Damn The Mutations, Full Speed Ahead

So now they want to tell us that cancer is mostly the result of genetic mutations, as opposed to other factors. I'm not sure how much of this I want to believe but I'll just say 'damn the mutations, full speed ahead'.

Cancer causes are supposedly:

• 66% - mutations when cells replace themselves
• 29% -  environmental factors
• 5% - hereditary factors

So can we stop blaming our parents and our bad diets, and just assume none of it is our fault? Probably not.

As a normal part of life, cells divide and multiply and little mistakes happen all the time. Its just that sometimes they turn into cancer....

"Lifestyle factors still matter for cancer prevention.

Just one mutation is not sufficient to cause cancer -- typically three or more mutations must occur, Tomasetti noted. If, say, your cells miscopy DNA and so cause two random mutations, a third mutation is still needed. Obesity, smoking, lack of exercise and poor eating habits might supply that necessary third gene defect that tips your body into a disease state."

So go eat a salad, quit smoking, and go to the gym. And for those of us who were already doing all of those and still got cancer, can we please just blame bad luck and not blame ourselves?

Finally Myriad Genetics has given up

Since 2013's Supreme Court ruling that Myriad Genetics and any other company cannot patent any natural occurring DNA, Myriad has been busy suing other companies over this same issue. Why? Well they do not want to give up their $9,000,000/month gravy train. Finally, this appears to be over.

Its about time.

I have no idea why they insisted on persisting their illegal monopoly but I am glad it is over.

I do hope this clears the way or more research on gene testing and to open up the field. My thoughts are that more research could lead to a better understanding on the differences in the BRCA genes and better explain why some people with the genes do get breast and ovarian cancer and some do not.

I am not educated enough on the BRCA genes to know why some people with the gene do get the cancers and some don't. I would think that if you have the gene you would get cancer and think that there must be more differentiation to explain why only some do and some don't. Do I make sense? Probably not so let me try again.

To my uneducated brain, I would think if you have a gene you would end up with whatever that trait is. For example, if you have the blue eyes gene, you have blue eyes. Right? So if you have one of the BRCA genes, why are you only at high risk of getting breast and/or ovarian cancer? Wouldn't it make sense that if you have the gene you are going to have the trait? Therefore I think that now more research can be done to show there is greater differentiation in the genes to explain why not all with the gene get cancer.

Okay, I know sometimes I am rambling and don't make sense.... But I hope that I do this time.

Say hello to our new pal - PALB2

PALB2, or PAL for short, is our new friend. She's a newly discovered breast cancer gene who hangs out closest to our old friend BRCA2, or B2. She also hangs with B1 but not as much. But what does PAL do? According to some new research:

"Overall, the researchers found, a PALB2 mutation carrier had a 35 percent chance of developing cancer by age 70. By comparison, women with BRCA1 mutations have a 50 to 70 percent chance of developing breast cancer by that age, and those with BRCA2 have a 40 to 60 percent chance..."

"The breast cancer risk for women younger than 40 with PALB2 mutation was eight to nine times higher than that of the general population. The risk was six to eight times higher among women ages 40 to 60 with these mutations, and five times as high among women older than 60...

"The data also indicated that women with the PALB2 mutations were slightly more likely to have “triple-negative” breast cancer — a form resistant to hormone treatment, more aggressive, and more likely to recur than other subtypes...."
A caution was added:

"“This has to be tailored to the patients, who may have other mutations and varying family risk,” she said. “With no family history, the increase they found is 35 percent. If you have two or more family members with cancer, they found a risk of 58 percent.”"

So PAL may be our friend but we don't want her to hang out with our family as well. 

You can learn more about PAL here and here (NEJM) and here (Genetics Home Reference).

The latest theories

So the latest theory, in case you missed it, is that a daily aspirin will reduce breast cancer deaths. Sho-wah. I'm all in. But I can't take a daily aspirin because I am on prescription anti-inflammatories for my back. I wonder if that is a good substitute.

Actually I ignore all that now because a newer study based on 70,000 adoptees found that if a biological parent had cancer, the child had a 80-100% greater chance of developing one of the three most common cancers - breast, colorectal or prostate.

"The study was led by Bengt Zoller, a reader at Lund University in Sweden. Dr. Zoller says:

“The results of our study do not mean that an individual’s lifestyle is not important for the individual’s risk of developing cancer, but it suggests that the risk for the three most common types of cancer is dependent to a greater extent on genetics.”"

