I was invited to give a talk at the Pink Out event in Harrisburg. I asked if I needed to bring my own computer or if they were all set up. She said "what do you need a computer for?" PowerPoint? So, I just realized I had agreed to give a speech, no slides, not a scientific presentation or lecture-- yikes just a talk. They wanted me to talk about the advances in cancer care since the 1950s in keeping with the fund raising theme. I told her I didn't do breast cancer research, but that I worked on ovarian cancer. No problem, the entire audience will have ovaries. So, I wrote the following speech. I practiced at the lecturn in my office, tried it out on my lab group, and it seemed like I had dialed it in just right for the anticipated audience. We packed flaxseed into about 200 eppendorf tubes as party favors, and the organizers put one at each place. I went around to the vendors,introduced myself and handed out flaxseed samples. One woman asked if it was a suppository. Yikes! It was quite an affair with vocal performances from music students at Southeastern Illinois College in Harrisburg. Impressive! Then after some more prefunctory comments, I took the microphone and delivered my spiel. The 200 women in the audience sat quietly staring at me, with no emotion or response. When I finished there was a brief delay, and then polite appluase. The organizer took the mike, thank me and said "ooo, that was a lot of information!" Too much I fear. I guess I am not ready to hit the talk show circuit yet.
Keynote address at Be-boppin’ for the cure
Harrisburg, IL March 7, 2015
We are all here because in one way
or another cancer has touched our lives.
To those of you who are survivors, congratulations—I wish you the best
in your continued recovery. About the
worst possible news anyone can get from their doctor is the cancer
diagnosis. You know that your life and
lives of your family, friends, and associates—are all now changed by the
elephant in the room. From that moment
the journey begins. For some that
journey is all too short, but more and more, every day that journey continues
for years, for decades, for the rest of your natural long life. My mother died of cancer when I was 16. Two of my sisters are breast cancer
survivors, each having survived recurrent disease. Everyone is touched by this monster. But there is hope and the tide is turning.
Because of our nation’s investment
in cancer research, more people are surviving cancer than ever before. Today, 2 out of 3 people live at least 5
years after the cancer diagnosis. In the
1970s, only 1 out of 2 survived that long.
The death rate has dropped nearly 20% since the 1990s—finally reversing
decades of increases. This progress
reflects advances in every area of cancer care—prevention, screening,
chemotherapy, surgery, radiation and increasingly molecularly targeted
treatments. These advances continue to
bring new hope every day and mark a change in our thinking—we now know that the
cure for cancer is prevention. The War
on Cancer, launched by President Nixon in the 1970s was a milestone in the
national investment, as was the doubling of the NIH budget during President
Clinton’s administration. Another
significant landmark was the sequencing of the human genome in the early 2000s
and we continue to draw new insights and develop new targeted therapies from
genetics—at an accelerating rate with the development of new more powerful gene
sequencing technologies.
Thinking back on previous
milestones—in the 1880s William Halsted was first to usher in more aggressive
surgical approaches—the radical mastectomy in which the entire breast,
surrounding lymph nodes and chest muscles were removed—to prevent recurrence by
removing the cancer beyond the margins.
He was quoted as saying he was “loathe to disfigure a woman” but knew he
had to, to save her life. In the 1970s
more limited surgery was introduced—total mastectomy, which set the stage for
more modern breast conserving surgeries such as lumpectomy.
In 1903 after Marie Curie
discovered radium, radiation therapy for solid tumors was introduced. Radiation therapy continues to be an
important tool in for the oncologist with methods of precisely targeting and
delivering the radioactivity to the tumor but sparing adjacent tissues. Radiation therapy following breast conserving
surgery is highly effective in treating breast cancer.
With the introduction of the Pap
test, named after George Papanicolaou, cervical cancers can be detected and
removed before they have a chance to spread.
Since the 1950s, widespread use of the Pap test has helped to reduce
cervical cancer rates by more than 70%.
