Sutter Research: Advancing Care for Patients with Breast Cancer
SAN FRANCISCO, Calif. – Breast cancer research has the potential to improve cancer care for the 3.8 million American women living with the illness. Recognizing Breast Cancer Awareness Month, we’re highlighting the bold science and game-changing breast cancer research at Sutter. This work can help advance knowledge of how to detect and treat the illness.
Clinical Research & Clinical Trials
With more than 150 cancer-related clinical trials, Sutter offers patients an opportunity to enroll in breast cancer studies that are testing new drugs, surgical procedures, new or combination uses for existing treatments, and new ways to improve quality of life for people with breast cancer.
In some cases, Sutter is the only site in Northern California offering access to certain breast cancer clinical trials, such as the Targeted Agent and Profiling Utilization Registry (TAPUR™) study. TAPUR™ is a national clinical trial examining the safety and efficacy of approved, targeted anticancer drugs in patients with advanced cancers who are unresponsive to standard treatment.
“We are thrilled to support patients who can benefit from access to targeted therapies made available through this unique trial,” says Peter Gasper, a Clinical Research Manager at Sutter’s California Pacific Medical Center. “One of the goals of the study is to gather data on the efficacy of targeted therapies in specific clinical situations and for patients in whom previous therapies have been ineffective.”
Beyond clinical trials testing new ways to treat breast cancer, Sutter also participates in clinical trials designed to improve early detection of the illness. STRIVE—a study that is evaluating a new blood test for the early detection of multiple cancer types—is one such clinical trial.
Begun in 2017 and now closed to enrollment, the study recruited the highest number of Sutter patients of any trials to date, regardless of therapeutic area. The test is being developed by GRAIL, Inc., a healthcare company based in Menlo Park. The study recruited women at the time of their screening mammogram across six institutions, with Sutter Health and the Mayo Clinic enrolling a majority of participants.
The multicenter study will evaluate this new blood test and its ability to screen for multiple cancer types as a complementary screening tool.
“Given its location in Northern California—one of the
most diverse populations worldwide—Sutter research work with the STRIVE study could
help pioneer breakthroughs in early diagnosis that may help improve patients’ experiences
throughout the United States and beyond,” says Steve Cummings, M.D., California Pacific
Medical Center Research Institute (CPMCRI) senior scientist, executive director of
the San Francisco Coordinating Center (SFCC) and principal investigator of the study
Find breast cancer clinical trials at Sutter.
Bold Science: The Cancer Avatar Project
CPMCRI is leading an innovative program to further Sutter’s cancer precision medicine research in Northern California through the Cancer Avatar Project—a living biology approach to translational research for fully individualized cancer care.
Through this project, CPMCRI is one of a small number of institutions worldwide using a unique method to create personalized treatment plans for cancer patients. CPMCRI researchers gather tumor cells from consenting CPMC and Sutter Health cancer patients and implant them into mice. This enables continued growth of the cancer in a laboratory setting so that drug treatments can be tested for maximum benefit.
“We not only have one clinical trial underway, but are actively developing multiple other trials in different areas—including different types of cancer and mechanisms of therapy,” says Liliana Soroceanu, M.D., PhD, a Senior Scientist at CPMCRI. “Through the Avatar Project, breast cancer may be investigated in future lines of study. We have also begun to refine a process for identifying tumor DNA circulating in the blood—a cancer-specific ‘liquid biopsy’—to help monitor treatment response and potentially detect cancer recurrence earlier.”
Putting Patients First: Research that helps improve the experience of care
Health systems researchers at Sutter including Ellis Dillon, PhD, and Dorothy Hung, PhD, MA, MPH, are studying ways to improve and refine Sutter’s Nurse Navigator Program at Palo Alto Medical Foundation. Launched in 2016, the Navigator Program provides Sutter cancer patients (including those with breast cancer) access to registered nurses who serve as a single point of contact while moving through treatment with healthcare professionals.
