William N. Hait, MD, PhD, director, The Cancer Institute of New Jersey, associate dean and professor of medicine and pharmacology, Robert Wood Johnson Medical School
Losing Friends to Cancer
by Eve Jacobs
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Sorrowful is not a word that comes to mind when thinking about Bill Hait. Buoyant. Boyish. Energetic. Smart. Any of those would aptly describe this baby boomer whose forward-thinking has been the driving force behind The Cancer Institute of New Jersey since 1993. Leadership sits squarely on his shoulders like a suit with no wrinkles.
o his sadness was an unanticipated wrinkle in an interview on the next best thing in cancer care for the 42 to 60 age group. But when cancer takes away a cherished friend in the prime of his life, it can reframe the question. The news for baby boomers concerned about cancer (that’s probably all of us) is certainly not all positive: Despite enormous advances in scientific knowledge, and solid progress in treatment, cancer will still rob us of friends, co-workers, parents and children, and carelessly throw them on the discard pile of cancer mortality statistics. And not even the director of the only National Cancer Institute-designated Comprehensive Cancer Center in New Jersey will be spared that sorrow.
Hait describes his friend as “in his 40s, a cancer researcher at Yale and one of my favorite trainees.” Despite catching the melanoma in its early stages and receiving state-of-the-art treatment at the NIH, he succumbed to the disease in December 2005, less than a year after relapse. “It was devastating,” states Hait, who has worked as a cancer researcher, clinician and administrator for his entire professional life.
With the death of a colleague from melanoma still uppermost in his mind, he names skin damage first among health concerns for boomers. “We’ve been out in the sun for 40 plus years and are now seeing its cumulative harm in the form of wrinkling, scaling, basal cell carcinoma [which has a low malignancy] and melanoma,” he says. According to The Skin Cancer Foundation, the rate for melanoma may rise to 1 in 50 Americans by 2010 because of exposure to ultraviolet rays (UVR) in early childhood, sunburns, and periodic increased exposure to the sun.
“We didn’t know about sun damage back then,” Hait says. “We used baby oil, Coppertone, and Sea and Ski, which didn’t protect us at all.”
Many boomers enjoy sports, he states, and “we spend hours at a time outdoors playing golf, biking and running. Our skin gets beat up.” He points to some progress made in the field by CINJ researcher Suzie Chen, PhD, who bred a genetically altered “melanoma mouse,” yielding insights into how the human form of the disease takes hold. By inserting bits of foreign DNA into a gene that encodes for a glutamate receptor, the researcher produced a line of mice with dark cancerous skin growths that spread throughout their bodies. Creating this animal model of melanoma is a major step towards understanding where scientists can intervene and, perhaps, halt its deadly path of metastasis.
Hait states that with sunblock readily available, younger generations have the tools to protect their skin from this kind of long-term damage. “But there is no way to turn back the clock on the harm that has already been done to the skin of those in their middle years,” he says.
In terms of making lifestyle changes that may inhibit cancer formation, Hait points to smoking and diet. “Stop smoking and your risk of lung cancer starts dropping immediately. In 10 years, your risk approaches that of a non-smoker,” he explains. “And a low fat diet has been shown to decrease recurrence rates of breast cancer in women with the disease who receive therapy.”
He also offers insights into colon cancer prevention: “Insufficient calcium in the American diet is known to contribute to colon cancer. We also know that taking certain drugs on a daily basis — among them aspirin, ibuprofen and the Cox-2 inhibitors — decreases the incidence of this cancer.”
According to Hait, other cancer preventatives include: green tea, which has high levels of anticarcinogens called cathechins and has demonstrated in the laboratory the ability to inhibit cancer growth, particularly of the liver, skin and stomach; and the anti-cholesterol drugs called statins, which have been shown to lower the risk for certain cancers, among them colorectal and skin.
Of course, the “biggest news in cancer prevention is the HPV vaccine — not for baby boomers, but for their kids. It’s a home run for Merck,” he says. Gardasil works against the human papillomavirus, the primary cause of cervical cancer, which kills more than 270,000 women annually. It prevents cervical cancer, precancerous lesions and genital warts, and should be administered between ages 9 and 25 in three injections over six-months.
The hepatitis B vaccine is another cancer preventative, continues Hait. Chronic infection with the hepatitis B or hepatitis C virus is a major cause of liver cancer worldwide. Studies in Africa and Southeast Asia showed that people chronically infected with HBV are 100 times more likely to develop liver cancer compared with people who are not infected.
But what Hait considers the “real news” is that “with early detection you can cure most cancers. The cure rate for adults with cancer is now 50 percent and for children 70 percent. That is real progress!
“Highly effective new drugs” play a significant role in these cures, he says. Gleevec® (imatinib, STI571), one of a new class of agents called signal transduction inhibitors, interferes with the pathways that signal the growth of tumor cells. The Novartis drug is particularly effective against chronic myeloid leukemia (CML). Herceptin® (trastuzumab) a monoclonal antibody produced by Genentech, is a highly effective therapy for metastatic breast cancer in which HER2 protein is overexpressed. Rituxan® (rituximab), a monoclonal antibody produced by Genentech and Biogen Idec, is used to treat B cell non-Hodgkin’s lymphoma and B cell leukemia.
“These are unbelievable drugs that have very few side effects,” Hait explains.
The improved cancer care package also includes newer, far more precise forms of radiation and supportive care measures — such as anti-nausea drugs, Procrit to increase the production of red blood cells, and Nupogen to increase white cells — that “have made a world of difference,” he says. “And new cancer drugs are being approved every day. It’s amazing.”
But despite the enormous inroads that have been made in treating cancer, Hait believes that real progress will come from a whole different direction. “Cancer is so tough to treat,” he says. “We need to treat pre-cancers in patients at high risk for the disease — and stop the cancer from ever developing.”
He explains that carcinomas in situ are forms of intraepithelial neoplasias that are not yet cancers, but left to their own devices, they will become cancers.
“If we could find out what a person is susceptible to, then we can strive to provide lifelong cancer protection by more frequent screening for the susceptibilities and treating the pre-cancerous lesions,” he says.
This is not in the realm of wishful thinking, but something that’s “happening now. We’re preventing breast cancer with Raloxifene. We’re targeting colonic polyps. We’re working on how to treat PIN [prostatic intraepithelial neoplasia], changes in prostate cells that can indicate a higher risk for cancer,” he explains. “And just over a year ago, CINJ researchers Arnold Levine, PhD, Kim Hirshfield, MD, PhD, and Deborah Toppmeyer, MD, found that women with a single nucleotide polymorphism [MDM2-SNP 309] are at higher risk for developing breast cancer at a young age.”
Baby boomers are by definition more at risk for cancer than ever before in their lives, since it is generally a disease of aging. But with the state of the science moving along at such a brisk clip, it’s likely that cancer’s impact will diminish in the future decades.
Despite being “always impressed with the incredible strength of the patients,” Hait’s ultimate goal is not only to find the cure, but to head-off this devastating disease long before it can ever sow its seeds.
What Baby Boomer Bill Hait Does to Stay Healthy
- Keeps his weight down
- Eats foods low in saturated fats
- Takes a nonsteroidal anti-inflammatory
medication [“It’s good for arthritis and probably
as a cancer preventative.”] - Stays active [He was a former athlete, playing basketball and tennis for the University of Pennsylvania.]
- Gives himself a solid break from his
demanding job — relaxing with family - Recommends having hobbies not connected
with work