The key to this success is early detection and effective screening
strategies. Certainly early detection
for breast cancer (mammography 1970s), prostate cancer (PSA, 1986), colorectal
cancer (fecal occult blood test, 1967—are key to the ever better news for these
cancers. Regular screening leads to the
detection of highly treatable early cancer, and this is why the cancer
statistics for these cancers have improved so dramatically—screening and
effective early detection.
In 1947 chemotherapy was added to
the armament of the physician—the use of nitrogen mustard, the same lethal
compound used in WWI—mustard gas, was shown to effectively kill cancer cells by
modifying their DNA. Hodgkin’s lymphoma
is still treated today by a modified variant of nitrogen mustard. But as is the case with all
chemotherapies—the fast growing cells are killed, usually cancer cells, but
unfortunately these are deadly toxic poisons that kill normal healthy cells—and
almost kill the patient in the process of delivering the cure. In the 1950s when my mother’s cancer was
discovered, she suffered through nitrogen mustard treatments. I was too young to know what she was going
through but she later told me how sick it made her. It worked though—she lived for 15 years with
her cancer.
In 1958 combination chemotherapy
was introduced and has proven to highly effective in treating many cancers,
especially leukemia and other cancers of the blood. These early findings set the stage for the
modern era of chemotherapy when multiple drugs at specific times and dose
intervals are proving effective against many cancers.
In the 1950s everyone smoked cigarettes,
but the probable connection with lung cancer was first suggested—then in the
1960s the link to smoking was widely accepted, and today, lung cancer is still the
most preventable form of cancer—prevention is the cure—quit smoking! Asbestos, other environmental toxins are now
also known to cause very specific cancers—again all curable by prevention. Sun exposure’s link to melanoma revealed
another environmental cause of cancer.
In the 1970s adjuvant chemotherapy
was introduced—chemotherapy following surgery was shown to increase survival in
breast cancer. Now adjuvant chemotherapy
is widely used, especially in the treatment of ovarian cancer. This has proven
to be one of the most important advances—9 out of 10 women with breast cancer
survive more than 5 years because of this innovation.
In the 1980s vaccines against
specific cancers ushered in the age of immunotherapy. Hepatitis B vaccination prevents a majority
of liver cancers. In 2006 vaccination
against human papillomavirus (HPV) was shown to completely prevent cervical
cancer.
Chemotherapy in the modern era was
ushered in with the discovery of taxanes in the early 1990s, highly effective
as adjuvant therapy for breast and ovarian cancer, now available as the
synthetic paclitaxel. Taxanes were
discovered as a natural product isolated from the bark of the yew tree. The development of the synthetic assuaged
fear that the natural source of the drug would be exhausted due to the
demand.
In the wake of the human genome
project and with every more sophisticated understanding of cancer biology, the
21st century heralds the era of targeted therapeutics which specifically
attack the cancer without attacking the innocent bystander. Gleevac, rutisumab, trastuzumab (Herceptin),
imatanib, gefintinib, avastin--- all are “pathway specific” drugs, either
immune based or activity based therapies.
Other important adjuvant therapies such as tamoxifen for estrogen
sensitive breast cancers are also proving to be powerful additions to the
oncologist’s toolbox.
One of the most significant
findings, which I believe heralds the new era of cancer prevention medicine,
was the discovery of the link between obesity and cancer in 1998, and then the
link of diabetes to cancer—leading to our understanding of the role of
inflammation, obesity and diet in cancer.
The idea that diet can cause—or prevent cancer is not new. But the actual use of “dietary intervention”
for cancer therapy is still an idea that is gaining acceptance. The concept that we can target the
inflammation that causes cancer with diet is the very essence of the research
in my lab.
It has long been known that ovulation—when
the egg leaves the ovary to enter the Fallopian tube—is an inflammatory
event. The ovary is wounded by when it
expels the egg, and then has to heal—a classic inflammatory event. Repeated rounds of this tear and repair
cycle, every month year after year creates a ripe environment for the cancer to
start. It’s been said the cancer is the
wound that will not heal. There is a
very strong link between the number of ovulations and ovarian cancer. The best way to prevent the disease is to
limit ovulations—multiple pregnancies, breast feeding, contraceptives are all
protective against the disease. The more
ovulations, the more inflammation and rounds of wound healing. We had a simple goal, find natural product
antioxidants that we can use to target the inflammation in hopes we could
attack the disease.
