NEWSLETTER OF THE NCI DIVISION OF CANCER PREVENTION 1

On May 9-10, 2002 the Lansdowne

Resort and Conference Center in

Virginia was the setting for the 4th

annual Division of Cancer Prevention All

Hands Seminar, “The Future is in Your

Hands.” The purpose of the yearly meeting is

to share ideas, strengthen working relationships, and explore opportunities for

Divisional growth and advancement of prevention science. The session afforded individuals the opportunity to reflect on Division

goals, directions and possibilities, and to plan

for the future. 

Dr. Greenwald opened the seminar with

his thoughts on the current state of prevention

science and his expectation of DCP as a global

leader in future endeavors. Dr. Rhey Palmer

served as the seminar facilitator, leading the

group in a variety of team-building and problem-solving exercises, group and self-evaluations, and strategic development activities.

Highlighting the seminar was an address

by Dr. Andrew von Eschenbach, the new

Director of the NCI. Dr. von Eschenbach

shared his vision for the NCI and emphasized

the importance of collaborative relationships

and partnerships as a way to move prevention

to the forefront of the national agenda. His

approach focuses on strong leadership skills

and the application of a sound business

model to translate discovery into clinical practice. In his address to the group he emphaAnnual DCP All Hands Seminar: “The Future is in Your Hands”

JUDY SMITH AND DON HENSON

IN THIS ISSUE

Annual DCP All Hands 

Seminar: “The Future is 

in Your Hands” 1

Mammography Screening 

for Breast Cancer: 

The Controversy Continues 2

DCP Changes Funding 

Mechanism for Contracts 2

Vaccination and Cancer 

Prevention 3

PreventionPOST Credits 3

Cancer Prevention 

Fellowship Program 4

DCP Awardees 5

DCP’s Biometry Research 

Group: What Do We Do? 6

History of Cancer Prevention:

Sylvester Graham 7

Annual Lecture on 

Cancer Prevention 10

Transitions 11

Endpoints 12

July 2002

V O L UME 4/ISSUE 2

NEWSLETTER OF THE NCI DIVISION

OF CANCER PREVENTION

PreventionPOST

The annual DCP All Hands Seminar at Landsdowne Resort 

and Conference Center in Virginia

continued on page 8
DCP is updating its way of conducting business with

scientific investigators interested in chemoprevention. As the time approaches for the old contract

mechanism to expire, a novel and streamlined system has

been formulated in order to enhance the success of the

clinical trial process. The new Request for Proposals

(RFP), titled “Phase I and Phase II Clinical Trials of

Cancer Chemopreventive Agents,” will replace the former

Master Agreement Holder mechanism for conducting these

initial phase drug trials. The closing date for response to

this RFP is August 15, 2002. 

The objective of the new RFP is to conduct multiple,

early phase clinical trials of DCP–sponsored cancer 

prevention agents. An additional goal is to establish an

infrastructure consisting of one or more collaborating institutions that will perform these studies. Chemoprevention

drugs to be evaluated in these clinical trials will be commercially available agents, study drugs developed by the NCI,

or those provided by the pharmaceutical industry to NCI

for collaborative usage.

DCP intends to award multiple contracts under this program. Each Contractor will be able to initiate from one to

five clinical trials per year. The size of each trial will vary

depending on the phase of drug development and the organ

site under study. This new mechanism encourages collaboration among investigators. Offerors must be well organized

and have the capability of recruiting an adequate number of

participants in order to facilitate prompt completion of trials.

Accrual to all trials will be closely monitored. As a further

incentive, Contractors will have the flexibility to subcontract

with investigators at additional sites who can consequently

provide specific technical expertise for biomarker studies. ■

2 PreventionPost JULY 2002

While currently viewed as a routine method for

the detection of breast cancer, conventional

mammography has been the subject of heated

debate over the decades after first gaining popularity in

the mid ’70s. The most recent cause for discussion

resulted from a critique published

in The Lancet by the authors of a

Cochrane Review (O Olsen and PC

Gotzsche, Lancet 358, 1340-1342,

2001). In this report Danish scientists examined seven large longterm trials that were conducted

between the 1960s and the 1980s. 

Five of the earliest studies found a benefit from

screening. However, the critique cited possible flaws in

the way that these early trials were conducted and in

the subsequent data analyses. NCI, after serious consideration of the evidence, reaffirmed its recommendation

that women have mammograms every one to two years

beginning in their forties. The U.S. Preventive Services

Task Force, after more than two years of study, took a

similar position.

Up until World War I there were no methods in place

to detect breast cancer before it presented itself as a

hard mass in the breast, in some instances accompanied

by ominous skin changes and nipple retraction.

