Doctors, scientists and patients are finding many reasons to be hopeful in the fight against breast cancer, as researchers at UC Davis and elsewhere figure out new ways of detecting and fighting the disease, the most common cancer in women.
But moving a promising new treatment or diagnostic technique out of the laboratory and into the clinic where it can help save lives is a long, involved process. For Tianhong Li, who joined the UC Davis Cancer Center in June as an assistant professor of medicine, it is a welcome challenge and one for which she is especially qualified.
"That's what needs to be done now," says Li, a physician-scientist who splits her time between research and clinical care. Li's job is to help spearhead the movement of new therapies and technologies developed at UC Davis into clinical trials. "It feels likes it's the right time, and I'm lucky to be in the right place."
As part of Li's role building a stronger bridge from the bench to the bedside, she is leading UC Davis' efforts in an ambitious new demonstration project – the ATHENA Breast Health Network, a multi-year, multi-center endeavor to provide the kind of boost to advances in breast cancer that the Framingham Heart Study in nurses had for cardiovascular disease.
ATHENA, launched this fall, will gather breast cancer screening, demographic, lifestyle and other information on 150,000 women from the five University of California cancer centers – Davis, Los Angeles, San Francisco, San Diego and Irvine – and will follow the patients for decades. Researchers hope the data will yield a greater understanding of the biology of breast cancer, which can be integrated into clinical care so that doctors better understand who is at risk for the most serious cancers, and how they can be prevented.
"We want to generate a new model of treating patients," Li explains – one that offers a personalized approach based on a more detailed picture of the individual's disease. By demonstrating the effectiveness and efficiency of such a strategy, ATHENA leaders hope to establish a model that could be used to manage other cancer types.
Also, by closely following women in the screening cohort treated for breast cancer, researchers will be able to hone their approach to managing the disease, so that patients with less invasive cancers can forego unnecessary procedures, and those with aggressive disease can get treatments tailored to their needs.
"It provides a way to view patients as a whole, and it enables us to follow them over time," Li says. "The idea is really to build an infrastructure so you monitor the patient from their screening mammogram through diagnosis, treatment, and then into survivorship." The ATHENA project requires "lots of layers of groundwork," Li says, and one of the first priorities is setting up standardized systems to gather and manage the wealth of information that will be generated.
A key part of that is creating the informatics architecture for the collection of data on a massive scale. Michael Hogarth, professor of pathology and laboratory medicine at UC Davis, is heading that effort.
Another goal is to establish a biospecimen repository of thousands of samples taken from women diagnosed with breast cancer at UC medical centers. The collection will include both specimens from tumors and from normal tissue adjacent to tumor. At UC Davis, that task will be directed by Regina Gandour- Edwards, professor of pathology.
That is good news to Colleen Sweeney, an associate professor of biochemistry and molecular medicine and co-director of UC Davis' breast cancer research program, who says one of the biggest challenges in her work is access to tumor specimens.
"Tumor specimens tell us if our hypotheses are valid," Sweeney says. "They are the ultimate litmus test."
A specimen can help determine, for example, whether a certain protein in breast tumors is a natural cancer fighter or if it has mutated into an oncogene that has the capacity to cause cancer.
"They're precious, and difficult to acquire," she says. "You need a large number of samples to make sure your results are statistically significant."
Leading ATHENA's pathology and biospecimen repository workgroup for all five campuses is Robert Cardiff, director of the Center for Genomic Pathology at UC Davis. He will be responsible for establishing common methods of managing breast tissue specimens, pathology diagnostic procedures and digital imaging of breast tissue.
Alexander Borowsky, an associate professor of pathology and laboratory medicine at UC Davis, is working on innovations for easier access to the specimens.
Tissue samples mounted on slides for examination under a microscope can be converted to digital images and stored in a database. But rather than downloading an entire image from a massive database, Borowsky says satellite image retrieval technology could be used to retrieve pixels on demand, displaying only a particular magnification of part of the specimen. Google uses the same kind of system to offer Web-surfers satellite views of their neighborhoods.
Borowsky also is figuring out how specimens could be collected and prepared not only for standard pathologic testing, but also for gene expression profiling. That could allow for personally tailored therapies, potentially revolutionizing treatment.
"Ultimately we might be able to say each patient's breast cancer is unique," Borowsky says.
The ATHENA biospecimen bank will be linked with various patient details, including whether their cancer went into remission, they developed resistance to a certain drug or their cancer recurred, for example.
"We need all this information so we can understand the impact of what we're studying on overall patient prognosis." Sweeney explains. The ATHENA network also will include a databank of mammograms and other imaging data from tens of thousands of patients.
Karen Lindfors, chief of breast imaging for the Department of Radiology, says that by correlating breast imaging results with other data, imaging specialists will better understand the implications of what they see.
Currently, breast cancer doctors don't have good data on what types of lesions may have a high likelihood of being benign and do not require aggressive treatment. In those cases, patients can be safely followed using surveillance imaging alone.
"It would be helpful for us to know what we need to worry about, and what we can ignore," Lindfors says. "The information gathered through ATHENA will allow us to come up with standards on such lesions like we have for mammography."
The ATHENA network also will create common systems integrating data collection, management and research across the UC campuses to advance every aspect of breast cancer science.
"Any time you have important clinical questions, it's always better to pull together our heads and resources," says Helen Chew, who leads the clinical breast cancer program at UC Davis. Dealing with breast cancer requires "a multimodality approach," she adds, in which medical oncologists work closely with surgeons, radiation oncologists and imaging specialists.
"There's nothing better than getting everybody in the same room, thinking about the same problem," Sweeney adds. "I think ATHENA will create a structure for that. Bringing together people from different disciplines and enabling their collaboration is really what's going to make the difference."