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Almost two decades later, doctor reflects on using embryo selection to save young girl’s life

July 11, 2017 - 8:41am

Molly Nash was not expected to live to the age of 10. But her parents, and John Wagner, M.D., professor with the Department of Pediatrics in the Medical School, refused to let the genetics of her disease have the final word.

Molly was born with Fanconi anemia (FA), a severe, inherited blood disorder with high risk of cancer. Based on her genetics, she was predicted to have marrow failure by the age of 6 and myelodysplastic syndrome or leukemia by the age of 8. She wasn’t expected to survive more than 10 years. The only proven treatment for the bone marrow failure, myelodysplasia and leukemia was a bone marrow transplant. Molly and her family sought help in the 1990s, a time when very few survived without a matched brother or sister marrow donor. Unfortunately, Molly had no siblings.

“After an unrelated donor bone marrow transplant, most children with FA died of graft rejection. We just couldn’t give enough radiation and chemotherapy to prevent rejection because of the underlying DNA repair defect characteristic of FA. When bone marrow didn’t take, it was a death sentence,” Wagner explained. “These were very hard times with little hope of making transplant a safer option.”

In 1994, after much ethical debate, Wagner offered a new option called embryo selection. Newly available technologies permitted rapid genetic testing on a single cell, allowing couples to obtain embryos after in vitro fertilization that were unaffected by FA and could also serve as HLA matched donors. The Nash family jumped at the idea knowing full well that this would be highly controversial. But, ultimately, they desired a healthy family and desperately wanted Molly to live.

On August 29, 2000, a day Wagner has memorized, Adam Nash was born. Several weeks later, Molly received her transplant.

“That’s when it all started,” Wagner remembers the headlines and criticism, “’Frankenstein’, ‘Crime against Humanity’, ‘Evolution is Dead’ and ‘Playing God.’” For a period of time, Wagner received both praise and threats.

“All we were trying to do was save this little girl’s life,” Wagner said. “This not only gave her the best chance but it provided a safe way for the Nash family to have healthy children without the fear of passing along FA.”

17 years later, both children are now happy young adults.

“When I see Molly, and how far we’ve come in the field, knowing that I’ve been a part of this journey, is really incredible,” said Wagner.

Wagner has also been a big part of a growing sense of community with the families faced with Fanconi anemia. In fact, the last time he saw Molly and Adam was also in the midst of a display of that connection. Over Father’s Day weekend this year, two men embarked on a coast to coast bike ride that stopped in Minneapolis.  Steve Rice and Dave Kummer

Steve Rice and Dave Kummer make a stop during their Coast to Coast for KATA bike ride outside Minnesota Masonic Children’s Hospital

rode from Oregon to Maine with the goal of increasing awareness for Fanconi anemia and connecting with families affected by the disease. They also hoped to raise money to improve medical treatment, increase life expectancy, and ultimately find a cure for FA. Minneapolis was an important stop along their route, specifically at the University of Minnesota Masonic Children’s Hospital, where they were greeted by several FA families, including the Nash’s.

Community members, and FA families greet KATA riders outside University of Minnesota Masonic Children’s Hospital

“The sense of community is important,” said Wagner. “We’re in this a life and death struggle together.”

Wagner is inspired by families like Molly’s, willing to take part in research even if they may not see the benefits directly but know how it may help others. As a result, Wagner and his colleagues have made great strides not only for FA but also cancer and a host of rare diseases.

The field has come a long way for FA. In the 1990’s the expectation of survival for Fanconi anemia patients undergoing unrelated transplant donor was 16 percent. Now it exceeds 90 percent. Wagner is clear that it’s still not good enough.

“Maybe someday we won’t even have to do a transplant,” said Wagner. “We never accept the status quo.”

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Research Snapshot: A detailed look at HTLV-1, the retrovirus that causes T-cell Leukemia

June 27, 2017 - 10:22am

Retrovirus replication remains an intriguing enigma to researchers. Scientists continue to unearth more and more insight, but the process is still poorly understood.

It is generally believed that virus particles need to be fully formed to transmit a virus. But a recent study by researchers in the Academic Health Center’s Institute for Molecular Virology (IMV) shows this may not be the case.

“It is quite surprising a virus would primarily produce virus particles that have structural defects,” said Louis Mansky, Ph.D., lead author of the study, director of the IMV, and professor in the School of Dentistry. Mansky is also a Masonic Cancer Center member.

Mansky’s team studied human T-cell leukemia virus type 1 (HTLV-1), which causes T-cell leukemia. Using the cutting edge technology of cryo-electron microscopy, researchers were able to capture detailed images of HTLV-1 particles. The researchers were surprised to find most particles were quite different. They varied in size and structure, many even lacking organized cores.

The main takeaway: The virus has physical defects that appear to render it non-infectious.

The study was recently published in the Journal of Virology.

“Why would a virus evolve to produce incomplete virus particles? This is currently a mystery, but the fact it does it this way means it must offer a selective advantage to the virus, perhaps to help evade the immune system,” Mansky said.

RNA, which initiates virus replication, is located in the “capsid” or particle core. With so many particles lacking a fully-formed capsid, it raises questions about how the virus spreads among infected individuals. More importantly, it suggests that intervening with core formation could block virus transmission.

That opens the door to new potential drug therapies, vaccines or other interventions.

“To fight these diseases, we need to understand how they work,” Mansky said. “Right now, we don’t have effective therapies for treating HTLV-1 infection, but gaining a deeper understanding of basic viral replication should help in identifying targets for therapeutic intervention. Our findings help provide important clues to direct the next steps, and could lead us to a potential treatment or preventative for human leukemia.”

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Research Snapshot: Some melanoma survivors still practice unhealthy sun behaviors

May 8, 2017 - 2:50pm

Over the past 30 years, melanoma rates have been rising. In 2017, 87,000 cases are expected to be diagnosed in the U.S alone. While it is an aggressive cancer, it is highly treatable when caught early and  highly preventable in about 90 percent of cases. In honor of May being Melanoma awareness month, HealthTalk is shining a spotlight on research to combat rising diagnosis rates as well as persisting cases in those who have been previously diagnosed.