However, technology was poised to

impact the diagnosis of a disease

that has plagued women since

ancient times. Roentgen discovered

the x-ray in 1895, and by 1913

Salomon in Germany had used 

x-rays to examine 3000 amputated

breasts. Through this he was able to

differentiate nodular types from other forms of breast

cancer and to make note of microcalcifications. GershonCohen of Philadelphia studied breast x-rays in an effort

to determine mammary patterns and in 1948 was the

first to show the feasibility of detecting non-palpable

cancers. Progress was slow until 1962 when Egan, a

radiologist at M.D. Anderson Hospital in Texas, reported on a study of 2,522 mammograms. These were interMammography Screening for Breast Cancer: The Controversy Continues

KATHLEEN FOSTER

DCP Changes Funding Mechanism for Contracts 

KATHLEEN FOSTER

continued on page 10
IN MEMORIAM

Vaccination and Cancer Prevention R ON LUBET

The Cancer Prevention

Fellowship Program lost an

outstanding young investigator in the field of cervical 

cancer prevention. Kathleen

Jennings-Dozier passed

away on May 16, 2002.

Majoring in nursing,

Kathleen received her

Bachelor of Science degree at

Rutgers University and her

Master of Science degree at

Hampton University. After

obtaining her doctorate at the

University of Pennsylvania,

Kathleen was accepted to the

Cancer Prevention Fellowship

Program, starting in the summer of 1997. Subsequent to

completion of a Master of

Public Health degree, she continued her research off-site at

Thomas Jefferson University,

focusing on cervical cancer

prevention in public housing

residents. In the summer of

2000, Kathleen was awarded

the Cancer Prevention

Research Training Merit

Award for outstanding performance as a Cancer

Prevention Fellow. At the

completion of her fellowship,

she joined the faculty of MCP

Hahnemann University as an

Associate Professor.

EDITORIAL

GROUP:

Doug Weed

(Editor-inChief),

Graça Dores,

Susan Perkins

DESIGN

GROUP:

Judy Smith,

Dee Sullivan,

David Kausal

(photos)

WEB GROUP:

Kathleen

Foster, 

Grant Izmirlian

PRINTING

GROUP:

Don Henson,

Ron Lubet

DISTRIBUTION

GROUP:

Susan Winer,

Gloria Rasband

PreventionPOST

DCP Newsletter Project Team

NEWSLETTER OF THE NCI DIVISION OF CANCER PREVENTION 3

I

n 1967 smallpox killed roughly 2,000,000 persons

worldwide. During the conquest of the Indian populations of North and South America between 1550 and

1850, smallpox, a European disease, killed at least three

times as many as were killed with the sword and the gun.

Yet today, due to immunization, smallpox has virtually

been eliminated. 

Employing the immune response in the realm of cancer

prevention and treatment has been a major hope for at

least 40 years. However, problems associated with this

approach include 1) a limited number of cancer-specific

proteins; and 2) the fact that most cancer-specific proteins

are not totally new to the individual. Therefore, an individual is likely to be “tolerant” or “immunologically unresponsive” to the protein of interest. Nevertheless, recent

advances in identifying proteins expressed primarily in

cancers, as well as discoveries in immunology that may

allow one to “break tolerance,” have resurrected the

hopes for cancer vaccines. 

Immunization Against Infection with Human

Papillomavirus (HPV)

HPV has been implicated in cancers of the larynx, anus,

and skin in immunosuppressed patients. However, its

clearest role is in cervical cancer, which kills roughly

200,000 women worldwide on an annual basis. In an

attempt to block HPV infection, a trial directed by NCI

intramural investigators will give young, sexually active

women a vaccine consisting of proteins from the outer coat

(capsid) of the virus (JT Schiller and DR Lowy, Expert

Opin. Biol. Ther. 1, 571-581, 2001). This vaccine does not

include any other viral proteins or viral nucleic acids, in

contrast to smallpox or polio vaccines, which employ killed

or attenuated whole virus. Success in this trial should affect

cervical cancer incidence, morbidity, and mortality in 15 to

20 years. A vaccine for women already infected with HPV

and with cervical lesions might be achieved by immunizing

against specific viral proteins (e.g., E6 and E7) that are

expressed in HPV-transformed cells. 

Carcinoembryonic Antigen (CEA)

The CEA protein is expressed during fetal development, in

the gastrointestinal (GI) tract, and in various endodermally

derived tumors. Thus, a high percentage of GI tumors

(colon, stomach, esophagus), ovarian cancers, and 

non-small cell lung cancers and perhaps 50% of breast

malignancies express CEA. In order for a substantial

immunologic response against a protein antigen to occur, continued on page 9
Lila J. Finney, a first-year fellow, received the Society of Behavioral

Medicine’s Outstanding Dissertation Award in April 2002. 

Mollie Howerton, a third-year fellow, won second place for her poster,

“Community-based Prostate Cancer Screening: Strategies for

Recruitment,” at the American Society of Preventive Oncology

Annual Meeting in March 2002. 

Claudine Kavanaugh, a third-year fellow, was the recipient of the

American Association for Cancer Research Scholar in Training Award

at the American Association for Cancer Research/NCI meeting,

“Molecular Targets and Cancer Therapeutics: Discovery, Biology, and

Clinical Applications,” in October 2001. 

