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Day after day, year after year, doctors and researchers toil, often in obscurity, seeking new ways to diagnose and treat diseases and injuries -- then do the exacting work of proving scientifically that their new theories and techniques actually make a difference.
Last year Ladies' Home Journal launched our annual Health Breakthrough Awards to honor these outstanding individuals, whose discoveries have enabled us to have longer, healthier lives. We also wanted to acknowledge our own long and rich history of health advocacy journalism, which began more than 100 years ago when the magazine helped spur the formation of the Food and Drug Administration and led the fight against bogus medications.
This year's winners were chosen through an exhaustive nationwide search of more than 80 medical organizations, teaching hospitals, foundations, and government agencies. From fashioning a more sophisticated prosthetic arm that rivals the real thing to developing an improved way to give radiation therapy, from discovering a new source of potentially lifesaving stem cells to charting early ways to detect cancer, each of our awardees has transformed his or her field -- and our lives -- as a result.
In addition, we are proud to announce the winner of the second Marianne J. Legato Gender-Specific Medicine Award, named in honor of our medical adviser, who has pioneered this field. It is awarded to an individual whose work has furthered our understanding of the different health needs of women and men.
You've just heard the shattering words: "You have breast cancer." Before you've had time to digest this life-changing news, your doctor adds that there is a five to 10 percent chance that you will develop breast cancer in your other, "contralateral" breast within 10 years. The mammogram and clinical breast exam you've already had showed no evidence of a tumor in that breast. Should you have it removed in the event a tiny cancer is lurking there? Or do you take your chances?
Now, thanks to Constance D. Lehman, MD, PhD, professor and vice chairman of radiology and director of breast imaging at the University of Washington School of Medicine and director of imaging at the Seattle Cancer Care Alliance, women newly diagnosed with breast cancer don't have to take chances. They can have an MRI (magnetic resonance imaging).
Dr. Lehman, 45, was principal investigator of a trial coordinated by the American College of Radiology Imaging Network that involved nearly 1,000 women at 22 sites in the United States, Canada, and Germany. Researchers found that an MRI is more effective than either standard mammography or a clinical breast exam at finding tiny tumors in the contralateral breast.
In fact, MRIs detected 30 tumors that the other two methods had missed. This amounted to 91 percent of all the cancer the trial found in women's other breasts. The cancers were so small that none had spread to surrounding breast tissue or the lymph nodes.
"We caught the cancers at the time when they were easily treatable, with significantly lower pain and discomfort associated with treatment and higher likelihood of a cure," says Dr. Lehman. The study, published in the New England Journal of Medicine, has also helped physicians better understand the role MRI might play in the diagnosis of breast cancer.
"Dr. Lehman is one of the leaders in the world in the use of MRI for breast cancer detection and diagnosis," says Etta Pisano, MD, Kenan Professor of Radiology and Biomedical Engineering at the University of North Carolina at Chapel Hill, who worked on the MRI study with Dr. Lehman. "She is very visionary about how we can use the technology."
Why did MRIs uncover more tumors than the other two methods? While mammograms capture a two-dimensional image of the breast, MRI uses magnetic fields to create a three-dimensional image. "That means we can find cancers that are hidden between layers of breast tissue," explains Dr. Lehman. In addition, a contrast agent injected into a woman before the MRI is performed highlights areas of new and/or leaky blood vessel growth, which might signal a cancerous lesion. Women who discover a tiny cancer lurking in the other breast can now have both treated simultaneously, avoiding a second round of surgery and chemo a year or two down the road. And those who find no cancer can rest easy, at least until their next MRI.
Because it's so expensive (upwards of $1,000, compared with around $125 for a mammogram), MRI isn't routinely used as a screening tool. "Whether or not women who have already had breast cancer will need to continue to be screened with MRI every year is still a matter of debate," Dr. Lehman says. However, the American Cancer Society recently recommended that all women classified as high risk for breast cancer get an annual MRI scan, starting at age 30.
"Without question, breast imaging is one of the most exciting areas in imaging," says Dr. Lehman. "We are moving into an era where we are seeing more individualized treatment of breast cancer. As imagers we want to provide as much information as possible on the true extent of the disease and the type so targeted therapies can be available to more women."
