Komen-Funded Research: Seeking New Approaches for Early Detection

For more than three decades, a primary focus of the breast cancer movement has been increasing access to breast cancer screenings, particularly mammograms. After all, early detection puts a woman on a path to early treatment, which generally leads to better outcomes.

Locally, breast cancer screening is a key funding priority, as evident in the services provided by Komen St. Louis’ current community grant recipients.

This focus has paid off. Through a combination of increased early detection and improved, more personalized treatments, breast cancer mortality rates have dropped more than 30 percent since 1990.

Much of the progress we’ve made in attaining better outcomes is due both to our improved understanding of the family of diseases known as breast cancer, and the advances in how we treat them. Yet little, unfortunately, has changed in the way we detect breast cancer. If you visit the doctor’s office today for a regular breast health exam, for example, you’ll most likely be given a clinical breast examination and, if over 40 (or at a high risk of breast cancer), have a mammogram to “see” what can’t be felt.

While mammography is the best general screening tool we have available today, it is far from perfect and it hasn’t evolved much over the past three decades. We not only hope that will change, but we’re aggressively investing in research to make certain it does. That’s why this year Susan G. Komen is investing $2 million in two new studies that seek to change your annual breast exam with improved technology and methods that will provide a more accurate, sensitive and cost-effective means of early detection.

The first grant, led by Dr. Andrew Maidment from the University of Pennsylvania, hopes to reduce the likelihood of a call-back visit to your doctor due to a false positive or inconclusive result by better distinguishing a non-cancerous calcification or calcium deposit from a potentially serious tumor. Currently, calcifications or calcium deposits appear similar to a tumor on film or digital image. Dr. Maidment is seeking to improve imaging results by further refining an emerging imaging technology, called Digital Breast Tomosynthesis (DBT). DBT can create a 3D image of the breast and has previously been shown to offer more comfort to the patient compared to conventional mammography. Yet, like mammography, today’s DBT technology cannot tell the difference between a tumor and calcifications. Through innovations to the technology, however, Dr. Maidment hopes to change that.

The other new study involves Ductal carcinoma in situ (DCIS), a non-invasive form of breast cancer that is still contained in the breast and has not yet spread. Many people have begun to argue that DCIS should not be treated as cancer, since it is non-invasive at this stage. However, DCIS can turn into invasive cancer over time, and doctors currently lack the ability to determine which DCIS growths will ultimately progress to invasive disease.

Drs. James Hicks and Jorge Reis-Filho, from Cold Harbor Springs Laboratory and Memorial Sloan Kettering Cancer Center, hope to uncover the key to DCIS’s evolution into invasive cancer. Drs. Hicks and Reis-Filho’s study will approach this question by using rare patient samples that have DCIS and invasive breast cancer laying side by side in the same area of the breast. The researchers will then uncover any genetic changes that occurred between the DCIS mass and invasive cancer using cutting-edge DNA sequencing technology. If successful, the study will produce prognostic markers that will help doctors choose between conservative or aggressive treatment approaches to DCIS.

It is Komen’s hope that by developing cutting-edge imaging technologies, finding new prognostic markers, and supporting innovative scientists today, it will translate to improving tomorrow’s methods for early detection and widen available treatment approaches.

Since 1999, Susan G. Komen® St. Louis has contributed nearly $9 million to Komen’s national research grants. At the same time, more than $20 million raised locally and nationwide has come back to St. Louis facilities to fund breast cancer research. Read more about Komen’s 2013 research investment – including $1 million granted to St. Louis researchers – here.

Komen St. Louis Community Partner: Washington University in St. Louis’ Breast Cancer Patient Navigator Project

Vanessa Finnie was unemployed and without health insurance when she discovered a lump in her right breast.

She had a feeling it was cancerous, but fear caused her to wait six years before seeking medical attention. She says, “It wasn’t the fear of having cancer; it was the fear of affording it.”

However, as she struggled to keep her apartment and find permanent work, the lump continued to grow. Eventually, in 2011, Vanessa sought treatment.

At the Alvin J. Siteman Cancer Center, Vanessa was diagnosed with bi-lateral invasive ductal cancer in her right breast and lobular carcinoma in her left breast. Then, she was introduced to Patient Navigator Vickie Knighten.

This is the 10th year of Komen St. Louis funding for Washington University’s Breast Cancer Patient Navigator Project. And Vickie has been there from the beginning.

As a full-time patient navigator, Vickie works with about 125 patients each year. Her job is to bridge the gap, whatever that gap may be, in order to reduce breast cancer mortality rates. She begins by working with patients as soon as their mammograms come back abnormal. “I try to find any resource possible to help,” she says.

This includes explaining medical terms and treatments in easily understood words, making sure patients know what to expect going through treatment, and lending emotional support by holding patients’ hands through treatment sessions.

“Some women don’t need as much help as others,” she says, “and a lot of them just need a friend.”

