One subtype of breast cancer shares many genetic features with high-grade serous ovarian cancer, a cancer that is very difficult to treat, according to researchers supported by the National Institutes of Health.

The findings suggest that the two cancers are of similar molecular origin, which may facilitate the comparison of therapeutic data for subtypes of breast and ovarian cancers.

The researchers, using data generated as part of The Cancer Genome Atlas (TCGA), described new insights into the four standard molecular subtypes based on a comprehensive characterization of samples from 825 breast cancer patients.

The study, a collaborative effort funded by the National Cancer Institute (NCI) and the National Human Genome Research Institute (NHGRI), both part of NIH, was published online Sept. 23, 2012, and in print Oct. 4, 2012, in the journal Nature.

“TCGA’s comprehensive characterization of their high-quality samples allows researchers an unprecedented look at these breast cancer subgroups,” said NIH Director Francis S. Collins, M.D., Ph.D.

Analyses of genomic data have confirmed that there are four primary subtypes of breast cancer, each with its own biology and survival outlooks. These TCGA findings are based on a large number of breast cancer specimens that capture a complete view of the genomic alterations. The four groups are called intrinsic subtypes of breast cancer: HER2-enriched (HER2E), Luminal A (LumA), Luminal B (LumB) and Basal-like. A fifth type, called Normal-like, was observed, but because of small numbers (only eight specimens) the researchers were unable to rigorously study it.

The TCGA Research Network uncovered marked genomic similarities between the Basal-like subtype and serous ovarian cancer. The mutation spectrum, or types and frequencies of genomic mutations, were largely the same in both cancer types. Further analyses identified several additional common genomic features, such as gene mutation frequency, suggesting that diverse genomic aberrations can converge into a limited number of cancer subtypes.

Computational analyses show that Basal-like breast cancer and serous ovarian cancer might both be susceptible to agents that inhibit blood vessel growth, cutting off the blood supply to the tumor, as well as to compounds that target DNA repair, which include chemotherapy drugs such as cisplatin.

The Basal-like subgroup has also been called Triple Negative Breast Cancer because many, though not all, Basal-like tumors are negative when tested for three receptors: the estrogen receptor, the progesterone receptor and human epidermal growth factor receptor 2 (HER2). These receptors can trigger potent cell growth responses and act like a nametag, identifying the cell to the environment. The absence of these receptors means that treatments that target them will most likely be ineffective.

“The molecular similarity of one of the principal subtypes of breast cancer to that found in ovarian cancer gives us additional leverage to compare treatments and outcomes across these two cancers,” noted Harold Varmus, M.D., NCI director. “This treasure trove of genetic information will need to be examined in great detail to identify how we can use it functionally and clinically.”

According to the World Health Organization, there are approximately 1.3 million new cases of breast cancer and 450,000 deaths worldwide annually. Breast cancer is the most common cancer among women. The majority of cases are sporadic, meaning there is not a family history of breast cancer, as opposed to genetic, where genes predispose a person to the disease. Men can also develop breast cancer, but it accounts for less than 1 percent of breast cancer cases.

Breast cancer tumors that have the HER2 receptor are called HER2-positive, and those that don’t are called HER2-negative. When researchers analyzed the genomic findings from tumors determined to be HER2-positive by standard cellular tests, they found that only half of the samples could be characterized as belonging to the HER2E subtype. The other half were characterized as Luminal subtypes, suggesting that there are at least two types of clinically defined HER2-positive tumors.

In general, the Luminal subtypes had the lowest overall mutation rate, but by contrast, had the largest number of genes observed to be significantly mutated. This suggests that each of the genes identified as significantly mutated in the Luminal subtypes is more likely to be important in fueling cancer progression.

The Luminal subtypes are characterized by the specific expression signature of multiple so-called transcription-factor genes, including ESR1, GATA3, FOXA1, XBP1 and cMYB. These genes have a complex interaction, cooperating in an orchestrated series of activations. GATA3 and FOXA1 are frequently mutated, but those mutations are mutually exclusive, meaning that mutations were observed in eitherGATA3 or FOXA1 but never in both. However, ERS1 and XBP1 are highly expressed but infrequently mutated.

The scale of the TCGA program allows researchers to perform the integrative analyses that detect these complex patterns of genomic changes and interactions. This close inspection of the cancer genome has led to a deeper understanding of the mutations essential for cancer progression, and several new candidates were identified in this study. The authors hope that discovery of these mutations will be a crucial step toward improving breast cancer therapies.

This publication focuses on the discoveries made through a combined analysis involving data from 825 breast cancer cases, which are freely available in the TCGA Data Portal, with several hundred more cases to come.

“The data generated by the TCGA program comprise a vast resource that investigators will be analyzing for years to come. The resource of information about breast cancer genomes will undoubtedly fuel myriad discoveries by the cancer research community,” said Eric D. Green, M.D., Ph.D., NHGRI director.

So far, The Cancer Genome Atlas Research Network has published analyses on these cancers: glioblastoma multiforme, ovarian serous adenocarcinoma, colorectal adenocarcinoma and lung squamous cell carcinoma.