Dr. Lehman, who at one point wanted to be a psychologist, was attracted to radiology because of both its intellectual excitement and the patient contact that is an integral part of the job. "It provides so many opportunities to have an impact on women's lives," she says.
That impact is needed. The American Cancer Society estimates that 178,480 women will be diagnosed with breast cancer this year. Dr. Lehman's own familiarity with the disease is not just clinical. Her godmother has battled breast cancer, and, she says, "I am at an age where more of my friends than I would like to count have been diagnosed with the disease."
It's 1988, and two Wisconsin scientists spend night after night giving radiation therapy to cancer patients. One is an oncologist born in Uganda to Indian parents; he was 12 when his family relocated to Zambia after Idi Amin assumed power. The other is a young physicist from Canada who grew up in the town where cobalt therapy, a form of radiation treatment, was developed.
Eating pizza between seeing patients, the duo begins to brainstorm about a new approach to radiation therapy, one that would target tumors more precisely and not damage so much healthy tissue at the same time. "We thought there had to be a better way to make the whole process easier and more efficient," recalls Minesh P. Mehta, MD, program leader of radiation and imaging services at the University of Wisconsin Paul P. Carbone Comprehensive Cancer Center and a professor of human oncology at the University of Wisconsin School of Medicine and Public Health, both in Madison.
"We just started dreaming of a new machine," adds T. Rock Mackie, PhD, a researcher at the cancer center and a professor of medical physics and human oncology at the medical school. In their minds it was a CT scan-like device that would also let doctors pinpoint the tumor before each treatment. "Even I thought it was a crazy idea," says Dr. Mackie, 52.
Fast-forward nearly two decades. The crazy idea -- now called TomoTherapy HI-ART System -- has become a first-of-its-kind technology that is poised to transform cancer treatment.
Standard radiation therapy begins with just one CT scan to pinpoint the tumor. Tiny tattoo dots mark where the radiation machine will aim a rectangular beam at the tumor from several angles for a few minutes per dose. The problem is that over time, tumors change in size, shape, and location, making the tattoo a less-accurate guide. Patients may get less radiation than needed and more healthy tissue may be affected, with side effects such as dry mouth, vaginal burning, or intestinal problems.
With TomoTherapy, each treatment begins with a CT scan that outlines the tumor's current position and shape. Instead of a few angles, the machine slowly carries the patient past tens of thousands of tiny fan-shaped radiation beamlets that bombard the tumor in a 360-degree pattern.
"We can deposit a dose of radiation that reproduces the exact shape of the tumor, so the surrounding normal tissue gets far less exposure to radiation," says Dr. Mehta, 52. In people with head and neck cancer, for example, this minimizes how much radiation passes through the brain, salivary glands, and spinal cord.
Targeting also means doctors can safely deliver more radiation per dose and potentially slash treatment duration. Dr. Mehta has been able to reduce the standard eight- to nine-week treatment for prostate cancer to four to five weeks for some patients and lung cancer from eight to 10 weeks to five.
About 125 radiation centers around the world already use TomoTherapy. "It's the next generation of radiation therapy treatment machines," says Christopher J. Schultz, MD, professor of radiation oncology at the Medical College of Wisconsin, who uses the technology for his patients.
The potential of research into stem cells is nothing short of awesome. Many scientists believe it may unlock the mysteries of such devastating conditions as diabetes, spinal cord injuries, and Parkinson's and Alzheimer's diseases, among others.
Stem cells are a kind of "master" cell that can develop into a number of specialized cell types, potentially replacing diseased or damaged tissue. They can be extracted from early-stage human embryos or from adult bone marrow and other tissues. Because they are not fully formed, embryonic stem cells have the capacity to become almost any cell type in the body, while adult cells are more limited in what they can do. But embryonic stem cells are also a subject of considerable ethical debate. In 2001 President Bush restricted federal funding for research on them; at press time he had just vetoed a bill that would have lifted this limitation.
