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Download the Print Version of Inside Stanford The Precision Health and Integrated Diagnostics Center aims STANFORD to prevent healthy people from becoming ill. INSIDE Page 4 Volume 10, No.MEDICINE 10 May 21, 2018 Published by the Office of Communication & Public Affairs Multigene tests for breast cancer on the rise STEVE FISCH By Krista Conger he use of genetic tests aimed at detecting the pres- ence of mutations in the BRCA1 and BRCA2 Tgenes in women with breast cancer is rapidly de- clining in favor of tests that can detect multiple cancer- associated mutations, according to researchers at the School of Medicine and five other U.S. medical centers. Some researchers had wondered whether multigene testing, which may identify genetic mutations of un- certain clinical significance, would lead more women to consider prophylactic mastectomies — a surgery in which both breasts are removed to prevent future can- cers — out of an abundance of caution. However, the current study did not show an increase in mastectomies associated with testing more genes. The shift reflects a growing acknowledgement by clinicians that multigene panel tests can yield more clinically useful information for patients and their unaf- fected relatives, the researchers said. Overall, multigene panels were about twice as likely as the tests for BRCA1 and BRCA2 to identify disease- associated genetic variants, the study found. However, multigene testing was more likely than the BRCA-only testing to be delayed until after surgery to remove the tumor. This time lag may limit a patient’s treatment op- tions, the researchers said. ‘Becoming the norm’ “In general, multigene panel tests yield more clinically useful results and are rapidly becoming the norm,” Allison Kurian said. “In general, multigene panel tests yield more clini- cally useful results and are rapidly becoming the norm,” Multigene panel tests are more likely than BRCA- they’d had genetic testing, and, if so, who ordered it, said Allison Kurian, MD, associate professor of medi- only tests to yield information about both a patient when it was performed and what type of tests they un- cine and of health research and policy at Stanford. and her family members, who may be unwitting car- derwent. A novel feature of this study was that genetic “Newly diagnosed women should ask their doctors riers of disease-associated mutations. “This is very results came directly from the testing laboratories and whether they may be appropriate candidates for genetic important because it offers the opportunity for geneti- were linked to population-based cancer registry data. testing. They should also advocate for the opportunity cally targeted, primary cancer prevention in unaffected This data linkage provided substantially greater depth to discuss genetic testing and its implications with an relatives,” Kurian said. “Some prior research has shown and accuracy of genetic information than in previous experienced clinician, such as a genetic counselor, in a that this ‘cascade testing’ of unaffected relatives is cost- studies. timely manner.” effective, and there are currently several initiatives un- They found that only about one-quarter of the A paper describing the research was published May derway to improve upon the delivery and success rates women had received any genetic testing. This number 10 in JAMA Oncology. Kurian is the lead author. Steven of cascade testing.” stayed relatively constant throughout the two-year pe- Katz, MD, MPH, professor of medicine and of health The researchers surveyed over 5,000 women who riod. However, of those who were tested, the propor- management and policy at the University of Michigan, had been diagnosed with stage-0 to stage-2 breast can- tion who received multigene panel testing increased is the senior author. cer between 2013 and 2015. They asked the women if steadily over time, from about See MULTIGENE, page 7 Scientists manipulate gut bacteria PET scan tracer predicts success in mice using a type of seaweed of cancer ‘vaccine,’ study reports By Krista Conger amount of a specific carbohydrate in By Hanae Armitage in their tumors, but those T cells aren’t each mouse’s water or food. always activated and killing tumor cells Gut bacteria thrive on the food we “We’re all endowed with a microbial By engineering a special molecule to — so we need a way to track activated T eat. In turn, they provide essential nu- community in our guts that assembled track certain immune cells in the body, cells more specifically, and I think we’ve trients that keep us healthy, repel patho- in a chaotic manner during our first scientists at the School of Medicine have done that here.” gens and even help guide our few years of life,” said Justin invented a litmus test for the With the tracer, doc- immune responses. Sonnenburg, PhD, associate effectiveness of a newly de- tors can theoretically see if Understanding how and professor of microbiology vised cancer therapy. a