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
A Comprehensive CancerCenter Designated by theNational Cancer Institute
N ICCCC
THE SIDNEY KIMMEL COMPREHENSIVE CANCER CENTER
AT JOHNS HOPKINS
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
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
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
Cancer Center Membership by Departments (253 Members*/27 Depts.)
Medicine4%
Rad Onc3%
Other10%
Oncology39%
Public Health8%
Pathology14%
Surgery17%
Radiology5%
Other includes: Anes, Bio Eng, Comp Med, Derm, Microbio, Mol Bio, Neur, Peds, Pharm, Phy, Radiol, SON
*18 Pending
NormalSmall
Adenoma CancerLargeAdenoma
Metastasis
APC/-catenin
TGF-RII/Smad4 p53K-Ras PRL-3
Chromosomal or Microsatellite
InstabilityVogelgram – early detection
30 to 40 years
Problems with DetectingAPC Mutations in Fecal DNA
1. Human DNA small fraction of fecal DNA
2. APC mutations are heterogeneous
3. Mutant APC genes <1% of WT genes
4. Contaminants in feces
Problems Comparison with widely used screening tests
Mammography
Sensitivity
75-88%
Specificity
83-98%Pap Smear
65-80%
90-98%
PSA 40-60% 88-94%
APC/fecal DNA 70% >99%
CA Cancer J Clin 2003;53:5-26
Decrease in UK and USA Breast Cancer Deaths from 1987 to 1997
Decrease in death rate per 100,000 women (Age Group)
20-49 50-69 70-79 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
Trends in Breast Cancer in Five-Year Survival Rates (%) by Race and Year of
Diagnosis 1974-1998
1974-76 1983-85 1992-98
White 75 79 88
African-American 63 63 73
All Races 75 78 86
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
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
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
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….
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
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
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