By: Richard Lee, M.D., and Lorenzo Cohen, Ph.D.

Cancer patients often take herbs and supplements with the hope of improving their outcomes, and utilization is especially high in women with breast cancer.

One controversial area is the use of soy and soy-related products during and after treatment. Natural soy is known to contain phytoestrogens such as isoflavones, and these compounds in preclinical studies promote estrogen-dependent breast cancer growth. Thus, breast cancer patients are commonly advised to avoid all dietary soy.  

Findings from two recent studies are starting to question whether soy may in fact be helpful. A study published at the end of 2009 in The Journal of the American Medical Association by Shu et al., investigated the association between soy food intake and breast cancer survival among a prospective, population-based cohort of 5,042 Chinese women diagnosed with breast cancer between 2002 and 2006. In-person interviews were conducted at baseline, and 12 and 36 months about food consumption, including soy. Soy intake was inversely correlated with breast cancer recurrence and mortality (i.e., higher soy intake was associated with increased survival). The findings remained when comparing estrogen positive/negative and tamoxifen users/non-users subgroups.

Earlier in 2009, results from the Life After Cancer Epidemiology (LACE) study appeared. In this prospective cohort trial involving 1,954 women with breast cancer, those who consumed soy isoflavones at levels comparable to Asian populations actually had a reduced risk of recurrence, especially if they were on concurrent tamoxifen therapy. The authors concluded: "Soy isoflavones consumed at levels comparable to those in Asian populations may reduce the risk of cancer recurrence in women receiving tamoxifen therapy and, moreover, appears not to interfere with tamoxifen efficacy."

These studies provide further information that regular dietary soy as part of a normal diet is probably safe and, in fact, may be beneficial for women with breast cancer. These studies, as well as others, create a growing body of evidence that the current advice that all soy foods should be removed from the diet of a woman diagnosed with breast cancer is probably untrue.

The role of non-dietary soy products such as soy supplements, powders or pills and the use of heavily processed soy items such as soy cheese, soy hot dogs or soy turkey remain unclear and should be avoided.

As the research to date is observational in nature, future randomized trials are needed to verify if a beneficial effect truly exists for the use of dietary soy. 


1.  Shu XO, et al. Soy and intake and breast cancer survival.  JAMA 302(22):2437-2443, 2009.
2.  Guha N, et al. Soy isoflavones and risk of cancer recurrence in a cohort of breast cancer survivors: the Life After Cancer Epidemiology study.  Breast Cancer Res Treat 118:395-405, 2009.

"Should I get proton therapy?" is a question that my patients often ask me, and you may be thinking about it right now. The short answer is that "it depends." Only you and your oncologist should be making this decision.  

Before deciding IF you should receive proton therapy, you need to know WHAT it is. Proton therapy is a form of external beam radiation that uses particles (i.e. protons) instead of photons (i.e. X-rays) to treat tumors. Both forms of radiation can destroy cancer cells by messing up their genetic blueprint (DNA). This makes it difficult for cancer cells to continue to grow and divide, and they ultimately die.

In general, the higher the radiation dose, the better the tumor control will be. However, such high radiation doses  can affect normal tissue near the tumor, which is what we all want to avoid.  

Photons (x-rays) deposit the majority of their dose within the first inch after they hit the skin, and they continue to deposit dose after they reach the tumor.  Hitting a deep tumor with just one or two x-ray beams is hard (that would be like trying to power-wash your driveway with a water pick).  We often need to use many different beams to cover the tumor and this can result in more radiation exposure to normal tissues.  This is where proton therapy has the edge. Protons deposit most of their dose at the tumor and more importantly stop traveling after they hit the tumor. This reduces the radiation dose beyond the tumor, allows the use fewer beams, and subsequently greater sparing of normal tissue.

Proton treatment requires sophisticated machinery and expert professionals to deliver it. The synchrotron will accelerate protons to almost the speed of light for maximal penetration. Inside the synchrotron they may travel 300,000 miles, which is equivalent to circling the earth 12-13 times. The protons are then fed to the treatment gantry, which is a massive 190-ton device that directs the proton beam before it enters the patient. Despite its large size (over 40 feet in diameter), the gantries have a precision of 1mm. We also have a highly trained, dedicated group of professionals who operate and maintain the Proton Therapy Center to ensure that everything works to its best level.

Proton therapy is currently available in only seven centers in North America. M. D. Anderson has one of the largest and technically advanced centers in the world. We have four treatment rooms, including one of the only centers with spot-scanning  (a.k.a. pencil-beam scanning) capabilities.

The first patient was treated with proton therapy at M. D. Anderson on May 4, 2006, and since then we have treated more than 1,700 patients. We have a lot of experience treating patients with lung cancer, esophageal cancer, brain tumors and prostate cancer, as well as various other tumor sites. Also, we're one of the most active centers in the world for treating children  with proton therapy.

Since the Proton Therapy Center is part of M. D. Anderson Cancer Center, we can provide our patients not only with outstanding proton therapy but also outstanding cancer therapy.

So, should you receive proton therapy? Please consult with your radiation oncologist or check out our website for more information.

Other Resources

ProtonPals is a support and outreach group for those who choose proton therapy treatment at The University of Texas M. D. Anderson Cancer Center Proton Therapy Center 

By Lora Shea, Staff Writer

The debate continues on the value of cancer screening. The latest target: prostate cancer.

