When the New York State Health Department issued maps this spring of the incidence of the three most common types of cancer – colorectal, lung and breast – found in each country throughout the State, and another map of the incidence of breast cancer in Nassau County, by zip code, the findings probably confirmed what many already suspected for the Manhasset area, and it brought comfort to no one. Based on State data collected from 1992 to 1996, the maps showed that the incidence of lung and colorectal cancer in Nassau County was within 20% below through 20% above, the State rate, for both men and women. No intra-county maps for these types of cancers have been issued yet by Health Department. For breast cancer, though, maps of both the county as a whole, and one of Nassau, broken down by zip code, were provided. The incidence of breast cancer between 1993-1997 in Nassau County revealed that communities like Port Washington, Manhasset, Roslyn, and Great Neck (as well as many others throughout the County) was 15% to 49% above the expected incidence. These zip-codes were also classified by the NYS Health department as "areas of elevated incidence not likely due to chance."

A 4-12-2000 Newsday article by Dan Fagin explained that State researchers developed the "expected" rate of breast cancer by first considering the breast cancer rates for the population on the entire state. "They then adjusted those rates for each zip code, depending on how old the population is and how many people line there, to come up with an estimate of the number of women who could be expected to have breast cancer,"the article explained. As cancer is more prevalent in older women than younger women, they took the age of residents into account as well. Researchers then compared this estimate to the actual number of women diagnosed and reported to the State’s cancer registry.

It is noteworthy that the map of breast cancer incidence in Nassau identifies not just Port Washington and nearby communities as having elevated rates; Valley Stream, Lynbrook, Oceanside, and West Hempstead fared the same, as did many others. Enigmatically, in the midst of the South Shore area mentioned just above, is Malverne, which was classified as 15-50% below the expected incidence. Sea Cliff was the zip code with the lowest incidence of breast cancer in Nassau County, with a rate more than 50% below what was expected. Oyster Bay had the highest in this county, with a rate 50-100% above the expected incidence of breast cancer. In the State, Rockland County had the highest rate of breast cancer.

For colorectal cancer in women, Nassau County was on a par with the majorities of counties throughout the State. Hamilton and Montgomery Counties, both upstate, have cancer rates that exceed the state’s by 30% or more. The same was true for the incidence of colorectal cancer for males; here, Clinton and Essex Counties joined Montgomery County in having the highest rates in NYS. Similarly, Nassau County’s rate of lung and bronchus cancer in males and females was within 20%below to 20% above the state rate. The majority of the counties seemed to be in this category. The northernmost counties NY, like St. Lawrence, Jefferson, and Essex, had the highest.

Though the mapping was not designed to identify caused of cancer, it has confirmed the observations of many and certainly pointed out the direction and need for further investigation. " We need some good statistical work." said oncologist Dr. Francis Arena, who is president of the Sass Foundation for Medical Research. His private practice on the North Shore has seen an increase in the number of people with lung, colorectal, and breast cancer, and he has observed that his patients are younger and younger. " It is almost common now to see people in their thirties and forties; this is a big change," he said. And when it comes to breast cancer, the changes are " more pronounced." More over, " We are also truly seeing pockets of these cancers," Dr. Arena added, which is one reason he advocates strongly for solid statistical studies confirming local observations. He feels such results can then be used to compare this community to similar ones, as do exist in Westchester, to examine shared factors, such as environmental influences. Such measures , he hopes, will Jcad to the identification of specific influences/causes. " The breast cancer rate represents something territorial," he emphasized , " and we have to focus our energies on what is different with these environments or these types of people…"

The information in these maps also came as no surprise to Geri Barish president of 1 in 9 The LI Breast Cancer Action Coalition, and a breast cancer survivor. " This has given us credibility for what we have been saying for a long time," she said. " We have a major problem." Like Dr. Arena, she felt we need to ask what is different here that might be a contributing factor, and she tends to think it might be the aquifer system. In addition, she hoped researchers will look into the wells. " As wells become contaminated they are closed," she stated, " but they seem to open another right next to the contaminated one." She encourages the public to press the Health Department to move ahead, rapidly. She hopes to see local health departments joining forces with water quality officials, to make changes. " We owe it to our families," she added, "even if it takes billions of dollars. We can’t be afraid of the unknown. We have to do it."