cancer vaccine has success- why some bacterial strains and immunology. “Although The molecule is a radioac- fully galvanized T cells into we ingest can successfully we continue to acquire new tive tracer that latches onto a protective state, though take up residence in the strains throughout life, this immune cells when they’re the research conducted in large intestine, while others acquisition is a poorly or- activated — the status that this study was exclusively in are quickly evicted, could chestrated and not-well-un- immune cells, in particular mice. The PET tracer’s ca- help scientists learn how to derstood process. This study T cells, assume when they’re pabilities aren’t limited to manipulate the makeup of suggests it could be possible poised to kill tumor cells. cancer therapies, Gambhir thousands of bacterial species to reshape our microbiome “It’s not good enough to added. Because the tracer there in ways that enhance Justin Sonnenburg in a deliberate manner to just image all T cells; you Sam Gambhir latches onto a molecule that our health or help fend off enhance health and fight need to image activated flags any activated T cell, it disease. But the sheer complexity of gut disease.” T cells because those are the ones that also makes for a powerful tool to detect ecology has hampered this task. A paper describing the research was are going to kill the tumor,” said Sanjiv autoimmune diseases, which occur when Now, researchers at the School of published online May 9 in Nature. Son- “Sam” Gambhir, MD, PhD, professor the immune system erroneously activates Medicine, working with laboratory mice, nenburg is the senior author. Former and chair of radiology at Stanford. “The T cells to attack healthy tissue. have shown that it’s possible to favor the graduate student Elizabeth Shepherd, problem that occurs in other approaches, A study describing the tracer was engraftment of one bacterial strain over PhD, is the lead author. including ones we’ve previously de- published online May 14 in the Journal others by manipulating the mice’s diet. Giving bacterium a leg up veloped, is that they’re sometimes not of Clinical Investigation. Postdoctoral The researchers also have shown it’s pos- specific enough. I could image tumor pa- scholar Israt Alam, PhD, and gradu- sible to control how much a bacterium The burgeoning field of probiot- tients who’ve yet to receive an immuno- ate student Aaron Mayer share lead au- grows in the intestine by calibrating the ics — live, See SEAWEED, page 7 therapy; they’ll sometimes show T cells thorship of the See TRACER, page 7 Student research symposium showcases curiosity and scholarship By Julie Greicius “Their projects reflect close collabora- driven from perhaps lack of knowledge, of your world in a new and possibly ex- tions between our students and our fac- a belief that you can’t get pregnant when panding way. And that’s also an exciting In his last year as an undergraduate ulty, because typically on each poster the you’re breastfeeding, or other ideas about thing for me to see.” student in bioengineering at Washington student is first author, and the faculty suppressed fertility.” “Just seeing and helping Stanford University in St. Louis, Missouri, Sheun mentor and sponsor of the work is senior Most student research is financially bring to bear what it can do for students Aluko took a contemporary dance class author.” supported by the Medical Scholars Re- is rewarding,” Baker said, “because of the and two yoga classes. Inspired by the ‘At the edges of science’ search Program, a grant program that way the students use it and run with it, intersection of movement and bioengi- has been active at Stanford for nearly 40 and because of the things they can do neering, Aluko was drawn to the pos- This year’s posters represented just a years. “Altogether, we fund something on when they get these chances.” sibility that technology could provide sampling of work by Stanford’s medical the order of 200 quarters of research by Winning poster presentations: real-time feedback for physical therapy. students, many of whom present their medical students each year,” Gesundheit On May 16, at the 35th Annual research at other national and interna- said. “That’s in addition to other sources • Alvaro Amorin, “Stereotactic ra- Stanford Medical Student Research tional conferences instead of, or in ad- of funding. And that’s what makes it diosurgery in the multimodal manage- Symposium, Aluko, now a third-year dition to, presenting at the symposium. remarkable.” ment of pituitary adenomas: a single medical student at Stanford, discussed Their research interests span an enor- Generous financial support is just center’s experience.” Mentor: Justin his research project, “Development of a mous range. part of what makes Stanford medical stu- Moore, MD, PhD, surgical neuro-on- wearable gait-training device for children “Our students are constantly inter- dents’ research projects happen.
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