As spring and summer months approach, sun protection becomes more pertinent, especially for melanoma survivors. However, a recent University of Minnesota study found this segment of the population may not be taking necessary sun safety precautions. The study was led by Rachel Vogel, Ph.D, assistant professor in the Department of Obstetrics, Gynecology and Women’s Health at the Medical School, in collaboration with researchers from the Masonic Cancer Center and School of Public Health.

The study, recently published in Cancer Epidemiology, Biomarkers & Prevention, looked at more than 700 melanoma survivors and surveyed what sun protection methods they used. Long-term melanoma survivors reported healthier sun exposure and protection behaviors than controls, however, many still reported getting a painful sunburn in the past year. Vogel suspects melanoma survivors participate in dangerous behaviors simply because lifestyle changes are difficult, especially when rooted in social activities.

“Educational and behavioral interventions are needed in this high-risk group to reduce their risk of future melanoma,” said Vogel, who is also a Masonic Cancer Center member. “We are in the preliminary stages of determining what such an intervention might entail. Before this can be done, we must understand what barriers exist that prevent survivors from discontinuing risky sun exposure.”

Still, Vogel recognizes a promising finding in the study.

“I would say, thankfully, some of our current messages appear to be working,” she said.

Current messages stress the adoption of simple behaviors including using sunscreen, covering up with clothing and sitting in the shade during peak hours.

“I would encourage patients who have survived melanoma to make these protection methods routine and to limit sun exposure whenever possible, regardless of how long it has been since their diagnosis,” Vogel said.

Moving forward, the  interdisciplinary research team hopes to develop an easily-disseminated intervention to address sun protection barriers and promote behavior change.

Lori Strayer, Leah Engelman, Heather Nelson, Ph.D., M.P.H., Anne Blaes, M.D., Kristin Anderson, Ph.D., M.P.H., and DeAnn Lazovich, Ph.D., M.P.H., all collaborated on the study.

(This study was also featured on NPR earlier this year)

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Should All Breast Cancer Patients Receive Adjuvant Chemotherapy Treatment?

April 7, 2017 - 3:53pm

Women who undergo surgery for breast cancer will often consider an adjuvant therapy, usually a precautionary regimen of chemotherapy to ensure the cancer is completely gone.

It was widely believed to ensure better long-term outcomes for the most common types of breast cancers, Invasive Lobular Carcinoma (ILC) and Invasive Ductal Carcinoma (IDC).

But, new research from the journal Cancer, shows that adjuvant chemotherapy may not be as cut and dry, particularly if these cancers are estrogen receptor (ER)-positive and human epidermal growth factor receptor 2 (HER2)-positive.

“Our initial thought was that histologic subtype, meaning the two common sub categories of breast cancer, would not be a factor for determining the use of adjuvant chemotherapy” said Schelomo Marmor, PhD., MPH, assistant professor in the Department of Surgery at the University of Minnesota Medical School who led the research. “But because no studies looked at treatment on this granular level, we felt it was worth exploring so that we could know for certain how best to treat our patients.”

Marmor and colleagues within the Masonic Cancer Center, University of Minnesota analyzed data from the California Cancer Registry spanning 2004 to 2013. They identified 32,149 patients with early stage ER -positive and HER2-negative IDC and 4,095 patients with early stage ER-positive and HER2-negative ILC.

The data demonstrate that the ILC patients did not benefit from adjuvant chemotherapy, while the IDC patients who received adjuvant chemotherapy had an improved 10-year overall survival.

“Most patients assume that breast cancers, no matter their subtype, can be treated in similar ways,” said Todd Tuttle, MD, MS, professor in the Department of Surgery and collaborator on the study. “This is not always the case and it might be beneficial for some patients to avoid ineffective chemotherapy because it also comes with risks.”

While more research is needed before considering changes in counseling patients, the findings have prompted investigators to rethink assumptions about chemotherapy for ILC.

Marmor added, “Because most ILC patients have stage I or II disease, avoiding chemotherapy when it’s not necessary could markedly reduce potential for side effects as well as the economic and emotional burden that comes with breast cancer treatment.”

The post Should All Breast Cancer Patients Receive Adjuvant Chemotherapy Treatment? appeared first on Health Talk.

ACA repeal could greatly impact women’s health

February 22, 2017 - 10:57am

Since President Donald Trump’s inauguration, there has been a steady drop in the probability that the Affordable Care Act will be repealed by the end of April. A recent Washington Post poll shows a 35 percent chance of that happening. However, this does not quell the fears raised by what a repeal could mean.

Under the Affordable Care Act, women’s preventive health care, namely mammograms, cervical cancer screenings, and prenatal care is covered. If it is repealed, the likelihood of women continuing those preventive care options decreases. Deanna Teoh, M.D.,  assistant professor in the Medical School, says people will prioritize if put in the financial position to choose between preventive care and for example, everyday expenses like food, transportation and other health care needs. But Teoh insists preventive care is not something that should fall to the way-side.

“Potentially we are preventing diseases, and if we stop screening, mortality rates could sky-rocket,” explained Teoh.

Cancer is already one of the top killers globally. In the United States alone, nearly 150 women out of 100,000 women will die from cancer.

Access to contraception would also be in jeopardy. That fear is even causing some women to “stock up” on birth-control supplies. With reduced access to contraceptives, unplanned pregnancies may increase. Currently, 49% of pregnancies are unintended. The teen pregnancy rate is substantially higher in the United States than in other nations, and racial disparities in teen birth rates are obvious. However, starting in 2014, we saw a dramatic decrease in teen pregnancies, reaching a historic low of less than 25 young women out of 1,000, ages 15-19.

There are other potentially unnerving situations which could unfold in the future, she explained, including in the workforce and in home-care. For example, if a woman is sick but doesn’t get treated, we lose her contributions at work, and if she is a mother, her children are also at risk of not being cared for properly.  Additionally, lack of access to prenatal care jeopardizes the health of women and the unborn child she is carrying.

“We all end up taking care of each other one way or another, through covering the missing workforce, caring for others’ children, or paying for their health care indirectly through taxes,” said Teoh.

More than that, Teoh went on to point that some people don’t realize just how many people will be affected if the ACA is repealed.

“You can be very educated, very skilled, and still not have insurance. Think of everyone who is self-employed, small business owners, the writers, artists and actors in our communities,” she said. “One way or another it would affect all of us, even those with insurance.”