La Creis Renee Kidd, a second-year fellow, was honored with two

awards this winter: the New Investigators Award by the American

Society of Preventive Oncology and the Minority Scholar Award in

Cancer Research by the American Association for Cancer Research.

Dina N. Paltoo, a second-year fellow, received the American

Association for Cancer Research Minority Scholar Award in Cancer

Research to attend the April 2002 Annual Meeting in San Francisco.

She was also nominated for Who’s Who Among America’s Teachers,

2002, by one of her former students. 

Rachael Stolzenberg-Solomon, a third-year fellow, was presented

with an award in April 2002 by Drs. von Eschenbach and Fraumeni in

recognition of the best paper published in 2001 by a postdoctoral fellow in the Division of Cancer Epidemiology and Genetics. The title of

her paper was, “Helicobacter pylori Seropositivity as a Risk Factor for

Pancreatic Cancer,” published in the Journal of the National Cancer

Institute, 93:937-941, 2001. ■

ON THE PERSONAL SIDE

A W ARDS 

Best wishes to Lila and Derek Finney on the birth of their son, Julian

James, born on March 19, 2002.

Congratulations to Susan Thomas and Matt Vadaparampil on their

recent marriage. ■

Eleven fellows have just returned from receiving their

Master of Public Health degree. Seven graduated from

Johns Hopkins Bloomberg School of Public Health - Hala

Azzam, PhD, MPH; Dilyara Barzani, MD, MS, MPH;

Amanda Greene, PhD, MSN, MPH; Qing Lan, MD, MS,

MPH; Nomeli Nunez, PhD, MPH; Arti Patel, PhD, MPH;

and Shanita Williams-Brown, PhD, RN, CS-FNP, MPH.

This year two fellows graduated from the Harvard School

of Public Health – Lila Finney, PhD, MPH and Kay

Wanke, PhD, MPH. Somdat Mohabir, PhD, MPH graduated from New York Medical College and Whitney

Randolph, PhD, MPH graduated from University of North

Carolina-Chapel Hill.

The Summer Curriculum in Cancer Prevention will

begin on July 1, 2002. Almost 100 researchers and clinicians will be attending this 17th annual, six-week, summer

lecture series. The NCI/All Ireland Consortium is sponsoring 10 students and the Office of International Affairs/NCI

is sponsoring 17 researchers from several countries, including Argentina, Costa Rica, Egypt, Ghana, India, Iran,

Jordan, Kenya, Korea, Malaysia, Nepal, Spain, Turkey,

and Vietnam. Scientists and clinicians from Australia,

Canada, Italy, Japan, South Korea and Thailand make up

the remainder of attendees in addition to current secondyear Cancer Prevention Fellows and other NCI researchers

who have enrolled in the course. 

Recruitment for the Cancer Prevention Fellowship

Program has been very busy this year and the recruitment

booth has an attractive new display. Recent meetings

attended include the American College of Preventive

Medicine, Johns Hopkins Bloomberg School of Public

Health career fair, American Society for Preventive

Oncology, Association of Teachers for Preventive

Medicine, American Association for Cancer Research,

Oncology Nursing Society, Federation of American

Societies for Experimental Biology, Society of Teachers of

Family Medicine, NCI-Frederick/Ft. Detrick Spring

Research Festival, American Society of Clinical Oncology,

Society for Epidemiologic Research and the Cancer Health

Disparities Summit. Assistance in the booth is provided by

Cancer Prevention Fellows attending the meetings. ■

At the Forefront of Training SUSAN WINER

4 PreventionPost JULY 2002

C ANCER PREVENTION FELLOWSHIP PROGRAM 

Cancer Prevention Fellowship Program

SUSAN PERKINS
NEWSLETTER OF THE NCI DIVISION OF CANCER PREVENTION 5

IN MEMORIAM

DCP was deeply saddened by the sudden passing of

our dear colleague, Judy Binstock, on March 15,

2002. Judy was a dynamic and delightful individual

and nurturing friend to us all.

Judy’s NCI career began in 1981 when she joined

the Office of the Director (OD), Division of Resources,

Centers and Community Activities. She worked as a

clerk-typist under the direction of Joyce Heinonen,

with Dr. Peter Greenwald as Director. In November 1982, Judy left OD to

work for Dr. Win Malone as Branch Secretary in the Chemoprevention

Branch, in the newly formed Division of Cancer Prevention and Control

(DCPC). She worked for Dr. Malone for 12 years. In February 1994, Judy

became secretary to the Executive Secretary, DCPC, Board of Scientific

Counselors, with Linda Bremerman as the Executive Secretary. In 1996,

Judy was reassigned to work for Dr. Diane Solomon. At the time of her

death, Judy was the secretary to Dr. Karen Johnson and the Breast and

Gynecological Cancer Research Group.

