Alyana Alfaro

In January, President Obama launched the Precision Medicine Initiative, a far-reaching national program aimed at incorporating individual variability in genes, environment, and lifestyle into the treatment of diseases. The initiative incorporates genomic medicine, a growing medical field that applies individual genetic information and variation to better tailor clinical care for each patient. The goal: to make a difference for the millions of Americans facing illness, improve treatment options, and revolutionize everyday clinical practice.

Federal Practitioner talked with Eric Green, MD, PhD, the director of NIH’s National Human Genome Research Institute about how the NIH is using genomics to meet the goals of the Precision Medicine Initiative and its impact on the future of medicine.

Click below to hear the full discussion.

Federal Practitioner: What is precision and personalized medicine?

Dr. Eric Green: Genomic medicine is something that reflects the use of genomic information about an individual patient to tailor their clinical care. That is very much focused on genomic information, but of course, there are other components of disease beyond genomics and genetics. It is not all in our DNA. There are also aspects of everyday life that influence our health and our well-being and our risk for diseases such as our diet, our lifestyle, what things we are exposed to in the environment, and so forth.

A larger framing of the notion of individualizing medical care around each individual’s makeup in terms of their blueprint and what they are exposed to brings us to phrases like personalized medicine or individualized medicine. More recently, the phrase that has been used is precision medicine. Precision medicine, essentially, takes a broader view of what are the things that contribute to health and disease. It is genomics, it is lifestyle, it is diet, it is environmental exposures, and then thinking about how to tailor medical treatment based on taking those individual aspects of a person into account.

FP: How can genomics be applied to hematology and oncology?

EG: Some of the earliest applications of using genomic information to tailor medical care come in the area of cancer; in particular, some of the leukemias that are studied and treated every day in hospitals around the world where we have learned by taking samples from individuals who have certain types of leukemia and opening up their genomes. In those tumor samples, in those leukemia samples, there turns out to be some very characteristic genomic changes that have taken place that are basically driving those cancers and making them behave the way they do.

It is now standard practice for some hematologic disorders, in particular types of leukemia, to consider getting genomic information on that specific patient—a blood sample—in order to help guide the best way to treat the patient and to get information about prognosis. It is only going to get more exciting and more advanced over the next 5 and 10 years.

FP: Why do you think this topic warrants discussion?

EG: I think this warrants discussing in almost any clinical group, because I completely believe that over the next 5 to 10 years, many aspects of medicine are going to be changed because of genomics. It is not going to just be in certain areas of medicine; I think it is going to be in almost all areas of medicine. This makes it very relevant to talk to clinical groups about this fast-moving area and how it will find its way into clinical practice in the next few years.

FP: You will be presenting the keynote presentation at the 2015 AVAHO Meeting in Washington, DC, in October. Are you excited to bring the discussion of genomics to AVAHO?

EG: I talk to clinical groups all the time, because I firmly believe this is going to be really important for them to know. I also fully appreciate that the field has moved so quickly that a lot of people who are out there in practice—whether they are physicians, pharmacists, nurses, physician assistants, or genetic counselors—when they were trained even 5, or 10, or 20 years ago, the things that we can do know using genomic information simply weren’t known about then. It is very important for us to use professional meetings as venues for furthering the education of professionals, especially in fast-moving fields where this is a great opportunity for them to catch up on what the latest is.

FP: Is there anything else you would like to say?

EG: The Precision Medicine Initiative aims to accelerate progress in precision medicine so that people in the United States can be the beneficiaries of these exciting developments. I think it is going to be an important partnership with scientists and practicing physicians to make this a reality, so it is really important for us to be talking about these things.

Don't have time to listen to the entire discussion? We understand. Use this guide to skip ahead to the topic that most interests you.

1:04 What is genomic medicine?
2:36 What is precision medicine?
3:48 How can genomics be used in hematology and oncology?
6:25 How is genomics changing the future of medicine?
7:22 Why should clinical groups like AVAHO learn about genomics?
8:20 How is the Precision Medicine Initiative using genomics?

