13th SACI symposium puts spotlight on cancer prevention

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Ian M. Thompson Jr., M.D., chairman of the department of urology at the Health Science Center and leader of the SACI Cancer Prevention and Population Science Program, set the tone for the conference with his discussion of health disparities and cancer prevention.

The 13th Annual Cancer Research Symposium of the San Antonio Cancer Institute (SACI) focused on prevention of the dreaded set of diseases that make up cancer. SACI, one of two National Cancer Institute (NCI)-Designated Cancer Centers in Texas, is a partnership of The University of Texas Health Science Center at San Antonio and the Cancer Therapy and Research Center.

Ian M. Thompson Jr., M.D., chairman of the department of urology at the Health Science Center and leader of the SACI Cancer Prevention and Population Science Program, set the tone with his discussion of health disparities and cancer prevention. He noted that in the United States, where a large percentage of men over 50 have had the prostate-specific antigen (PSA) test, physicians have seen a 27 percent decline in mortality related to prostate cancer since 1987. “That fall in mortality has not been seen in Mexico, where PSA is not prevalent,” Dr. Thompson said. “In fact, there has been an increase.”

Dr. Thompson discussed the San Antonio Biomarkers of Risk for Prostate Cancer (SABOR) study, the large-scale Health Science Center program that is part of the NCI’s Early Detection Research Network. In addition to genetic biomarkers, SABOR is examining diet, obesity and other variables with the goal of moving toward tailored risk factors for prostate cancer.

Keynote speaker Douglas Weed, M.D., Ph.D., director of the Cancer Prevention Fellowship Program at the NCI, said obesity increasingly is linked to many cancers, including breast, colon, endometrial, prostate, kidney and gallbladder, and that an estimated 15 percent to 20 percent of cancer deaths may be linked to obesity.

Dr. Weed showed slides depicting the steady advance of obesity nationwide. He said the NCI will focus on diet, energy balance and other factors in the next few years to answer the question, “Does obesity really cause cancer?” He pointed the audience to a new NIH Web site http://www.obesityresearch.nih.gov/ that presents information about NIH-supported research to facilitate progress towards obesity prevention and treatment.

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Raymond Bergan, M.D., of the Robert H. Lurie Comprehensive Cancer Center at Northwestern University, presented on the multiple molecular abnormalities of cancer and the effectiveness of using multiple drugs in preventing cancer.

Raymond Bergan, M.D., of the Robert H. Lurie Comprehensive Cancer Center at Northwestern University, invited to speak on the development of cancer prevention agents, said no single gene operates independently in cancer and that each cancer has multiple molecular abnormalities. Drugs that hit multiple targets therefore are critical to preventing cancer.

Cancer Among other topics, Dr. Bergan also spoke about ongoing studies of genistein, a nutraceutical agent contained in soy.

Gregory R. Mundy, M.D., professor of cellular and structural biology at the Health Science Center and leader of the SACI Cancer-Related Bone Disease Program, discussed the possibility that compounds that inhibit osteoclasts (cells that break down bone) might also prevent tumor growth in bone. He also discussed the possibility that certain nutraceuticals may have beneficial effects in the bone disease associated with myeloma.

Dr. Mundy’s talk also touched on evidence that bone pain related to metastatic bone cancer is associated with increased osteoclast activity and that bone pain can be decreased by radiation therapy.

Other SACI Symposium plenary speakers included David H. Boldt, M.D., professor of medicine at the Health Science Center, chief of hematology and interim director of the SACI; Sang Eun Lee, Ph.D., assistant professor of molecular medicine and SACI staff investigator and member; and Peter J. Hornsby, Ph.D., professor of physiology and SACI member.

Attendees had the opportunity to view 93 scientific poster presentations submitted by researchers from several research institutions in the San Antonio area that were displayed in the Tom and Nancy Loeffler Atrium at the Health Science Center’s Children’s Cancer Research Institute, site of the symposium. An additional 12 posters describing the SACI Shared Resource Facilities were also available for viewing. Recipients of the best trainee poster awards were (predoctoral student category) Robert Nichols and Cynthia Norris; (Ph.D. category) Samy L. Habib, Ph.D., and Julie A. Sterling, Ph.D.; and (M.D. category) Xiu Fen Lei, M.D., Ph.D., and Seung-Min Yoo, M.D., Ph.D.

