NEWSLETTER OF THE NCI DIVISION OF CANCER PREVENTION 1

Mounting evidence points

to variation in the consumption of foods as

a significant contributor to worldwide 

disparities in the incidence and biological

behavior of cancers.

Compelling data demonstrates

that numerous dietary components, including essential and non-essential nutrients, 

are capable of modifying the carcinogenic

process. The bioactivity of these nutrients

relate to biological effects including alterations in carcinogen formation or metabolism, influences on signals associated with

cell proliferation and/or apoptosis, or to

changes in immunocompetence. 

We in the health research community can

no longer minimize the significance of nutrition as a determinant of cancer risk, yet we

must also be careful not to propagate the

belief that diet is a “magic bullet.” Some of

the most compelling evidence that diet can

impact cancer risk comes from the reduction

in lung, prostate and colorectal cancers with

supplemental selenium. These observations,

coupled with a host of preclinical studies,

serve as the rationale for a more comprehensive investigation of how selenium and vitamin E might function together to suppress

prostate cancer in men as part of the

Selenium Vitamin E Cancer Trial (SELECT)

being conducted by the DCP Community

Oncology and Prevention Trials Research

Group. Variability in response to dietary components, both in terms of direction and magnitude, should be expected. In fact, evidence

is surfacing that nutrients may be protective

under some circumstances, yet harmful during

others. Evidence that flavonoids can cause a

translocation of the MLL gene and possibly

increase the incidence of infantile leukemia

while retarding the risk of various experimentally induced cancers in models systems serves

to emphasize that uniformity in response

Frontiers in Nutritional Science and Cancer Prevention JOHN A. MILNER

Chief, Nutritional Science Research Group, DCP

I

t is estimated that one-third of all cancers relate to diet. In fact five of the 10 leading causes of death are linked to the food we eat” (Greenwald and Milner) 

Cancer rates for specific organs vary profoundly across different parts of the world. 

For example, breast cancer incidence and prostate cancer mortality rates are roughly 3-fold

higher in the U.S. and Western Europe as compared with Southeast Asia. In contrast, the incidence of liver cancer is strikingly lower in the West than in Southeast Asia. Although some

portion of this variability is due to a genetic component, a major portion is environmentally

related. “Environmental” in this context, extends beyond impurities in water or air to include

infections, smoking habits and, in particular, diet. Certain negative consequences of diet, for

example, aflatoxin B1 exposure and its role in liver carcinogenesis, have been clearly defined.

This relationship has been easier to define because the striking increases in cancer risk in 

persons consuming this food is primarily attributable to a single agent. 

continued on page 2

IN THIS ISSUE

Frontiers in Nutrirional Science 1

Diet and Cancer Prevention Studies 1 

History of Cancer Prevention:

Peyton Rous 3

Dietary Data: A Tough Nut to Crack 3

PreventionPOST Credits 3

Cancer Prevention Fellowship Program 4

Nutrition Management and the 

Cancer Patient 6

SCORE Workshop 7

DCP Recipe Contest 7

Walking for Research 8

Reflections from Inside STAR 8

Individual Spotlight 9

DCP Colorectal Cancer Screening 10

Transitions 11

True Corn-fessions 11

Endpoints 12

June 2001

V O L UME 3/ISSUE 1

NEWSLETTER OF THE NCI DIVISION

OF CANCER PREVENTION

PreventionPOST

Cancer Prevention Studies Employing Changes 

In Diet Or Specific Dietary Components

R ON LUBET

continued on page 5

“
2 PreventionPost JUNE 2001

Complexity of Foods

Defining the potential impact of diet can be quite difficult.

The unexpected results with beta carotene in lung, which

showed an increase in lung cancer among current smokers,

demonstrates that it is often difficult to determine what, if

any, specific component in a diet will confer chemopreventive

properties, or if some combination of dietary components is

more effective than any single component. Epidemiologic

evidence that high consumption of fruits and vegetables is

beneficial to long term health is more difficult to translate

into a specific intervention than is epidemiologic evidence

regarding a specific class of agents, for example, NSAIDs in

colon cancer. The relatively specific nature of NSAIDs and

their presumed targets, the cyclooxygenases 1 and 2, yield a

relatively straightforward trial design. In contrast, determining that specific components in a high fruit and vegetable 

diet have chemopreventive properties, or even which classes

of fruits and vegetables may be particularly relevant, is 

difficult. Nevertheless, dealing with the complexity while

simultaneously attempting to define specific components

remains a major goal in cancer-nutritional research with. 

The potential benefit of a healthy diet on a variety of chronic

diseases, including cancer, and others, demands continued

efforts in the area of general as well as specific examination

of dietary interventions.

Nutritional Intervention Trial Design

Another difficulty in evaluating dietary interventions and in

fact any long-term intervention, is how to optimally conduct a clinical trial. Design of most phase III clinical trials

routinely require an intervention period of at least five

years. Therefore any intervention that is primarily 

effective during the time of tumor initiation or early tumor

progression will be difficult to confirm, as the carcinogenic

process for many cancers may be greater than 20 years. 

A trial exposure period of only five years means that 

many of the pre-existing lesions that are present during the

trial will already have significant genetic alterations. 

For example, the preinvasive lesions ductal carcinomas in

situ (DCIS) in breast cancer or prostatic intraepithelial 

neoplasias (PIN) in prostate cancer already have many of

the genetic changes associated with invasive cancer.