Others caution against rushing off to sell one’s PW home and move away; the causes, they feel, are multiple. Dr. Dwight DeRisi, a breast surgeon/specialist with a Great Neck practice, commented, " Just because one area has a higher incidence doesn’t mean that living there is bad for you. You have to really know the patient population, like people with family histories of breast cancer. Still, (the maps) do tell us there is a problem with Long Island, and we must investigate." Seval LaRocca, director of the Manhasset Women’s Coalition Against Breast Cancer, commented that a survey they conducted 2 years ago which was sent to every Manhasset home, found " hereditary links." The coalition had a 20% return rate on their survey, and they did not focus heavily on "hot spots" or specific streets/sections of Manhasset which seem to have cluster of those with cancer, because of high turn over rate. " Some people are moving into and out of the area every three to four years," she said.

For County Legislator Craig Johnson, whose mother , legislator/lawyer Barbara Johnson, lost her battle with breast cancer several months ago, " The maps confirm my concerns regarding the high incidence of breast cancer especially in my legislative district. " He feels we must " push forward with the cure, and it’s important to get all the information out to the public, including new breakthroughs." For this reason he is sponsoring a public forum about breast cancer on October 15 at the PW Elks Lodge; the forum is named in memory of his mother. He’d like to see state and federal funds dedicated to helping our researchers investigate, more funds for research , and monies to make treatments available to everyone. Seval LaRocca concurs." Researchers, work together!" is her message.

Newsday, Tuesday December 21 1999
By Delthia Ricks

Cecilia Benevisto knows what it’s like to lose all of her hair, to have breast cancer change her life irrevocably, to bargain repeatedly with God for one more time. "I would say, please let me live long enough to see this, or please let me live long enough to do that. I was really happy to turn 40," said Benevisto, who was diagnosed eight years ago, at age 33, "I mean very, very happy. I had a very big party," the Glen Cove woman recalled. "We invited everybody. All of our friends, the neighbors. It meant so much to me."

Before being diagnosed, Benevisto wouldn’t have imagined, even in her lowest moments, that breast cancer would so come to dominate her life. More disturbing still has been the battle with metastasis, cancer’s spread, that has flared in unexpected episodes, infiltrating her bones, invading her spirit. A mother of two daughters, 15 and 10, Benevisto knows her story is unusual, not just because breast cancer struck early in life, but also because her resilience in fighting the aggressive metastasis that have come back again and again.

Metastatic cancer often is potentially more dangerous and certainly more complicated to treat than the originating tumor, doctors say. "Primary cells do not bring about the demise of the patient," Dr. Isaiah J. Fidler, chairman of cancer biology at the M.D. Anderson Cancer Center in Houston, said of the originating tumor. It is metastasis, Fidler underscores, that poses one of the biggest conundrums in cancer.

Even though primary tumors give rise to metastases, metastatic tumors can be far more aggressive and, as a result of mutations, often carry a different set of genes. Once an offshoot tumor is established, thou, its own runaway cells can spread to other sites.

For more than two decades, Fidler’s studies have captured a spotlight in tumor biology, delineating how metastasis occurs as well as providing innovative ways to think about a process that poses a wide range of challenges for both physician and patient.

Challenges in metastatic disease abound. Benevisto’s oncologist, Dr. Frank Arena of Great Neck, has pulled out all the stops, battling aggressive metastases that have arisen in his patient’s sternum, spine and hip. He has introduced stepped-up drug regimens and kept his patient on some therapies as long as her will and his expertise could sustain them. And despite other medical problems occurring mostly as a result of the treatment, such as the elevated blood sugar which lately has surfaced, Benevisto is holding her own and is encouraged that her oncologist is meeting the challenges.

"He is willing to do more than other doctors and he has been with me every step of the way," Benevisto said. Her physician and his knowledge of metastatic disease, she said, have helped her over many hurdles, ever since the first metastasis was discovered in 1994.

