With a eye on helping the next generation, the Breast Wellness Clinic has recently embarked on several new initiatives for preventative breast cancer treatment, keeping patient needs-present and future-at the forefront of its researchers' minds.
With a eye on helping the next generation, the Breast Wellness Clinic has recently embarked on several new initiatives for preventative breast cancer treatment, keeping patient needs—present and future—at the forefront of its researchers’ minds.
“Research is something that you do not only for yourself but for your daughter,” said Dr. Victoria Seewaldt, director of the clinic and associate professor of oncology. “I look back and see what’s been done in every generation, and I want to do something different.”
The clinic, a subdivision of the Duke Comprehensive Cancer Center that focuses on women who are at a high risk for breast cancer, opened in January 2003. In addition to providing traditional cancer screening services, the center also acts as a “clearinghouse where we put people in contact with different clinical trials, so we don’t just promote for our trials, we promote for everybody’s trials,” Seewaldt said. “The thought is that this is how we’re honest and honorable.”
Among the most promising of these clinical trials is the “breast pap smear,” known formally as Random Periareolar Fine Needle Aspiration. Unlike conventional cancer screening methods that only detect tumors, such as mammograms and self-exams, RPFNA provides a way to access cells from women who do not have cancer. Clinicians then use these cells to determine the location of pre-cancerous tissue changes.
Based on the number of abnormal cells, researchers assign the patient a number between 10 and 18, with 10 being normal, 18 being cancerous and 14 to 15 being atypia—meaning that some cells are abnormal but cancer is not necessarily imminent.
This method was pioneered at the University of Kansas 12 years ago, and Duke became the second leading university to perform the procedure about a year and a half ago. Although RPFNA is relatively new to Duke, the clinic’s volume—at 250 to 300 patients per year—already rivals that of Kansas, which performs about 400 annually.
Seewaldt said although the RPFNA is more invasive than other procedures, patient response has been positive. She also spoke from experience, as she had researchers practice on her before starting the trial. “I’ve got to make sure this is okay before I’m offering it to people,” she said.
The clinic’s focus on patients’ comfort needs can also be seen in the Patient Navigator initiative, scheduled to begin in January 2005. Based on a model from Harlem Hospital Center, this developing program will act on a larger level to create more trust between the clinic and community members by providing each clinic patient with an “advocate within the system,” Seewaldt said.
The program began because it became evident that black women in the community were not taking advantage of available treatments, said Stephanie Robertson, director of the Navigator Program and a staff assistant in the oncology department.
The program will target women at high risk for breast cancer. Robertson said she plans to collaborate with local outreach centers and clinics to make patients aware of their options.
Once the patient is at the Breast Wellness clinic, Navigators will pair her up with a companion who will accompany her to appointments in order to provide comfort and answer any questions. Robertson said that ideally, the companions would be a mixture of breast cancer survivors and nurses—this way, both emotional and medical patient needs would be addressed.
“We want to provide them with someone who would be more empowered than the next person so [patients] can develop a level of confidence,” Robertson said.
She said she plans to expand the program to help with transportation, child care and educational materials for the patients to deliver more comprehensive support.
Another promising cancer diagnostic tool the clinic is developing is the use of methylation markers. This technology allows scientists to identify potentially cancerous cells by looking at whether certain genes are turned on or off. If genes are turned on that are supposed to be off or vice versa, scientists know that the cells containing these genes are likely to be precancerous.
Seewaldt said new techniques such as RPFNA and the methylation markers were created in response to women declaring that “mammograms are not the be-all and end-all”—a backlash that she said began about five years ago. To address this issue, research institutions across the country put more money into research for new screening techniques, and only recently have the benefits of these efforts become apparent.
Many of the center’s future plans will explore a new way of approaching cancer prevention. Instead of the current cancer prevention drugs such as Tamoxifen, which can have serious side effects, the clinic will focus on developing more natural preventative measures.
“[The research] is a whole different way of thinking about the development of cancer. This is all about prevention or investigating and knowing about how cancer develops,” said Dr. Pearl Seo, an oncologist and associate in the department of geriatrics. “Our hope is that [by] investigating the way in which cancer develops, we’ll be able to use medications that are less toxic.”
Seo, who writes protocol for clinical trials, is working on a trial testing aspirin as a possible preventative agent. She also hopes to research the use of flax seed oil, another more benign and natural drug alternative.
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