Partners in Prevention — the Colon Cancer Challenge
promoting colon cancer awareness, prevention, advocacy, and research

Overview & Mission

Colon cancer is one of the first major health challenges of the 21st Century, averaging approximately 150,000 cases with 55,000 deaths per year, making it the number two solid tumor killer after lung cancer. It is an equal opportunity killer for men and women where 5% of Americans will be affected. However there is a silver lining in this challenge:

• screening can substantially reduce the incidence and severity of this cancer by removing pre-malignant lesions (polyps) and promoting early stage diagnosis and
• the well understood progression of the disease from normal to pre-cancerous to cancer along with the number of people who develop polyps makes it a unique scientific opportunity to gain a precise understanding of the molecular genetics of this cancer which will help in developing better screening and treatment protocols for this and other cancers.

The fundamental purpose of “Partners in the Challenge” is to reduce colorectal cancer incidence and death nationwide and worldwide as well through sustained efforts in four interrelated areas: awareness, prevention, patient advocacy, and research. The mission includes:

1. Increasing public awareness about colorectal cancer and its prevention
2. Promoting colorectal cancer screening and supporting efforts to remove barriers to screening especially for the uninsured. This includes advancing public health policies that support the comprehensive planning of colorectal cancer screening programs.
3. Educating both health care providers and the public about optimal screening strategies.
4. Supporting and conducting research into the causes of and cures for colorectal cancer. This includes improving our understanding of who is at increased risk of colorectal cancer so that screening methods of proven benefit can be directed to individuals at increased risk in a timely fashion.
5. Encouraging and developing the next generation of researchers and leaders through specialized training and research opportunities for young scholars in medicine, surgery, and science – as well a opportunities for both college and high school students.
6. Partnering with other institutions and constituent groups.

History

“Partners in the Challenge” was formed in 2002 following Dr. Weber’s move to the Albert Einstein College of Medicine and Montefiore Medical Center from Roswell Park, one of only three National Cancer Institute (NCI) Comprehensive Cancer Centers in New York State. AT Roswell Dr Weber was served as a staff surgeon and was the founder of the Applied Genomics Laboratory which conducted colorectal cancer translational research. The first undertaking of the organization was to establish and launch “The New York Colon Cancer Challenge” to raise awareness of the importance of this health issue and raise funds to support colorectal cancer patient advocacy, outreach, and research.

The New York Colon Cancer Challenge is an annual event held in New York City’s Central Park each March (Colon Cancer Awareness month). The Challenge takes place with the assistance of the New York Roadrunners (web) and consists of 4 mile and 10K coed races and an all important 1.7 mile Remembrance and Prevention Walk focused on the colon cancer survival community. The “Challenge” has grown from a small event to becoming a major rallying point for colon cancer awareness in the New York area attracting thousands of people including a large number of people personally touched by colon cancer; corporate sponsors as well as TV, radio, and newspaper coverage from the major outlets. Corporate and personal donations raised by the event go directly to support awareness, screening, advocacy and research.

Under the guidance of Albert Ferro, the 2007 New York Colon Cancer challenge was the most successful to date raising approximately $200,000 with a record number of sponsors and participants (approximately 5,000). For the first time money was donated to the New York City Health Department ($10,000) to fund ($10,000) colon cancer screening for the uninsured and Colon Cancer Alliance (the largest not profit advocacy group for colon cancer victims and their families) to support ($24,000) advocacy efforts. Other moneys were used to insure the awareness message reached as many people as possible, to support advocacy and screening, and to fund colon cancer research.

Along with the March event, “Partners in the Challenge” dove into “advocacy and awareness” and research. Dr. Weber and his team worked actively with such organizations as the New York State and New York City health departments, the American Cancer Society (www.cancer.org), the national colon cancer round table (www.nccrt.org) , the collaborative group of Americas (CGA — colon cancer registries and research), and the Colon Cancer Alliance (www.ccalliance.org CCA – the largest not profit advocacy group for colon cancer victims and their families) to increase the national awareness of the critical importance of colon cancer screening The quality of this work was recognized with Dr. Weber’s current appointment as chair of the national colon cancer roundtable, his previous tenure as president CGA, and CCA decision in 2007 to collaborate directly with “Partners in the Challenge”. For current screening guidelines go the web sites of American Cancer Society (www.cancer.org) and the National Cancer Institute www.cancer.gov/cancertopics/screening/colon-and-rectal) and talk your physician).

On the research side, Dr. Weber’s research team at Einstein College of Medicine has helped pioneer a new understanding of the diversity of molecular pathways of colon cancer with a focus on microsatellite instability (MSI). Historically, cancers have been classified by their location (colon, lung, skin, etc) and their outward appearance. In reality, the “same” cancer is really different cancers depending on the actual cause of the abnormal growth. Knowing the actual cause ultimately helps with the treatment and the screening protocols. As a simple example, think of the importance of blood typing.

The “Partners in the Challenge” team has been a leader and partner in developing a more detailed understanding of the MSI pathways and their impact on regulating cell growth and death. His team has published 4 papers in this area and made numerous presentations including Insight – the premier international colon cancer research organization.

Last, but perhaps most importantly, “Partners in the Challenge” provides research programs to mentor and develop future researchers, health care providers, and advocates. Opportunities exist for surgical residents, young researchers in molecular genetics, medical school students, college students, and high school students. These dedicated young men and women are the future.

