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Breast CancerBreast Cancer Research

A New Center, an Ongoing Mission by Robert Levy

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The Susan F. Smith Center for Women’s Cancers began with an insight into the nature of cancer – and of human psychology. Researchers were discovering that cancers of the breast and female reproductive tract were more closely related at a basic biological level than had been thought. It was also clear that women’s cancers – wherever they originate – unite patients in a kind of sisterhood of shared concern and experience.

Bringing research and clinical programs in all women’s cancers under a single umbrella would, it was thought, create a natural alliance for better care and smarter science. That goal proved well-founded. Since its creation in 1993 as a research collaborative, the center has expanded its scientific portfolio multiple times, producing scientific advances that continue to shape the course of patient care. Since 1996, when the center’s clinical service opened, its physicians have cared for tens of thousands of patients-– more than 10,000 in 2010 alone.

The original impetus for the center came in a meeting between David Livingston, MD, and Dana-Farber Trustee Susan F. Smith in 1993, in which Dr. Livingston suggested combining the Institute’s then-separate breast and gynecologic cancer programs. This somewhat unorthodox notion – of a center dedicated to studying and treating all women’s cancers – captured Mrs. Smith’s imagination. Her determination and that of many others, to make it a reality has been a constant force behind the center’s growth.

“Dr. Livingston explained there was a great deal of research being done in breast and other women’s cancers that would benefit from more coordination and collaboration among scientists,” Mrs. Smith recounts. “The best way to create a strategic direction for women’s cancers at Dana-Farber was to bring together all this research and the clinical care it supports.”

In 1993, Mrs. Smith formed a National Advisory Council of leaders in health, education, philanthropy, and the news media to make recommendations on the program’s structure and composition. In 2001, Dana-Farber’s Board of Trustees established a Visiting Committee which serves as a liaison between women’s cancer specialists and the community at large. The committee informs scientists and physicians about the public’s major interests and questions concerning cancer care for women, and spreads the word about recent advances at Dana-Farber, while helping raise funds for research. Its leader since its founding has been Mrs. Smith, joined by trustee Jane Jamieson as co-chair in 2008.

The committee has sparked a range of innovations. One of the most far-reaching was the development of an Executive Council, which has mobilized thousands of women in Greater Boston to learn about and support research into women’s health and women’s cancers at Dana-Farber.

All Together Now

The all-in-one philosophy is visible in the physical structure and layout of the new Susan F. Smith Center (SSC), in its scientists’ ability to garner major research grants, and in the direction of research itself.

The center’s clinical areas occupy adjacent floors of the newly opened Yawkey Center for Cancer Care on Dana-Farber’s Longwood Medical Area campus. Patients with breast cancer are treated on the 9th floor, and women with gynecological cancers on the 10th.

Designed with broad input from patients, the clinical floors of the SSC resemble the other treatment areas in the Yawkey Center, an indication of how fully a center for all women’s cancer patients – something non-existent or novel at other cancer centers – has been integrated into Dana- Farber’s concept of care.

The attention to detail is visible as soon as one steps off the elevator. Shoulder-high, wood-and-etched-glass partitions divide the waiting area into a variety of spaces – some large and open, some more secluded. Nooks with easy chairs and floor lamps create an almost living-room feel. Paneled walls hung with artwork – still-lifes and landscapes, primarily, in a variety of media – meet a bank of picture windows with views of the surrounding area. A pantry holds drinks and snacks.

The new Susan Smith Center, as with the entire Yawkey Center, was designed to increase the opportunities for scientific collaboration. SSC physicians and scientists don’t have to travel far to meet: an enclosed bridge furnished with chairs, tables and a small café station connects clinical units with corresponding research facilities in the Richard A. and Susan F. Smith Research Laboratories next door. The proximity promotes translational research that converts scientific advances into new treatments.

Meetings of the Minds

The SSC’s research initiatives have expanded in unison with its clinical growth. In 2000 and 2005, center scientists led by J. Dirk Iglehart, MD, secured Specialized Program of Research Excellence (SPORE) grants in breast and ovarian cancer research, which support precisely the kind of inter-disciplinary, collaborative work that the SSC was created to enable. SSC scientists are also recipients of a much-sought-after Stand Up to Cancer grant to study gene pathways linked to several types of women’s cancers. Several are participating in a large program project grant to study the biology of mammary epithelial cells, the cells where most breast cancers originate.

The grouping of scientists who specialize in breast cancer with those who focus on gynecologic cancers foreshadowed a host of later discoveries about the basic biology of tumors. Scientists have found that cancers once thought to be radically different because they arose in different tissues and organs harbor surprising similarities at the molecular level.

“It’s become increasingly apparent that many of these diseases share a great many molecular features,” says J. Dirk Iglehart, MD, director of the Susan Smith Center. “One example is PI3 kinase, a protein involved in a pathway that is frequently altered in both breast and gynecologic cancers.” As cancers come to be identified by their genetic signatures as well as by their tissue of origin, more precisely honed therapies will be possible.

Beyond the Walls

A key element of the center’s growth has been its outreach to medically underserved groups in Greater Boston. Center clinicians have visited the Suffolk County Jail, elderly housing facilities, community centers, police stations, and other sites to teach women about health issues and the importance of early cancer detection and treatment.

The increase in patient visits to the center is mirrored in the expansion of the clinical staff. When Eric Winer, MD, director of the Breast Oncology Center, arrived at Dana-Farber in 1997, there were five medical oncologists specializing in breast cancer. Now there are more than 20. Six years ago, when Ursula Matulonis, MD, became director of gynecologic oncology, she was one of just three physicians focusing solely on ovarian cancer. She recently hired two physician/ scientists whose specialty is ovarian cancer treatment and research. Over the past decade, the number of breast cancer surgeons has risen from three to 10, the number of breast cancer pathologists, from two to five, and the number of gynecologic pathologists from one to four.

As the size of the clinical and scientific team has increased, so have the opportunities for people in different specialties to work together. “The extent of cross-disciplinary research we’re able to do has risen dramatically,” Dr. Iglehart remarks. “We’re creating a tissue bank – called the Tissue Resource for Research – for both breast and gynecologic tumor samples. It will streamline our process and spur, we think, a great deal of communication and creative interchange among our scientists.”

That determination to create ways for people to work together has always been the center’s hallmark, Mrs. Smith says. “I look back with pride at what we’ve accomplished, not only in the research area, but also in the compassion with which we’ve treated patients. I look forward to and hope for more and deeper collaboration between the research and clinical faculty to translate scientific findings into better and more effective treatments for patients.”

Courtesy of Dana-Farber Cancer Institute

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