In January, President Obama launched the Precision Medicine Initiative, a far-reaching national program aimed at incorporating individual variability in genes, environment, and lifestyle into the treatment of diseases. The initiative incorporates genomic medicine, a growing medical field that applies individual genetic information and variation to better tailor clinical care for each patient. The goal: to make a difference for the millions of Americans facing illness, improve treatment options, and revolutionize everyday clinical practice.

Federal Practitioner talked with Eric Green, MD, PhD, the director of NIH’s National Human Genome Research Institute about how the NIH is using genomics to meet the goals of the Precision Medicine Initiative and its impact on the future of medicine.

Click below to hear the full discussion.

Federal Practitioner: What is precision and personalized medicine?

Dr. Eric Green: Genomic medicine is something that reflects the use of genomic information about an individual patient to tailor their clinical care. That is very much focused on genomic information, but of course, there are other components of disease beyond genomics and genetics. It is not all in our DNA. There are also aspects of everyday life that influence our health and our well-being and our risk for diseases such as our diet, our lifestyle, what things we are exposed to in the environment, and so forth.

A larger framing of the notion of individualizing medical care around each individual’s makeup in terms of their blueprint and what they are exposed to brings us to phrases like personalized medicine or individualized medicine. More recently, the phrase that has been used is precision medicine. Precision medicine, essentially, takes a broader view of what are the things that contribute to health and disease. It is genomics, it is lifestyle, it is diet, it is environmental exposures, and then thinking about how to tailor medical treatment based on taking those individual aspects of a person into account.

FP: How can genomics be applied to hematology and oncology?

EG: Some of the earliest applications of using genomic information to tailor medical care come in the area of cancer; in particular, some of the leukemias that are studied and treated every day in hospitals around the world where we have learned by taking samples from individuals who have certain types of leukemia and opening up their genomes. In those tumor samples, in those leukemia samples, there turns out to be some very characteristic genomic changes that have taken place that are basically driving those cancers and making them behave the way they do.

It is now standard practice for some hematologic disorders, in particular types of leukemia, to consider getting genomic information on that specific patient—a blood sample—in order to help guide the best way to treat the patient and to get information about prognosis. It is only going to get more exciting and more advanced over the next 5 and 10 years.

FP: Why do you think this topic warrants discussion?

EG: I think this warrants discussing in almost any clinical group, because I completely believe that over the next 5 to 10 years, many aspects of medicine are going to be changed because of genomics. It is not going to just be in certain areas of medicine; I think it is going to be in almost all areas of medicine. This makes it very relevant to talk to clinical groups about this fast-moving area and how it will find its way into clinical practice in the next few years.

FP: You will be presenting the keynote presentation at the 2015 AVAHO Meeting in Washington, DC, in October. Are you excited to bring the discussion of genomics to AVAHO?

EG: I talk to clinical groups all the time, because I firmly believe this is going to be really important for them to know. I also fully appreciate that the field has moved so quickly that a lot of people who are out there in practice—whether they are physicians, pharmacists, nurses, physician assistants, or genetic counselors—when they were trained even 5, or 10, or 20 years ago, the things that we can do know using genomic information simply weren’t known about then. It is very important for us to use professional meetings as venues for furthering the education of professionals, especially in fast-moving fields where this is a great opportunity for them to catch up on what the latest is.

FP: Is there anything else you would like to say?

EG: The Precision Medicine Initiative aims to accelerate progress in precision medicine so that people in the United States can be the beneficiaries of these exciting developments. I think it is going to be an important partnership with scientists and practicing physicians to make this a reality, so it is really important for us to be talking about these things.

Don't have time to listen to the entire discussion? We understand. Use this guide to skip ahead to the topic that most interests you.