So lifestyle doesn't do squat. Not really squat. We know smoking and drinking and sodas and fried foods are bad for us in other ways but in terms of cancer risk, check your family tree.

Over-Awareness, Focus, Hype and Expectations

The media did a damn good job about making sure we all knew about Angelina Jolie's double mastectomy. She went public, if I recall correctly, to raise awareness about the BRCA gene. I respect this decision and congratulate her on a brave decision to take something very personal and make it public.

In a recent survey, three quarters of us did know about her surgery and decision. Considering that it happened less than a year ago and and was much less significant than a war, earthquake, typhoon, etc 75% is a pretty good number.

I would also like to point out that all those years of breast cancer awareness and pinkification have allowed this to become a major news topic and not get buried under the carpet or something. However the information stops at awareness.

Only 10% of those asked in the survey knew about Angelina's BRCA diagnosis and why she had the mastectomy. I think I am okay with this. If you are not embedded in the breast cancer world you can't be expected to know chapter and verse about the genetic causes of breast cancer.

For example, I know there is some family genetic trait that leads to Huntington's disease and don't really feel I need to know more about it because it does not affect me directly. If it did, I would be up on it and have read all the research.

I think we have reached a level of breast cancer awareness that is overdone. But I do not think we need to expect that all American's know the great details of a breast cancer diagnosis and all its risk factors. There are many other diseases and ailments that deserve more awareness and shouldn't be hidden behind a pink curtain of over-hype and over-awareness.

I do think Americans need to embrace overall awareness of a healthy lifestyle and not focus on a few diseases at a time - the ones that are closest to them and causing them the most problems.

This didn't take long

The Supreme Court announcement last month probably surprised no one more than Myriad Genetics who had 'patented' the BRCA genes. But is anyone surprised that less than 30 days later they have already sued two competitors who have rolled out BRCA tests?

That's right, lose your patents, your lawyers are bored so its time to start litigation. What a productive use waste of money.

Please, I am sure since the genes were first discovered others have figured out how to test them. Maybe Myriad should come up with ways to test for some of the other myriad of genes out there? (Or was that a really bad play on words?)

More on the breast cancer treatment gap

A few weeks ago I blogged about the breast cancer treatment gap where women who are told they are BRCA positive only have surgical options to lower their risk of breast or ovarian cancer. It turns out this is growing in significance because of genetic testing progress.

This started when Angelina Jolie announced she had a prophylactic bilateral mastectomy because she was BRCA positive. Unless you have been living under a rock you couldn't have missed that story in the news recently.

While many people are supportive of her decision, some are not. Here is an article on the other side of the issue - which shows how some people are not in favor of this type of prophylactic surgery. I think this kind of decision is very personal but unfortunately there are not a lot of options for those with who test for the genetic mutation.

We can also add in the fact that insurers often are reluctant to pay for the tests. Not just the BRCA test but others for Cowden's syndrome or Li-Fraumeni syndrome, both of which are shown to raise risk for breast and other cancers.

Finally, let's top this all off with the fact that University of Alberta researchers have pinpointed markers for sporadic cases of breast cancer - meaning ones without a family history. Or about 80% of all breast cancers could be caused by these markers. They suggest that women with the marker could then proceed with prophylatic options. We know what that means.

So let's add it up:

• Researchers are finding genetic causes to more cancers.
• Insurers don't want to pay for genetic tests.
• The only options for women with the genetic mutations or markers are significant disfiguring surgery with long term complications.

So where does that leave the patients? Over the barrel without a lot of options.

What would you pay?

Would you pay $4000 for something that is only should cost $99? Apparently women who get a BRCA test pay nearly $4000 for something that should cost around $99. This because of the monopoly Myriad Therapeutics has by patenting the genes. I know I have logged about this before so may you call me redundant.

We are still waiting for the Supreme Court's response to the argument that gene's can't be patented. But Myriad is so sure that there will not be a problem for them, they are planning further profits later this year.

"Without competition, Myriad can effectively charge whatever it wants. Later this year, the company said it would begin incorporating the BRCA test into a 25-gene cancer-risk evaluation and phase out the à la carte BRCA test by 2015. For that broader test, it projects a gross profit margin of 87 percent."

I wouldn't mind an 87% profit on my investments. Would you? I'm just awaiting the Supreme Court''s response.

Misconceptions about breast cancer risk

Last night we had dinner with a friend who's mother had breast cancer more than 15 years ago. She was talking about her concern about getting breast cancer. I think both her grandmothers and a couple aunts had breast cancer. Several of them had bilateral mastectomies. This is dating back decades to the 1970s and earlier.