The first program implemented was a “surgical residency” research program. Typically a residency in general surgery runs 5 years – two years a junior resident, two years as a senior resident, and 1 year as a chief resident. With the “Partners in the Challenge” program a qualified and interested surgical resident spends either one or two years between completion of their junior residency and starting their senior residency working in Dr. Weber’s lab. The bulk of their time is focused doing research in understanding the underlying molecular genetics of colon cancer which includes participating (and presenting) in major conferences. In addition to the research, the surgical residents get a firm understanding of the social aspects of colon cancer (advocacy and screening) rounding their experience. To date this program has been an outstanding success.

A second program provides a high school student an opportunity to be directly involved with one or two specific lab investigations. The student typically comes to Einstein once every two weeks and works directly with a member of the research team. The student does actual bench work, participates in the science meetings, and is part of the abstracts and papers associated with that bench work.

Building on this base two additional research opportunities have been added: one for a senior year medical school student and a summer internship for an undergraduate college student. More programs will be implemented in 2007 and 2008.

Future: 2007–2010

The “Partners in the Challenge” will continue to actively engage and move forward in each of the areas describe above. There are five specific growth areas we are focused on are: increased screening; improved accuracy in screening guidelines; additional opportunities for young researchers and health care professionals; improved understanding of the molecular genetic mechanisms that regulate cell growth and death; and population genetics. Their combination will reduce colorectal cancer incidence and death.

Screening — although, the percentage of people who are screened for precancerous polyps has increased over the last 5 years, there is still substantial “room for improvement”. As the Colon Cancer Challenge and other awareness events gain in momentum, we are working with others to insure the “screening message” is broadly made to all Americans and our political leaders understand the importance of such programs. Some specific programs we hope to either extend or implement include:

1. The Colon Cancer Challenge in March continues to grow in success, over the next two years we hope to leverage this success into
   • increasing levels of publicity about the importance of awareness and screening so the message is broadly made to all Americans and our political leaders under stand the importance of such programs as funding colonoscopies (colon cancer screening method) for all Americans and navigators (people assigned to work with individuals who need some help in navigating the screening steps)
   • funding additional screening programs
   • an improved Web Cite to facilitate communication among the members of the challenge community.
2. Collaborating with other institutions
   • establishment of additional screening and awareness centers in New York
   • research the economics and efficiency of screening and treatment protocols
   • advocacy for improved access to screening and treatment

Another critical area is expanded research and awareness opportunities for young health care providers and researchers; our goal is extend the current programs in place as follows:

• a second surgical resident research and awareness internship
• enable resident researchers to spend 6 months at another lab inside or outside of the US
• sponsoring a young molecular genetics researcher for 1 to 3 years perhaps in a cooperative fashion with another lab
• full time summer program for a young researcher either late in their undergraduate career or early in their graduate carrier

Translational research refers to migrating our understanding of the molecular genetic aspects of cancer and other diseases from the lab into clinical practice. Some of the best known examples of this “translation” have occurred in treating and screening for breast cancer. “Partners in the Challenge” dual expertise in lab work and clinical practice makes it well positioned to make a real contribution to this critical area for the advancement of cancer treatments. A key component of its expertise is continuing its work on the molecular genetics of colorectal cancer with a focus on dissecting unique pathways of malignant transformation in microsatellite unstable (MSI) colorectal cancer (CRC). This includes the current on CDK2-AP1 (which regulates cell death) and extending this to other regulators such as EGFR (promotes cell growth) and TGF-ßRII (cell death). [produce side bars on (a) cell growth and death and (b) a quick summary of our current understanding of CDK2-AP1]

In terms of science (and ultimately screening and treatment protocols) our goal is to make substantial strides in an area that is essentially untapped, but critical — population genetics. Many of the anticipated benefits of the Human Genome Project in advancing cancer research have yet to be realized as we have come to understand the need and importance to move from a very limited sample set to a larger and more diverse collection of individual profiles to provide the base for the kinds of scientific analysis needed to increase screening and therapeutic benefit and matching the level of skill society brings to monitoring purchasing patterns. This requires the genetic analysis of a large and rich variety of people which requires the collection this data. During the 2007–2009 timeframe we anticipate (a) working various government agencies and other population genetic groups (such as the Human Genome Variation) to establishing a registry in the Northeast which collect genetic samples from people with and without colon cancer and (b) determining the population frequency of the DNA mismatch repair genes – as amazing as it might sound, the true population frequency of these genes remains unknown.

In terms of science and ultimately screening and treatment protocols our goal it make substantial strides in an area that is essentially untapped, but critical — population genetics. Many of the anticipated benefits of the Human Genome Project in advancing cancer research have yet to be realized as we have come to understand the need and importance to move from a very limited sample set to a larger and more diverse collection of individual profiles to provide the base for the kinds of scientific analysis needed to increase screening and therapeutic benefit and matching the level of skill society brings to monitoring purchasing patterns. This requires the genetic analysis of a large and rich variety of people which requires the collection this data. During the 2007–2010 timeframe we anticipate:

• Working the Federal government, other population genetic groups such as the Human Genome Variation, New York and other state governments to establishing a registry in the Northeast which collect genetic samples from people with and without colon cancer.
• Determining the population frequency of the DNA mismatch repair genes – as amazing as it might sound, the true population frequency of these genes remains unknown. The reasons for this somewhat surprising situation are many and include the consistent focus of the literature on highly selected families with multiple affected individuals as well as a universal focus on cancer affected individuals. This approach precludes robust estimates of the true population frequency of cancer predisposition genes in the human population because unaffected carriers in the population have not been reported. Our work will addresses this important gap.
• Continue our work in the MYH gene.

There is a lot we don’t know about colon cancer, but we have a good start. Working together we can meet this 21st Century challenge.