Vickie also works to ensure patients are able to continue with their treatment, despite any possible barriers. According to Vickie, the reasons some patients are noncompliant with their breast cancer treatment are varied and complicated. Some lack transportation and miss their appointments, while others must choose between working to pay bills and continuing their medication. Vickie makes follow-up calls if the women miss appointments, and she helps them apply for financial resources to keep roofs over their heads.

For patient Vanessa, Vickie was invaluable in providing many of these services.

“Vickie has been marvelous from the first appointment,” Vanessa says. “She listened to me when I needed help. She got in touch with a nurse to get my Social Security. If I needed gas for my car, she made sure I was all right. She even told me what to do when I was two months behind on my rent.”

Thanks to Vickie and the Breast Cancer Patient Navigator Project, Vanessa was able to complete her treatment. Now she intends to give back and reach out to other African-American women with breast cancer.

“It’s my life’s mission to help other women get through it,” she says. “The fact that I am a survivor is all the fuel I need.”

In 2013, Komen St. Louis granted $2.2 million to 13 local breast health programs in our 17-county Missouri/Illinois service area, including The Breast Cancer Patient Navigator Project at Washington University in St. Louis. These grants help fund breast health and breast cancer screening, education and patient navigation services for those in our community who otherwise may not have access due to low income, lack of insurance or other barriers.

Komen-Funded Research: Seeking Causes of Breast Cancer

Do certain products cause breast cancer? Does the air we breathe contribute to breast cancer rates? Do X-rays increase an individual’s breast cancer risk? It seems like we’re daily inundated with news stories warning about the health risks of something in our environment. Yet the difficult truth is that there is a lack of substantive data linking environmental exposures and the risk of breast cancer. So there is much we don’t know – even though much is claimed or reported.

In 2001, Susan G. Komen® funded a study with the Institute of Medicine to examine the state of the science on environmental issues in breast cancer development. The report recommended large-scale research over the course of a woman’s life, with a goal of developing interventions that can reduce breast cancer risk.

Based on that report, Komen has made it a key priority for our organization’s research investment to understand potential environmental impacts on breast cancer development and treatment – and to do so in ways that are scientifically sound, through large-scale and peer-reviewed research.

That’s why last week Komen announced approximately $4.5 million in new research funding across five new grants to understand a variety of environmental-related issues. These grants, which are part of $42 million in Komen’s 2013 portfolio of new research grants, will examine the impact of radiation exposure on breast cancer development; the potential impact of exposure to environmental pollutants in areas where breast cancers are disproportionately high, or in so-called “cancer clusters”; the impact of air pollution on breast cancer development; and the role in breast cancer development of synthetic chemicals (phthalates) found in consumer products and medications.

In each of these grants, we are attempting to move beyond theories to a solid base of scientific evidence to understand the specific role of environmental exposures and breast cancer development. These environmental grants will build on the nearly $14 million Komen has already invested (into 38 research grants) in studying environmental and lifestyle factors that may affect breast cancer risk, such as chemicals, diet, weight, exercise and alcohol use.

Three studies propose innovative ways to analyze an incredible amount of data, taking into account important breast cancer risk factors, place of residence, timing of exposure, genetic makeup, and socioeconomics. This type of analysis at multiple levels allows for unraveling of the actual effects of the exposure apart from any other unrelated effects. In addition, these studies will be conducted in unique populations, which will allow investigators to identify subgroups that may be particularly vulnerable to the health effects of a certain exposure.

Komen is also funding two additional projects that will determine the risks and benefits associated with medical radiation used in the detection and the treatment of breast cancer, so we can learn how to minimize exposures while giving maximum benefit to the patient. One project will determine the personalized radiation dose that each patient receives during her breast cancer screening with a new type of three-dimensional mammography known as tomosynthesis.

Another study aims to determine how radiation to the breast can damage the heart, and in addition, develop therapies that could be given during radiation therapy to minimize cardiac injury.

The 2013 grants add to Komen’s investment of more than $790 million in breast cancer research – the largest investment in research of any nonprofit outside of the U.S. government. This year’s environmental grants have an incredible potential to increase our knowledge of how breast cancer develops, as we seek to find cures.

Komen cannot fund this type of research without the generous support of our friends, Race for the Cure participants, survivors and sponsors. Three out of every four net dollars raised locally are invested locally to help reach, support and educate women and men about breast cancer. The other dollar comes back to our community in the form of better treatments, improved screening and the hope of better ultimate outcomes. Together, we can save lives and end breast cancer forever.

Since 1999, Susan G. Komen® St. Louis has contributed nearly $9 million to Komen’s national research grants. At the same time, more than $20 million raised locally and nationwide has come back to St. Louis facilities to fund breast cancer research. Read more about Komen’s 2013 research investment – including $1 million granted to St. Louis researchers – here.