The American Cancer Society has issued new prostate cancer screening guidelines that encourage doctors to better communicate the risks and benefits to their patients before testing is pursued. The guidelines question the value of mass prostate screening.

M. D. Anderson urologist John Davis, M.D., says the new guidelines represent "a growing shift from the more simplistic days when doctors told men to go get screened, and we'll deal with the results as needed."

Studies show that more men die with prostate cancer than because of prostate cancer. Screening for prostate cancer may be the right choice for some men, but that decision should be made after careful consideration of a man's personal and family health history, and the risks and benefits of the specific tests. M. D. Anderson's screening guidelines affirm the need for men to discuss testing with their doctor and give specific recommendations based on a man's risk, should he decide to be tested.

The ACS guidelines also call into question the value of community screening events, in which large groups of asymptomatic men are tested. M. D. Anderson has replaced mass screening with education events for the past few years, Davis says. "These events give us the opportunity to talk to men not only about the issues around screening, but also about the variety of treatment and disease management options available to them if they are found to have prostate cancer."

Davis worries that the ACS guidelines "paint a very negative picture of prostate cancer treatment, that harm is inevitable." He says that for those properly evaluated, treatment in the right hands can offer the best outcomes.

"Furthermore, the guidelines are mostly based on two randomized trials. The American trial showed no benefit to screening, but unfortunately has numerous flaws (especially contamination between the treatment arms) and therefore is not conclusive," he says.

"On the other hand, the European study, which did not suffer from as many problems as the American trial, demonstrated a 20% lower risk of dying of prostate cancer as early as nine years from diagnosis. Given the slow natural history of prostate cancer, the percent of men who benefit from screening should go up as these patients are followed to the 15- and 20-year marks."

So who will choose to screen versus not screen? Davis predicts that "for most men who have greater than 10 years of life expectancy and work with their physicians to minimize their cancer AND cardiac disease-related risks, the result will be the well-informed decision to screen."

"Those who are not screened may be due to other more threatening health concerns, or the occasional patient who places a high personal value on avoiding any treatment-related side effects -- even if that means accepting a higher risk of dying of prostate cancer," Davis says.
 
If you've been screening already, should you stop? According to Davis, "The guidelines provide concise summaries of the relevant data, and it's probably best to let your screening physician talk to you about what age is best to stop."

 

By: Lorenzo Cohen, Ph.D., and David Servan-Schreiber, M.D., Ph.D.

Integrative medicine aims to enhance cancer care by creating a comprehensive, integrative treatment plan that addresses all dimensions of care: physical, psychological-spiritual and social. It makes use of all appropriate therapeutic approaches, providers and disciplines to improve quality of life, help to manage symptoms, and achieve the best possible treatment results.

Recent research shows that tumors grow and become malignant not only through genetic anomalies in the cancer cells themselves, but also through factors in the cells' microenvironment. These microenvironmental factors include, but are not limited to:

• The ability of the cells to form blood vessels to feed the growing tumor (angiogenesis).
• The propensity for inflammation and stimulating inflammatory pathways, and suppressed cell-mediated immunity.

The tumor microenvironment is the terrain that largely determines whether cancerous cells will grow or not. The body possesses a number of natural defenses that can create a barren, inhospitable terrain for cancer growth. These natural defenses are influenced and strengthened by healthy lifestyle choices such as a proper diet, physical activity, stress management, social connection, and limiting exposure to environmental pollutants.  

Modern oncology treatment is focused on destroying cancer cells or blocking cancer-related pathways. This is an essential aspect of therapy. However, it's becoming increasingly clear that truly effective cancer care should simultaneously foster a strong anticancer terrain by strengthening the body's natural defenses.

Existing initial research that follows the tenets of integrative oncology -- making changes in lifestyle and behavior -- shows evidence that this approach can, in fact, strengthen natural defenses, modify the terrain of the body, and have an impact on long-term treatment results.  

It's time to provide our patients the education and clinical tools necessary to support an anti-cancer lifestyle to help them remain cancer free and to improve clinical outcomes, quality of life, and symptom control for those with cancer and cancer survivors.

We need to empower people to become active participants in their own health. We need to show them how to best care for themselves; not only because they will feel better if they get involved, but because it's good science and good medicine.

Further Reading:

David Servan-Schreiber: "Anticancer - A new way of life." (Viking)

Andersen, B.L., et al., Psychologic intervention improves survival for breast cancer patients: a randomized clinical trial. Cancer, 2008. 113(12): p. 3450-8.

Ornish, D., et al., Increased telomerase activity and comprehensive lifestyle changes: a pilot study.[see comment][erratum appears in Lancet Oncol. 2008 Dec;9(12):1124]. Lancet Oncology, 2008. 9(11): p. 1048-57.

Ornish, D., et al., Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proceedings of the National Academy of Sciences of the United States of America, 2008. 105(24): p. 8369-74.

Ornish, D., et al., Intensive lifestyle changes may affect the progression of prostate cancer. Journal of Urology, 2005. 174(3): p. 1065-9; discussion 1069-70.

Saxe, G.A., et al., Potential attenuation of disease progression in recurrent prostate cancer with plant-based diet and stress reduction. Integrative Cancer Therapies, 2006. 5(3): p. 206-13.

