Subscribe to the RSS feed.The future of cancer prevention: An interview with Brian Druker, M.D.
By: CHP | Posted on: November 12th, 2008 | 
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Categories: Interviews • Disparities • Education • Public Health
On October 29, 2008, Oregon Health & Science University (OHSU) announced that Phil and Penny Knight pledged to give $100 million to the OHSU Cancer Institute. According to OHSU, the largest gift in its history “represents a critical step toward achieving the cancer institute’s ambitious goal to make Oregon’s cancer death rate the lowest in the nation.”
OHSU is now renaming its cancer institute the OHSU Knight Cancer Institute.
The center will be directed by oncologist Brian Druker, who has been at OHSU since 1993. Dr. Druker revolutionized the treatment of cancer through is research developing the first drug to target the genetic defects of a particular cancer while leaving healthy cells unharmed. Based on his studies, Gleevec is now the treatment of choice for patients with CML, and its success has opened the door to developing targeted therapies for other cancers.
CHP’s Chris Palmedo spoke with Dr. Druker about the role of prevention at the Knight Cancer Institute.
What part of your work will be dedicated to trying to prevent cancer from occurring in the first place?
When I think about lowering cancer death rates, I look at both prevention and screening.
My work has always been in targeted cancer therapies, and an important area of our work here at the Knight Center will be the area of cancer screening.
Right now most of the cancer prevention trials connect a drug or a vitamin with preventing different types of cancer. We have traditionally looked at cancer prevention as a one-size fits all program.
Now let’s look 20 to 50 years into the future, when preventive therapy will be targeted to each individual person’s susceptibility to cancer.
For example, if you took vitamin E or selenium it might work well to prevent you from getting cancer, but it’s not going to work in every man. It may work in a small subset, but we need to know who that small subset is, based on our genetic makeup.
So that’s where preventive cancer therapy will be in 20-50 years and we expect to do the research here that’s going to allow us to get to that point.
What about preventing cancer in a population?
In terms of prevention, the data is clear that can prevent one-third of all cancers if we got people to stop smoking or never got them to start. Is that easy? No. But I’m supportive of every effort to get them to stop and never get them to start.
Education programs are important but they need to be comprehensive. There have been successful teenager cessation programs that have had no impact on adult smoking rates, and adult education programs that did nothing to curb smoking among teens. So any program has to be global in scope. If you put out only one edge of a forest fire, the other end could get out of control. You need a comprehensive plan. And that’s where you could have a huge impact, and we are very aware of that.
It’s absolutely clear that if you detect cancer in its earliest stages, it’s highly curable. Oregon and Washington have some of the highest rates of breast cancer in this country. It’s important to figure out why, but until we do, lots of women will continue to die of breast cancer if we don’t detect early.
If we do detect early, we can decrease death rates by 40%.
If you do appropriate screening for breast, colon and prostate cancer on a population basis, you actually save money. You identify cancer early when it’s curable. You don’t take people out of the work force and you don’t have to pay the hundreds of thousands of dollars for advanced cancer therapies. So you actually save money if you do appropriate screening. Our goal is to start with breast cancer as the paradigm. How do you get into communities and get women — with or without insurance — to get screened.
In terms of cancer prevention, weight regulation is also becoming more important with an increasingly solid link between being overweight and the rates of cancer.
Active lifestyles are important, and in that respect, what better name than Phil Knight to be associated with this cancer institute!
How will you connect the research on prevention you’re doing with the work being done in the community?
At the Knight Cancer Institute, Lisa Domenico has recently been hired to help us build a coalition around cancer prevention in this state. We expect to lead some efforts and participate in other efforts and help everyone ensure there isn’t duplication.
Through Lisa, we plan to work with the state Public Health Division and other agencies, Susan G. Komen Foundation, the American Cancer Society, and groups focusing on minority populations.
(Ed note: Lisa Domenico is currently Board President of the Oregon and SW Washington affiliate of Susan G. Komen Foundation).
We want to work with everyone to make this a priority and funding will be an important part of it. Everyone will agree that we should do this or that, but how will we pay for it? That’s where we’ll need state agencies and national agencies to help work with us to lower death rates, by having more women screened. My goal is for that process to become a paradigm for others to learn from.
Establishing paradigms and setting high standards is very important to me.
What are the greatest opportunities - the lowest hanging fruit - for reducing cancer right now?
Even with clear data, it’s never easy when you’re talking about changing people’s behavior. More active lifestyles, more healthy food choices, weight regulation, not smoking — those can be very hard behaviors to change.
It’s especially difficult for people who have less access to information and resources to make these lifestyle changes.
Nevertheless, public education is very important. Think about seatbelt use. When I was growing up, my parents threw me in the car and drove and now we have car seat laws. And it’s now second nature.
Safety belt laws had a lot to do with that.
But it’s not only law changes that make us change our behaviors. When I started riding bikes I never wore a helmet and now I wouldn’t think of getting on my bike without a helmet. That huge population behavior change didn’t occur because of laws.
It’s similar with drinking and driving.
Despite existing laws, some of the biggest behavior changes occurred because of a comprehensive movement of campaigns by organizations like MADD.
That’s right. We can change behaviors. It takes a lot of time and energy and effort but we can do it.
We can also look at the successes in other countries. Australia with their high rate of melanoma launched a very effective campaign called Slip! Slop! Slap! which addressed hats, sunscreen and shirts, and it has worked very well.
You can change behavior, but it takes concerted effort. We can’t do it on our own from the Cancer Institute, but we certainly want to be a part of that effort.
Where does the Knight Institute fit into the rest of cancer treatment and research at OHSU?
The Knight Cancer Institute will be all of cancer at OHSU. Everything that touches cancer will be our domain – from research to treatment to the public health and preventive and screening efforts.
Medicine in the U.S. has always reflected the American culture’s embrace of technology, achievement, competition, and winning. Between your success, and the success embodied by Phil Knight and Nike, it seems like a great match.
Twenty years ago, people were talking about molecular targeted therapy and what we needed to do. Back then, I would hear that “we need to do this,” or “we need to do that.” But no one seemed to be doing it. That’s when I made it a goal to step in and establish a paradigm for getting it done.
Today, I hear a lot of the same things. We need to figure out how to implement all these things that we know. And we need to study this and study that and see where our deficiencies are.
My response has always been, “can’t we just do it?”
And “just doing it” to you will mean participating in community efforts and working to improve screening technologies.
Screening, researching to new ways to detect cancer early, and also thinking to the future of molecularly targeted preventive therapies.
One we accomplish that, we can say that if you take this or that vitamin or medication, you may reduce your likelihood of getting cancer ten-fold, or even one hundred fold.
And there will be ways to read someone’s DNA and say this person will benefit from this or that vitamin or therapy.
Exactly right.
And we’re not there yet.
We’re not there. But I’m confident that my children will live to see that day.
And this institute will help lead us all in that direction.
That’s my goal.
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Preventing cancer with a pill is a nice idea that will likely take years to achieve, but there is much that can be done now.
marire sani