A memorial service was held April 12, 2002 in the Executive Plaza

North Conference Center to remember and celebrate the life of our colleague. Supervisors, colleagues, and close friends shared stories, photos, and memories of one who will not be forgotten. Among those participating in the service were Lindy Wong, Dr. Peter Greenwald, Dr.

Karen Johnson, Dr. Diane Solomon, Dr. Win Malone, Kathleen Foster,

Laura Egan, Marilyn Goldberg, Dr. Ron Lubet, Dr. Marjorie Perloff, Dr.

Vernon Steele, and Dan Kaplan. Judy was well-loved and respected by

all in the Division and will be greatly missed. ■

DCP AWARDEES

Congratulations to Dr. Peter Greenwald

(OD) for being selected to receive the

prestigious American Cancer Society

Award at the American Society of Clinical

Oncology Annual Meeting in Orlando,

Florida in May 2002. The award was 

presented to Dr. Greenwald in recognition

of his “unwavering leadership in establishing the science 

of cancer prevention and for building a national clinical

research program in cancer prevention.”

The American Society for Nutritional

Sciences honored Dr. Stephen Hursting

(OPO) with the Bio-Serv Award in

Experimental Animal Nutrition at the

Federation of American Societies for

Experimental Biology meeting held in

New Orleans, Louisiana in April 2002.

This award is given for “meritorious research in nutrition”

and was presented to Dr. Hursting “in recognition of his 

creative use of molecular techniques, including transgenic

mouse models, to study the potential role of nutrition in

cancer prevention.”

In recognition of his contributions as

Acting Chief of the Community

Oncology and Prevention Trials

Research Group, Dr. Joseph Kelaghan

(COPTRG) was awarded the Public

Health Service Commendation Medal in

the fall of 2001.

At this year’s annual DCP All Hands Seminar in May, 

individuals and project teams were recognized for their

contributions to cancer prevention research, leadership,

and distinguished service. Individual awards were presented

to Dr. Diane Solomon (BGCRG), Dr. Ernie Hawk

(GICRG), and Dr. Doug Weed (OPO), with a special

award extended to Dr. Peter Greenwald (OD). The

achievements of the Chemoprevention of Tobacco-Related

Cancers in Former Smokers Project Team, the Prostate,

Lung, Colorectal and Ovarian Cancer Screening Trial

(PLCO) Project Team, the Program Operations Staff

Project Team, and the Staff Orientation Project Team were

also acknowledged (please see page 1 for more details).

Felicitations to all on these laudable achievements! ■

Dr. Peter Greenwald

Dr. Stephen Hursting

Dr. Joseph Kelaghan

Judy Binstock

1935-2002

GRAÇA DORES
What do the scientists in the Biometry Research

Group do? Much the same thing that biostatisticians (plus one epidemiologist) at any worldclass research unit do: a mixture of service activities, collaborative research, and individual research. While these

three motifs are well defined and to some extent exclusive,

there is a high degree of overlap and cross-fertilization

between them.

For example, in the collaborative research/service arena,

there is the highly visible Prostate, Lung, Colorectal and

Ovarian Cancer Screening (PLCO) Trial. Our chief, Phil

Prorok, is co-principal investigator with John Gohagan of

the Early Detection Research Group (EDRG). Many of us

in BRG are involved with the operations and analysis of

data from this trial. On the immediate horizon are several

manuscripts presenting the baseline population characteristics and screening findings for each of the respective organ

sites. Each organ site paper has as its primary author someone from the appropriate field of oncology, while one or

two of us on the organ-specific subcommittees will provide

statistical expertise. Other organ-specific research projects

arising from the PLCO trial may originate from these

oncologists at the screening centers and result in collaborative work within BRG. Dave Levin and Grant Izmirlian

serve on the prostate subcommittee, Pam Marcus and Ping

Hu serve on the lung subcommittee, and Richard

Fagerstrom and Jian-Lun Xu serve on the ovarian subcommittee. Also on the horizon is an interim analysis of the

PLCO trial primary outcome data. Group sequential methods and stochastic curtailment methods will both be used

to check the primary endpoint (organ-specific cancer mortality) in the intervention versus control arms for any indication, affirmative or null, of early stopping. Richard

Fagerstrom, Grant Izmirlian, and Phil Prorok are involved

in this project. Other PLCO-related work includes Grant

Izmirlian’s analyses of quality assurance in the assays of

prostate-specific antigen (PSA) and cancer antigen 125

(CA125). The above-mentioned work has spawned several

other projects. Jian-Lun Xu is comparing several published

methods against his own methods for quantifying and estimating the false positive rate in a trial of repeat screening.

Richard, Grant, and Phil will be benchmarking early stopping methods on several well-known and completed large

screening trials such as the Health Insurance Plan (HIP)

study, the Minnesota Fecal Occult Blood (FOB) trial, and the

Mayo Lung Screening Study. Ping Hu has analyzed data

comparing chest x-ray readings at PLCO screening centers.