Saxe, G.A., et al., Biological mediators of effect of diet and stress reduction on prostate cancer. Integrative Cancer Therapies, 2008. 7(3): p. 130-8.

In Her Own Words ... by Rebecca Esparza

Thanksgiving Day 2007 couldn't have been more non-traditional: my fiancé Robert Marraro and I spent it in Las Vegas. Ever since my diagnosis of late-stage ovarian cancer at Thanksgiving in 2001, the holiday has never been the same, so we've tried unique and different ways to celebrate over the years.

But there was something special about this trip: It marked my five-year, cancer-free anniversary. We visited the Grand Canyon, stayed at a luxurious suite in a five-star casino and experienced a decadent spa day. On the way home from our week-long trip, we stopped in San Antonio for an extra evening of fun.

That night, I was horribly sick.

The signs are there
Robert later told me it was at that moment, he knew something was seriously wrong with me.

But I was cancer-free. The five-year mark was monumental, especially for an ovarian cancer survivor. For the next five months, I carried on despite being extremely lethargic, gaining weight and losing tremendous amounts of hair. Plus, there were still a host of side effects I was suffering as a result of my chemotherapy, like chronic joint pain, fibromyalgia and neuropathy.

I refused to let my disabilities dampen my spirits for fighting cancer at the grassroots level. The year prior I had been selected as a "Hero of Hope" by the American Cancer Society, which entailed traveling to Relay For Life events across Texas as a survivor spokesperson. I was at a Relay event in Alice, the hometown of my grandmother, Elida Garcia, who had passed away in December 2007 of lung cancer.

As soon as I stepped on the track that night, I could feel her spirit.

An hour later, I tripped and fell, hit my head and passed out. When I awoke, I was in traction and emergency personnel were loading me into an ambulance.

My body demands attention
CT scans of my head and neck revealed no head injuries, but there was something suspicious in my thyroid. The exact verbiage: "Small hypodensity and tiny adjacent calcification within left lobe of thyroid may represent nodule versus cyst."

Despite the fact my doctor at the emergency room was not concerned about it, I decided to take my health in my own hands. I called my gynecologic oncologist at M. D. Anderson, Pamela Soliman, M.D., assistant professor in the Department of Gynecologic Oncology. She advised coming to M. D. Anderson for a fine needle aspiration.

The procedure itself was painful, but the radiologist, nurses and technicians all made sure I was comfortable. The next day I met Camilo Jimenez, M.D., assistant professor in the Department of Endocrine Neoplasia and Hormonal Disorders.

He and I had an instant connection. Looking back on this meeting, I think he sensed the news I had thyroid cancer would be particularly difficult for me.

"Two of the samples came back negative for cancer," he said slowly. "And one ... one came back positive."

I was completely stunned: I had cancer. Again. Two primary cancers and I was only 37.

Dr. Jimenez couldn't have been more caring and sympathetic. He assured me I would receive excellent care, immediately putting my mind at ease. We discussed surgery to remove the thyroid and subsequent radioactive iodine treatment.

In June 2008, Randal Weber, M.D., professor and chair of the Department of Head and Neck Surgery, performed a three-hour surgery to remove my thyroid, one parathyroid and 50 lymph nodes. Seven of those lymph nodes came back positive for cancer and my radioactive iodine treatment was scheduled for November -- around Thanksgiving.

Everything seems to go back to Thanksgiving
After enduring a low-iodine diet for two weeks to ensure proper uptake of the radioactive iodine and undergoing several diagnostic tests to see where the cancer still existed, I was mentally prepared for the treatment.

At this point, I knew Dr. Jimenez was preparing to send me to the hospital for the treatment. He entered the room with the biggest, broadest smile I have ever seen on a physician.

"There is no evidence of cancer. So since there's no cancer, there's nothing to radiate.
This rarely happens, so go home and enjoy your life," he said happily.

I thought I would literally bounce off the walls. And although today I have numerous "reactive" lymph nodes in my neck that are being closely monitored for signs of cancer, I don't spend much time worrying about it.

I like to relish the fact I am a walking miracle that kicked cancer to the curb twice. I'll do it as many times as I need to in the future, but I'll make sure I have my invaluable medical teams at M. D. Anderson by my side every step of the way.

And I believe my grandmother was with me that night in Alice. She gave me a gentle, loving push that would eventually help save my life.


In 2008, Esparza was honored for her networking efforts with other cancer patients by Lance Armstrong when she received the Livestrong Challenge Award.

Related story:
Q&A: Thyroid cancer

M. D. Anderson resources:
Thyroid cancer

Endocrine Care Center

Thyroid cancer survivor (video)


Additional resources:
Thyroid cancer (National Cancer Institute)

Detailed guide: thyroid cancer (American Cancer Society)

Thyroid cancer is a disease in which cancer cells are found in the tissue of the thyroid gland.

Camilo Jimenez, M.D., assistant professor in the Department of Endocrine Neoplasia and Hormonal Disorders at M. D. Anderson, answers questions about this disease.

Are there several types?
Yes, there are four types. The most common is papillary thyroid cancer; the second is follicular thyroid cancer; the third, medullary thyroid cancer; and the rarest, anaplastic thyroid cancer.

