I believe research is the only answer to combat breast cancer.
Knowing there are researchers and oncologists sacrificing countless hours in their labs and clinics to bring an end to this disease inspired me to join them in any way I can. That is why I established the Ginny L. Clements Breast Cancer Research Institute in 2020 in celebration of my 64th anniversary of living cancer free.
On April 12, 1956, when I was just 15 years old, I was diagnosed with breast cancer. Back then, doctors not only removed my breast, but they removed lymph nodes and muscle, which was very traumatic for a young girl. It was not something I talked about.
Since then, I have learned the importance of telling my cancer story and supporting the researchers and clinicians who are making enormous strides in understanding cancer and stopping it in its tracks so patients with breast cancer have brighter futures.
This year alone, University of Arizona Cancer Center researchers have used their talents to make incredible new discoveries. Like Ghassan Mouneimne, PhD, who confirmed that tissue sti ening in the most common types of breast cancer, HER2-negative, can directly cause disease progression and metastasis, leading to detrimental outcomes for patients.
Or Srinivasan Vedantham, PhD, who is developing an advanced mammography system that no longer requires physical compression of the breast to create a high-resolution, 3-D image. Instead, a patient lies prone on a table and gets a 360-degree breast screening.
Read about their life-changing work and that of others in the pages of this brochure. You'll find that our research team is passionate about curing breast cancer, caring for patients, and saving lives through their tireless work.
“I feel that research is our only answer. For all of you who have breast cancer or are a survivor, you are all sisters and brothers to me.”
—Ginny L. Clements
New breast cancer surgery: Precise, targeted, preserving healthy tissue
Every week, all the doctors at the Breast Program at Banner–University Medicine across specialties — the surgical oncologist, medical oncologist, radiation oncologist, radiologist, pathologist and all the ancillary support services — get together for what they call a weekly multidisciplinary treatment conference.
“During that meeting, we review each individual patient with a new breast cancer diagnosis.” said Nova Foster, MD, FACS. “We look at their pathology and imaging slides together, we discuss their diagnosis and general health as well as any anticipated barriers to care. We put everything together and as a team collaborate to determine the best treatment approach for that particular patient before we even start treatment.”
As the medical director for the Breast Program at Banner–University Medicine and a surgeon, Dr. Foster said that multidisciplinary care is key to every treatment plan.
“As a part of an NCI-Designated Comprehensive Cancer Center, patients get the benefit of the whole spectrum of comprehensive care, from basic science research, all the way through phase three clinical trials, and then moving into standard of care clinical practice,” she said. “It’s a process, and having everything in the same place under the same roof helps improve our treatment of breast cancer and our care of that individual patient.”
Dr. Foster said that over the last 20 years, breast cancer outcomes have improved substantially primarily due to successful clinical trials, which have improved early detection as well as identified new effective drugs and novel surgical techniques. She noted that during the last few years, breast cancer surgery has transformed to be less aggressive and more precise.
“We now have innovative options such as a nipple sparing mastectomy, which is performed through a cosmetic incision often hidden below the breast,” Dr. Foster said. Other surgical innovations relate to management of the lymph nodes in the underarm, which is the first place that breast cancer typically spreads when it leaves the breast.
“Traditionally, we thought we needed to clear out a lot of those lymph nodes to optimize outcome for these patients,” she said. “Through research and clinical trials, we have learned that we can do much less aggressive surgery on the lymph nodes and have the same oncologic outcome. This leaves patients with normal function and minimizes the chance of swelling of the arm that can happen after a more extensive underarm surgery.”
“Personalized treatment is really the fundamental building block of doing the best possible breast cancer treatment for any patient,” she said. “But as we learn more, as we do more research, as we discover more drugs, or learn more about which drugs work better in which situations and for which patients, it will continue to allow us to tailor the care that we provide to patients in even a more personal way.”
“You can perform the cancer surgery but leave all of the normal skin, in some cases including the nipple, and really give these women a fabulous cosmetic result that is so important to survivorship and their ongoing life after breast cancer.”
— Nova Foster, MD
BREAST CLINICAL RESEARCH TEAM AND INNOVATIVE WORKING GROUP
Our Breast Cancer Clinical Research Team uses a multidisciplinary approach to breast cancer diagnosis and treatment. In addition to a team of doctors and specialists, we have a breast cancer nurse navigator who works closely with each patient to provide education, support and guidance from diagnosis through treatment, and ultimately survivorship.
