2:00 P.M. EDT
Link to Stamp
DR. BODAI: (In progress.) -- report that lists all of the studies that have been funded. And I should tell you that 70 percent of the funds go to the National Cancer Institute and 30 percent of the funds go to the Department of Defense, which has an incredible research program that the Lieutenant Colonel will describe shortly.
After the success of the program here in the United States, about three years ago, I decided that this would be a good project to introduce on a global level, and I started a project called the Global Journey. And I should also let you know that I fund all of these activities out of my own money. I don't take any money. I don't charge anybody for the image of the stamp. The Post Office has released that image for any country that is not hostile to the United States that wants to use that as an image.
I'm very proud to announce, too, that Hungary, my native country, was the second country to issue the breast cancer stamp, and that was issued a few years ago. Since that time, we have issued stamps in Belize, Grenada, Gambia, Kenya, Micronesia, and I was recently in the Balkan countries and I've got on line Kosovo, Albania, Macedonia, Serbia and Croatia. In addition, I've been to the Middle East, and Jordan and Israel are going to be introducing stamps. The Philippines announced that they were going to introduce a version of their stamp as well. And in addition, Romania is also coming out with a stamp sometime in the next few months. And again, they will have the same image. It'll be translated into their appropriate languages.
Another very important fact that I want to share with you is that each country that issues the stamp keeps the money, so the money stays in that country. So third-world countries where there is no research infrastructure, such as Belize, the money is used - we use it there to set up a cancer registry cause they really had no idea of how many breast cancers they had there even in a year, so they're now establishing a cancer registry. And also in the Third World countries, the monies are used for education, outreach, and treatment of women diagnosed with breast cancer. But every penny stays in the country that issues that stamp.
And again, there is no cost to the country that wants to get the stamp. It's a small process that we go through at the United States Postal Service where they provide the artwork and then each country then translates the stamp into their respective languages.
The very exciting news about the stamp, in the United States, the monies that have been raised have produced some tremendous results in the treatment of breast cancer, not only in identifying various genetic markers, but protonomics of the drugs have been identified. And most importantly, very recently, it was announced that there is a company here called Genomic Health which makes a test called the Onco DX. And without getting very technical, it's a very simple test that is performed on the breast cancer tumor of the individual patient and it will predict - it'll give you a recurrence score. It'll predict how likely you are to have the cancer come back, given chemotherapy or not given chemotherapy.
And the importance of the study, which is called TAILORx, is that we clearly expected to identify one-third of the women who are diagnosed with breast cancer who will not benefit from chemotherapy. And the treatment of breast cancer is awful at best, but possibly the worst part is the chemotherapy which has all the tremendous side effects associated with the hair loss, menopause if you're premenopausal, fatigue, infection, et cetera, et cetera. So if we look at a number of 250,000 women diagnosed each year just in the United States alone, and we could spare 80,000 or more of those ladies from the torture of chemotherapy, which may last from three to twelve months typically, that would be a major stride in and of itself.
And then there's another group within that. There's a middle group that we're going to assign to hormonal treatment and chemo together, and then there's the third group that definitely needs the chemotherapy. But we now will have the first tool available to identify which subset of women we don't need to poison anymore and which ones will benefit from maximum therapy. So that's very, very exciting research studies that have come forward. We've also found issues that apply not just to breast cancer, but ovarian cancer and colon cancer as well, because cancer is cancer; it's uncontrolled division of cells, and so any intervention that can be effective in one form of cancer will often cross-fertilize into treating other cancers as well.
So that's the basis of the story, and my mission is twofold. One is to - my dream is that one of the studies that is funded by this breast cancer stamp might find that little piece of information that is so crucially needed to actually find a cure for the disease. And there are many, many brilliant scientists throughout the world who are underfunded, particularly in poor countries, and if we can find a mechanism to put some extra money into their hands and direct their research and recruit their brilliance into the fight against cancer, then that would be a very, very great thing. And the more countries that sign on, the easier is it for me to move on to the rest of the world. I've got six countries, twelve countries, eighteen countries and, you know, moving along at that pace, I'm here to basically ask for your help in recruiting other countries to join the fight that we're battling against cancer.
