Report from the San Antonio Breast Cancer Symposium

December 13 - December 17, 2006

Nan Van Den Bergh, PhD, LCSW,
Florida Breast Cancer Coalition
and
School of Social Work, Florida International University
Miami, Florida

As a representative from FBCC and as a scholarship recipient from the Alamo Breast Cancer Foundation I had the good fortune to participate within the SABCS. This is an extraordinary opportunity to be privy to the most recent research related to breast cancer. What was most impressive to me about the sociology of the conference is that over 8000 people attended from over 60 countries, and the majority of attendees were NOT from the Untied States. This was truly the most international conference that I have ever participated in and it was heartening to realize that scientists, physicians and advocates from around the world are working together on eliminating breast cancer and finding more effective and less toxic treatments. In terms of the advocate community international representatives included women from Russia, Israel, Greece, Italy, and Germany. Also part of our advocate coalition were two male survivors; hence, we were a very diverse group including survivors from every region of the U.S., East to West Coast, North to South and the great Midwest.

Perhaps the single most important finding from SABCS was that there was a 7% drop in incidence of breast cancer during 2003. This is the year that warnings were issued from the Women’s Health Initiative study of over 90,000 post menopausal women noting the increased link between taking hormone replacement therapy and breast cancer incidence. This is quite extraordinary as an epidemiological finding which will be monitored to see if this pattern plateaus or continues to drop.

Another interesting finding was that a link has been discovered between a low fat diet predicting to less likelihood of breast cancer occurrence. There was some suggestion that this link was stronger for women with ER- than ER+ tumor types.

An additional lifestyle finding of interest is that women who engaged in exercise DURING chemotherapy felt better than a control group of women not exercising. This is excellent information and makes sense as dopamine is released during exercise which is an innate, endogenous pain killer. In other research unrelated to breast cancer, exercise has also been seen as effective in improving mood. So, this is good news for breast cancer patients as well as doctors. Despite the nasty side effects from chemotherapy, women should be encouraged to remain as active as possible, and as noted above, eating a low fat diet could also be helpful.

As an advocate at SABCS we each are given a “hot topic” to study during the conference and to then write a report. What follows is a report on the topic assigned to me, new technology for breast cancer research. This was a topic area for which I have no academic training, as it pertained to molecular biology. However, by asking the scientists to translate into lay person’s terms their study design and findings, I am able to share that the new frontier in breast cancer research extends beyond the human genome, to the most basic component of cells, protein. This is exciting and it feels as though we are ever closer to gaining greater clarity on the causes of breast cancer. Breast cancer is not one disease but many. The most basic unit of analysis for studying diseased cells is its proteins, which are the cells’ building blocks. Scientific instruments such as mass spectrometers have been developed to gauge the size and weight of protein molecules. This allows for those minute particles, proteins, to be measured and compared which advances the potential to have more targeted treatments. Hence, it may be the case that an idiosyncratic “chemo-elixir” could be created for each individual patient, based on an assessment of the discrete proteins within her malignant cells.

So, to be the beneficiaries of these important advances within breast cancer research, advocates must be ever vigilant to keep pressuring for maintenance and expansion of breast cancer research endeavors through the Department of Defense and NIH funding mechanisms, as well as elsewhere. Remember, the extent to which important research is undertaken is highly influenced by our ability as advocates to stand up and be heard. Survivors: don’t agonize, organize!

New Technology and Its Impact on Breast Cancer Cause and Cure.

“The best treatment for the average woman is not necessarily the best treatment for the individual woman.”

The above quote encapsulates the “whys” of new technology discussed at the San Antonio Breast Cancer Symposium. Just as exploration of the human genome has allowed for the development of better treatments, new technology has peeled away more “skins on the onion” in terms of understanding breast cancer causation and hence, cures.

In essence new technology allows for identifying proteins related to metastatic growth as well as those which respond to specific drug treatment. The human genome contribution to breast cancer has been a greater understanding of the role of DNA components, genes, which serve as the blueprint for cell division. The new technology focuses on proteins (proteomics) which are the “foot soldiers” carrying out the work of the cell. It is ultimately protein which explains the diversity of human beings. Hence, new technology is moving breast cancer microbiology from the human genome to the most basic aspect of a cell, protein.

One new technology involved in breast cancer proteomics utilizes lasers and mass spectrometers. A laser vaporizes a cell and those vapors are captured within a mass spectrometer where the amount of protein can be measured. Within one general session report the utilization of this new technology was as follows. A frozen slice of tumor cell was “zapped” with a laser. The vaporized proteins were drawn into a mass spectrometer which assessed the protein molecules’ weight. This technology created an understanding of how much of a certain protein was within a malignant cell. Such knowledge helps to identify which proteins to focus on in terms of those implicated in breast cancer growth. This information facilitates a better understanding of what causes cancer which enables progress toward more effective and targeted treatments. ( General Session 2 #9, D.L. Ellsworth et al, Direct tissue characterization of protein expression in metastatic breast cancer)

A second proteomic study discussed a technology which can interrupt the translation process between the genetic code of a cell and its creation of cell protein.

By doing this it is possible to isolate how a certain protein responds to taxol. If it is seen that a particular protein does not respond to taxol, then it helps to understand the kinds of patients for whom provision of taxol would not be helpful. The implications are physicians would be able to do tests assessing as to whether a patient has “protein x.” This would determine whether that patient would or would not be given taxol. (General session 7 #44, Swanton C et al, Functional genomic RNA interference screen to identify regulators of multidrug sensitivity and resistance)

The individual from who I gained the greatest understanding of new proteomic technologies and their implications for breast cancer cause and cure was a recipient of a Department of Defense Breast Cancer Innovator Award. Dr. Susan Clare was effusively grateful to the breast cancer advocate community for continuing to lobby for maintenance of the DOD awards. Because her project was innovative and exploratory, the probability of her receiving funding through the typical NIH award structure was unlikely. Dr. Clare felt she would not have been able to undertake her project without the DOD award. “Keep up the excellent advocate work” was her feedback. (Poster#4104 Choi, M R et al, Effects of operative intervention on the growth of metastases)

Dr. Clare’s study was precipitated by an interest in exploring why mastectomy patients had a greater likelihood of recurrence after 4 years. She compared a “control” mouse with a mastectomy mouse. She was looking at protein differences focusing on cytokine growth factors that lead to cell proliferation. Her research team chose one protein, leukemia inhibitory factor, which is well known for stem cell proliferation. By the use of laser and mass spectrometer technology she found that tumor cells expressed more of the leukemia inhibitory factor. Consequently, this protein could be more implicated in propensity for subsequent proliferation in post menopausal women.

Hence, the new technology highlighted at SABCS focused on proteomic assessment. The question becomes why is this important? The answer is that by this explicit identification of proteins implicated in tumor growth or not responsive to neither chemotherapy nor hormone therapy, it becomes possible to create more targeted treatments.

This understanding takes us back to the opening quote highlighting that there really cannot be a one size fits all “best practices” approach to breast cancer. The new technologies move breast cancer research beyond study of genes (genomics) to investigation of proteins (proteomics) which can facilitate the development of more targeted and less toxic interventions.