by John Bach

The statistics are alarming. The death rate for cancer in the Cincinnati metropolitan area ranks among the top 10th percentile in the country. The fact that area cemeteries are full of its victims is evidence enough we are losing the local battle against cancer. But it gets worse.

Patients are leaving town for care. Cincinnatians are leaving town for hope. They leave their homes, their families, their friends, their churches behind to seek new treatments, to seek second opinions and to put off death. And not just at the Mayo Clinic. Cancer victims are turning to regional doctors and hospitals as close as Lexington, Ky.; Pittsburgh, Pa.; and even Columbus, Ohio.

"There is the perception that cancer care is not what it should be in the Cincinnati area," says Cecilia Fenoglio-Preiser, director of the University of Cincinnati Department of Pathology and Laboratory Medicine and newly appointed director of the Barrett Cancer Center. "We have scattered excellence, but we need more uniform excellence. For much of cancer treatment, you can get reasonable care within the general community. But there is the perception, particularly for a person who is incurable, that we don’t have access to state of the art clinical trials and we are not as cutting edge."

That, she says, will change. Not just the perception, but also the reality. If admitting a problem is the first step, it is time to move to step two. Fenoglio-Preiser, an internationally known expert on genetic alterations in tissue, says plainly, "Cancer is not a success story in this institution."

The good news is it can be. In fact, she expects UC to attain the high distinction as a National Cancer Institute within the next five years.

UC's Millennium Research Plan calls for doubling funded research for the university by 2006 to focus particularly on four areas. Cancer research made the short list. "We have basic scientists studying what makes a cell become a cancer cell," says John Hutton, dean of the college of medicine. "We are placing an emphasis on developing a stronger arm in translational research, taking the basic science and translating it into direct patient care delivery."

The goal for cancer research at UC and the Barrett Center is to create a first-rate integrated clinical cancer program that provides quality care and guarantees patients are treated promptly and with compassion.

The vision is to build a unique cancer research program that capitalizes on and expands upon existing strengths. And UC's strength lies squarely with its genetic research.

"We have to begin to take advantage of the human genome project and analyze individual tumors in individual patients," says Fenoglio-Preiser. "It isn't enough to analyze 500 patients with breast cancer. You have to figure out what is different in each patient.

"The first step in creating any cancer cure is to understand what is abnormal about the cells. You have to develop a genomics approach to cancer."

Genetic predisposition accounts for only about 15 percent of common cancers, she says. "There has to be something else that accounts for people developing cancer. It is our hypothesis that what is at play here is a gene-environment interaction. We have to begin to understand how the environmental exposures we have relate to how we develop cancer."

Much of the area's high cancer mortality rate can be pinned to two health risks. Cincinnati is among the highest in the United States for both tobacco use and obesity. But according to Fenoglio-Preiser, there are many other factors to consider.

"This is a fairly industrialized area," she contends. "We have a substantial river running through us with large amounts of traffic. We drink that water. We are a major transportation pathway with one of the busiest north/south interstates in the United States (I-75). We get all the exhaust fumes and spills. And we also have very heavy train traffic.

"Basically, this is a major traffic corridor that can bring things into the area that maybe weren't here in the first place. We need to begin to figure out what those things are and how they interact with folks."

Before that can happen, UC will need to recruit prominent clinicians and international leaders in cancer research to help attract appropriate funding. Administrators are also recommending a new Department of Cancer Biology, a partnership between the College of Medicine and the College of Pharmacy to focus on drug discovery.

All of these things will pave the way for UC to become a National Cancer Institute. A nod from the NCI is like a Good Housekeeping seal of approval, Fenoglio-Preiser says.

"It says you have had peer review and you have outstanding programs. You have research. You have cancer control and prevention. You've got the clinical activity and are basically state of the art. It is a statement of excellence."

Most important, however, it will mean Cincinnatians will stay home for care.

Another step closer to a cure

Pockets of outstanding cancer research at UC reflect its step toward becoming a comprehensive cancer care center. A few examples follow:

• Lyon Gleich and Jack Gluckman are treating patients who experience recurring head and neck tumors with gene therapy, helping the patient's immune system to recognize and destroy their own tumor cells.
• Elyse Lower has conducted clinical trials of promising chemotherapy agents in patients with advanced breast cancer.
• Joanna Groden has isolated genes for colon cancer and Bloom's syndrome.
• Cecilia Fenoglio-Preiser is studying genetic alterations in the tissue samples taken from tumors from around the world to predict how well a patient will respond to cancer treatments.
• Marshall Anderson is building a medical database of families that have suffered multiple cases of lung cancer to identify genetic mutations that make people more susceptible to cancer from smoking.
• Peter Stambrook is developing new gene therapy treatments for cancer by studying mice models in cancer-causing environments and studying cellular mechanisms that lead to mutant genes.
• Elizabeth Shaughnessy is studying ways to treat people with a high cancer risk based on their genetics, while heading up the local portion of a national study of drugs that help reduce cancer risk.
• Nira Ben-Jonathan is studying the effects of environmental estrogens, found in everyday plastic, on hormone production and particularly on the growth of reproductive organs.
• Andrew Lowy is studying pancreas and colorectal cancer to find the best treatment for tumors.