And with that, I think I'll turn it over to Lieutenant Colonel Macedonia for some comment, perhaps.
LCOL MACEDONIA: Well, thank you. I'll -- what I'll do is I'll just read a quick prepared statement and then add just a quick comment, and of course, open things up for any discussion.
So first off, on behalf of Major General George Weightman, the Commander of the U.S. Army Medical Research and Materiel Command, the parent command of all medical research done in the Department of Defense, and Colonel Craig Shriver, who is the Director of the Clinical Breast Care Program, I'd like to thank you for your interest in this topic, in this very timely topic.
Of course, we run a program of cancer research that spans the spectrum of diagnosis and treatment, spending, over the last decade, almost two-thirds of a billion dollars on breast cure research. I was asked just to comment a little bit on a new program that we've started called the Missiles to Mammograms program. It's a joint program sponsored by the Clinical Breast Care program in the U.S. Army Space and Missile Defense Command.
QUESTION: (Off-mike.)
LCOL MACEDONIA: For clarification, I'm an Army researcher, but my role is supervisory in nature with respect to breast cancer research, and I'm filling in for Dr. Shriver, who is unavailable for today's discussion. His line of work includes ongoing collaboration between scientists in Huntsville, the home of Space and Missile Command, who have developed software algorithm libraries to be used in missile detection, and now these are being ported into medical software design for cancer detection at the Windber Research Institute near Johnstown, Pennsylvania.
So Windber is looking at multiple factors related to breast cancers, including demographic, genomic, proteomic, some people call - there's a new category called transcriptomic, imaging and microscopic details to improve not only the detection, but also the focused treatment in what has been called personalized healthcare, and you just heard some exciting news about that in other arenas.
So breast cancer is not one disease, but instead a complex set of diseases requiring individualized detection and treatment schemes, and this is why the words of Dr. Shriver and Bodai and their colleagues are so critically important. I'd like to thank you for listening to that prepared statement.
I will just add that some people raise an eyebrow when they see, you know, Department of Defense interested in breast cancer research. It seems rather odd. Just to explain to everybody, we - the military in the United States runs a healthcare system that includes 11 million beneficiaries, of whom half - half of whom are women, because we not only take care of our soldiers, of whom 20 percent are women, but we also take care of all their families and dependent family members. And so roughly about half of that 11 million figure are female, and one in nine of those individuals is going to develop breast cancer in their lifetime.
So it's not simply a matter of public interest that the Department of Defense invests money in breast cancer research. It's also because it's dependent on its bottom line. We have a $43 billion a year healthcare system in the Department of Defense, so it's a matter - it's not only a matter of the vital importance that we've all talked about, but it's also a matter of economic importance to the Department of Defense that address many of these issues.
Now, that being said, the Department of Defense interest in breast cancer research really started at the end of Star Wars. So when we were drawing down our Star Wars programs in the '91, ‘92 budget years, there was additional monies left over. And the Congress, in its wisdom, decided to take some of that money and transfer it into management of breast cancer research programs, well over $200 million in that year alone. And because of the Department of Defense's excellent management of those programs, they decided to get follow-on funding to be used in a similar manner.
So the Department of Defense runs a center called the Congressionally Mandated Research - Medical Research Program, CMRP, Congressionally Directed Medical Research Programs - excuse me - that takes block grants from the Congress and then disburses that to not just national researchers, but international researchers interested in breast cancer research. And over the - like I said, over the last decade, we've disbursed over two-thirds of a billion dollars in research of breast cancer. But that's also spun off other research projects in prostate cancer and other notable killers.
So the Department of Defense also likes to note the fact that we try to leverage technologies that we've developed in other arenas, so developing - we've developed algorithms to detect missiles, for instance, in enemy territory, but those same algorithms can be used to detect enemy cancers, if you will, inside - developing inside a woman's breast. And therefore, many of those algorithms can be used in the fight against cancer.