Yet to understand why metastatic disease becomes such a challenge for patients, Fidler said, is first to grasp why it occurs in the first place. As he sees it, metastases are among the most unusual aspects of tumor biology and he wonders aloud why metastases even occur at all.

Without the spread, Fidler said, cancer is handily a treatable disease. "The process of metastasis consists of multiple steps that are sequential and very selective," Fidler explained. "A tumor first has to grow at the local site, and this involves angiogenesis," he said, referring to the tumor’s tapping into the host’s blood supply for sustenance to grow. Nearly 20 years ago, Fidler and Dr. George Poste of the department of experimental pathology at Roswell Park Cancer Institute in Buffalo summed up what makes metastases a challenge, the cancer equivalent to continually putting out fires.

"Metastases do not result from [the] random survival of cells released from the primary tumor," they said, "but from the selective growth of specialized subpopulations of highly metastatic cells endowed with specific properties that…[allow] them to complete each step of the metastatic process."

In a recent interview, Fidler said that statement is as true today as it was in 1980 when their defining report on metastasis first appeared in print. Cancer researchers further emphasize that to grasp the process of metastasis is largely to look at the array of molecular changes that can befall an escaping cancer cell and how these derangements can enhance the aggressiveness and motility of cells on the run. Cancer cells are genetically mutated to start with and typified by wild, uncontrolled growth. And it is such instability, researchers say, that makes them easily susceptible to additional mutations. Foremost, say researchers such as Dr. Linda Meade-Tollin, a tumor biologist at the University of Arizona’s medical school in Tucson, a metastatic cell is a hardy survivor, even though theoretically the odds are against it from the start.

"In metastasis, it is currently thought that tumor cells from the primary tumor invade the surrounding tissue matrix," Meade-Tollin said of the membranes that form the organ where the tumor resides. Then the errant cells must "penetrate blood or lymph vessels and travel in the vessel until they lodge at a second site." A key characteristic of a metastatic cell, she said, is its inability to leave the mother tumor and chew through tissue to make a run. To do this requires a number of internal changes that metamorphose the cell from a sedentary one anchored in the tumor to a cell capable of movement and escape.

Scientists currently believe that metastatic cells bore through tissue to free themselves, using enzymes known as proteases, or more formally, matrix metalloproteases. Once in the blood, the drama of metastasis begins and the life of most metastatic cells comes to an end.

The blood flow, studies show, is rapid and turbulent; it buffets and batters runaway cancer cells. And if that’s not enough, warrior cells from the immune system engulf and destroy most of these interlopers when they are en-route to distant sites. "Many malignant tumor cells, which escape the primary tumor, may be destroyed by the host’s defense system. The strength of an individual’s defense system will determine the odds of survival of the metastases," Meade-Tollin said. "Some tumors have more of a tendency to metastasize than others. But so many tumor cells could be released from the primary tumor," Meade-Tollin said, "that the odds are that a small number of cells will survive all the obstacles." Fidler likens surviving metastatic cells to decathletes. "For every gram of [cancerous] tissue –that’s about the size of a grape—we estimate about one million cells are shed from the tumor," Fidler added. "But a patient doesn’t have thousands of tumors. Therefore it’s clear very few cells from a tumor give rise to new tumors; only one cell in a million can do so."

Among the ways tumor cells survive the tumultuous trip through the blood is to travel in clumps of cancer cells, or to latch onto the sticky blood cells known as platelets. Traveling with cellular companions helps individual cells gain the proper dynamics to navigate the bloodstream’s raging flow. The journey is potentially so perilous and so much like attempting to white-water raft without the raft, scientists say, that the mechanical forces of the blood alone are enough to rip apart an errant cancer cell.