Our clinic also offers genetic counseling and testing through our certified genetic counselors, and we have a robust clinical trials program for access to the newest breast cancer treatments. At the U of A Cancer Center, we strive to provide complete care through our integrated breast cancer team. Breast cancer is diverse. Some patients can safely be treated with surgery alone. Other patients may benefit from up-front chemotherapy, surgery and then radiation. Deciding which approach is best in your situation requires a team of specialists who have access to all of the available treatment options.
Each member of the breast cancer treatment team is exclusively dedicated to treating patients with breast cancer. In the rapidly changing world of breast cancer research, this specialization allows our doctors to provide individualized care to every patient, every day. As an NCI-Designated Comprehensive Cancer Center, our team has access to, and is actively conducting, the newest research. Clinical research team members are also part of the Innovative Working Group.
The Breast Cancer Innovative Working Group translates discovery about fundamental breast cancer mechanisms to the clinical setting. Its three goals are:
• to investigate the cellular and molecular mechanisms of breast cancer metastasis
• to promote collaboration among scientists and clinicians with diverse expertise to enhance discovery, diagnosis and treatment
• to promote the translation of discoveries to clinical application in the form of new targeted therapies, biomarkers, and diagnostics
Breast Cancer Clinical Research Team
Jad
Dr. Ehsani serves as the Breast Cancer Clinical Research Team leader at the cancer center. Her clinical expertise is breast oncology, treatment of breast cancer and management of related complications. She is a member of City of Hope Clinical Cancer Genomics Community of Practice, and she sees women in the highrisk clinic for counseling and management of their increased risk for breast cancer. She also has an interest in breast cancer survivorship, cancer prevention, and genetic risk assessment of cancer.
Dr. Abdelsattar is a surgical oncologist and clinical assistant professor in the Division of Surgical Oncology at the University of Arizona College of Medicine. He specializes in breast cancer surgery and offers his patients breast conserving surgery when applicable. Dr. Abdelsattar completed his fellowship training in breast surgical oncology and oncoplasty at the University of Southern California-Hoag Breast Fellowship program and is board certified by the American Board of Surgery.
*Clinical research team members are also part of the Innovative Working Group listed after this section.
Sima Ehsani, MD*
Abdelsattar, MD
Dr. Rozell assists patients in treatment decisions regarding chemotherapy, hormonal therapy, targeted therapy, second opinion consultation and survivorship.
Umbreen Arshad Rozell, MD*
Dr. Erdrich is a surgical oncologist and assistant professor with the Division of Surgical Oncology at the University of Arizona Department of Surgery who specializes in melanoma, sarcoma, and breast cancers. Dr. Erdrich also researches Native American cancer disparities and works with tribal partners to improve cancer education, prevention, and treatment.
Jennifer Erdrich, MD, MPH, FACS*
Dr. Foster’s clinical focus is exclusively on the management of breast cancer and breast disease. She has a special interest in the multidisciplinary management of breast cancer. She is an expert in all aspects of breast cancer surgery, benign breast disease, and in management of patients at high risk for breast cancer.
Nova M. Foster, MD, FACS*
Reya Sharman, MD
Karen L. Weihs, MD*
Dr. Sharman is a cancer physician and purveyor of health and wellness. She explores and promotes systems of medicine outside the biomedical model that are crucial to providing wholesome healthcare to people. She also leads the University of Arizona Cancer Center’s Tom and Catherine Culley Circles of Holistic Care program and the Integrative Medicine in Hematology Oncology Fellowship.
Dr. Weihs researches psychosocial interventions and maintains an active clinical practice of psychiatric care for cancer patients embedded with her multidisciplinary team. She collaborates with intervention scientists to test innovative psychosocial interventions for breast cancer patients. She has conducted three prospective longitudinal studies to determine the impact of emotional and interpersonal processes on medical, psychiatric, functional and quality of life outcomes. *Clinical research team members are also part of the
Advancing early detection and prevention of breast cancer through patient-focused trials
According to cancer center member Sima Ehsani, MD, one of the most important goals of breast cancer research is to improve early detection and prevention in her patients.
