By Mary Jane Dittmar
“You just can’t imagine what it’s like to sit there and hear the doctor tell you, ‘You have cancer,’” my husband said while we were discussing options for treating his prostate cancer. He was right. Only the person involved can truly know that feeling. But, those close to the patient—family members, coworkers, and friends—come pretty darn close. I can attest to that. Our family was engaged in working through prostate cancer (husband, age 59) and ovarian cancer (daughter, age 39).
There’s no denying that cancer is a formidable opponent for firefighters, as is fire. The closer you are to the top of your wellness game, the more resources you can bring to the battlefront.
As with fire, you do not engage in the fight alone. Dealing with cancer is not a one-person activity. In addition to the physical issues, it often adds to our mental and emotional burdens. As is true for other mental and emotional burdens, the wisest and the most effective course of action is to seek help. Preventing and fighting cancer are jobs for a team.
Similarities of the “Healthground” and the Fireground
Performance on the “healthground” is in some ways no different from that on the fireground. They both necessitate preparation, commitment, self-awareness, and courage. For example, you must do the following:
Study and train. Just as there is no such thing as having too many tools in your toolbox or too much information in the “computer under your helmet,” there is no such thing as learning too much about what makes you “tick,” what works best for you, or what is going on in the medical field and the technological arena that will aid you.
Be open-minded. Just as research and technology have made firefighting safer for firefighters, cancer research has been reporting almost daily findings that identify genes, enzymes, and other components of the human anatomy and their roles in cancer. Researchers are methodically stripping away those mysteries that have made cancer treatment a challenge, resulting in the development of new diagnostic tests, treatments, and medications and the lessening of side effects for patients. Individuals will share in these benefits only if they are open to evaluating new information and trying new ideas.
Strive for wellness—a more fit body, a better diet, a balanced and moderate lifestyle independent of alcohol/drugs and other “crutches,” and regularly scheduled check-ups and screenings. Don’t neglect your mind and spirit. They have power over your body as well. Take the time to “lighten up,” whether by listening to music, doing puzzles, watching videos, or reading books that make you laugh. Reading the Bible or other inspiring messages have done much to get me through the tough times. There is something liberating about sharing a problem that is beyond our capacity to resolve with a Power that is unlimited. Faith can move mountains, even if the mountain is fear or uncertainty.
Experience has taught me also the value of other perspectives:
Never lose sight of the fact that you and your body are unique. Therefore, no food, medicine, or therapy will work the same in all people. Don’t let the statistics interfere with your fighting spirit. In many cases today, if one protocol doesn’t work, there is another to try, and chances are that some of the new ones may be more genetically akin to you. There is no average person, and only God knows when we will die. There are inexplicable things happening every day that doctors and scientists cannot explain and that some people call “miracles.”
In fact, researchers in the 2016 National Institute for Occupational Health and Safety (NIOSH) firefighter cancer study state that the findings in the study “do not mean that healthy firefighters will get cancer. The message is: Firefighters, on average, have a higher risk of certain types of cancer compared to the general population.”1 They explain that additional factors are involved, including genetics.
Consider also that some of the high-risk factors like not wearing your self-contained breathing apparatus (SCBA) during overhaul and other situations where you may be exposed to smoke or fumes were the vogue in the fire service at one time; therefore, firefighters entering the service after wearing the SCBA under these conditions became mandatory may benefit from being spared those exposures in their career. Precautions like cleaning carcinogens from your skin with wipes until you can get to the shower after a call, having an exhaust removal system for diesel fumes in your station, and not storing dirty gear in your sleeping quarters that are now common in departments also can affect the degree of risk for firefighters.
Think positively. There has never been a time when as much has been known about cancer as today. Granted, there is much more to learn, but we have come a long way from those days when cancer, if mentioned at all, was spoken of only in a whisper or was referred to as “a long illness.” It is not possible to relate in this article all that has been happening that allows us to dare to hope (in some cases, even expect) that breakthroughs will change the cancer landscape once and for all. Research findings have been changing the lives of many cancer patients for the better and are extending hope to many others. Let’s look at some of the technology and initiatives involved in this progress.
