Walter Eckhart and his Salk Institute team developed an innovative gel method to observe early growth of breast cancer cells.

The American Cancer Society estimates in 2006 about 212,920 women and 1,720 men in the United States will have invasive breast cancer and 40,970 women and 460 men will die of the disease. About 21,200 women in California will be diagnosed with breast cancer in 2006 and 4,080 of them will die. More than 2 million U.S. women are alive who have been treated for breast cancer. In San Diego, more than 2,000 women will be diagnosed this year. “The chance of a woman having invasive breast cancer some time during her life is about one in eight,” the society reports. “The chance of dying from breast cancer is about one in 33.” Survival rates are increasing, most likely because of quicker discovery and improved treatment.

Breast cancer is the most common cancer among women and is second to lung cancer in killing women. While men also can get the disease, it is about 100 times more common in women. Unavoidable risk factors are family history, gene mutation, age, early menstruation or late menopause. Controlled risk factors include obesity, smoking and alcohol intake.

Research Partnerships

San Diego is among the leading U.S. regions in terms of breast cancer research. Within walking distance of each other and working in conjunction to battle the disease are the Salk Institute, Sidney Kimmel Cancer Center, UCSD’s John Moores Cancer Center and Burnham Institute for Medical Research.

“A lot of the work that is going on is to try to understand the genes that are altered in all kinds of cells to be able to tell what might be specific for breast cancer cells,” says Walter Eckhart, professor and director of Salk Institute for Biological Studies Cancer Center. “Then we work to try to understand growth-signaling pathways that affect the growth of breast cancer cells.”

Understanding those pathways is important for being able to design ways of reversing the growth of the cells. Working mostly on the growth signaling pathways, Salk labs are using a novel culture system. Typically, cells are nurtured in tissue cultures grown on a flat surface on a dish. A new method grows them in a 3-D culture by suspending them in a gel. “That mimics much better the circumstances that they grow in the body,” Eckhart says. “So people here, and other places, are using this system to try to see the early events in breast cancer.”

Other Salk endeavors include researching the hereditary changes in breast cancer. “About 10 percent of breast cancer is hereditary in the sense that there is an inherited mutation that predisposes women to breast cancer,” Eckhart says. “People are working on the genes that are changed to understand how that works. There has been a lot of progress (overall). There will be cures, a little bit at a time.”

Down the road from Salk, the Sidney Kimmel Cancer Center is celebrating being on the receiving end of a $240,000 research grant from the New York-based Breast Cancer Research Foundation. This grant supports breast cancer research under the direction of Dr. Albert Deisseroth, president and CEO of SKCC. Deisseroth’s research is described as a vaccine that activates the body’s immune system to suppress the recurrence of breast cancer following initial surgery. The same week Deisseroth was in New York accepting the grant, the Kimmel Center announced the completion of its $24 million research center on its 10-acre campus on Torrey Pines Mesa. Deisseroth says the building reflects SKCC’s belief that San Diego is an enabling environment in which the academic and business sectors work together to make possible the development of “less toxic and more effective cancer treatments.”

Finding The Right Test Subject

Recruiting research volunteers is a difficult task for Georgia Robbins Sadler, associate director of the UCSD Cancer Center, because of privacy laws.

Testing research on a daily basis with long-term follow-up goes on at the Rebecca and John Moores UCSD Cancer Center. “UCSD participates in early phase trials developing new drug therapies and trials designed to study breast cancer risk, the effects of chemotherapy on the brain, the effects of light on fatigue in breast cancer patients, treatment of older women with breast cancer, the effects of weight loss on breast cancer survivors and studies of biomarkers in breast tumors and bone metastases,” explains Dr. Teresa Helsten, an associate physician specializing in breast cancer at the Moores Center.

Georgia Robins Sadler, associate director for the UCSD Cancer Center in charge of community outreach, says the most difficult aspect of research studies is contacting the public to obtain participants. “It is a constant challenge to get the word out.” Privacy protection laws make it impossible for UCSD to contact patients directly and doctors are unable to keep up with the changing needs of studies on top of new studies. Therefore, they must rely on the press, community and word of mouth. “Basically it falls on patients to find the studies,” Sadler says. “You just need to ask and find out if it’s right for you.”

UCSD is currently looking at the impact of exercise and light treatment for patients coping with fatigue following treatment of breast cancer. “So if a woman who is reading this article has been experiencing fatigue, maybe more than three months following breast cancer, there is probably a study for her,” Sadler says. Another study is looking at women prior to chemotherapy to obtain a base-line level of their fatigue. The fatigue is measured and sleep patterns are studied. “The doctor looks at them before the start of chemotherapy and then follows them through during chemotherapy to see how their sleep patterns change.” Through its hospital and on to its cancer center UCSD is able to track patients from discovery to treatment and beyond recovery.

Providing Technology, Programs

The Young Women’s Program and Young Women’s Forum for women ages 20-39 at Scripps Polster Breast Care Center are unique in San Diego, says liaison nurse Bev Mangerich.

On campus at Scripps Memorial Hospital in La Jolla is the Scripps Polster Breast Care Center. From one of two machines, the center begins breast care with digital mammography. The technology is so popular the center is looking to add a third machine for diagnostic mammograms. Continuing care is provided under the coordinated care of a panel of physicians. Radiology, surgery and psychosocial support are available under the same roof.

