Excerpt: Tackling a Racial Gap in Breast Cancer Survival

Every day in our work with cancer patients and research doctors, we are reminded of the importance of continuing to fund life-saving advancements and consistently renew our commitment to our foundation’s mission. A recent article in The New York Times states the eye-opening fact that black women are far more likely to die of breast cancer than white women, shining new light on the urgency of funding better treatments for every woman:

The cancer divide between black women and white women in the United States is as entrenched as it is startling. In the 1980s, breast cancer survival rates for the two were nearly identical. But since 1991, as improvements in screening and treatment came into use, the gap has widened, with no signs of abating. Although breast cancer is diagnosed in far more white women, black women are far more likely to die of the disease.

And Memphis is the deadliest major American city for African-American women with breast cancer. Black women with the disease here are more than twice as likely to die of it than white women.

“The big change in the 1990s was advances in care that were widely available in early detection and treatment,” said Steven Whitman, director of the Sinai Urban Health Institute in Chicago. “White women gained access to those advances, and black women didn’t.”

Over all, black women with a breast cancer diagnosis will die three years sooner than their white counterparts. While nearly 70 percent of white women live at least five years after diagnosis, only 56 percent of black women do. And some research suggests that institutions providing mammograms mainly to black patients miss as many as half of breast cancers compared with the expected detection rates at academic hospitals.

To read the full article, please click here.

Women of Influence!

We’re excited to congratulate Randi Rahm, one of our esteemed honorees for the Women of Influence Awards coming up on May 1st, 2014. The one and only Beyonce wore one of Randi’s gorgeous dresses to the White House this weekend for Michelle Obama’s birthday!

For more information on the Women of Influence Awards and to buy your tickets, please click here.

Guest Blog Post: What Causes Breast Cancer?

Dr. James Holland is the Distinguished Professor of Neoplastic Diseases at the Icahn School of Medicine at Mount Sinai and his leadership is instrumental in the development of the T.J. Martell Memorial Laboratories in the Icahn School of Medicine at Mount Sinai.

Although there has been wonderful progress in diagnosing breast cancer in the last 35 years using physical exam, sonography, mammography and magnetic resonance imaging, and in surgery, substituting lumpectomy for radical mastectomy, and sentinel node biopsy for wide dissection, and in radiation therapy, hormone therapy, chemotherapy and immunotherapy, so that the majority of women are now cured of this common disease,  little research has been done on finding one or more causes that makes this disease so common.

Recognized inherited genetic factors account for less than 10% of cases. The T.J. Martell Memorial Laboratories in the Icahn School of Medicine at Mount Sinai has a deep program exploring a viral cause for human breast cancer. Breast cancer in mice is known to be caused by a mammary tumor virus (MMTV).  We have found a virus 90 to 95% identical to MMTV which we have named HMTV, in 40% of the breast cancers in American women.  We can infect other cells with it, indicating HMTV is alive and active.  It is not in the normal tissues of the patient, thus excluding genetic inheritance, but rather is acquired after birth.  The distribution of the virus in breast cancers around the world (high in the USA, low in China for example) parallels the content of MMTV in the different species of mice which varies widely.

The work will continue until we provide rock solid proof that HMTV causes human breast cancer, which then opens up new means of prevention and therapy.  And none of this would have happened without Martell Foundation support.

Guest Blog Post: Breast Cancer Research is Saving Lives

Dr. Jennifer Pietenpol, Director of the Vanderbilt-Ingram Cancer Center, B.F. Byrd Jr. Professor of Oncology and Professor of Biochemistry and Otolaryngology (with notebook), meets with breast cancer advocates.

Dr. Jennifer Pietenpol is Director of the Vanderbilt-Ingram Cancer Center, B.F. Byrd Jr. Professor of Oncology and Professor of Biochemistry and Otolaryngology.

During October, the nation seems to be awash in the color pink as individuals, sports figures and even businesses recognize Breast Cancer Awareness Month. This colorful display is a visual reminder that more than 230,000 women will be diagnosed with breast cancer this year and nearly 40,000 will die from the disease. We all have a stake in trying to save the lives of these family members, friends and neighbors.