She has not been tested for the BRCA genes because it would require her mother to be tested and she didn't want to put her mother through that. That was probably 15 years ago and she hadn't asked since. She was very concerned and sounded like she was sure she would get breast cancer.

I asked her a couple questions. What stage cancer did all her relatives have? She had no idea. She thought they were relatively advanced because of the bilateral mastectomies. But those were done in the 1970s when more radical surgery prevailed.

I also said that the BRCA genes only account for 5-10% of all breast cancers. But I did suggest that even though she was told years ago that she would have to have her mother get tested for the BRCA gene first, maybe times had changed and she could be tested now. She is going to ask her doctor about that now.

Her other comment was that there is cancer on both sides of her family and both her parents had cancer which further reinforced her thought that she would definitely get cancer. 

I was somewhat surprised at her misconceptions that she was sure she would get cancer because of her family history. Yes she is probably at higher risk than the average population of getting cancer. But there is  no reason to think she definitely will get cancer. And with regular mammograms and annual physicals, anything would probably be caught early.

I think this is a case of her mind getting ahead of reality. You start thinking well everyone else got cancer so I will too and I'll die some kind of horrible death as a result. I hope I was able to reassure her that she is doing the right thing and cancer is not a certainty for her.

Breast Cancer Patients Go to Washington

Today is a big day. Around here it is Patriots Day which means there are parades (mostly yesterday), Revolutionary re-enactments, pancake breakfasts, award ceremonies, a little road race called the Boston Marathon, and a minor hint of spring - its a tropical 32 degrees right now.

In Washington DC, its typical pomp and circumstance, the ego battles, and political denials, as well as oral arguments in the Supreme Court on the patent-ability of human genes and the genome. The ACLU, breast cancer patients, scientists, Biotech companies, and more are all meeting together to hear the oral arguments and then the Supreme Court will make some big decisions.

At the root of the matter is are human genes and the genome patentable? They have been awarded patents in prior years. For example, Myriad Genetics patented BRCA1 and BRCA2 genes using the grounds that they isolated them so they should be able to patent them. Then they developed the breast cancer BRCA tests which they sell for a paltry $3340 and have earned $2.1 billion on these tests. They want to retain their patent because it makes them rich. Some scientists say the gene patents allow them to earn money from their research.

On the other side,  people like the ACLU say they are naturally occurring and therefore should not be patented. And that the patents actually restrict research.

Personally I don't think naturally occurring things should be able to be patented. Does someone want to patent the crab grass in my lawn? Then they can pull it out because I'm not going to pay them for it (free weeding).

Maybe they can patent the tests that are done using the genes but not the genes themselves. Other people could then patent their own tests and there would be competition and someone wouldn't be $2.1 billion richer on a test that some insurance companies won't cover because of the cost. (Patients first please.)

Medical research often includes genetics and molecular level testing these days. Our legal system needs to catch up to current scientific research. If genes are patented, will we have to start tattooing their bodies to show where other people own bits and pieces? What if someone patented the human heart, would they get a fee every time someone had heart surgery. Let's think rationally here.

Its about time

Finally, they have done enough research (because the researchers always need to be sure and there are plenty of them out there) to say that there is no connection between breast cancer and thyroid cancer.

For years there have been questions on this. Basically women are more likely to get both. Breast cancer is the most common woman's cancer (I think) and thyroid cancer is most common in young women and growing in incidence. Both are hormone (endocrine) related cancers so I guess it seemed they were connected.

Standard procedure has been for women with both to be tested for Cowden's syndrome which is a genetic condition that has both cancers are indicators. I was tested and I do not have it.

So basically this tells us that all medical research can be proven wrong over time. Can you name one thing that 'they' have not told us was good for us and now is bad or was bad for us and now is good? Which is why everything always needs more research.

DNA mapping

Hmmm.... I like this concept of mapping the DNA of  cancer patients. Actually the UK's National Health Service has announced a plan to map the DNA of 100,00 patients with rare diseases and cancers. (And the immediate comments on the article are how did the British government come up with the 100 million pounds to pay for this during the time of austerity.)

Politics and financing (and squabbling) aside I think this is a good idea. I have always wondered why I have been lucky enough to have cancer twice while the rest of my family remains healthy. If my DNA would tell something about it, I would welcome the opportunity to learn more about me.