Alternatively, one can conduct trials of considerably greater

length. These trials, however, have potential problems

regarding both cost and changes in standard of care during

the trial. One scenario is that radiography or early 

detection improves during the course of a 10-15 year trial

and as a result the tumor incidence for which the trial was

designed and powered changes. Food and nutritional 

interventions have the additional difficulty of compliance.

To that end, development of biochemical or pharmacologic

markers of food or supplement intake is a significant goal

for nutritional research.

There are many questions in nutrition and cancer that

need to be answered. Which specific substances in foods

are particularly beneficial? Do certain combinations of

foods or food constituents provide more protection than the

sum of the individual parts? Do the beneficial substances

help protect against all cancers or in some instances do 

they increase risk? Can biomarkers be developed that will

facilitate the study of interventions? The task is daunting

but the potential impact is great. ■

Cancer Prevention Studies continued from page 1

Peyton Rous: Pioneer in Nutrition and Cancer Research DOUGLAS L. WEED

Caloric restriction and reduced tumor incidence is a

well-established relationship in nutrition and cancer

research. One of its earliest investigators was

Peyton Rous, a Texan by birth and a Huguenot by heritage, who spent most of his early life in Baltimore, graduating from Johns Hopkins University Medical School in

1905. After a short stint at the University of Michigan,

Rous joined the Rockefeller Institute for Medical Research

(now Rockefeller University). There he studied cancer,

physiology, and blood transfusion. Rous’s study of the

influence of diet on transplanted and spontaneous mouse

tumors, published in the Journal of Experimental Medicine

in 1914, found dramatic and reversible reductions on

recurrences and growth of tumors in underfed mice. 

Rous is best known for his 

discovery of the viral etiology of 

a solid tumor in chickens—the Rous 

sarcoma virus—and for his insights 

into malignant transformation. 

Rous was one of the first to be convinced that, contrary to popular 

belief, the transformation of a normal

cell to cancer—tumor progression—

was not a sudden event but rather took a considerable

length of time, what we now refer to as latency. For 

these discoveries, Rous was awarded the Nobel Prize 

in Medicine in 1966. ■ Copyright: The Nobel Foundation (www.nobel.se)

HISTORY OF CANCER PREVENTION
CONGRATULATIONS

Dietary Data: A Tough Nut to Crack

P AMELA MARCUS

DCP is proud of Rose Mary

Padberg, Office of the Associate

Director for Clinical Research

and Jennifer Flach, POI who

along with Mary McCabe, 

Office of Education and Special

Initiatives, NCI , received the

Award for Creativity and

Innovation in Bringing

Government Services and

Information to the American

People from Vice President

Gore’s National Partnership for

Reinventing Government. 

And, on March 5, 2001 all three

also received the NIH Plain

Language Award.

Plain Language Award left to right

Rose Mary Padberg, Jennifer Flach

and Mary McCabe.

EDITORIAL GROUP

Doug Weed 

(Editor-in-Chief), 

Don Henson, Pamela

Marcus, Dee Sullivan

LAYOUT & CONTRACT

GROUP

Terri Cornelison, 

Jennifer Flach, Ron Lubet

DISTRIBUTION &

INTERNET GROUP

Kathleen Foster, 

Judy Smith, Susan Winer

PreventionPOST

DCP Newsletter Project Team

NEWSLETTER OF THE NCI DIVISION OF CANCER PREVENTION 3

Perhaps you’ve be asked to fill out a questionnaire

about what you eat. Sounded simple at first, didn’t it? 

But then you were asked how many times a week 

you eat strawberries. It’s December, and you haven’t gotten

near a strawberry in about 5 months. So you think 

back to the summer and you recall that during prime

strawberry season, you ate a lot strawberries. How do 

you turn “a lot” into a number? How do you record that

you eat strawberries obsessively for 3 weeks in June, 

but otherwise haven’t really had any? Are you tempted 

to quietly turn away and toss the questionnaire in the 

recycling bin?

As any epidemiologist or biostatistician will tell you, 

collecting data is no easy task. But collecting dietary 

data has its own challenges. And as our diets diversify 

due to our ever-increasing food choices, the collection 

of nutritional data has become even more complex.

A number of dietary instruments have been developed 

to help collect this type of data. A commonly-employed

instrument is the traditional questionnaire. Persons are

instructed to note whether, at a certain point in their lives,

they ate a specific food, and if so, how often they ate that

food and how much of that food they ate. Such an instrument usually relies on memory, which can be problematic.

Someone may forget that she occasionally eats an avocado.

Or, someone may report that he eats carrots every day,

when in fact they are only eaten on weekdays as part of a

brown-bag lunch. Portion sizes can be problematic too. 

If someone asks me how much orange juice I drink a day, 

I couldn’t say, because I drink it straight from the carton

more often than not. 

Food records can circumvent the problem of recalling

what has been eaten. A food record allows a person to

record exactly what he or she has ate, immediately after 

eating. While portion sizes can still be a problem with this

dietary instrument, troubles regarding long-term recall are

removed. New problems are introduced however. Because

food records generally cover a short period of time, the diet

during that time may not be representative of a person’s

usual diet. Additionally, the person recording his or her

intake may either subtly (or not so subtly) change their diet

if they view their usual diet as unhealthy or extreme. 

All is not lost, however, in our efforts to collect dietary

data. There have been a number of creative solutions to

these problems, thanks to the work of nutritionists, nutritional epidemiologists, and biostatisticians. To avoid the

problem of seasonal foods, for example, people are asked to

report how many weeks of the year they eat a certain food.

