Planting the Seeds of Prevention - Siteman Cancer Center

Planting the Seeds of Prevention
Report to Our Community 2008

Table of Contents
1 From the Director
2 Effective Interventions
6 Powerful Communications
10 Prostate Cancer Screening
14 Cancer Genomics
16 Clinical Research
18 Highlights
24 Leadership and Committees

From the Director
When people think of the Alvin J. Siteman Cancer Center
at Barnes-Jewish Hospital and Washington University
School of Medicine, our efforts to study and treat cancer
usually come to mind first. Indeed, Siteman’s work in these
areas is significant, and through it, our outstanding faculty
and staff members have had a profound effect on cancer
patients and their family members.
But as a National Cancer Institute-designated
Comprehensive Cancer Center, Siteman also is deeply
committed to preventing cancer and educating the public
about the disease. This includes improving access to medical
care, creating education and screening programs, and
establishing partnerships with communities. Perhaps not
as well-known as our other endeavors, Siteman’s efforts in
this area are far-reaching: The seeds we are planting with
these initiatives will affect the entire population of our region.
This annual report shines a spotlight on Siteman’s prevention and control
program. It is a program that has grown during the past few years with the addition
of staff and the expansion of activities. The program is expertly led by Graham
Colditz, MD, DrPH, who came on board as Siteman’s associate director for prevention
and control in late 2006. Since his arrival, Dr. Colditz has broadened the program’s
scope and fostered closer ties with colleagues at Washington University and
throughout the St. Louis area.
This report also provides information about research advances, including
groundbreaking work to sequence the first cancer genome; facility expansions; and
the strong support Siteman receives from the community, which is crucial to our
success. Advocates from every arena — volunteers, former patients, civic leaders
and corporations — provide time and resources that help us further our work.
Their contributions, coupled with those of our faculty and staff, propel Siteman
forward in the fight against cancer.
Timothy Eberlein, MD
Director, Alvin J. Siteman Cancer Center
Professor and Chairman, Department of Surgery
Spencer T. and Ann W. Olin Distinguished Professor
Surgeon in Chief, Barnes-Jewish Hospital
www.siteman.wustl.edu 1

To improve access, Siteman’s
mobile mammography van
visits churches and community
clinics in underserved areas.
In 2008, the van screened 6,149
women, including more than
2,600 who received mammograms
free or at a reduced cost.
2 The Alvin J. Siteman Cancer Center
Promising Field
Effective Interventions Rooted in Prevention Research
Advances in medical science are making it possible to customize cancer care for each
patient, taking into account the specific form of the disease and the patient’s DNA to
arrive at the most effective treatment. At the Siteman Cancer Center at Washington
University School of Medicine and Barnes-Jewish Hospital, parallel efforts drive the latest
work in cancer prevention and control. Researchers identify targets for effective intervention
by integrating disease information, individual influences such as home setting and dietary
choices, and environmental forces such as neighborhood access to resources.
The goal is to make populations healthier and reduce the burden of cancer. The payoff:
A single, effective intervention can improve thousands of lives. “We target the many people
who are at risk but don’t have the disease and define ways to identify various risk levels so we
can intervene to prevent cancer most effectively,” says Graham Colditz, MD, DrPH, associate
director of prevention and control at Siteman.
Colditz came to Siteman from Harvard University, where he was director of the Harvard
Center for Cancer Prevention. Joining Siteman in November 2006, he assumed the Niess-Gain
Professorship in the School of Medicine, established by Hilda Gain Niess, an Illinois native

who battled cancer. Her gift to Washington University also set up an endowed research
fund attached to the professorship. The Barnes-Jewish Hospital Foundation provides additional
ongoing funding for Colditz’s work.
Prevention scientists know more than 50 percent of all cancer is avoidable. They also know
the simple formula that eliminates most avoidable cancer: Don’t smoke, eat a diet heavy in fresh
fruits and vegetables, maintain an appropriate weight, exercise every day and take advantage of
screening services. But applying this knowledge is difficult; people must overcome deeply
ingrained habits to make lifestyle changes.
Colditz and his colleagues are profoundly motivated when they consider what is possible.
“By actively translating prevention research into practice, we can implement strategies that
work with clinicians, that work at the community level and that work with individuals,” he says.
“We can have an impact on our community, the region and beyond.”
They also are aware that if they do nothing, by 2050, the number of cancer patients will
double as the population ages. That is a situation for which the medical infrastructure and
caregivers are unprepared. “We would be completely overwhelmed,” Colditz says.
So prevention experts at Siteman undertake efforts like those based in the Program for the
Elimination of Cancer Disparities (PECaD). Recognizing that African Americans and other
minorities suffer disproportionately from breast, prostate, lung and colorectal cancers, the program
aims to reduce and eliminate differences in cancer burden through community partnerships,
outreach and education, and research. The work is supported by core funding from the National
Cancer Institute and grants from the WellPoint Foundation, Harrah’s Foundation and others.
PECaD’s effects have been significant. During 2008, the program helped provide nearly 1,700
PSA screenings for prostate cancer at no charge and educated hundreds of men about the disease
and the importance of informed decision-making related to screening. A speakers’ bureau trains
prostate cancer survivors to bolster the general outreach strategy. The program gains insight into
women’s decisions to get screened through the Mammography Outreach Registry, a database that
tracks patients who have received services on Siteman’s mobile mammography van. A quarterly
newsletter keeps the community advised about PECaD’s endeavors and upcoming outreach events.
PECaD’s efforts benefit from recent research conducted by Mario Schootman, PhD,
co-leader of Siteman’s prevention and control research program. Analyzing data from 1996 to 2004,
Schootman outlined cancer disparities by race in Missouri. He found the overall rate of new cancer
cases was 18 percent higher for African Americans than for whites in 1996 but that the difference
had declined to 6 percent by 2003. He speculates the change reflects a reduction in smoking rates,
an increase in prostate cancer screening and other preventive measures.
Although the overall decline is good news, disparities still exist when the focus shifts to
specific types of cancer, says Schootman, associate professor of epidemiology and medicine and
chief of health behavior research. By focusing efforts on the cancer types that did not show a
decrease in disparity — colorectal cancer, for instance — prevention and control experts might
maximize the effects of their work.
Objective:
Use research
to reduce
cancer risk
www.siteman.wustl.edu 3

Vetta Sanders Thompson, PhD, left, is a leading researcher in the area
of racial identity and health care disparities. Her current work includes
seeking the most effective ways to promote vaccination for human
papillomavirus (HPV) in the African-American population.
4 The Alvin J. Siteman Cancer Center
Schootman’s research also revealed a decline in disparity for overall
mortality rates. In 1990, cancer deaths among African Americans were
48 percent higher than in whites. By 2005, the disparity had decreased
to 28 percent. The slow pace of this decrease means racial disparity in
cancer deaths will probably continue for several decades unless more
aggressive interventions are used, Schootman says. He also notes that
disparity in mortality rates for colorectal cancer did not narrow, and
the difference between the races in breast cancer mortality actually
increased, again suggesting precise targets for prevention work.
Vetta Sanders Thompson, PhD, is working to improve cervical cancer
prevention efforts. Sanders Thompson, associate professor of public
health at Washington University’s George Warren Brown School of Social
Work, is studying the social and cultural factors that influence African-
American parents’ decisions about whether to have their daughters
vaccinated against human papillomavirus (HPV), a known cause of
cervical cancer. After surveying attitudes and concerns in collaboration
with community agencies, she hopes to produce communications that
resonate with this population and improve public health.
In the area of breast cancer, Donna Jeffe, PhD, research associate professor and director
of Siteman’s Health Behavior and Outreach Core, is conducting a longitudinal study of
quality-of-life measures among breast cancer survivors diagnosed at various stages, including
ductal carcinoma in situ — a preinvasive cancer — and stages I and IIA invasive breast cancer.
One piece of this large six-year study investigates patients’ perceptions of their risk for
recurrence. Jeffe asks, “If they underestimate their risk for recurrence, do they stop followup
care? If they overestimate their risk, does their quality of life suffer from the attendant
anxiety?” She aims to develop educational programs that help breast cancer patients interpret
their risks appropriately so they make wise choices concerning their health.
Also aiming to change behavior, Ross Brownson, PhD, professor of epidemiology and
surgery, is studying evidence-based approaches to cancer prevention. “We know a lot about
how to prevent cancer, but too often, what we know is not used,” he says. For example,
Brownson heads a project exploring the best way to approach state lawmakers about cancer
so they take informed action to improve health policy. “What do they remember, and what
do they act on — stories, data or something else?” he asks. In another study, he is evaluating
the decision-making process in state health departments to identify gaps in their use of
scientific evidence.
The work of Brownson and other cancer-prevention experts at Siteman dramatically
expands the cancer center’s reach beyond individuals directly affected by a cancer diagnosis.
By precisely identifying populations, customizing messages and rigorously defining best
practices, these researchers are helping entire communities avoid cancer.