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Cervical cancer is killing more women than medical experts thought, study says

February 14, 2017 - 8:53am

“In my opinion, the study’s most disturbing revelation was this: black women living in the United States die at the same rate from cervical cancer as women living in sub-Saharan Africa,” said Christopher Pennell, Ph.D., associate director for Community Engagement at the Masonic Cancer Center, University of Minnesota, referring to a recent study about cervical cancer. “If this isn’t a wake-up call, I don’t know what is.”

The study showed cervical cancer is killing more woman than medical professionals originally thought. Black women in the United States are dying from the disease at a rate 77% higher than previously estimated and white women are dying at a rate 47% higher.

Pennell says unfortunately, those numbers do surprise him. “We knew there were differences in cervical cancer mortality rates between white and black women in the United States, but not to the extent now reported.”

In response to the disparities they already knew existed, the University of Minnesota has been making efforts to close racial gaps, largely in the form of outreach. Many of the outreach efforts provide knowledge to the community, which is critical to addressing the underlying causes of health disparities, whether it’s knowledge of cancer itself or the best care and how to get it. Experts admit this outreach is a give and take and community input is critical to the University as it shapes research and care efforts.

The Masonic Cancer Center, University of Minnesota plays a huge role in this process. The mission of the Masonic Cancer Center is to reduce cancer’s burden on all Minnesotans. To facilitate this, the center formed an office of Education and Community Engagement to share information about how to prevent, identify, and treat cancer with the public. That office also acts as a tool for Minnesotans to voice their concerns they may have about cancer, often meeting directly with various community groups to have these discussions.

“These concerns impact how we allocate resources and efforts,” explained Pennell. For example, promoting HPV vaccines and lung cancer prevention.

The Masonic Cancer Center also works closely with the University’s Program in Health Disparities Research on various cancer initiatives. It’s this program’s goal to promote equity in all aspects of health, including cancer. This is done through collaborative research, education, and community partnerships. Additional support comes from the Office of the President to fund research in precision medicine that addresses lung cancer in Native Americans.

As far as the importance of staying informed and educated on this subject, the stakes are high. Reminds Pennell: “This disease affects all of us; one in three women and one in two men in the United States will develop cancer in her/his lifetime. So we all have a vested interest in reducing this burden.”

Pennell also encourages people to continue seeking education and outreach, as the University does, because the information is often changing.

“I hope people remember researchers and cancer care professionals are constantly generating new data, and trying to look at things in a new light, to prevent or cure cancer.” said Pennell.

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Expert Perspective: 1-in-4 U.S. men has HPV strains linked to cancer

January 25, 2017 - 1:46pm

Last week, a study published in JAMA Oncology revealed one in four men in the U.S. are infected with human papilloma virus (HPV). And, that’s just the people with the cancer-causing strains.

HPV is the leading cause of cervical cancer in women, and also a leading cause of anal and oropharyngeal cancers, especially in men.

In fact, some studies have hypothesized that oral or oropharyngeal cancers (neck & throat) will soon become the most common HPV-related cancers.

Unfortunately, there is no widely-implemented screening test for  HPV in men, so early detection can be difficult. And, with one-fourth of the U.S. male population infected with a cancer-causing strain of the virus, HPV could continue to spread and affect cancer outcomes.

HPV vaccination, currently recommended for all 11-12 year olds, provides primary prevention against the several strains of the virus.

“We’re doing better with getting more boys vaccinated but vaccination coverage still remains far below goals. HPV vaccine can protect males from multiple types of cancer as well as genital warts,” said Annie-Laurie McRee, Dr.P.H., assistant professor in the University of Minnesota Medical School’s Department of Pediatrics.

McRee is also a Masonic Cancer Center member. She specializes in HPV vaccination and how provider recommendations play a role in vaccination uptake.

The JAMA Oncology study, from the Womack Army Medical Center in North Carolina, found that 45 percent of the 1,868 men studied had HPV, but only 10 percent of the study group was vaccinated.

“This study highlights the importance of vaccinating both boys and girls for HPV and underscores the need for vaccination at the recommended age when the vaccine offers maximum protection,” said McRee.

What steps should be taken moving forward? McRee added:

“Even though it has been available for males since 2009, boys are still less likely than girls to receive a healthcare provider’s recommendation to get vaccinated against HPV, and the main reason parents report that their son has not received HPV vaccine is that they were either unaware it was available for boys or that they have not received a recommendation from a provider. Given the importance of a strong provider recommendations for HPV vaccine uptake, this is a critical gap to address.

It also means, though, that providers have the power to help parents protect their sons against HPV by simply making that recommendation and we know a lot at this point about how to do that well (for example, by making age-based recommendations to all 11-12 year olds and by along with other adolescent vaccines).”

McRee added that providers should take any opportunity to discuss vaccination, not just well-child visits or annual check-ups.

Read more about HPV

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Tunneling Nanotubes: Cellular Highways for Cancer Drug Delivery, Study Suggests

December 15, 2016 - 10:40am

Cancerous tumors are complex. The diseased cells multiply among healthy cells, spread to tissue and leech valuable proteins and nutrients from their surrounding microenvironments.

An emerging pool of evidence shows that cancer cells form miniscule tubes that they use to communicate and shuttle vital signals and nutrients back and forth, making them more aggressive and potentially more resistant to drugs intended to treat cancer. But, new research from the Masonic Cancer Center, University of Minnesota suggests that these tubes may also serve as an ideal pathway to deliver cancer-killing viruses and other drug particles designed to treat cancer.

Called tunneling nanotubes, these exceedingly narrow but long offshoots stem from cancer cells and attach to nearby cells. These tubes then exchange important cellular cargo that are vital to sustaining cancer cells, like mitochondria, proteins, and genetic materials called microRNAs.

Researchers in this growing field had hypothesized that these tunneling nanotubes could also transfer virus-based cancer drugs. A new study in the journal Molecular Therapy – Oncolytics led by Emil Lou, M.D., Ph.D, assistant professor of the University of Minnesota’s Medical School, confirms this idea.