Other important screening trials are being planned and

coordinated in collaboration with EDRG. With the advent

of spiral CT (radial computed tomography), the Lung

Screening Study, a pilot, was conducted in order to gauge

the feasibility of conducting a full-scale trial. The results 

of that pilot study are nearing publication. The National

Lung Screening Trial (NLST) is now underway. Richard

Fagerstrom and Pam Marcus have made major contributions to this trial. Also involved is Ping Hu, who provides

additional statistical support.

While research dealing with screening is a major component of the work done at BRG, several investigators are

making a big impact on the interplay between nutritional

epidemiology and cancer. Blossom Patterson works with

data from several trials on the preventive effects of dietary

selenium. Victor Kipnis, Doug Midthune, and several collaborators from other organizations study the consequences of dietary measurement error in studies of diet and

cancer. One completed investigation, the Observing Protein

and Energy Nutrition (OPEN) study, was a study of two

dietary assessment instruments conducted alongside biomarkers for long-term energy and protein intake. Results

indicate that dietary risk factors over two-fold can easily

be attenuated out of significance by a very plausible mechanism of measurement error in reported dietary intake.

Simon Rosenfeld collaborates with Victor and Doug on

the nutritional epidemiologic work and is also interested in

the issue of model selection and model misspecification. He

has also been studying molecular biology and the analysis

of microarray data. Together with Richard Fagerstrom and

Grant Izmirlian he serves on the Applications of Biomarkers

to Cancer Data (ABCD) project team. As in many parts of

the Division, there is a strong impetus towards involvement

with molecular biology and microarray data analysis.

Currently, several of us are collaborating with Stephen

6 PreventionPost JULY 2002

DCP’s Biometry Research Group: What Do We Do?

GRANT IZMIRLIAN

continued on page 7
NEWSLETTER OF THE NCI DIVISION OF CANCER PREVENTION 7

DCP’s Biometry Research Group: What Do We Do? continued from page 6

Hursting of the Office of Preventive Oncology on the analysis

of data from knockout mice and human cancer cell lines.

Several of the Cancer Prevention Fellows with interest in 

statistical research are involved in this project as well as other

ongoing studies at BRG. Janet Tooze, our current Cancer

Prevention Fellow, was preceded by Lori Dodd, now on staff

in the Division of Cancer Treatment and Diagnosis. Also of

note is the fact that Pam Marcus started out as a Cancer

Prevention Fellow.

Our trialist, Vance Berger, is very interested in pitfalls in

the design and conduct of randomized clinical trials. His

work deals with exact inference and selection bias. Together

with the other members of BRG, Don Corle and Blossom

Patterson, he is at work applying some of these ideas to

other studies arising out of collaborative efforts at BRG.

Don Corle coordinates BRG’s statistical review of all of the

concepts and protocols that originate in the Division’s

Protocol Information Office. Each of the BRG scientists

serves as a statistical reviewer on three to ten protocols per

year. Most of the protocols are from the Community

Clinical Oncology Program and deal with adjuvant therapy,

but there are others, such as the periodic review of chemoprevention trial protocols.

Stuart Baker is our local expert in missing data problems.

His projects deal with estimating sensitivity and lead time in

screening trials, historical controls, missing-by-design trials,

and surrogate endpoints. For example, the missing-by-design

work has applications in the meta-analysis of the noncontrolled clinical trials. Stuart’s work with surrogate endpoints addresses important issues in prevention studies and

has spawned a discussion group that includes Victor Kipnis

and Grant Izmirlian.

Perhaps I have just scratched the surface by giving such a

small snapshot of what goes on at BRG. One thing is clear:

that service/collaboration and individual research are symbiotic components of our work here. ■

DOUGLAS L. WEED

Sylvester Graham

1794-1851

The names of most staple foods are

straightforward and simple, providing

us with clear descriptions of what we

are about to eat. White bread. Green

beans. Artichoke hearts. Peanut butter. A “dish”, on the other hand, comprised of several different single foods,

is more likely to have a name that

reflects its origins or its creator; Waldorf and Cobb salads

are good examples, as is General Tso’s Chicken found on

every Chinese Restaurant bargain lunch menu. What is

exceedingly rare is a simple food that still carries its creator’s name with it with every bite. Like the lowly graham cracker that graces the bottom of cream pies and

s’mores. Its creator was born over 200 years ago. 

Sylvester Graham was the 17th child of a Connecticut

preacher who, with little formal training, followed in his

father’s footsteps, and launched a career as a traveling

evangelist. Crusader may be a better description of his

approach to saving souls. He railed against the evils of

strong drink, sexual excess, and the “unnatural stimulants” of rich foods, meats, and condiments. Prime

among his dietary targets were baked goods made from

highly refined white flour. Graham became famous, touting vegetarianism and whole-grain brown wheat flour,

later nicknamed “graham flour.” In the1840s, Oberlin

College tried unsuccessfully to keep their undergraduate

students happy on a diet of graham crackers and water.

