This is a summary to date of the collaborative activities between the Windber Medical Center and Walter Reed Army Medical Center under the Congressionally funded project, Clinical Breast Care Project (CBCP).
The Windber/Walter Reed collaboration under the CBCP is based on five separate pillars: clinical care, tissue banking, risk reduction, informatics, and research. By section, the progress is as follows.
The clinical care pillar in FY01, both Walter Reed and Windber sites have been rapidly building state-of-the-art comprehensive breast centers, which will form the foundation of the ongoing collaborative efforts of the rest of the project pillars. At the Walter Reed site, the space for the new breast center was designated and approved by the command and in-depth architectural design and development plans were made in conjunction with the Patient Advocacy Group, which consists of military and civilian breast cancer survivors.
Site visits between Walter Reed and Windber personnel, and visits to established comprehensive civilian breast centers, and with the ongoing consultation of an outside civilian consultant with expertise in the development of new breast centers, both the Walter Reed and Windber sites learned much from each other and others as they move forward with the foundation breast centers at the two locations, both of which are due for completion in middle-2001. The ground breaking ceremony at Windber was at the end of August 2000 for their wonderful new facility, and the equivalent ceremony, that is the Space Dedication, was held at Walter Reed on February 8, 2001 and we were honored by the presence of Mrs. Joyce Murtha, wife of the Congressman. The Walter Reed Breast Center opened on July 31, 2001, and the Joyce Murtha Breast Center in Windber on February 21, 2002.
The next pillar, tissue banking, is a vital and integral component to the success of the project and was developed with extensive collaboration amongst the Windber and Walter Reed sites as well as the excellent input from the Uniformed Services University, and will be a unique arrangement whereby the strengths of the Walter Reed clinical care system, which performs over 1,000 breast surgery procedures per year and sees thousands of breast patients in its clinics per year as well as in radiology, teams up with Windber Center in establishing a large-scale tissue and serum bank of fresh tissue breast specimens from all kinds of patients with breast disease and along with the associated clinical information, all done on approved research protocols, will use the Windber Research Institute as the center of research of investigations at the genome and molecular levels of that tissue, using its new state of the art high-throughput genomics, microarray, and proteomics facility. This planned cooperative resource and research effort is unique in both its scope, its development, and its capability to acquire, store, and study large volumes of breast tissue, with the intent of answering many questions as to how breast cancer forms and what may be done to prevent it. The present detail status of both sites in this endeavor is that the tissue bank freezers are in place at the Walter Reed site and the Windber site, the tissue bank protocol to acquire tissue from patients at the Walter Reed site in anticipation of it being used for its research at the state of the art Windber facility is finished and we have proven feasibility. The robust CBCP Tissue Banking and CBCP Blood/Serum Repository Protocols are through the IRBs and open for accrual.
The risk reduction pillar of the CBCP is a clear triumph of the appropriation which has allowed us to establish a program whereby we can use a computer model that has been extensively validated as accurate at identifying most women who are at high risk of developing breast cancer, identifying who those women are, and then entering them into a very extensive and in-depth Risk Reduction Program where they are seen by a Specialist Physician and Nurse. The collaboration between the two sites has included the setting up of the exact same policy and protocol for the risk reduction clinics at both sites and the collaborative data management seen under the programs at both sites. The physician who has been hired through the project appropriation to see the risk reduction patients is a world-class medical oncologist who spends nearly an hour with each patient explaining the potential risks and benefits of chemoprevention to prevent breast cancer in these high risk patients. This capability for a physician to spend this marked amount of time as well as a program establish a screening mechanism whereby patients are screened to see if they are at high risk for breast cancer through this computerized model, is very resource intensive and could only be done through the generosity envisioned of an appropriation such as this. In the project so far since the beginning of the Risk Reduction Clinic in November 2000, over 400 patients have now been seen and identified as above average risk of developing breast cancer and whom after appropriate medical counseling have made decisions as to taking the preventive medications that will decrease their risk of developing breast cancer literally in half. Additionally, we have another 50 patients on the waiting list to get into the risk reduction program and we are expanding our outreach screening efforts even more as well.