The SACI members thank the following symposium sponsors: The USAA Foundation, The William Knox Holt Family Foundation, The San Antonio Area Foundation, The University of Texas Health Science Center at San Antonio, the Cancer Therapy and Research Center, the American Cancer Society and the National Cancer Institute.

New professorship honors longtime gastroenterologist Schenker

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Dr. Steven Schenker addresses the audience after the announcement of the Steven Schenker Endowed Professorship in Medicine.

San Antonio (Nov. 30, 2004) – Steven Schenker, M.D., professor of medicine and pharmacology at The University of Texas Health Science Center at San Antonio and former chief of the divisions of gastroenterology at both the Health Science Center and the Vanderbilt University School of Medicine in Nashville, is being honored with a new academic endowed professorship established in his name.

Colleagues from the Health Science Center and the local private practice community announced the Steven Schenker, M.D., Endowed Professorship in Medicine at an awards dinner Nov. 6 at The Vault, the elegantly restored lobby of the historic Alamo National Bank Building. Many of Schenker’s past trainees, including several members of the Bexar County Medical Society, contributed to the new professorship.

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(L-R) Dr. and Mrs. Steven Schenker celebrate with Dr. Glenn Gross and Dr. and Mrs. Elliot Weser at an awards dinner Nov. 6.

Dr. Schenker, a native of Poland who trained at Harvard, the National Institutes of Health, and the University of Cincinnati, has practiced medicine for more than 40 years, including 22 years at the Health Science Center. He has made large contributions to the clinical understanding of liver disease, including the effects of alcohol on the adult and fetal liver.

Also at the dinner, Glenn Gross, M.D., Chief of the Division of Gastroenterology, announced that additional funds have been donated to the Elliot Weser, M.D., Lectureship Endowment, established in 1998 to honor the longtime Division of Gastroenterology faculty member.

Awards were presented as well to six private practice San Antonio gastroenterologists who serve as clinical faculty at the Health Science Center. They are Drs. Delbert Chumley, Ravi Botla, Gabriel Magraner, Shailesh Kadakia, Steven Hearne and David Stump.

American Board of Internal Medicine invites Verghese to serve on board

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San Antonio (Nov. 23, 2004) – Abraham Verghese, M.D., D.Sc. (Hon), the Marvin Forland Distinguished Professor of Medicine at The University of Texas Health Science Center at San Antonio and director of the university’s Center for Medical Humanities and Ethics, recently was appointed to the board of directors of the American Board of Internal Medicine.

Dr. Verghese, who is board-certified to practice internal medicine, pulmonary diseases and infectious diseases, is an award-winning author whose essays appear in The New York Times, The Wall Street Journal and many other publications. At the Health Science Center, he and Associate Director, Dr. Therese Jones are at the forefront of educating tomorrow’s physicians through an integrated, four-year humanities and ethics curriculum that reminds students to “imagine the patient’s experience.” They have brought in nationally recognized authors and ethicists to meet and challenge students.

The American Board of Internal Medicine is the only board with authority to certify internal medicine physicians, who constitute a substantial percentage of U.S. physicians. The Board is one of 24 certifying boards of the American Board of Medical Specialties.

Board members are “nationally recognized leaders in medical education, clinical practice, academic medicine, and research,” according to the Board’s Web site. “The Board establishes the requirements for certification and recertification, creates its examinations, strives to improve training, and contributes to setting the standards for internal medicine.”

Dental faculty help develop resource for cancer patients’ oral health

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San Antonio (Nov. 16, 2004) – Several Dental School faculty members at The University of Texas Health Science Center at San Antonio made significant contributions to a newly released monograph for dentists treating cancer patients.

The second edition of Oral Health in Cancer Therapy: A Guide for Health Care Professionals is a 62-page text developed by the statewide Dental Oncology Education Program, a component of the Texas Cancer Council. This monograph was supported by grants from the Texas Cancer Council and the Academy of General Dentistry Foundation. Topics range from the effects of chemotherapy, bone marrow transplant, and head and neck radiation therapy to nutritional support of cancer patients, management of acute oral pain and special considerations for pediatric patients.