I do want to just show you something to say that this is not an unusual effort. If you look at the history of medical imaging, and I'll just - I can pass this around. But if you look at the history of medical imaging, really, the major imaging modalities that we have now, which include computed tomography, magnetic resonance imaging and ultrasound, were all developed by researchers who either got their start in the U.S. Department of Defense, or the department of defense of other allied nations, or by civilians working on those projects, so - including several Nobel Prize winners, I might add. So it's not unusual that the Department of Defense has an interest in taking dense research projects that we've worked on in other areas and applying them toward public killers.
So that said, I'll open the floor up for any discussion or questions that you might have.
MODERATOR: And please state your name and your media organization.
QUESTION: Okay. Lambros Papantoniou, Greek correspondent for the Greek daily newspaper Eleftheros Typos.
Sir, you mentioned earlier that you started an extensive research since 1992 when the Star Wars (inaudible) to find a solution to this deadly disease. Do you have to report from this research, at this point, any progress so far? Because millions of women are dying from breast cancer.
LCOL MACEDONIA: Absolutely. You know, the developments - we're particularly proud of the fact that many of the developments in some of the most recent advanced cancer drugs have been, in part, funded either through basic research grants or more advanced grants in drugs that are specifically targeting cancers. And we're talking about these new cancer drugs that are - we've heard mentioned the standard chemotherapeutics, basically poisons that unfortunately poison all cells within the body, to new classes of those medicines, like Herceptin and Avastin, for instance, that target specific patterns within the cancer cells themselves. And much of that work has been - or some of that work has been sponsored through these Congressionally Directed Research Programs.
So we're very proud of that fact and - but you know, a lot of - you know, one thing that the public needs to - I think it's important for us to let the public know is that this is a long struggle against a very, very complex problem. It would be one thing if breast cancer were one disease with one gene defect with one problem. It would be much easier to attack. But it's really a whole class of illnesses, that - some situations, it's a matter of exposures to toxins. In other cases, it may be an underlying genetic susceptibility. And because of the complexity of the problem, it requires many research efforts across a large amount of the research space.
MODERATOR: Dr. Bodai --
QUESTION: Do you, sir --
MODERATOR: Wait. Dr. Bodai, do you want to add anything?
DR. BODAI: Yeah, I think that - you know, I had started up before you had come in about, you know, how frustrated I am about the lack of progress. You know, and as the Lieutenant Colonel points out, it is a very, very difficult problem.
Some of the funds that have been raised through the stamp monies and distributed to the DOD and the NCI have, in fact, made inroads in identification of other genetic markers, the proteins that are associated with this, the microenvironment of breast cancer, and how we can try and knock it off before it even develops into a malignancy. And these funds have done that, in terms of identifying what are called the number of growth factors which are - it's a very complicated situation, but it involves the regulation of cell division, if you will. And the Avastin is a specific drug that's developed now, which is to stop the flow of blood to a cancer. When a tumor becomes larger than one millimeter, then it needs its own blood supply. Typically, that's what our understanding is. And these new drugs will actually inhibit the new blood vessels from forming and therefore stopping the cancer before it becomes a serious problem.
The Herceptin, which the Lieutenant Colonel also mentioned, was - is a very effective drug which is - only applies to a small percentage of women because of certain criteria that they have to meet, but that small percentage of women essentially had a death sentence at the time of diagnosis if they had a particular protein marker, an oncogene marker. And this new drug that was developed is now able to extend the life of those ladies into many, many future years, disease-free. So there has been a lot of advances. We still have a long way to go.
QUESTION: Any hope for a vaccination from this research?
DR. BODAI: Actually, another interesting point: The military developed a vaccine that was used only in a very small trial. I believe it was 168 patients or so. It's called NeuVax. And the military just licensed that to a company, I believe, called Apthera and they are working on a vaccine. Now, vaccinations are very interesting in - not only in breast cancer but melanoma, colon cancer, pancreatic cancer, and lung cancer. So there is a lot of work going on in vaccination. And again, much thanks to DOD.
LCOL MACEDONIA: And the lead researcher on that was a Colonel George Peoples right here at Walter Reed.
QUESTION: Any results from those - even a few, from those vaccinations, positive or -
LCOL MACEDONIA: Well, there were. And I'd have to actually - in order to give you more than what you've already heard, you know, more detailed, I'd have to actually pull the papers up for you and cite them. But yes, there was - there was benefit from the vaccination.
