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Buys Group Research

Identification of those most at risk for cancer, either because of genetic/familial factors or because of environmental/lifestyle factors, and then screening those at highest risk for cancer to achieve early detection, is one of the several ways that cancer mortality can be reduced. Both are the focus of work done by Saundra Buys’ group.

Even before breast cancer predisposition gene mutations were identified, it was recognized that some families have an increased risk for breast and related cancers. We started the High Risk Breast Cancer Clinic in 1994 with HCI support, shortly before BRCA1 was identified, in order to provide researchers with access to data and biospecimens from individuals in families with an apparent excess of breast cancer in order to answer various questions about breast cancer: Why are some people more at risk than others? What genes are involved? Are there environmental or lifestyle factors that modify the risk? What kind of cancers are seen in those with a genetic predisposition? What is the best way to screen for these cancers? What are the psychological effects on individuals and families of being at increased risk? In 1995 we received funding from the National Cancer Institute (NCI) to support this work as a collaborative effort (The Breast Cancer Family Registry, or BCFR) with 3 additional U.S. institutions and a Canadian and an Australian institution. This grant was renewed for a total of 15 years and we currently have three NCI grants arising from the BCFR, including a 15-year prospective follow-up of individuals enrolling in the BCFR; a cohort study of new cases arising from these individuals; and a study of young girls in breast cancer families and families without breast cancer (LEGACY) with the goal of identifying early-life factors that can predict or protect against breast cancer. The BCFR has also provided subjects for two additional studies: IMPACT, which is evaluating prostate cancer screening in BRCA gene mutation carriers; and a newly-funded NCI grant evaluating background parenchymal enhancement on MRI scan as a predictor of risk for breast cancer.

The Buys group has helped to define the role of screening for several cancers through the NCI-funded Prostate, Lung, Colorectal and Ovarian Cancer (PLCO) Screening Trial. PLCO, which was funded from 1992 through 2011, enrolled more than 150,000 subjects from 10 centers (15,000 at the University of Utah) throughout the U.S. to evaluate the effect on mortality of screening for these cancers. Final results showed that colorectal cancer screening with flexible sigmoidoscopy reduced mortality, but screening for the other cancers (rectal exam and PSA for prostate cancer, chest x-ray for lung cancer, and CA-125 and transvaginal ultrasound) did not. The National Lung Screening Trial was a PLCO special study examining the effect of screening for lung cancer with CT scans compared to chest x-ray. CT scanning was associated with a 20% reduction in lung cancer mortality and has become a new standard of care.