Hollings Cancer Center

Carolyn D. Britten, MD, chief, Division of Hematology Oncology, associate director, Clinical Investigations, at the Hollings Cancer Center, Medical University of South Carolina, discusses questions that remain in immunotherapy.

Immunotherapy offers a lot of promise to the field of oncology, says Britten, but it is not the only option. 

Proper patient selection will be the key to best utilizing immune checkpoint blockage therapies, she says. A better understanding of which combinations work best is also needed.     

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Dr. Carolyn Britten on Next Steps in Immunotherapy

Carolyn D. Britten, MD, a noted expert in phase I cancer clinical trials, has been named Director of the Hematology/Oncology Division in the Department of Medicine at the Medical University of South Carolina (MUSC). She continues in her role as Associate Director for Clinical Investigations at the MUSC Hollings Cancer Center, one of 68 National Cancer Institute (NCI)-designated cancer centers in the U.S.

Britten was recruited to MUSC in 2012 from the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles (UCLA), where she held several leadership positions from 2001 to 2012, including Associate Director of the Signal Transduction and Therapeutics Research Program. At MUSC, she holds the Charles Westfield Coker Endowed Chair in GI Oncology, which is part of the prestigious South Carolina SmartState Centers of Excellence. Since arriving at MUSC, Dr. Britten has spearheaded the development of a Phase I Clinical Trials Program that now includes a portfolio of more than 20 actively accruing trials for patients with advanced cancer.

Patrick Cawley, M.D., vice president for clinical operations at MUSC and chief executive officer for the MUSC Medical Center, commented, “I am excited to have Dr. Britten join the oncology senior leadership team in MUSC Health. She has a collaborative, approachable, and persistent style that makes her a successful leader. In addition, she is a noted scientist and clinician, and she will continue the Hollings Cancer Center tradition of bridging the research lab and clinical care which is vital in the care of cancer patients today.”

Originally from Canada, Dr. Britten received her medical degree from the University of Toronto, and completed internship, residency and chief residency at the University of Western Ontario. She subsequently trained in medical oncology at the University of British Columbia in Vancouver, and completed a research fellowship in cancer drug development at the Institute for Drug Development at the University of Texas at San Antonio. She then joined the faculty at UCLA, where she developed their solid tumor Phase I clinical trials program.

“After joining MUSC in 2012, Dr. Britten quickly became a sought after collaborator among the scientists at Hollings,” according to Dr. Anthony J. Alberg, interim director of the Hollings Cancer Center. “With a keen insight into the latest scientific underpinnings of cancer, she has been able to work with our scientists to translate their laboratory findings directly into the clinic via clinical trials.

Not many places in the country can claim to have this capability, but the scientists at the Hollings Cancer Center, with Dr. Britten’s insight and leadership, have been able to do this.”

Dr. Britten has extensive experience in the medical oncology field at a national level. In addition to her Phase I clinical trials expertise, she specializes in the treatment of gastrointestinal cancers. Dr. Britten has served on multiple committees for the American Society of Clinical Oncology and is highly active in national oncology networks. She recently co-led Hollings Cancer Center’s effort to become one of 12 sites funded as a minority-based institutional site for the NCI Community Oncology Research Program which conducts multi-site, NCI-sponsored cancer clinical trials and cancer care delivery research studies.

In her new role as Director of the Hematology/Oncology Division, Dr. Britten has a vision to greatly expand the clinical services and research within the division through doubling the numbers of clinicians committed to clinical and translational research, leading the development of partnerships with regional community-based cancer programs to extend the specialized oncology services of the division, and refining the training within the division’s fellowship program to yield a new generation of medical oncologists equipped to practice in an era of targeted therapies.

According to Don Rockey, M.D., chair of the MUSC Department of Medicine, “We launched a national search for this critical leadership position within the Department and the Hollings Cancer Center, and it became clear to the search committee early on that we had one of the best and brightest talents in the field of medical oncology already in our own ranks. Dr. Britten brings great energy, passion and leadership to this position, and we all anticipate great things for both her and the division. I look forward to working with her, and I am certain that she is going to have a great impact within a short time frame not only within the institution, but also for the community we serve, in delivering the very best in patient-oriented cancer care.”