But survive they do, and more intriguing still to scientists studying metastasis is that surviving cells bear a key characteristic of immune system cells. Dr. Bruce Zetter, a cancer biologist at Children’s Hospital in Boston and a member of Dr. Judah Folkman’s Harvard team studying how tumors create their own vessels, says metastatic cells can take on some of the features of immune system cells, a disguise that bolsters the tumor cells’ clandestine journey to other physiological sites. This "allows them to zip in and out of blood vessels," Zetter said. In healthy people, an array of white cells, especially lymphocytes and those involved in the inflammatory response, are the only cells capable of moving in and out of blood vessels. With a metastatic cancer cell having the ability to implant elsewhere in the body is greatly enhanced.

More frightening, scientists say, is the implication in a recent series of studies in Switzerland that wayward cancer cells may possess the ability to destroy some cellular members of the immune system. This suggests the body’s defenses, at least in some patients, may be at risk. "It is important to remember that not all malignant tumors are the same," Meade-Tollin added. "A metastatic cell may be genetically different from the primary tumor, or from other metastases. There may be great differences in their tendency to metastasize, in their preferential sites of metastasis, in their resistance to cancer drugs, in their growth rate.

"Metastatic tumors, which have survived the body’s natural defenses, may thus grow more rapidly or be more difficult to treat than the primary tumor," Meade-Tollin said. Meade-Tollin and her colleagues on an international team of researchers are trying to fully understand the molecular underpinnings of metastasis. Along with her counterparts at the University of Amsterdam in the Netherlands, she and a number of scientists are analyzing a host of biological phenomena peculiar to metastatic cells; among them, the genetic disruptions that allow cancerous offshoots to create new tumors.

Dr. C.J. Van Noorden, who heads the department of cell biology at the University of Amsterdam, said metastatic cells sometimes survive as a result of coincidence, that runaway malignant cells have switched on the right genes that code for proteins to bolster their survival. "The idea I find very attractive is the following," he said. A normal cell becomes cancerous because in the first instance, the genes that encode for control proteins that check DNA for errors…are mutated themselves."

Control proteins are vital to keeping cancer at bay, but when control mechanisms are lost, tumors are then free to develop and shed metastatic cells into the blood. "You can consider these control proteins as policemen in the cell. When the policemen in a society are killed, he society may develop chaos. That’s what happens in cancer cells. So now control is lost, anything goes." But according to Van Noorden, cancer cells are not subject to just a single mutation. Cancer cells can mutate many times during their evolution from a normal cell. "When a tumor cell is mutated again, that makes the life of that cancer cell easier. It has a greater chance of survival," Van Noorden said. And that means survival of the fittest, not just of that cell but of its offspring, which will carry those same survival mutations.

Meade-Tollin and Van Noorden say drugs that intervene with a metastatic cancer cell’s ability to enter and exit tissues could be one way to stop cancer’s spread. One such inhibitor currently is in clinical trials. In the meantime, patients such as Benevisto must rely upon their physicians’ knowledge and daring, their willingness to take chances.

"There are a lot of doctors who might have given up on my now, but not him," Benevisto said of Arena. She’s pleased with her progress, despite the challenges.

"I look at my daughters," she said. "They’re far wiser, compassionate and understanding than most adults. The only way to describe it is [that] they have more empathy because they’ve been through so much," she said. She and her husband, along with the girls, attend counseling to cope with cancer’s many ups and downs. But Benevisto underscores that she finds happiness in som ething every day. "Life goes on," she said. "I want to paint the kitchen. I’m getting kind of tired of the way it looks now. And you know what? We’re going to make that change.

Assemblyman Thomas P. DiNapoli was pleased to greet Francis Arena, M.D., on his recent TV show, Assembly Update. Dr. Arena is president and regional director of the Sass Foundation for Medical Research, a not-for-profit organization that is committed to providing education, research and patient support for programs dealing with cancer and related diseases.

State Assemblymember Thomas P. DiNapoli, Democrat-Thomaston, has released information concerning special scholarships that will be awarded to qualified students enrolled in approved medical and dental schools in New York State.

The program will provide awards from $1,000 to $10,000 a year for up to four years. To qualify, applicants muste be (1) economically disadvantaged and/or a member of a minority group historically under-represented in medicine or denistry, and (2) a graduate of a state-sponsored EOP, HEOP, SEEK or College Discovery opportunity program.