Food models - plastic renderings that show portion size -

have allowed for more accurate reporting of how much of a

certain food was consumed. Statistical methods have been

developed that can account and partially correct for certain

types of measurement error and thus, in some instances, 

produce more meaningful results.

Despite these improvements, dietary data will remain a

tough nut to crack. Although the task of collecting dietary

data is daunting, we won’t give up: food consumption is a

critical part of cancer research and is a particularly important area of cancer prevention science. Researchers in the

Division of Cancer Prevention will continue to study the

relationship of diet and cancer, and will, no doubt, make

important contributions towards cracking the nut. ■
C ANCER PREVENTION FELLOWSHIP PROGRAM 

Philip Castle received a Division of Cancer Epidemiology and Genetics

Intramural Research Award for his proposal “Cytokine Profiles in

Cervical Secretions and Their Relationship to HPV Persistence and

Progression to Neoplasia.”

Lisa Colbert, a third year fellow, has recently been awarded a grant

from the Department of Defense’s Breast Cancer Research Program.

The award was for Dr. Colbert’s proposal “Exercise and caloric 

restriction in a spontaneous mammary tumorigenesis model.” She 

also won 2nd place for a poster presentation “Physical activity and

lung cancer risk in a cohort of male smokers” in the Student and

Junior Investigator Competition at the Physical Activity and Cancer

Conference at the Cooper Institute in November, 2000.

Jackie Lavigne received an award for her doctoral dissertation in 

May 2000. It was the Cornelius Krusé Award for outstanding 

dissertation in the field of Environmental Health Sciences at Johns

Hopkins University.

Susan Scott received a Lineberger Fellow Award in October, 2000. 

This award, given at the University of North Carolina, Chapel Hill, 

was for excellence in dissertation research and was supported by the

Cancer Research Foundation of America.

Rachael Stolzenberg-Solomon was awarded an NCI intramural grant

entitled “Evaluation of integrative molecular markers of methylation

status.” In addition, she received the NIH Fellows Award for Research

Excellence (FARE). Also, she received the Poster Presentation Award

from the Society of Epidemiologic Research Annual Meeting in 

2000 and won First Place in a poster presentation at the American

Society of Preventive Oncology Annual Meeting in 2001. ■

ON THE PERSONAL SIDE

A W ARDS

Best wishes go to Claudine

Kavanaugh and her husband Joe

and to Jackie Lavigne and her 

husband Matt on their recent 

marriages ■

CAREER MOVES

Christian Abnet has taken a

position in the Division of

Clinical Sciences as a Senior

Research Fellow. In the fall,

Beth Dixon will be taking a 

position as an Assistant

Professor at New York

University in New York City. ■

Molecular Prevention Training Lab

The newest addition to the Cancer Prevention Fellowship

Program is the establishment of a Molecular Prevention

Laboratory located at the Frederick Cancer Research and

Development Center in Frederick, MD. Through the

Molecular Prevention Lab, prevention fellows and other

NCI trainees can obtain advanced training in applying 

laboratory techniques to address problems in cancer prevention through short-term training exercises as well as

intermediate and long-term mentored research experiences. 

The laboratory, under the direction of Drs. Stephen

Hursting and Susan Perkins, facilitates the Nutrition and

Molecular Carcinogenesis Section of the NCI’s Laboratory

of Biosystems and Cancer.

At the Forefront of Training SUSAN WINER

Steve Husting shows off the Nutritional and Molecular Carcinogenesis

Section in the Laboratory of Biosystems and Cancer.

Doug Weed, Mary Lou Carter, Steve Hursting, Larry Keefer, Chief of the

Laboratory of Comparative Carcinogenesis and Susan Perkins, tour the

Laboratory of Biosystems and Cancer at NCI-Frederick.

4 PreventionPost JUNE 2001

SAVE THE DATE

The Annual Advances in Cancer Prevention Lecture will be held on

August 2, 2001, 3:00 pm in Lister Hill Auditorium on the main NIH

campus. The keynote speaker will be Dr. Frederick P. Li from the

Dana-Farber Cancer Institute in Boston, Massachusetts. ■
across all cells is an unrealistic expectation. Intriguing 

evidence also suggests that selenium inadequacy, and 

possibly inadequacies in other nutrients, can lead to mutations in the genome of some viruses. Could it be that while

genetic polymorphism may alter nutrient needs, nutrient 

availability might also lead to non-viral genomic mutations

and/or instability?

While it remains prudent to eat a variety of foods and

avoid over indulgences, such generic recommendations may

be insufficient to address the specific dietary challenges that

individuals face. Thus, future dietary recommendations will

likely need to be based on the physiological status of the 

individual and his/her genetic profile.

The overall response to a bioactive food component probably reflects numerous genetic and epigenetic events that are

highly dependent on the quantity consumed, interactions with

other dietary constituents, and the duration of exposure.

Unraveling the myriad of possible interactions between specific dietary components and specific genetic pathways involved

with the cancer process is fundamental to establishing 

tailored dietary recommendations. The significance of this

approach is that it not only provides clues to “optimizing”

nutrition for health, but also provides a non-invasive strategy

for altering potentially every aspect of the cancer process. 

Innovative research that builds on current knowledge and

moves the science of nutrition forward to develop effective,

targeted cancer prevention strategies that can be readily integrated into everyday lifestyles is needed. Without dedicated

and enthusiastic investigators who are willing and able to 

initiate studies in basic science and molecular biology, the

deciphering of the complexities will be unduly protracted.