A brilliant internist, hematologist and breast oncologist, Dr. Ehsani is the cancer center’s Breast Clinical Research Team leader and has devoted the past seven years of her work to the center’s patient care, advancing future breast cancer clinical discoveries and increasing the center’s available options for treatment of breast cancer, metastasis and resistance to treatment. To assist her patients and to further future discoveries, Dr. Ehsani aims to increase the center’s number of breast cancer clinical trials for better access to innovative translational science.
“Taking care of patients, that’s my first priority,” said Dr. Ehsani, who has been a faculty member in the University of Arizona Department of Medicine, Division of Hematology and Oncology since 2016.
Dr. Ehsani said that in the past 50 years, breast cancer treatment options have significantly increased, but there are still many side effects and toxicities to drug therapies, and countless patients remain on treatments indefinitely.
To get to the origins of how these treatments interact with cancer, she and other cancer center members have joined forces with the Caris Life Sciences company in molecular testing to study the genomic aspects of different cancers.
“We are looking at mutations that help us discover new targeted therapies for patients,” she said. “The University of Arizona Cancer Center is part of a Precision Oncology Alliance through Caris, which gives our scientists access to the Caris datasets, collaborations and interinstitutional research strategy meetings.”
Collaborating for a cure
To improve breast cancer treatment acceptance, Dr. Ehsani and cancer center member Janet Funk, MD, MS, professor in medicine and nutritional sciences at the University of Arizona, are studying ESR1 mutation, which is frequently acquired in hormone receptor–positive metastatic breast cancer. They are examining surrogate mutations to discover when breast cancer treatment is becoming resistant to hormonal therapy.
In other research, Dr. Ehsani is working on chemotherapy induced hair loss, or alopecia, with Jennifer Bea, PhD, a physiological scientist, associate professor of medicine and co-lead of the center’s Cancer Prevention and Control Research Program.
“We recently acquired two units of scalp cooling systems to reduce the risk of chemotherapy induced alopecia and we are using them in the clinic for patients who are interested,” she said. “This is mainly used in patients with early breast cancer, but we had an idea to use it in patients with metastatic disease who are indefinitely on treatment.”
The cancer center includes a high-risk clinic that is now accepting patients. Dr. Ehsani encourages cancer patients to learn more about its offerings and primary care physicians to refer their patients.
“The high risk clinic that I am part of includes medical oncologists, breast surgery team and genetic counselors who are determined to recognize individuals who are at higher risk for developing breast cancer and monitoring them with high risk screening and if eligible, starting on chemoprevention therapy,” Dr. Ehsani said. “Our goal is to improve those by bringing in more clinical trials in the future.”
For the cancer center’s future, Dr. Ehsani will continue improving cancer treatment and finding better ways to treat cancer with fewer side effects and toxicities.
“We are here to serve patients and make a difference in their lives. It’s not just by treating their cancer, it’s by looking at them as a person, having that relationship and being there for them.”
— Sima Ehsani, MD
Breast Cancer Innovative Working Group
Dr. Badger’s team investigates symptom management to decrease psychological distress and symptom severity for English and Spanish-speaking survivors and their families. Dr. Badger has tested telephone-delivered interventions to improve access to care. Her current symptom management and supportive care research includes survivors/families who are currently in or completing cancer treatment.
Terry Badger, PhD, RN, FAPOS, FAAN
Dr. Farr joined the faculty in the U of A College of Medicine, Division of Rheumatology and the Arthritis Center in 2024 after spending 10 years as a research scientist at Mayo Clinic Rochester. He is currently collaborating with Dr. Sima Ehsani and Dr. Janet Funk on translational research about bone metastasis and breast cancer.
Dr. Funk is an expert in bone metastases that affects most women with stage IV breast cancer, which is why it is a major focus of study in her research. Her current work clarifies the importance of bone specific metabolism of dietary compounds for bioactivity, and the development of unique and more clinically relevant (ER+) models of breast cancer bone metastases.
Dr. Gurtner is an internationally known plastic surgeon, scientist, inventor and entrepreneur. His focus is on improving the quality of life for patients with breast cancer. Dr. Gurtner has published 350+ papers, received over $27 million in federal grants, and been awarded 60 patents. His work has led to the formation of venture backed companies producing innovative products, many of which have been acquired by industry.
