Walter Reed National Military Medical Center, BETHESDA, Md.  –   Highlighting ongoing cancer research and care, the John P. Murtha Cancer Center (MCC) hosted its annual Cancer Summit on June 26 at Walter Reed.

The MCC, the only Department of Defense (DOD) Cancer Center of Excellence, was officially established in December 2012 at Walter Reed National Military Medical Center (WRNMMC). It operates jointly between Walter Reed and the Uniformed Services University (USU) to support the clinical, educational, and research aspects of cancer throughout the DOD community.

Retired Army Col. (Dr.) Craig Shriver, director of the MCC and its research program, said the Cancer Summit has been held annually since June 2013. “We do nine summits a year, and this is our longest running [one]. Throughout the years, we’ve had a variety of themes, and this year’s the focus is ‘You,’…with the ultimate hope of enhanced collaborations [for improved patient outcomes, care and research].”

U.S. Navy Capt. (Dr.) Melissa Austin, WRNMMC director and a pathologist, welcomed attendees to the summit. “I think it’s amazing the theme is about ‘you,’ because you drive patient care. You drive clinical advancement. You drive quality. You execute. I, and the rest of the leadership team, are here solely to remove barriers and facilitate those efforts.”

Austin encouraged those in attendance to use information from the summit to “embark on a line in inquiry to improve patient outcomes.” She explained that Walter Reed educates approximately a third of all military medical trainees and supports a third of Military Health System (MHS) research in concert with the MCC/USU. She said these connections are “imperative to keep driving clinical care forward. This is our obligation to those we serve.”

A Pentagon directive has tasked the MCC with tackling cancer as a readiness issue, Shriver said, explaining that approximately 1,200 active-duty service members are diagnosed with cancer annually, and 15,000 service members are currently serving with a diagnosis of cancer. A diagnosis of cancer may take a service member away from their unit for months or longer for treatment. “This is clearly an issue that demands attention," he added.

More than 20 speakers discussed their research involving cancer, which each presentation lasting for approximately 10 minutes, during the day-long summit. Research involved breast cancer among military women, prostate cancer, lung cancer, Merkel cell carcinoma, databasing, and biobanking, among other areas of discussion.

Air Force Lt. Col. (Dr.) Christin DeStefano, program director of the Hematology/Oncology Department at Walter Reed, presented a number of studies her teams are researching, including one involving burn pit exposure that might increase the risk of a certain cancer in service members. The team is investigating monoclonal gammopathy in burn-pit exposed service members, with DeStefano explaining that MGUS (monoclonal gammopathy of unknown significance) is a non-cancerous condition that can lead to multiple myeloma, a type of blood cancer.

Another one of research projects DeStefano’s teams is involved in is looking at the impact of deployment history and exposure history on immune functions.

Army Maj. (Dr.) Patrick Walker, a trauma surgeon at Walter Reed, discussed research concerning the clinical needs in cancer care and battlefield medicine, highlighting platelet-derived exosomes.

“Exosomes are extracellular vesicles released from cells such as platelets,” Walker explained. He added that exosomes “carry genetic information and proteins to cells throughout the body, serve as the key messaging system for cells and are naturally biocompatible, stable and can traverse biological barriers.”

“Platelets are the body’s first responders to the site of injury. [They] are readily available and cost-effective source,” he continued.

Researchers are exploring the use of exosomes for signal tissue regeneration, targeted treatment and immunotherapy, Walker explained. Platelet-derived exosomes therapy can be directed specifically to cancer cells, reducing off-target effects and improving treatment, he added.

“This is an exciting line of work that we’re looking to investigate further,” he added.

Air Force 2nd Lt. (Dr.) Megan Doherty, of USU, discussed the research work she’s involved in concerning targeting homologous recombination deficiency in leiomyosarcoma using a novel murine intrauterine model. She explained that uterine leiomyosarcoma (uLMS) is a rare, highly aggressive form of cancer and that African American women develop nearly two times as often as Caucasian women. “There’s a 38 percent five-year survival rate,” she added.

Julie Bytnar, Ph.D., a cancer epidemiologist with the MCC Research Program, addressed cancer incidence in active-duty U.S. service members in comparison with the general U.S. population. “Cancer incidence rates in the military tended to be lower than those in the general population, particularly among younger age groups,” she shared. She explained a number of factors contribute to this, including the better general health of military members when compared to the general population.

“Among older age groups, incidence rates in the military (for cancers of the bladder, prostate, testicular, cervical, colorectal, neuroepithelial brain) were equivalent to the general population, or higher than those in the general population for some cancer sites (kidney, breast, prostate),” she added. She explained that military occupations, as well as the increase incidence of smoking among service members, especially with those who served on deployments, could be factors contributing to these rates.

Also, “differences between rates in the military and the general population tended to be larger for Black than White individuals for some cancer sites (papillary, thyroid, lung, cervical, oropharyngeal).”

“Among older age groups which are typically recommended for cancer screening programs, military rates of local staged cancers were found to be higher and distant staged tumors equivalent to those in the Surveillance, Epidemiology, and End Results (SEER) program (breast, prostate, thyroid), or military rates of locally-stage cancers were found to be equivalent and distant staged tumors lower than those in SEER (colorectal, lung),” Bytnar added.

In discussing health care access and cancer survival, Jie Lin, Ph.D., MCC Research Program senior epidemiologist, said disparities in access to care among the U.S. population affect outcomes. She explained that uninsured individuals are less likely to be screened for cancer and more likely to be diagnosed at a higher staged cancer. They are also less likely to get treatment and have their treatments delayed, she added.

Lin said based on studies she’s been involved with, cancer patients of the “equal access system of the Military Health System” have better survival rates than the general U.S. population.”

Presenters during the summit agreed that U.S. service members may differ from the U.S. general population in exposure to factors associated with cancer risk, including physical fitness, smoking, alcohol use, diet, and sunlight exposure. In addition, risks associated with military deployments, such as burn pits and other occupational hazards, may also influence cancer risk among military personnel. But compared with the general population, the military population may be generally healthier and more likely to undergo cancer screening and surveillance because military members have free access to health care, Lin explained.

“MHS beneficiaries have improved survival than patients in the general U.S. population. This suggest that equal access to health care is important to improve the survival of cancer patients,” Lin, and other presenters during the summit, stated.