Sophisticated technologies are continually emerging that will

assist in identifying the critical molecular targets where nutrients influence the cancer process. Identification and validation of sensitive biomarkers that can be used to predict those

who will and will not benefit from dietary intervention are of

paramount importance.

Researchers should not only be aware, but take advantage

of, the opportunities that exist in nutrition and cancer research

at the NCI. A summary of the resources that the NCI offers

to scientists can be found at 

http://www.nci.gov/scienceresources/index.html.

The Nutritional Science Research Group is eager to assist in

advancing the science of nutrition. ■

Summer Curriculum

Next month, the Office of Preventive Oncology will 

hold its annual Summer Curriculum. Two courses will 

be featured: Principles and Practice of Cancer Prevention

and Control, and Molecular Prevention. Space for 

75 participants has been reserved. Sixteen international 

participants sponsored by the Office of International

Affairs, NCI, will attend the summer program along with

ten individuals sponsored by the NCI/All Ireland

Consortium. Countries represented are Bolivia, Brazil,

China, India, Ireland and Northern Ireland, Jordan, Kenya,

Korea, Lithuania, Peoples Republic of China, Romania,

Spain, Thailand, Turkey, Vietnam and Yugoslavia. Fifteen

Cancer Prevention fellows returning to the NCI after just

completing their Master in Public Health will also attend.

The courses will be held in the Neuroscience Building on

Executive Boulevard.

Recruitment

Recruitment is an ongoing activity for the Cancer

Prevention Fellowship Program. Recently, the Cancer

Prevention Fellowship Program has begun a partnership

with the Office of Communications. Together, we attend

many meetings and share a display booth. For the past two

years, the NCI booth has won first place at the American

Public Health Association meeting! Every year the

Fellowship Program sets up a display at the Johns Hopkins

University School of Public Health Career Day. Current 

fellows and former Hopkins graduates helped answer 

questions about the fellowship program.

Prevention Fellows

The Cancer Prevention Fellowship Program is sending 11

first year fellows to their school of choice to earn a Master

of Public Health degree:

Hala Azzam, Dilyara Barzani, Amanda Greene, Qing Lan,

Nomeli Nunez, Arti Patel, and Shanita Williams Brown will

be attending Johns Hopkins University.

Lila Finney and Kay Wanke will be attending Harvard

University. Somdat Mahabir will attend New York Medical

College. Whitney Randolph will be attending the University

of North Carolina at Chapel Hill. 

Gary Ellison, a PhD in Epidemiology and a MPH in

Biostatistics, one of our first year fellows, will come directly

into the fellowship program. ■

NEWSLETTER OF THE NCI DIVISION OF CANCER PREVENTION 5

Frontiers in Nutritional Science continued from page 1
6 PreventionPost JUNE 2001

The relationship of nutrition and cancer has been

described since the time of the Ancient Egyptians writing

on papyrus manuscripts. Compounds of barley and pigs

ears were concocted in an effort to treat this age-old disease.

Modern scientists are still examining the interplay between 

the food that we eat and its role in the management of cancer.

Advanced cancer and its treatment is

frequently associated with a host of

symptoms known as cancer cachexia.

Among these are anorexia, early satiety,

anemia, malnutrition, and organ 

dysfunction. Over half of patients with

cancer have a history of weight loss.

The process of cancer cachexia involves

an equal metabolism of both body fat

and muscle protein for energy, leading

to weakness and wasting. In addition

to problems caused by the progression

of disease, cancer treatments such as

chemotherapy and radiation often exacerbate problems with malnutrition,

because of changes to the gastrointestinal tract. Treatment side effects such as

dry mouth and altered taste can affect

the desire for food. These changes can

have a long-term impact on a healthy

diet, and present challenges to the

patient and their caregivers. 

A person newly-diagnosed with cancer often experiences an

increased awareness of, and a new resolve to adhere more

closely to standard guidelines for healthy eating. However,

depending on the stage of the disease, the nutritional advice

that he or she receives may vary from what has been heard in

the past. Dietary counseling may be needed to address a new

set of nutritional needs.

Dietary recommendations for persons with cancer frequently focus on ways to ingest adequate amounts of the

nutrients needed to help maintain energy levels. Often this

includes higher calorie foods that emphasize protein. 

It could also mean an increased intake of dairy products,

sauces and other food sources. Sometimes a decrease in

high-fiber foods is suggested.

From a research perspective, evidence from ecological,

epidemiological, and laboratory studies consistently support

the contention that diet may provide a protective effect

against breast cancer and its recurrence. In the Division of

Cancer Prevention, Dr. Carolyn Clifford monitors two 

randomized clinical trials, the Women’s Healthy Eating 

and Living Study (WHELS), and the Women’s Intervention

Nutrition Study (WINS).

WHELS is a multi-center randomized trial testing

whether a daily dietary pattern high in vegetables (5 servings, plus 16 ounces vegetable juice), fruits (3 servings), 

fiber (30 grams) and low fat (15-20% of calories) will affect

the course of breast cancer in women with Stage I, II, or

IIIA disease after they have received standard treatment

therapy. This trial is being conducted

in 3,000 pre-and post-menopausal

women enrolled at 7 clinical centers.

Women are randomized to one of two

dietary groups: dietary intervention

group (dietary counseling) or control

group (no dietary counseling). 

Data collection includes dietary 

assessment, anthropometrics, health

status and quality of life. Blood 

specimens are collected for measurements of carotenoids, lipids, estrogens,

and future mechanistic studies of 

recurrence.