And by some peculiar stroke of fate, these crackers

remain with us today, a reminder that diet has long been

considered an important avenue to better health, if not

spiritual salvation. Today whole grain foods, high in fiber

and vitamins, continue to be examined for their chemopreventive properties. ■

HISTORY OF CANCER PREVENTION
8 PreventionPost JULY 2002

sized that “the individual can succeed, but only the team can

win.” Dr. von Eschenbach answered questions from the group

relating to issues of health disparities, interdisciplinary

approaches to problem solving, balancing the NCI portfolio,

and developing a closer relationship between cancer treatment

and cancer prevention.

Working in small groups, one of the initial activities of the

seminar charged individuals with identifying their area of

expertise and professional contribution to DCP. The results

were then discussed in the context of the Division’s working

groups. A framework emerged that reflected the cohesive spirit and impact of individuals on the Division’s mission. Later

in the day, exercises were conducted that helped participants

formulate the vision for DCP in the context of the global cancer prevention agenda.

As a closing activity, small groups identified and shared priority items for the future. Recommendations included the

development of a scientific strategic plan, addition of a bioinformatics project team, integration and centralization of biomarker activities and projects within the Division, development of new partnerships across agencies, integration of

Community Clinical Oncology Programs (CCOPs) into

research group activities, and exploration of potential interactions with the cancer genetics networks. 

An awards ceremony was held at the end of the first day to

recognize and honor individuals and project teams. There were

three award categories: Distinguished Achievement in Cancer

Prevention Research Awards, Division of Cancer Prevention

Leadership Awards, and Distinguished Service Awards. 

Dr. Diane Solomon (BGCRG) received the Distinguished

Achievement in Cancer Prevention Research Award for her

extensive contributions to the understanding of cervical neoplasia, advances in cervical screening, and outstanding efforts

with the ASCUS/LSIL Triage Study (ALTS). Also honored

with the Distinguished Achievement in Cancer Prevention

Research Award was Dr. Ernie Hawk (GICRG) for his accomplishments in the understanding of cyclooxygenase-2 (COX-2)

as a prevention target and translation to clinical practice.

The Division of Cancer

Prevention Leadership Award,

given in recognition of exemplary leadership and service to

cancer prevention, was presented to Dr. Doug Weed

(OPO). Dr. Greenwald cited

Dr. Weed’s outstanding leadership and organizational capabilities, and dedication to the

mission of the Division and to training the next generation of

prevention scientists.

Distinguished Service Awards were presented to two scientific project teams that address issues critical to the

research objectives of DCP, demonstrate collaborative effort

through open and active communication, and are responsive

to team management. Awardees were Drs. Eva Szabo

(LUACRG) and Vernon Steele (CADRG) for the

Chemoprevention of Tobacco-Related Cancers in Former

Smokers Project Team, and Drs. John Gohagan (EDRG) and

Phil Prorok (BRG) for the Prostate, Lung, Colorectal and

Ovarian Cancer Screening Trial (PLCO).

Two project teams received Distinguished Service Awards for

addressing issues critical to the Division’s infrastructure, operations, and special projects. Awardees were Lindy Wong (COPTRG) and the Program Operations Staff Project Team, and

Jenny Gaegler (BRG) and the Staff Orientation Project Team.

A special award was presented to Dr. Greenwald by the

Division members in recognition of his many contributions,

vision, and leadership in the field of cancer prevention. ■

Dr. Diane Solomon receives

Distinguished Achievement in

Cancer Prevention Research Award 

Drs. Phil Prorok and John Gohagan

receive Distinguished Service Award

for the PLCO Project Team

Dr. Ernie Hawk receives

Distinguished Achievement 

in Cancer Prevention Research

Award

Lindy Wong accepts Distinguished

Service Award for the Program

Operation Staff Project Team

Jenny Gaegler accepts Distinguished

Service Award for the Staff

Orientation Project Team

Dr. Vernon Steele accepts Distinguished

Service Award for the Chemoprevention

of Tobacco-Related Cancers in Former

Smokers Project Team

Dr. Doug Weed receives Division of

Cancer Prevention Leadership Award

Annual DCP All Hands Seminar: “The Future is in Your Hands” continued from page 1
NEWSLETTER OF THE NCI DIVISION OF CANCER PREVENTION 9

antigen-presenting cells (e.g., dendritic cells, macrophages)

must capture the antigen and present it to T-cells and their

receptors. A simultaneous co-stimulatory signal is required

for T-cell activation, and the activated T-cells release

immune stimulatory factors, e.g., interleukin-2 and interferon. Investigators at the NCI have been working on an

immunization protocol against CEA that stimulates an

immune response by combining a recombinant avian

poxvirus containing CEA and three co-stimulatory molecules with a second poxvirus expressing granulocytemacrophage colony-stimulating factor (GM-CSF) to further

enhance the immune response (DW Grosenbach, et al.,

Cancer Res. 61, 4497-4505, 2001). Employing this vaccine

strategy, these researchers have elicited a substantial

immune response to CEA in humans and in animal models.

