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Emerging Issues in Cancer Control :

Emerging Issues in Cancer Control :. The Perspective from The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Martin D. Abeloff, M.D. Director – SKCCC November 12, 2003. Mission. To decrease the mortality and morbidity from cancer

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Emerging Issues in Cancer Control :

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  1. Emerging Issues in Cancer Control: The Perspective from The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Martin D. Abeloff, M.D. Director – SKCCC November 12, 2003

  2. Mission • To decrease the mortality and morbidity from cancer • To excel in cutting edge basic, clinical and translational research • To provide the full range of highest quality, affordable, preventive, diagnostic, and therapeutic services • To be a leader in education • To demonstrate respect and provide support for faculty and staff while fulfilling the Center’s mission

  3. Research AccomplishmentsThe Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins • Elucidation of the molecular steps in the development of colon cancer • Identification of markers of risk for development of cancer • Therapies for prevention of cancer

  4. Research AccomplishmentsThe Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins - (continued) • Discovery and development of new anti-cancer therapies including drugs, vaccines, and bone marrow transplantation • New approaches to supportive and palliative care

  5. Cancer Center Membership by Departments (253 Members*/27 Depts.) Other includes: Anes, Bio Eng, Comp Med, Derm, Microbio, Mol Bio, Neur, Peds, Pharm, Phy, Radiol, SON *18 Pending

  6. Vogelgram – early detection 30 to 40 years APC/ -catenin TGF-RII/ Smad4 K-Ras PRL-3 p53 Small Adenoma Large Adenoma Cancer Metastasis Chromosomal or Microsatellite Instability Normal

  7. Problems with DetectingAPC Mutations in Fecal DNA • Human DNA small fraction of fecal DNA • APC mutations are heterogeneous • Mutant APC genes <1% of WT genes • Contaminants in feces

  8. Problems Comparison with widely used screening tests Sensitivity Specificity Mammography 75-88% 65-80% Pap Smear 83-98% 90-98% PSA 88-94% 40-60% 70% APC/fecal DNA >99%

  9. CA Cancer J Clin 2003;53:5-26

  10. Decrease in UK and USA Breast Cancer Deaths from 1987 to 1997 Decrease in death rate per 100,000 women (Age Group) 20-4950-6970-79 UK 22% 22% 12% USA 19% 18% 9% “This substantial reduction in national mortality rates has come not from a single research breakthrough but from the careful evaluation and adoption of many interventions, each responsible on its own for only a moderate reduction in breast cancer mortality” Peto et al:Lancet 2000:355:1822

  11. Trends in Breast Cancer in Five-Year Survival Rates (%) by Race and Year of Diagnosis 1974-1998 1974-761983-851992-98 White 75 79 88 African-American 63 63 73 All Races 75 78 86

  12. Key Factors Leading to Changes in Management of Breast Cancer • Marked increase in understanding of biology of breast cancer (molecular and cellular biology) • Development of clinical research centers, networks, infrastructure, and methodologies • Improvements and innovations in surgery and radiation therapy • New drugs and combinations: cytotoxic, endocrine, targeted biologic therapies • Patient autonomy • Patient advocacy movement

  13. The Future of CancerResearch and Care • Greater emphasis on prevention Changes in life style – nutrition, exercise, tobacco, alcohol Chemoprevention • Screening and early detection Molecular markers Molecular imaging • Molecular targeting of cancer as basis of therapy and prevention

  14. The Future of CancerResearch and Care (cont.) • Multimodality therapy will continue to be central theme • Incremental gains • Not simply a biomedical challenge – Societal imperatives! • Integration with State initiatives in particular the State cancer plan

  15. MD Cancer Plan Chapter 13:Cervix Cancer Objective 6 • Conduct a follow-back study to determine factors that contribute to women developing or dying from invasive cervical cancer…. • Establish and maintain mechanisms to monitor the proportion of cervical cancer cases and deaths attributable to failures of detection….

  16. CRF Research Grants atThe Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Connie Trimble: Center for Cervical Studies • Proportion without timely screening • HPV status follow-up • Case management • Vaccine development Kristen Kjeruff: Racial Disparities among Cervical Cancer Patients • Patient characteristics • Treatment outcomes

  17. MD Cancer Plan Chapter 8Environmental Health and Cancer Objective 2 – Improve data collection and carcinogen exposure assessment Objective 3 – Enhance collaboration between academic research institutions and State and local public health departments

  18. CRF Research Grants atThe Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Tim Buckley and Tom Burke: Cancer Prevention in Maryland through Risk Characterization • Identify environment-related cancers • Quantify human risk from monitoring data • Test correlations and calculate environmental contribution to cancer occurrence • Tracking projects with MD health officials underway Anthony Alberg: The Joint Influence of Active and Passive Smoking on Cancer Incidence • Quantification of active and passive smoking risks in a western MD population

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