In January, seven years of research led by Anthony Atala, MD, W.H. Boyce Professor and director of the Wake Forest Institute for Regenerative Medicine and chairman of urology at the Wake Forest University School of Medicine, found a crucial third source: human amniotic fluid and the placenta.
"His discovery has turned the stem cell field upside down," says Robert Lanza, MD, vice president of research and scientific development at Advanced Cell Technology, a Worcester, Massachusetts, firm that develops stem cell technology.
Like embryonic stem cells, amniotic cells double every 36 hours, providing scientists with ample material. But unlike embryonic cells, which can be rejected and may form tumors in human tissue, amniotic cells are stable. "They don't form tumors, and we can avoid the rejection issue," says Dr. Atala, 49, who has produced liver, bone, and brain cells from them.
The new cell lines will not end the debate over embryonic cells -- nor should it, maintains Dr. Atala, who received the 2000 Christopher Columbus Foundation Award, given to a living American involved in research that will dramatically affect society. "It's not a good thing to eliminate one stem class completely," he says. "You don't know what is going to be best in the future for patients." Indeed, last year Japanese researchers developed a line of cells that come from adult mice, behave like stem cells, and may eventually help scientists develop more types of cells from adult human issue.
Dr. Atala also pioneered a technique transplanting new bladders made from patients' own cells into seven children ages 4 to 19. The work took 16 years. Following up on them for five years after surgery, Dr. Atala found the new organ helped the kidneys and reduced urinary incontinence.
Ladies' Home Journal has regularly reported on the strain on the nation's ERs. Now two physicians from the emergency department at Washington Hospital Center (WHC) have devised a dazzling computer system that may be the most significant tool to improve emergency-room care in decades. Bought last year by software giant Microsoft, it's now spreading nationwide.
Mark S. Smith, MD, and Craig F. Feied, MD, friends and colleagues since 1983, were as frustrated as their ER patients by the long wait times, made worse by doctors' inability to quickly access information on a patient's health history. "We were making decisions in a vacuum," says Dr. Feied, 53. "The only information I had was what a sick or injured patient could tell me." Any earlier medical records the hospital had were very hard to access. "That doesn't help you make life-or-death decisions," he says.
Before entering medicine Dr. Smith earned a degree in computer science, and Dr. Feied in biophysics. Both were fascinated with an emerging field called medical informatics, the study of how medical information is handled. Both felt healthcare was light-years behind.
"There is more information technology at an Avis or Safeway checkout than there is at most hospitals," says Dr. Smith, 60, who became chairman of WHC's department of emergency medicine and professor and chairman of emergency medicine at Georgetown University School of Medicine in 1995. He hired Dr. Feied as director of the Institute for Medical Informatics.
In January 1997, after just 13 months of work, the duo launched a software program in WHC's emergency department. Called Azyxxi, it gathers all medical data the hospital has about a patient (blood work, x-rays, an ultrasound, etc.), no matter which computer program stored it originally. The software creates a new file for each patient and lets staffers call it up in just one-tenth of a second.
Azyxxi's effect was seismic. ER wait times dropped from about six hours to about one, allowing 37,000 additional patients per year to be seen. Later it was adopted by the six other hospitals in WHC's MedStar Health network, which attracted Microsoft. Dr. Feied is now general manager of Microsoft Health Solutions Group, while staying a professor at Georgetown. Next in line: New York-Presbyterian Hospital, in New York City, the Johns Hopkins Health System, in Baltimore, and the Wisconsin Health Information Exchange.
Claudia Mitchell remembers May 27, 2004, all too well. It was a beautiful Arkansas afternoon so she accepted a friend's invitation to go for a ride on the back of his motorcycle. But half an hour into the ride something went horribly wrong. While navigating a curve, her friend lost control of the bike and Mitchell's life changed forever. She was thrown off the bike, suffered internal injuries and her left arm was severed below the shoulder when her body hit a guard rail. She was just 24.
Recovery was tough. Mitchell, a former Marine who had served in Kuwait, was fitted with a prosthetic arm that fall but became extremely frustrated when it proved difficult to use. Extending her arm and opening and closing the hand to pick up an object, for example, was a 25-step process of figuring out each move, adjusting her shoulder muscles and flexing one muscle at a time. Result: The arm "basically collected dust on a shelf," she says.
