Although tremendous strides have been made towards understanding the basic biology of breast cancer, very few of these advances have directly translated into improved outcome for the breast cancer patient. Several reasons may account for the inability to turn research findings into clinical applications. 1. A successful translational breast cancer program requires several elements: a critical mass of basic scientists, breast cancer clinicians who function in a multi-disciplinary setting, administrative support, and adequate resources. The SPORE program was designed to facilitate the merging of these elements. 2. Research technology has become increasingly complex and specialized. This trend can limit the kinds of questions any individual investigator can ask, and collaboration between investigators is absolutely required. For example, if the chemotherapist wishes to investigate p53 mutation and response to chemotherapy, collaboration with a skilled molecular biologist will be necessary. The molecular biologist may wish to study breast cancer tissues, which requires collaboration with a breast cancer pathologist. Real advances in improving patient outcome will come from a collaborative team approach, drawing together the various basic science disciplines (molecular biology, cell biology, protein chemistry, etc.) and the clinical disciplines. 3. Research and clinical training has become highly specialized. The Ph.D. investigator often trains in a very narrow field of technology and application. Such training may leave the investigator ill-prepared to approach the complex clinical questions posed by the breast cancer patient. Similarly, the M.D. investigator can become narrowly focused in clinical areas such that the potential applications of basic research findings are not understood or utilized. In order to more rapidly translate basic science advances into clinical advances, a special type of investigator is required. There are still relatively few investigators who can operate at the critical interface between basic science research and clinical medicine. Several barriers evident in the current training of scientists may be responsible for this observation.
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