1:04 What is genomic medicine?
2:36 What is precision medicine?
3:48 How can genomics be used in hematology and oncology?
6:25 How is genomics changing the future of medicine?
7:22 Why should clinical groups like AVAHO learn about genomics?
8:20 How is the Precision Medicine Initiative using genomics?

In January, President Obama launched the Precision Medicine Initiative, a far-reaching national program aimed at incorporating individual variability in genes, environment, and lifestyle into the treatment of diseases. The initiative incorporates genomic medicine, a growing medical field that applies individual genetic information and variation to better tailor clinical care for each patient. The goal: to make a difference for the millions of Americans facing illness, improve treatment options, and revolutionize everyday clinical practice.

Federal Practitioner talked with Eric Green, MD, PhD, the director of NIH’s National Human Genome Research Institute about how the NIH is using genomics to meet the goals of the Precision Medicine Initiative and its impact on the future of medicine.

Click below to hear the full discussion.

Federal Practitioner: What is precision and personalized medicine?

Dr. Eric Green: Genomic medicine is something that reflects the use of genomic information about an individual patient to tailor their clinical care. That is very much focused on genomic information, but of course, there are other components of disease beyond genomics and genetics. It is not all in our DNA. There are also aspects of everyday life that influence our health and our well-being and our risk for diseases such as our diet, our lifestyle, what things we are exposed to in the environment, and so forth.

A larger framing of the notion of individualizing medical care around each individual’s makeup in terms of their blueprint and what they are exposed to brings us to phrases like personalized medicine or individualized medicine. More recently, the phrase that has been used is precision medicine. Precision medicine, essentially, takes a broader view of what are the things that contribute to health and disease. It is genomics, it is lifestyle, it is diet, it is environmental exposures, and then thinking about how to tailor medical treatment based on taking those individual aspects of a person into account.

FP: How can genomics be applied to hematology and oncology?

EG: Some of the earliest applications of using genomic information to tailor medical care come in the area of cancer; in particular, some of the leukemias that are studied and treated every day in hospitals around the world where we have learned by taking samples from individuals who have certain types of leukemia and opening up their genomes. In those tumor samples, in those leukemia samples, there turns out to be some very characteristic genomic changes that have taken place that are basically driving those cancers and making them behave the way they do.

It is now standard practice for some hematologic disorders, in particular types of leukemia, to consider getting genomic information on that specific patient—a blood sample—in order to help guide the best way to treat the patient and to get information about prognosis. It is only going to get more exciting and more advanced over the next 5 and 10 years.

FP: Why do you think this topic warrants discussion?

EG: I think this warrants discussing in almost any clinical group, because I completely believe that over the next 5 to 10 years, many aspects of medicine are going to be changed because of genomics. It is not going to just be in certain areas of medicine; I think it is going to be in almost all areas of medicine. This makes it very relevant to talk to clinical groups about this fast-moving area and how it will find its way into clinical practice in the next few years.

FP: You will be presenting the keynote presentation at the 2015 AVAHO Meeting in Washington, DC, in October. Are you excited to bring the discussion of genomics to AVAHO?

EG: I talk to clinical groups all the time, because I firmly believe this is going to be really important for them to know. I also fully appreciate that the field has moved so quickly that a lot of people who are out there in practice—whether they are physicians, pharmacists, nurses, physician assistants, or genetic counselors—when they were trained even 5, or 10, or 20 years ago, the things that we can do know using genomic information simply weren’t known about then. It is very important for us to use professional meetings as venues for furthering the education of professionals, especially in fast-moving fields where this is a great opportunity for them to catch up on what the latest is.

FP: Is there anything else you would like to say?

EG: The Precision Medicine Initiative aims to accelerate progress in precision medicine so that people in the United States can be the beneficiaries of these exciting developments. I think it is going to be an important partnership with scientists and practicing physicians to make this a reality, so it is really important for us to be talking about these things.

Don't have time to listen to the entire discussion? We understand. Use this guide to skip ahead to the topic that most interests you.