In general, papillary thyroid cancer exhibits the best survival rate and prognosis with survival rates up to 100% after five years of initial diagnosis, even in patients with metastatic disease.

Anaplastic thyroid cancer is perhaps the most aggressive cancer that humans may suffer from. Almost 100% of patients survive fewer than three months after its diagnosis. Fortunately it is very rare.

How common is thyroid cancer?
Papillary thyroid cancer is very common. Its incidence has increased during the last decade, and now it's one of the 10 most common cancers in the United States.


What causes it?
In most papillary and follicular thyroid cancer cases, we do not know the cause.
Approximately 3% of papillary thyroid cancer cases have predisposition because other family members have been affected by this disease. Exposure to sublethal radiation, such as that observed in survivors of radiation from Hiroshima, Nagasaki or Chernobyl, is another risk factor for the disease.

In the case of medullary thyroid carcinoma, up to 35% of patients may have a genetic predisposition.

The causes of follicular and anaplastic thyroid carcinomas are unknown.

What are the symptoms?
These tumors are usually found because of the presence of a palpable or visible neck mass. Frequently, they're accidentally found by radiographic studies recommended to evaluate diseases that are not related to thyroid cancer.

In some cases, thyroid cancer is found because of manifestations related to metastatic disease (for example, a fracture due to skeletal metastases).

Papillary, follicular and anaplastic thyroid carcinomas usually do not secrete hormones. Medullary thyroid carcinomas secrete excessive amounts of calcitonin (a hormone produced in the thyroid) making some patients susceptible to flushing and chronic diarrhea.

What are the most common treatments?
Surgery is the most important treatment for thyroid cancer. In a vast majority of papillary and follicular thyroid carcinomas, once surgery is performed, ablation therapy with radioactive iodine is recommended.

Thyroid suppressive therapy with a dosage of thyroid hormone -- enough to suppress the thyroid-stimulating hormone -- is required after ablation therapy in almost every patient. For medullary thyroid cancer, ablation with radioactive iodine and thyroid suppressive therapy are not necessary.

What other information can you share?
We've noticed that both the incidence and aggressiveness of thyroid cancer have increased over the last decade. Some tumors present with metastases that are not possible to remove by surgery.

To attack these tumors, we now have drugs that target molecular pathways important for the tumor development and survival. Many of these drugs are under evaluation in clinical trials, and they include names such as sorafenib, sunitinib, motesanib, XL184, E7080 and others. A new era for thyroid cancer has begun.

Related story:
Patient deals with ovarian, then thyroid cancer

M. D. Anderson resources:
Thyroid cancer

Endocrine Care Center


Thyroid cancer: questions and answers (PDF)

Thyroid cancer survivor (video)


Additional resources:
Thyroid cancer (National Cancer Institute)

Detailed guide: thyroid cancer (American Cancer Society)

Although colorectal cancer is often preventable and many are aware of the disease, most people still fail to get screened.

Colorectal cancer remains the fourth most common cancer in the United States. According to the American Cancer Society, more than 148,800 people were diagnosed with the disease in 2008 and 49,960 died because of it.

That's why every March there's a concerted effort to raise awareness of this disease and to encourage people to get screened.

New guidelines for screening
A multidisciplinary panel of M. D. Anderson experts in medical oncology, surgical oncology, radiation oncology, cancer prevention, imaging and other areas have developed new risk categories and related guidelines for colorectal cancer.

For men and women at average risk who are 50 years and older, M. D. Anderson recommends a colonoscopy every 10 years (preferred screening), and either a virtual colonoscopy every five years or a yearly fecal occult blood test (FOBT).

For men and women at increased or high risk, the type and frequency of exams, including colonoscopy and flexible sigmoidoscopy, depend on the following factors:
•    Personal history of precancerous (adenomatous) polyps
•    Personal history of colorectal cancer
•    Family history of colorectal cancer or precancerous (adenomatous) polyps
•    Genetic diagnosis of familial adenomatous polyps
•    Genetic history of hereditary nonpolyposis colorectal cancer, or clinical history suggesting such
•    Inflammatory bowl disease (ulcerative colitis or Crohn's disease)

If you fit these guidelines, celebrate March with a check-up and chat with your primary physician about getting screened for colon cancer.

Related stories:
Metastatic Colon Cancer Survival Jumps Dramatically Almost a Third of Patients May Live Five Years

Colorectal Cancer Survivors' Stories Become More Common


M. D. Anderson resources:
Colonoscopy versus Virtual Colonoscopy (podcast)

Colorectal Cancer Treatment and Screening (podcast)



Additional resources:
Colon and Rectal Cancer (National Cancer Institute)

Colon and Rectum Cancer (American Cancer Society)

National Health Observances Toolkit (U.S. Department of Health & Human Services)

By Laura Prus, Staff Writer

According to a recent study, adding pistachios to your diet may help lower your risk of lung cancer. However, researchers caution that more research is still needed.

Among the most commonly consumed nuts in the United States, pistachios also are one of the best dietary sources of gamma-tocopherol, a form of vitamin E.

Results of a study aimed at discovering if these nuts have anti-cancer properties was presented in December 2009 at the American Association for Cancer Research's Frontiers in Cancer Prevention Research conference.