Spencer W. Redding, D.D.S., M.Ed., professor of general dentistry, served as one of the three editors with V. Kendrell Rankin, D.D.S., and Daniel L. Jones, D.D.S., Ph.D., both of Baylor College of Dentistry, a component of the Texas A&M University System Health Science Center. Contributing authors from the Health Science Center general dentistry department were Laurie L. Bradley, D.D.S., assistant professor; Carl W. Haveman, D.D.S., M.S., associate professor; and Stephanie R. Jackson, D.D.S, assistant professor who since has moved to practice in a community health center in the Lower Rio Grande Valley. Dr. Jones, from Baylor, previously was a faculty member in the Health Science Center department of community dentistry.

The authors note that about a third of the 1.2 million Americans diagnosed with cancer each year will suffer oral complications from their cancer treatments. “Oral infections involving the teeth should be managed prior to the initiation of cancer therapy, as these infections could cause serious morbidity and even mortality in selected patients,” Dr. Redding said. “Also, oral soft tissue infections such as with Candida, a species of yeast, and herpes simplex virus commonly occur during cancer therapy. These topics, among many others, are extensively covered in the monograph.”

The monograph is available to any dentist in Texas through the Dental Oncology Education Program atwww.doep.org.

Study: Disease management gave heart failure patients more time

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San Antonio (Nov. 16, 2004) – Patients with congestive heart failure who received disease management services – such as home visits and telephone calls from registered nurses – between trips to the doctor’s office lived longer than patients who did not receive the services, reported Gregory Freeman, M.D., and Autumn Dawn Galbreath, M.D., at the American Heart Association Scientific Meetings Nov. 7 in New Orleans. Drs. Freeman and Galbreath are faculty members at The University of Texas Health Science Center at San Antonio.

“We found that congestive heart failure disease management improved mortality of patients but did not save money,” Dr. Galbreath said. “This is very different from previous literature on the topic, and I predict it will have a big impact on policy.”

Medicare alone pays $3.6 billion per year for congestive heart failure.

Disease management involves closer monitoring of patients by professionals including registered nurses, and it is accomplished through home visits, telephone calls and educational materials sent by mail. The study group enrolled 1,069 patients with congestive heart failure; 710 received varying levels of disease management and 359 in the control group did not.

The patients in the disease management group lived an average two-and-a-half months longer during the study follow-up period. However, costs of hospitalizations, procedures and overall care were not reduced in the intervention group, as was previously theorized.

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“It shows you have to spend dollars to get better care,” Dr. Galbreath said.

The trial focused on publicly funded plan beneficiaries such as Medicare, VA and military beneficiaries, and unfunded patients. The patients came from the southern half of Texas.

“This is one of the first studies that had no industry funding and had a true control group for comparison,” Dr. Galbreath said. “That makes our data more scientifically rigorous and more objective.”

The study was conducted under a contract with the U.S. Department of Defense (DOD). U.S. Rep. Henry Bonilla worked with his colleagues on the Defense Appropriations Subcommittee to make sure the funding was included in the 2000 defense appropriations bill.

At the time of the study’s announcement in May 2000, it was predicted that the DOD award would have a direct impact on the 4.5 million Americans who suffer from congestive heart failure because it sought to improve management of day-to-day variations in symptoms.

Congestive heart failure results from impairment of the heart’s ability to pump oxygenated blood through the body. Patients accepted to the study had ejection fractions less than 49 percent (a normal, healthy value is 60 percent). The ejection fraction, which is determined by an echocardiogram (a sonogram of the heart), is a measurement of the amount of blood pumped by the heart during each beat.

Weight gain, a signal of fluid retention, is one of the signs of congestive heart failure progression. Patients in the disease management arm of the trial received bathroom scales to help nurses keep tighter surveillance on changes in their weight.

The Health Science Center partnered on the study with Brooke Army Medical Center, Wilford Hall Medical Center, the South Texas Veterans Health Care System (STVHCS), TRICARE Region 6, the University Health System and private physicians in South Texas.

Dr. Freeman was principal investigator for the study. He is professor and chief of the division of cardiology in the department of medicine at the Health Science Center and staff physician with the STVHCS.