You know, obviously, I mean, we're all - the thing is, our bodies are constantly producing cancers, and our immune system is constantly suppressing them. And if we can immunize - enhance people to direct their immune system against emerging cancers, it's one way to prevent and also prevent expense. So for - particularly in the developing world, cancer vaccines have the hope of really reducing their costs.
DR. BODAI: You know, one of the more recent vaccines that came out was just released with a cervical cancer vaccine, which is extremely effective.
QUESTION: (Inaudible.)
DR. BODAI: Yeah, and that's very exciting news. And it's along those guidelines that we're looking at all the other cancers that I had mentioned, including breast.
QUESTION: Do you cooperate with the private sector fighting this disease, or just you're doing it as the Department of Defense separately from whatever the National Cancer Institute is doing?
LCOL MACEDONIA: Our organization has many, many connections with private industry. And in fact, one of our mandates is to spur private industry to action because, really, in the end, if it doesn't become a product that we can purchase, then it does us no good. So, you know, there's a great deal of encouragement now over the last decade or so the government has really increased the encouragement of government agencies like Department of Defense to spur commercial development in this regard in order to speed the diffusion of these technologies and these cures.
DR. BODAI: There's a - there actually - if I might comment, too. There is a tremendous interaction between technologies that are developed, and the DOD, in fact, actively encourages the recipients of their funds to develop products for the general public. And they're allowed to get their own patents on these products and have ownership, maintain part ownership in the products that are turned over to the private sector.
QUESTION: And as far as cooperation abroad?
DR. BODAI: Abroad, it's quite different. You know, each country is very different, you know, and I've had the privilege of being in many, many countries around the world, and everybody's got their own individual systems of working.
But I think ultimately, they're all following the role model of the U.S. DOD in terms of teaming up with private industry. There is a lot of very, very brilliant people in private industry, you know, that not only know how to maybe take the drugs and advances one step further, but also turn it into a financial win-win for them so that they can make some money to continue their future research. And ultimately, it'll all come back to helping cut the cost of healthcare around the world, because one of the biggest cost expenditures is treating people who are advanced in later stages of cancer. The earlier we find them, the cheaper it is to treat them. And I'm not trying to make an economic issue about it, but it's very important when we have, even in the United States, 45-some million that are uninsured.
QUESTION: For the prevention.
DR. BODAI: Exactly.
LCOL MACEDONIA: And we actually have a representative in Brussels. My organization has a representative in Brussels to coordinate research activities that we fund through NATO. So - and we have ongoing projects that we fund with our NATO allies.
QUESTION: So NATO is (inaudible)?
LCOL MACEDONIA: Yes. I mean, we - I mean, you know, and we do this in close collaboration with our friends at the State Department, so we do have ongoing research projects and we're always developing new ones with allied countries in the medical space. It's so much so that we actually have a person sited and stationed full-time in Brussels, Belgium. His name is Dr. Dave Lam, and his role in my organization is to build new international partnerships.
QUESTION: How big is the percentage of the - for the American woman in the Army who has breast cancer today (inaudible)?
LCOL MACEDONIA: Well, the military women, remember, are in the age subset where we're talking about one in 700 or one in 650 have - will develop breast cancer, based on their age, just women under the age of 50, more or less, for our - but in many ways, that's the group that we have the most difficult time in dealing with their breast cancers, largely because the breasts of young women tend to be more dense and more complex on imaging, so they tend - cancers tend to be harder to detect. And the ones that are detected tend to be found at later stages and they tend to be more aggressive in terms of their - how they act within the body.
So even though there are - it sounds, well, that statistic you give, Macedonia, it's only one in 650, I mean, that doesn't seem like a whole lot - those are the patients that have the devastating stories of being - you know, having their cancer detected in pregnancy or with new children or whatever. So this is a group not to be neglected.
DR. BODAI: Actually, there is a trend that I've noticed in my practice where I'm seeing younger and younger women with breast cancer. And as the Lieutenant Colonel points out, it's much more aggressive and much more difficult to treat. And the chances of younger women, pre-menopausal women of dying from the disease are significantly higher than post-menopausal.