Background
The 2016 NIOSH report was one of the major studies that brought to national attention the higher incidence of cancer among firefighters than in the general population. (1) It cited a 14 percent increased risk of dying from cancer compared to the general population. Close to 30,000 firefighters from the Chicago, Philadelphia, and San Francisco Fire Departments participated. Researchers from the National Cancer Institute (NCI) and the University of California at Davis Department of Public Health Sciences observed the firefighters.
Among some of the other findings of the study were the following:
- The most common cancers among firefighters were digestive, oral, respiratory, and urinary.
- Twice as many firefighters as in previous studies had malignant mesothelioma, caused by exposure to asbestos.
- Younger firefighters had more cases of bladder and prostate cancers than expected.
- The incidence of lung cancer increased with the amount of time spent at fires.
- Leukemia deaths increased with the number of fire runs. (1)
It is not within the scope of this article to discuss the numerous actions the fire service has taken to lower the cancer risks in the fire station and on the fireground or initiatives fire departments have implemented in addition to those mentioned above, such as nutrition and exercise programs and educational programs offered by the unions and fire service organizations.
Cancer MoonshotSM2
The Cancer MoonshotSM, later renamed the “Beau Biden Cancer Moonshot,” in memory of the late son of former Vice President Joe Biden who died of a brain tumor, is a multiyear comprehensive initiative that has as its goals the following: to accelerate cancer research, to make more therapies available to more patients, and to prevent cancer by detecting it at an early stage. Joe Biden heads the program. A blue-ribbon panel of experts was established as a working group of the National Cancer Advisory Board. In December 2016, Congress passed the 21st Century Cures Act, which authorized $1.8 billion in funding for the Cancer Moonshot over seven years3 and appropriated an initial $300 million in fiscal year (FY) 2017 to fund Moonshot initiatives.
Panel Recommendations
The Moonshot blue-ribbon panel recommended that the network include the following:
- Direct patient involvement. Patients would contribute their comprehensive tumor profile data, which would increase knowledge about what therapies work, in whom, and in which types of cancer.
- A cancer immunotherapy network to discover why immunotherapy is effective in some patients but not in others.
- Therapeutic targets for detecting mechanisms that lead cancer cells to become resistant to previously effective treatment.
- A national ecosystem for sharing and analyzing cancer data so that researchers, clinicians, and patients can contribute data.
- Intensified research on the major drivers of childhood cancers.
- Accelerated development of guidelines for routine monitoring and management of patient reported symptoms.
- Expanded use of proven cancer prevention and early detection strategies.
- Studying past patient data to predict future patient outcomes.
- Predicted response to standard treatments through retrospective analysis of patient specimens.
- Dynamic 3-D maps of human tumor evolution to document the genetic lesions and cellular interactions of each tumor as it evolves from a precancerous lesion to advanced cancer.
- New cancer technologies to characterize tumors and test therapies. (2)
Precision Medicine
A significant provision of the Cures Act was to create a National Institute of Health Innovation Account ($4.8 billion) to support the Precision Medicine Initiative ($1.45 billion over the next 10 years). The Cures statute states the purpose of the Cancer Moonshot funding as follows: “To support cancer research, such as the development of cancer vaccines, the development of more sensitive diagnostic tests for cancer, immunotherapy and the development of combination therapies, and research that has the potential to transform the scientific field, that has inherently higher risk, and that seeks to address major challenges related to cancer.”
Precision Medicine is a new model of patient-powered research. It “promises to accelerate biomedical discoveries and provide clinicians with new tools, knowledge, and therapies to select which treatments will work best for which patients.” The rationale is that most medical treatments have been designed for the “average patient,” (2) meaning that treatments may be very successful for some patients but not for others. Precision Medicine takes into account individual differences in people’s genes, environments, and lifestyles.
Advances in Precision Medicine have already led to powerful new discoveries and several new treatments tailored to specific characteristics of individuals, such as a person’s genetic makeup or the genetic profile of an individual’s tumor. Through collaborative public and private efforts, Precision Medicine will make it possible to manage and analyze large data sets while protecting privacy to accelerate biomedical discoveries. A million or more Americans will volunteer to contribute their health data to improve health outcomes, accelerate the development of new treatments, and bring about a new era of data-based and more precise medical treatment. A fact sheet on the Precision Medicine Initiative is at http://bit.ly/2xf9dxh.