1:04 What is genomic medicine?
2:36 What is precision medicine?
3:48 How can genomics be used in hematology and oncology?
6:25 How is genomics changing the future of medicine?
7:22 Why should clinical groups like AVAHO learn about genomics?
8:20 How is the Precision Medicine Initiative using genomics?

Recently, Federal Practitioner talked with Fengming Zhong, MD, PhD, about treatment options for patients with pancreatic cancer. Metastatic pancreatic cancer is one of the deadliest malignancies, with patients usually being diagnosed at an advanced stage. While 5-year survival is only between 25% and 30%, new clinical trials and treatment options may improve survivorship in coming years.

Dr. Zhong’s article, “Systemic Treatment and Outcomes of Metastatic Pancreatic Cancer,” appeared in Federal Practitioner’s August 2014 issue.

Federal Practitioner: In your article, you discuss that pancreatic cancer is one of the deadliest malignancies. Why do you think that is the case?

Fengming Zhong, MD, PhD: Pancreatic cancer does not get diagnosed in the early stages. Most early stage patients are asymptomatic, so if early stage diagnosis is made, it is usually just because of another test or scan conducted for some other reason. Surgery is the only way to potentially cure this cancer, but because of that low level of early diagnosis, only 20% of patients are candidates for surgery at diagnosis. Even for patients who have early stage surgery, the 5-year survival is only 25% to 30%. Currently available therapies are only marginally effective for treatment, especially in the late stages most patients present with. The tumor biology is also poorly understood. We need more basic research to understand how this cancer grows and to help develop a new treatment.

FP: The article also states that pancreatic cancer incidence rates have been increasing in men and women since 2000. Why do you think this is?

FZ: According to data, the rates have been increasing slightly over the past decade or so. The rates of increase, we think, is because the population is aging. Other lifestyle factors like smoking, drinking alcohol, diet, and obesity may also be contributing to the increased rates of pancreatic cancer.

FP: What kinds of treatment options do you feel are most effective for pancreatic cancer?

FZ: The treatment of pancreatic cancer is a rapidly developing area. We now have more options available for treatment, including the systemic treatment discussed in my article. Many other options are currently available in clinical trials, so we hope that patients will participate when they are eligible to help develop more comprehensive treatment.

FP: What do you think needs to be changed in order to improve patient outcomes?

FZ: For the general population, there needs to be a reduction of risk factors and people need to live a better lifestyle. With these new clinical trials, we are hoping to make earlier diagnosis a reality, and we will hopefully be able to improve the outcomes for pancreatic cancer. This will help identify new and more efficient treatment. Also, we need to see increased funding in basic research to understand the biology of the disease. There are some exciting things developing.

Dr. Zhong is the author of “Systemic Treatment and Outcomes of Metastatic Pancreatic Cancer” in Federal Practitioner’s August 2014 issue.

Dr. Zhong serves as staff physician, Hematology and Oncology, at VA New Jersey Health Care System and is an assistant professor for the Department of Medicine at Rutgers-New Jersey Medical School.

Recently, Federal Practitioner talked with Fengming Zhong, MD, PhD, about treatment options for patients with pancreatic cancer. Metastatic pancreatic cancer is one of the deadliest malignancies, with patients usually being diagnosed at an advanced stage. While 5-year survival is only between 25% and 30%, new clinical trials and treatment options may improve survivorship in coming years.

Dr. Zhong’s article, “Systemic Treatment and Outcomes of Metastatic Pancreatic Cancer,” appeared in Federal Practitioner’s August 2014 issue.

Federal Practitioner: In your article, you discuss that pancreatic cancer is one of the deadliest malignancies. Why do you think that is the case?

