Program Co-Leaders Joe W. Gray, PhD Laura J. Esserman, MD, MBA

The Breast Oncology Program at UCSF is a longstanding program that has served as a model for other translational research programs within the Cancer Center. Involving nearly 60 faculty scientists, the program supports and stimulates basic, clinical, and population research in breast cancer and facilitates translation of these findings into improved cancer management and control.

Program research is supported by major grants from the National Cancer Institute (NCI), the U.S. Department of Defense, and other agencies. Among the program's components are these:

• NCI-funded Bay Area Breast Cancer Specialized Program Of Research Excellence (SPORE)
  
  
• Bay Area Breast Cancer and the Environment Research Center, funded by the National Institute of Environmental Health Sciences and the NCI
  
  
• "A Blueprint For Regional Excellence In Breast Cancer Care" -- Center of Excellence for Breast Cancer Care

Additionally, programmatic research is facilitated by a $12.2 million gift from the Avon Products Foundation, which supports research in carcinogenesis and early detection, development of new approaches to therapy, identification of genes that modify susceptibility to cancer, and elucidation of differences in tumor biology and genotype that arise in ethnically distinct populations. The Avon gift also supports outreach activities among economically disadvantaged populations, including mammography services, education, and improved access to clinical trials throughout UCSF, especially at San Francisco General Hospital.

Five strategic program themes underlie the work of the Breast Oncology Program:

Carcinogenesis, Early Detection, and Cancer Prevention
This theme addresses four clinical questions:

• Who is truly at increased risk for developing breast cancer and when? Age, hormones, breast density, and genetics are leading indicators of risk; but current assessment tools are neither good predictors of individual risk nor are they helpful in designing or testing the impact of interventions.
• What is the optimal way to identify women at very high risk for developing breast cancer?
• What actions do we take to avoid or reverse the early lesions that lead to breast cancer?
• Can we predict who is likely to develop estrogen receptor positive and negative tumors, toward the aim of tailoring the use of Selective Estrogen Response Modifiers (SERMs), such as tamoxifen and raloxifene?

2006 Scientific Progress & Achievements

Genetics and Biology of Cancer Progression
Conventional and newer biologically targeted therapies for breast cancer operate through complex mechanisms. Because of wide differentiation in breast cancers (genetics, genomics, gene expression, etc.), opportunities exist to identify and characterize markers that correlate with response to specific anti-cancer agents. Such markers will become increasingly important as novel targeted biological agents are developed, since these agents are likely to be most effective in specific subsets of women with breast cancer.

2006 Scientific Progress & Achievements

New Therapeutic Targets and Approaches
Despite progress in understanding the molecular and cellular basis of cancer, translation of these discoveries into new therapies is a complex, multi-step process. Translational research requires improved strategies for the development of therapeutic agents, and the goal of this theme is to bridge the critical gap between "bench and bedside."

2006 Scientific Progress & Achievements

Cancer Epidemiology
This initiative aims to characterize the populations that develop pre-malignant and invasive breast cancers, as well as those at risk for cancer, and to study aspects of disease outcomes within a given region. While clinical trials define the efficacy of an intervention in a carefully controlled study, population studies help to define the effectiveness of interventions more globally.

2006 Scientific Progress & Achievements

Outreach, Clinical Care Delivery, and Outcomes
Careful research can lead to improved management strategies for clinical care, benchmarks of success, quality improvement, and better integration of clinical research into the process of care. Stratified risk assessment, tailored treatment based on biologic and genetic characteristics, incorporation of patient preferences after clear presentation of diagnostic and therapeutic options -- all are important aspects of this theme, which will lead to clear improvements in clinical care and disease outcome.

2006 Scientific Progress & Achievements

All of the work of the Breast Oncology Program is critically informed by a committed group of patient advocates, who participate in regular research meetings, help to establish program priorities, and undertake efforts to educate their peers about participation in clinical research studies.