NCI and the Cloud4
The Cancer Moonshot goal of expanding cancer data access and data sharing led to the sharing of public and private data between the NCI and Cloud providers Amazon Web Services and Microsoft, which will facilitate collecting, integrating, and sharing cancer datasets of researchers across the country. “Using the Cloud enables the integration of large datasets stored in different databases and formats so the data can be analyzed as an integrated dataset,” explains Tony Kerlavage, Ph.D., chief of the NCI Center for Biomedical Informatics and Information Technology. As part of the Precision Medicine Initiative, NCI undertook the NCI Genomic Data Commons, which, the NCI stated in a 2014 press release, is “to store, analyze and distribute cancer genomics data generated by NCI and other research organizations.”
“Launched in 2016, the Cancer Genomics Cloud (CGC) Pilots are providing cancer researchers access to genomic data colocated with the elastic computer of the cloud and a variety of analytic tools and pipelines,” says Kerlavage. Many in the cancer research community have come to rely on the Cloud platforms built by the Broad Institute, the Institute for Systems Biology, and Seven Bridges for their cancer research. NCI will continue to support them beyond the pilot phase as Cloud Resources. Additionally, NCI anticipates collaborating with other commercial cloud providers to broaden access to the data. “The commercial cloud collaborations and the CGC Pilot expansion are expected to enhance cancer researchers’ abilities to make new discoveries from an unprecedented range of datasets and data types and could significantly change cancer outcomes and benefit patients around the world,” Kerlavage says.
CANDLE: Artificial Intelligence5
NVIDIA Corporation is working with the NCI, the U.S. Department of Energy, and national research laboratories to build a common discovery platform for cancer called CANDLE, based on today’s state-of-the-art technology: artificial intelligence (AI). AI uses “deep learning,” a technique in which computers teach themselves from massive volumes of data.”
“We now know that AI requires three key elements to be practical,” says Kimberly Powell, senior director, Deep Learning, “massive amounts of data, sophisticated algorithms, and high-performance parallel processors (GPUs).” She explains: “We apply these same three ingredients, feeding petabytes of cancer data from the NCI into CANDLE, a deep learning platform for the nation’s most advanced GPU-accelerated supercomputers.” NVIDIA engineers and computational scientists will develop an AI software framework optimized for the latest supercomputing infrastructure. The goal is to achieve 10× annual increases in productivity for cancer researchers.
Deep learning techniques are used in the three CANDLE precision medicine pilot projects:
- Discovery of the underlying genetic signatures in the DNA and RNA of common cancers. Researchers will use the molecular data collected by the Cancer Moonshot Initiative to predict how patients will respond to treatment.
- Acceleration of the molecular dynamic simulations of key protein interactions. This information will help researchers understand the underlying biological mechanisms that create conditions for cancer.
- Automated information extraction and analysis of millions of clinical patient records to build a comprehensive cancer surveillance database of disease metastasis and recurrence.
“The goal of all these efforts is simple: expedite individual treatments, discover new treatments faster, and more accurately predict how each patient’s cancer will evolve,” Powell says.
Some Recent Research Findings
CAR-T gene therapy. Developed by the University of Pennsylvania and Novartis Corp. Immune cells are removed from a patient’s blood, reprogrammed to create a supply of cells that can target and destroy cancer cells, and are injected back into the patient. In a key test, results were said to be “far better than chemotherapy and even newer types of cancer drugs.” According to Dr. Malcolm A. Smith, NCI, “This is a major advance. The treatment is ‘ushering in a new era.’” Other biotech and pharmaceutical companies are developing types of gene therapy to treat solid cancers and rare gene-linked diseases.
Source: WABC, Linda A. Johnson, July 12, 2017.