The encouraging news is that breast cancer death rates in the U.S. are actually falling, thanks to better diagnostic tools and improved cancer therapies. Vanderbilt-Ingram Cancer Center in Nashville has been one of the leaders in the effort to understand what is happening at the molecular level in breast cancer and to test new therapies to address those molecular markers.

In the past two years, investigators in my laboratory have discovered at least six subtypes of triple negative breast cancer – a particularly aggressive form of the disease for which there are few treatments. We are now initiating clinical trials to target these subtypes with specific therapies. A clinical trial for the luminal androgen receptor subtype will combine anti-androgen therapy with a drug targeting the PI3K pathway, which is often altered in this subtype. Another clinical trial will use chemotherapy with a PI3K inhibitor to target the other subtypes of triple negative breast cancer.

Using tumor biopsies that are embedded into the trials, we will also gain information about why certain tumors respond to these treatments while others don’t. In other breast cancer studies, we have tested new therapies that can shrink breast tumors before surgery, giving some women the option for less aggressive surgery and a better chance for a cure.

Many of these research initiatives at Vanderbilt-Ingram are made possible through the support of the T.J. Martell Foundation, which has been a longtime partner of the Cancer Center. In 1993, the Martell Foundation helped launch the Frances Williams Preston Laboratories in support of cancer research at Vanderbilt. Today, under the leadership of Harold (Hal) Moses, M.D., director emeritus of Vanderbilt-Ingram, dozens of scientists in the Preston Laboratories are exploring the mysteries behind breast cancer and working to uncover clues that will lead to better treatments.

In an era of dwindling federal funding for research, financial support from organizations like the T.J. Martell Foundation is crucial for the future of our research mission. We are grateful for the grassroots efforts of Martell-supported initiatives like Team Martina, an organization of singer Martina McBride’s fans who raise funds in support of breast cancer awareness and research. Martina McBride and Team Martina recently donated more than $40,000 to Vanderbilt-Ingram to help us expand our leading-edge cancer research efforts.

Guest Blog Post: Mammography – A Limited Tool for Early Detection of Breast Cancer

Dr. Margaret Cuomo is the author of “A World Without Cancer: The Making of a New Cure and the Real Promise of Prevention.”

Margaret I. Cuomo, M.D. is a Board-certified radiologist; Board member, Lesscancer; Author, ‘A World Without Cancer;’ and T.J. Martell Foundation Women of Influence honoree. She wrote the following post on this week’s mammography report for HuffingtonPost.com, which we excerpt below:

Mammography has been the gold standard for early detection of breast cancer since the 1970s but has been surrounded by controversy more recently. In 2009, the United States Preventive Services Task Force (USPSTF) recommended that routine screening mammography begin at age 50, and that screening should be optional for younger women. Mammograms performed every two years, rather than annually, was advised for women of average risk of breast cancer.

The American Cancer Society, American College of Radiology, and others opposed the USPTF recommendations and supported annual mammograms and also advised annual mammography for women younger than 50.

This week, a study in Cancer by Blake Cady, M.D., of Massachusetts General Hospital in Boston, and co-authors reported that annual mammography has a definite survival benefit for young and older women:

Regular screening increases the likelihood of detecting nonpalpable cancers (cancers that cannot be detected by physical examination), and annual screening further increases the likelihood relative to biennial screening.

These authors also analyzed breast cancer and non-breast cancer deaths by age and discovered that half of all breast cancer deaths occurred in women younger than age 50, and 69 percent before age 60.

What Dr. Cady and his colleagues are not examining is the effect on cancer risk due to the radiation exposure of annual mammograms beginning at a young age.

Other scientific studies have reported on the radiation risk from screening mammography in women younger than age 50, especially among women with a family history of breast cancer, or a genetic predisposition. [1] While these studies have admitted a risk of cancer due to annual mammograms, the public’s perception is that the risk is small compared with the benefit in saving women’s lives. [2] [3]

We can all agree that mammography is a limited screening tool at best. It is time to engage in an intensive, focused research effort to discover the specific biomarkers that will assess a women’s breast cancer risk and identify those patients most likely to benefit from a specific molecularly-targeted therapy. A non-invasive test that is sensitive and specific for the early detection of breast cancer is a goal worthy of our investment and dedication.