In June 2019, Dr. Dillon and Dr. Hung began a study to evaluate how the Nurse Navigator Program impacts key outcomes such as patient satisfaction, physician satisfaction, practice efficiency and retention of patients within the system. Survey results are anticipated by the end of this year, with remaining analyses completed in 2020.
“By examining best practices during a critical time—whether it involves sensitively communicating a positive biopsy result to seamlessly coordinating follow-up care—we can help shape how cancer navigation services are implemented across the health system,” says Dr. Hung.
In a separate study, Dr. Dillon collaborates with J.B. Jones, Ph.D, MBA, on research to better understand the patient experience in breast cancer care at Sutter. From 2018-2019, the team conducted in-depth interviews with 20 women who are 50 years or younger at various stages of their breast cancer journey at cancer care sites across Sutter.
“Health systems research at Sutter incorporates ‘real world’ findings to help us improve the patient experience and enhance the clinical and health systems environment supporting their care,” says Dr. Dillon.
Findings of the study suggested that women’s most pressing concerns related to the emotional and daily challenges of life with breast cancer (i.e., logistical, scheduling, financial). “The nurse navigator work at Sutter may be expanded to provide some of this support. Our research will be used to inform structural changes in how cancer care is provided,” says Dr. Jones.
Better Breast Cancer Risk Models—Research at Sutter’s San Francisco Coordinating Center
At Sutter’s San Francisco Coordinating Center, Steve Cummings, MD, California Pacific Medical Center Research Institute (CPMCRI) Senior Scientist, Executive Director of the San Francisco Coordinating Center (SFCC), has collaborated with scientists at the University of California, San Francisco (UCSF) and the national Breast Cancer Surveillance Consortium (BCSC) on studies assessing breast density, breast cancer risk, and use of mammography for early detection of breast cancer.
Dense breasts have a higher proportion of connective and milk duct tissue compared with non-dense breasts. A mammogram with dense breasts appears white or opaque. As part of routine interpretation of mammograms, radiologists provide a qualitative assessment of breast density. Women whose breast density is 75 percent or more have roughly three to four times the risk of being diagnosed with breast cancer compared with women whose breast density is 25 percent or less.
Recent research suggests that having dense breasts accounts for a large part of breast cancer risk, apart from age or having two or more first-degree relatives (i.e., mother, sisters, daughters) diagnosed with breast cancer.
“Breast density is the one of strongest and prevalent risk factors that we know of, stronger than family history,” says Dr. Cummings. “We now have more information about what factors influence breast cancer risk and are able to more accurately analyze the relationship between breast density and breast cancer risk.”
Dr. Cummings collaborated with UCSF researchers Karla Kerlikowske, MD, and Jeffery Tice, MD, to develop a new, simpler model (the BCSC risk model) for estimating breast cancer risk, compared to the Gail model, a previously validated breast cancer risk assessment tool that is primarily based on non-modifiable breast cancer risk factors. Their new model, now widely used in clinical practice, incorporates breast density, age, race/ethnicity, whether a woman has had any breast biopsies, and whether she has a mother, sister or daughter who has had breast cancer.
The BCSC risk model was developed in U.S. women undergoing mammography in community settings, and has been externally validated in two different mammography cohorts. U.S. Preventive Services Task Force (USPSTF) recommendations, updated in January 2019, suggest using the BCSC risk calculator to identify women who might benefit from medication to reduce breast cancer risk.
“Collaboration with community mammography facilities—including the Breast Health Center at California Pacific Medical Center (CPMC), and mammography services at Sutter’s Alta Bates Summit Medical Center and CPMC’s Mission Bernal Campus/St. Luke’s Hospital—helped develop the BCSC risk model that can be used in clinical practice,” says Dr. Kerlikowske.
With ongoing partnership with these mammography facilities, the BCSC risk model is being updated to include three new variables: body mass index, age at first live birth, and family history of breast cancer in second degree relatives, to increase accuracy of the model.
Learn more about Dr. Cummings’ research in this area and his collaborative work with UCSF investigators.