Continuing its commitment to increasing the numbers of primary care physicians in California, the Office of Statewide Health Planning and Development (OSHPD) awarded more than $2.89 million to 29 family practice residency training programs.

The awards are administered through OSHPD’s Song-Brown Program.

“Educating and training these new medical professionals improves quality and access for all Californians as we continue to promote a diverse and competent health care workforce,” said OSHPD Director Robert P. David.

Family practice programs receiving awards:

Natividad Medical Center $206,460

UCSF – San Francisco General Hospital $206,460

University of California, Davis $206,460

USC – California Hospital $206,460

White Memorial Medical Center $206,460

San Joaquin General Hospital $154,845

UCSD Combined Family Medicine-Psychiatry $154,845

Hanford Family Medicine $103,230

Harbor – UCLA Medical Center $103,230

Kaiser – Orange $103,230

Kaweah Delta Health Care District $103,230

Mercy Medical Center, Merced $103,230

Riverside County Regional Medical Center $103,230

UCSF – Fresno $103,230

Valley Family Medicine Residency of Modesto $103,230

Contra Costa County Health Services $51,615

Glendale Adventist Medical Center $51,615

Kaiser Permanente – San Diego $51,615

Loma Linda University $51,615

Long Beach Memorial Medical Center $51,615

Mercy Medical Center, Redding $51,615

Northridge Hospital $51,615

Pomona Valley Hospital $51,615

Presbyterian Intercommunity Hospital $51,615

San Jose – O’Connor Hospital $51,615

Santa Rosa Family Medicine $51,615

Scripps Mercy Hospital, Chula Vista $51,615

University of California, Los Angeles $51,615

Ventura County Medical Center $51,615

The awards are funded by the California Health Data and Planning Fund, which was statutorily established to receive and expend revenues in support of health care related programs.

The funds are generated through annual fees collected from health facilities.

The Song-Brown Program was established by the Health Care Workforce Training Act to increase the number of family practice physicians, family nurse practitioners, physician assistants, and registered nurses trained in the state to provide needed primary care medical services to Californians.

For more information about the Song-Brown Program, please contact the program at 916-326-3752, or visit http://www.oshpd.ca.gov/HWDD/Song_Brown_Prog.html .

UKIAH, Calif. – Michele Ford Barrera, LVN, has been named the new gastroenterology (GI) coordinator at Ukiah Valley Medical Center.

“You need a good sense of humor when talking about GI,” said Barrera.

Barrera, who accepted the position in August, was selected for her vast knowledge of GI services and experience in working with local GI specialists Harry B. Matossian, M.D., and Brian L. Hanson, M.D., said Heather Van Housen, UVMC chief nursing officer and vice president of patient care.

“Michele is helping to develop a more robust GI program at UVMC,” said Van Housen. “Her knowledge and skill will be utilized in performing procedures, helping us acquire equipment and the supplies we need to provide advanced up-to-date services for the communities we serve.”

According to Barrera, “I have a great working relationship with the GI specialists, Drs. Hanson and Matossian, and with the general surgeons that perform specialized GI procedures already. I look forward to working even more closely with them to ensure we’re providing our guests with the most excellent care possible.”

In addition to working with the physicians, Barrera explained, “I will also be responsible for coordinating staff training on new technology and procedures, implementing infection control and performance improvement programs and coordinating and performing preventive maintenance on equipment.”

Most importantly, Barrera shared, “UVMC has the most advanced GI procedures available anywhere in Lake and Mendocino counties, so there is no need to travel further than UVMC.”

NORTH COAST, Calif. – Every year, Mendocino Community Health Clinic (MCHC) brings HealthCorps to the area to reach out to vulnerable populations and improve health in the community.

This year Lucy Shapiro and Jessica Ohland have joined the MCHC team.

HealthCorps is a national program similar to the international program, Peace Corps. HealthCorps members devote 1,700 hours over the course of about ten months at a pay rate that makes some of them feel they are volunteering most of the time.

The HealthCorps mission is to implement innovative in-school models that inspire students to make healthier choices for themselves and their families.

As such, a big focus of the MCHC program is a school-based dental outreach program called SMILES.

The SMILES team is made up of HealthCorps members and licensed MCHC dental employees who go to local classrooms in Lake and Mendocino counties to educate students about the importance of dental hygiene. The age-appropriate education focuses on the importance of brushing and the effect of sugar on teeth.

In spring, HealthCorps members will shift their attention from the SMILES program to the patient-centered health home (PCHH) initiative.

MCHC is working toward national recognition as a pioneering clinic in this new approach that encourages patients to play a more central role decisions about their health care.

The PCHH works with patients to create care plans to address both acute and chronic problems. It is a proactive model that helps assure that patients get the education and screenings they need to treat health issues before they reach a crisis point.

This year’s HealthCorps members have different backgrounds, but a similar dedication to community health. Shapiro is returning for her second year of HealthCorps this year.

Originally from the Washington, DC suburb of Alexandria, Virginia, Shapiro fell in love with Mendocino County. “I had never been in a place where people recognize you and you can really make a difference. I feel like I can be part of important changes here,” she said.

