with the ultimate goal of a more effective, less toxic, tailored prevention treatment. Increasing research and clinical assistance have been recently dedicated in our Division to the selection, surveillance, risk-reduction strategies in subjects at very high risk, being carriers of constitutional genetics mutations (BRCA1 and 2, MLH1, MLH2, MSH6, APC, MYH, TP53, CDKN2A) in strict collaboration with the genetic lab at the IEO-IFOM campus. We have in fact an established high risk clinic (HRC) run by our staff and involving a multidisciplinary group of specialists (radiologists, pathologists, surgeons, gynecologists, endoscopists, psycologists). Our HRC provides to the public the possibility of cancer risk assessment, genetic counselling and testing, tailored surveillance and prevention programs, psychological support, nutritional and physical activity guidelines, access to chemoprevention trials or off-trial personalised treatment, up to prophylactic surgery in highly selected subjects.
conduction on phase II trials, studying how candidates biomarkers of risk (in different organs and in the blood) are modulated by preventive compounds. We utilize a large spectrum of potentially useful preventive agents, including SERM’s (Selective Estrogen Receptor Modulators), AI's (Aromatase Inhibitors), retinoids, NSAID’s (Non-Steroidal Anti-Inflammatory Drugs), corticosteroids, statins, metformin, TK-inhibitors, preferably using the minimal active doses. Considerable effort is also being put in pharmacogenomic studies, such as those on CYP2-D6, in order to stratify patients in different classes of tamoxifen metabolizers,
During 2009 we performed more than 2,600 visits in our prevention outpatients’ clinic. Whereas in our HRC service we offered 200 counselling sessions, 184 subjects underwent genetic test, we found 33 BRCA1 mutations, 29 BRCA2, 98 wild type and 16 true negative subjects. Eight subjects, were found carriers of other gene alternations (including 1 familial adenomatous polyposis and 5 Lynch syndromes). We coordinate various national research networks collaborating in multicentre phase III studies. We have also a long established research collaboration with international institutions, including the US National Cancer Institute, the M.D. Anderson’s Consortium for Chemoprevention Trials, Cancer Research UK, the University of Pennsylvania and the University of Bergen. In 2009, the Division published 22 articles in international peer reviewed journals with a total Impact Factor of over 105. The teaching activities included: Master in Senology, University of Milan; Master in Senology, University of Siena; Postgraduate Course in Pharmaco-oncology, University of Milan; Scuola Italiana Senologia (SIS).
49 IEO — Scientific Report 2009 — Ongoing research 2010