Why Focus on Prevention?

According to the National Cancer Institute (NCI), about 1.6 million people were diagnosed with cancer in the United States in 2014. In addition to the physical and emotional distress caused by cancer, the high costs of care are a burden to patients, their families and the public.

Fortunately, the number of new cancer cases can be lowered and many cancer-related deaths can be avoided by cancer prevention research and education. Here at Moffitt our researchers and physicians are studying many different ways to prevent cancer.

TOBACCO RESEARCH AND INTERVENTION PROGRAM
Moffitt’s Tobacco Research and Intervention Program (TRIP) began in 1997 under the leadership of director Thomas Brandon, Ph.D., and is located on Fowler Avenue. TRIP scientists conduct basic and applied behavioral research on tobacco use, with an emphasis on investigating factors contributing to the maintenance of smoking, smoking cessation and smoking relapse.
TRIPS’s self-help booklet series aimed at tobacco cessation, Forever Free™, was so effective that the National Cancer Institute adopted it to assist in its national efforts to help people quit smoking.

MOFFITT CANCER SCREENING AND PREVENTION (LIFETIME)
Moffitt Cancer Center Screening and Prevention is a multi-modality clinic near the cancer center’s main facility. Originally called Lifetime Cancer Screening & Diagnostic Center, the clinic opened its doors in 1993 at the Fowler Avenue location. After the arrival of Dr. Sellers and a focused review of the clinic’s vision, the name was changed to Lifetime Screening & Prevention Center and more recently to its present name to reflect its expanded vision. The facility provides a full range of cancer screening, prevention, and genetic counseling and testing services, and it is scheduled to move to the Moffitt McKinley Outpatient Center in November 2015.

SCREENING, EDUCATION AIM TO PREVENT SKIN CANCER
Moffitt Cancer Center’s Mole Patrol® was established in 1996 to provide screening, educational materials and sunscreen samples to the public, free of charge. The Mole Patrol® comprises physicians and mid-level practitioners, as well as registered nurses and support staff, who specialize in dermatology and/or skin cancer. This skin cancer screening program is mobile and travels to venues all across Florida. If a suspicious skin lesion is found by the Mole Patrol®, the individual receives follow-up recommendations to take to a primary care physician, one of the program’s participating affiliate institutions or Moffitt Cancer Center.

CANCER PREVENTION THROUGH GENETIC SUSCEPTIBILITY STUDIES
Identifying genetic susceptibility to cancer allows focused interventions to lower risk and to screen for cancer at early stages when therapies are most effective. Changes in technology have enabled studies that scanned the entire genome on a single “chip” to identify susceptibility genes. Moffitt is involved in several genome-wide association study consortia, and it played key roles in the identification of numerous genetic links to a variety of cancers.
One of the consortia is focused on ovarian cancer, the fifth-leading cause of cancer death among women. Although mutations in the BRCA1 and BRCA2 genes remain the strongest genetic risk factors for ovarian cancer, they don’t account for all of the familial risk, confirming that other genetic risk factors remain to be identified.

Moffitt plays a leading role in the Ovarian Cancer Association Consortium. “Through this collaborative effort, we were able to conduct a large-scale analysis of more than 18,000 women with ovarian cancer and more than 26,000 healthy women, bringing us much closer to understanding the inherited factors that contribute to this disease,” says Dr. Sellers, principal investigator on both Moffitt-led studies. “With the much larger study population in our collaboration, we were able to identify three new genomic regions on chromosomes 8, 10 and 17 that are strongly associated with ovarian cancer risk.” To date, 40 susceptibility genes for ovarian cancer have been discovered.

