery, will discuss new applications for magnetic resonance imaging (MRI) in the clinic and in research. Esserman's clinical research team has found that MRI can provide valuable information that breast cancer patients and their doctors can use to make decisions about surgery or chemotherapy.
With more women choosing less invasive surgery or using chemotherapy to shrink tumors prior to surgery, it becomes increasingly important to define the boundaries of tumor tissue adequately, so that the tumor can be removed while healthy breast tissue is preserved.
Esserman and colleagues have determined that MRI can be used to more precisely define the boundaries of already diagnosed breast tumors. This information can be used to minimize the amount of healthy breast tissue destroyed during surgery and can reduce the incidence of repeated surgery to remove previously missed tumor cells.
Joe Gray, PhD, director of the Breast Oncology Program at UCSF, will discuss the genetic characteristics of breast cancer that may contribute to disease progression and response to therapy. He will describe new, highly efficient procedures developed at UCSF for discovery and classification of genetic abnormalities and illustrate their use for analysis of breast cancer. These studies clearly show that the genetic characteristics of breast cancers are highly variable, even for tumors that appear clinically similar. Application of the new analysis procedures promises to allow classification of tumors into groups that progress and respond to therapy in the same way.
Gray also will discuss how efficient genome-analysis procedures coupled with information from the human genome program have increased the speed with which genes involved in breast cancer can be discovered and studied. Details of genes discovered using this approach will be presented.
David Livingston, MD, the Emil Frei Professor of Genetics and Medicine at Harvard Medical School and the Dana-Farber Cancer Institute, will describe the state-of-the-art in understanding how breast cancer genes actually contribute to breast cancer at the level of an individual cancer cell.
The breast cancer gene BRCA1 was discovered in 1994, and a second breast cancer gene, BRCA2, was discovered in 1995. However, until Livingston and colleagues published their findings in the January 24, 1997 issue of Cell, researchers did not know how either BRCA gene -- when abnormal -- could contribute to cancer. Livingston's research suggested that BRCA1 normally helps maintain and repair DNA, in effect suppressing the accumulation of mutations that is essential to tumor development.
Albert G. Mulley, MD, MPP, associate professor of medicine and health policy at Harvard Medical School, chief of the General Internal Medicine Division and director of the Medical Practices Evaluation Center at Massachusetts General Hospital, and Deborah E. Collyar, president of the Patient Advocacy In Research (PAIR) and director of the Clinical Trials Information Project (CTIP) and Advocacy Core, will discuss the role of patients in improving treatment outcomes.
Programs that foster shared decision-making among physicians and breast cancer patients lead to better patient satisfaction and lower health care costs, according to Mulley. Mulley will discuss shared-decision-making programs to support clinicians and breast cancer patients in their decision-making roles. Mulley has found that these approaches decrease utilization of high-cost medical and surgical interventions while improving patient satisfaction, decision quality, and health-care outcomes.
Collyar will discuss breast cancer patients' perspectives on the decision-making process. Collyar is a two-time breast cancer survivor herself, and through her patient advocacy programs, aims to "bring the voices of breast cancer patients into the research dialogue."
The Advocacy Core program, of which Collyar is program director, supports the NCI-funded San Francisco Breast SPORE research program. The Advocacy Core program has over 100 members, and conducts focus groups, projects and activities that are designed to identify the treatment and research issues that breast cancer patients believe to be the most important.
Larry Norton, MD, Chief of the Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center, will explain how researchers are trying to make the best use of genetic information in improving the lives of cancer patients, by learning to interpret the genetic fingerprints of tumors, the quality of which is improving exponentially with recent advances in laboratory technology and techniques.
Norton is using fractal geometry to develop models to help interpret these increasingly detailed genetic fingerprints so that the information can be used to improve cancer prognostication and treatment. If this genetic information is demonstrated to have value in tailoring treatment to individual cancer patients, as is expected, researchers suggest that within a few years oncologists will routinely be able to order new laboratory tests -- making use of sophisticated biosensors called "microarrays" -- to obtain detailed read-outs of the many genetic abnormalities commonly present in cancer cells.
Jeffery Struewing, MD, of the NCI's Division of Cancer Epidemiology and Genetics aims to determine just how cancerous "cancer genes" really are. In his presentation, Struewing will describe creative scientific approaches he is using to find more accurate answers to questions of genetic cancer risk.
Struewing and his NCI colleagues published findings in the May 15, 1997 issue of the New England Journal of Medicine suggesting that mutations in the breast cancer genes BRCA1 and BRCA2 are somewhat less deadly than originally reported. Struewing is now studying BRCA defects in Iceland, where population characteristics offer unique advantages to genetics researchers.
Long known as a major center for basic cancer research, UCSF is working to enhance clinical research by arranging to provide access to both clinical care and trials under one roof. Construction of a new building to house the clinical cancer programs of UCSF Mount Zion Medical Center, part of UCSF Stanford Health Care, is scheduled to break ground this year. In addition, UCSF opened its new cancer research building in 1997 and is continuing to recruit nationally recognized researchers to the facility.
The UCSF Cancer Center's research and clinical programs are being established with a focus on integrating all aspects of research and treatment around specific cancers. The Breast Oncology Program at UCSF, supported by several major grants, is serving as a model for the continuing development of these programs.
THURSDAY, APRIL 30, 1998
UCSF CAMPUS, COLE HALL
9:00am-5:15 pm
BETWEEN 1:20-2:00 PM, MORNING SPEAKERS WILL BE AVAILABLE TO ANSWER MEDIA QUESTIONS
BETWEEN 5:00-5:45 PM, AFTERNOON SPEAKERS WILL BE AVAILABLE TO ANSWER MEDIA QUESTIONS
9:00-9:30:
Introduction
9:30-10:15:
Overview of Breast Cancer Epidemiology
Virginia L. Ernster, PhD
10:15-11:00:
BRCA 1 & 2: Cancer Risk Estimates
Jeffrey P. Struewing, MD
11:00-11:15:
BREAK
12:00-12:45:
A Catalyst for Change: Developing Technology in Breast
Cancer Imaging
Laura J. Esserman, MD, MBA
12:45-1:20:
LUNCH
1:20-2:00:
MEDIA SESSIONS FOR MORNING SPEAKERS
2:00-2:45:
Models for Neoplasia: Multifactorial Carcinogens in
Breast Cancer
Larry Norton, MD
2:45-3:30:
Shared Decision Making in Breast Cancer
Albert J. Mulley, Jr., MD, MPP, and Deborah Collyar
3:30-3:45:
BREAK
3:45-4:30:
Cancer Genomics: Genomes to Genes
Joe W. Gray, PhD
5:00-5:40:
MEDIA SESSION FOR AFTERNOON SPEAKERS