WINS is testing the hypothesis that

dietary fat reduction as an adjuvant to

standard breast cancer therapy will

reduce recurrence and increase survival

for post-menopausal women with localized breast cancer. This randomized

clinical trial is being conducted in 2,500

women, enrolled at 38 clinical centers.

Women are randomized to one of two dietary groups:

Intensive Intervention Group (IIG) or a control Non-Intensive

Group (NIG). The IIG participants receive an individualized

nutrition program targeted to reduce dietary fat intake to

15% of calories. The NIG participants receive the Dietary

Guidelines for Americans, which recommends 30% of calories from fat, as well as minimal ongoing nutrition education.

Data is being collected on dietary intake, supplement 

intake, food patterns, anthropometrics, and quality of life.

Banking of blood specimens will provide a unique resource

for the future testing of hypotheses regarding mechanisms of

dietary fat reduction.

The results of these two clinical trials will have major

implications for future research in breast cancer prevention

and control of recurrence, and will provide insight into the

mechanisms of how diet might influence this disease. Both

trials are slated for completion in approximately 5 years.

NCI researchers have established many links between dietary

intake and cancer. As nutrition science continues to advance, it

will hopefully reveal the answers to not only how to prevent

cancer, but how to best utilize the foods that nourish us in both

health and disease. ■

Nutrition Management and the Cancer Patient

KATHLEEN FOSTER
Welcoming site coordinators representing research centers from across the nation and around the globe, 

Dr. Peter Greenwald eloquently opened the first

annual Site Coordinator’s Opportunity for Research

Excellence (SCORE) Workshop. The conference was held 

on March 19-20 at the Pooks Hill Marriott in Bethesda,

Maryland. Citing the mission of the division, Dr. Greenwald

thanked participants for their ongoing commitment and collaborative efforts with DCP to advance

biomedical science, strengthen preventive

medicine, and improve public health.

Through their role as site coordinators,

these individuals are responsible for the

local management of Phase II and III

chemoprevention clinical trials conducted

through a contract mechanism with DCP.

SCORE was the result of a pioneer

effort of a DCP Project Team, headed by

Ellen Richmond (GOCRG), to unite site

coordinators of DCP-sponsored cancer

prevention clinical trials with members of the DCP staff.

Project team members included Jenny Gaegler (BRG), Jennifer

Flach (POI), Martha Basinger (CADRG), Kathleen Foster

(BOCRG), Judy Smith (LUACRG), Linda Parreco (POI), and

Rose Mary Padberg (OADCR). The goal of the conference

was to build a collegial atmosphere among research partners

by providing an educational forum to discuss issues such as

chemoprevention agent development, trial design, trial implementation, contract mechanisms, recruitment, compliance, 

and ethics. Additionally, the conference provided six individual

break-out sessions led by DCP and NCI staff addressing 

issues such as common study problems, audit preparation,

data management, media and outreach strategies, as well as 

an opportunity to meet and talk with medical monitors.

Among the highlights of the workshop

was a Power Point presentation by Dr.

Leslie Ford that included a comprehensive overview of clinical chemoprevention

research. Other presentations were provided by James Crowell (Chief, CADRG),

Ernest Hawk (Chief, GOCRG), Anne

Ryan (OD), Gary Topper (Contracts),

Eva Szabo (Chief, LUACRG), Linda

Parreco, Kara Smigel-Croker (OD), Jaye

Viner (GOCRG), Mary Wargo (University

of Texas), Linda McClure (Clinical Trials

Monitoring Branch, NCI), Joan James (Fox Chase Cancer

Center), Worta McCaskill-Stevens (COPTRG), Jennifer Flach,

Charmaine Cummings (Professional Continuing Education

Branch), Jeff Cohen (OHRP), and Judy Smith. Kathleen Foster

hosted a NCI information table, replete with cancer chemoprevention and clinical trials materials. ■

DCP Convenes First SCORE Workshop

JUDY SMITH

NEWSLETTER OF THE NCI DIVISION OF CANCER PREVENTION 7

“Dr. Peter Greenwald and Jenny Gaegler exhibit the kind

of tireless efforts that made SCORE a huge success.”

And the winner is...

Mark Zweig, a Special Volunteer in the

Biometry Research Group. Mark submitted a

zesty dish entitled “Chick Peas with Apricots”. 

The DCP Recipe Contest was held earlier

this year. All members of DCP were invited to

participate. The only requirements were that

the dish contain fruits and/or vegetables, and

that the dish be vegetarian. Seven DCP’er 

submitted recipes, and six partook in the taste-test on March 2. 

In addition to the winning recipe, Terri Cornelison (BGCRG) prepared chili, Nancy Simpson (EDRG) prepared vegetarian stuffed

cabbage, Rose Mary Padberg (OADCR) prepared “Rosie’s Rice,”

Vance Berger (BRG) prepared lentil and barley casserole, and 

Susan Perkins (OPO) prepared pumpkin bread. The judges, Dave

Levin (BRG), Sharon Ross (NSRG), and Rachael StolzenbergSolomon (OPO), rated the dishes on taste as well as healthfulness. 

It was tough to pick a winner, as all the dishes were excellent!

The five runner-up recipes can be found at the PreventionPOST

website.

