Friday, December 15, 2006

Jane Zones, Board Member

Embracing Complexity at the San Antonio Breast Cancer Symposium

Dr. George Sledge, one of the winners of the Nancy Brinker Award at this year’s SABCS, has given the only talk so far that takes a broad view of breast cancer. Dr. Sledge grounded his presentation in pointing out that what matters most about breast cancer is that it kills women.

This in itself was an important reminder for the researchers in attendance, since there as been notable movement in defining primary outcomes of studies from overall survival to metastasis to time to progression. Benefit creep in assessing new technologies allows researchers and product developers to follow patients for shorter periods and to find significant benefit before troubling safety concerns can be shown.

Sledge argued that the dramatic gains in reducing breast cancer mortality have already been made (like “picking the low-hanging fruit on a tree”). He cited screening mammography and CMF chemo as examples. He predicted that the road ahead would be marked by “radical incrementalism”—piling on many elements of small triumphs in rapid succession.

This conference is definitely focused on the small, complex properties and interactions that give rise biologically to new and metastasizing breast cancer cells in the universe of the human body. Sledge urged us to “embrace complexity” in the kaleidoscopic features of these microscopic processes that currently govern breast cancer research and subsequent clinical applications.

I am a sociologist, familiar with the realm of clinical trials and biostatistics, and even some of the major features of breast cancer treatment, but walking into the domain of SABCS is overwhelming. The language of most presentations is beyond my understanding, and the gorgeous slides incomprehensible to me much of the time.

The organization of the conference was welcome to me, because in general there are not competing events. There is a procession of speakers and activities that go on from 7 a.m. to 9 p.m. that we attend largely in unison. This makes the values of those who organize the conference quite apparent. New technologies—cancer biology, aromatase inhibitors, chemoprevention, sentinel node biopsies, micrometastases (indeed—nanomicrometastases)—these are the ruling topics. There is little consideration of surgery, radiation treatment, standard chemotherapies, or screening, as if those are settled issues.

Dr. Sledge, in setting out a list of best bets for progress against breast cancer mortality, identified “lifestyle change,” particularly dietary fat reduction in ER negative patients, as an important focus. This is the furthest out I have seen any speaker stretch at this conference, and I am grateful to Dr. Sledge for his broad thinking.

I was disappointed, however, though not surprised, that Dr. Sledge did not speculate on including our physical environment in the embrace of complexity. That’s a fruit on top of the tree that could provide dramatic impact on breast cancer incidence and mortality. After all, as one of the other speakers pointed out, identical twins, with the exact same genes at birth, are shown to have altered genetic codes as they age. There are big things out there that are assaulting our genetic makeup to cause these microscopic events that are so evident here in San Antonio.