Mammography will remain a controversial issue because it is an imperfect tool involving ionizing radiation. Let’s move beyond this method that is decades old and move forward with an early detection method for breast cancer that will not increase a women’s cancer risk at all. The National Cancer Institute, American Cancer Society and research institutions across the U.S. could join in a collaborative effort to achieve this goal so that our daughters and granddaughters will have a safer, more intelligent approach to breast cancer screening.

For the full article, please click here.

A World Without Cancer – Guest Post

Dr. Margaret Cuomo is the author of “A World Without Cancer: The Making of a New Cure and the Real Promise of Prevention;” she is a board-certified radiologist who served as an attending physician in diagnostic radiology at North Shore University Hospital in Manhasset, N.Y. for many years. She was the keynote speaker at the T.J. Martell Foundation’s inaugural Women of Influence Awards at Riverpark in New York City.

We are honored to share her perspective here on Angelina Jolie’s courageous decision regarding the discovery of her BRCA1 genetic mutation and subsequent bilateral (aka “double”) mastectomy, as well as the implications for the cancer community.

Dr. Margaret Cuomo is the author of “A World Without Cancer: The Making of a New Cure and the Real Promise of Prevention.”

Angelina Jolie has my admiration for her courage in publicly describing her decision to undergo a bilateral (aka “double”) mastectomy. Her BRCA1 genetic mutation significantly increases her risk of developing breast cancer and ovarian cancer.

According to Jolie’s New York Times op-ed piece, her doctors estimated that she has an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer. Women who have inherited BRCA1 and BRCA2 mutations account for 5 to 10 percent of breast cancers and 10 to 15 percent of ovarian cancers (for white women) in the United States, according to the National Cancer Institute.

Knowing that her own mother died at the age of 56 following her battle with cancer, Angelina Jolie, the mother of six children, decided to be pro-active, and decided to sharply reduce her risk of breast cancer by undergoing the mastectomy.

The question that I hope many women are asking is: “Is this the best that we can do in the 21st century?” After 41 years and more than 90 billion dollars spent since the War on Cancer was declared, we should expect more effective and less invasive solutions to reducing breast cancer, and all cancers.

Are the National Cancer Institute and the pharmaceutical industry committing enough of their intellectual and financial resources to the discovery of safe, new ways of detecting breast cancer and ovarian cancer in their earliest stages?  If a patient has a BRCA1 or BRACA2 mutation, are there techniques available to “turn-off” the faulty genes?

Is there a sense of urgency about finding new tests to detect breast cancer and ovarian cancer, and other cancers, that do not involve radiation – a known carcinogen?

The prevention of cancer should be our ultimate goal and it should have the full benefit of the National Cancer Institute’s and industry’s vast resources.

Our children are our future, and we should expect that their generation will prevent cancer without the traumatic solution that Angelina Jolie felt obliged to accept.

Genetic Evaluation and Testing for Cancer – Guest Post

Many thanks to Georgia L. Wiesner, M.D., Director, Vanderbilt Hereditary Cancer Program, for this informative guest blog post.

Recent headlines about Angelina Jolie, a well-known actress and movie producer, and her decision to have a prophylactic bilateral mastectomy to reduce risk for breast cancer have taken the world by surprise. In a recent article, Ms. Jolie outlined her genetic evaluation in which she was found to be the carrier of a mutation in a gene called BRCA1. Because of her gene status, she decided to reduce risk for breast cancer by removing her normal breast tissue.

Why would someone choose to have such a “radical” response to cancer risk? In order to understand the dilemma that many people face, it is important to know that Ms. Jolie’s situation is relatively unusual. In fact, mutations in BRCA1 and BRCA2 only account for 5 percent to 10 percent of breast cancers and 10 percent to 15 percent of all ovarian cancers every year. If a person is found to have a high-risk mutation, then prophylactic surgeries are one of several high-risk management options.  In addition to surgery, there are certain medications as well as enhanced screening and surveillance available for these patients. An important point is that anyone considering this option should be evaluated by a specialist prior to making such an important decision.

The next question might be “how does someone know whether they are at high-risk for cancer?” Fortunately, there are genetic specialists and other health professionals who can help patients understand whether they are at high risk for cancer and then guide patients through the process of genetic testing. The process of genetic evaluation risk assessment and counseling is a new area of medicine called cancer genetics. Genetic professionals will use details from the family history to determine whether testing is a reasonable option.