In animal studies this immunization is effective in cancer

prevention and in therapy of colon cancer and seems to

overcome “tolerance.” Preliminary results in humans with

cancer also appear promising (M von Mehren, et al., Clin.

Cancer Res. 6, 2219-2228, 2000). 

Vaccination Against HER-2/neu Employing 

Specific Peptides

The HER-2/neu protein is a member of the epidermal

growth factor receptor family and is involved in signal

transduction and cell growth. Neu is overexpressed in a

variety of tumors including breast, ovary, and prostate cancers. Recently Herceptin, a monoclonal antibody directed

against neu, has been shown to be effective in the treatment

of advanced breast cancers that highly overexpress neu.

Herceptin works through passive immunity: antibodies or

cytotoxic T-cells not produced by the host are injected into

the patient in order to kill cancer cells. In contrast, the

examples for HPV and CEA employ active immunization,

whereby the host develops her/his own immunologic

response (e.g., antibodies or cytotoxic T-cells) to the tumorexpressed protein. The two vaccination strategies discussed

for CEA and HPV utilize intact proteins, whereas this third

approach uses synthetic peptides (fragments of a complete

protein, e.g., neu) for immunization. Development of specific peptides involves determining sequences of amino acids

from the immunizing protein (e.g., neu) that will preferentially form complexes with the major antigen-presenting

molecules, major histocompatibility complex classes I and

II. Since different groups of individuals have different antigen-presenting molecules, scientists can optimize the specific

peptides to be employed for immunization of specific groups

of individuals. The use of these specific antigenic peptides

in humans has only recently begun in therapy (H Bernhard,

et al., Endocr. Relat. Cancer 9, 33-44, 2002). The fact that

strong, long-term immunologic responses have been

observed in persons with cancer appears promising. The

possibility of using this vaccine in cancer prevention is particularly appealing, and this approach has already proven to

be successful in animals.

These three examples illustrate some of the varied potential approaches to the use of vaccination in the field of cancer. HPV-related studies in cervical cancer represent a classic

approach since the vaccine will attempt to block infection

by the major etiologic agent, HPV. Although the other

approaches utilized to elicit a therapeutic immune response

in individuals with cancer are more difficult to achieve, initial studies appear hopeful. Studies in the area of cancer prevention have not yet been undertaken on a large scale

despite the fact that vaccines may be a particularly promising approach. Even if successful, vaccination still raises

questions relevant to most preventive or therapeutic strategies: 1) Must different vaccines be developed for cancers in

different organs? 2) Must different vaccines be developed

for specific histologic types of cancer within a specific

organ? and 3) Are significant side effects likely?

Nevertheless, the vaccination field appears ripe for continued and more detailed studies and may well play a major

role in cancer prevention in the future. ■

Vaccination and Cancer Prevention continued from page 3

DCP home base: Executive Plaza 
1 0 PreventionPost JULY 2002

preted independently of clinical findings, and demonstrated the ability to differentiate between benign and

malignant tumors. 1963 brought the Health Insurance

Plan (HIP) study, the first randomized trial using mammographic screening of healthy women. After 7 years 

of follow-up, there was a 30% reduction in the breast

cancer mortality rate in the study group relative to the

control group. A reduction in breast cancer mortality

rate of 23% was still observed after 18 years of followup. This early detection effort was followed up with the

NCI-funded Breast Cancer Detection and Demonstration

Project (BCDDP) in 1973. Both of these studies illustrated the ability of mammography to detect non-palpable 

cancers. In data collected by the BCDDP, the relative contribution of mammography alone was 41.6% of the cancers found. Of these cancers, 59% were non-infiltrating. 

It was during this era of mass screening that controversy first erupted. The BCDDP was criticized for not

being designed as a randomized clinical trial, thus having

no pre-selected comparison group. Instead, its goal was

to get the word out to both the medical profession and

the public about techniques for the early detection of

breast cancer. In this it was successful, screening over

280,000 women for the initial visit, with 51.7% completing the 5-year program. In fact this program opened

the door to many other issues such as radiation dosage

and safety, leading the way for improved monitoring of

mammography facilities and dose reduction. Another

crucial issue that evolved was the treatment of early

lesions, both non-infiltrating and pre-malignant. These

management questions have since paved the way for a

better understanding of the cancer process and in the

decreased need for invasive breast surgery. The importance of clinical breast exam in conjunction with a mammogram was also illustrated. The combined modalities

of physical exam with mammography resulted in

increased rates of detection as each modality contributed

cases not detected by the other.

This latest debate serves to illustrate the need for careful scientific evaluation of new screening technologies.

Dr. Peter Greenwald, Director of the Division of Cancer

Prevention, stated that NCI scientists are modeling the

effect of screening on stage-specific incidence. In the

U.S. diagnosis of late-stage breast cancer has decreased,

and early-stage cancer has increased. Breast cancer mortality has declined 13% since 1990. 