Recipients of the scholarships must agree to practice in a geographic area or facility within New York State and approved by the Regents as having a shortage of physicians or dentists.

All applications must be postmarked by May 1, 1999. For additonal information and to request an application, write to New York State Education Department, HEOP/VATEA/Scholarships, Room 1071 EBA, Albany, New York 12234 or call (518) 486-1319. Information is also available at any New York State approved medical or dental school.

Manhasset Press - March 10, 1994
By Sharon Abruzzo

It’s not every day a doctor can confer the particulars of a case with a Nobel Laureate, but last Thursday physicians at North Shore University Hospital got that chance when Dr. E. Donnall Thomas, 1990 winner of the Nobel prize, spent the day there.

Referred to in the medical world as "The Father of Bone Marrow Transplantation," Dr. Thomas, who has also been rewarded the Presidential Medical of Science, began his visit by hearing cases at Morning Report, attending Medal Grand Rounds with doctors, residents and nurses and then speaking to a standing room only crowd on the subject of Leukemia at an afternoon session.

Dr. Thomas’ visiting professorship, which also included at Memorial Sloan-Kettering Cancer Center in Manhattan, was sponsored by the Hematologic Research Foundation, a non-profit organization dedicated to promoting research in the areas of leukemia, lymphoma and related hematologic diseases. In addition to visiting professorships, the foundation has sponsored a yearly research fellow through the Cornell Medical School at North Shore. Thanks to the tremendous success of its golf outing last fall, the foundation will be sponsoring two research fellows this year.

In his thank you speech at a dinner held in his honor, Dr. Thomas made particular note of the fellowship program and credited some of his accomplishment to this kind of opportunity.

Throughout his career, Dr. Thomas has published more than 900 papers on bone marrow transplantation and hematologics diseases. Somehow I am reminded of what Ernest Hemingway wrote, "some writers are only born to help another writer to write one sentence;" in Dr. Thomas’ case, his rich contributions have and will continue to aid many for a long time to come until that final sentence can be written.

Roslyn - Medical assistant Susan Treanor pricked Vincent Rotolo’s index finger recently and drew a few drops of blood into a narrow glass tube. By the time Rotolo had finished swabbing his finger with gauze, Dr. Francis Arena already had transferred the blood to a machine that immediately measured Rotolo’s red, white and platelet counts.

The blood-count analyzer, which cost about $20,000, is the first piece of equipment that the Hematologic Research Foundation has bought. And the machine represents just one facet of the research that the new national group - founded by donations of $65,000 from anonymous Long Islanders - will conduct as it studies various blood diseases, Arena, the foundation’s president said.

"We’ll be taking a unified approach to research" Arena said. "We’re trying to say that there’s an interrelationship among diseases that affect the blood system, among the things that may predispose people to these conditions.".

Starting this year, the nonprofit group - whose research will focus on such disease as cancer, leukemia and anemia - also will offer research grants and sponsor teaching visits by hemotologists at North Shore University Hospital in Manhasset and memorial Sloan-Kettering Cancer Center in the city, Arena said.

The foundation, formed last summer, is governed by a board of directors from North Shore, Sloan-Kettering, New York Medical College, University of California and University of South Florida.

Although several groups nationwide already focusing on blood diseases and cures, blood experts say the field is so broad that new organizations can always fill a void.

"This is one area that needs as many people working on it as possible," said Dr. Chester Alper, scientific director of the Center for Blood Research in Boston, where research during the past four decades had led to techniques for dealing with blood problems in newborn babies.

For now, North Shore patients like Rotolo, a 62-year-old retired postal worker from Oceanside who has been fighting malignant tumors since 1980, can use the foundation’s blood-count analyzer free of charge to determine how well their bodies are responding to treatment.

The analyzer automatically record the patient’s blood-count data, providing researchers with an opportunity to study the effects of various drugs. For the past three months, Rotolo has been using a new drug, called DXDX, which has reduced the size of his lung and liver tumors.

"We’re seeing shrinkage of the tumors, and it makes us very hopeful," Arena said.