Preventing metastases. A nanolaser, known as the spaser, can detect and then kill metastasized cancer cells (CTCs) in the bloodstream. Used as an optical probe, it is released into the body (possibly through an injection or by drinking a solution); it can find and go after circulating tumor cells, stick to them, and destroy them by breaking them apart to prevent cancer metastases. The discovery was made by researchers at Georgia State University, the University of Arkansas for Medical Sciences, the University of Arkansas at Little Rock, and the Siberian Branch of the Russian Academy of Science. ”There is no other method to reliably detect and destroy CTCs,” says Dr. Mark Stockman, director of the Center for Nano-Optics and professor of physics at Georgia State. “This is the first.” The spaser does not kill or damage healthy cells.
Source: Georgia State University press release, Aug. 21, 2017.
Lethal brain cancers in mice. New research conducted in mice has shown that high-grade gliomas (highly lethal brain tumors) stop growing when they do not have access to a specific molecule naturally produced when brain cells fire. The experiments were led by a group of scientists from Stanford University, Palo Alto, California, who say that targeting the neuroligin-3 protein may prove beneficial in patients with gliomas. “This study transforms our understanding of how neurons influence the growth of gliomas and opens a new door for potential treatments,” says National Institute of Neurological Disorders and Stroke (NINDS) Program Director Jane Fountain, Ph.D. The work was supported by NINDS, part of the National Institutes of Health (NIH).
Source: Venkatesh et al. “Targeting neuronal activity-regulated neuroligin-3 dependency in high-grade glioma.” Nature. September 20, 2017. doi: 10.1038/nature24014). The NIH News release is at http://bit.ly/2xsJnF4/.
Predicting cancer recurrence. This genetic test involves the study of mitochondrial genes and could help predict when cancer will recur. The goal is to develop more precise, personalized treatments. Mitochondrial genes prove more accurate than current methods of predicting a patient’s response to treatment.
Sources: University of Salford. Federica Sotgia, Marco Fiorillo, Michael P. Lisanti. “Mitochondrial markers predict recurrence, metastasis and tamoxifen-resistance in breast cancer patients: Early detection of treatment failure with companion diagnostics.” Oncotarget, 2017; DOI: 10.18632/oncotarget.19612 “New genetic for predicting cancer recurrence.” ScienceDaily. ScienceDaily, 21 September 2017. www.sciencedaily.com/releases/017/09/170921095026.htm.
Cancer cells sometimes take over healthy cells. When cancer-associated fibroblasts (CAFs) take over fibroblasts, healthy cells that hold together various types of organs, they help tumors grow, spread, and resist therapy. Previous attempts at targeting these CAFs have been unsuccessful.
In this study, researchers at the University of Southampton in the UK confirmed findings of previous studies that CAFs resulted in poorer survival in patients with several cancers including bowel, head, and neck cancers. They discovered that the enzyme NOx4 is needed for the formation of CAFs and that they could stop the CAFs by blocking NOx4 using a drug being developed to treat organ fibrosis. Additional research is being funded to see if this approach improves treatments like immunotherapy and chemotherapy. The sizes of tumors in mice were reduced by up to 50 percent.
Sources: Christopher J. Hanley, Massimiliano Mellone, Kirsty Ford, Steve M. Thirdborough, Toby Mellows, Steven J. Frampton, David M. Smith, Elena Harden, Cedric Szyndralewiez, Marc Bullock, Fergus Noble, Karwan A. Moutasim, Emma V. King, Pandurangan Vijayanand, Alex H. Mirnezami, Timothy J. Underwood, Christian H. Extensimeter, Gareth J. Thomas. “Targeting the Myofibroblastic cancer- “Associated Fibroblast Phenotype through Inhibition of NOX4.” JNCI: Journal of the National Cancer Institute, 2018; 110 (1) DOI: 10.1093/jnci/djx121. Cancer Research UK. “Scientists deliver knockout blow to multiple cancers.” ScienceDaily. ScienceDaily, 2 August 2017. www.sciencedaily.com/releases/2017/08/170802201201.htm.