The hypothesis is that disease is increasingly being

detected at a point where treatments are more likely to

be effective. In support of this, statistical modeling

shows a clear benefit from mammography and from

recent improvements in treatment for breast cancer.

NCI Director, Andrew von Eschenbach, MD, has said,

“Early detection of cancer saves lives and we continue to

recommend mammography for women 40 and older.”

However, “it is absolutely essential to look beyond the

debate over the limitations of current data and to accelerate the development of better screening tools....While we

seek improved methods of diagnosis and treatment of

breast cancer, today mammography remains an important

part of our efforts to save lives through early detection.” ■

Mammography Screening for Breast Cancer: The Controversy Continues continued from page 2

Annual Lecture on Cancer Prevention

SUSAN WINER

Dr. Leslie Bernstein, American Family

Life Assurance Company, Chair in

Cancer Research, Professor of Preventive

Medicine, and Senior Associate Dean of

Faculty Affairs, Keck School of Medicine

of the University of Southern California

in Los Angeles, CA will be the speaker at

the third Annual Advances in Cancer Prevention Lecture. The

title of her lecture is “Cancer Prevention: Opportunities for

Action.” This keynote lecture is part of the Summer

Curriculum on Cancer Prevention and will be held on

Thursday, August 1, 2002, 3:00 PM in the Lister Hill

Auditorium on the main NIH campus. A reception will be

held following the lecture. ■
We would like you to join us in welcoming new staff to DCP:

Stephen Carrington, M.A.

Program Analyst,

Nutrition Science Research Group

From the Baltimore City Health Department

Margaret House, R.N., B.S.N., O.C.N.

Nurse Clinician,

Prostate and Urologic Cancers Research Group

From Ashbury Methodist Village Retirement

Community

Sara Hursen

Secretary,

Office of the Director

From Division of Cancer Epidemiology and

Genetics

DEE SULLIVAN

BEST WISHES TO: 

Nicole Harris, Lung and Upper

Aerodigestive Cancer Research Group, 

who joined the National Institute of Child

Health and Human Development.

Andrew Hruszkewycz, Prostate and

Urologic Cancer Research Group, who

joined the Organ Systems Branch, NCI.

Lora Kutkat, Cancer Biomarkers Research

Group, who joined the Office of Science

Policy and Planning, Office for Special

Populations, NIH.

Claudette Varricchio, Community Oncology

and Preventive Trials Research Group, who

joined the National Institute of Nursing

Research as Director for Extramural

Research.

Thea Kalebic, Lung and Upper

Aerodigestive Cancer Research Group, 

who joined Novartis Pharmaceuticals.

TRANSITIONS

NEWSLETTER OF THE NCI DIVISION OF CANCER PREVENTION 1 1

Jacob Kagan, Ph.D.

Program Director,

Cancer Biomarkers Research Group

From M.D. Anderson Cancer Center

Guillermo Marquez, Ph.D.

Special Expert,

Early Detection Research Group

From Texas A & M

Myra Terrell

Administrative Program Assistant,

Protocol Information Office

From the private sector
1 2 PreventionPost JULY 2002

PreventionPOST

Newsletter of the Division of Cancer Prevention

National Cancer Institute

Executive Plaza South, Suite T-41

6120 Executive Boulevard, MSC-7105

Bethesda, Maryland 20892-7105

Several months ago, the leadership of the Division undertook

an exercise designed to elicit feedback on managerial skills and

competencies from the people with whom and for whom they

work. The exercise, sometimes referred to as a “360,” is sort of

like looking in the mirror Ms. White and her stepmother made

famous years ago in the full-length feature for which Mr. Disney

won an Oscar. By design, it tells you in brutally frank language

how you are perceived by others. The “360,” otherwise known

by its copyrighted name, PROFILOR, is a long questionnaire

addressing issues of leadership, interpersonal relations, communication, motivation, and organizational knowledge, to name

several. Wall Street business speak, in other words. 

For each of us who participated, the questionnaire was distributed to a supervisor, to peers, and to direct reports, all of

whom rated how well we are doing. Do we “treat people with

respect”? How well do we “coach others in the development of

ENDPOINTS

Mirror on Wall Street 

DOUGLAS L. WEED

Editor-in-Chief

their skills”? Literally hundreds of such questions. The ratings

were anonymous, except for those submitted by a supervisor and

those assigned to one’s self. Wary at first, most of us felt that it

was a worthwhile exercise in self-assessment. In the end, it

seemed a good idea to elicit the opinions of those who don’t

often have an opportunity to make their voices heard. I know

that I learned a lot about how my leadership style is perceived

and what I can do to improve. We all did. Not sure I’m going

to divulge all my strengths much less my weaknesses here, but I

do want to thank everyone who pointed them out. ■

GRAÇA DORES

DCP leadership explores PROFILOR to determine strengths and 

weaknesses CART OON