Conducting the study
The six-week controlled clinical trial investigated the effect of pistachio consumption on serum levels of gamma-tocopherol. It was divided into three two-week blocks, allowing for a two-week pre-intervention period and a four-week intervention period.

Involved in the study, conducted by researchers at M. D. Anderson and Texas Woman's University, were 36 healthy participants who were randomly assigned to either a normal diet or a diet consisting of 68 grams of pistachio per day. Data for each participant were recorded in a diet diary.

Results show promise
Participants in the pistachio-diet group showed a significant increase in energy-adjusted dietary intake of gamma-tocopherol at weeks three and four. At the end of the study, this group also had a significantly higher value of cholesterol-adjusted serum gamma-tocopherol compared to baseline.

Ladia Hernandez, senior research dietitian in the Department of Epidemiology and the study's first author, says this positive outcome shows promise of the anti-cancer properties of pistachios. "Because pistachios are a good source of gamma-tocopherol then eating them may help to decrease lung cancer risk," she says.

Pistachios are good for you
Although results are encouraging, Hernandez says the chemopreventative effects of pistachio consumption need further clarification. In particular, she says, the effects related to the targeted molecular pathways need to be studied.

However, she does recommend adding gamma-tocopherol to your diet. "Pistachios are one of those 'good-for-you' nuts, and 2 ounces per day could be incorporated into dietary strategies designed to reduce the risk of lung cancer without significant changes in body mass index," she says.

She also states that foods such as peanuts, pecans, walnuts, soybean and corn oils are rich sources of gamma-tocopherol and could prove beneficial for your health as well.

M. D. Anderson resources:

Department of Clinical Nutrition


Additional resources:

Energy Value of Macronutrients From Pistachio Nuts and Mechanisms of Nutrient Action (National Cancer Institute)

Pistachios May Reduce Lung Cancer Risk (AACR)

By DeDe DeStefano, Staff Writer

Our patients are inspirational, courageous fighters. With each one, I am reminded of the journey I made alongside my mother 11 years ago, as if it were yesterday. Each July we celebrate the end of her treatment as much as we do the day she was born.

On Feb. 18, I had the opportunity to work at an M. D. Anderson event honoring cancer patients everywhere -- celebrating with those who survived their cancer and mourning with family and friends of those who did not. Some of these patients are my colleagues. Some are friends. And some I'd just met. Some told their stories. Others listened and applauded. Everyone cried.



These patients are my heroes. They are why I love my job. Although I am not in direct patient care, I have the honor of telling their stories. Sometimes in the middle of the night I wake up and worry about them, just like I know their care teams do, and I think it's like that with everyone here.

The evening's purpose was to thank the philanthropic donors who have made a difference in the lives of our patients and announce that M. D. Anderson is raising $1 billion to continue that work. Although the celebration thanked donors, the focus was not on the donors themselves, but rather the reason behind the gifts. Testimony after testimony was given -- some planned, others not. From Jeff Wigbels, a non-smoking athlete who learned he had stage IV metastatic lung cancer the day before his son was born, to "America's Got Talent" lymphoma survivor Barbara Padilla, whose operatic voice brought down the house, there was not a dry eye in the room.

In his opening remarks, M. D. Anderson President John Mendelsohn, M.D., paid tribute to Bob Mosbacher, who recently lost his battle with cancer. Mosbacher was the only person to chair M. D. Anderson's Board of Visitors twice. "Bob worked hard to bring national attention and critically needed resources to M. D. Anderson, and did so with the modesty and quiet charm for which he is so admired. He was a great personal friend to Anne and me, and we miss him terribly," he told the audience, which included members of Mr. Mosbacher's family.

Originally slated to serve as master of ceremonies, CNN's Sanjay Gupta, M.D., had to regretfully cancel due to his participation in the earthquake relief efforts in Haiti. Former Miss America Phyllis George stepped in graciously and offered her own personal story with the institution, though we did not know she had one when we asked her to take part. A dear friend was misdiagnosed elsewhere (twice) and ultimately came to M. D. Anderson, where he survived six years. "If he had come to M. D. Anderson first, I have no doubt he'd still be alive today," she said tearfully. She then paid tribute to the patients in the room whose stories were told in the campaign brochure, including Patsy Bodie who struggled with pancreatic cancer for 10 years. The entire room of 600 held a moment of silence for Patsy, who lost her battle with the disease 22 days before the event.    

The tribute continued with the spectacular voices of the Houston Five Tenors' performance of "Amazing Grace" joined by St. Thomas' Episcopal School Pipe Band's bagpipes.

Memorial Drive Presbyterian senior pastor Rev. Dave Peterson offered his own testimonial before delivering the invocation. He spoke about his young daughter who, just weeks after getting married, was diagnosed with breast cancer. She came to M. D. Anderson for treatment.

After dinner, Board of Visitors Chair Nancy Loeffler welcomed board and Advance Team members and campaign chair Harry Longwell encouraged guests to spread the word about the need for philanthropic funding for cancer research programs.

After an extraordinary performance of "Ave Maria" by Barbara Padilla, eight patients on eight miniature stages around the room's perimeter gave a moving tribute to cancer patients everywhere as the program's finale. One by one, they were spotlighted, each telling his or her story and each physically striking out the word "cancer" on a screen behind him or her. Barbara Padilla struck hers out on the main ballroom stage and gave a closing rendition of "The Prayer" with one of the five tenors, Ken Gayle.