Actually I would not be surprised if a lot of the secrets of us less than healthy people could be discovered in our DNA. Now that the price has dropped significantly to between 5 and 10 thousand pounds, it is getting within the range of affordability (come on, work with me if some cancer drugs can cost upwards of $100,000/year this is affordable). Maybe a little more money should be spent on looking at why some people seem to get the ailments. (I could be their poster child.) Instead of just throwing money at a cure.

An ounce of prevention is worth a pound of cure.

Patenting Genes Again

I have blogged about this before here and here. Who owns our genes? According to Myriad Genetics, which 'owns' the BRCA genes and tests and gets to charge $3,000 per test, they own the two BRCA genes. That sounds stupid, doesn't it? Apparently Myriad Genetics is full of rocket scientists who believe they can own parts of the human body that naturally occur. Maybe we can start selling patent rights to our big toes or something to pay our medical bills.

Well stupidity now faces the US Justice system as the Supreme Court announced on 11/30/2012 that they will hear the case on whether companies can patent human genes. As science and medical research grows and focus more and more on genetics this ruling could affect medical research in decades to come.

The two sides come down to this:

"The justices' decision will likely resolve an ongoing battle between scientists who believe that genes carrying the secrets of life should not be exploited for commercial gain and companies that argue that a patent is a reward for years of expensive research that moves science forward."

If we take this a step farther could lawn seed companies claim they own the genes in the grass seed they breed to make greener lawns so that we would need to pay rent to walk barefoot on the grass? Or someone could patent oxygen and we could start paying rent to breathe.

I am sure that the people with the BRCA gene would be happy to get rid of it so if Myriad wants to own the gene, why can't people get paid to have it taken out of their body?

I am in favor of the scientists, patients, medical research, and good health. I am against corporate greed.

I mean, seriously? Get over it. But now since it is going to the Supreme Court I am sure your lawyers will be rich by the time a decision is reached.

New BRCA tests

New BRCA tests have been developed that are faster and less expensive than the ones done by Myriad Genetics. I think this is great news. Myriad has claimed they patented the BRCA genes but these new tests were developed in Canada so maybe they escaped the long arm of the law.

I had blogged about this before and Myriad was still waiting for a final ruling on their patent. The Supreme Court had thrown it out because they said the laws of nature can't be patented.  This I agree with. Now that a second test has been developed on the genes it reinforces this idea that the genes shouldn't be patented. How could it be that a single company could have power over women needing this test? This is where laws need to catch up with technology.

XRCC2

Do you know the secret handshake that tells you what this is? Hmmm.... I'm not sure if I can tell you. Do you have the clearance? Pinky swear you are okay to know?

Its another breast cancer gene that was recently discovered by Australian researchers. This is very important. The BRCA genes only account for 10-20% of all breast cancer diagnoses. Another gene may not account for as many but it is the next step in discovering more genetic mutations which lead to breast cancer and other cancers.

The significance of this breakthrough is due to the latest type of gene sequencing - called 'massively parallel technology'. Now that's a mouthful. But if it works and creates progress, I don't care how many big words they use.

I also hope that with the discovery of another gene, Myriad Genetics, which thinks they 'own' the BRCA genes, will
lose their ability to 'keep' their gene.

News of the day

Random news that piqued my interest this morning:

1. Three Quebec mammography clinics missed 109 cases of breast cancer - primarily due to one radiologist who has since retired. I am glad I did not go there. But also this is just an example that errors can occur everywhere and if we are not happy with results or have questions, we should get a second opinion or ask our questions until we get the answers we need.
   
2. A giant leap in personalized medicine occurred as two Boston area teams compiled a giant encyclopedia   "...that predict the vulnerability of hundreds of different subtypes of cancer to dozens of drugs. The massive catalogs, which were made freely available online Wednesday, are an important step toward the routine personalizing of cancer care, in which patients will receive treatments tailored to the specific genetic changes that influence a tumor’s response to drug regimens."
   
   This is sounds cool and sounds like lots of progress but its more than my tiny brain can comprehend. I'll just let someone else summarize it for me. If I could find the encyclopedia I might attempt to look at it.
   
3. Its time for all of us to start growing wild tomatillos - which are a native weed - which has been discovered to contain medical properties.
   "So far, the researchers have demonstrated 14 compounds found in the plant can fight numerous cancers and tumors without any apparent side effects or toxicity—namely: melanomas, thyroid cancer, head and neck squamous cell cancer, breast cancer, glioblastoma brain tumors, and certain leukemias. Other studies suggest these same molecules may combat both esophageal cancers and pancreatic cancers." I'll ditch the flower garden and lawn and grow some weeds instead.