Lou, a member of the university’s Masonic Cancer Center, collaborated with researchers at Memorial Sloan-Kettering Cancer Center and the City of Hope Cancer Center to complete the study. Currently, viral gene therapies – drugs that leverage common viruses like herpes, polio and measles – are engineered to be safe in humans, and are injected into tumors. When the virus infects the cancer cells, it triggers an immune response and kills the cancer.

“The concept of engineering viruses to treat cancer has been around for decades and gained more traction the past few years,” Lou said. “Current forms of viral therapies infects cells and destroy them from the inside out; the viruses then move on to the next set of cells to create a cycle of infection.”

For this study, the researchers used a mutant strain of herpes simplex virus genetically engineered to infect and kill cancer cells, and emit a green fluorescent protein that could be used to track its progress.

They infected mesothelioma cancer cells with the mutant virus. Under a high-resolution microscope, they visualized the glowing virus multiplying in the cancer cells, then saw it move from cell to cell through the tunneling nanotubes.

“Through our experiments, we found that the virus could not only spread from cell to cell via nanotubes, but also that the activated drug could as well,” Lou said. “This dramatically increases the number of cancer cells that could be killed through this combined approach to treatment.”

This behavior has potential implications for the design of new drugs and treatment of cancerous tumors. Lou’s research suggests the cancer cells forming nanotubes may more readily absorb nano-sized drugs and cancer-treating viruses, making them efficient and effective.

These findings indicate the nanotubes can act as auto-routes for drug delivery. If researchers learn more about how and when the nanotubes sprout, they could be used to treat patients with drugs designed to travel through the auto-routes.

“This provides a better picture of how cancerous tumors are constantly evolving, communicating and growing,” Lou added. “By learning about these processes, we can figure out how to either stop the cancer cell communication or make sure the drugs are being circulated throughout the tumors. It’s a good first step to build upon.”

Co-authors of this article with Lou include: Yuman Fong, M.D., from the City of Hope Cancer Center; Justin Ady, Kelly Mojica, and Joshua Carson, M.D., from Memorial Sloan-Kettering Cancer Center; and Venugopal Thayanithy, Ph.D., Phillip Wong, and Prassanna Rao from the University of Minnesota.

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Aspirin use shown to slightly lower risk of cancers

October 17, 2016 - 1:47pm

According to a study recently published in Cancer Causes & Controls, regular aspirin use may slightly reduce the risks of certain cancers.

The study, conducted by Kristin Anderson, Ph.D., M.P.H., and colleagues at the University of Minnesota School of Public Health suggests that aspirin use could have a small but protective effect in preventing breast, pancreatic, ovarian, and colon cancers in older adults. Other studies provide evidence of moderate benefits.

“Looking at the specific types of aspirin use alone is not highly informative in this study, but the patterns of frequency, duration and accumulated dose by year or lifetime, indicated a potential protective benefit from cancer,” said Anderson.

Anderson also notes that there are other benefits to taking aspirin, like preventing stroke, heart attack or other cardiovascular events.

As always, ask your doctor before starting routine use of aspirin because there are risks in addition to potential benefits.

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Research snapshot: Gay prostate cancer patients have unique social support networks and needs

September 8, 2016 - 2:27pm

Note: This article originally appeared on the School of Public Health website.

In the United States, an alarming 1-in-7 men will develop prostate cancer. Although gay men are not at higher risk for prostate cancer than heterosexual men, if they are in a relationship, both men may have the disease. And research shows gay men appear to suffer poorer outcomes from prostate cancer compared to heterosexual patients.

A key factor in how well all prostate cancer patients recover from the disease is their access to social support. Benjamin Capistrant, Sc.D., assistant professor in the School of Public Health, recently looked at the social support bisexual and gay prostate cancer patients have or need and discovered that it can differ greatly from heterosexual men.

Capistrant’s study was recently published in the journal Psycho-Oncology.

According to the study, when gay men only had access to standard, mainstream support services focusing on the sexual concerns and issues common to heterosexual men, those services failed to provide them with information they felt they needed for critical conversations.

In contrast, patients who were part of gay-specific groups not only felt they received improved emotional and informational support, but also that they gained valuable insight into the pros and cons of treatment options from people like themselves who have used them.

“Almost uniformly, they said that they wanted more resources specific to gay and bisexual men with prostate cancer, such as support groups and information,” Capistrant said. “The men who had access to those things relied heavily on them in order to have frank discussions with others about things like deciding which treatment to undergo and the significant sexual side-effects of cancer treatment.”

“The implication is health care systems and providers can help gay prostate cancer patients by identifying or creating local and on-line resources for support groups and other services,” Capistrant said.

In the case of gay men in relationships, the study showed that having a partner didn’t guarantee support and that in some cases, partners were not involved in helping patients make treatment decisions.

“Clinicians should also be conscious that gay and bisexual men have a different social network through which they get support: Friends and family  — other than a partner — may have roles and caregivers could be different compared to heterosexual men who are typically looked after by a wife or adult children,” Capistrant says.

Capistrant is now expanding on this line of research and focusing on the role partners play in the treatment of prostate cancer patients. He plans to use what he discovers to design interventions that increase or enhance partner support.

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Strong provider recommendation can make significant difference in HPV vaccination rates

August 25, 2016 - 11:20am

At any point, 1 out of 4 people has at least one strain of Human papillomavirus (HPV), according to the Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH), making HPV the most common sexually transmitted infection (STI).

HPV can cause cancer, specifically cervical, oral, vaginal, penile, anal and oropharyngeal (throat, head and neck). In fact, nearly all cervical cancer cases are caused by HPV. More than 90 percent of anal cancers are caused by HPV and 70 percent of oropharyngeal cancers.

The HPV vaccine is proven to prevent HPV infection, and in turn, prevent cancer.

Despite these glaring figures, vaccination rates remain low. According to the CDC, 6 in 10 girls are vaccinated for HPV, and only 4 in 10 boys.

Physician recommendations could make all the difference.

“Simply put, physicians have a lot of influence on whether or not adolescents receive the HPV vaccine. In fact, a provider’s recommendation is one of the strongest and most consistent predictors of HPV vaccination,” said Annie-Laurie McRee, Dr.PH., assistant professor in the Department of Pediatrics at the University of Minnesota Medical School. McRee is also a Masonic Cancer Center member.

