Distinguished and committed physician, researcher, teacher, and leader

What genetic education topics are you currently researching and/or teaching?

This is an exciting time for cancer research. We are constantly seeing new findings and emerging therapies across a range of areas. There has been a recent focus on cancer genetics – studying how a person’s genes or genetic changes might contribute to cancer development and treatment. Most cancers are caused by genetic changes that occur during a person's lifetime, and there have been significant advancements made with regards to genetic testing for cancer.

I am also very focused on minimal residual disease (MRD). While recurrence rates vary from cancer to cancer, solid tumor cancers like breast cancer can have a 30% chance of patient recurrence. This means nearly one in three patients must contend with the experience of a second wave (or more) of cancer treatment. Given this prevalence, MRD is an important topic to explore and one with potential to impact care for many people.

Please explain minimal residual disease (MRD) testing. What types of cancer is MRD testing currently used for?

Cancer can recur following treatment due to residual disease that persists after surgery. This remaining cancer, referred to as minimal residual disease (MRD), may consist of no more than a few cancerous cells that remain after surgical removal of a solid tumor. Yet, left untreated, these cells can spur the original cancer to recur or relapse.

For this reason, providers can use new MRD technology to closely monitor patients after primary surgical treatment. This monitoring can extend for years afterward. Conventional techniques for spotting residual, recurrent or resistant cancer can be limited in their ability to detect cancer in early stages, but new MRD testing using a simple blood draw can detect residual cancer in the body at low levels, often even before it may appear on imaging.

According to the National Cancer Institute, solid tumor cancers including breast, lung, prostate and colorectal account for about half of all new cancer cases in the United States and are responsible for nearly 50% of all cancer deaths. These are cancers where MRD testing has the potential to make an impact.

How is MRD testing used in clinical practice today?

MRD testing is used by clinicians not only to understand remaining disease after treatment, but also to screen patients long-term to help identify early signs of cancer recurrence. In recent years, circulating tumor DNA (ctDNA) has emerged as a MRD biomarker empowering physicians to assess recurrence risk and patient selection for adjuvant chemotherapy following surgical treatment. ctDNA MRD testing may enable precise monitoring with high levels of sensitivity and specificity. 

Personally, I have always wondered how much effect lifestyle factors have on someone’s genetic risk for cancer. Would you please share your view on this?

Cancer is a genetic disease. While genetic changes that increase a person’s risk of cancer can be inherited, this accounts for a small number of cases (only 5-10% of all cancers). Inheriting a cancer-related gene doesn’t mean an individual will necessarily develop cancer – just that the risk is increased.

We know from research a number of lifestyle factors can be linked to different cancers. Smoking’s impact on lung cancer is well-documented, just like sun exposure’s relationship to skin cancer. While inherited genetic changes aren’t modifiable, lifestyle factors can be changed to reduce a person’s risk of cancer. Things like a healthy diet, increased physical activity, and lower alcohol consumption may all reduce risk for cancer development.