Frontiers in Cancer Prevention Research (American Association for Cancer Research, October 14-18, 2002 Boston, MA Reported by Ann Fonfa, The Annie Appleseed Project This was the first annual meeting on prevention ever held by AACR. There was one other advocate present beside myself. She was representing the National Breast Cancer Coalition. Over 800 people attended this event. Monday, October 14, 2002 The opening three educational sessions were: Clinical Prevention Trial Design, Oncogenomics, and The Role of Pharmacogenics in Cancer Prevention and Intervention. I attended the Session 1. Genomics and Proteomics in Cancer Risk and Response Assessment, presented by Emanuel F. Petricoin, US FDA, Bethesda, MD. (See his remarks in the summary of Nutritional Genomics and Proteomics [meeting held in September, 2002]). Molecular Pathologies in Exfoliated Cells: Applications in Clinical Prevention, presented by David A. Ahlquist, Mayo Clinic, Rochester, MN. Exfoliated cells are used to diagnose epithelial neoplasms via lavage, sputum, urine, stool, etc. There validity is limited by cell distortion or difficulty in ‘grabbing’. Exfoliated molecular markers could be used for screening, risk assessment, or to monitor treatment. ”…noninvasive detection of presymptomatic cancers and premalignant lesions occurring on internal epithelial surfaces.” Dr. Ahlquist discussed the use of a video capsule in the colon. He stated that it required a completely emptied bowel. Some people have as much as a 5-day transit time for food so it is difficult to achieve that empty area. Additionally the majority of patients screened did not benefit from ‘early’ detection. There are over 500 distinct bacteria (peptides) in the colon. It might be possible to use altered DNA as a marker. It is fairly stable and DNA is shed continuously. DNA is stable in stool. It may also be useful for lung, pancreatic, stomach, bile duct, and esophagus, as their DNA markers may be found in the stool too. (Aerodigestive/Supracolonic cancers). New Methods of Breast Cancer Risk Assessment, presented by Monica Morrow, Northwestern Memorial Hospital, Chicago, IL. The incidence of atypia is low upon surgical biopsy, only present in 4%. “It is recognized that there are a spectrum of morphological changes in the breast duct epithelium associated with an increasing risk of invasive breast cancer development with progression from hyperplasia to atypical hyperplasia, to in situ carcinoma. The serial observation of these changes in an individual could provide an improved means of risk assessment and short-term endpoints for the evaluation of chemopreventive agents.” Dr. Morrow discussed three methods for sampling the ductal epithelial tissue: nipple aspirate fluid (NAF), random fine needle aspiration (FNA) and ducal lavage (DL). She then discussed the evidence supporting the value of each of these methods. As may be expected, none are ‘perfect’. None were able to diagnose 100% of those with either malignancies or pre-malignancies. There is evidence that both NAF and DL are better used with premenopausal women. Novel Imaging Technologies: Applications in Clinical Prevention, presented by Jacques Van Dam, Stanford University Medical Center, Stanford, CA. This talk looked at various techniques such as: Magnification Endoscopy (no dye)-4 different patterns were examined under 35X magnification, the sensitivity in one study was 95%. Chromo Endoscopy (w/dye)-two different papers came to opposite results, this is used for Barrett’s Esophagus. Spectroscopy-fluorescence, using laser light to examine mucosa (apparently looks differently if cells are changing to malignancy). Optical Coherence technology-creates data rather than an image and is seen in real time. 97% sensitivity and 92% specificity (used for Barrett’s Esophagus). Mie Scattering (may have messed up the spelling here)-small particles and spheres determined by reflection of light. Trimodal Spectroscopy-combined modalities are better. Confocal Endoscopy-laser light source through a pinhole with a movable stage. Scanning mechanism, optical detector, reduced light comes from out-of-focus planes. Done in real time, after or during a colonoscopy. Innovative Designs for Translational Prevention Trials, presented by J. Jack Lee, UT M.D. Anderson Cancer Center. This talk focused on how biomarkers could be used as endpoints in developing prevention trials. Dr. Lee is a biostatistician. “By using both a short-term response and a long-term time-to-event endpoint (such as time-to-progression), the new design allows a seamless integration of phase II and phase III trials by rolling the phase II development into phase III if the agent is sufficiently promising for further development”. Translating Prevention Science into Benefits: Clinical and Subclinical, presented by Ernest T. Hawk, NCI, Bethesda, MD “We now recognize that cancer is less an event, than one late step in the prolonged evolutionary disease process termed carcinogenesis. With that understanding come increased opportunities, and even responsibilities, for prevention”. Dr. Hawk pointed out that it is very important to look at the unintended effects when doing prevention planning. “Agent combinations are terribly important”. “In brief, trial designs, and the overall agent development scheme, are optimized by studying subjects with elevated and/or accelerated risk of neoplasia; agents with specific mechanisms and optimal preclinical efficacy/toxicity indices; and multiple, mutually corroborative endpoints identified by highly sensitive and specific technologies (e.g., preinvasive neoplastic lesions, as well as cellular and molecular biomarkers within them). Dr. Hawk mentioned the following natural products that might be used in colon cancer prevention trials-DFMO, Inulin, Selenium, B12, Folate, Calcium, Aspirin and Curcumin. (see our website for more on these product-Relevant Studies-Vitamins/Dietary Supplements section). The entire conference assembled for a talk by Dr. Andrew C. Von Eschenbach now Director of the National Cancer Institute. Dr. Eschenbach was a past president of the American Association for Cancer Research. Sessions from the speaker abstracts and Ann's notes Tuesday Afternoon, 10/15/02 From the abstracts and Ann's notes Mol Epi & Tobacco/Mol Basis of Cancer Prev/Delay Symposia 6-10 Press Conferences/Press Releases Forum 7 and 8 Plenary Session 5 Symposium 11, 12 & 13 Symposium 14:Cancer Prevention & Diet Variety of topics Carotenoids/Retinoids Indole-3-Carbinol Selenium Chemoprevention by Foods/Spices Flavinoids Plant Extracts/ Seaweed/Venom Dietary Supplements & Soy/Genistein Green Tea & Black Tea Dietary/Behavioral Change Miscellaneous Abstracts Caloric Restriction "Managing" Breast Cancer Workplace Issues Tobacco Industry Strategy:Influence Public Opinion/Second-hand Smoke Racial/Ethnic/Cultural Issues The Scientist, 9/02 Prevention only 2% of Budget Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. 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