In this interview with ONCOLOGY Editor-in-Chief Nancy Davidson, MD, we dive into the “gray area” of breast biopsies and how the oncology community can meet this challenge. Dr. Davidson, AACR’s president-elect, also discusses the changes she has seen during her career with regard to how cancer patients are treated and looks forward during this optimistic time in treatment and research.
As part of Cancer Network’s coverage of the 2015 American Association for Cancer Research (AACR) Annual Meeting, we spoke with AACR’s president-elect, Nancy Davidson, MD, whose term as president will begin April 2016. Dr. Davidson is a world-renowned breast cancer researcher and the director of the University of Pittsburgh Cancer Institute and UPMC Cancer Center, and is also an editor-in-chief of our journal, ONCOLOGY. She spoke with us about her plans for her AACR presidency, and also discussed some of the breast cancer research that has been in the news lately, specifically regarding the discordance in breast biopsy analysis.
-Interviewed by Nora Ray
Cancer Network:You were recently elected by the members of the AACR to serve as their president-elect for the 2015–2016 year, and you will become the AACR president in April 2016. What does this appointment mean to you? Can you tell us some of your plans for your presidency?
Dr. Davidson: I’m extremely excited to have the opportunity to work with the members of AACR to promote cancer research in a way that we hope will continue to have an impact on human health. I’m newly elected, as you know, so I’m just beginning to formulate what the specific goals of my presidency will be, but the themes of AACR are really unwavering: to support professionals, researchers, physicians, clinicians, trainees, and everybody who’s passionate about cancer research so that they can make the important discoveries and apply the science that’s necessary to improve human health.
During my upcoming presidency, I think we will continue to work on the common AACR themes of engaging the membership, providing them with the tools they need, and helping to advocate for funding for research. We need to try to make sure that we populate the pipeline and that the next generation of cancer scientists are being supported, because unfortunately cancer won’t be solved during my career. In sum my overarching goal will be to promote great science that will translate into ever more effective and precise care for cancer.
Cancer Network:You serve on a number of professional committees and boards, including as one of the editors-in-chief of our journal, ONCOLOGY. What is the significance of this kind of service for you, and how has it contributed to or influenced your career as a cancer researcher and clinician?
Dr. Davidson: My involvement on these committees and boards has been a terrific opportunity to continue to promote messages that have been near and dear to my heart during my entire career. I’ve been able to serve on a number of professional organizations and societies, philanthropic groups that are passionate about cancer, and of course I’ve had the chance to work in several great cancer centers across the country, so to me this is a natural evolution, a way for me to take my passion about cancer and use it to try to help all of us to be galvanized about the importance of the field.
Cancer Network: There has been a lot in the press lately about the “gray area” of breast biopsies, based on the article by Elmore et al recently published in JAMA about how pathologists analyze breast specimens. You wrote an editorial accompanying this article, essentially saying it should be a call-to-action for pathologists and breast cancer scientists. How do you think this can be accomplished? How can the oncology community come together to try to narrow the gap in interpretation of biopsies that result in a discordance of diagnoses?
Dr. Davidson: I had the great fortune of writing that editorial with David Rimm, a molecular breast pathologist from Yale, and our collaboration on the piece really sets the scene for what we need to do as practitioners. First, we needed to understand that this is a problem, and that was evident as a consequence of the study published in JAMA-there is really a gray area in breast pathology where we don’t have uniform opinions about how to proceed or how to diagnose. Now that that’s been done I think that we probably will see collaborations between clinicians, scientists, and pathologists to try to think about how we can better characterize those atypical lesions. It’s increasingly important now because we do know that there are things we can do about this. There are interventions that patients can consider if they know that they have a bona fide diagnosis of atypia. People like Dr. Rimm are going to be in the vanguard of figuring out how to do this going forward. Of course, this will be a complicated thing to do! Once you find a profile or a pattern of atypia, you must go through a number of very important steps to make sure that it’s validated and has clinical meaning.
Cancer Network: You recently attended the 14th St. Gallen Breast Cancer Conference, which this year focused on primary therapy of early breast cancer. What were the highlights of this meeting for you?
Dr. Davidson: The St. Gallen meeting is a little bit less about presenting new data and more about taking the information we have available to us at the present time and thinking about how we should use it to drive clinical practice for the many patients who are not on clinical trials. I think that this year’s review was a comprehensive one, and the areas that certainly have changed a lot over the last 2 years, and which received a lot of attention at this meeting, had to do with the local therapy of breast cancer and how to optimize surgery and radiation therapy. Also, a lot of attention was given to the area of systemic therapy for breast cancer, specifically on hormone therapy for premenopausal women with hormone responsive breast cancers, and how we can integrate the results of some larger trials that were presented over the last couple of years into practice.
Cancer Network: There continues to be controversy and debate about how to treat ductal carcinoma in situ (DCIS). In what direction do you think this issue is moving? Is there more consensus these days about how to manage DCIS?
Dr. Davidson: I think this is another gray area, like atypia, but perhaps a little more developed than atypia since there’s more uniform agreement on the diagnosis of DCIS. However, I think it’s an area in flux for us; on one hand, we identify a lot of DCIS, on the other hand we’re trying to figure out whether or not we are overtreating some patients, so I think we’ll see a focus on that, which will continue over the next couple of years. And to me the big questions in treating DCIS will be: How much surgery is necessary? Does everyone need radiotherapy? How can we best apply our systemic therapies and prevention agents for these patients? This is an ongoing area, and some large trials will be coming out over the next couple of years that will address some of these questions.
Cancer Network: During your career as an oncologist thus far, what has been the biggest change you’ve seen in terms of how patients with cancer are treated?
Dr. Davidson: I like to think that we have seen a major adoption of multidisciplinary care for cancer that is wrapped around the patient. So we’re very patient-centric; we know it takes a large team to treat cancer. We are trying evermore to bring the science of cancer and the clinical evidence that exists to bear for the individual patient to provide real precision cancer care. And that’s a tremendous evolution over the last couple of decades, going in a very positive direction! And I also hope that patients increasingly understand that while the diagnosis of cancer is never good, for many patients there is an opportunity to receive appropriate therapy, and then get on with the rest of their lives. There is much more optimism in the field than there has been in the past. This optimism is a direct result of our ability to translate scientific discovery to clinical application to reduce the burden of cancer. We cannot afford to lose our momentum at this crucial time.