For the past 8 years, McRee has studied the impact of provider recommendations for the HPV vaccine, and how that can affect whether or not parents and patients decide to vaccinate.

“Health care providers may not recommend the vaccine at all, or do so halfheartedly. Some may actually undercut their efforts to get preteens vaccinated by making weak or ambiguous recommendations,” McRee said.

In fact, McRee said her research has found:

  • About one-fourth of Minnesota health care providers reported they do not routinely recommend HPV vaccination for 11 and 12-year-old girls (based on a statewide survey of 575 care providers)
    • And, more than half of those health care providers say they do not recommend HPV vaccination for boys
  • Nearly 2 out of 3 health care providers reported offering the HPV vaccine as optional for either sex
  • Instead of following a solely age-based recommendation, many health care providers reported “gently” broaching the topic of HPV vaccination on-time, but delayed making a stronger recommendation until older adolescence, or based on their perception of the patients’ risk of sexual debut

Additional research shows a lack of a provider’s recommendation can contribute to a parents’ reasoning for not vaccinating. The CDC’s annual National Immunization Survey-Teen showed 15 percent of parents who said they would not be getting their child vaccinated stated not receiving a health care provider recommendation as the primary deciding factor.

“Levels of vaccination are below where they should be for both boys and girls,” McRee said. “The HPV vaccine is a safe and effective prevention strategy against several different types of cancer. HPV is extremely common. Most people get HPV at some point in their lives.”

McRee’s research demonstrates the importance of a strong health care provider recommendation for the vaccine. So, how do health professionals implement that into practice?

McRee provided these guidelines:

  • Recommend HPV vaccine according to guidelines
    • That is, for all 11 to 12-year-olds, not just people who appear to be at risk
  • Stress the importance of vaccination
  • Emphasize the cancer prevention benefits of the vaccine
  • Offer the HPV vaccine in tandem with other recommended adolescent vaccines
  • Suggest vaccination on the same day as the visit, rather than another day
  • Consider all clinical encounters as potential opportunities for vaccination, not just preventative care check-ups.

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Biomarker may predict recurrence in endometrial cancer patients

May 17, 2016 - 3:33pm

Endometrial cancer is the most common gynecologic cancer in the U.S. Most cases are diagnosed at early stage and have good prognosis. Unfortunately, some patients with early stage and low grade endometrial cancer experience recurrence – and the reasons are not entirely clear. When recurrence happens, the cancer is often resistant to chemotherapy and has a high rate of mortality.

New research from the lab of Martina Bazzaro, Ph.D., of the Masonic Cancer Center, University of Minnesota and Department of Obstetrics, Gynecology, and Women’s Health, suggests the deubiquitinating enzyme (DUB) USP14 as a promising biomarker for identifying risk of recurrence in endometrial cancer patients. DUBs have been linked to cancer progression, initiation and the resistance of chemotherapy. Thus, the inhibition of certain DUBs have been proposed as a targeted therapy for cancer. However this is the first time where DUBs are used as a cancer biomarker.

“We have discovered that women with high levels of USP14 are seven time more likely to recur than women with low levels of it,” says Bazzaro a medicinal chemist and cancer biologist who leads this investigation and holds a patent for this biomarker. She adds that: “knowing a patient’s status with regards to USP14 positivity could make a tremendous difference in terms of how a patients is treated and ultimately save her life”.

Bazzaro is currently leading an international effort to validate the findings is a larger cohort of low risk endometrial cancer patients. “Our next step is a clinical trial. Patients with low risk endometrial cancer will be given the diagnostic exam, utilizing USP14 to gauge the levels of the cancer,” said Bazzaro. “Those with high amounts – a positive test – will be treated more aggressively than current treatments to help prevent potential recurrence. Knowing more about their individual cancers can help us as clinicians to tailor a care plan specifically for them.”

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Calling communities to engage in National Cancer Moonshot Initiative

May 2, 2016 - 10:52am

Defeating cancer – a lofty goal, but no more bold than the idea of putting a man on the moon. When President Obama set forth the charge and launched the National Cancer Moonshot Initiative, the scientific community was rallied toward accelerating progress in therapies, diagnosis tools, and prevention tactics.

The NCI is now inviting the public to join the venture, launching a web portal for anyone to come and contribute ideas, concepts, or pathways of study. Many researchers are excited about this partnership with the public and the opportunity for mutual learning and collaboration.

We spoke with Christopher Pennell, Ph.D., associate director for Education and Community Engagement at the Masonic Cancer Center, University of Minnesota, about this new step in the Moonshot Initiative.

What role does the public play in combating cancer?

Probably the most important role the public plays in combating cancer is a direct one: reducing cancer’s risk through prevention and screening.

Another big role is in clinical trials, something qualified patients should strongly consider. These trials contribute directly to our understanding of what therapies work best.

Why is it important for the public to be engaged in discovery?

Dialogue between the public and the scientific community contributes significantly to our greatest cancer therapy aspiration: knowing enough about cancer to control or eliminate it quickly and effectively.

When scientists and citizens are both at the table, the public learns what we know about avoiding cancer, how it arises, and how best to treat it. Meanwhile, those in the laboratory and clinics learn what most concerns patients and their families. It opens the door to new initiatives designed to address public concerns.

What do you suggest for community members who have passion and investment for cancer treatment and cures but perhaps aren’t scientifically inclined?

An applicable phrase here would be, “think globally, act locally.” Start by identifying one thing you can do to alleviate a patient’s or caregiver’s burden, no matter how small it seems. Community members can also support local, statewide, and national non-profit organizations that promote cancer research, as research is what ultimately leads to reducing the burden of cancer.

How can people get involved with supporting research and discovery beyond suggesting scientific ideas?

Community members play a big role in sharing information about cancer prevention, screening, therapy, and patient care. Information is available from local support groups, American Cancer Society chapters, and the Masonic Cancer Center. The more people that have this information, the better off we all will be.

What are some of the most exciting elements for YOU about the Moonshot Initiative?

The most exciting element to me is the potential to draw really bright people to the fields of cancer research and therapy – people who might not otherwise have considered applying their skills to this problem. The more people we have thinking about cancer, the more quickly we’ll reduce the burden of cancer.

It will also provide more resources to those of us in the field already, allowing us to work more quickly and perhaps more daringly.