One of the reasons that so little
progress has been made in ovarian cancer is because there are very few adequate
animal models for studying the disease.
Rodents do not get ovarian cancer unless you cause them to get it,
either by manipulating them genetically, or by causing it with chemicals or
drugs. These are useful models for
studying therapies for late disease, but can’t help us understand what causes the
disease—because the investigator has to induce the cancer. Amazingly, chickens are the only animal that
gets the same kind of ovarian cancer that women get, and importantly they are
afflicted with the cancer spontaneously—so we can study old, cancer prone hens
which have ovulated every day for over 2 years, and study the earliest stages
of ovarian cancer, to help us find a way to prevent it from starting and also
to develop tests for early detection.
Prevention and early detection are both seriously lacking in the treatment
of ovarian cancer.
There is a lot of public interest
in omega-3 fats—fish oil is known to be cardioprotective and potent
anti-inflammatories. We were considering
how to give chickens fish oil, to give them omega-3 fats, when I discovered
“omega eggs” in the dairy case at the health food store. Wow, I thought, if the chickens accumulate
omega-3 in the eggs, the ovary has to see it too. How do they get all that omega 3 into eggs?? They
feed the chickens flaxseed! I thought
that surely there must be a lot known about the health benefits of feeding hens
flaxseed, after all the omega egg business represents about 15% of the shell
eggs sold in Canada, and about 3 % in the USA.
Nothing was known about flax effects on hens. All that the large scale egg producers care
about are the eggs, not the chickens. So
we decided to see if we fed hens flaxseed if it might not have some beneficial
effects and maybe even prevent or reduce ovarian cancer. We conducted a series of studies to fine tune
the feeding and analysis, and then embarked on a one year study where we fed
400 chickens 10% flaxseed for one year.
The diet had profound effects.
The flax fed hens looked better, maintained the same lean body weight throughout
the study, far fewer of them died—their overall wellbeing was much improved by
the diet. But the important finding was
that the severity of the disease was significantly reduced by the diet. There was a 70% reduction in the severity of
the cancer, the hens that did get cancer presented with early stage
disease. This exciting finding indicated
that flaxseed reduced the inflammation that drives the cancer, and causes it to
slow to the point that the cancer was no longer lethal to the hens!
These exciting findings enable us
to attract substantial funding from the NIH to conduct more studies on how the
flaxseed works to treat the disease. These
studies are ongoing in my laboratory at the SIU School of Medicine in
Carbondale. We are finding some very
exciting things, including possibly identifying a potential biomarker to help
detect early disease, and we are just now starting a clinical trial to test the
effectiveness of flaxseed in women who are in remission after initial surgery
and chemotherapy for ovarian cancer.
The use of taxane and platinum
based therapy post-surgery (i.e. adjuvant therapy) has proven to be highly
successfully in the initial treatment of ovarian cancer but the standard of
care and outcomes for ovarian cancer have not significantly improved for the
last four decades. The initial round of
therapy is successful and provides on average two years of disease free
living—but in some 75% of women the disease returns, and the recurrent disease,
again treated with combinations of chemotherapeutics with good success—but
eventually in the majority of cases, the disease will return, and now be
resistant to chemotherapy, and the woman will ultimately succumb to the
cancer. We have just started a new
clinical trial for women who are in remission post initial therapy to try and
prevent the disease from returning.
Instead of just waiting, we are giving these women a daily dose of
flaxseed, 20 grams a day, every day in hopes that this simple dietary
supplement will keep the disease at bay.
Based on the success of our trials in the cancer prone hens, where the flax
significantly reduced the progression of the cancer, we are hopefully that this
intervention will prove to be effective for women. Our goal is to turn ovarian cancer into a
disease women can live with instead of die from. Talk to me if you know someone who would like
to enroll in this trial.