DCP Recipe Contest

P AMELA MARCUS

Chick Peas with Apricots

2 cups cooked chick peas (garbanzos)

3 tablespoons olive oil

1 onion, chopped

2 to 4 cloves garlic, finely chopped

2 teaspoons salt (unless chick peas were salted in cooking)

1/2 teaspoon freshly ground pepper

2 teaspoons marjoram or oregano

1 teaspoon cumin powder

14-ounce can tomatoes or a scant pound of fresh tomatoes,

chopped

1/2 pound dried apricots

Water or stock as required (minimum of 2 cups)

1 tablespoon chopped parsley or cilantro

Drain the chick peas. In a pan, heat the oil and gently fry the onion

for 2 minutes. Add the chick peas, garlic, seasonings, tomatoes,

and apricots. Stir together and fry for 5 minutes. Add 2 cups of

water or stock and allow to simmer until the apricots are tender.

Add more water or stock if necessary. Serve garnished with

chopped parsley or cilantro. Excellent with lemon juice, yogurt,

and lettuce. (4 servings)
Since January, “Joan” has been rising every morning at

5, putting on her jogging gear, and going for a brisk

walk. At first, 3 miles was her limit, but with persistence, that soon doubled. By March, she reached 10 miles.

Although rising at 5 AM became a habit, initially it was 

difficult for “Joan”. But “Joan” had a reason.

“Joan” was determined to make a personal contribution 

to breast cancer research as a memorial for her sister who

died from the disease two years ago. According to “Joan”

the best memorial would be a donation of her time and

energy to raise money for the fight against breast cancer. 

Because the problem is so great, an estimated 182,800

new cases and 43,000 breast cancer deaths this year, all

available resources are needed to secure funds for research

and treatment. For this reason, “Joan” volunteered to take

part in the Avon Breast Cancer Crusade walkathon, which

raises money for research and treatment. This walkathon 

is more than merely giving; it reflects a personal sacrifice

and commitment on the part of the participants, and for

“Joan” a tribute to her sister. 

The Walkathon was held May 4-6 in the D.C. area. It covered approximately 60 miles from Frederick, MD to the mall

in Washington. More than 3000 participated including men

and women. Linda Gray from DCP was also a participant.

The distance walked per day was 20 miles. A support

crew of more than 550 volunteers was available to 

provide meals and sleeping facilities for the night. These 

volunteers spent up to 20 hours preparing for the event 

and worked with the walkers for the entire distance. For

transportation, the volunteers were provided with mobile

lounges, however. More than 25,000 meals were served,

14,000 energy bars distributed, and nearly 1500 tents used.

The biggest casualty, beside sore muscles, was walking

shoes. “Joan” wore out three pair. Doctors, podiatrists, 

and massage therapists were all available to relieve the sore 

tender muscles and aching swollen feet.

The Avon walk for breast cancer is a national event.

Walks have been held in major cities including Chicago,

Boston, Los Angeles, and Atlanta. The first walk was held 

in Los Angeles in the fall of 1998. Four walks were held in

1999, seven in 2000, and 9 are scheduled for 2001. The first

walk in Washington was held last year. All proceeds are for

the Avon Breast Cancer Crusade. Each participant is requested in advance to ask friends, colleagues, and neighbors to

pledge to the Crusade. In fact, pledge support is a requirement for the walk. The average pledge per walker is $3200.

More than 60 million dollars have been raised for research

and treatment through these walks.

Another walkathon will be held next year. Walkers from

DCP will be welcome. ■

Walking for Research

DON HENSON

Reflections from Inside STAR a DCP Clinical Prevention Trial 

Reflections” was written by a STAR (Study of Tamoxifen

and Raloxifene) participant from Washington, DC.

Following are excerpts from the original article which

was printed in the Constellation, the STAR participant

newsletter. The thoughts and words are her own and we

thank her for sharing them with all of us.

Some people I’ve known wanted more than anything to be

rich; others dreamed of beauty, influence, accomplishment.

Myself, I’ve harbored the dream that I might be remembered

as interesting, a character whose secrets, observations and

habits were seen as noteworthy, even instructive. 

I’m a middle-aged woman... famous only within my

nuclear family. My dramas have been small, my triumphs

parochial. 

Suddenly, however, ...I’ve been celebrated, fed, photographed, and quoted. The mere act of taking one daily

dose of [Tamoxifen, or maybe: Raloxifene] has turned me

into something of a fascination, even a hero of sorts.

How can this be, when hundreds of thousands of women

take these medicines every day? Because of the leap of faith

required of us who participate, we are esteemed by the [STAR]

study staff. To them, we are pioneers who risk the consequences

of taking a pill we can’t name... We hope to further a science

that may save many lives.

I have lived all my life under the shadow of breast 

cancer. And then I read about Tamoxifen and Raloxifene. 

I began to think I could take a hand in steering my life

instead of waiting for it to happen to me. I felt exhilaration

lightly tinged with the panic I’d experienced once running

downhill when gravity got more of a hold on me than 

I liked. But...this was an invitation to do something in 

my own interest that would also fulfill a scientific need 

and give me a shot at saving lives in the future, among 

them those of my beloved daughter and niece, swimmers 

in my own gene pool.

I said yes. 

I know absolutely that something good will come out of

this for all women. I know that, if something sorry should

befall me or my study fellows, someone will detect it good and

early. And I know we have a rooting section of wise and wonderful people who would say that we are, without exception,

interesting! ■

8 PreventionPost JUNE 2001

“
LINDA GRAY joined in the Avon Breast Cancer Three Day Walk

on May 4-6, 2001. Participants trekked 60 miles from

Frederick, Maryland, camping in tents along routes once 

traveled by Civil War soldiers, and completed their journey 

on the Mall in Washington, D.C., raising nearly 6.6 million

dollars for breast cancer research. Linda Gray is a native

Washingtonian and enjoys discussing politics. She is currently

a Program Specialist in the Early Detection Research Group,

Division of Cancer Prevention (DCP) where she works with

the PLCO Cancer Screening Trial and Lung Screening Study

(LSS). It was her administrative background and interest in

cancer research that brought her to the DCP nine years ago.