Shapiro attended college in Colorado, but before finishing felt she needed a little real-world experience to guide decisions about her future. HealthCorps provided just that. “I want to do something with nutrition and education, but I’m not sure exactly what,” she said. She’ll be applying to colleges to begin again next fall, and plans to attend graduate school after that.

Ohland is homegrown, more or less. Although she was born in South Africa, she has lived in Mendocino County for the past 10 years. She recently graduated from Sonoma State with a bachelor’s degree in cellular and molecular biology after first attending Mendocino College.

Her husband works at the Savings Bank of Mendocino County in Ukiah, so when she finished school, she applied for a position at MCHC. When the MCHC interviewer saw Ohland’s impressive resume, she recommended Ohland apply for the HealthCorps position and the rest is history.

Because she says she “doesn’t want to spend the rest of her life on the [laboratory] bench,” Ohland plans to attend graduate school to pursue a master’s degree public health after her HealthCorps term.

LAKEPORT, Calif. – Sutter Lakeside Hospital is making upgrades to its facilities in order to improve safety for its patients and staff.

This month, Sutter Lakeside Hospital will install bariatric lifts in all four of the intensive care patient rooms. These lifts are mounted on the ceiling and allow hospital staff to transfer, lift and transport patients using an overhead track system. The lifts can be raised and lowered by a motor via a control panel.

“These lifts will improve both patient and staff safety,” said Chief Administrative Officer Siri Nelson. “Nurses and aides, in particular, do a lot of lifting throughout their workday. These lifts will make it possible to lift and transport critically ill patients safely and effectively with very little physical effort on the behalf of staff.”

The new lifts are just one piece of Sutter Lakeside’s overall plan to continue to highlight patient safety.

This fall, Sutter Lakeside Hospital launched a standardized communication technique known as S-BAR. This communication technique allows staff and physicians to share patient information in a concise and structured format, ensuring all critical information is passed from one caregiver to the next.

S-BAR, which stands for “situation, background, assessment, recommendation,” is used during patient hand-offs at nursing shift changes, patient transfers to other levels of care and critical conversations between physicians and staff.

“S-BAR was actually designed by the U.S. Navy as a communication system. Hospitals around the country have used it to improve efficiency and accuracy, so that patients get the right kind of care that they need when they need it,” explained Teresa Campbell, chief nursing executive at Sutter Lakeside.

Sutter Lakeside Hospital is also continuing to improve its documentation related to Core Measures.

Core Measures are designed to improve the quality of health care by instituting a national, standardized performance measurement system. They were created as part of value based purchasing by the Centers for Medicare and Medicaid Services.

There are 35 different Core Measures that fall into four categories: care for pneumonia patients, congestive heart failure, surgical care infection prevention and acute myocardial infarction.

Each category includes a list of actions that represent evidence based clinical practices that have demonstrated improvements in patients’ health over time. Core Measures have been proven to prevent recurrences and reduce the risk of complications.

“Core Measures help us improve patient care quality by focusing on the results of their care,” said Tammy Spitzer, RN and quality delivery specialist with Sutter Lakeside. “Instead of reviewing patient charts after their release from the hospital, we now evaluate their charts during their inpatient stay to ensure that all patients are treated with the state-of-the-art care practices.”

“I’m excited to be a part of health care today at Sutter Lakeside,” said Sutter Lakeside Chief Administrative Officer Siri Nelson. “We have the tools that we need to ensure that our patients receive the safest care and that our staff is able to perform their jobs with both a high level of accuracy and a low risk of injury.”

LAKEPORT, Calif. – Donors, employees and physical therapy patients gathered at the Sutter Lakeside Hospital campus on Aug. 30 to celebrate the opening of the completed outdoor mobility park.  

The park will provide a private space for those recovering from illnesses and injuries to master real-world skills, from navigating difficult terrains to redeveloping fine-motor skills under the watchful eye of a physical therapist.  

The mobility park allows patients to build their physical skills while developing the sense of confidence necessary to accomplish these tasks in a public environment.

Dr. Martin Brotman, Sutter Health senior vice president of education, research and philanthropy, spoke about the importance that philanthropy will play in the future of health care.  

“Philanthropy actually has a Greek origin. ‘Philos’ means ‘loving’ and ‘anthropos’ means ‘man.’ So the word means “love of mankind in general,” Dr. Brotman explained. “And Lake County particularly exhibits this quality.”

Chief Administrative Officer Siri Nelson agreed with Dr. Brotman’s sentiments. “I am just so excited to share this project with you. The mobility park, this space that we’re looking at right now, would still be just grass and trees without your generosity and support. Thank you for believing in this project.”

Director of Rehabilitation Services Joe Prisco introduced a physical therapy patient who attended the ribbon cutting ceremony to guests, adding, “The mobility park will make an enormous impact on so many people for years to come. It provides a higher level of rehabilitation that will help our community members gain the essential level of skills that they need to return to an active, satisfying and happy life.”

Certification of the park is expected to be completed before Oct. 1 and physical therapy patients of Rehabilitation Services at Sutter Lakeside will use the park immediately.