Then a friend showed her an article about a high-power lineman who had lost both arms in an electrocution and been given amazing new prosthetic arms created at the Rehabilitation Institute of Chicago (RIC). A team headed by Todd A. Kuiken, MD, PhD, director of RIC's Amputee Programs and director of the institute's Neural Engineering Center for Artificial Limbs, had developed a bionic, or myoelectric, arm. Weighing just 6 pounds, it enabled the user to move his arm simply by thinking about it. This is possible thanks to a breakthrough surgical procedure called targeted muscle reinnervation, pioneered by Dr. Kuiken, 47. Four major nerves that travel down a patient's arm are moved from the shoulder and reconnected to healthy chest muscle and chest skin. Then, simply the thought to move the arm generates nerve impulses that are sensed by the electrodes. "It's very intuitive," explains Dr. Kuiken.
Determined to get one of those arms for herself, Mitchell contacted the institute, told her story to anyone who would listen and eventually was connected to Dr. Kuiken. The two met in January 2005 and on August 2 of that year -- Mitchell's 25th birthday -- she underwent the life-changing surgery that last year enabled her to become the first woman, and the fourth person, to receive the three-motor arm, so called because it lets a person move three joints -- the hands, wrist, and elbow. What's more, Dr. Kuiken, with plastic surgeon Gregory Dumanian, MD, of Chicago's Northwestern Memorial Hospital, devised a way to implant the nerves without cutting into or removing the tissue from Mitchell's chest, as had previously been done with male patients.
What makes the arm so unique is that Mitchell can open and close her hand, flex her wrist, and bend her elbow almost as naturally as she can her other arm. For example, when she thinks "close hand," a perfectly choreographed sequence of events takes place: Muscles in her chest contract, electrodes attached to her body when the arm is strapped in place detect that movement and then signal a computer in her prosthetic arm to close the hand. Now, marvels Mitchell, "I can cook more easily because I can hold certain utensils, I can put on my makeup, and I can do laundry."
It took Dr. Kuiken nearly two decades to develop the three-motor arm. "It started with reading one line in a research paper suggesting how you might be able to relocate nerves," he recalls, and he continued the quest as a doctoral student in biomedical engineering at Northwestern University through the Feinberg School of Medicine at Northwestern University and a residency at RIC. His big breakthrough came in 2005 when Jesse Sullivan, the lineman, was able to lift a glass of water using the three-motor arm.
With the help of Sullivan and Mitchell, Dr. Kuiken and his team are now fine-tuning a six-motor arm that permits more movements and may enable a person to sense how hard they are squeezing something and whether the object is hot or cold, smooth or rough. They hope it will be ready within the next few years. The team has also been tapped by the Department of Defense to join an effort to improve prosthetic arms, including equipping them with movable thumbs and fingers.
In the pipeline: a new, improved version of the prosthetic leg. It could take years, but Dr. Kuiken isn't daunted. "I am a gearhead and proud of it. I am also a doctor and proud of that. The two actually go together quite well," he says. "I am not going to have to worry about retiring early."
Among gynecologic cancers, ovarian cancer is the deadliest. It accounts for just 4 percent of all cancers in American women, yet it's the fifth leading cause of cancer death. An estimated 22,430 new cases will be diagnosed in the United States this year, and 15,280 women will die of it. The reason the prognosis is so poor compared with, say, breast cancer is that currently there is no definitive screening test. As a result, experts have historically dubbed it the "silent killer," maintaining that it is symptomless until it has spread, giving patients an overall five-year survival rate of just 45 percent.
So when a groundbreaking January 2007 study in the journal Cancer showed that ovarian cancer does, in fact, cause symptoms in its early stages, doctors, medical organizations, and ovarian cancer advocates paid attention. Barbara A. Goff, MD, 47, director of gynecologic oncology at the University of Washington, found that women with ovarian cancer reported common symptoms prior to their diagnosis: pelvic or abdominal pain, increased abdominal size or bloating, frequent or urgent urination, and difficulty eating because they felt full before finishing a regular-size meal. What's more, the women had experienced the symptoms for 12 or more days per month, over less than a year. This spring the American Cancer Society, the Gynecologic Cancer Foundation, and the Society of Gynecologic Oncologists issued a consensus statement embracing the symptom list as useful, the first official recognition that ovarian cancer is not silent. It was endorsed by 18 cancer and ovarian-cancer groups.