My hope is the initiative will allow us to soon see a day when cancer is routinely eliminated or relegated to the status of a chronic disease not severely impairing one’s quality of life. Cancer is part of our biology and it will always arise in our population because it is a consequence of genetic mutations. Early detection and intervention are our best hope, and more targeted and efficient therapies to eradicate advanced stage disease.

 

Learn More

National Cancer Moonshot Initiative

Benefits of aspirin on cancer risk

Researchers ID mechanisms determining the aggressiveness of bone cancer

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The Cancer Moonshot: Dr. Christopher Pennell on cancer research and treatment

February 19, 2016 - 10:37am

When President Obama delivered his final State of the Union address last month, he challenged Americans to channel the innovation and spirit that lead to putting a man on the moon to achieve the next great “moonshot”: finding a cure to cancer. In honor of the cancer moonshot, Health Talk will be drawing upon the vast knowledge of the researchers in the Masonic Cancer Center, University of Minnesota in an ongoing series dedicated to cancer research. To kick things off, we sat down with Christopher Pennell, Ph.D., Associate Professor in the Department of Laboratory Medicine and Pathology, to gain insight into the work he does at the Masonic Cancer Center and where cancer research is headed.

Health Talk (HT): What is your area of research and why did you focus on this area over any other one?
Christopher Pennell (CP): My areas of research are tumor immunology and tumor immunotherapy. These areas respectively address interactions between tumors and the immune system, and how we can exploit the immune system to treat malignant tumors (cancers).

I focused on this area because the immune system has evolved to be exquisitely specific, and specificity is the holy grail of cancer therapy. If a therapeutic agent kills only tumor cells, and not normal cells, then the therapy has very low toxic side effects and a relatively large therapeutic potential. The immune system can distinguish between highly related molecules, such as those expressed by malignant cells and the normal ones from which they were derived. So specificity is one aspect of the immune system that makes it attractive for cancer therapy. The other two are potency and memory. This combination of specificity, potency and memory is ideally suited for cancer therapy.

HT: What is your role at the Masonic Cancer Center, University of Minnesota?
CP: I have several roles at the Masonic Cancer Center (MCC). I was recently named the Associate Director of Education and Community Engagement. My primary goal in this role is to develop mutually beneficial relationships between MCC and Minnesota residents that reduce the burden of cancer in Minnesota. To achieve this goal I lead a team that engages with community organizations. We hope to become better educated as to their concerns and needs regarding cancer. If the MCC has programs in place that already meet these needs, then we share that information. If not, then we bring these issues to MCC leadership to inform new initiatives and directions. My other roles in MCC include serving on our Scientific Council, Executive Council and as an MCC representative on the faculty advisory committee for the University Flow Cytometry Resource Core.

HT: Cancer is something that either directly or indirectly affects the lives of many people around the world. Because it’s so prevalent, the average person might know more about cancer than other diseases. What is something that is often overlooked?
CP: Something that is often overlooked is that cancer is not a single disease. Cancer is an umbrella term that describes hundreds of different diseases. As such, there cannot be a single cure for all cancers, just as there is not a single cure for all infections (because infections result from many different viruses and bacteria, all with different biologies). All cancers share two characteristics, though: uncontrolled proliferation and metastasis (spread). Uncontrolled proliferation is exploited by some drugs, such as chemotherapeutics, that kill rapidly dividing cells and so can be applied to many types of cancer. However, these drugs lack specificity and do not distinguish between normal cells that are rapidly dividing naturally, and malignant cells that are rapidly dividing aberrantly.

HT: You were instrumental in programming the upcoming Mini Medical School session at the University of Minnesota. How did you determine which areas of cancer research to focus on?
CP: I have to give a lot of credit to my MCC colleague, Jim McCarthy. He and I bumped into each other the day after we received the wonderful news that cancer was the topic chosen for the upcoming Mini Med session. Jim is an outstanding experimentalist and teacher, and I highly value his opinions. So I asked for his thoughts on how to organize the sessions. We had a 30-45 minute impromptu conversation about what areas to choose, and how to structure the series to provide continuity both within and between the five sessions. We arranged the topics to lead the audience in a stepwise manner to a deeper understanding of cancer research, and how the knowledge gleaned from research impacts cancer prevention, therapy and patient care. We start with Cancer 101, proceed through key areas such as how mutations and aberrant cell signaling relate to cancer, then it’s on to new therapies in people and pets, and we end with quality of life issues. All of these areas are ones in which MCC has existing programs and strengths.

HT: How has cancer research changed over the years? Have interdisciplinary collaborations grown? What are the benefits to these types of collaboration?
CP: Cancer research has changed significantly over the years due to improvements in technology and the recognized need for interdisciplinary collaborations. An example of the former is in gene sequencing. It took years and over a hundred million dollars to sequence the first human genome. Now a human genome can be sequenced in days for about $1,000. We are awash in data, which is both good and challenging.

The recognized need for interdisciplinary collaborations has evolved from our appreciation of cancer’s complexity. No one person has all the knowledge and tools needed to tackle cancer. So we talk to one another. The cool thing is that scientists get excited when we learn new things; successful new collaborations are mutually beneficial and stimulating to the investigators involved. The net result is often a novel finding that impacts the field.

HT: What’s on the horizon for cancer research?
CP: Cancer therapy is ever-evolving. We have gone from non-specific therapies (e.g. chemotherapy), to tumor-specific therapies (e.g. Gleevec for chronic myelogenous leukemia), and now to targeted, patient-specific precision therapies. Our ultimate goal is to identify a unique feature of a tumor, relative to the normal cells from which it derives, that can be targeted for therapy. Ideally we’d like to identify several such features to target simultaneously to reduce the likelihood of the tumor developing resistance to any one drug. To summarize, the field is moving towards combination targeted therapy that is patient-specific. To achieve this, we need to combine genetic, pharmacological and immunological approaches, and to have collaborations that span the biomedical spectrum from basic to translational to clinical research. This is what we do at MCC.

To hear Dr. Pennell speak further about key concepts in cancer and cancer research, consider registering for the Spring 2016 session of Mini Medical School, which begins on Monday, March 7 and continues each Monday until April 4. The theme this session is Breakthroughs in Cancer Research, Detection and Treatment.

