Andrew C. von Eschenbach

Just one month after Andrew von Eschenbach was sworn in as National Cancer Institute director, he was called to a US Senate hearing as the government's lead witness that day. The topic was one that he had grappled with before during his tenure at the American Cancer Society—and one that his predecessor and other physicians had not endured well: the pitched debate over the effectiveness of mammography screening for women in their 40s. The hearing was triggered by a systematic review1 that concluded that mammography screening offered no benefit and could confer harm in the form of excess tumorectomies and excess mastectomies. Government officials in the United States were up in arms over the message. Von Eschenbach put forward a certain, affirmative stance at the hearing. He quelled any concerns of politicians who in unison agreed that airing any uncertainties surrounding mammography's benefits would confuse women and be bad for the American public. Unstated, however, would be how damaging it could prove for the mammography industry and mammography advocates, whose bread and butter depend on mammography. Von Eschenbach took the problem in stride. He reiterated the government's position, backing mammography screening every one to two years for women in their 40s, while senators on both sides of the aisle practically climbed over each other to applaud him. Von Eschenbach is no stranger to debates over mammography. Just prior to his appointment, he gave up his role as American Cancer Society vice president/president-elect and he had just coauthored a report with American Cancer Society (ACS) director of cancer screening Robert Smith.2 "The writing was on the wall," says Karla Kerlikowske, whose position on mammography screening is that the uncertainties, benefits, and harms of mammography should be made public so women can make the best decisions. Kerlikowske, assistant professor of medicine, epidemiology, and biostatistics at the University of California, San Francisco, maintains a Web site on the topic (mammography.ucsf.edu/inform/index.cfm). But her dissenting opinion was drowned out and hardly heard. Toward Better Technologies Instead, von Eschenbach put forward this tack: "Where we believe we should be focusing our energies is in studying even better technologies and their applications. NCI should back studies comparing digital mammography with conventional film-screen mammography, as well as studies of PET [positron emission tomography] scanning, MR [magnetic resonance], and a new blood test for ovarian cancer.... Molecular studies and translational research will significantly improve the rational application of our therapies." Von Eschenbach spent his entire career at M.D. Anderson Cancer Center in Houston. An affable person, he is unabashed about his limitations. "What I learned very quickly," he told The Scientist, "is that no matter how great a surgeon I might become, surgery was not likely to solve cancer." He was an early advocate of multidisciplinary and integrated care. "Given the complexity of cancer, there is no way to resolve it and understand it without work in a laboratory," he said. Lacking an infrastructure between the clinic and laboratory, von Eschenbach foresees little headway in cancer care and research. Since 1996, he has headed the prostate cancer research program at M.D. Anderson. He also is a two-time cancer survivor. He had melanoma in 1989 and prostate cancer two years ago. "So I know this problem both as a clinician, from a research perspective, and the patient's perspective—and it's all part of a continuum." Von Eschenbach is proud that he was a founding member of the National Dialogue on Cancer, whose agenda he describes as "building comprehensive cancer plans in a variety of state cancer plans. Regarding NCI, he says: "I intend to immerse myself, listen and learn, and work together to foster the 'we' effectively." So Watch for It Some observers say that's exactly what he'll do. Says Martin Gleave, professor of surgery at the University of British Columbia, who trained under von Eschenbach: "His appointment undoubtedly signals that there is going to be some change at NCI toward translational research and the training of clinician scientists." Leland Chung, who also trained under von Eschenbach, credits the new NCI director with inspiring him to move from basic science to translational research. Chung is professor of urology, hematology/oncology and biochemistry, and director of molecular urology and therapeutics at Winship Cancer Institute at Emory University School of Medicine in Atlanta. "What sets Andy apart is that he is a great listener, has strong abilities as a consensus builder, and he brings out the best in everybody," said Chung. And Mary Woolley, president of Research!America, said, "It is extremely important to have someone accessible, open to the public, with a big-picture view. You don't have to be from Houston to realize how important transparency and accountability are, especially when you are working with taxpayer-supported dollars. He understands those things." Woolley remembers von Eschenbach's tenure on the ACS Board. "He was a really strong advocate for basic science research," she says. "I met him at a small dinner party after President George W. Bush's State of the Union Address. He talked about his twin grandsons who lit up his life." She continued: "It's very reinforcing that he speaks from the heart. He has a real commitment to life and health—and is the kind of person you want in leadership positions." Laura Newman (newman@nasw.org) is a freelance science writer in New York. References 1. O. Olsen, P.C. Gotzsche, "Cochrane review on screening for breast cancer with mammography," The Lancet, 358:1340-2, 2001. 2. R.A. Smith et al, "American Cancer Society guidelines for the early detection of cancer," CA - A Cancer Journal for Clinicians, 52[1]:8-22, January-February 2002.

Andrew C. von Eschenbach

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