Dr. Kim’s research focuses on oncogenes and tumor suppressors that play a role in the emergence and therapy-resistant recurrence of breast cancer. One of her main projects is to characterize the ING4 tumor suppressor related to its functions in chromatin remodeling, transcriptional regulation, and tumor immune microenvironment modulation metastasis.
Geoffrey Gurtner, MD, FACS
Joshua Farr, PhD
Janet Funk, MD, MS
Suwon Kim, PhD
Discovering pain medication that does not lead to drug tolerance
Regents Professor Todd Vanderah, PhD, is on a quest to develop a non-addictive treatment for patients with cancer pain.
Together with a multidisciplinary group of researchers from the University of Arizona, Dr. Vanderah recently discovered one with promise called PNA6, a derivative of the peptide angiotensin-(1-7), that binds to the marker assisted selection, or MAS, receptor.
In a publication in the International Journal of Molecular Sciences, the research team showed through their study that PNA6 relieves acute and chronic spontaneous pain from both cancerinduced and chemotherapy-induced nerve pain, called chronic inflammatory peripheral neuropathy (CIPN), making it a leading candidate for treating chronic inflammatory and complex nerve pain particularly in metastatic breast cancer patients with bone metastases.
In the study, PNA6 was effective in mitigating pain without altering tumor growth or bone loss, unlike what has been reported with the use of opioids, which is the current clinical practice.
This discovery indicates that patients with bone cancer pain may still receive chemotherapeutic intervention while being treated with PNA6––which is often halted or reduced due to CIPN––further eradicating the metastasis proliferation while having pain relief.
Further studies are needed to evaluate the efficacy of PNA6 and to evaluate how it acts to treat CIPN.
“Overall, our results suggest that PNA6 may have therapeutic potential for managing CIPN, a significant challenge in oncology care,” Dr. Vanderah said.
“For clinicians, the primary objective of therapy is to mitigate and prevent the persistence of pain in cancer patients, which is the most significant impairment and debilitating challenge for patients with bone metastasis.”
— Todd Vanderah, PhD
Dr. Montfort’s research concerns the link between protein structure and function, including how drugs bind to their targets and influence activity. One focus is on nitric oxide signaling, and nitric oxide driven breast cancer. His group is studying how excess nitric oxide production in breast cancer drives an aggressive tumor phenotype and has identified novel targets for therapeutic intervention.
William R. Montfort, PhD
Dr. Mouneimne’s team in collaboration with breast oncologists, pathologists, biophysicists and biomedical engineers, is tackling the problem of breast cancer metastasis. The team approaches their work from diverse angles, rationales, and training backgrounds, broadening their scope to include basic, translational and patientoriented research strategies.
Mouneimne, PhD
Dr. Paek investigates how cancer cells decide between transient and terminal cell fates following cell stress from chemotherapy treatment. His lab develops fluorescent reporters to track the dynamics of key transcription factors involved in cell-fate decisions. Their goal is to alter the activation of these proteins in order to increase cancer cell death and enhance treatment efficacy.
Andrew L. Paek, PhD
Dr. Thatcher’s research has resulted in two novel drugs that have completed Phase 1 and 2 clinical trials in estrogen receptor positive breast cancer and further exploitation of epigenetic mechanisms to confront endocrine-resistance in combination with checkpoint inhibitors. New research in triple negative breast cancer is exploring targets associated with cancer cell metabolism, inflammation, and the tumor microenvironment.
Gregory R.J. Thatcher, PhD
Dr. Schroeder’s lab studies drivers of metastatic breast cancer and differences between the function of receptor tyrosine kinases (RTKs) in normal versus transformed epithelium. Many RTKs are involved in cancer progression, especially the ERBB or HER family, including the epidermal growth factor receptors (EGFR), HER2, ERBB3 and ERBB4. The team researches the non-canonical role of these receptors in cancer progression and develop novel therapeutics.
Joyce A. Schroeder, PhD
Ghassan
Dr. Vanderah’s laboratory investigates metastatic breast cancer utilizing a syngeneic mouse model to reduce cancerinduced bone pain while also trying to reduce bone wasting. We have found that a novel type of non-psychotropic cannabinoid as well as increasing endogenous cannabinoids (endocannabinoids) can significantly reduce cancer-induced pain and improve bone integrity.