Fengming Zhong, MD, PhD: Pancreatic cancer does not get diagnosed in the early stages. Most early stage patients are asymptomatic, so if early stage diagnosis is made, it is usually just because of another test or scan conducted for some other reason. Surgery is the only way to potentially cure this cancer, but because of that low level of early diagnosis, only 20% of patients are candidates for surgery at diagnosis. Even for patients who have early stage surgery, the 5-year survival is only 25% to 30%. Currently available therapies are only marginally effective for treatment, especially in the late stages most patients present with. The tumor biology is also poorly understood. We need more basic research to understand how this cancer grows and to help develop a new treatment.

FP: The article also states that pancreatic cancer incidence rates have been increasing in men and women since 2000. Why do you think this is?

FZ: According to data, the rates have been increasing slightly over the past decade or so. The rates of increase, we think, is because the population is aging. Other lifestyle factors like smoking, drinking alcohol, diet, and obesity may also be contributing to the increased rates of pancreatic cancer.

FP: What kinds of treatment options do you feel are most effective for pancreatic cancer?

FZ: The treatment of pancreatic cancer is a rapidly developing area. We now have more options available for treatment, including the systemic treatment discussed in my article. Many other options are currently available in clinical trials, so we hope that patients will participate when they are eligible to help develop more comprehensive treatment.

FP: What do you think needs to be changed in order to improve patient outcomes?

FZ: For the general population, there needs to be a reduction of risk factors and people need to live a better lifestyle. With these new clinical trials, we are hoping to make earlier diagnosis a reality, and we will hopefully be able to improve the outcomes for pancreatic cancer. This will help identify new and more efficient treatment. Also, we need to see increased funding in basic research to understand the biology of the disease. There are some exciting things developing.

Dr. Zhong is the author of “Systemic Treatment and Outcomes of Metastatic Pancreatic Cancer” in Federal Practitioner’s August 2014 issue.

Dr. Zhong serves as staff physician, Hematology and Oncology, at VA New Jersey Health Care System and is an assistant professor for the Department of Medicine at Rutgers-New Jersey Medical School.

Recently, Federal Practitioner talked with Fengming Zhong, MD, PhD, about treatment options for patients with pancreatic cancer. Metastatic pancreatic cancer is one of the deadliest malignancies, with patients usually being diagnosed at an advanced stage. While 5-year survival is only between 25% and 30%, new clinical trials and treatment options may improve survivorship in coming years.

Dr. Zhong’s article, “Systemic Treatment and Outcomes of Metastatic Pancreatic Cancer,” appeared in Federal Practitioner’s August 2014 issue.

Federal Practitioner: In your article, you discuss that pancreatic cancer is one of the deadliest malignancies. Why do you think that is the case?

Fengming Zhong, MD, PhD: Pancreatic cancer does not get diagnosed in the early stages. Most early stage patients are asymptomatic, so if early stage diagnosis is made, it is usually just because of another test or scan conducted for some other reason. Surgery is the only way to potentially cure this cancer, but because of that low level of early diagnosis, only 20% of patients are candidates for surgery at diagnosis. Even for patients who have early stage surgery, the 5-year survival is only 25% to 30%. Currently available therapies are only marginally effective for treatment, especially in the late stages most patients present with. The tumor biology is also poorly understood. We need more basic research to understand how this cancer grows and to help develop a new treatment.

FP: The article also states that pancreatic cancer incidence rates have been increasing in men and women since 2000. Why do you think this is?

FZ: According to data, the rates have been increasing slightly over the past decade or so. The rates of increase, we think, is because the population is aging. Other lifestyle factors like smoking, drinking alcohol, diet, and obesity may also be contributing to the increased rates of pancreatic cancer.

FP: What kinds of treatment options do you feel are most effective for pancreatic cancer?

FZ: The treatment of pancreatic cancer is a rapidly developing area. We now have more options available for treatment, including the systemic treatment discussed in my article. Many other options are currently available in clinical trials, so we hope that patients will participate when they are eligible to help develop more comprehensive treatment.

FP: What do you think needs to be changed in order to improve patient outcomes?