The Vanderbilt-Ingram Cancer Center, a recognized leader in genetic medicine for cancer, has recently established the Clinical and Translational Hereditary Cancer Program with the primary mission to care for patients and families at high risk for cancer. Importantly, after patients are seen in the Hereditary Cancer Clinic, they can be referred to other caregivers, such as surgeons or high-risk nurse practitioners for further care.

Main Points

  • A small number of people will have an inherited risk for cancer
  • It is important to know your family history of cancer
  • Genetic evaluation and counseling is the first step in understanding cancer risk
  • The VICC Hereditary Cancer Clinic at Vanderbilt University Medical Center is open to all patients for full evaluation and counseling
  • Appointments can be made by calling (615) 343-7400

Georgia L. Wiesner, M.D.
Director, Vanderbilt Hereditary Cancer Program
Ingram Professor of Cancer Research and Professor of Medicine

Vanderbilt Researchers Find Potent Genetic Risk Factor for Breast Cancer

Researchers at Vanderbilt University have found a powerful new genetic risk factor for breast cancer.

Using data from population-based studies of women in Shanghai, China, Jirong Long, Ph.D., assistant professor of Medicine, and colleagues discovered a deletion in a cluster of genes, called APOBEC3 genes, that are known to trigger DNA mutation and which have previously been implicated in cancer.

If a woman has a deletion in one of the two sets of genes she inherits from her parents, her risk of breast cancer increases by 31 percent. If the deletion is present in both sets of genes, her risk increases by 76 percent.

“This is the first copy number variation or CNV identified for breast cancer and is one of the strongest common genetic risk variants identified so far for breast cancer,” the researchers reported in the Journal of the National Cancer Institute.

For the full article, please click here.

Martina McBride – A True Class Act

 

 

 

 

 

 

We at the T.J. Martell Foundation are lucky enough to count country music superstar Martina McBride among our kindest supporters. This award-winning artist has one of the most beautiful voices in the world, and she has come to many of our events in New York and Nashville over the years. Now her amazing fans have raised over $26,000 for breast cancer research after being inspired by her song, “I’m Gonna Love You Through It,” which describes one woman’s emotional true story about her breast cancer diagnosis and treatment. Hitting a particular chord during October, which was Breast Cancer Awareness Month, her fan club members formed Team Martina and have dedicated over $26,000 to a grant in Martina’s name at the Vanderbilt-Ingram Cancer Center in Nashville through our foundation.

 

So I just want to take this opportunity to thank Martina and her amazing team of fans, who show no sign of stopping in their fundraising efforts! We are so blessed to have an internationally beloved artist like Martina McBride using her fame to raise funds for cancer research. We truly hope that other celebrities will be inspired to follow in Martina’s footsteps and join us in funding better treatments and cures for leukemia, cancer & AIDS! To donate to this amazing cause,please click here!

Coping with a Cancer Diagnosis

October is Breast Cancer Awareness Month, and we are excited to feature several guest bloggers on this topic. Today’s post is from Jimmie C. Holland, MD, Wayne E. Chapman Chair in Psychiatric Oncology and Attending Psychiatrist at Memorial Sloan-Kettering Cancer Center. She offers these tips for families who are dealing with a recent diagnosis:

1)      Communication is critically important between all members of the family. The more open and transparent it is, the better. Secrets usually turn out not to be helpful.

2)      Recognition of the stress on all family members. There is often a need for a family member to take on a new role (eg managing the household, cooking and caring for the patient) while also assuring that the job of the breadwinner continues. The role changes are difficult, both for those taking the new role, and for the person who is ill who must relinquish control and prior role to others; a “new normal” must be accepted by all.

3)      Frustration and even anger are going to occur; it should be identified as normal in these circumstances and become a topic for discussion among family members, often bringing them closer to one another by understanding how it feels to each one.

4)      There are families who pull together under stress and become all the stronger for it. They usually manage without help. However, some families lack cohesiveness and members are unable to support one another as would be helpful. It is important that these families ask for help. The American Psychosocial Oncology Helpline can help you find counselors in your community who can help: 1-866-276-7443.

Jimmie C. Holland, MD
Wayne E. Chapman Chair in Psychiatric Oncology
Attending Psychiatrist
Department of Psychiatry & Behavioral Sciences
Memorial Sloan-Kettering Cancer Center