Dr. Goff's involvement in ovarian cancer research came from conversations with patients, who, despite the medical community's hard line that the disease's early stages were symptomless, begged to differ. "I was impressed by the ease with which these women could recall the health problems that preceded their diagnosis," she says. "So many had been significantly blown off when they tried to talk to their doctors. Then they ended up having ovarian cancer after all."
One survivor -- a nurse named Cindy Melancon -- made a particular impression on Dr. Goff, who asked her to join a research project to document whether symptoms did exist. The study was published in Cancer in 2000. "I did that project on a shoestring," says Dr. Goff. A patient donated $1,000 to cover research costs, and a statistician donated her time, while Melancon came up with a mailing list. "We found that 97 percent of the 1,700 women in the study reported symptoms prior to their diagnosis," says Dr. Goff. An astounding 89 per cent with early-stage disease had symptoms.
Since many symptoms, such as bloating, also indicate benign conditions, the next step was to distinguish women with ovarian cancer from those with a less-serious problem. For that study, published in the Journal of the American Medical Association in 2004, Dr. Goff again partnered with Melancon. "It showed a big difference in the frequency, severity, and duration of symptoms in women with ovarian cancer," says Dr. Goff. Sadly, Melancon died of the disease in 2003, before the study was released. "Dr. Goff's doggedness and persistence have been crucial," says Patricia Goldman, a 14- year ovarian-cancer survivor and president emeritus and a founder of the Ovarian Cancer National Alliance, which has endorsed the consensus statement. "As people who had ovarian cancer, we knew there were symptoms in the early stages. Dr. Goff listened. That wasn't the case with many physicians."
Dr. Goff hopes the index will give women a fighting chance. "When ovarian cancer is caught in stage 1 or 2, the cure rate can be 70 to 90 percent," she says. "For the many patients who get a later diagnosis, the cure rate can be 10 to 20 percent."
If signs point to cancer, women need a medical exam and may further need a transvaginal ultrasound, a blood test for CA-125, a protein associated with ovarian cancer, and exploratory surgery.
Can you imagine doctors waiting for a patient to have a stroke -- and then checking her blood pressure? That after-the-fact approach is how osteoporosis care is currently dealt with, says Ethel S. Siris, MD, professor of clinical medicine and the director of the Toni Stabile Osteoporosis Center at Columbia University Medical Center, New York-Presbyterian Hospital.
As president of the National Osteoporosis Foundation (NOF) and a major osteoporosis researcher, Dr. Siris has been leading the charge to draw attention to the disease, which affects 8 million American women and 2 million men. Nearly 34 million more have low bone mass, a less-serious condition that boosts the risk of osteoporosis. Dr. Siris is also working to help Americans realize that osteoporosis is not just a problem for women.
Dr. Siris's passion is fueled by personal experience. Her mother fell on her back and suffered several vertebral fractures in her 70s as a result of osteoporosis. "I remember vividly how distressed I was and how little we could do for her," recalls Dr. Siris. Though her mother lived to 88, she suffered from a back deformity for the remainder of her life.
Dr. Siris is principal investigator for the National Osteoporosis Risk Assessment study, a 1997 to 2006 assessment of the risk of osteoporosis in more than 200,000 women, ages 50 to 99, resulting in more than 20 papers so far, with more likely to come.
In the future the NOF hopes to issue guidelines for women and -- a first -- men. "It's gratifying to see clinicians of her stature thinking of the unique needs of men with diseases considered women's illnesses," says Dr. Marianne J. Legato, founder and director of the Partnership for Gender-Specific Medicine at Columbia University, for whom this award is named.Medical Heroes
We held our first annual Health Breakthrough Awards last year. Winners were celebrated for their pioneering work on breast cancer, ovarian cancer, stroke, and other women's health issues.
Originally published in Ladies' Home Journal, September 2007.