Category Archives: Brain Waves

Finally understanding the impact of sequestration

“How has sequestration affected you and other postdocs?” a journalist asked me a few weeks ago. He was doing a story on the impact on scientific research of this year’s $85 billion reduction of federal spending. The vast majority of scientific research in the United States is funded by the federal government.

To be honest, I wasn’t really sure how to answer his question. I happen to work at a world-class cancer research center that has been able to provide an incredibly supportive environment for research, even during the financial downfall of 2008. I figured we’d be ok for now. The future, however, is less certain.

A likely direct impact of sequester is that fewer scientists may choose to go into academia. Colleagues who are hoping to have careers in research at academic institutions are worried since it’s becoming more and more difficult to get research grants funded. The funding situation was already pretty tough before sequester. The question on everyone’s minds is how will it change now? Academic career pursuits are also in trouble due to the fact that university departments may also slow down hiring of faculty. In the current climate, PhDs may choose to explore other science-related fields—biotech, science writing, consulting, to name a few. How these non-academic sectors handle the potential increase in PhDs being funneled towards them remains to be seen.

As PhDs in the US, how are we going to train ourselves for nonacademic careers with limited resources? As graduate students and postdocs in academic institutions, we’re generally trained to do one thing: how to do academic research. We can choose to take part in extracurricular activities that do train us for the non-academic job market. The extent of this training and participation varies from institution to institution. Luckily, I work in a place where there is a lot of institutional support (financial and administrative) for such programs. We probably have one of the best* student and postdoc associations in the nation but our budget has taken substantial hits several times this year. Going forward, we’ll have to think hard about the kinds of career development programs we can offer and become more creative with our resources. I feel deeply for my colleagues at other institutions who are starting or trying to maintain programs with almost nonexistent institutional support.

There are likely to be broader impacts on science in the US. Our commitment to scientific progress has played a huge role in the amount of innovation that comes out of the US—and this very innovation (and our immigrant history) is what has made us a global leader. (It sounds cheesy, but I believe in this strongly.) I worry that this will change if we don’t continue our commitment to science. This problem is bigger than this year’s sequester. Rates at which research grants are funded have been steadily decreasing over the last decade.

These were the issues as I understood them at the time of the interview when I shared them with the reporter. I now know that my understanding of the impact of sequestration on science was far from complete. I hadn’t considered the impact on people—not just careers.

The main function of a research center is, of course, to support and carry out research. In order to preserve funding for this essential function, difficult decisions have to be made to reduce the number of support staff (administrative, technical, etc). This happens at the level of research centers and in individual labs. Saying goodbye to these valued colleagues is when I finally understood the impact of sequestration.

 

*Ok, as chair of the said association, I might be slightly biased. The assertion as to the strength of our program is based on my experience at a recent national conference, where I had the chance to compare ours with other organizations.

Angelina Jolie’s Story—An Incomplete Picture

In an op-ed piece in The New York Times, actress and director Angeline Jolie wrote that she recently had a prophylactic double-mastectomy to reduce the chances of developing breast cancer, a disease that took her mother’s life. She explained that she carried a “’faulty’ gene, BRCA1” which puts her at high risk for developing breast and ovarian cancer. She underwent the double mastectomy to reduce the risk of breast cancer by removing the tissues that generally give rise to tumors.

I heartily applaud Jolie’s documentation of a very personal experience on such a public platform in an attempt to encourage women with family history of breast and ovarian (and other) cancers to have open discussions with their medical professionals about genetic testing and possible preventative options that may be available to them. I can’t stress how important it is to have open conversations about scary health issues like breast cancer, especially since they may be tied with health, identity and possibly sexuality.

However, I must admit that as a scientist who studies BRCA1-associated breast cancer, I also felt a sense of alarm as I read the article. Many thoughts whirled in my head. Jolie’s focus on primarily breast cancer in women with BRCA1-mutations and double-mastectomy as a preventative option is far from complete. Though I respect Jolie for speaking openly about her personal matter, I feel that she and others who speak on such matters in public platforms have a responsibility to make the discussion as close to complete as possible. As a person of great influence, I wish she had provided a more complete picture, especially to a world in which medical and scientific information is often presented over-simplified to the brink of being inaccurate (more on this in another blog).

Below I attempt to touch on a few of the issues and questions that were largely ignored in Jolie’s piece.

Is it really that simple?

The article suggests that it’s quite straightforward: Everyone can go get tested for BRCA1 mutations and if positive for a mutation, can get a double-mastectomy and they’re cancer free! Let’s ignore for the moment that mutations in BRCA2, and a growing number of genes involved in similar cellular pathways, also lead to increased breast cancer risk. It also implies that mastectomy is the only preventative option available. Generally, women with family history or with known BRCA mutation are followed closely to allow early detection (and treatment) of breast cancer though they tend to have slightly higher risk of breast cancer (a yearly incidence of 2.5%) than those who have undergone prophylactic mastectomies (Meijers-Heijboer et al). Other, less invasive, options exist.

