I have been thinking more about the moonshot to cure cancer and am eager to see how it evolves. And, it’s great to see the conversation developing about the budget for this program. But throwing more money at the problem will not change the course of cancer research unless we reframe how we approach the problem. Funding the same people who will continue to conduct research the same way will not get us any closer to a cure.
The cancer research establishment is designed to support itself with small iterative changes over time. Much of the funding is subject to peer review which, in and of itself, is good, but can also lead to the dismissal of crazy, innovative ideas that might just lead to a breakthrough. With each government grant, academic institutions receive additional funding for overhead, and many, if not all, are now addicted to and rely on that funding to keep the lights on. In the current system, small steps along an accepted path of experimentation are more likely to succeed in getting funding than moonshots and, in fact, many of the research institutions are now scrambling to position themselves as the most likely to succeed.
There needs to be another path to innovation that is not based on expanding knowledge for knowledge’s sake and then developing an application. Rather, a problem or need should be identified and a team of the right people should be brought together to solve it. A new book called The New ABC’s of Research: Achieving Breakthrough Collaborations by Ben Shneiderman has caught my eye. He presents “The ABC Principle” combining applied and basic research to produce higher impact research as compared to research conducted independently. This type of organizational partnership and teamwork accelerates innovation and produces more frequent success stories than individuals working alone.
Dr. Susan Love Foundation for Breast Cancer Research collaborates in exactly this way and that is why I am so excited about this book! Our current NIH-funded study includes an all-female team of radiologists, a face-recognition software expert, and a surgeon developing a self-reading ultrasound that will be able to triage palpable breast lumps in remote areas around the world where resources are limited. Each of us approaches the same problem differently and bringing together these different ways of thinking has created a wonderful problem-solving synergy. Our goal for this study is to easily identify the 75% of premenopausal women with palpable lumps that are obviously benign, and focus resources on the ones that might well be malignant.
We have put together another amazing team of physicists, engineers, radiologists, and lactation experts from multiple institutions on a study for which we’re currently seeking funding. This multi-disciplinary team of people who don’t usually get to work together is attempting to map the anatomy of the breast ducts. Believe it or not, this has never been done! This is partly because most current research is conducted on rats and mice who have one duct per teat (nipple). Women, on the other hand, have six to nine openings in the nipple and many ducts that arborize, like branches of a tree. If we had a map, we would know exactly what tissue to remove for ductal carcinoma in situ (DCIS), which is contained in one duct system, and open the door to intraductal therapy or image-guided surgery. This has been a goal of mine for a long time, but it is the combination of a multidisciplinary, multi-institutional, international team that has allowed us to collect the preliminary data necessary to support a major grant application. The basic premise is that lactating women have ducts filled with milk which can be seen on 3D ultrasound, allowing us to capture the pictures which the physicists and engineers can analyze to determine the usual pattern and common variations of breast ducts. We are excited about the potential of this project and will report back on our progress.
Our third collaborative project is working to identify the microbiome of the breast and investigating the differences between women with and without breast cancer. The breast has been shown to normally have bacteria and viruses in its ducts/tissue and our multidisciplinary team has shown some differences between women with and without breast cancer. If funding for this project is granted, we hope to confirm the presence of a protective bacteria that was identified in our preliminary data!
My advice to Vice President Biden is to go beyond the usual players as he plots the course for the moonshot on cancer. Include both applied scientists (engineers, clinicians, and advocates!) and basic researchers in breakthrough collaborations so that we can go beyond the status quo to ending cancer once and for all. We at Dr. Susan Love Foundation for Breast Cancer Research will be happy to show him how it’s done!