Charles Drescher, M.D., leader of the Initiative for Cancer Prevention and Early Detection at Swedish
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Charles Drescher, M.D., will lead an initiative at Swedish dedicated to the early detection, and ultimately the prevention, of cancer.
Researchers will gain a better understanding of how precancerous cells turn into cancer.
The initiative will use leading-edge technology to address disparities in access to screening and preventive services, including genetic counseling and testing, which is a critical component of understanding a patient’s risk of cancer.
Charles Drescher, M.D., is a gynecological oncologist whose research focuses on the early indicators of gynecological cancers. Dr. Drescher has spent almost three decades caring for people who are at risk of or diagnosed with cancers in the female reproductive system. Seeing the impact of ovarian cancer firsthand — which is often at an advanced stage when diagnosed — inspired him to look for ways to catch cancer earlier, when it’s more treatable.
For this last installment in our series about the physician researchers who are leading the Paul G. Allen Cancer Research Center at Swedish Cancer Institute, we caught up with Dr. Drescher in between meetings with his research team to find out more about the center’s three pillars of research, the importance of collaboration and the pillar Dr. Drescher will lead, the Initiative for Cancer Prevention and Early Detection (IPED), which will focus on the early detection, and ultimately prevention, of cancer.
What cancers currently have early detection methods?
There are only a few cancers for which we have effective early detection programs. Historically this has included breast cancer with mammography, colon cancer with colonoscopy and stool testing, and cervical cancer with Pap smears. More recently, low-dose CT scanning has been approved to monitor patients at high risk for lung cancer. But they’re imperfect methods that can give both false positives and negatives, which means undue anxiety for some and a delayed diagnosis and a potentially worse prognosis for others.
Left out are many other common cancers for which we don’t have good early detection strategies. This includes ovarian cancer, the second most common and the most lethal gynecological cancer. One of the biggest challenges for ovarian cancer is that it’s quite advanced by the time it’s diagnosed, and patients are already in a difficult situation, in terms of truly effective treatment options.
If you could move cancer detection earlier, when the cancer hasn’t spread from where it started, or even before it becomes cancer, then that would be huge for patients. That’s one of the driving forces behind IPED.
What are your goals for IPED?
Our work at IPED is driven by the fundamental observation that for almost every cancer we know about, the prognosis is better if it’s found at an earlier stage. Our goal is to develop early detection strategies for cancers that have none, as well as improve the accuracy of the ones we do have.
That includes parsing out which cancers are not likely to cause problems for patients. Surprisingly, some cancers are indolent, which means they will not go on to cause symptoms or threaten a patient’s life. Detection and treatment of these indolent cancers, which include certain types of breast cancer and prostate cancer, can put patients through unnecessary procedures and treatments. Our hope is to better understand where to safely draw the line for those patients.
What we’re really looking to do is to understand the biology of how precancerous cells turn into cancer. That can help us find biomarkers, something present in the blood, tissue or fluids that is measurable and signals the presence of a developing cancer. Simple blood tests or other noninvasive tests can then identify who should have further testing to confirm a cancer diagnosis.
One of our areas of interest is looking for an immune response as tumors grow. Once the immune system encounters something dangerous like cancer, there’s a cascade of activities that we can measure including an anti-cancer antibody response. Some cancers are caused by viruses or bacteria, so the immune response might be expected to be more robust and provide a better target for antibody-related early detection tests. Those only make up 16% of cancers, though, so that’s why we’re casting a wide net when looking for other immune-related markers and targets.
Beyond the immune system, even a very small cancer can cause changes in the environment, including nearby cells. This causes a response we can measure. We’re looking for any changes that can be detected, even if they’re not coming from the cancer itself.
How does this work tie in with the other side of IPED, prevention?
Early detection and prevention are closely linked, and cervical cancer is the classic example. Before pap smears, patients were diagnosed with cervical cancer at an advanced stage and had a poor prognosis. Once Pap smears were used to detect cancer at an earlier stage, it gave researchers a window into the progression of cancer that they didn’t otherwise have. Pap smears even captured the earliest stages of cervical cancer before it became invasive, which helped us understand that it was caused by the human papillomavirus (HPV). The result is an HPV vaccine that effectively protects millions across the country and the world from cervical cancer.
Similarly, removing certain types of polyps during colonoscopy prevents the development of colon cancer down the road. Studies of these high-risk polyps are leading to new ideas for preventing colon cancer. As we learn more about other difficult-to-diagnose cancers, we want to add them to the list of potentially preventable cancers.
A critical aspect for both cancer early detection and prevention is ensuring that all patients have access to up-to-date cancer risk information, standard-of-care testing and the opportunity to participate in research to new approaches. One of our goals is to engage communities. We want to use technology to address disparities in access to screening and preventive services including genetic counseling and testing, which is a critical component of understanding a patient’s risk of cancer. There are many ways that we can do better for our patients and lead the way for the larger medical community.
How important is collaboration in cancer research?
I’m fortunate to have such talented and knowledgeable colleagues in Kelly Paulson, M.D., Ph.D., and Hank Kaplan, M.D. We all know each other and work well together, which is more important to research than you might think. We’re part of a community, our skills are complementary, and we share a vision for the future of cancer care.
All three pillars of the Paul G. Allen Cancer Research Center at Swedish Cancer Institute are connected. The same way that immune responses are useful for early detection, they can also help inform more effective therapies at the Center for Immuno-oncology (CIO) led by Dr. Paulson. And vice versa: new treatments that harness the immune system can give new insight into early detection and prevention.
This is also true at the genomic level. When you’re investigating alterations in DNA that are critical to cancer evolving, those changes can help us pinpoint targets for both treatment and early detection. Dr. Kaplan is following this line of inquiry at the Initiative for Molecular and Genomic Evaluation of Cancer (IMGEC),
Each pillar is looking at different aspects of the disease process, but the information gathered, as well as the tools developed, are completely interrelated. Each new development will fuel further progress in the fight against cancer.
Courtesy Allen Institute/Paul G. Allen Frontiers Group
What is philanthropy’s role in leading-edge research?
Transformational gifts like Mr. Allen's jumpstart innovation, and philanthropy allows us to think big and shape the future. But I would also say that every gift, large or small, is critical. There are so many opportunities for everyone to support and accelerate this research at any level of giving.
The thing about research supported by philanthropy is that it gives us the flexibility to change, when necessary, our approach as we learn more and hone our ideas, which is a more productive way of working. While still being accountable to our original proposals, we can integrate new concepts as we gain insights along the way.
Everything we do is driven by the desire to improve patient outcomes. My colleagues and I are all clinicians caring for patients in our day-to-day work who could benefit from this research. That’s one of the unique things about the Swedish Cancer Institute: We both care for patients and conduct research, which means we’re able to ask the questions that will have a more immediate impact on our patients.
Working closely with patients also serves as a source of scientific inspiration. When we see something in clinic that is unusual or doesn’t fall in line with what we would anticipate, we can work backwards and examine why. Support from our community helps us think beyond the bounds of grants and pharmaceutical-funded trials to ask the questions that will propel cancer care forward.
How you can help
Research at this scale requires a significant investment in technology, personnel and laboratory resources. Your philanthropic support will unlock the secrets of cancer’s evolution and how patients respond to treatments. Learn more and give today at www.swedishfoundation.org/PaulGAllenResearchCenter.
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