Researchers have provided a map of dependencies between some 500 known tumor alterations and their response to more than 200 common cancer drugs. They found that some co-occurrences between genomic alterations can make tumor cells resist some drugs and also make them sensitive to other “unexpected” drugs. The researchers developed a theoretical framework to predict the co-occurrences of such alterations and their anticipated response to more than 200 common cancer drugs, a crucial first step in improving the design of personalized therapeutic approaches. It can be a reference for functional and preclinical studies.
Sources: Marco Mina, Franck Raynaud, Daniele Tavernari, Elena Batistello, Stephanie Sungalee, Sadegh Saghafinia, Titouan Laessle, Francisco Sanchez-Vega, Nikolaus Schultz, Elisa Oricchio, Giovanni Ciriello. “Conditional Selection of Genomic Alterations Dictates Cancer Evolution and Oncogenic Dependencies.” Cancer Cell, 2017; DOI: 10.1016/j.ccell.2017.06.010.
Swiss institute of Bioinformatics. “From cancer evolution to personalized therapies.” ScienceDaily. ScienceDaily, 14 August 2017. www.sciencedaily.com/releases/2017/08/170814092727.htm.
Endnotes
1. “Findings from a Study of Cancer among U.S. Fire Fighters,” National Institute for Occupational Health and Safety. July 2016; https://www.cdc.gov/niosh/pgms/worknotify/pdfs/ff-cancer-factsheet-final.pdf/.
2. Cancer MoonshotSM https://www.cancer.gov/research/key-initiatives/moonshot-cancer-initiative/blue-ribbon-panel/.
3. Cures funds the Beau Biden Moonshot Initiative through FY2023: $300 million for FY 2017 and FY 2018; $400 million for FY 2019; $195 million for FY 2020 and FY 2021; $194 million FY 2022; and $216 million for FY 2023.
4. “Advancing a National Cancer Knowledge System,” Tony Kerlavage, Ph.D., National Cancer Institute Center for Biomedical Informatics and Information Technology (CBIIT); https://medium.com/@theNCI/advancing-a-national-cancer-knowledge-system-a1c016046fbe.
5. “How We’re Bringing AI to the Fight Against Cancer,” Kimberly Powell,” Dec 12, 2016; https://medium.com/cancer-moonshot/how-were-bringing-ai-to-the-fight-against-cancer-3a7949f12b51/.
Additional Resources:
“Fire Station Aims to Prevent Firefighter Cancer Risk,” 09/08/2017; http://www.fireapparatusmagazine.com/articles/pt/2017/09/fire-station-aims-to-prevent-firefighter-cancer-risk.html/.
“Harvard Researchers Examine Firehouse Cancer Threat,” 08/14/2017; http://www.fireapparatusmagazine.com/articles/pt/2017/08/harvard-researchers-examine-firehouse-cancer-threat.html/.
“Fire Service Cancer Drives Regionwide Collaboration in Florida,” Todd J LeDuc and Samuel A Eaton, June 2017; http://emberly.fireengineering.com/articles/print/volume-170/issue-6/features/fire-service-cancer-drives-regionwide-collaboration-in-florida.html/.
IAFF Redmond Symposium 2018: GPS Cancer, Lennie Sender, MD NantHealth, presents about cancer,” 08/10/2017; http://www.firefighternation.com/articles/2017/08/iaff-redmond-symposium-2018-gps-cancer.html/.
The National Cancer Institute; https://www.cancer.gov/.
NIOSH Fire Fighter Cancer Study Website http://www.cdc.gov/niosh/firefighters/ffcancerstudy.
NIOSH Study of Firefighters Finds Increased Rates of Cancer; press release; http://www.cdc.gov/niosh/updates/upd-10-17-13.html/.
NIOSH Science Blog: Is There a Link Between Firefighting and Cancer? – Epidemiology in Action http://blogs.cdc.gov/niosh-science-blog/2014/12/17/cancer-ff/.
Mary Jane Dittmar is senior associate editor of Fire Engineering and conference manager of the Fire Department Instructors Conference (FDIC) International. Before joining Fire Engineering in January 1991, she served as editor of a trade magazine in the health/nutrition market and held various positions in the educational and medical advertising fields. She has a bachelor’s degree in English/journalism and a master’s degree in communication arts.
