Funding improves breast cancer survival rates

April Kloxin is part of an ever-growing body of researchers and clinicians making it their mission to outsmart breast cancer cells.

Kloxin, a University of Delaware engineering professor and Pew Scholar in Biomedical Science, wants to know why 20 percent of women who are treated and declared breast cancer-free by their doctors develop breast cancer five to 25 years later. When cancer strikes again, it metastasizes in other parts of the body such as the bones and lungs.

She has been awarded a $450,000 grant from Susan G. Komen – one of the largest grants awarded to Delaware researchers in the past 20 years – to find out why breast cancer cells stay quiet in the body for years after treatment and what makes them reawaken. 

Breast cancer awareness advocates say funding for new programs and research innovation, like Kloxin's, has made a considerable impact on women's health. Susan G. Komen has invested $889 million in breast cancer research since the organization began in 1982. 

Money from 5K races, bake sales and other events have contributed millions of dollars from many groups. That is in addition to hundreds of millions of federal dollars that go into research every year.

Because of better detection technology, diagnoses continue to rise. The National Cancer Insitute estimates there will be 246,660 new breast cancer diagnoses this year, which makes up about 14.6 percent of all new cancer diagnoses.

Experts say newly funded research and patient programs have helped improve survival. Cancer data from the National Institutes of Health shows that in 1975, about a quarter of women diagnosed with breast cancer were not likely to live five years after their diagnoses. Now, the current five-year survival rate for patients is about 89.7 percent.

"We are one piece of a much bigger puzzle," Kloxin said of her work, which is being performed in tandem with other UD professors and cancer research at Christiana Care Health System, a National Cancer Institute-designated community cancer center.

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In the 1990s, Delaware had the second highest cancer death rate in the nation. Today, the state's overall cancer death rate is ranked 14th.

"You can't make progress without resources and resources usually means money," said Dr. Nicholas Petrelli, medical director of Christiana Care's Helen Graham Cancer Center and Research Institute.

"We have made dramatic progress in the state of Delaware in cancer mortality," he said, highlighting increased breast cancer detection and gene profiling initiatives and clinical trials. 

"I consider what has been done in Delaware as a model for the country."

Moving the needle

The number of breast cancer-related deaths has declined over the last 20 years. According to data from the National Cancer Institute, death rates from 2004 to 2013 have been falling on average 1.9 percent each year.

Even so, breast cancer is still the second most common cause of death among Delaware females, which officials say signals a need for more resources and funding.

But budget woes have impacted the amount of federal money given to researchers. Christiana Care clinicians said funding for clinical trials has dropped, and there are less open studies for breast cancer patients. Four breast cancer patients are on an active clinical trial currently, below historical averages.

NCI research funding for breast cancer has decreased from $631.2 million in fiscal year 2010 to $559.2 million in fiscal year 2013, according to the organization's budget fact book.

Inconsistent funding streams have focused more efforts on local and private fundraising. Dewey Goes Pink, a 5K run/walk for breast cancer awareness, for example, has raised over $220,000 for the Delaware Breast Cancer Coalition in five years. 

Kloxin's $450,000 grant was part of $32.7 million in new research grants Komen doled out this year, which officials say will help the organization's pledge to reduce the current number of breast cancer deaths by 50 percent over the next 10 years. This year, NCI estimates there will be 40,450 breast cancer-related deaths.

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"We are going to move the needle here in the Delaware Valley," said Elaine Grobman, chief executive officer of Susan G. Komen's Philadelphia branch.

"[Women] are still dying," she said. "But we are giving them, because of research, longevity and less costly treatment. But we have more work to do."

Kloxin hopes that her research may lead to more targeted treatments for women. She and her team of researchers are creating 3-D synthetic tissues that will mimic environments that breast cancer cells are likely to spread to. The tissues are made with synthetic polymers that are similar to what is found in shampoo.

Breast cancer cells will then be added to the tissue, and researchers will watch to see if the cells divide immediately or stay as single cells. Kloxin said the goal is to see what changes in the environments occur for the dormant cells to turn active. Then they can isolate what specifically is happening around the cells to trigger them to be active.