Dr. Vedantham’s research interests are in the design, development and clinical translation of novel x-ray imaging systems and imaging techniques with particular focus on oncological and interventional imaging. He has made major contributions to breast cancer imaging research and is currently developing advanced tomographic techniques and systems for breast imaging and its clinical translation.
Dr. Wang is an associate professor of Radiation Oncology specializing in breast cancer and lymphoma cancers. Her primary research interests are in breast cancer and individualizing care for patients. She also researches health disparities in minority populations as they pertain to cancer diagnosis, prevention, and treatment.
Dr. Yao’s research is primarily focused on investigating the gene network “switches” that control cancer cell dormancy and growth. By combining single-cell and omics measurements with mathematical and machine learning models, he seeks to unravel the intricate and heterogeneous biological systems underlying breast cancer dormancy, drug resistance, relapse, and metastasis.
Dr. Zohar’s lab works on development of microfluidic-based in vitro human models of several aspects of metastatic breast cancer. Two major projects are development of organ-ona-chip platforms to investigate organ-specific extravasation of circulating tumor cells from blood vessels to the bone microenvironment, and study stromal interactions and dormancy of metastatic cancer cells in the lung microenvironment.
Yitshak Zohar, PhD
Todd W. Vanderah, PhD
Lora Wang, MD
Srinivasan Vedantham, PhD
Guang Yao, PhD
Innovative prototype makes mammograms more effective and less painful
One glaring limitation of mammography, an x-ray screening tool for early detection and diagnosis of breast cancer, is that it provides a two-dimensional projection of a three-dimensional breast, which may lead to missed cancers or unnecessary recalls.
More than a decade in the making, this U of A Cancer Center member’s research is poised to revolutionize breast cancer screening.
Srinivasan Vedantham’s new cone-beam breast CT prototype system installed at the University of Arizona Advanced Breast Imaging Center, produces superior images and alleviates the discomfort typically associated with mammograms.
“It does not require breast compression, provides high-resolution images, operates at radiation dose equal to a mammography screening, and takes only 10 seconds to scan each breast,” said Dr. Vedantham, PhD, a professor in U of A Medical Imaging and Biomedical Engineering, director of Biomedical Imaging Innovation and Clinical Translation in Next-Gen CT, and director of the Office for Project Statistical and Design Support in the department of Medical Imaging.
Dr. Vedantham said that in typical three-dimensional mammography, called digital breast tomosynthesis, it reduces but does not eliminate tissue overlap, called superposition, and it still requires uncomfortable breast compression. For cone-beam breast CT, the patient lays face down on the machine and places his or her breast in an opening within the 3D imager, and it does not require breast compression.
Dr. Vedantham said that in developing the cone-beam breast CT prototype there were several challenges, primarily because the components needed to build the system were not readily available.
“Working with vendors, we were able to improve on the technology and we currently have one of the most advanced prototypes available for clinical research,” Dr. Vedantham said.
He said that there are only five or six groups actively conducting research on cone-beam breast scanners in the world.
Srinivasan Vedantham, PhD in front of the Cone-Beam Breast CT Protoype
“Our research program is unique in that we cover the entire spectrum, from physics and engineering modeling, designing the system, and developing and fabricating the system in collaboration with industry,” Dr. Vedantham said.
According to Dr. Vedantham, breast CT is FDA-approved for diagnostic imaging, and they are pursuing NIH funding opportunities to conduct a clinical trial to demonstrate its potential for breast cancer screening.
“Ultimately, cone-beam breast CT has the potential to become the primary imaging modality for screening, diagnosis, image-guided biopsy, and monitoring or predicting response to therapy,” he said.
“We investigate advanced mathematical algorithms to identify the best quality images for radiologists, conduct clinical trials to demonstrate improvement, and translate the technology to the clinic for various breast imaging tasks.”
— Srinivasan Vedantham, PhD
Researchers identify mechanism that disrupts breast cancer metastases to the brain Cancer cells are clever.
They can hijack a system in the body and use it as a highway to travel, replicate and invade other areas. But U of A Cancer Center researchers were able to stop cancer from spreading by using hydroxychloroquine, a Food and Drug Administration-approved drug, that could potentially be used to treat breast cancer that has metastasized to the brain.
