New oncology testing program by Stanford professors receives $3.5 million

Oncology and epidemiology professor Allison Kurian ’95, M.S. ’06 and assistant oncology professor Jennifer Caswell-Jin received a $3.5 million donation for the Preventive Risk Outreach And Cascade Testing (PROACT) program, a digital cascade testing tool for breast cancer, last year.

Funded by Bright Pink, a breast and ovarian cancer organization, PROACT will be led at Stanford Medicine in collaboration with the University of Michigan.

Steven Katz, a professor and PROACT collaborator at the University of Michigan, outlined the program’s roadmap as providing “a blueprint and a roadmap to drive cancer genetic risk evaluation and support to patients and their families who have hereditary cancer syndromes,” he wrote to The Daily.

In providing education and genetic testing, PROACT ultimately hopes to “reduce the burden of cancer,” Katz continued.

With the ever-evolving field of genomics, Kurian and Caswell-Jin’s work has been largely characterized by “eras of scarcity” and “eras of abundance” in genetic information,” Kurian said.

When Kurian, with a background in oncology and epidemiology, started in the field in 2002, testing for BRCA1 and BRCA2 — the best known breast and ovarian cancer genes — cost about $4,000. Today, sequencing technology can accomplish an abundance in data all available at patients’ fingertips.

As a result of this abundance in data, Caswell-Jin, who specializes in breast cancer care and research, noted three key areas for oncology research: implementation science, epidemiology and population health and computational biology. The PROACT program was started to target implementation science.

More specifically, with the field’s current knowledge of treatments, Caswell-Jin said that a guiding question remains: “How do we get that into the population in an equitable way so everybody’s benefiting from the knowledge?”

The answer to this question is cascade testing, or genetic testing through families. Starting with one diagnosed patient, this work involves more testing to investigate if the patient carries a hereditary cancer risk variant. According to Caswell-Jin, “once they find out, we get everybody who wants to know and who stands to benefit in their family tested.”

“That’s the goal of PROACT,” Caswell-Jin continued, “to build something that can help get families tested for these genes.”

Currently, many clinics perform cascade testing but there is no population-wide solution. To address this, the PROACT program is conducting a national trial using this platform in a cancer registry setting, with an ultimate goal of expanding beyond the US.

“Families are everywhere, and we are interested in taking care of people everywhere,” Caswell-Jin said.

There are many well-studied genes of associated risks and how to mitigate them. “We know if we get people the right care for the gene that they have, they should be able to live a full, long, healthy life like everyone else” because of improvements in screening, prevention and other technologies, Caswell-Jin said.

On a broader level, Kurian and Caswell-Jin hope to increase the public’s knowledge of cancer. 

“When people hear the word cancer, it’s still a terrifying thing to hear,” Kurian said. Compared to many other diseases, “cancer feels more mysterious, and a lot of the time, we don’t know what causes it.”

From Caswell-Jin’s perspective, “The more you look at cancer as an entity, the more complex and heterogeneous it becomes,” she said. “The more technologies you have to interrogate cancer, the more complex and heterogeneous it becomes.”

Kurian continued to describe a need in the field to better understand its biology, thinking about cancer as “personalized therapy” instead of a “one size fits all” approach.

And for the few times a therapy is successful, Kurian likes to joke that it’s like potions in Harry Potter. “It’s a sort of spiritual moment… We chase that moment a lot. We don’t always catch it, but we’re catching it more often, and it’s the basic science and the genetics that help us do that right.”

The physicians reflected on this “moment” in the scope of their own experiences.

Both Kurian and Caswell-Jin’s journey to medicine happened to be centered by French philosopher Albert Camus’s novel “The Plague” and by storytelling. After reading Camus in college, Kurian hoped to “interact with patients in the heart of their story” and “be a character like the doctor in the plague.”

“We represent the problem as the doctor. We kind of represent our patients, the difficulty they’re navigating in the healthcare system and getting their cancer treated, then we go out and work with people who are experts in solutions,” Caswell-Jin said. “It is quite powerful, being the person who lives the problem.”

Kurian also found inspiration in her patients.

“So for me,” Kurian said, “it’s driven by the patients. It’s driven by the questions and the needs that we see. And that drive never goes away, because it is renewed by what we see, by the compassion we feel and the drive to do better.”

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