New Institute Enables Bountiful Partnership
With the creation of the Washington University Institute for Public
Health in 2008, prevention efforts at the Siteman Cancer Center
gained a powerful partner that provides interdisciplinary expertise
and the infrastructure to support new perspectives on widespread
health problems. The common goal: Improve the public’s health.
“The field of public health works to improve health status at
the population level rather than at the individual level, and that is
precisely the orientation that Siteman brings to its prevention and
control work,” says Edward Lawlor, PhD, director of the institute,
dean of the George Warren Brown School of Social Work and the
William E. Gordon Professor. “One of the institute’s first efforts will
be to assemble teams of faculty members focused on applied public
health and to map them to our areas of strength, such as cancer.
This is a fantastic example of how we can come together.”
Graham Colditz, MD, DrPH, deputy director of the institute
and associate director of prevention and control at Siteman,
says the institute will provide the new strategies required to
address problems that traditional public health approaches have
not resolved. “It brings together skill sets that haven’t previously
been included in our efforts,” Colditz says.
As an example, Colditz points to the issue of smoking
cessation, one of cancer prevention’s big concerns. Through the
institute, Siteman can convene addiction scientists, communication
strategists, public-policy experts, air-quality specialists and
even architects. Colditz says this approach extends the cancerprevention
orbit to be certain thinking is broad enough.
In the past year, Siteman has added many prevention
scientists who also are affiliated with the institute. Their areas
of expertise include:
• Ross Brownson, PhD — promoting physical activity;
environmental policy and interventions; dissemination
research
• Sarah Gehlert, PhD — social influences on health;
disparities research
• Debra Haire-Joshu, PhD — preventive health education
in the areas of diet and smoking
New faculty member Christine Hoehner, MSPH, PhD, left, developed a
widely used assessment tool that helps measure the built environment and
its effects on physical-activity behaviors such as walking and bicycling.
• Christine Hoehner, MSPH, PhD — environmental and policy
influences on cancer prevention; behavioral risk factors
• Aimee James, PhD, MPH — psychological factors
affecting colorectal cancer screening
• Matthew Kreuter, PhD, MPH — tailoring health messages
• Douglas Luke, PhD — youth smoking
• Amy McQueen, PhD — social psychology approaches to
cancer screening
• Vetta Sanders Thompson, PhD — evaluating the
effectiveness of health-related publications
• Katherine Stamatakis, PhD, MPH — reducing cancer
disparities through public-health efforts
• Siobhan Sutcliffe, PhD, ScM, MHS — risk factors for
prostate disease
With the institute breaking down barriers among disciplines
and new faculty members bringing fresh perspectives, Colditz says,
“the payoff will be huge for the public’s health.”
www.siteman.wustl.edu 5

Matthew Kreuter, PhD, MPH, and
colleagues Debbie Pfeiffer, MA,
left, and Deidre Griffith, MPH,
review some of the customized
publications produced by the Health
Communication Research Laboratory
at Washington University’s Brown
School of Social Work.
6 The Alvin J. Siteman Cancer Center
On Target
Communications Center Propagates Powerful Messages
The publications created by Matthew Kreuter, PhD, MPH, and his colleagues — welldesigned
magazines, colorful children’s books and heavily illustrated brochures —
could be the work of an ad agency or marketing firm. But they are so much more.
The work comes from the Health Communication Research Lab (HCRL) at Washington
University’s Brown School of Social Work, which is led by Kreuter, and the publications share
a theme — they all promote healthy choices: cancer screening, a balanced diet and regular
exercise. More subtly, the publications are similar because they are intended for an African-
American audience. Most importantly but perhaps least visibly, all are based on rigorous
science. The messages, images and delivery methods have been shaped by research to increase
their reach and effectiveness.
The work is directed at African Americans for good reason. “For almost every type of
cancer, African Americans suffer disproportionate rates of disease, higher death rates and
shorter survival times,” explains Kreuter, co-leader of the prevention and control research
program at the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University
School of Medicine. His efforts are designed to help eliminate those differences.
Kreuter, a professor in the Brown School, and his team have devised experiments to
shape and evaluate their cancer-prevention messages and delivery systems. In October
2008, a five-year, $8.6 million grant from the National Cancer Institute was awarded to
support the work and establish the HCRL as one of only five Centers of Excellence in
Cancer Communication Research nationwide.

One recently completed investigation aimed to boost coverage of cancer topics in African-
American newspapers. Reaching between 6 and 15 million readers, more than 200 such
newspapers are a valuable network for delivering health information, Kreuter says, because
they are trusted and perceived as racially unbiased by their audiences.
After identifying 24 papers to study, investigators tracked everything the newspapers published
about health. Simultaneously, they created a news agency they called Ozioma, an African word for
good news. The name was selected with care because previous research showed articles crafted to
say African Americans are making progress in managing their health are received more positively
than articles that say their health is comparatively poorer than that of whites. “Pointing out
disparities is the wrong approach.” Kreuter says. “To be effective, we have to focus on progress,
and our news agency’s name reflects that.”
Ozioma distributes news about cancer in an upbeat fashion, with the catch phrase “The good
news is … ” appearing in most news releases. An advisory board of six leading black journalists
helped steer the project, in which half of the 24 newspapers got news releases tailored to their cities
while the other half served as a control. After two years, results were clear, Kreuter says. “Ozioma
significantly increased the amount of health coverage about cancer. We can increase our reach to
African Americans by packaging newsworthy cancer information specifically for the community.”
Finding better ways to deliver the message is important, Kreuter says, because blacks view
cancer as less important to them than other diseases, even though it is the No. 2 killer of African
Americans. A second phase of Ozioma research has just begun, expanding to new cities in a
national partnership with the American Cancer Society.
Another study is evaluating various methods of delivering customized health information.
“Health professionals are dedicated to providing information to patients and the public, but that
doesn’t mean we always do it well,” Kreuter says. “We tend to give people facts and reasons, logical
arguments for behaving differently. That’s not how most people communicate; usually people tell
stories about the events and activities of their lives.”
So Kreuter and HCRL researchers produced 50 hours of video that features breast cancer
survivors sharing their personal stories and then studied the effectiveness of the narratives
compared to logical arguments. “We thought the power of a story would be tied to how good it
was — the dramatic tension, thematic continuity and image-evoking language,” he says. But his
team found that what makes a difference in impact is how well the viewer identifies with the
cancer survivor telling the story. Are they similar? Does the viewer like the storyteller?
The next step was to allow a viewer to select the survivor from whom she hears a story.
To make that possible, the investigators created electronic tablets — like laptop computers with
big screens — that display the various storytellers along with information about them. A woman
can take a tablet home from her clinic and choose the storyteller she wants to watch or the subject
she wants to hear about. If her first impression was wrong, she can change storytellers or subjects
on the tablet instantaneously. The effects of this new tool are now being studied in a clinical
study at Siteman.
Objective:
Match the
message to the
audience
www.siteman.wustl.edu 7