The next pillar of the project is the research aspect, which is really founded on two very highly focused research platforms. The first being clinical breast cancer vaccine development whereby we using the collaborative nature of this project and the strengths of Windber and Walter Reed personnel and facility resources to identify women who are candidates for a new effort whereby women who are breast cancer survivors are vaccinated against the recurrence of breast cancer. It should be noted that this program is one of only three in the nation to offer this hope for these types of patients. The secondary aspect of the research that is a focus of the CBCP is functional genomic and proteomics. This being achieved through the acquisition under the project and located at the Windber site of the state of the art gene microarrary and proteomics research platform that will allow our CBCP / Windber researchers working in conjunction with Walter Reed scientists and tissue collection personnel to delve deep into the changes that occur in breast tissue as in undergoes transition from benign to malignant cells. This unique collaboration between Walter Reed and Windber sites is made possible through the appropriation and only because the excellent working relationship between the two centers whereby the important raw materials and information of patients undergoing biopsies and treatment for breast cancer will then be targeted for study of their genomics as well as the protein derivatives for proteomics by the scientific researchers centered at the Windber site. Briefly, the genomics using microarrary technology is a way to analyze thousands of genes within the cells of tissues from biopsies taken from breast disease patients and to follow those changes over time looking for unique patterns in the change of gene structure as patients’ breast tissue undergoes cancerous development. We have a gene sequencer as well, and the ability to search for SNPs (single nucleotide polymorphisms) in the genetic code of breast tumors. Additionally, the proteomics involves the large scale search for the products of those gene changes which then appear, for instance in the blood stream, and which may lead to the identification of a form of “marker” that can be used for earlier breast cancer detection and prevention.
The next pillar of the project, tissue banking, is central to the success of the research focus of the Windber and Walter Reed collaboration. Through the appropriation funding we are setting-up tissue bank acquisition and storage facilities both at the Walter Reed and Windber sites with the intent being to acquire breast tissue on the over 1,000 patients who undergo some form of breast surgery at Walter Reed annually, along with blood samples from those and other patients, which will then be used in research and further stored at the Windber site. An intermediate term goal is the expansion of this tissue bank effort throughout other military facilities as well as other civilian sites. The key to this tissue banking project is that the tissue will be fresh frozen tissue and not standard pathology archival tissue, the latter of which has many defects in its ability to be analyzed at the deep genomic level due to destruction of certain cellular processes by the archival methods. This will be overcome by this tissue banking effort which requires great collaborations between our sites as well as the personnel, desire, and capital investment to establish such a resource, which is expected to be of national use.
The final thread that will hold all these pillars together is informatics. This has been a wellspring collaboration between the Walter Reed and Windber sites in that we have all contributed to the database entry fields which will be captured on all patients being treated for breast cancer and then entered into a developing high-end breast cancer database which will then be used in conjunction with the tissue bank resource and the data achieved from studying those tissues at the scientific research center at Windber to find out the behavioral meaning of those changes on a clinical level. Already in this collaboration the protocols allowing data collection at both sites have been written and approved by the institutional review board, and the initial database is expected to deployed at both centers within the next two weeks. Moreover, we have wide area network hardware personnel who have been hired at the Windber site and in collaboration with the Walter Reed site are working to establish the telecommunications link between the centers which will allow for constant virtual interaction, patient care, tumor boards, and scientific research meetings between the sites.
It should be noted that one of the great events of this project occurred on 10 – 12 Dec 2000 when over 50 personnel from both the Winder and Walter Reed sites attended an Offsite retreat in Shepherdstown, WV for extensive meetings and discussions where the vision of the project, origins, and the hard work of putting together the database, research plan, and clinical flow of patients was all worked on, as well as the wonderful interactions between the personnel from both sites. It was our privilege to have as our honored guest during a period of time at that retreat, Mrs. Joyce Murtha, who was briefed by the Director of the project and spent a luncheon with us learning about the wonderful work and mutual collaborations that have come out of the vision of the appropriation. Additionally, personnel of the Walter Reed site have traveled to the Windber site on a monthly basis and conversely various personnel from the Windber site have traveled to the Walter Reed site on a monthly basis as well. As there was a ground breaking ceremony in August 2000 at the Windber site for the clinical care center there was a similar event, the Space Dedication at the Walter Reed site on February 8, 2001. In less than 6 months later, we at Walter Reed are proud to have completed the renovation project for the Army’s first and only Comprehensive Breast Center, which had its Grand Opening on Tuesday, July 31, 2001 at 10AM. The Joyce Murtha Breast Center at Windber will similarly enjoy its Grand Opening on February 21, 2002, an event at which both Congressman and Mrs. Murtha will be Honored Guests.
In summary, this unique collaboration is growing rapidly, achieving its goals, and resulting in a strong future for the Windber location and for Walter Reed. We are proud to be a part of it.
Craig D. Shriver COL MC
Director and Principal Investigator, CBCP