Miles to go before we sleep

Judith A. Salerno, M.D., M.S.

This article appeared on October 1, 2015 in The Huffington Post.

“What are those things about breast cancer that keep you up at night?”

It’s a question I’m asked frequently in my role as president and CEO of the largest breast cancer organization. And to be honest, there are many things. Among them is a misconception I sometimes hear that because breast cancer still kills, we’ve made no progress over the past three decades. And, because we have so more to do in breast cancer, what science, medicine, technology and a large and dedicated breast cancer community have already accomplished means little.

But ask any patient who has another year of life thanks to therapies like Tamoxifen, Herceptin or Kadcyla, and they’ll tell you – it means everything. 
Truth is, we are gaining on breast cancer every single day.

You may not have heard (there was very little in the media about it), but earlier this year, we reported on a newly discovered breast cancer susceptibility gene, RECQL, unlocking another piece of the puzzle that will someday help identify who is at increased risk of breast cancer. 

We have begun to investigate the power of our own immune systems to attack cancer lurking throughout the body – without subjecting patients to treatments like chemotherapy and radiation, which can leave behind lifelong side effects my friend and colleague Dr. Susan Love refers to as “collateral damage.”

We’ve seen enormous gains in precision medicine in the last decade alone, and it seems clear that precision medicine may hold the answer to some of the most complicated and vexing treatment questions we face today.

As a community, we’re facing these questions and challenges together. Gone are the days when nonprofits operated in a vacuum – which is a good thing. We believe in the old adage: the whole is greater than the sum of its parts. For example, through shared knowledge and resources, we have already begun to move toward health equity for minority women in this country, through community roundtables and programs designed to ensure equal access to quality cancer care for all.

In partnership, we are also recognizing, elevating and addressing the needs of metastatic patients through organizations like the Metastatic Breast Cancer Alliance (MBCA), and we’re inviting women to take an active role in breast cancer research (and even speed up breakthroughs) through partnerships like Dr. Love’s Health of Women [HOW] Study and the Share the Journey iPhone app. Komen has invested half of its research funding to metastatic disease this year, bringing its metastatic research portfolio to $147 million for 377 specific metastatic studies to date. 

We see the promise in early-career investigators, who have novel ideas and innovative approaches, and whose knowledge we need for continuity in breast cancer research. Komen, the American Association for Cancer Research (AACR) and other organizations have targeted this next generation of researchers who will someday lead the field, and half of Komen’s 2015 research portfolio included funding to this group. 

We’re extremely encouraged by all of these gains and opportunities. But sometimes it feels as though we’re the only ones.
But to those who have asked: what keeps me awake is the reality that many young researchers are leaving the research altogether because funding is so hard to come by. Federal funding for research has stayed flat for the past 10 years and translates to real-dollar funding cuts of 25 percent.

These early-career investigators are a riskier investment – like choosing whether to invest your funds in a technology start-up or in a more established Apple. We can and will do both, mindful that research pioneer Harold Varmus was a 31-year-old postdoctoral fellow when he discovered viral oncogenes – work that later earned him a Nobel Prize. He also later led the National Cancer Institute and the National Institutes of Health. 

Which of the young researchers we’re funding will be the next Nobelist? How many will benefit from the guidance of those who are today’s leaders?
I’m up late at night thinking about what we can do better. A member of our staff is currently undergoing treatment for a rare, slow-growing form of lymphoma. Her treatment options: no treatment or overtreatment. We can’t keep asking patients to literally pick their own poison.

I also think about the women and men who need us today. Like the young woman who noticed a change in her breast, but doesn’t speak English, and doesn’t know where to go. Or the father who is working extra hours and maxing out credit cards to help cover the growing medical bills from his wife’s breast cancer treatment.

Research will bring us the cures, but these people need help now. How can we continue to be there for them? How can we do more?

I’ll admit – there’s a lot left to do. But the movement is strong, and our commitment is stronger. 

This October – my third National Breast Cancer Awareness Month with Susan G. Komen – our focus is clear. Komen will be there for those who need help with the financial, emotional and practical issues that accompany every breast cancer diagnosis. We will step up to try to fill the gaps of ever-tightening federal research funds. And we will work with others to achieve the solutions we seek.

We will also remind women and men everywhere that while we haven’t reached our destination, millions or people are alive today because of their investment and involvement in the breast cancer movement.  

We are gaining on this disease, and that’s the good news for those who are impatient, like all of us who work every day to find the cures and help the people who need us.  

Judith A. Salerno M.D., M.S., is the president and CEO of Susan G. Komen.

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If concerted, long-term investments in research are not made, America will lose an entire generation of young scientists.
Brenda Canine, PhD; McLaughlin Research Institute, Montana