8 The Alvin J. Siteman Cancer Center
Kreuter previously evaluated the effectiveness of storytelling
in a series of studies comparing videos using the narrative
approach with videos employing a more didactic, instructional
style of information delivery. While study participants learned
new information from both videos equally, they remembered
it longer after watching stories. The narrative videos were liked
better, evoked more emotion and prompted greater motivation
to get a mammogram compared to the non-narrative videos.
Also effective are interactive kiosks that generate customized
publications on the spot. Kreuter and his team developed
the kiosks to deliver health information to women at high risk
for breast cancer. The kiosks pose questions about breast cancer
and mammography, and women select answers on the screen.
The kiosks then create and deliver a magazine, Reflections of You,
with breast-cancer information tailored to each individual user.
Kreuter wanted to know where kiosks could be placed to
reach the most women and women who needed the information
most acutely — those who had never had a mammogram or were
poorly informed. For almost four years, kiosks were placed in
Claudia Gálvez reads a newsletter she created using a touch-screen
beauty salons, churches, libraries, coin laundries, social service
computer kiosk at the Catholic Charities Southside location. Matthew
Kreuter’s team developed the kiosk for Spanish-speaking women — as
agencies and health centers throughout St. Louis. Results showed
well as kiosks for African-American and Bosnian women — to deliver coin laundries were the most promising locations.
customized breast cancer information in a community setting.
Kreuter is now in discussions with the Coin Laundry
Association and the nation’s largest chain of coin-operated
laundries to put kiosks into laundromats across the country. He says this sort of immediate,
practical application distinguishes prevention research from bench science, where a promising
compound might not become an effective drug for years or even decades. His work to
tailor messages that reflect the language and value systems of his subjects can be taken up
immediately by community organizations to improve health.
Sherrill Jackson, founder and president of the Breakfast Club, a breast-cancer support
group primarily made up of African-American women in St. Louis, says she and her
organization have worked with Kreuter on a number of projects to craft communications
that resonate with the intended audience. “We are very candid with our opinions and
suggestions in reviewing materials,” she says. “Criticism of your work is not easy to hear.
However, Dr. Kreuter listens and makes changes. His imagery is accurate, and he delivers a
positive message. I think we arrive at communications that are very effective and honest.”

Web Site Cultivates Healthy Choices
In an Internet environment that is increasingly market-driven, one
Web site designed to assess a visitor’s risk of disease — especially
cancer — is unusual: It stores no information about users after they
leave the site and is absolutely free of charge and advertising.
Instead, the Web site, called Your Disease Risk, evaluates
personal information that visitors enter securely then returns an
assessment of their risk, congratulating them for what they are
doing to safeguard their health and offering tips for making
healthier choices. Its goal is to provide customized education in
disease prevention, and it’s another innovative way the Siteman
Cancer Center is spreading the word.
The brainchild of Graham Colditz, MD, DrPH, Siteman’s
associate director of prevention and control, the tool evolved from
pencil-and-paper quizzes devised more than 10 years ago as the
Harvard Cancer Risk Index. Early on it became clear that having
people calculate their risk by hand was an inefficient way to deliver
such important messages, says Hank Dart, the project leader who
has worked for years with Colditz to fine-tune the Web site. So in
1999, work began in earnest to bring the tool online, where users
wouldn’t have to worry about the math and could get personalized
messages to improve their health.
The first Web version, called Your Cancer Risk, focused
exclusively on four types of cancer. Eight additional types eventually
were added, and in 2004, a major advance changed the name to the
current one. The site now assesses risk for heart disease, diabetes,
osteoporosis and stroke as well as 12 cancers. The goal of expanding
the site was not only to broaden its reach but also to reinforce
the importance of healthy lifestyles since so many risk factors are
shared by the major chronic diseases.
Your Disease Risk made the trip from Harvard when Colditz
moved to Siteman in late 2006, and the site went live in spring
2007. Colditz remains the site’s medical officer; he and an advisory
council undertake a detailed review of the science behind the
scenes every 18 months.
The site receives about 33,000 visits a month and won a
silver award for interactive Web sites at the eHealthcare Leadership
Awards in 2008. Licensed versions run in a number of countries,
and an expanded site with added features has been set up for
Washington University employees. Plans call for the creation of
risk assessments for more diseases and the development of a
related site for use in physician offices.
www.yourdiseaserisk.wustl.edu
The Your Disease Risk Web site
offers easy-to-use online risk assessments
for 12 types of cancer
as well as heart disease, diabetes,
osteoporosis and stroke.
www.siteman.wustl.edu 9

Gerald Andriole, MD, talks
with longtime patient Paul
Colombo of St. Louis. In 1990,
a then-new PSA test detected
Colombo’s prostate cancer.
Andriole performed surgery and
still provides follow-up care.
10 The Alvin J. Siteman Cancer Center
Unearthing Disease
Refining the Science of Prostate Cancer Screening
It is evidence of the complexity of prostate cancer that so much of the disease’s story
remains unresolved, even though it is the most common nonskin cancer in men, affecting
one in six, with an estimated 186,000 new diagnoses in 2008. Large studies performed
over several years have examined prostate screening’s effectiveness, but still, the endings to
many of its subplots have yet to be written.
A major character in the prostate cancer story always has been the Siteman Cancer
Center at Barnes-Jewish Hospital and Washington University School of Medicine, a leader
in the field. It was here, beginning in 1989, that the then-new PSA test for prostate cancer
— a blood test for an elevated level of the protein called prostate-specific antigen, or PSA —
was systematically evaluated. In this study, more than 30,000 St. Louis-area men had their
PSA levels tested regularly. If their level was abnormal, they underwent biopsies to see if
they had cancer.
The results were clear: The PSA test found prostate cancer when it was still contained in
the small gland in 95 percent to 98 percent of the cases. “That was a terrific improvement,” says
Gerald Andriole, MD, professor and chief of urologic surgery at Washington University School

of Medicine. Before the advent of the test, about one-third of men diagnosed with prostate
cancer had disease that had metastasized to the bones, and another third had tumors that
had grown outside the prostate.
In that sense, screening for prostate cancer is an undeniable success story. But even after
fine-tuning the test and beginning to examine the rate of increase in PSA rather than just the
amount in the blood, there still are uncertainties.
How often to test remains a question. Annual testing has been recommended, but
some men with very low PSA levels may require testing only once every two to five years.
Another issue is the test’s tendency to produce false-negative results. Andriole says about
15 percent to 20 percent of men with prostate cancer have a low or normal PSA level, so the
blood test misses their disease.
PSA also may be falsely positive. “If a man’s PSA level is 5 — a high number — he still has
only about a 20 percent to 25 percent chance of having cancer,” Andriole says. In other words,
up to 80 percent of the biopsies that follow a high reading find no tumor. Eliminating these
false positives is highly desirable because the biopsy process is unpleasant and the costs of
unnecessary care are high.
To achieve greater precision, new tests are being evaluated. The PCA3 gene test looks for
cancer-specific RNA molecules in cells washed out in urine, while the ProCAM test, which is
being investigated by Andriole’s team, looks for DNA methylation modifications in these same
cells. Not as far along in development is a test for EPCA-2, a protein expressed principally by
cancerous tissue. That’s unlike PSA, a normal product of the prostate.
The emerging technologies of proteomics — the study of proteins and their patterns within
cells — also hold promise. Andriole says that precise patterns of many blood proteins may be
closely associated with various cancers. “If we can train computers to recognize telltale patterns,
we might not even need to know what all of the involved proteins do,” he says.
Does screening save lives? That’s one of the biggest remaining questions, Andriole says.
“The average 50-year-old man has a 3 percent chance of dying of prostate cancer,” he explains.
“Altogether, when we screen a man every year with PSA, after only a few years, his chance of being
diagnosed with cancer exceeds his lifetime risk of dying of it. We find five to seven times as many
men with cancer as will die of it. So if we treat everyone with the disease, we’re clearly overtreating.”
Overtreating is expensive, with side effects that can include incontinence and impotence.
As chairman of the prostate committee of the National Cancer Institute’s Prostate, Lung,
Colorectal and Ovarian (PLCO) Cancer Screening Trial, Andriole seeks answers about whether
screening extends life. PLCO compares men who are screened with men who receive conventional
care. The prostate portion of the trial has enrolled 75,000 participants at 10 centers nationally,
including Washington University School of Medicine.
Objective:
Perfect
prostate cancer
screening
www.siteman.wustl.edu 11