Now I am off to work for the day to ponder these latest advances.

Who owns that gene?

That depends on who you ask. Personally I find the idea that someone can own the patent on a gene which was created naturally in my body a bit creepy. Now the court is saying the same thing.  Here is a summary of what my tiny brain understands:

• The US Patent office has been issuing patents on genes for about 30 years.
• Myriad Genetics developed the BRCA 1 and 2 tests and patented the two genes.
• Anyone who wanted to perform a BRCA test to test for the breast/ovarian cancer gene had to pay a fee to Myriad
• People sued and a judge in 2010 invalidated the BRCA patents.
• Myriad continued the fight and it got to the Supreme Court (even though they are very busy with that healthcare reform stuff) threw out the case on the grounds of another case which said the laws of nature are not patentable.
• This not the final ruling as it returns to the district court for further ruling. So stay tuned...

Great, what I see here are a lot of lawyers getting rich off greedy companies (assisted by the Patent office) while patients, cancer research, personalized medicine, and genetic research. But I think the odds are in favor here that this will be throw out as they Supreme Court tossed it already. (Or at least I hope so because I believe patients should come first and corporate greed should come last.)

More on 'owning' the genetic test

The other day I blogged about 'owning' the genetic breast cancer test. Now there is new outrage against Myriad Labs. They have developed another test, called the BART test, that can pick up further cancers and reduce risk additionally:



I completely agree with this argument. Myriad Labs is in the wrong here. But I do have a few comments:

- How the hell (pardon my language but its worthy here) did they get to 'own' the breast cancer gene? I have genes in my body - are we going to start selling them off to the highest bidder? This adds a really creepy touch to the Big Brother concept. This is the part that really gets me. I understand the basics of patent law but do not consider myself in anyway an expert. I just don't understand why they now own the gene. Maybe they own the test. But they certainly should not own a gene. Maybe this article has it slightly wrong. If they don't, we clearly need to have our laws catch up with genetic testing abilities.

- If you get the BRCA test, I think your insurance covers it. But now that this next test exists and it is a medical genetic test, shouldn't there be insurance coverage for it? Well, maybe not necessarily covered by insurance (insurance can't cover everything and this is actually for a small population but that's another discussion - perhaps tomorrow if I remember with my tiny chemobrain), but at a lower cost. $700 for a lab test that is done over and over again is a bit outrageous. From a business point of view, if your costs are that high that you can justify a $700 customer fee, you need to look at business efficiencies and cost reductions to be more competitive. Oh that's right, they own the gene so they don't need to compete.

- Why is the lab tech upselling the additional test? Are we going to start seeing sales people in the waiting rooms upselling additional tests? 'Excuse me, would you like to have a test to see if your grandchildren might have green eyes? It only takes 5 minutes.' Yeah, right.

- Genetic testing is optional and not required. Some people want it and some people don't - they simply don't want to know if they are more likely to get a specific ailment. Its a personal choice. I think the current recommendations are that women with breast cancer in their family get a BRCA test. Some women do, and some don't.

- The other thing about genetic testing is that just because there is cancer or whatever in your family doesn't mean you are going to get it. (Who was that scientist with the pea plants who looked at inherited traits that was part of a biology class decades ago?) You know what I mean. Two brown eyed parents can have blue eyed children even though it is a recessive trait. You can have a history of an ailment in your family but that doesn't mean you will get it. And a genetic abnormality can suddenly appear - you can be the mutant.

Genetics are going to tell us a lot in the future but our laws need to catch up so no one owns a gene or becomes a single source for a test at the risk of patient lives. And individuals still need to be the one to decide if they want a test or not. A technician should not become the sales person for the test. And no one should own my genes.

Who owns the genetic tests

As genetic testing gains ground as a way of learning if one is at greater risk of a hereditary ailment, shouldn't the testing be available at multiple labs? This would allow for competitive pricing and more importantly - a second test to confirm or refute the original one's result.

Using the BRCA - breast cancer gene - test (BRCA - say it as bracket but with an 'a' instead of an 'et' on the end so you don't have to feel stupid saying the letters B-R-C-A) to determine a woman's risk of hereditary breast cancer as an example, currently there is only one lab who does all the testing in the US. They hold a patent on it and are ordering other labs to cease and desist in offering the same test. They made $350 million last year and charge $3000 per test which may or may not be covered by decision. As a result of the test, you get a score telling you how likely or unlikely you are to develop the hereditary breast cancer. One end of the scale is very high risk and the other end is very low risk - leaving a middle full of 'maybes.'