TERRI L. CORNELISON

NEWSLETTER OF THE NCI DIVISION OF CANCER PREVENTION 9

Who was your most influential

teacher?

My dad because he taught me

about life — how to be self-sufficient, how to get along with others,

and how to be well rounded. He

raised my sister, brother, and me

with the help of my grandmother,

after my mom died of breast cancer when I was 11.

What event has had the biggest

effect on your life?

My marriage: finding a partner with

whom I can be myself, be comfortable, and have fun.

What do you like most about 

your work?

Variety. I am encouraged to grow

and to become involved.

Tell about your most perfect day.

A leisurely breakfast, more than

one cup of coffee, in the summertime with my husband. We put our

kayaks on top of the car, go to

Eastern Shore, and paddle around

all day.

How do you relax?

Well, on an imperfect day, I walk,

exercise, work in the garden, 

and read.

What are your favorite books, 

and why?

Patricia Cornwell novels. The stories occur local to Washington DC,

and deal with crime, death, mystery, and medicine.

What are you currently reading? 

The Brethren by John Grisham.

Who is your favorite musician?

I like blues: BB King, Eric Clapton,

Aretha Franklin, and Bonnie Raitt.

What place have you never been

to that you would like to visit?

Alaska and Switzerland because

the mountains seem so clean 

and fresh, and Italy because of 

my heritage.

What is the best meal you have

ever had?

Oh that’s easy! Italian Christmas at

grandma’s house – antipasto,

bread, wine, lasagna, meat, braccioles, meat balls, salad, cannoli, coffee. It takes hours to enjoy.

What is your favorite color?

Blue.

What is your favorite sound?

Rain on the roof.

What is your favorite vegetable?

I like them all.

What is your favorite sport?

Basketball.

What do you hate the most?

Aggressive drivers.

Who is your greatest love?

My husband.

If you could change just one

thing in the world, what would 

it be?

For all parents to love their children

unconditionally and spend time

with them so they feel loved and

important.

What is your greatest accomplishment to date?

Raising our two children.

For what do you wish to be most

remembered?

Being a good friend, wife, and

mother.

What made you want to do the

Avon Breast Cancer Walk?

I wanted to challenge myself physically and mentally, and I wanted to

walk in honor of my mother. ■

INDIVIDUAL SPOTLIGHT

Linda Gray

DCP home base: Executive Plaza 
1 0 PreventionPost JUNE 2001

T

he world’s leading experts

on screening 

for colorectal cancer gathered in Bethesda in March –

not coincidentally Colorectal

Cancer Awareness Month – to

debate and discuss the role of

screening for people at average

risk of colon cancer. Gathered

by invitation of the Division of

Cancer Prevention, they debated the role of seemingly conflicting recommendations 

from various groups and discussed the kind of research 

the National Cancer Institute

could sponsor to help fill in the

scientific gaps.

One common message was

that any kind of colorectal cancer screening –- be it fecal occult

blood testing, sigmoidoscopy,

double-contrast barium enema, or colonoscopy – it is better

that nothing at all, and most Americans who might be

screened, are not. Depending on the test, only 20% to 40%

of people over age 50 get tested for colorectal cancer.

Compared to no screening at all, any test is cost effective,

according to Michael Pignone, M.D., M.P.H., of the

University of North Carolina, Chapel Hill, one of the evidence-based practice centers that inform the Agency for

Healthcare Research Quality, the government agency called

on to address medical practice issues. AHRQ is in the process

of updating the U.S. Preventive Services Task Force recommendations on colorectal screening (http://www.ahrq.gov/).

Marion Nadel, Ph.D., from the Centers for Disease

Control and Prevention in Atlanta, pointed out the complexities with choosing one test over the other, noting that cost,

acceptability of the procedure, effectiveness of the test, and its

availability will all come into play. “While colonoscopy is the

most effective and we may choose it for ourselves, we have to

weigh these other factors when making recommendations to

the public.”

Speaking for the public, Kevin Lewis, co-founder and

chairman of the Colon Cancer Alliance noted that most 

people “assume they are at low-risk for colorectal cancer”

and don’t need to be screened. And those who are screened

say that insurance coverage, the unpleasant preparation needed for most tests (laxative solutions), and the procedures

themselves are major obstacles.

Two main viewpoints

emerged among workshop participants: those who look at

colonoscopy as a gateway – i.e.

start with colonoscopy and

then add other screening as

needed. The other perspective

is that other, often simpler or

less invasive, tests could be

used to signal a need for fullfledged colonoscopy. Bernard

Levin, M.D., co-chair of the

meeting and vice president for

cancer prevention at the

University of Texas M. D.

Anderson Cancer Center in

Houston espoused the latter

view. “We need to think of

strategies to reduce the need for

colonoscopy,” said Dr. Levin.

Researchers also discussed

new techniques on the horizon,

some closer to common use than others. One that is heading

to large-scale study is a genetic test done from a Fecal 

Occult Test stool sample. A positive results would lead to

colonoscopy. On the far horizon is a Virtual Colonscopy—

using computer technology with a CT scan to “see” the structure of the colon and its lining—where the screenee doesn’t

have to prepare the colon with cleansing agents/laxatives, as is

usually the case. Virtual colonoscopy with cleansing is not in

large-scale trials, and the added benefit of doing so without

cleansing the colon is farther away.

