What are the connections between breast cancer and bone health, breast cancer and heredity, and obesity and cancer risk? Top Israeli and American experts gathered at Soroka Medical Center in Beersheva on April 2 to share new frontiers in cancer research and therapy that are changing our understanding of the disease dramatically.

The Israeli venue for a major meeting of medical minds was an obvious choice, according to conference co-chair Dr. Larry Norton, medical director of the Evelyn Lauder Breast Center at Memorial Sloan Kettering Cancer Center.

"To move into exciting new areas takes a pioneering spirit, confidence and courage, and I feel this spirit in Israel in general," Norton explained at a pre-conference press briefing in Jerusalem. "In Soroka in particular, the setup has what it takes to be a world center in this area."

Soroka, the teaching hospital for Ben-Gurion University Medical School, is the sole hospital serving the diverse population of the Negev Desert. It has launched a $40 million development project to construct a cancer research and treatment center to better serve the South's resident Bedouin Arabs, Jews, Christians and military personnel stationed there.

Bones and breast cancer

The diversity of the patient population is the main reason that Norton pinpointed Soroka for a long-term study of breast cancer and bones with his colleague Dr. Ethel Siris, director of the Toni Stabile Osteoporosis Center at Columbia University Medical Center.

The study began in 2010 with funding from the New Jersey-based Cure Breast Cancer Foundation.

"Soroka was carefully chosen for this research," Norton says. "It is one hospital serving many people in one geographic area; it keeps immaculate records; it has superb clinicians and great science; and it has a university right there. I've been setting up cancer programs for decades, and this is literally made in heaven."

The study seeks to challenge the assumption that women who have breast cancer don't get osteoporosis, and vice-versa. Siris and Norton suspect that medications to manage breast cancer over many years might harm bones.

"The relationship with bone health has intrigued me for decades because most of the long-term patients I treat also have abnormalities in bone - sometimes too strong and sometimes too weak," says Norton.

"Understanding bone metabolism, how bone cells communicate, the role of the white blood cells in the bone marrow and how that relates to cancer growth, is an exciting and emerging area. We're making some collaborative discoveries with the help of the extraordinary talent of individuals at Soroka, and we will be pursuing this aggressively."

At the conference, Soroka endocrinologist Dr. Merav Fraenkel updated participants on this study, which is the first-ever attempt to evaluate the relationship between bone health and breast cancer progression.  

  From left, doctors Davidson, Norton and Geffen.

Dr. David Geffen, Soroka's chief of breast oncology services and co-chair of the conference, says 15,000 patients have already been evaluated retrospectively, and the prospective part of the study is about halfway done. He expects it to result in a definitive guide for physicians to advise breast cancer patients on how to keep their bones healthy.

Israeli contributions to new cancer research

Geffen tells ISRAEL21c that several Israelis are contributing significantly to cutting-edge cancer research.

Dr. Eitan Friedman, director of oncogenetics at Sheba Medical Center at Tel Hashomer, is one of those leading lights. At the conference, he discussed the genetics of breast cancer in Jewish women.

"Prof. Friedman has done a lot of important investigations as to which mutations of the BRCA-1 and BRCA-2, and other genes, are present in which subpopulations," says Geffen.

"In Israel, we have a unique combination of people from different ethnic groups that make this kind of study possible. The research done by Prof. Friedman and colleagues at other institutions in Israel has significantly advanced the ability to do genetic testing and prevention."

Personalized decision-making in chemotherapy for breast cancer is another area where Israeli scientists are making strides, says Geffen.

"For many years, we had rough guidelines of who to give chemotherapy to, but we gave it to a lot of people who probably didn't need it and suffered side effects. Now there are some molecular genetic tests that enable us to characterize the individual's tumor and probably characterize their risk."

Israeli researchers have also been demonstrating how the genetic test 21G (21-gene recurrence) can effectively predict which patients are most likely to be helped by chemotherapy.

"We have made unique contributions to the medical literature about the usefulness of this test and have shown that molecular analysis gives a more accurate picture than the traditional pathologic approach," Geffen says.

Down in the Negev

Cure Breast Cancer Foundation founder Andrew Abramson, whose wife has suffered three bouts of breast cancer, came in for the conference with his family. He tells ISRAEL21c that the breast cancer-osteoporosis study is the first one his foundation is supporting in Israel.

"It was a byproduct of the research we're done in New York with Dr. Siris, a bone specialist," he says. "My wife is on the verge of osteoporosis, so she could very well be helped by the results of these studies."

Norton, considered one of the foremost breast cancer researchers in the United States, emphasized that the general theme of the conference was how the "microenvironment" of the body - genetic factors and obesity, for example - affects the growth of cancer.

"Most early cancer research focused on the cancer cell, while in the last 15 years we've been paying more attention to how they relate to the cells in their environment, such as blood cells. We've realized the entire human body is involved, because of the extraordinary communication between cells and the chemical receptors that make this possible," says Norton. "I hope this will be the first of a series of conferences we hold at Soroka to explore these topics."

Soroka Medical Center Director-General Dr. Ehud Davidson noted that with the growth of the Negev, Soroka is positioned "to become a larger player in groundbreaking research and advanced healthcare. This conference helps us realize this dream."

Dr. Samuel Ariad, director of oncology at Soroka, presented his research along with Sloan-Kettering participants. Other Israeli presenters included Dr. Bella Kaufman, director of the Breast Cancer Unit at Sheba Medical Center at Tel Hashomer near Tel Aviv, and Dr. Tamar Peretz, director of the Sharett Cancer Center at Hadassah-Hebrew University Medical Center in Jerusalem.