Dr. Galbreath is vice chair for clinical programs in the department of medicine and staff physician with the STVHCS, and she served as director of the Health Science Center’s UT Disease Management Center for several years of the project. At the time of her promotion to vice chair, she was succeeded in that capacity by Monica Lee, M.D., instructor of cardiology.

$1.1 million project seeks prevention of lead exposure

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San Antonio (Nov. 16, 2004) – The U.S. Department of Housing and Urban Development (HUD) has given The University of Texas Health Science Center at San Antonio a $1.1 million grant to support expanded screening of children and pregnant women for lead exposure and to encourage more physicians to test for lead before symptoms appear.

The Health Science Center’s division of community pediatrics is coordinating Project L.I.F.E., short for “Lead Investigation and Family Education,” which engages partners including the San Antonio Metropolitan Health District, the Neighborhood Action Department of the city of San Antonio, The University of Texas at San Antonio and The University of Minnesota.

Lead poisoning, which affects an estimated 1 million American children ages 1 to 5, is linked to kidney damage, anemia, developmental deficits, poor memory and other cognitive issues, skin problems, failure to thrive, and damage to nerves that transmit information from the brain and spinal cord throughout the body. Alarmingly, lead crosses the placenta into the womb.

The Health Science Center will provide instruction on the dangers of lead to 250 primarily Hispanic mother-and-child pairs, including about 50 pregnant women. The researchers also want to reach 300 children’s health professionals. “Lead is being phased out of use, but it is still in our environment,” said Victor German, M.D., Ph.D., chief of the division of community pediatrics at the Health Science Center and principal investigator of the HUD grant. “Through increased education, we want to mediate the short- and long-term effects of lead on the children and mothers and prevent future lead exposure.”

Bexar County data for 2001 showed that 452 children under age 6 were identified as having a blood lead level greater than or equal to 10 micrograms per deciliter (µg/dl), the level considered to be toxic. Risk factors for lead exposure include minority ethnicity, age of housing, income level and occupation. “The scary thing about lead exposure is we don’t really have enough good information about how high it is in San Antonio,” said Anthony Scott, Ph.D., associate professor of community pediatrics and a member of the lead education project.

Lead can come from many sources, including lead-based paint, pottery with lead glaze, pipes soldered with lead, automotive repair shops, factories, and even cultural remedies such as azarcon, a lead salt used as a folk remedy in Mexico. Children are especially vulnerable to lead-contaminated soil because of hand-to-mouth play, said Kayan Lewis, Ph.D., project evaluator from the division of community pediatrics.

“Lead is hazardous for young children,” said Project Coordinator Monica Minter from the Health Science Center. “It is absorbed into bones and blood, and it can last in a child or an adult up to 20 years depending on the person’s metabolism.”
Lead can be especially damaging to the unborn. “Lead toxicity has several potential adverse effects during pregnancy, such as increased risks for miscarriage, high blood pressure late in pregnancy and reduced birth weights,” said Project L.I.F.E. Co-Investigator Donald Dudley, M.D., professor of obstetrics and gynecology at the Health Science Center. “Excess lead also is associated with male infertility. Importantly, we do not have good data that says what a normal lead level is during pregnancy, or what the best treatment of lead toxicity is in the pregnant woman.”

Obstetric care providers often are not aware of the impact that high lead levels have during pregnancy and rarely test for it, Dr. Dudley said. One aspect of the project is to educate obstetric care providers in San Antonio and South Texas about the dangers of lead toxicity during pregnancy.

Most programs focus on lead abatement but don’t seek to engage families and health professionals, Dr. Scott said. Project L.I.F.E. unites the Health Science Center researchers with the San Antonio Metropolitan Health District, which does child lead screenings and referrals; the Neighborhood Action Department, which handles lead abatement; and UTSA researchers, who will conduct soil sampling to assess local lead levels. The University of Minnesota Children, Youth and Family Consortium will provide consultation on lead curriculum for families and health professionals.

The project’s soil sampling component involves UTSA’s Center for Water Research and is headed by Dibyendu Sarkar, Ph.D., director of the university’s Environmental Geochemistry Lab.