Scripps offers the only Young Women’s Program in San Diego, and the Young Women’s Forum, the only support group for young women diagnosed with breast cancer, says Bev Mangerich, Scripps Polster Breast Care Center liaison nurse. “This first-of-a-kind program group is open to the entire San Diego community as part of our educational, community-wide outreach program supporting women ages 20-39.” The goal is to disseminate information to young women on breast health, breast cancer awareness, breast self-exams and genetic risk. This is done by partnering with local university health clinics, corporations, cultural clubs, sororities and various women’s groups. Also available is the Breast Buddy Program. Patients are matched with volunteers to help shepherd them through treatment and recovery.

Scripps works with local community clinics and the Susan G. Komen Foundation to offer mammograms for women who can’t afford them and don’t quality for government assistance. Also with help from the foundation and in collaboration with the Scripps Otay Family Health Center and Operation Samahan Clinic is Mujeres en Acción, a program that targets Latino, Filipino and Asian women, ages 40 and over, living along the San Diego/Tijuana border who are considered medically underserved. In an effort to promote breast cancer early detection services, the program links community outreach activities with a continuum of clinical preventive services. To date, the effort has educated about 14,000 hard-to-reach South County women.

Scripps La Jolla does not participate in breast cancer research, but the Scripps Cancer Center, a collaboration between Scripps Health and its hospitals and the Scripps Research Institute, is recognized as one of the top biomedical research institutions in the world. Just released from Scripps Research Institute are findings of an enzyme that is highly elevated in aggressive human tumor cells. Shutting the enzyme off impairs tumor growth and migration in both ovarian and breast cancer cells. “There are 20,000 to 25,000 protein products in our bodies,” says Benjamin F. Cravatt, a Scripps Research Institute professor who led the study. “We’re lucky if 5,000 to 10,000 of those have any known function. When we try to find things for altering cancer, it’s done one protein at a time. Now with the genome mapping sequence and the technologies being developed, one can look broadly at many proteins at parallel in cancer cells. That allowed us to identify this totally uncharacterized protein that no one had ever looked at before.”

This research has led scientists from seeing just a sequence in a database to seeing a protein with a defined metabolic function. “And if you disrupt that metabolic function, cancer cells no longer tumor effectively,” Cravatt says. “It provides a potentially new target for the most refractory forms of breast cancer that exist.”

A System Approach To Care

Kaiser Permanente, with a national database of more than 8.6 million members, is one of the largest research organizations in the country. “There are so many encouraging research projects and clinical trials,” says Dr. Jon Polikoff, a San Diego Kaiser Permanente oncologist. “We’re fortunate to have the ability to pursue promising leads with dedicated, caring physicians and researchers throughout our system. We also have the advantage of being the medical home for our patients who participate in trials, so we can not only follow them for years to come, but also provide their comprehensive medical care as their health plan.” Polikoff also serves as the Southern California regional cancer research coordinator and principal investigator for numerous studies.

As members of the Kaiser Permanente health system, patients receive all their care at Kaiser hospitals or contract locations that provide specialty care to health plan members. Within the system are breast care centers in La Mesa, San Marcos and Otay Mesa. Patients who suspect a lump, or who have an abnormal mammography reading, can call or walk in for a same day appointment. At the same place they will receive a clinical exam, go through imaging and have a biopsy. “In most cases, patients are seen by a surgeon within 24 hours, and appropriate treatment begins within days,” says Judy Bamburg, Kaiser Permanente breast care coordinator. “This has become a model program, which is being implemented in other Southern California Kaiser Permanente locations. The philosophy behind the breast care centers is a belief that no one should have to wait for weeks to get tested, get results, see a surgeon and start appropriate treatment.”

More than 100 patients have received breast cancer treatment and follow-up care at Kaiser through the statewide Breast Cancer Early Detection Program, created in the mid- 1990s from Proposition 99 Tobacco Tax and other earmarked state funds. When the program started, funding only provided for breast cancer screening, but no treatment.

A unique part of breast cancer care at Kaiser Permanente is the ROSE Program. Resources, Options, Support and Encouragement is an all-volunteer service made up of more than 20 trained breast cancer survivors who meet with newly diagnosed patients — usually the same day as diagnosis — and provide patients with information about services. Kaiser programs reach beyond its own system. Working with the American Cancer Society is a cancer committee that coordinates care and services. Health educator Silvia Bustamante serves as the liaison to the American Cancer Society. “We work closely together to make sure patients have access to all the programs and information resources available, from classes and support groups to services, studies and online resources.”

Four times a year Kaiser hosts the ACS “Look Good Feel Better” program. It also makes direct links to the ACS available to health plan members. Kaiser is a founding grantor and ongoing contributor to Cancer Navigator, a countywide coalition of organizations that provide online and telephone support, local and national resources, direct links to clinical trials anda community calendar. Available in English and Spanish, the Web site is a free program initiated by the San Diego County Board of Supervisors to provide resource information to cancer patients, their families, health providers and the public. Visit cancernavigator.org or call (866) 324-2628 for details.

In The Hands Of The Patients

But back to basics. Dr. Galen Hansen says research and discovery aside, the key to surviving breast cancer is early detection. Most women don’t do a breast self-exam because they are afraid of finding something. Hansen says it usually takes a friend getting the disease to encourage women to do self checks. When caught early the cure rate is 80 percent. Hansen is a private practitioner who promotes routine screening at age 30 with a repeat mammogram every other year until 40 and then continued annually. “I’ve kept track of how many breast cancers I’ve detected by mammogram since 1984 and I’m up to 109,” Hansen says. “To my knowledge, every one of those women is fine because of early detection.”