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In The News: New research shows cancer diagnoses are associated with higher voter turnout in 2008

November 23, 2015 - 2:08pm

Many factors can affect voter turnout: older people generally vote more, as do people with higher income and more years of education. Researchers have recently begun to study how people’s health affects their involvement in politics. Previous research shows healthy people are more likely to vote, even after taking account of other factors known to be associated with turnout.

However, new research published in the Journal of Health Politics, Policy and Law and featured in a Washington Post article written by Sarah Gollust, Ph.D., an assistant professor in the School of Public Health and Wendy Rahn, a professor in Political Science, shows voter turnout is related to not just by how healthy you are, but whether you suffer from specific chronic illnesses. The biggest surprise from their research was that cancer was associated with higher voter turnout in the 2008 presidential election.

“We found that three of these diseases — diabetes, asthma, and arthritis — were not related to voter turnout. Heart disease was associated with a lower chance of voting. But cancer was associated with a higher chance of voting,” said Gollust and Rahn in their article. “Compared with those who did not have cancer, those with cancer were almost 3 points more likely to vote in 2008 — again, even after taking into account many other factors.”

They also found different relationships between chronic diseases and voting for people who identified as black versus white and with more years of education versus yes. In particular, the boost in voting among people with cancer was actually higher for blacks and those with less education.

So, why would cancer be associated with higher turnout?

“Perhaps the experience of having cancer gives patients and cancer survivors more social resources and richer social networks, in contrast to the experience of heart disease,” wrote Gollust and Rahn. “These factors may be especially consequential for groups — like ethnic minorities or those with less formal education — who typically have less access to these participation-boosting assets.” Their article offers other hypotheses as well, including the size and scope of advocacy groups representing cancer compared to other chronic diseases.

 
Although the study highlights correlations between having a chronic illness and voting, their research does not demonstrate that having a chronic disease is actually what causes people to vote at a higher rate. Gollust and Rahn suggest that future research should explore the mechanisms that might explain this intriguing association.

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In the news: Study shows processed meats may increase cancer risk

October 30, 2015 - 10:23am

It might be time to rethink the typical American backyard barbecue with hot dogs and bacon cheeseburgers. Recent research from the International Agency for Research on Cancer (IARC) found more evidence that red meats and processed meats should be eaten in moderation. The study revealed consumption of hot dogs, ham and other processed meats is linked to colorectal cancer. The University of Minnesota collaborated on the study.

The IARC classifies processed meat as a carcinogen and the associated risk of developing colorectal cancer is small, but increases with consumption. Experts determined 50 grams or 1.75 ounces of meat per day (about two strips of bacon or six thin slices of ham) can increase the risk of colorectal cancer by 18 percent.

“Frequent consumption of processed meat increases the risk of colorectal cancer. The risk is small but it is there, and with increased consumption, generally that risk goes up,” said Robert Turesky, Ph.D., professor in the College of Pharmacy and member of the Masonic Cancer Center, in a recent WCCO-TV interview. Turesky was part of the IARC’s working group.

Turesky and colleagues examined more than 800 studies from different countries and populations with varying diets, identifying potential links between cancer and consumption of processed meat.

Findings from the study reinforce expert suggestions from previous years about the risks of overindulging in processed meats. The exact causes of cancer remains unknown.

“We are still doing research on that, what we know is that the nitrite treated process can introduce chemicals that can damage the colon,” Turesky told KARE-TV.

Despite the link, Turesky stressed meat-eaters can continue to consume processed meat, but in moderation.

“If a parent wants to give a hot dog to their child for dinner, that’s fine. I go to the baseball park, and I still enjoy a hot dog,” Turesky told KARE-TV. “But the point is everything should be in moderation. You need to use common sense, having a hot dog once in awhile, or bacon or other processed meats, it is part of our diet. We used, need, to moderate and have a healthy well-balanced diet.”

Turesky suggests diversifying a diet by eating fish and poultry as well as fruits and vegetables. He notes that although it is classified as the same risk as smoking a cigarette, the health risks are not the same.

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In the news: Newlyweds donate wedding gifts to UMN glioblastoma multiforme research

October 1, 2015 - 2:30pm

While most newlyweds expect a new dish set or place settings as wedding gifts, one couple skipped the registry altogether. Instead, they asked guests to donate towards a cause that hit close to home.

In 2007, Deb Koepsell learned her late husband, Tom Hastings, had developed glioblastoma multiforme, a cancerous brain tumor, when he lost vision in one eye. While seeking treatment at the University of Minnesota, the two met Stephen Haines, M.D., from the Department of Neurosurgery in the Medical School.

“These tumors are terrible and they ultimately kill the people that they affect,” Haines told KARE 11 in a recent story.

Hastings died 14 months after being diagnosed. The median survival rate for patients receiving treatment for this type of cancer.

Years after her husband’s death, Koepsell remarried, and her husband suggested donating their wedding gifts in honor of Hastings and everyone affected by the serious disease. The donation was nearly $5,000 to the University of Minnesota Foundation, and will allow the large team of doctors and scientists to continue studying and developing new treatments for children and adults with glioblastoma multiforme.

“When something like this comes along that both helps us try to improve what we can do for people, but also recognizes the hard work that’s been done, it’s very gratifying,” Haines told KARE 11.

The donation will amplify the department’s research efforts and explore new projects by paying for activities that can lead to large research grants and fill in funding gaps, said Haines.

Making strides in research, the Department of Neurosurgery is currently teaming up with the College of Veterinary Medicine as they focus on an important model of the spontaneously arising brain tumors. The model allows researchers to utilize treatments on dogs that also have naturally developed glioblastoma multiforme.

“Dogs with the disease are brought in by people for treatment where they receive surgery and immunotherapy, helping us to work out treatment protocols before trying them on people,” said Haines.

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Why Are Some Cancers More Deadly Than Others?

August 17, 2015 - 1:07pm

Minnesota Timberwolves coach Flip Saunders announced last week he has been diagnosed with Hodgkin’s lymphoma. He is currently undergoing chemotherapy treatment for what his doctors call a “very treatable and curable form of cancer,” and will continue to coach as he goes through treatment.

So, why are some cancers more deadly than others?