Initially due to share results in 2013, PLCO investigators led by
Andriole issued an early report in March 2009 stating that annual
screening doesn’t appear to reduce deaths from prostate cancer among
those with a limited life expectancy. “For men with a life expectancy
of seven to 10 years or less, it’s probably not necessary to be screened
for the disease,” Andriole says. But it’s too soon, he adds, to make
broad recommendations for all men based on the study’s initial
findings. “We don’t have enough data yet about the youngest men
in the study — those in their 50s — and it may be that over time,
we will in fact see a benefit from screening.”
Another big issue: “We can’t tell the difference between killer
prostate cancer and slow-growing, nonkiller prostate cancer,”
Andriole says. That uncertainty confounds treatment planning.
To make the distinction, molecular studies by Adam Kibel, MD,
professor of surgery and assistant professor of genetics, look for
signatures in DNA that separate dangerous, fast-growing cancers
Senior research technician Bill Wu prepares prostate cancer samples for from less threatening cases.
high-throughput analysis as Adam Kibel, MD, looks on. In his research, Kibel, who also serves as director of urologic oncology, has
Kibel is looking for genetic markers that could help distinguish
identified a number of small changes in DNA, called polymorphisms,
more deadly forms of prostate cancer from less aggressive ones.
that might be reliable markers for prostate cancer. He is examining
three cohorts of patients for the presence of those polymorphisms: 3,000 men in the PLCO
trial, to see if there is a concordance between prostate cancer and any of the DNA changes;
800 to 1,000 men in a Johns Hopkins University study of metastatic disease, to see if any of the
polymorphisms are associated with aggressive prostate cancer; and all newly diagnosed cases
at Siteman. From these patients, Kibel also collects dietary and environmental information to
find any differences among them that ameliorate the disease. “The goal is not only to tell men if
they are at high risk for prostate cancer but also to tell them how to decrease that risk,” he says.
12 The Alvin J. Siteman Cancer Center
On the prevention front, it was thought that vitamin E and selenium might have a
suppressive effect on prostate cancer development. But surprisingly, the SELECT clinical trial,
in which Andriole was involved, recently closed with the finding that neither supplement reduces
a man’s chance of getting the disease. Another study directed by Andriole — the REDUCE trial
— evaluated the preventive power of dutasteride, a drug widely prescribed to shrink enlarged
prostates. Worldwide, 8,200 men at high risk for prostate cancer took part. The study, funded
by dutasteride manufacturer GlaxoSmithKline, showed the drug lowered prostate cancer risk
by 23 percent, an encouraging result, says Andriole, a consultant for the company.
Andriole still recommends screening, even though the odds of dying from the disease are
slim. “It’s better to know what’s going on in your prostate,” he says. “I’d rather know and make
an informed decision about what course to take, whether that’s watchful waiting or aggressive
treatment, than stick my head in the sand and hope everything turns out all right.”

Herbal Compound Offers Promise as Preventive
To grasp the potential impact of cancer prevention, consider Ming
You’s evaluation of a Chinese herbal compound as a preventive of
lung cancer in mice. You, MD, PhD, professor of surgery at
Washington University School of Medicine, projects that if human
studies under way replicate animal results, as much as 50 percent
of lung cancer might be prevented. With 170,000 U.S. cases
diagnosed annually and a mortality rate of 80 percent to 90 percent,
such an advance would be a colossal victory over the disease.
The promise of this work has led to support from a National
Center for Complementary and Alternative Medicine grant and
from private sources such as the Vernon and Mae Thompson
Charitable Foundation. Five years ago, David Bolesta, trustee of
the foundation named for his aunt and uncle, began an endowed
fund to support You’s work and RNA research, and he continues
to provide $50,000 per year. “My uncle was the sort of man who
developed solutions before problems arose, which is the very idea
behind chemoprevention research,” Bolesta says. “And my aunt
was a survivor of stomach cancer for more than 25 years. During
that time, she was very conscious of her diet as a way to mitigate
her cancer’s possible recurrence.”
You devotes his professional life to tracking down natural
compounds — dietary and other — with reputations for cancer
prevention. He subjects them to scientific scrutiny to locate legitimate
inhibitory effects, especially on lung cancer, his primary interest.
To date, his most promising results have been with antitumor B
(ATB), an ancient botanical mixture of six herbs also known as
Zeng Sheng Ping, which translates as “anti-proliferation drug.”
Because chemopreventives are designed for precancerous
or high-risk but otherwise healthy patients, You says side effects
must be absent or minor. The strongest agents often have the
most severe side effects, so he seeks balance.
Possessing a long history of safety, ATB has been shown to
be an effective inhibitor of esophageal cancer. To test its value in
lung cancer, You used mice genetically engineered to develop the
disease, mimicking human predisposition to lung cancer.
With the help of the Missouri Botanical Garden, Ming You, MD, PhD, left,
is working to classify and grow a standardized version of antitumor B for
use in future clinical trials. You is shown here with garden director Peter
Raven, PhD, and assistant curator Wendy Applequist, PhD.
He also evaluated a group that received a tumor-generating drug
to duplicate the effects of smoking, by far the biggest cause
of lung cancer. Some of the mice in the experiment developed
20 times more cancer than those in the control group. But all of
those treated with ATB showed almost no increase in cancer.
With the support of an $8 million National Cancer Institute
grant, a large human trial is now under way with You’s colleagues
in Vancouver to evaluate ATB’s effectiveness in precancerous
patients — the first lung-cancer study of its kind. Preliminary
results look promising.
In collaboration with the Missouri Botanical Garden and
the Donald Danforth Plant Science Center, You is pursuing local
production of ATB. This work is supported by the National Cancer
Institute’s Rapid Access to Preventive Intervention Development
(RAPID) Program.
www.siteman.wustl.edu 13

Timothy Ley, MD, led the effort
to unravel the first complete DNA
sequence of a cancer patient.
Groundbreaking
Discovery
Scientists Sequence
First Cancer Genome
14 The Alvin J. Siteman Cancer Center
Cancer is personal. Every patient’s disease is fundamentally
different, and there are hundreds, perhaps thousands, of types.
That’s why searching for individual culprit genes has been
only partially successful. It’s also why the evolving discipline
of cancer genomics — which examines the sum total of
a patient’s genetic material, or genome, for functionally
important changes — holds real promise for finally unraveling
cancer’s genetic roots.
“All of us are born with approximately 25,000 genes. A small number of mutations
among them can cause cancer,” says Richard Wilson, PhD, director of Washington
University School of Medicine’s Genome Center and a member of the Siteman Cancer
Center senior leadership team. “A genomewide understanding of cancer, which is
now possible with faster, less expensive DNA sequencing technology, is the foundation
for developing more effective ways to prevent, diagnose and treat the disease.”
Wilson says the Human Genome Project, an international effort to map all
human genes, completed in large part at the Genome Center, gave us a huge
reference book — the equivalent of the haystack. Cancer genomics is the search of
that encyclopedia for relevant mutations — the needles. Until recently, no one had
gone so far as to do a full side-by-side comparison of all genes from normal cells
and tumor cells of the same patient.