What is the impact on healthcare and more?

How many women without family history of cancer will visit their physicians and demand testing for BRCA? As Jolie mentions, the current cost of genetic testing for genes for breast cancer predisposition is over $3000. It is currently recommended for individuals who have family history of breast and ovarian cancer (and sometimes others) to have genetic testing to look for disease causing mutations and insurance generally covers this cost. We must think about the general impact on the cost of healthcare more broad genetic testing will have (at current costs), without even considering the cost of additional doctors’ visits by individuals at low-risk.

Another complication is what is known in the BRCA research and clinical community as ‘Variants of Unknown Significance’ or VUS. VUS refers to ‘mutations’ in BRCA1 that may just be changes in the gene that are not known to lead to cancer. We all carry differences in our genetic code in many of our genes compared to others in the human population. Many of these changes are benign—they don’t have any perceivable effect on our biology and health. We usually refer to changes in our genetic code that do have a perceivable effect on our health as ‘mutations.’ It is unclear whether a lot of the changes that are known to exist for BRCA are benign or real mutations. We must consider the potential scenario of a nervous individual with a benign VUS deciding to undergo major surgery like prophylactic mastectomy or oophorectomy (see below). Is the benefit in this case worth the physical, emotional and financial costs?

What about the ovarian cancer risk?

Discussing breast cancer (and preventative mastectomy) without a thorough mention of ovarian cancer for BRCA1-mutation carriers is an incomplete discussion. Jolie briefly touches on ovarian cancer risk; she does not provide it the weight it deserves. Granted I may have a biased perspective as a breast cancer researcher, I don’t perceive education on breast cancer in the US to be lacking. We are constantly inundated with emails, media campaigns, professional sports stars wearing pink athletic shoes, among other things that bring awareness to the real dangers of breast cancer. We have many options (with varying degrees of effectiveness) for early detection of breast cancer.

Ovarian cancer is a different beast. One of the biggest problems with ovarian cancer is that it is often not detected until it is progressed to an advanced stage. Chemotherapy and surgery are among the treatment options that can increase survival but the prognosis is generally not great, 5-year survival rates of 18-35% for aggressive, late-stage disease (American Cancer Society). For individuals with advanced risk, like BRCA1 mutation-carriers, prophylactic oophorectomy (preventative removal of the ovaries), which can accompany removal of other organs like fallopian tubes, is an option. But, it’s complicated. It’s a difficult decision since it can affect when a woman has children and has many long-term health complications including hormonal changes, increased risk for osteoporosis and cardiovascular disease. Furthermore, risk of ovarian cancer after surgery is lowered not eliminated.

I thank Angelina Jolie for sharing her personal story with women and opening up conversation about genetic testing for women at high risk. The story is much, much more complicated. It is imperative that those who have the knowledge and the platform inform the public in the most thorough way possible.

References

American Cancer Society: www.cancer.org

Meijers-Heijboer, H., et al. (2001) Breast cancer after prophylactic bilateral mastectomy in women with BRCA1 or BRCA2 mutation. The New England Journal of Medicine, 345 (3): 159-164.

1st Seattle Genetic Instability and Cancer Symposium–a team success!!

After attending the American Society of Human Genetics Meeting in San Francisco last November, I decided to organize a scientific symposium that showcased science in the general field of genetic instability and cancer in Seattle. After getting the green light from my advisor and funding from the director of the division, I began the organization process. The first step was forming a team of talented individuals with whom I would put together this event. The SGICS team included Celine Jacquemont, a postdoc, Tony Abeyta, a graduate student, Naina Phadnis, a postdoc, and myself.

Together we moved the symposium project from conception to realization. As a team, we secured additional funding, invited a keynote speaker (Dr. Junjie Chen from MD Anderson Cancer Research Center), solicited and scored abstracts for oral and poster presentations and worked out the logistics for hosting an event for 100+ individuals. We made decisions ranging from how we would deal with bias in our abstract selection process to what kind of food we would serve for lunch.

Months of planning and hard work culminated in the Seattle Genetic Instability and Cancer Symposium (SGICS) held, April 22, 2013. It was a day for exchanging ideas, building new collaborations, and celebrating local scientific accomplishments!

Team work has it’s rewards and it’s challenges–different personalities and styles/preferences for communication, task completion, for example. However, our shared commitment to put together an event that would provide the best platform for pushing local science in our field forward allowed us to move swiftly past any such challenges. I’m extremely proud of the SGICS team! That pride, that stems from mutual respect and appreciation for each other, was visible on each of our faces Monday as we were being carried by the momentum of SGICS.