I wish u knew… the role of cancer biology and genetics in cancer

Tim Hampshire

If you give Dr. Timothy Rebbeck a good team of biologists, sociologists, and clinicians, he can look at a population of people and tell you about the cancer risks that affect it disproportionately. This is no small task. He’s not just finding cancers in people and making sure they get treated; he’s researching the biomarkers that suggest what types of people might get certain types of cancer. I was excited to talk to him because of the old Einstein quote: “I’m simply trying to read the mind of God.”

Dr. Rebbeck is too unassuming to seem like he wants to beat God at the poker table. He told me calmly about how the people in his field incorporate biomarkers, genetic information collected in blood, urine, or other biological materials, to pool evidence from large populations of people. The patterns and consistencies that seem to overlap become the hypotheses and theories in his field of molecular epidemiology. For example, research throughout Africa has shed some light on the freakish occurrence of prostate cancer among African American men.

But what is the goal of research like Dr. Rebbeck’s? Even if we could find out with near-perfect certainty that a certain group of people would end up getting cancer, have we really won a victory in the field of science? Doesn’t that still just mean people are getting cancer?

Dr. Rebbeck is privy to this issue. He told me, “Everything we do has to have a kind of translational component. It has to become relevant to human health in some way or another. If we understand biology via genetics or biomarkers, we might be able to develop new drugs or think about different ways of intervening before somebody gets sick.”

So it’s not just research for research’s sake. Dr. Rebbeck believes that understanding what leads to cancer—at the genetic level as well as at the sociological level—is important to stopping it.

A good example of genetic research that led to a clinical impact is the testing for BRCA1 and BRCA2, two mutations that strongly suggest risk for breast and ovarian cancer in women. Once those biomarkers were found to correlate with cancer, the strategy of prevention for ovarian cancer changed drastically. “For ovarian cancer, there are really no good preventive strategies. The standard of care now is actually to remove healthy ovaries before they develop a tumor,” said Dr. Rebbeck.

BRCA1 and BRCA2 have received a lot of media attention recently because of a series of controversial Supreme Court proceedings regarding whether or not the genes should be patentable by the company that first developed a test for them (Myriad Genetics of Salt Lake City.) Dr Rebbeck commented on the issue, saying “I think patenting genes is something that is probably not necessary and probably doesn’t help science…Genetic information should be considered free information.”

His Robin Hood mentality regarding the availability of genetic information probably has something to do with his vision for the future of molecular epidemiology. “The key for a genetic test is whether the data we get from it is medically actionable or not,” he told me. “If you have genetic information, but it doesn’t change how you act, or it doesn’t change what your doctor can do for you, it’s not very valuable.”

His wish for the public is for us to know what it takes for discoveries like his to come together. “Science can occur in a lot of different ways,” he said. He thinks that his field is one that “benefits from having people from different disciplines work together.” With enough cooperation, perhaps Dr. Rebbeck and the people he works with can find out what it takes to make sure we combat the issue of cancer where it begins—in our DNA, or in our national public health priorities, or wherever that may be.

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