"The goal is to find which cells are going to be dormant and later reactive," she said.

Dr. Ashley Carter is a biology professor and researcher at California State University Long Beach. Carter doesn't deny progress has been made in breast cancer treatment thanks to grants like the one Kloxin has received, but the funding level has stayed high for years.

In a 2012 article published in BMC Public Health, Carter and other researchers found that breast cancer received the most government funding out of 21 cancers, but other cancer types that have been deemed to have a higher "societal burden" may be losing out.

The societal burden is calculated by the years of life lost to cancer, Carter explained. For instance, a patient who dies from cancer at age 30, has more years of life lost than a patient who is 65.

Leukemia, breast and prostate cancers are funded at higher levels than their relative societal burden suggests, the article says, while other cancers, such as liver and pancreatic, are underfunded. Breast cancer research funding is about $631 million according to the 2012 study, while pancreatic cancer research funding is $97.1 million.

"To us, that doesn’t make sense," Carter said.

If one cancer kills 10 times as many people, you'd expect there to be 10 times as much funding for research to attack that cancer type, he explained.

"The funding should be proportional to the total societal burden," Carter said.

Grobman said funding is needed to battle cancer in general. Researchers can potentially learn about multiple cancers even if the research funding initially was earmarked for a specific cancer type.

Sharing information is crucial, she added.

"I don’t think one is more important that the other I think we need to wipe it out," Grobman said. "I think women drive this. When we first started in 1991 nobody even talked about breast cancer."

Work still to be done

Grants are harder and harder to come by so local fundraising efforts plays a big role, explained Lois Wilkinson, the Delaware Breast Cancer Coalition's manager of education and survivorship programs. 

Around 80 percent of the coalition's total expenses goes towards community, survivorship and screening programs.

Many of the funded programs focus on helping a woman's quality of life. Nurture with Nature is a program where survivors will do outdoor activities together, while another program helps women with prescription costs or with buying post-mastectomy apparel.

Insurance can be one of the larger barriers, Wilkinson said.

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Mandy Giannattasio, of Smyrna, has a $15,000 yearly deductible for her family of five. Insurance has caused issues with her breast cancer treatment, she said. After she was diagnosed with cancer in 2014 at age 36, she needed a year of chemotherapy and 28 rounds of radiation treatment.

Insurance covered 16 chemotherapy sessions, but fought her on the last two she needed to complete treatment. Still, she has turned down help from the coalition. Other people need it more, she said.

"We do what we have to do to make it work," she said.

Each October for the past 10 years, Kathleen Woikoski, 72, makes a commitment to breast cancer awareness.

The Felton resident has two relatives who were diagnosed with breast cancer. She said buying pink apparel is a way to help.

"I buy one every year," Woikoski said while perusing tables at Bayhealth Medical Center's Go Pink! Health Fair and Fundraiser last Friday, clutching a newly bought hot-pink Go Pink! commemorative shirt. The annual event helps fund the Delaware Breast Cancer Coalition, which turns 25 this year.

The shirts are sold for $5 or $10. Last year Bayhealth raised $16,500, which in part goes toward offering free or reduced cost mammograms and health insurance help. 

"The big piece is supporting patients," said JoEllen Workman, manager of the Bayhealth Cancer Insitute.

Contact Jen Rini at jrini@delawareonline.com or (302) 324-2386.

Here are the most common types of cancer, based on the estimated new cases diagnosed in 2016      

1.    Breast cancer: 246,660    

2.    Lung and bronchus cancer: 224,390    

3.    Prostate cancer: 180,890    

4.    Colon and rectum cancer: 134,490   

5.    Bladder cancer: 76,960    

6.    Melanoma of the skin: 76,380    

7.    Non-Hodgkin lymphoma: 72,580    

8.    Thyroid cancer: 64,300    

9.    Kidney and renal pelvis cancer: 62,700    

10.    Leukemia: 60,140    

Source: National Cancer Institute