Then late last year, a group of Washington University
clinical specialists and geneticists, with the help of a brave
patient and visionary philanthropist, reported the first
successful effort to decode the complete DNA sequence
of a cancer patient. They traced her disease — acute
myelogenous leukemia (AML) — to its genetic roots.
The patient, a woman in her 50s who ultimately died
of her disease, contributed normal skin cells and leukemia
cells from bone marrow. Comparing the two genomes, the
team discovered just 10 mutations in genes that appeared to
be relevant. Eight of them occurred in genes not previously
linked to AML, though “they make sense,” says lead author
Timothy Ley, MD, the Alan A. and Edith L. Wolff Professor
of Medicine at Washington University.
Francis Collins, MD, PhD, former director of the
National Human Genome Research Institute, says, “In the
past, cancer researchers have been ‘looking under the lamppost’
to find the causes of malignancy, but now the team from
Washington University has lit up the whole street. This
achievement ushers in a new era of comprehensive understanding
of the fundamental nature of cancer.”
Sequencing the two genomes took six months; analysis
required another three. “There was no book for how to
do this,” Ley says. But with that early experience in hand,
a second patient’s genomic analysis required only a few
months. The increase in speed makes data-intensive,
genomewide evaluations possible. Wilson says sequencing
techniques are 100 times faster and 100 times cheaper than
they were just two years ago.
The trend is important because Ley believes a complete
understanding of a patient’s cancer may always require
genome sequencing. As evidence, he says the team surveyed
187 additional AML patients and found none of the eight
new mutations. That is neither surprising nor demoralizing
to Ley. “Cancer is an extremely heterogeneous disease,” he
says. “That’s why we need to devise precise therapies based
on the mutations in individual cancers.” Wilson hopes that
once a critical mass of data is obtained, patterns among
genes will make it possible to identify cancer subtypes and
design specific treatments.
The cost of a complete genome sequencing study
currently approaches $250,000. The groundbreaking work
to sequence the first cancer genome cost more than
$1 million, and the project was completed only because
Alvin Siteman, for whom the Siteman Cancer Center is
named, supported the effort. “Funding was and is the
ultimate limiting factor,” Ley says. “We simply could not
have done this without his gift.” Support also was provided
by the Barnes-Jewish Hospital Foundation.
Genome Center director Richard Wilson, PhD, believes cancer genomics
is the key to developing better, more targeted treatments.
Monetary considerations aside, genomic studies of
cancer will remain challenging. Brave patients willing to
reveal their genetic identities have to step forward, and
it will take years to bank the necessary tissue samples.
No matter the hurdles, the handbook is being written at
the Genome Center and Siteman, and work to reveal the
molecular basis of cancer continues for one fundamental
reason. “This is not an intellectual exercise,” Ley says.
“We do this for our patients.”
www.siteman.wustl.edu 15

The Center for Clinical Imaging
Research provides leadingedge
technology and the
expertise of radiologists such
as Farrokh Dehdashti, MD,
foreground. The center supports
185 clinical studies and
produces 2,000 scans a year.
Harvesting Hope
Advancing New Treatments
Through Clinical Research
16 The Alvin J. Siteman Cancer Center
For advancing cancer care, clinical studies are the crucial bridge
between idea and practice. Without them, medical scientists
would have no reliable way to evaluate new therapies, and
clinicians would still be caring for cancer patients as they did in
the 1950s. As they cautiously usher new ideas into widespread
use, clinical studies also offer patients the opportunity to receive
potentially helpful treatments that would otherwise be unavailable.
The breadth of Siteman Cancer Center’s clinical research program ensures that
many studies to evaluate drugs, combinations of drugs, devices and techniques are
under way at all times, according to Lee Ratner, MD, PhD, professor of medicine at
Washington University School of Medicine and co-director of Siteman’s translational
and clinical research program.
More than 250 therapeutic clinical studies, also called clinical trials, are being
conducted at Siteman at any moment. Every participant in these studies is carefully
protected: An institutional review board made up of professional and lay members
examines the details of each clinical study, and participants receive thorough
explanations before signing an informed consent.

Many of the studies are institutional in origin, born out
of the ideas of Siteman researchers and clinicians, and are
unavailable anywhere else. Others arise from collaborations
with cooperative oncology groups or institutions pursuing
similar research. And a smaller number are initiated by
pharmaceutical companies.
Among Siteman’s promising institutional efforts are:
• A study testing the efficacy of a vaccine that
stimulates the immune system to identify and
overcome cancer cells in late-stage melanoma
• A trial of implanted radiation seeds to treat
early-stage breast cancer
• A Siteman-led national investigation of a
chemotherapy agent for patients with Hodgkin
lymphoma whose disease has come back or is
difficult to treat
• A vaccine study that uses a patient’s immune
system to prevent the progression of metastatic
breast cancer
Siteman also has a number of radiology studies at the
Mallinckrodt Institute of Radiology’s Center for Clinical
Imaging Research (CCIR), the only facility of its kind in the
nation. The center, with its full range of the latest imaging
equipment, is dedicated to research. “The CCIR greatly
enhances the role of imaging in clinical research,” says
radiology professor Mark Mintun, MD, who spearheaded
creation of the center.
Siteman’s Imaging Response Assessment Team (IRAT)
also promotes the use of imaging in clinical research,
particularly to assess patients’ response to therapy. The
IRAT, one of eight formed nationally through National
Cancer Institute grants, integrates radiologists into the
planning of cancer clinical studies.
Clinical studies proceed in stages, beginning with
phase I. “This is the point where newly developed drugs
— or perhaps established drugs in new combinations or
doses — are tested for the first time in people,” explains
medical oncologist A. Craig Lockhart, MD, MHS, leader of
Siteman’s developmental therapeutics program. Lockhart is
working to expand the number of Siteman’s phase I studies
to provide important alternatives to patients for whom
standard therapy is either ineffective or nonexistent.
Siteman’s clinical investigators make concerted efforts
to recruit participants in ways that serve science and the
community equally. “Study populations balanced by gender
and race let us know that any medical benefit works in all
PERCENT
Siteman Minority Participation in Trials
20
15
10
5
0
13.74%
14.38%
15.88% 15.81%
2005 2006 2007 2008
Increasing minority participation in clinical studies is a key priority at Siteman.
Improvements have come about through extensive outreach efforts.
groups,” says Lannis Hall-Daniels, MD, MPH, director of
radiation oncology at the Siteman Cancer Center at Barnes-
Jewish St. Peters Hospital. Hall-Daniels, who leads the
clinical-trials outreach team for Siteman’s Program for the
Elimination of Cancer Disparities, has been instrumental
in encouraging minority participation, which has increased
from 13.7 percent in 2005 to 15.8 percent in 2008.
To bring all available resources to bear, Ratner says
the translational and clinical research program, co-directed
by professor and chief of endocrine and oncologic surgery
Jeffrey Moley, MD, is creating centers of excellence to focus
on studies in areas of strength: breast, endometrial, gastrointestinal,
lung and prostate cancer as well as leukemia.
The goal, he says, is to streamline the process of designing
and testing targeted therapies.
www.siteman.wustl.edu 17