All in all, it was an evening of hope. Not everyone has survived cancer, but everyone had such an extraordinary story of what this terrible disease does. So many people are fighting cancer, and so many more are fighting with all they have to cure it, whether that means in a lab, in a clinic or with a checkbook.

It was hopeful and moving and quite honestly one of the best evenings I've ever had the privilege to be a part. I think everyone left the event with an understanding of the urgency of the problem of cancer and the compelling desire to do more.

Web site - www.makingcancerhistorycampaign.org
Facebook - The Campaign to Transform Cancer Care


These are the stories of the eight finale participants.

Victoria Johnson

Victoria Johnson is a survivor of more than 11 years of stage IV breast cancer with metastases to all major organs, including her brain. After being extremely conscientious for years about annual mammograms and additional precautionary ultrasounds, Victoria was diagnosed with the late-stage cancer and told that she had approximately 1½ years to live. Searching for hope, Victoria came to M. D. Anderson. She has since had seven brain tumors successfully removed and credits ongoing Herceptin® treatments with enabling her to live a full life. Victoria has repeatedly given her awe-inspiring testimonial to audiences at M. D. Anderson events. Passionate about enjoying each cherished day, she appeared in the CNN video "Taming the Beast," quoting her grandmother: "It's time to use the good china. Enjoy life!"

Nikita Robinson

An M. D. Anderson employee for five years, Nikita is a senior research coordinator in the Department of Health Disparities. She also is a four-year colon cancer survivor and a contributing member of the Employee Cancer Support Group. Nikita says her illness has influenced her perspective of her work, and she is eager to educate others about the institution. Within months of diagnosis, her mother was diagnosed with stomach cancer and her grandfather was diagnosed with pancreatic cancer. Neither survived. Nikita says that her insight gained as a patient and employee enabled her to be a vessel of support for her loved ones through their own cancer battles. Nikita says, "I am a real survivor, and for them -- to honor them -- I have to do this. I feel so honored to represent all the survivors at this institution."

Kenneth Woo

Kenneth is a 17-year Hodgkin's lymphoma survivor, and a 6 /2-year acute myelogenous leukemia and stem cell transplant survivor. Kenneth has many ties with
M. D. Anderson. He is a longtime volunteer with the Anderson Network and routinely supports its members in their time of need. Kenneth chaired the 2009 Anderson Network steering committee and will chair the 2010 Anderson Network Living With, Through and Beyond Cancer Conference. Thoughtfully helping others touched by cancer is a priority in Kenneth's life, and he is quiet but passionate about doing so, helping not only other patients but also their caregivers. Because of Kenneth's cancer experience, he, wife Clara, and daughters Ashley and Kimberly have made the words "be a channel of blessings to others" their family motto.

Janice Duplessis

Janice is a 10-year breast cancer survivor and three-year metastatic cancer survivor. Soft-spoken and serene, she chaired Anderson Network's 2007 annual patient conference of 500 attendees while going through radiation treatments for brain metastasis. She adopted the conference theme, Power of Hope, to describe herself: "We who have cancer must believe in the power of hope. M. D. Anderson has given me hope for the strongest and longest survivorship." Janice volunteers at various conferences, with the Telephone Outreach Program for Breast Cancer and with the American Cancer Society. She and her husband, Rogers, have three sons. Janice credits Rogers, who established the Lean on Me Caregivers Group to support others who care for loved ones facing cancer, with being her strength.

Nadia Jones

Nadia Jones may only be 5 years old, but she's an experienced driver of a pint-sized pink power-wheels Ford Mustang, which she thoroughly enjoys. She is being treated for rhabdomyosarcoma in the Children's Cancer Hospital at M. D. Anderson, and attends kindergarten in Richmond, Texas. Nadia's mother, Brandie, says that despite the numerous obstacles Nadia has encountered since birth, she has always managed to maintain an extremely positive outlook on life.

Jason Connelly    

Diagnosed with stage IV melanoma in 2006, Jason has been a survivor for three years. He generously and passionately shares his story of diagnosis, intense treatment and survival, emphasizing the importance of philanthropic funds and their role in advancing the therapy that helped save his life. Jason was one of three cancer patients honored as Person of the Week on "ABC World News" in 2008. The joy of Jason's life is his adorable son, Jacob, 5. "I'm happier now than I have ever been. I'm happier now than I was before I got sick," Jason says.

Jaime Ramirez

Diagnosed in Mexico at age 4, Jaime had osteosarcoma that returned every two years for 17 years. His parents brought him to Houston when he was 7, and after other hospitals could do no more, Jaime, by then a teenager, came to M. D. Anderson. Jaime survived 18 surgeries on his leg, often enduring hospital stays alone while his mother returned home to South Texas to care for his nine brothers and sisters. Jaime has been cancer-free for 22 years, beginning in 1988, when he became an M. D. Anderson employee. "They saved my life, so as long as I'm alive, I will be part of this team's mission to end cancer," he says. Jaime also volunteers on M. D. Anderson's Diversity Council, as an Anderson Network Ambassador and as a caring guide to pediatric patients faced with losing a limb.

