Fred Hutchinson Cancer Research Center is celebrating its 25th anniversary at a unique time in the history of medical science. Just this year, a nearly complete DNA sequence of the human was announced. This information, together with new molecular technologies that search and compare these vast amounts of data, provides us with unprecedented molecular information that will be the driving force for many advances in cancer research during the next decade.

We are enthusiastic about the enormous possibilities for improvements in diagnosis, treatment and prevention resulting from high-resolution genetic analysis. The first significant outcomes for patients are likely to be in the area of early diagnosis. Cancer cells can be distinguished from normal cells by the genetic changes they have incurred. There are now extremely sensitive techniques for detecting these changes in tissues that can be biopsied and in cells or molecules circulating in the blood or discarded in other body fluids. Early detection would drastically reduce the death toll from cancer since most cancers are curable if they are found early enough.

The cover story in this issue of Quest demonstrates the value of early diagnosis. Esophageal cancer is one of the most deadly—only about 5 percent of patients survive more than five years after detection. However, that dire statistic has been turned into greater than 80 percent survival merely by early detection. Dr. Brian Reid works with patients who are at increased risk for esophageal cancer. They are people with chronic stomach-acid reflux that damages the tissue of the esophagus. About one in 10 people with this condition, known as Barrett’s esophagus, will get esophageal cancer. If they wait until they have trouble swallowing before the cancer is detected, their chances of survival are very low. However, if they are patients of Reid’s, they are examined at regular intervals. In this group of patients, cancer onset is detected very early and surgical removal at this early stage results in high survival.

It is our hope that a variety of different molecular tests will permit early detection of breast, prostate, colon, pancreas, ovarian, kidney, liver and other cancers with equally dramatic effects on survival. Another story in this issue is about a recent addition to the Hutch, Dr. Pete Nelson, who is using genomic technologies to search for molecules that may earlier reveal prostate cancer.

One key to the successful deployment of early detection methods may be the identification of high-risk groups of people. It is likely to be too expensive to examine every individual for many types of cancer at regular intervals. This is where inherited genetic changes or environmental exposures that predispose to cancer become critical. Our public-health scientists are hard at work trying to identify these risk factors, not only so we can eliminate them when possible, but also so that we can apply more intensive surveillance to those known to be at risk.

Lee Hartwell
President & Director