QUESTION: One more, sir. Do you still apply the well-known Papanicolaou test on the breast cancer?
DR. BODAI: That's a very interesting question. I'm working with a company called NeoMatrix right now, and we just developed a test called the Breast Pap Smear .
QUESTION: The --
DR. BODAI: Breast Pap Smear. Now, what this does, it's - there used to be a technique called ductal lavage, which was a gruesome technique where we put a small needle into a duct, put some salt water in it, suck it out, and look for atypical or abnormal cells. Well, the technique was absolutely brutal and it was extremely expensive. Each of those catheters was about $450.
NeoMatrix has now made a device that uses the combination of vacuum, warmth and massage. They put it on a patient's breast, and typically, this will be a younger patient that is not going to benefit from mammography, as the Colonel points out. And if you get nipple aspirate fluid from them, and about half the women do produce nipple aspirate fluid, you can analyze those for a condition called atypical ductal hyperplasia, which, simply put, is excess number of breast cells that shouldn't be there.
They are - it doesn't mean that they have cancer, but then we take those women and we subcategorize them into a high-risk group and perhaps do some of the following changes: if they're on birth control pills, we take them off; if they're on hormone replacement therapy, we take them off; if they're smokers and they're overweight, we try and put them on diets and have them quit smoking and quit drinking. Sometimes we'll do genetic testing on those ladies because their risk is four to five times higher if they have ADH in their nipple aspirate fluid.
And finally, we might want to take that particular patient and move them on into further, more advanced imaging technology such as MRI, magnetic resonance imaging.
QUESTION: So far, the best - so far, the best solution is early detection?
DR. BODAI: Absolutely.
QUESTION: Here we stand today.
DR. BODAI: The best chance for cure is early detection.
MODERATOR: Others, please?
QUESTION: I would like to make a (inaudible) interview if it's possible after this.
MODERATOR: Sure, absolutely.
QUESTION: If there is time to ask some more questions.
MODERATOR: Okay, all right. Sir.
QUESTION: Hi, I'm Korean journalist Hyung Choi --
QUESTION: (Off-mike.)
QUESTION: -- Munhwa Daily from Korea. First question, I wondered if Korea or any other Asian country participates in this program.
DR. BODAI: At the moment, I have not established any connections in Korea, but I would certainly welcome enthusiastically anybody you could put me in touch with that I could bring to broach the subject with. And I have a package that I can send to the appropriate officials in Korea for their consideration.
QUESTION: But basically, I think that this funding would be - it could be relayed through the public support, right?
DR. BODAI: Yes.
QUESTION: So how could you, you know, raise the -- make public to support this (inaudible)?
DR. BODAI: Well, in the United States, what we did was to get, you know, the word out about the initiative to have it become a law originally. But in other countries, it's much simpler. In the United States, we had to go through a lot of bureaucracy. But in some of these other countries, they simply approach the Postal Service and the Minister of Health for Korea, and basically, if those two sectors bought in, all they have to do is send a letter to a connection of mine at the U.S. Postal Service, they sign a memorandum of understanding, and the image is yours and the money is yours.
QUESTION: So besides U.S. -- U.S. actually has pledged, in the U.S., $63 million -
DR. BODAI: Yes.
QUESTION: -- nationwide. And so what has - what - how - what about other countries, like -
DR. BODAI: Well, Hungary has raised nearly a million dollars and they had set up a mobile mammography unit. And there is the Hungarian Oncology Institute, headed by Dr. Edith Olah, who is in charge of distributing the research dollars there.
And to be very frank with you, I don't have the time to police where those monies go, nor do I have time to help direct where the monies go. My mission is simply: Set up the program; once it's done, it has to be policed by the individual government and, you know, distributions, allocations need to be done by the individual government. And the postal service should have a say in it, and if Korea has advocacy groups which are involved in the issue, you know, I encourage them to be involved with asking where it should go, whether they want it in environmental causes, of breast cancer, genetic, drug development, et cetera.
MODERATOR: Anything else? (No response.) All right. Well, thank you so much for coming.
DR. BODAI: Thank you very much.
LCOL MACEDONIA: Absolutely.