Kay Rogers
 
Kay is a 38-year breast cancer survivor and 21-year colorectal survivor. She has inspired others through 34 years of volunteer service with new volunteers, the Children's Art Project card program and the children's Health Adventures program. She is a motorcyclist and began the Ride for Life for Anderson Network's annual patient conference, served 18 years on the Pediatric Brain Tumor Foundation's Ride for Kids task force and supports the Harley's Angels calendar fundraiser. Kay is retiring soon from her accountant position at Northwest Honda but plans to continue her active lifestyle. Recently, she skydived and hopes to jump again with her husband for her 80th birthday next month. Kay lost her daughter, Patricia Rahl, one year ago to endometrial cancer and today honors her along with all those who did not conquer cancer, yet contributed greatly to the mission to eradicate it.

 

By: Isabelle Bedrosian, M.D., F.A.C.S.

"What about the other breast?" This is a question newly-diagnosed breast cancer patients are asking with increasing frequency. However, providing them with an appropriate answer has never been easy.

We've known for some time that removal of the opposite healthy breast, a procedure called contralateral prophylactic mastectomy (CPM), reduces the likelihood of a second breast cancer event (a contralateral breast cancer) down the road. The question we haven't been able to answer for our patients is whether this actually makes a difference in their survival.

If CPM reduces the odds of a contralateral breast cancer, then why might it not have any impact on survival? Why would there be a disconnect between reducing the likelihood of a second breast cancer and survival?

There are a number of reasons for this:

• For some women, there's a greater risk of dying of the cancer they currently have than of developing a contralateral breast cancer.

• Even if a contralateral breast cancer develops, in many cases it's caught early and is highly curable, thereby having no effect on survival.

• As women get older, other medical conditions may predominate and become more life-threatening than breast cancer.

• With newer dugs, especially anti-estrogens that are administered to a majority of breast cancer patients, the risk of contralateral breast cancer is diminished.

To provide patients with breast cancer more information about potential survival benefit of CPM, we undertook a study specifically focusing on the question of survival. We were able to demonstrate that for a small group of women, those diagnosed before age 50 with stage I or stage II, estrogen receptor negative breast cancer, there was a small, but measurable improvement in five-year breast cancer specific survival associated with undergoing CPM. For the rest of the study population, no similar benefit was seen.

How should these results be interpreted?
I believe they should bring to bear greater certainty to the recommendations, both for and against the procedure. For women who fall into the group where we detected a survival benefit, physicians should initiate a discussion about CPM. For the remainder of the breast cancer population, physicians should be able to state with greater certainty that CPM is not necessary to improve odds of survival from breast cancer.

At the national level, current recommendations for CPM among women who aren't BRCA mutation carriers, are largely vague and broadly derived. At the personal level, the decision to proceed with CPM is highly subjective, and greatly influenced by personal biases and fears. With the objective findings of our study, we hope that national guidelines may be made more precise and that for individual patients, the decision to proceed with CPM can be made more objectively and less out of fear.

Although this new data can help tailor more precise recommendations for CPM, the results shouldn't be interpreted as a mandate either for or against CPM. CPM is an irreversible procedure, so for some women, a 5 percent survival benefit may not be worth the potential emotional, psychosocial and quality of life issues that occasionally arise following CPM.

Conversely, among women where we saw no survival benefit associated with CPM, individual factors in the personal history of such women may make CPM a reasonable option to consider.

Listen to Isabelle Bedrosian , M. D. Ande George Chang M.D. discuss research on CPM on Cancer Newsline

Recent findings published in the Journal of Clinical Oncology suggest that aspirin may play a role in reducing the recurrence of breast cancer in women who have been treated for that disease.

 

Dr. Michelle Holmes of Brigham and Women's Hospital in Boston and her colleagues studied self-reported data from 4,164 nurses who had an earlier diagnosis of breast cancer. They found that nurses who reported taking aspirin two to five days a week (often for problems unrelated to breast cancer) were 60% less likely to have a recurrence of breast cancer than their counterparts who did not take it, and 71% less likely to die from the disease.

 

Based on this study, scientists can't confirm a direct cause-effect relationship between lower breast cancer recurrence and aspirin use. However, it has stimulated a lot of discussion about the role of inflammation and anti-inflammatory drugs, like aspirin, on cancer.

 

Inflammation can open window

Inflammation is the body's response to an assault, such as an injury or infection. The body retorts by producing chemicals that signal immune cells to rise up, attack and kill the invading germs. Unfortunately, in the process they also can damage surrounding tissue, leading to pain and redness, and in some cases of chronic inflammation, open a window for uncontrolled cell growth -- which is cancer.

 

Certain drugs known as NSAIDs (non-steroidal anti-inflammatory drugs), including aspirin, ibuprophen and other over-the-counter and prescription medicines, have been known to reduce inflammation. Since the 1970s, we have known that these drugs work by inhibiting the production of prostaglandins, body chemicals that are necessary for blood clotting and that also sensitize nerve endings to pain.

 

NSAIDs can block two different cyclooxygenase (COX) enzymes, COX-1 and COX-2, which are produced by the body at sites of inflammation and also are produced by some precancerous tissues. COX-1 and COX-2 are key players in the conversion of certain fatty acids into prostaglandins, which in turn are associated with inflammation.