FZ: For the general population, there needs to be a reduction of risk factors and people need to live a better lifestyle. With these new clinical trials, we are hoping to make earlier diagnosis a reality, and we will hopefully be able to improve the outcomes for pancreatic cancer. This will help identify new and more efficient treatment. Also, we need to see increased funding in basic research to understand the biology of the disease. There are some exciting things developing.

Dr. Zhong is the author of “Systemic Treatment and Outcomes of Metastatic Pancreatic Cancer” in Federal Practitioner’s August 2014 issue.

Dr. Zhong serves as staff physician, Hematology and Oncology, at VA New Jersey Health Care System and is an assistant professor for the Department of Medicine at Rutgers-New Jersey Medical School.

Recently, Federal Practitioner talked with Benjamin Powers, MD, and Suman Kambhampati, MD, about factors that come into play when treating patients with chronic myelogenous leukemia (CML) and the dramatic improvements in treatment that have been made. To find out more about these factors and improvements, read Blast Phase Chronic Myelogenous Leukemia from the August 2014 issue.

Dr. Powers is a fellow and Dr. Kambhampati is an associate professor of medicine, both in the Department of Internal Medicine, Division of Hematology/Oncology, at the University of Kansas Medical Center in Kansas City, Kansas. Dr. Kambhampati is also a staff physician in the Hematology/Oncology Division at the Kansas City VAMC in Kansas City, Missouri.

Recently, Federal Practitioner talked with Benjamin Powers, MD, and Suman Kambhampati, MD, about factors that come into play when treating patients with chronic myelogenous leukemia (CML) and the dramatic improvements in treatment that have been made. To find out more about these factors and improvements, read Blast Phase Chronic Myelogenous Leukemia from the August 2014 issue.

Dr. Powers is a fellow and Dr. Kambhampati is an associate professor of medicine, both in the Department of Internal Medicine, Division of Hematology/Oncology, at the University of Kansas Medical Center in Kansas City, Kansas. Dr. Kambhampati is also a staff physician in the Hematology/Oncology Division at the Kansas City VAMC in Kansas City, Missouri.

Recently, Federal Practitioner talked with Benjamin Powers, MD, and Suman Kambhampati, MD, about factors that come into play when treating patients with chronic myelogenous leukemia (CML) and the dramatic improvements in treatment that have been made. To find out more about these factors and improvements, read Blast Phase Chronic Myelogenous Leukemia from the August 2014 issue.

Dr. Powers is a fellow and Dr. Kambhampati is an associate professor of medicine, both in the Department of Internal Medicine, Division of Hematology/Oncology, at the University of Kansas Medical Center in Kansas City, Kansas. Dr. Kambhampati is also a staff physician in the Hematology/Oncology Division at the Kansas City VAMC in Kansas City, Missouri.

Over 200,000 new cases of breast cancer are diagnosed in the U.S. annually, according to the National Cancer Institute. Dr. Anita Aggarwal, an oncologist at the Washington, DC VAMC, recently completed an extensive study to compare male and female breast cancer in VA patients. The study found that males with breast cancer had higher stage and grade at presentation and higher mortality compared with females. But, when adjusted for age, stage, and grade, males had better survival rates.

Federal Practitioner talked with Dr. Aggarwal about the new breast cancer research group she is currently developing at the Washington, DC VAMC. Dr. Aggarwal’s hope is to help doctors in the federal health system to identify etiology, biology, and improve treatment of both male and female patients with breast cancer.

Federal Practitioner: What is a breast cancer research group, and why do you think one needs to be created at the VA?

Anita Aggarwal, MD: I would like to build a breast cancer research group with the help of all oncologists and health professionals who take care of patients with breast cancer at all VAMCs nationwide. From my retrospective comparison study, breast cancer in our veterans seems to be different than in the general population. The goal of this research group will be to build a data bank with all the pertinent information as well as tissue gene profiling. This will help us to diagnose them early and treat accordingly in a timely fashion.

FP: As more women join the military, do you think breast cancer treatment at the VA will change?

