A World Without Breast Cancer?

There isn’t a country on this planet where there isn’t someone dreaming of curing cancer. What if there was something even more spectacular than curing cancer? What if you could stop cancer right in its tracks and eliminate its existence. Prevent it. Squash it before it starts.

Vincent Tuohy, PhD, an immunologist at Cleveland Clinic, may be on a path toward living this dream. This month at our hospital’s quarterly meeting, Tuohy was awarded Cleveland Clinic’s F. Mason Sones Award for 2010 Innovator of the Year for his recent breakthrough that may one day prevent breast cancer and perhaps revolutionize our approach to fighting all cancers.

Tuohy has spent the past eight years working to create a vaccine to prevent breast cancer. He and his team have found that vaccination with the protein α-lactalbumin prevents breast cancer in mice. His results were published in Nature Medicine, one of the most respected science journals, last summer.

The study yielded dramatic results. A group of mice that were at high risk to develop cancer according to their genetic profile was selected. Half of the mice were given the vaccine and half were not. All the ones given the vaccine did not develop breast cancer. All the ones not given the vaccine developed breast cancer. Yes, these are mice, and human trials are yet to begin. It may be ten years before we have a finished product, but such overwhelming results are promising and exciting.

Two vaccines that prevent cancer actually already exist. Vaccines that prevent Hepatitis B Virus and the Human Papilloma Virus, which in turn prevent hepatocellular carcinoma and cervical cancer respectively, are currently widely available. However, they work by preventing viruses that cause the cancer. Neither actually prevent the cancer directly. Tuohy’s strategy to prevent breast cancer doesn’t use a secondary target such as a virus, but rather targets the cancer directly.

What makes this story remarkable is that Tuohy is not an oncologist by training. He is an immunologist. His unique perspective allows him to approach the eradication of cancer from an entirely different angle. First, he searches for immune targets within tumors that aren’t found in healthy tissues. For example, the protein α-lactalbumin is found in most breast cancers but not found in healthy women (except during lactation). Then, by exposing an individual to a tuned down less harmful version of this self-target (in this case α-lactalbumin) an immune response is created that protects against any developing tumor without attacking normal healthy tissue. Thus, the “self-protein” (α-lactalbumin in this case) serves as a safe substitute for a viral target to provide immune protection against the development of the cancer.

I spoke with Tuohy that evening after he won the award. He sees the world of cancer and prevention differently. I’ve always advocated telling my patients to stop smoking and to eat healthy and schedule their cancer screenings. While this is important, Tuohy pointed out that such screenings are early detection rather than true primary prevention. Prevention in its purest form is actually eliminating the existence of disease through means such as vaccination. Most of our vaccinations are targeted toward children to combat traditional diseases that served as major causes of death in the past. The childhood vaccination initiative is one of the most successful breakthroughs in the history of medicine, but we’ve failed to think about how modern adult diseases could be approached from a vaccination perspective.

In this case an alternative perspective has allowed for the development of a revolutionary strategy that may halt breast cancer one day. A decade ago, while at an entrepreneurial conference, I was exposed to the concept of convergence, which postulated that all great breakthroughs are simply the creative assembly of different ideas already in play. This is precisely what happened in this instance. Tuohy borrowed his ideas from the immunology field and tied them to his interest in oncology to develop a new way of doing things. Analyzing historical breakthroughs across fields reveals that society is littered with similar examples. Unfortunately, medicine is an insular field that operates in silos too often and thus fails to value and use this approach enough. In fact, Tuohy has been rejected repeatedly for funding for this novel and effective strategy in large part perhaps because he is perceived as an “outsider” and not thinking within the mainstream of medical orthodoxy.

I love the field of medicine. The medical breakthroughs developed by great minds that I read about or witness every day are awe inspiring. However, we have much work to do as many basic operational principles omniscient in other industries have failed to become standard in medicine. In my experience, other industries create an environment that is more open to new ideas than the healthcare industry is. The culture in healthcare is to either agree or dispute a new idea (more often disputing it) in a binary fashion. A new idea should be viewed as a seed, and people in the organization should bounce ideas off it to allow the seed to sprout and grow. The most creative companies in the world such as IDEO do this by bringing people from all fields together in an open and non-threatening environment to brainstorm new ideas . Contrast this to the medical field where words such as brainstorm and creativity are essentially foreign.

This resistance in medicine not only halts the development of ideas but it also prevents our ideas from being disseminated at a rapid rate. Medicine still produces great innovations, but I can’t help but think how much faster these innovations could be disseminated if our culture embraced alternative viewpoints more often? Vince Tuohy has realized that our healthcare system has failed to exploit the potential of immune protection against cancers and other adult diseases. People can either resist this idea or they can embrace it and join in on developing innovative solutions to battling cancer and disease.

Vipan Nikore, MD, is an Internal Medicine Resident Physician at the Cleveland Clinic. He received an MBA from the Yale School of Management, an MD degree from the University of Illinois-Chicago, and a BS in computer science and software engineering from the University of Western Ontario. He has led projects at UNICEF in India, the WHO in Geneva, IBM, Sun Microsystems, Citibank, UCLA, and the Ontario Ministry of Health. He is the President and Founder of the youth leadership non-profit Urban Future Leaders of the World (uFLOW). His posts are personal views and do not necessarily reflect the opinions or positions of the Cleveland Clinic.

5 replies »

  1. This is amazing news, and I’m so excited to see where this will take cancer prevention in the future. Being a woman whose family has a history of breast cancer, and having three children, this is extremely important to me. I too thank Dr. Tuohy!

  2. It works on mice. What about human? However, I’m happy to hear this news and hope the vaccine works on human as well. Thanks to Dr. Tuohy.

  3. Okay – do we:
    a] have a date for the commencement of human trials and
    b} somewhere where we can sign up?
    Great article about a very interesting man.

  4. Vip – great article. I cannot wait to see how Dr Tuohy’s vaccine will perform in human subjects at high risk to develop breast cancer. I love IDEO, and agree that a standard in medicine to help foster innovation could be greatly rewarding for all of us.