CHEMOPREVENTION RESEARCH REQUIRES SYSTEMATIC APPROACH
Cancer chemoprevention is the prevention of cancer or the treatment of identifiable pre-cancers through the use of natural, synthetic or biologic compounds. Nagi Kumar, Ph.D., R.D., F.A.D.A., senior member of Moffitt’s Epidemiology Program, joined Moffitt in 1986 and currently directs Moffitt’s cancer chemoprevention research efforts. Dr. Kumar and her team have initiated and completed numerous preclinical and early phase I-II clinical trials with purified isoflavones, curcuminoid complex, green tea
catechins, lycopene and more.

HPV VACCINE, THE FIRST CANCER PREVENTION VACCINE
The Center for Infection Research in Cancer (CIRC) was established at Moffitt in 2012 with Anna Giuliano, Ph.D., who came to Moffitt in 2004, as its founding director. Dr. Giuliano’s research explores the connection between viruses, such as human papilloma virus (HPV), and cancer, as well as possible connections between other pathogens and cancer. CIRC was launched with the purpose of revealing the role of various infectious agents in the origin of cancer and translating that knowledge into novel and effective strategies for prevention and treatment.
The HPV vaccine has been a success story. Work with the HPV vaccine has demonstrated success in moving research from the lab to clinical trials and ultimately to U.S. Food & Drug Administration (FDA) licensure. Today, with just one vaccine, it is possible to prevent four types of cancer affecting both women and men.

In December 2014, the FDA approved an eagerly awaited vaccine that protects against nine types of HPV with the potential to increase overall cervical cancer prevention from 70 to 90 percent, nearly eliminating this cancer altogether. The vaccine was Gardasil 9, and the leader of the Moffitt Cancer Center team was researcher Dr. Giuliano. The research report appeared in the Feb. 19, 2015, issue of the New England Journal of Medicine.

Read more about Dr. Giuliano and her work with HPV vaccine research by visiting MOFFITT.org/Momentum and selecting Volume 2; Issue 2.

M-POWER HAS A LONG HISTORY OF EDUCATION, PREVENTION EFFORTS IN THE COMMUNITY
Since 1999, the Moffitt Program for Outreach Wellness Education and Resources (M-POWER; originally called Community Education and Outreach) has provided the community with health education in cancer prevention, early detection and screening. Programs presented in English, Spanish and Haitian Creole have been offered on breast, cervical, prostate, lung, colorectal and skin cancers. Additionally, outreach workers have provided workshops on healthy lifestyles and education about clinical trials. The delivery of cancer prevention occurs via a number of channels, including health events and fairs, such as the Men’s Health Forum and community mammogram screenings.
In partnership with other institutions, including local schools, Moffitt’s Healthy KIDZ Program promotes healthy lifestyles and literacy among children by providing cancer awareness and wellness education in a fun, family-friendly environment.

AUTOMATED BREAST DENSITY MEASUREMENT HELPS PROVIDE CANCER RISK ASSESSMENT
Although mammography is a screening tool for detecting breast cancer and not a preventive measure, a new development in mammography made by researchers at Moffitt could play an important preventive role. “We recently developed an automated method to estimate mammographic breast density that assesses the variation in grayscale values in mammograms,” explains study lead author John Heine, Ph.D., associate member in the Cancer Epidemiology Program at Moffitt.
Studies have shown increased levels of mammographic breast density to be correlated with elevated risk of breast cancer. This new discovery opens the door for translation to the clinic, where it can be used to identify high-risk women for personalized care.

COLORECTAL CANCER EDUCATIONAL MATERIALS DEVELOPED TO IMPROVE SCREENING RATES
Colorectal cancer is the third-leading cancer killer in the United States, despite its detectability and preventability. Low screening rates are a factor, especially among black men and women, a group that has the highest incidence of colorectal cancer. Research by Clement Gwede, Ph.D., M.P.H., R.N., associate member in Moffitt’s Health Outcomes and Behavior Program, seeks to reduce the excess burden of colorectal cancer among this population and has been instrumental in developing a culturally targeted booklet designed to educate participants on the importance of colorectal screening. The booklet has been provided with a home colorectal cancer screening kit.