AA: As the number of female veterans increases, I suspect we will see an increase in the number of female patients with breast cancer. As reported by the 2012 Women’s Task Force, women are now the fastest growing cohort within the veteran community. In 2011, there were about 1.8 million women veterans, which is about 8% of the 22.2 million vets in the VA system. That is expected to increase to 2 million in 2020, at which time women will make up to 10.7% of the total vet population. To accommodate these changing needs, the VHA made women’s health programs a priority in 2007, including a recommendation to improve access to screening, mammograms, and related breast care services. The treatment of breast cancer is becoming more personalized with the advent of new, targeted therapies. The treatment will change if we can identify different biological targets in veterans with breast cancer.

FP: Do you think all veterans, male and female, are more susceptible to breast cancer than is the general population?

AA: In general, incidence of breast cancer is decreasing but, as per the Walter Reed General Hospital and USA Today, breast cancer is one of the most common cancers in our veterans. Not only is the number of women with breast cancer increasing, but so too is the number of male veterans with breast cancer. In general, breast cancer in males is rare, < 1% of all breast cancer cases. Our retrospective data from 1995 to 2012 had more than 6,000 patients with breast cancer; out of that, 1,100 were males with breast cancer.

FP: What do you think needs to be changed about how breast cancer is approached in veterans?

AA: I don’t have an answer to that, but if we can build a breast cancer research group, we may be able to answer some of these questions.  Collection of the data prospectively on all of breast cancer at all VA facilities will help us to understand etiology, risk factors, and biology by molecular profiling. In turn, this will help health professionals to give personalized treatment to veterans.

Email: anita.aggarwal@va.gov

Read more about Dr. Aggarwal’s breast cancer initiative: http://www.research.va.gov/currents/spring2014/spring2014-45.cfm

Over 200,000 new cases of breast cancer are diagnosed in the U.S. annually, according to the National Cancer Institute. Dr. Anita Aggarwal, an oncologist at the Washington, DC VAMC, recently completed an extensive study to compare male and female breast cancer in VA patients. The study found that males with breast cancer had higher stage and grade at presentation and higher mortality compared with females. But, when adjusted for age, stage, and grade, males had better survival rates.

Federal Practitioner talked with Dr. Aggarwal about the new breast cancer research group she is currently developing at the Washington, DC VAMC. Dr. Aggarwal’s hope is to help doctors in the federal health system to identify etiology, biology, and improve treatment of both male and female patients with breast cancer.

Federal Practitioner: What is a breast cancer research group, and why do you think one needs to be created at the VA?

Anita Aggarwal, MD: I would like to build a breast cancer research group with the help of all oncologists and health professionals who take care of patients with breast cancer at all VAMCs nationwide. From my retrospective comparison study, breast cancer in our veterans seems to be different than in the general population. The goal of this research group will be to build a data bank with all the pertinent information as well as tissue gene profiling. This will help us to diagnose them early and treat accordingly in a timely fashion.

FP: As more women join the military, do you think breast cancer treatment at the VA will change?

AA: As the number of female veterans increases, I suspect we will see an increase in the number of female patients with breast cancer. As reported by the 2012 Women’s Task Force, women are now the fastest growing cohort within the veteran community. In 2011, there were about 1.8 million women veterans, which is about 8% of the 22.2 million vets in the VA system. That is expected to increase to 2 million in 2020, at which time women will make up to 10.7% of the total vet population. To accommodate these changing needs, the VHA made women’s health programs a priority in 2007, including a recommendation to improve access to screening, mammograms, and related breast care services. The treatment of breast cancer is becoming more personalized with the advent of new, targeted therapies. The treatment will change if we can identify different biological targets in veterans with breast cancer.

FP: Do you think all veterans, male and female, are more susceptible to breast cancer than is the general population?

