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The Cutting Edge - Needle-in-a-haystack investigations get a boost

Cutting Edge Spring 2012

Needle-in-a-haystack investigations get a boost

Date: March 1, 2012

When only a handful of clinical situations meet given research criteria, finding the right data can be a challenge. To help, Christopher Umbricht and colleagues have created a time-saving database.
When only a handful of clinical situations meet given research criteria, finding the right data can be a challenge. To help, Christopher Umbricht and colleagues have created a time-saving database.

You wouldn’t get a tetanus shot for a paper cut. Or a cast for a bruised shin. In medicine, the consensus is that the treatment should fit the condition at hand.        

But sometimes that’s just not possible. Cancer, for instance, is often such a case.

Physicians want to do all they can to treat it thoroughly and prevent a recurrence. But the reality is that the disease has stages, and some cancers are less serious than others. The treatments, however, don’t always take that into account, so someone with a smaller cancer might receive treatment comparable to that of a patient with more advanced disease.

Physicians are scientists, not fortunetellers, and figuring out the appropriate amount of treatment has proved nearly impossible—in part because of a paucity of access to patients who meet the criteria for certain clinical trials, and because standard clinical databases are traditionally ill-equipped for researchers attempting multiparameter queries into how a disease evolves. But, with the creation of a database available to researchers across Johns Hopkins, that’s precisely what oncology researcher Christopher Umbricht is trying to accomplish.

Umbricht’s research focuses on breast and thyroid cancer. One National Institutes of Health-funded study involves a specific kind of breast tumor called ductal carcinoma in situ, a noninvasive tumor that involves the milk ducts in the breast. Although this tumor is not considered life-threatening, it can increase a patient’s risk for developing a more dangerous form of breast cancer later on. Anything less than the maximum treatment for this condition and the odds of recurrence become much greater. So physicians tend to treat it aggressively.

That treatment commonly includes a lumpectomy, which removes the growth while preserving the breast. The lumpectomy alone decreases the chances of recurrence to 25 percent to 30 percent. Factor in radiation and those odds decrease to 15 percent. Although the majority of patients will not experience a recurrence, most undergo both treatments, just to play it safe. That means that a huge portion of patients are receiving preemptive treatments. “Basically they’re overtreated and, therefore, hugely successful in terms of preventing cancer,” Umbricht says, “but most wouldn’t need the intensive treatments they’re getting.”

Pinpointing which patients fall into which category, however, is complicated. To conduct a thorough and successful investigation, Umbricht explains, he and his colleagues needed to find a cohort of patients who had been treated for ductal carcinoma in situ, only to experience a recurrence later on. Under simpler circumstances, a researcher might be able to search through the hospital’s existing databases for records of patients who met their needs. But Umbricht and his colleagues found themselves sifting through 80,000 records just to find 100 patients.

In the process, they created a valuable database that not only has helped Umbricht to procure additional grant funding, but now, multiple researchers are benefiting from its availability as well. “I have collaborations with people across Hopkins who are using it to find certain kinds of patient cases,” Umbricht says. “It’s become a resource for a lot of different people.”

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