Highlights
Jeffrey Bradley, MD, was recently installed as S. Lee Kling
Endowed Chair in Radiation Oncology.
Unique Radiation
Treatment Center
Construction is under way at the Siteman Cancer Center
on a proton therapy facility that could revolutionize the
way this unique treatment is delivered.
Although proton therapy is not new, the cost of
building a facility — including an immense cyclotron to
generate charged particles — has been prohibitive for most
cancer centers and hospitals around the country, requiring
an investment of $100 million to $150 million. Only six
proton therapy facilities currently operate in the United
States, with one more set to open this year.
The new S. Lee Kling Center for Proton Therapy,
scheduled to open in 2010, will be the first in the nation
featuring a new-generation technology that costs about
$20 million. Siteman is working with Still River Systems Inc.
of Littleton, Mass., to build a cyclotron that fits into a space
not much bigger than what’s needed to house traditional
radiation therapy equipment.
“This will change the scope of facilities that use
protons,” says Washington University School of Medicine
radiation oncologist Jeffrey Bradley, MD, who has been
named director of the Kling Center.
18 The Alvin J. Siteman Cancer Center
Unlike traditional X-ray radiation, proton therapy
deposits its maximum dose at the site of a tumor and
doesn’t go beyond that point, resulting in less damage
to surrounding healthy tissue.
The proton facility is named for the late S. Lee Kling, a
prominent St. Louis businessman and philanthropist. His
efforts helped raise $2.3 million through the Barnes-Jewish
Hospital Foundation’s illumination gala to fund research
into applications of proton therapy.
New Research Building
Construction continues on the BJC Institute of Health
at Washington University, which will serve as home base
for the University’s BioMed 21 initiative. The 11-story,
700,000-square-foot facility will house laboratories for
research aimed at rapidly applying basic science findings
to improve patient care. Among other occupants, the
institute will provide space for five interdisciplinary
research centers, including one focusing on cancer
genomics. BJC HealthCare contributed a $30 million
gift toward the estimated $235 million cost of the project.
The building is scheduled to open in December 2009.

Pioneering Surgical Techniques
Washington University surgeons at the Siteman Cancer
Center continue to make advances in minimally invasive
surgery that are reducing risks for patients and improving
outcomes. Most recently, new techniques for head and neck
cancers and kidney cancer are attracting attention from
around the world.
Bruce Haughey, MB ChB, Dr. Joseph B. Kimbrough
Chair in Maxillofacial Surgery and Prosthodontics, has
worked with colleagues to pioneer the use of transoral
laser microsurgery for cancers of the mouth, throat or
neck. These minimally invasive procedures performed with
special instruments and lasers through the mouth — or
transorally — are getting patients out of the hospital faster,
controlling cancer better and preserving mouth and throat
function more effectively.
Traditionally, surgeons remove tumors in the throat
or neck from the outside by cutting through skin, muscle,
cartilage and even bone. This threatens the structure and
function of the larynx, trachea, esophagus, blood vessels
and more. It also creates a wound that even when healed
can interfere with mobility and function.
In a study of patients with larynx, oral cavity and
pharynx tumors who were treated with transoral techniques
and radiation therapy when necessary, none of the patients
with small growths had a primary tumor recurrence after
two years, the interval when treatment failure usually
occurs. In patients with larger tumors, only one primary
tumor had recurred at five years. In addition, only about
10 percent of patients undergoing transoral surgery need
a tracheostomy, a breathing hole made in the windpipe for
ventilation, compared to more than 80 percent of patients
who undergo open surgical procedures.
Haughey and his team held a course at Washington
University School of Medicine in 2008 to teach transoral
techniques to professionals from around the world. This
was the first formal course in the United States on this type
of surgical approach to head and neck cancer. A second
course was held in early May 2009.
In the area of kidney cancer, assistant professor of
urology Sam Bhayani, MD, has led the way in the use of
robotic surgery to remove tumors. Instead of using his
Siteman is pioneering minimally invasive surgery techniques that improve
cancer control and preserve normal tissue and function. Sam Bhayani, MD,
seated above, uses robotic tools to remove a kidney tumor.
hands to perform surgery, Bhayani sits at a computer
console to maneuver controls that guide robotic scalpels,
scissors and high-resolution cameras.
For patients, robotic surgery means less pain, smaller
scars, minimal blood loss and a faster return to normal
activities. Moreover, because surgeons remove only the
tumor and surrounding tissue, the procedure preserves
the function of the healthy portion of the kidney, unlike the
standard open surgery, which typically involves removing
the entire organ. Some 60 percent of patients who have their
whole kidney removed eventually develop renal failure,
compared to 15 percent who have only a portion of the
kidney removed, Bhayani says.
The first worldwide robotic renal symposium was
hosted by Bhayani at the School of Medicine in 2008.
He chaired a workshop on a similar topic in March 2009.
Washington University urologic surgeons also perform
robotic surgery for prostate, bladder and testicular cancer,
and gynecologic oncologists use it to treat cervical,
endometrial and ovarian cancer.
www.siteman.wustl.edu 19

Expansion in West County
In the past year, the Siteman Cancer Center has expanded
its presence on the campus of Barnes-Jewish West County
Hospital in Creve Coeur, Mo., moving to a building with
more public and treatment space, adding radiation oncology
services and offering more support and education programs.
Siteman has operated a facility in west county since
2001. In July 2008, the facility relocated to Medical Office
Building 2 on the hospital campus. The new location, with
greatly expanded space, offers a chemotherapy treatment
area with 28 infusion chairs; 14 exam rooms for Washington
University medical oncologists and surgeons; and a large
lobby with a spacious seating area, a resource center and
wireless Internet access. On-site lab testing is available as
well as access to clinical research studies.
In February 2009, treatment programs at the facility
were expanded with the addition of radiation therapy.
Washington University radiation oncologists who specialize
in various types of cancer provide treatment using a new
linear accelerator that delivers image-guided therapy.
To make patients feel more comfortable, CD players are
available in treatment areas. Ceilings in these areas feature
backlit art depicting clouds and green trees.
Wellness Community Partnership
To give cancer patients and their families easier access to
programs providing support, education and hope, the
Siteman Cancer Center has joined The Wellness Community
of Greater St. Louis in a three-year partnership.
The partnership, made possible by a grant from
the Barnes-Jewish Hospital Foundation, allows Siteman
to enhance the support programs it currently offers to
patients and family members. New programs presented
in collaboration with The Wellness Community include
support groups and classes such as Music for Recovery,
Therapeutic Drumming, Ask an Attorney and Gentle Yoga.
“The Wellness Community does an outstanding job of
helping those diagnosed with cancer work through difficult
20 The Alvin J. Siteman Cancer Center
Support programs
held at the west county
facility include a weekly
support group, caregiver
group and movement
class offered in partnership
with The Wellness
Community of Greater
St. Louis. Pet therapy sessions
also occur weekly,
and additional education
and art programs are held
throughout the year.
Plans for the facility
call for the creation of a
Siteman’s new West County facility
features comfortable family waiting
areas with internet access.
healing garden, funded by a $540,000 gift from Marilyn
Schnuck, a breast cancer survivor who was treated by
Siteman physicians in west county. Schnuck made the
gift in honor of her husband, the late Edward Schnuck.
The garden, which will be visible from treatment areas
inside the building, will feature seating areas and a
Zen garden.
times,” says Teresa Deshields, PhD, manager of psycho-
oncology services at Siteman. “With this partnership,
Siteman can offer patients a truly comprehensive program
that not only helps them better understand cancer but also
makes fighting the disease an easier process.”
Programs available through the partnership are held
at Siteman’s main campus at Barnes-Jewish Hospital in
St. Louis and also at Siteman’s location on the campus of
Barnes-Jewish West County Hospital in Creve Coeur, Mo.
The Wellness Community of Greater St. Louis is part
of an international nonprofit organization dedicated to
providing free programs to people with cancer and their
loved ones.