AA: In general, incidence of breast cancer is decreasing but, as per the Walter Reed General Hospital and USA Today, breast cancer is one of the most common cancers in our veterans. Not only is the number of women with breast cancer increasing, but so too is the number of male veterans with breast cancer. In general, breast cancer in males is rare, < 1% of all breast cancer cases. Our retrospective data from 1995 to 2012 had more than 6,000 patients with breast cancer; out of that, 1,100 were males with breast cancer.

FP: What do you think needs to be changed about how breast cancer is approached in veterans?

AA: I don’t have an answer to that, but if we can build a breast cancer research group, we may be able to answer some of these questions.  Collection of the data prospectively on all of breast cancer at all VA facilities will help us to understand etiology, risk factors, and biology by molecular profiling. In turn, this will help health professionals to give personalized treatment to veterans.

Email: anita.aggarwal@va.gov

Read more about Dr. Aggarwal’s breast cancer initiative: http://www.research.va.gov/currents/spring2014/spring2014-45.cfm

Over 200,000 new cases of breast cancer are diagnosed in the U.S. annually, according to the National Cancer Institute. Dr. Anita Aggarwal, an oncologist at the Washington, DC VAMC, recently completed an extensive study to compare male and female breast cancer in VA patients. The study found that males with breast cancer had higher stage and grade at presentation and higher mortality compared with females. But, when adjusted for age, stage, and grade, males had better survival rates.

Federal Practitioner talked with Dr. Aggarwal about the new breast cancer research group she is currently developing at the Washington, DC VAMC. Dr. Aggarwal’s hope is to help doctors in the federal health system to identify etiology, biology, and improve treatment of both male and female patients with breast cancer.

Federal Practitioner: What is a breast cancer research group, and why do you think one needs to be created at the VA?

Anita Aggarwal, MD: I would like to build a breast cancer research group with the help of all oncologists and health professionals who take care of patients with breast cancer at all VAMCs nationwide. From my retrospective comparison study, breast cancer in our veterans seems to be different than in the general population. The goal of this research group will be to build a data bank with all the pertinent information as well as tissue gene profiling. This will help us to diagnose them early and treat accordingly in a timely fashion.

FP: As more women join the military, do you think breast cancer treatment at the VA will change?

AA: As the number of female veterans increases, I suspect we will see an increase in the number of female patients with breast cancer. As reported by the 2012 Women’s Task Force, women are now the fastest growing cohort within the veteran community. In 2011, there were about 1.8 million women veterans, which is about 8% of the 22.2 million vets in the VA system. That is expected to increase to 2 million in 2020, at which time women will make up to 10.7% of the total vet population. To accommodate these changing needs, the VHA made women’s health programs a priority in 2007, including a recommendation to improve access to screening, mammograms, and related breast care services. The treatment of breast cancer is becoming more personalized with the advent of new, targeted therapies. The treatment will change if we can identify different biological targets in veterans with breast cancer.

FP: Do you think all veterans, male and female, are more susceptible to breast cancer than is the general population?

AA: In general, incidence of breast cancer is decreasing but, as per the Walter Reed General Hospital and USA Today, breast cancer is one of the most common cancers in our veterans. Not only is the number of women with breast cancer increasing, but so too is the number of male veterans with breast cancer. In general, breast cancer in males is rare, < 1% of all breast cancer cases. Our retrospective data from 1995 to 2012 had more than 6,000 patients with breast cancer; out of that, 1,100 were males with breast cancer.

FP: What do you think needs to be changed about how breast cancer is approached in veterans?

AA: I don’t have an answer to that, but if we can build a breast cancer research group, we may be able to answer some of these questions.  Collection of the data prospectively on all of breast cancer at all VA facilities will help us to understand etiology, risk factors, and biology by molecular profiling. In turn, this will help health professionals to give personalized treatment to veterans.

Email: anita.aggarwal@va.gov

Read more about Dr. Aggarwal’s breast cancer initiative: http://www.research.va.gov/currents/spring2014/spring2014-45.cfm