Each year, we invite our grantees to New York for our October Symposium and Awards Luncheon. Before taking the stage, our researchers take part in a scientific meeting, a tradition that’s been in place since 2003. Conceived by Scientific Director Dr. Larry Norton, the conference presents the opportunity to explore important topics in breast cancer research, with a program carefully chosen by BCRF’s Scientific Advisory Board. This year’s meeting, held at Memorial Sloan Kettering Cancer Center, featured a series of presentations and lively discussion from BCRF-supported experts on the genetic and environmental risks of breast cancer and strategies to improve outcomes through prevention and better screening.
Defining Genetic Risk Across Populations: BRCA and Beyond
Advances in DNA sequencing now allow scientists to examine the minute details of DNA and identify changes that occur in tumors as cancer begins and progresses. This information is changing how we think about cancer, how it occurs, and how to prevent and treat it.
Work by Dr. Funmi Olopade has revealed differences in genetic risk across populations of African descent. Part of this diversity can be explained by widespread migration from Africa and subsequent marriages across racial and ethnic lines. The blended ethnicities add to the complexity of a population-wide risk prediction. At the meeting, Dr. Olopade emphasized the need to study how genetic risks may differ across African populations around the world.
The BRCA genes are the most commonly mutated genes in hereditary breast cancer, but the types of mutations and their impact on risk vary widely. In recent years, scientists have uncovered many less common gene mutations associated with breast cancer, and work by Dr. Kenneth Offit and others suggests that many of these act to modify risk (either increasing or decreasing it) when combined with BRCA or other mutations. Dr. Offit discussed international efforts to study these risk modifiers and plans for a clinical trial in BRCA2 mutation carriers to test how knowledge of modifying mutations will impact patient treatment decisions and outcomes.
Mutations in the BRCA1 and BRCA2 genes are highly prevalent in Ashkenazi Jews, but genetic screening is typically only recommended for those with a family history of cancer. Drs. Mary-Claire King, Ephrat Levy-Lahad and Moein Kanaan, who collaborate on international studies in Israel, the United States and the Palestine Authority, presented findings that suggest that population-wide screening for BRCA mutations in Ashkenazi Jews—including the novel method of screening men in families without a known history of cancer—will identify high-risk women who wouldn’t otherwise be screened. Dr. King proposed that early genetic screening in the general population could ultimately identify other high-risk women with no family history and provide opportunities for early preventive measures.
Prevention: What We’ve Learned & Where We Need To Go
Research suggests that at least 30 percent of breast cancers could be prevented by lifestyle changes such as weight loss and exercise. Dr. Melinda Irwin has shown that these factors can also improve outcomes after diagnosis. At the meeting, she discussed how weight loss affects the way tumors utilize energy and reduces levels of inflammatory molecules that promote tumor growth and spread. Weight loss and exercise can also work together to improve quality of life during and after cancer treatment and reduce chemotherapy-related side effects. Dr. Irwin’s work underscores the need to include weight management and counseling as part of cancer care.
Obesity increases the risk for many cancers, including breast cancer, particularly after menopause. While scientists have known about this relationship for many years, there has not been a clear cause-and-effect explanation.
Drs. Andrew Dannenberg and Clifford Hudis have uncovered a very important link between obesity, inflammation and breast cancer that helps to explain why obesity increases risk after menopause. During his presentation, Dr. Dannenberg showed that crown-like structures (CLS) in fat tissue release inflammatory molecules that promote the production of estrogen, a driver of most post-menopausal breast cancers. A striking discovery from their research revealed that about 30 percent of women at a healthy weight had CLS in their fat tissue. Their next step is to develop a blood test that can identify otherwise healthy women who may be at risk of breast cancer.
Because risk factors, both modifiable (weight and other lifestyle choices) and non-modifiable (age, family history or inherited genes) vary widely, prevention needs to be individualized. Dr. Powel Brown presented some of the challenges and opportunities in improving risk assessment and prevention. He emphasized the need to identify biomarkers that can better predict risk and inform the best preventive strategy, the importance of public perception of risk, and clinical trials to test chemopreventive drugs that can reduce the risk of triple negative breast cancer. Opportunities on the horizon include the potential development of preventive vaccines and the re-purposing of existing drugs for chemoprevention.
The Sum Is Greater Than Its Parts
At BCRF, we have always recognized the power of collaboration and know the complexities of cancer will only be resolved when our researchers come together to catalyze each other’s thinking and provide new perspectives. These meetings have historically inspired new collaborations and scientific discourse that accelerate discovery, and we are confident that the outcomes of this year’s meeting will be no different in taking us to our ultimate goal of better prevention and treatment of breast cancer.
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