Imaging Center Grant
David Piwnica-Worms, MD, PhD, leads Washington University
School of Medicine’s Molecular Imaging Center.
An innovative imaging center at the Siteman Cancer Center
received a five-year, $10 million grant from the National
Cancer Institute (NCI) in late 2007. The grant funds a second
cycle of research at Washington University’s Molecular
Imaging Center, where scientists from different specialties
collaborate on projects using positron emission tomography
(PET), magnetic resonance imaging (MRI) and other
radiology techniques to track changes in specific cells,
receptors, enzymes and genes.
“A number of research projects from the first grant have
led to technology and approaches to imaging that we’re now
leveraging to answer major biological questions in this second
grant,” says center director David Piwnica-Worms, MD, PhD,
professor of radiology and of molecular biology and pharmacology.
The grant is one of eight awarded nationally.
Other recent NCI grant recipients include:
• Graham Colditz, MD, DrPH, associate director for
prevention and control at Siteman, who serves as
primary investigator for a four-year, $1.4 million grant
to assess genetic and blood biomarkers associated with
multiple myeloma. Colditz and colleagues also will
examine risk factors for the disease.
• Matthew Kreuter, PhD, MPH, co-leader of the
prevention and control research program at Siteman,
who received a five-year, $8.6 million grant to
establish the Health Communication Research Lab
at Washington University as one of only five Centers
of Excellence in Cancer Communication Research
nationwide. (See related article, Page 6.)
• Timothy Ley, MD, Alan A. and Edith L. Wolff
Professor of Medicine, and colleagues, who received
a five-year, $14.3 million renewal of a program project
grant to examine the genomics of acute myelogenous
leukemia. As part of this work, the group became the
first to sequence the complete genome of a cancer
patient. (See related article, Page 14.)
Patient and Family
Advisory Council
The Siteman Cancer Center at Barnes-Jewish St. Peters
Hospital has established a patient and family advisory
council (PFAC), giving these groups a voice in the care
provided at the center. The council, which meets monthly,
convened for the first time in October 2008.
According to Sharon Lee, manager of the St. Peters
center, PFACs give patients and family members an
opportunity to share their experience, expertise and
insights with the physicians and staff members providing
their health care. “They have proved to be invaluable in
bringing about change in health care and enhancing
quality and safety,” she says.
Lee, who has spent the majority of her more than
30-year career serving cancer patients, was enthusiastic
about starting a PFAC after attending a conference on the
topic in early 2008. That summer she brought together
a planning group that met for nine weeks to discuss the
council’s mission, vision, goals and bylaws. They decided
the group should consist of 18 patients and family members
and nine staff liaisons.
Timothy Pluard, MD, director of medical oncology at
Siteman’s St. Peters location, says the council will provide
crucial input. “It’s going to be a tremendous vehicle for
improving the care of our patients.”
www.siteman.wustl.edu 21

Breast Cancer Research
A set of just 50 genes can be used to
reliably identify the four known types
of breast cancer, according to research
conducted at the Siteman Cancer
Center and collaborating institutions.
Using this 50-gene set, oncologists can
potentially predict the most effective
therapy for each breast tumor type and
thereby personalize breast cancer
treatment for patients.
“Unlike a widely used genomic test that applies only
to lymph-node-negative, estrogen-receptor-positive breast
cancer, this new test is applicable for all women diagnosed
with breast cancer,” says Matthew Ellis, MB, BChir, PhD,
Anheuser-Busch Chair in Medical Oncology.
The study was reported in February 2009 in the
Journal of Clinical Oncology. Ellis’ collaborators include
researchers at the University of North Carolina at Chapel
Hill and the University of Utah in Salt Lake City.
Siteman investigators also presented the following
breast cancer research in the past year:
In a study presented at the San Antonio Breast Cancer
Symposium in December 2008, Ellis and colleagues at five
other centers showed that estrogen therapy can help control
metastatic breast cancer. In about one-third of the study’s
66 participants — women with metastatic disease who were
resistant to standard estrogen-lowering therapy — a daily
dose of estrogen stopped tumor growth or shrank tumors.
Research led by associate professor of surgery Rebecca
Aft, MD, showed that maintaining bone density could be a
key to decreasing the spread of breast cancer to the bones,
a common site for metastasis. Aft and colleagues found
that women treated for stage II/III breast cancer who also
received the bone-strengthening drug zoledronic acid —
commonly used to treat osteoporosis — were less likely to
have breast tumor cells growing in their bones after three
months. The findings were reported at the June 2008 annual
meeting of the American Society of Clinical Oncology.
22 The Alvin J. Siteman Cancer Center
Matthew Ellis, MB,
BChir, PhD
Community Involvement
As a National Cancer Institute-designated Comprehensive
Cancer Center, the Siteman Cancer Center is committed to
community involvement. In 2008, Siteman participated in
many important community events and outreach initiatives.
In June, Siteman once again served as a platinum sponsor
of the Komen St. Louis Race for the Cure. One of the
largest of a series of similar events held around the country,
the St. Louis race attracted
nearly 64,000 participants
and raised $3.3 million.
About 3,600 Siteman team
members raised more
than $100,000.
Through a variety of
events, Siteman provided
1,690 free prostate cancer
screenings to men in the
St. Louis region. These
screenings were offered
at the Missouri Black
The 2008 Komen St. Louis Race for the
Cure raised millions for cancer research.
Expo, Dave Sinclair
Auto Group locations,
corporations and events
held by Siteman’s Program for the Elimination of Cancer
Disparities. Siteman also was a sponsor of the sixth annual
Prostate Cancer Survivors and Awareness Walk.
In 2008, Siteman’s mobile mammography van screened
6,149 women at churches, community clinics, corporations
and Schnucks store locations. This includes 2,644 mammograms
that were provided free or at a reduced cost through
funding from the Susan G. Komen for the Cure organization
and Missouri’s Show-Me Healthy Women initiative.
In recognition of the Great American Smokeout in
November, Siteman organized its fourth annual Keep Kids
Tobacco-Free program in partnership with Bayless Junior
High School in Affton, Mo. Students developed anti-smoking
messages for essay and poster contests. The program was
sponsored by the St. Louis Rams and Young Choices.