 

Aspirin and other aspirin-like drugs (called NSAIDs) can block both COX enzymes. However, they also can cause medical problems, such as stomach bleeding, when taken regularly for long periods of time. To try to circumvent these side effects while still providing relief against inflammation, in the early 1990s pharmaceutical companies began developing NSAIDs that inhibit only COX-2 enzymes (sometimes called COXIBs) and were marketed as Celebrex.

 

NSAID-cancer prevention connection

The connection between NSAID use and cancer prevention has been studied for a few decades. Scientists conducted a series of animal experiments to see if NSAIDs might inhibit the occurrence or growth of colorectal cancers. They found that, in fact, the colorectal tumors regressed in animals given NSAIDs. Later, randomized clinical human trials established that two NSAIDs (sulindac and celecoxib) suppressed adenomatous polyps and caused existing polyps to regress in patients with familial adenomatous polyposis (FAP, a rare hereditary condition).

 

The next step was to see how these medicines might affect people who didn't have FAP but might still be at risk for colon cancer. During the 1980s, epidemiologists began collecting evidence from population studies showing that people who reported regular NSAID use had a lower incidence of adenomatous polyps and lower colorectal cancer death rates. These results indicated a possible protective effect against colon cancer from NSAIDs for the general population.

 

In my laboratory in the early 1990s, we began investigating why NSAIDs might convey this protective effect. My research team and I discovered that some intestinal epithelial cells made significant amounts of the COX-2 enzyme in response to growth factors or tumor initiators. This led us down a path of discovery that connected the two and helped explain, in part, how selective COX-2 inhibitors can reduce the risk of some cancers in people.

 

Scientists moved forward to test this theory in human patients. Two randomized clinical trials conducted in the 1990s and early 2000s confirmed that aspirin suppresses the recurrence of adenomatous polyps in people with a previous colon polyp. What's more, other limited epidemiologic data has shown that NSAID use may be associated with a lower incidence of or death from cancers at other sites, including the esophagus, stomach, breast, lung, prostate, urinary bladder and ovary.

 

Unfortunately, patients at high risk for cardiovascular disease have more serious cardiovascular events when taking NSAIDs and selective COX-2 inhibitors at high dosages for prolonged periods of time. On the other hand, some patients can tolerate these medications without cardiovascular complications quite well, especially at lower dosages when given once daily.

 

Further NSAID study needed

Scientists and clinicians are now working to determine how NSAIDs might protect against various cancers, possible effects of the long-term use of these drugs, optimum dosages and contraindications. They also are studying the benefits and risks of NSAID treatment across a broad range of treatment regimens, outcomes and patient populations.

 

Evidence from the nurses' study suggesting that aspirin use may be associated with a reduction in the recurrence of breast cancer may provide one more piece to this complicated puzzle. It certainly will launch the field further into this line of investigation.

  Isaiah J. Fidler, D.V.M, Ph.D., a pioneer in understanding how cancer spreads to other organs and then taps its new environment to thrive and grow, will receive the Lifetime Achievement Award from Nature Publishing at the 2010 Miami Winter Symposium - Targeting Cancer Invasion and Metastasis.

Fidler, a professor in M. D. Anderson's Department of Cancer Biology and director of the Cancer Metastasis Research Center, will be honored tonight and will deliver an award lecture on the biology and therapy of metastasis . 

Organizers of the annual scholarly meeting select an important topic as a theme, invite experts in the field to present the program, and honor a select few influential scientists. Metastasis -- the spreading of cancer from its original site to other organs -- causes 90% of all cancer deaths.

"This honor is fitting recognition of Dr. Fidler's crucial contributions to our understanding of the origins and mechanisms of cancer metastasis," says Raymond DuBois, M.D., Ph.D, executive vice president and provost of M. D. Anderson. "His insights into how the metastatic cell subverts routine biological processes to support its growth in a new organ underpin today's routine study of the tumor microenvironment."

Fidler's major findings include:

• 99.99% of cancer cells that depart a primary tumor die, with metastases originating from less than .01% of cells, even from a single cell.
• Metastatic cells exist in the genetic diversity of the original tumor and are uniquely suited to spread and grow. Like a "decathlon athlete," they must overcome at least 10 separate biological hurdles to escape the main tumor, run a gauntlet of hazards, and then settle in their new home. 
• The destination of a metastatic cell is not governed by a random process or physical proximity. Rather the metastatic "seeds" of a given cancer only take root and grow in certain organs with a welcoming microenvironment, or "soil." For example, prostate cancer metastasizes mainly to bones. By demonstrating this, Fidler revived the "seed-and-soil" hypothesis of metastasis, an insight by 19th century British physician Stephen Paget that had been neglected for nearly 100 years. 

Successful cancer therapy must target both the seed and the soil. Fidler's research currently focuses on brain metastasis, which afflicts more than 200,000 people annually in the United States. Fidler and colleagues have shown that lethal metastases from primary cancers, such as lung or breast, resist therapy because they trick astrocytes -- brain cells that nourish neurons -- into supporting them.

The Winter Symposium is a 42-year-old series of annual sessions focusing on major biological questions. It's organized by the Nature Publishing Group, the Department of Biochemistry and Molecular Biology and the Sylvester Comprehensive Cancer Center, both  at the University of Miami Miller School of Medicine.