In a recent interview with Heather Brown of WCCO-TV’s Good Question, Edward Greeno, M.D., medical director of the Masonic Cancer Clinic, explained why some cancers are more deadly than others.

“People often want to know when we’re going to cure cancer,” said Greeno. “We actually frequently cure cancer already, but we don’t cure all kinds of cancer.”

Simply put, some cancers pose bigger threats. Difference in survival rates can be attributed to a particular cancer’s ability to spread as well as how easy they are to detect. It is predicted for the year 2015, cancer will take the lives of 589,430 Americans, or roughly 1,620 people per day.

The deadliest cancers for men are lung, prostate, colon and pancreas, while for women, the deadliest are lung, breast, colon and pancreas. Lung cancer has more deaths due to the sheer volume of cases each year, but pancreatic cancer bodes one of the worst five-year survival rates at a mere 7.2 percent.

“[Pancreatic cancer] has a bad combination of being very aggressive, being hard to detect early and once we find it, it’s poorly responsive to most of our therapies,” said Greeno.  “We don’t really understand always but it may have to do with the function of the pancreas that it’s inherently designed to be resistant to toxins, which is what a lot of our treatments are.”

In Saunders’ case, about 86 percent of Hodgkin’s patients survive 5 years, almost 12 times more than pancreatic cancer.

“The cells that turn into the cancer, that represent Hodgkin’s disease, turn out to be very sensitive to some of our chemotherapy drugs,” he said.

Greeno notes the importance of research to further understand how cancers spread and respond to treatment. In the past 25 years, breast cancer mortality rates have dropped 34 percent.

“That’s an example of the value of our research,” said Greeno. “It’s a really good example of that we’ve learned how the cancer works.”

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UMN expert: Cancer screenings are best tool we have to lower cancer deaths

June 23, 2015 - 8:47am

According to the American Cancer Society, more than one million people in the United States get cancer each year. Furthermore, two in three people diagnosed with cancer survive at least five years, due in large part to early detection through cancer screening.

Cancer screenings are the best tool we have right now to lower the rates of death from cancer says Timothy Church, Ph.D., professor of environmental health sciences in the School of Public Health and a member of the Masonic Cancer Center, University of Minnesota. Church is also currently a member of the American Cancer Society’s Guideline Development Group.

“Detecting any disease earlier is beneficial when treatment can be administered more effectively at that point, but only if the harm done by screening is outweighed by the increased effectiveness of the treatment,” said Church. “By definition, screening tests are not diagnostic tests, so when a positive screening test indicates a person might have early disease, it is usually necessary to do more diagnostic testing to determine if the disease is really present.”

Some cancer screening programs may be more beneficial than others. Some screenings may, if a test comes back positive, require a more invasive, painful, and potentially costly diagnosis and treatment.

While this may sound a little worrisome, Church argues expanded tests are acceptable and warranted if the cancer found could be deadly. Still, there are some cases of over diagnosis, where the cancer is inactive and would not have harmed the patient had it never been discovered.

Church says over diagnosis is more prevalent in prostate cancers and some forms of breast cancers. In these instances, the patient is harmed by having their cancer detected. For example, a woman may have her breast removed and a man may end up impotent or incontinent and may have chronic pain or bleeding due to aggressive testing or treatments.

“We must do rigorous randomized trials to determine whether the net outcome of screening is beneficial or harmful before screening is recommended to the general public,” said Church.

So, who should get screened for cancer?

  • Currently, screening for colorectal, breast, and cervical cancer is widely recommended for average-risk individuals.
  • For heavy, older smokers (those over age 55 with at least 30 pack-years [years of smoking times number of packs/day] and fewer than 15 years of cessation), lung cancer screening with low-dose spiral CT (computed tomography) is recommended.

Church’s biggest takeaway is for men over 50 or those with a family history of cancer to discuss with their primary care provider which colorectal cancer screening method is best for them, and then to follow through on it. Those over 55 who have smoked a lot and as recently as 15 years ago should discuss low-dose CT screening with their provider as well. If people are concerned about their risk for prostate cancer due to family history of prostate cancer or are African-American, they should also discuss this issue with a physician and seek guidance.

During June’s men’s health month, make sure you know which cancer screening tests are recommended for you. Make an appointment with your primary care physician and discuss your options and medical history to help better understand your options.

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Expert Perspective: Debunking indoor tanning myths

May 22, 2015 - 2:08pm

If you’ve ever vacationed to a sunny beach spot, you’ve probably considered hitting the tanning salon to get a ‘base tan’ before leaving. In light of National Melanoma Skin Cancer Awareness Month, Health Talk spoke to DeAnn Lazovich, M.P.H., Ph.D., from the School of Public Health at the University of Minnesota, who debunked four common tanning myths.

Myth 1: A base tan is a safe tan. Reality: No tan can be considered a ‘safe tan.’ The often-desired golden skin tone from hours in the sun is actually the skin’s attempt to repair the sun’s damage from the harmful rays.

“The skin tans as a response to the damage of DNA in skin cells caused by UV radiation. Thus, these ‘base tans’ are indicators that the skin has already been damaged,” said Lazovich.

Lazovich suggests wearing clothing that cover arms and legs, as well as hats that shield both the face and neck, for the best prevention against burns.

Myth 2: If I’m already tan, I don’t need to worry about burning. Reality: People often assume a ‘base tan’ allows them to lie out in the sun without protection, or that it will reduce their risk of sunburn, but that’s not the case.

“In reality, the ultraviolet radiation adds up, so that a person can go to a tanning salon and expose themselves to UV without any obvious burning. Then, going outside these people are still susceptible to getting burned,” said Lazovich.

Myth 3: Indoor tanning only causes melanoma if the session results in a burn. Reality: Every visit to the tanning salon increases the risk of melanoma by 2 percent. Although one tanning session may not seem significant, repeated use will increase your risk of developing melanoma exponentially.

Myth 4: I’m too young to develop melanoma. Reality: In Minnesota, young women are the primary users of indoor tanning beds and melanoma is the most common cancer among women in their 20’s. Looking at women with melanoma between the ages of 18-29, who also had tanned indoors, 76 percent of the cases were related to tanning beds.

“It is important to get the message out to high school girls and college-aged women about the harms of base tans and indoor tanning to understand the risk of melanoma,” said Lazovich.

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