Holway Gift Supports Cancer Research
What if scientists could identify genetic mutations associated
with multiple myeloma and use that information to develop
better treatments? Or administer a vaccine that stimulates
the immune system to fight certain types of breast cancer?
A $1.1 million gift from George and Diana Holway is
allowing physician-scientists at the Siteman Cancer Center
to pursue promising research in these areas and more.
Funding from the gift is split between multiple myeloma,
a disease that has affected George Holway, and breast
cancer, which affected his wife.
“We highly value the work of the Siteman Cancer Center
and the impact it has made in our community and in our
lives,” George Holway says. “We hope our contribution will
help further the cancer center’s efforts toward a future
without cancer.”
The multiple myeloma portion of the gift is designated
for several initiatives, according to associate professor
of medicine Ravi Vij, MD, who leads Siteman’s multiple
myeloma program. One project will investigate the genetics
of the disease. Another involves the development of cell
lines and mouse models that could be used to screen new
drugs for their effectiveness.
Among the projects supported by the breast cancer
portion of the gift is work under way to begin testing
a vaccine in humans. “If the vaccine works,” says lead
investigator William Gillanders, MD, associate professor
of surgery, “it could ultimately be used with existing
patients to prevent a recurrence or even with high-risk
patients to prevent the development of cancer.”
The potential benefits of this vaccine approach —
and the multiple myeloma projects — are huge. But
obtaining funding for new and developing research
programs has become difficult in recent years, which
makes the Holway gift so significant, Vij says. “In an era
where there is a squeeze on the amount of federal dollars
available to support research, philanthropy is critical.”
Other major gifts received in the past year include:
• A $7.5 million contribution from Emerson and AT&T.
Emerson, a global manufacturing and technology
company, and AT&T, the world’s largest communications
holding company, provided the funding in
support of research and other key initiatives.
A Night to Remember
Surgery fellow Lora Melman, MD, left, and Mary Lee Hermann demonstrate
suturing techniques to Don and DeDe Lambert at the Night of Discovery
event held Sept. 25 at the Four Seasons Hotel St. Louis. Guests at the event,
all friends of the Siteman Cancer Center, explored several discovery stations
to learn firsthand about new frontiers in cancer research and care.
The gift will be used as a challenge to generate
$15 million in additional support.
• Two endowed chairs established through gifts to the
Barnes-Jewish Hospital Foundation. Amy and Bill
Koman provided funding for the Koman Chair in
Medical Oncology, which was awarded to associate
professor Nancy Bartlett, MD, in December 2008.
In February 2009, associate professor Jeffrey Bradley,
MD, was installed as S. Lee Kling Endowed Chair in
Radiation Oncology. That chair was established by
multiple donors to honor St. Louis businessman and
philanthropist S. Lee Kling, who died in July 2008.
• A $445,487 gift from the 2007 QVC Presents “FFANY
Shoes on Sale” event, a fund-raiser for breast cancer
research and education programs across the country.
Siteman is one of the event’s eight beneficiaries.
Ron Fromm, past chair of the Fashion Footwear
Association of New York (FFANY) board of directors
and CEO of Brown Shoe, was instrumental in
introducing Siteman to the association in 2005.
www.siteman.wustl.edu 23

Leadership and Committees
Senior Leadership
Timothy Eberlein, MD
Director
John DiPersio, MD, PhD
Deputy Director
Graham Colditz, MD, DrPH
Associate Director of Prevention and Control
Jeffrey Moley, MD
Associate Director of Translational and
Clinical Investigation
Michael Welch, PhD
Associate Director of Oncologic Imaging
D. Craig Allred, MD
Professor of Pathology and Immunology
Jeff Michalski, MD, MBA
Professor and Interim Chair
of Radiation Oncology
Lee Ratner, MD, PhD
Professor of Medicine, Molecular
Microbiology, and Pathology
and Immunology
Richard Wilson, PhD
Professor of Genetics and
Molecular Microbiology
Brian Springer, MHA
Executive Director of Research and
Business Administration
24 The Alvin J. Siteman Cancer Center
Barnes-Jewish Hospital
Cancer Committee
Martha Ballentine, LCSW
Julie Allen Berger
Jeffrey Bradley, MD
Graham Colditz, MD, DrPH
Maryann Coletti, RN
Jill Conway, RN
Maria Dans, MD
Alex Denes, MD
Teresa Deshields, PhD
Pam Dowling, RN
Erik Dubberke, MD
Keith Fischer, MD
Victoria Fraser, MD
Maria Grabowski, RN
Lori Grove, CTR
Bruce Haughey, MB ChB
Tara Hendrix, MHA
Peter Humphrey, MD, PhD
Jennifer Ivanovich, MS, MBA
Leni Javier, MS, RD
Lisa Kehlenbrink, RN, MSN
Adam Kibel, MD
Mark Krieger
Marilee Kuhrik, RN, MSN, PhD
Nancy Kuhrik, RN, MSN, PhD
Julie Margenthaler, MD
Jennie Mayfield, RN
Eileen McCarthy, RN
Angel Medina, MHA
Wilfred Milton, CTR
Pat Mueth, RN
David Mutch, MD
Michael Naughton, MD
Cynthia Newsome, RN
JoAnn O’Neill, RN, MBA
Jay Piccirillo, MD
Joel Picus, MD
David Ray
Keith Rich, MD
Shabbir Safdar, MD
Mario Schootman, PhD
Maryann Scott, RN, MS
Bernard Shore, MD
Jill Skyles, RN, MBA
Brian Springer, MHA
Steven Strasberg, MD
Robert Swarm, MD
Christine Swyres, RPh
Marie Taylor, MD
Coreen Vlodarchyk, RN
Arlinda Warren
Geri Weis, LCSW
Michael Welch, PhD
Alison Whelan, MD
Barnard Cancer Institute
Board of Directors
John MacCarthy
President
George Andersson
Vice President and Treasurer
Thomas Blackwell
Secretary
Graham Colditz, MD, DrPH
John DiPersio, MD, PhD
Timothy Eberlein, MD
Frederick Hermann Jr.
Edwin Meissner Jr.
William Peck, MD
Larry Shapiro, MD
Andrew Ziskind, MD

Community Advisory Board
Ned Lemkemeier
Chair
Walter Ballinger, MD
Andrew Craig III
Beth Davis
John Dubinsky
Joy Dunkelman
Timothy Eberlein, MD
Ronald Evens, MD
David Farrell
Sam Fox
Frederick Hermann Jr.
Mary Lee Hermann
Datra Herzog
William Holekamp
Joanne Knight
DeDe Lambert
Steven Lipstein
Jacqueline Maritz
Paul McKee Jr.
Edwin Meissner Jr.
Gordon Philpott, MD
Larry Shapiro, MD
Alvin Siteman
Michael Staenberg
Kenneth Steinback
Norma Stern
John Stupp Jr.
Donald Suggs, DDS
Donna Wilkinson
Andrew Ziskind, MD
External Advisory Committee
Murray Brennan, MD
Memorial Sloan-Kettering Cancer Center
George Canellos, MD
Dana-Farber Cancer Institute
Mark Clanton, MD, MPH
American Cancer Society
O. Michael Colvin, MD
Duke Comprehensive Cancer Center
Nancy Davenport-Ennis
Patient Advocate Foundation
Robert Day, MD, PhD
Fred Hutchinson Cancer
Research Center
H. Shelton Earp III, MD
UNC Lineberger Comprehensive
Cancer Center
Judith Gasson, PhD
UCLA Jonsson Comprehensive
Cancer Center
Ellen Gritz, PhD
University of Texas M.D. Anderson
Cancer Center
Datra Herzog
Herzog & Rhoads Inc.
Hedvig Hricak, MD, PhD
Memorial Sloan-Kettering Cancer Center
William McBride, DSc
University of California, Los Angeles
Philip McGlave, MD
University of Minnesota Cancer Center
Donald L. Trump, MD
Roswell Park Cancer Institute
Richard Wahl, MD
Johns Hopkins Medical Institutions
Marcy Waldinger, MHSA
University of Michigan Comprehensive
Cancer Center
Disparities Elimination
Advisory Committee
Graham Colditz, MD, DrPH
Director, Program for the Elimination
of Cancer Disparities
Leon Ashford, PhD
Timothy Eberlein, MD
Denise Hairston
Sherrill Jackson, RN, CPNP, MSA
Matt Kreuter, PhD, MPH
Ned Lemkemeier
Katherine Mathews, MD, MPH
Christine Nolan, MSW
Rev. Norman Owens Jr.
Veronica Richardson
Mario Schootman, PhD
Brian Springer, MHA
Donald Suggs, DDS

The Alvin J. Siteman Cancer Center
660 S. Euclid Ave., Box 8100
St. Louis, MO 63110-1093
Siteman Cancer Center at
Barnes-Jewish West County Hospital
969 N. Mason Road, Suite 230
Creve Coeur, MO 63141-6338
Siteman Cancer Center at
Barnes-Jewish St. Peters Hospital
150 Entrance Way
St. Peters, MO 63376-1645
Phone: 314-747-7222
Toll free: 800-600-3606
Fax: 314-454-8051
E-mail: info@ccadmin.wustl.edu
www.siteman.wustl.edu
MPA5219 5.09