If you get a maybe, you have no way of getting a second test. You have to rely on the one lab to have been accurate when making a life changing or life saving decision. I am sure they do their tests following all proper protocol but there is always a margin of error - a bad sample, lab tech having a bad day, etc - there is always a degree of subjectivity that can influence what should be a basic test.

As this article explains:


"The BRCA1 gene was discovered by a Berkeley research team led by geneticist Mary-Claire King in 1990. Over the next few years, scientists raced to sequence it. Myriad’s got there first. But did the company’s work in isolating and cloning the gene transform it from a “product of nature” (which can’t be patented) into an “isolated composition of matter” (which can)? The ACLU – together with about 150,000 patients, scientists, and medical ethicists – contends that the answer to this question is no.

In 2009, the ACLU filed suit against Myriad and the US Patent and Trademark Office, arguing that the company’s BRCA patents are invalid and unconstitutional. In 2010, a New York federal court decided in favor of the ACLU, but this July, that decision was overturned by the US Court of Appeals. “Cleaving” the gene from the body, that court found, renders it eligible for patent protection. The ACLU now intends to bring the case to the Supreme Court."

In the meantime people are making life changing or life saving decisions based on this one lab. And the real question it comes down to is are their patents hindering research that could help save lives of others? Researchers should work together but the patents that Myriad seems to be hiding behind are impeding the collaboration that could greatly speed up break throughs.

Genetics are not something that are made, they are not created, they are part of nature. So why can they be patented? When do patents become things that stop research instead of helping it? Why can't Myriad's researchers collaborate with others? Let me take a wild guess - someone is only interested in the money.

The way of the future

My non-medical opinion of cancer treatment is that there are a lot of assumptions built it. If you have a tumor,they should take it out. If they think you need chemotherapy, they guess at the dose based on your body weight. If you need radiation, they try to hit only where the tumor was, this is a change from hitting the entire area of the body. They assume you will respond as well as everyone else who had the same treatment protocol but realize that not everyone does and they don't necessarily understand why. It is realized that many cancer patients are either under treated or over treated because they simply don't understand enough about cancer.  And often the treatment is almost as bad as the disease - it causes significant short (hair loss, nausea, etc.) and long term side effects (future cancers from radiation and chemotherapy, heart damage).

Cancer treatment is often only treating the symptoms. Surgery excises the tumor and the clump of cells. They hope chemotherapy will zap any remaining cancer cells in your body - but my non medical brain asks if chemotherapy zaps all cancer cells, why are there so many kinds of chemo if they zap all cancer cells? I feel that this goes back to the all cancers are the same theory that was disproved generations ago. One treatment does not fit all. Radiation tries to zap the cancer cells in a certain area - where they think they are. But it also damages the healthy cells and causes all kinds of burning. Some systemic treatments like Tamoxifen or aromatase inhibitors work for some women and not for others and are trying to make your body less attractive to hormone receptor cancer cells.

But none of these treatment focus on what I call the key questions:

- Where did these cancer cells come from? Why did they start mutating in the first place?
- Why was this part of the body more attractive to the cancer cells than others?
- What is the underlying cause of all of this?
 
When I heard Dr Love talk on Friday and she talked about the importance of the type of cancer not just its location, I was intrigued to say the least. I have also heard many times of the trend to personalized medicine. But now the next step is beginning to expand on these areas and actually take concrete steps to make changes.

Brigham and Women's Hospital and Dana-Farber Cancer Institute have launched a massive study to test cancer patients' tumors for hundreds of genetic aberrations. The goal is to obtain a better understanding of the underpinnings of cancer and how to tailor patient's treatments.  They want to have 10,000 patients each year to include in their study.

There is another program at Mass General since 2009 where they have been scanning the genes of 50-60 patients each week of their tumor tissue and have identified 160 genes and 15mutations. Their goal is to help guide treatment or to pave the way for new clinical trials. MD Anderson is moving toward a broad genetic analysis of all cancer patient's tumors.

There are two issues here. Dr Susan Love wasn't talking about  genetic markers but more of the type of tumor characteristics - hormone receptors, Her2/nu status, etc. However as cancer cells have damaged DNA, their genetic sequencing grows in importance.

I think this is the way of the future and how we will look at cancer as we move forward in both a way to find their cause and to find a cure.