Equally important, there was discussion about what the 

target of screening should be – cancer itself or a preinvasive

growth? And which preinvasive growth is the best determinant of risk for cancer? Current practice focuses on small 

adenomatous polyps, but more advanced lesions might be 

a better target, noted DCP’s Ernie Hawk, M.D., chief of 

the Gastrointestinal and Other Cancer Research Group and 

co-chair of the meeting.

While many workshop participants voiced support of a

large-scale trial of colonoscopy, there was debate as to what

colonscopy would be compared to in such a trial. In addition,

Ted Levin, M.D., of the Kaiser Permanent Division of

Research in Okaland, Calif, noted, “If we did a colonoscopy

trial that showed no benefit, would anybody believe it? 

The horse it already out of the barn.”

Summary and recommendations from the workshop are being

formulated and will be submitted to a journal for publication. ■

DCP Colorectal Cancer Screening Workshop Stirs Discussion 

on Good Tests, Better Technologies, and Best Choices

KARA SMIGEL CROKER

Dr. Peter Greenwald, Dr. Ernie Hawk and Dr. Bernard Levin listen intently to 

speakers at the Colorectal Cancer Screening Workshop.
NEWSLETTER OF THE NCI DIVISION OF CANCER PREVENTION 1 1

We would like you to join us in welcoming new staff to DCP:

Raheleh Amini, MS

Clinical Research Program

Specialist, Protocol Information

Office 

From NIAID

Dawn Fisher

Office Automation Clerk, Office

of Preventive Oncology

She is a also Biology major at

Bowie State University

Jill Hughes

Administrative/Personnel

Technician, Administrative

Resource Center

From SAIC

Elizabeth McMillan

Administrative Program

Assistant, Nutrition Science

Research Group 

from the Department of

Commerce

DEE SULLIVAN

Robert Negm, PhD

Bioinformatics Specialist,

Cancer Biomarkers Research

Group

From Boston University

Susan Perkins, PhD

Special Expert, Office of

Preventive Oncology, NCI at

Frederick

From Division of Basic Sciences

Anne Ryan

Program Specialist, Office of

the Associate Director

From the Southwest Oncology

Group, Statistical Center,

Seattle, WA

Asad Umar, PhD, DVM

Program Director,

Gastrointestinal and Other

Cancers Research Group

From NIEHS

Good Luck!

Please join us in wishing Ann Malner well as she begins

her new position as Secretary to the Deputy Director 

of NIAAA.

TRANSITIONS

Did you know that corn is a vegetable? I didn’t.

I have claimed for years that corn was NOT a vegetable,

because it is classified, botanically-speaking, as a grain. Grains

aren’t vegetables, right?

Wrong. Grains are vegetables. Beans are vegetables. In fact,

any edible plant, or edible part of a plant, is considered to be

a vegetable.

I have more news for you. Fruits are parts of plants and

therefore they are vegetables too.

Troubled by this knowledge? Wondering where it’s leading?

Let me explain. 

The botanists say that a fruit is a mature ovary of any

plant1

. Take a guess as to what those corn kernels are.

Yes, the corn we eat is actually a fruit.

Who knew? 

I ought to apologize for all those times I’ve been wrong.

For all the times I made my mother serve something green

instead of something yellow. For all the times I’ve scowled

when corn appeared with potatoes (gasp!) next to my chicken. 

Potatoes????? I guess I have to apologize for that one too.

1 Ensminger, Ensminger, Konlande, and Robson. The concise encyclopedia of foods and

nutrition. Boca Raton, Florida: CRC Press, 1995. 

True Corn-fession

P AMELA MARCUS

CONGRATULATIONS!

Congratulations are in order for James Crowell,

PhD named the Chief of the Chemoprevention

Agent Development Research Group and Eva

Szabo, MD named the Chief of the Lung and Upper

Aerodigestive Cancer Research Group.
1 2 PreventionPost JUNE 2001

PreventionPOST

Newsletter of the Division of Cancer Prevention

National Cancer Institute

Executive Plaza South, Suite T-41

6130 Executive Boulevard, MSC-7105

Bethesda, Maryland 20892-7105

Two years have passed since the Division

of Cancer Prevention began to recreate

itself as a team-based matrix organization. Painless is not the best word to

describe our transformation. We 

needed to learn a new vocabulary; we

adjusted to new working relationships,

and we took on responsibilities added to

those that accumulate in any state-of-the-art scientific research

institution like the National Cancer Institute. Change is hard

but change we did. Team participation is now a part of each

DCP staff’s performance evaluation. Leadership opportunities

for scientists and support staff regularly emerge as new teams

are developed and old teams complete their tasks. Each DCP

employee spends some portion of their week working with

ENDPOINTS

Teams Work DOUGLAS L. WEED

Editor-in-Chief

individuals outside their respective research groups. As a result,

we know each other better and can help each other succeed.

There is a palpable sense of accomplishment and progress

among those who have championed these changes; teams 

work, to put it bluntly. Scientific concepts—such as the Lung

Screening Study—have successfully emerged from teams with

members not only from DCP but also from other Divisions and

from beyond the NCI. The support staff team meets regularly

to examine and improve the working lives of the unsung heroes

of our organization. And the newsletter team—of which I am

extremely proud—keeps you posted on news about NCI’s cancer prevention efforts, complementing the efforts of a new DCPbased communications and marketing team. Over two dozen

teams help to define the future of cancer prevention at the NCI.

Why not join us? ■

CART OON

GRAÇA DORES