Women's Cancers Program: the first 10 years
A message from DFCI President Edward J. Benz
In a visionary move a decade ago, the Dana-Farber Cancer Institute unified its many research and clinical efforts in women's cancers under a single umbrella— the Women's Cancers Program, or WCP. The aim was to foster communication among individual scientists and provide coordinated, one-stop care for women with breast and gynecological cancers.
This year, we mark the 10th anniversary of the program, which was prompted by a suggestion from David Livingston, MD, and realized through the energy and commitment of Dana-Farber Trustee Susan Smith. The year 2004 also marks the 10th anniversary of Turning Point, which has chronicled the WCP as it has become widely recognized for its innovative clinical research and contributions to the fundamental science of cancers in women.
In this issue of Turning Point, we focus on the pillars of our program: tracking down the genetic causes of breast and gynecologic cancers; diagnosing these cancers in time for effective treatment; and devising new therapies to extend life. Our tools are increasingly sophisticated. They include the new technologies of "genomics" and "proteomics," which enable scientists to understand the behavior of cancer cells and to pinpoint molecular targets that can be attacked with designer drugs.
This issue describes how, for example, investigators in the program are using proteomics to discover new diagnostic markers for ovarian cancer, and other investigators are using genomics to unmask the many differences we observe in types of breast cancers.
Mrs. Smith, who headed a national advisory committee of the WCP, foresaw the central role these technologies would play. In the first issue of this magazine she wrote, "We have reached a turning point in the battle against cancer, thanks in large part to the revolution in human genetics. A key goal of the Women's Cancers Program is to pinpoint faulty genes that spark cancer's growth."
This statement looked prescient almost immediately. In 1994 and 1995, scientists discovered two genes, BRCA1 and BRCA2, which, when they are inherited in a mutant form, raise a woman's risk of breast and ovarian cancer to very high levels. J. Dirk Iglehart, MD, director of the Women's Cancers Program and chief of Surgical Oncology at Brigham and Women's Hospital (both part of the Dana-Farber/Brigham and Women's Cancer Center), was a member of the international teams that discovered both of these genes. The BRCA2 gene was isolated by investigators working in the Iglehart group, then located at Duke University.
These historic discoveries opened an era when, for the first time, an individual woman in a family hard-hit by breast or ovarian cancer could learn whether she carried a mutant high-risk gene and take measures to lower that risk.
When breast cancer does strike, "I truly believe there is no finer place than the Breast Oncology Center within the WCP to obtain care," says the center's director, Eric Winer, MD. "Clinical research is integrated into our clinical program, so that we provide outstanding care and answer important questions that will help alter the way we treat women with breast cancer."
In the laboratory, genomics technology has brought "gene chip" devices that can measure the activity of thousands of genes in a cancer cell at once and compare this snapshot against a normal cell's pattern of gene activity. These devices have revealed that breast cancers can be divided into a number of genetically distinct diseases, which promises improved diagnosis and more specific tailored therapies. As Dr. Iglehart explains, "one form of breast cancer is as different from another as a heart attack is from a stroke." Already, this new view is toppling the traditional "one-size-fits-all" approach to breast cancer treatment: instead, a woman with breast cancer is becoming more likely to receive treatments matched to the genetic characteristics of her tumor.
It has, indeed, been a decade of discovery in women's cancers. Jay Harris, MD, chief of Radiation Oncology at Dana-Farber, says that the accomplishments of the WCP demonstrate the ability of Institute leaders and trustees "to build a world-class treatment and research focus.
"It is remarkable," Dr. Harris says, "how much has been accomplished in terms of the clinical care team, basic research, and translational research in a mere decade."
Edward J. Benz Jr., MD
President, Dana-Farber Cancer Institute