“The prognosis for individuals with brain metastases from breast cancer is extremely unfavorable, and managing breast cancer metastases in the brain remains a formidable challenge,” said senior author Jennifer Carew, PhD, who is a professor of medicine at the U of Arizona College of Medicine –Tucson and a member of the U of A Cancer Center Clinical and Translational Oncology Program.
By studying the metabolic differences between primary breast cancer cells and those that spread to the brain, they found that a process called autophagy had increased brain metastases. Autophagy is a cellular recycling process that cancer cells can use to stay alive when faced with stressful conditions such as those triggered by anticancer drugs.
The research team combined hydroxychloroquine with lapatinib, which is FDA-approved to treat breast cancer. They showed that this drug combination successfully reduced the number and size of breast cancer brain metastases in mouse models.
Jennifer Carew, PhD, and student Madison Gamble study a microscopic image of cancer cells.
“Most drugs do not efficiently cross the blood-brain barrier, and that is one of the key reasons why brain metastases are so difficult to treat. We were able to disrupt breast cancer cells’ ability to form brain metastases by impairing the autophagy pathway.”
—Jennifer Carew, PhD
Hydroxychloroquine has been combined with several other anticancer agents in early phase clinical trials, but this is the first time researchers have studied its effectiveness when combined with lapatinib for breast cancer therapy.
Carew said the team was amazed by how significantly they were able to diminish the ability of breast cancer cells to form brain metastases by targeting a single pathway.
“Cancer cells, unfortunately, have evolved in so many ways that make it difficult for us to stop their growth or kill them,” Carew said. “It is always somewhat surprising when you see how changing only one thing can have an impact.”
Managing breast cancer metastases in the brain is challenging, with only 20% of patients with breast cancer brain metastases surviving beyond five years.
“Because hydroxychloroquine and lapatinib are already FDA approved, we can advance this drug combination quickly into a clinical trial for patients with breast cancer brain metastases.” said first author Steffan Nawrocki, PhD, co-director of the cancer center Clinical and Translational Oncology Program and professor in the U of A College of Medicine – Tucson.
Jennifer Carew, PhD, and Steffan Nawrocki, PhD in their laboratory at the University of Arizona Cancer Center.
Leading scientific research at the Ginny L. Clements Breast Cancer Research Institute is turning discoveries about cancer biology into clinical innovation. Cancer center member, Ghassan Mouneimne, PhD, has discovered that breast cancer cells become more aggressive when they encounter tissue stiffening, known as fibrosis.
This collaboration with fellow cancer center member, Casey E. Romanoski, PhD, has led to the development of a “MeCo Score” which measures tissue stiffness and may one day be used as a guide to provide individualized, precision care for patients.
More recently, Mouneimne collaborated with researchers from Spain on a study published in Clinical Cancer Research and confirmed that tissue stiffening in the most common types of breast cancer, HER2-negative, can directly cause disease progression and metastasis.
When standard chemotherapy alone was prescribed prior to more invasive interventions, high MeCo Scores were associated with much worse survival compared with low MeCo Scores; however, this difference was minimized in patients who received antifibrotic therapy in addition to chemotherapy. Among high MeCo Score patients, antifibrotic therapy reduced the risk of recurrence by 62%, with an average follow-up period of 9.7 years after therapy.
“We were able to determine that a drug with no previously known benefit to breast cancer patients, an antifibrotic called nintedanib, led to better outcomes when used in conjunction with traditional chemotherapy. The use of the MeCo Score was crucial to this effort.”
— Ghassan Mouneimne, PhD
Dr. Mouneimne is hopeful that the results of this study will lead to U.S. Food and Drug Administration approval of the MeCo Score. “There’s certainly a lot more work ahead of us, as it will require more clinical validation to get FDA approval,” Dr. Mouneimne said, “but this really is a big step in the right direction.”
As a generic-emergent drug, nintedanib is set for a substantial drop in price, which may help mitigate the rising cost of treating breast cancer, according to Dr. Mouneimne. “It’s all about seeking new ways to personalize care and find more cost-effective treatments,” he said.
The MeCo Score
A breast cancer biomarker breakthrough
The goal for the MeCo Score, which is determined using early biopsies, is to give patients an opportunity to select the correct therapy for their needs, whether anti-fibrotic therapy, or more drastic courses of action like surgery.
Ghassan Mouneimne, PhD works with an image captured using the Nikon AXR Multiphoton microscope
