Revolutionary statewide UC collaboration targets breast cancer

By Elizabeth Fernandez on September 29, 2009

Laura J. Esserman, MD

The University of California is launching an unprecedented statewide collaboration for breast cancer patients with the goal of revolutionizing the course of their care by designing and testing new approaches to research, technology and health care delivery. 

Named the ATHENA Breast Health Network, the groundbreaking project will initially involve 150,000 women throughout California who will be screened for breast cancer and followed for decades through the five UC medical centers. ATHENA is a University of California system-wide project supported by a $5.3 million University of California grant and a $4.8 million grant from the Safeway Foundation. 

The project is expected to generate a rich collection of data and knowledge that will shape breast cancer care in the way the renowned Framingham heart study changed the care of patients with heart disease. 

“ATHENA is a model of multi-institutional collaboration and demonstrates the enormous potential in shared systems,” said John D. Stobo, MD, UC senior vice president for health sciences and services. “This is a great example of the power of our statewide university network of academic medical centers; this initiative will demonstrate that the total of what can be accomplished by UC functioning as an integrated system can far exceed the sum of contributions by the individual campuses. ATHENA represents an unprecedented opportunity to play a leadership role in driving critical changes in health care. The public nature of the UC institutions make them uniquely positioned to study the appropriateness and effectiveness of treatment. It also allows for the applied use of new scientific evidence, much of which has been developed in the UC medical centers, to truly change the delivery of care.” 

The medical centers involved in the large-scale demonstration project are UC San Francisco as the host campus, UC Davis, UC Los Angeles, UC San Diego, and UC Irvine. Also participating in the collaboration are the UC Berkeley School of Public Health, the Northern California Cancer Center, Quantum Leap Healthcare Collaborative, the National Cancer Institute’s BIG Health Consortium, and the Center for Medical Technology Policy. 

“We are excited to be supporting this innovative collaboration that, to date, has the clearest potential to produce ground breaking research that will bring us closer to a cure,” said Larree Renda, Safeway Inc. executive vice president, chief strategist and administrative officer and chair of the Safeway Foundation. 

Breast cancer, the most common cancer in women, is a devastating and costly disease, striking more than 200,000 women annually and killing more than 40,000 women each year, according to the American Cancer Society. In the United States, more than $20 billion is spent annually screening and treating the disease. 

ATHENA is designed to more efficiently integrate financing, technology, research and clinical care, creating an infrastructure model that could be utilized for many medical conditions. 

“Our goal is to improve survival and reduce suffering from breast cancer, to accelerate research and compress the time to implement innovations in clinical practice,” said ATHENA principal investigator Laura Esserman, MD, MBA, professor of surgery and radiology, director of the UCSF Carol Franc Buck Breast Care Center and co-leader of the breast oncology program at the UCSF Helen Diller Family Comprehensive Cancer Center. 

“By working together as a community, the University of California medical centers, their affiliates, primary care and specialty physicians and patient advocates will work to change the options for patients today and create a better future for all women at risk for developing breast cancer,” she added. 

The goals of the ATHENA initiative are: 

  • To create common systems to integrate clinical research and care across the UC campuses to advance the science of prevention, screening, diagnosis, and treatment of breast cancer.
  • To drive innovation across the UC system to deliver and finance more effective and efficient systems for personalized and biologically targeted care, using breast cancer as a prototype.
  • To create a biospecimen repository that has broad racial and ethnic representation.
  • To reduce morbidity and mortality by gaining a molecular understanding of breast cancer and factors that fuel breast cancer risk.
  • To improve understanding of who is at risk for what kind of cancer, and whether the risk of that cancer is significant or minimal.
  • To generate the evidence for developing more effective and less toxic treatments and to drive innovation in prevention, diagnosis and treatment.
  • To provide tools to change the way patients and providers interact to prevent and manage the disease.

The science fueling personalized medicine is experiencing explosive growth. Molecular tests are now available that can analyze a breast cancer tumor and categorize the risk of breast cancer recurrence with and without treatments, according to Esserman. 

“Giving doctors sophisticated tools to tailor treatments to the individual tumor will revolutionize care, potentially enabling thousands of women to safely forgo toxic treatments and providing those at high risk of dying from their cancer with more targeted and effective treatments,” said Esserman. “Equally, if not more exciting, is the promise of molecular tools to more accurately predict the risk of getting breast cancer, which may ultimately lead to better ways to prevent the disease.” 

Women who present for breast cancer screening at the five UC medical centers and their affiliates will be enrolled into the ATHENA Breast Health Network and followed for decades. All women undergoing screening and treatment will be offered the opportunity to collaborate by contributing information about themselves, any risk factors they have, including health status, and other related lifestyle behaviors, such as diet, tobacco and drug use, environmental factors, gynecological history and family risk. This information will be used to help target prevention services now and in the future. Women diagnosed with breast cancer will additionally join a “survivorship cohort” comprised of women who have been diagnosed with breast cancer. 

“We will be able to create a state-wide cohort of women at risk of breast cancer and develop the optimal methods for the early detection of all types of breast cancer,” said Robert Hiatt, MD, PhD, professor and co-chair of the Department of Epidemiology and Biostatistics at UCSF. He is also director of population sciences and deputy director of the UCSF Helen Diller Family Comprehensive Cancer Center, and his research focuses on breast cancer and the environment. “The size and diversity of the survivorship cohort and the depth and quality of the information we’ll have will be unprecedented and will enable the development and testing of robust new models of cancer outcomes and prognosis.” 

The UC system is particularly well-positioned for a project of ATHENA’s magnitude because the medical centers annually screen as many as 80,000 women, and diagnose 2,500 patients with breast cancer. Still, said Esserman, the new project calls for “a re-imagining and then a re-engineering so that we can continually improve what we do—to improve our current processes, to streamline communication and access to information among care providers and patients, and to improve the efficiency of services.” 

The potential rewards are significant, she stressed. “This project will standardize the collection of structured data from both patients and physicians so that it is computable, interoperable, and reusable, and it will integrate molecular profiling at the time of diagnosis, and create an unparalleled biospecimen repository.  The result will be a network that enables personalized care informed by science and that fuels the accelerated and continuous improvement in treatment options and outcomes,” said Esserman. “With ATHENA, wisdom will be waging war against breast cancer and the learning system will continue to evolve until we have cured this disease.” 

While the ATHENA Breast Health Network focuses on breast cancer, the tools and infrastructure developed for this project are readily transferable to other cancers and conditions. ATHENA has the potential to serve as a transformative model to drive innovation, alter the culture of research and clinical practice and ultimately change health care delivery, according to the project team. 

For further information, visit http://www.AthenaCareNetwork.org

About UCSF 

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life science and health professions, and excellence in patient care. For further information, please visit http://www.ucsf.edu

About Safeway 

Safeway is a Fortune 50 company and one of the largest food and drug retailers in North America based on sales. The company operates 1,739 stores in the United States and Canada and had annual sales of $44.1 billion in 2008. The company’s stock symbol is traded on the New York Stock Exchange. Safeway supports a broad range of charitable and community programs and in 2008 donated more than $248 million to important causes, such as cancer research, education, hunger relief and programs focused on assisting people with disabilities.