The Hollings Cancer Center at the Medical University of South Carolina is a National Cancer Institute-designated cancer center and the largest academic-based cancer research program in South Carolina. The cancer center is comprised of more than 120 faculty cancer scientists with a research funding portfolio of $43 million and a dedication to reducing the cancer burden in South Carolina.

Hollings offers state-of-the-art diagnostic capabilities, therapies and surgical techniques within multidisciplinary clinics that include surgeons, medical oncologists, radiation therapists, radiologists, pathologists, psychologists and other specialists equipped for the full range of cancer care, including more than 200 clinical trials. For more information, please visit www.hcc.musc.edu.

Articles

Britten continues as Associate Director for Clinical Investigations for the MUSC Hollings Cancer Center. 


Cancer Phase I Trials Expert Carolyn D. Britten, MD, Named Director of Hematology/Oncology Division for Medical University of South Carolina

LOS ANGELES — New research by an international team including Hollings Cancer Center, Duke University, and USC Keck School of Medicine scientists is bringing the origins of ovarian cancer into sharper focus.

The study, published online June 15 in the peer-reviewed journal 

, highlights the discovery of three genetic variants associated with mucinous ovarian carcinomas (MOCs), offering the first evidence of genetic susceptibility in this type of ovarian cancer. The research also suggests a link between common pathways of development between MOCs and colorectal cancer and for the first time identifies a gene called HOXD9, which turns genes on and off, and provides clues about the development of MOCs.

“It remains a mystery where these cancers come from,” said Simon Gayther, Ph.D., professor in preventive medicine, Keck School of Medicine of USC, corresponding author of the international genome-&shy;â€wide association study (GWAS). “By finding these genetic markers, we begin to understand more about the biology of the disease itself. This study tells us more about the biology of ovarian cancer from the early development stage than most research has.”

Ovarian cancer is the fourth leading cause of cancer in American women and seventh most common cancer in women throughout the world (World Health Organization). In 2015, more than 14,000 American women will die of ovarian cancer, according to the American Cancer Society.

Most ovarian cancers have low survival rates, typically because of the misunderstanding of symptoms and discovery of the cancer in later, less treatable stages.

“Although MOCs are a less common type of ovarian cancer with generally good prognosis when diagnosed in early stages, they are twice as likely to be resistant to treatment at later stages,” said Andrew Berchuck, M.D., director of gynecologic oncology at Duke University Cancer Institute, and senior author of the study. “Our results will contribute to the identification of women at greatest risk of developing the disease with the long-&shy;â€term goal of prevention.”

The association analysis was based on 1,644 women diagnosed with MOC and more than 21,000 women without ovarian cancer. The research was conducted as part of the Collaborative Oncological Gene-&shy;â€environment Study (COGS), launched in 2009 with the goal of determining risks of breast, ovarian and prostate cancer.

“A major strength of this study is the large number of women with MOCs, which was made possible by pooling data contributed by investigators from over 40 international studies of ovarian cancer within the Ovarian Cancer Association Consortium,” said Linda Kelemen, Sc.D., associate professor and researcher at the Hollings Cancer Center at the Medical University of South Carolina, and co-first author. “By using a genome-wide scan, we could identify genetic variants that were significantly more common in women with MOC compared to those without ovarian cancer.”

Co-first author Kate Lawrenson, Ph.D., of Keck Medicine of USC believes the research will lead the way to the development of risk prediction strategies followed by clinical interventions with the potential to prevent ovarian cancer altogether, rather than treating the disease once it has already taken hold.

“The five year survival rates for ovarian cancer have not changed much in the past 30 years and is partly from viewing ovarian cancer as a single disease,” she said. “Our results shed light on differences in genetic risk factors for the different ovarian cancers such as MOCs. I’m hanging my hopes on prevention. My bet is that prevention approaches will be better than finding a cure for a disease that is often diagnosed late.”

The study, “Genome-wide significant risk associations for mucinous ovarian carcinoma,” was published online in 

on June 15, 2015. Also contributing to the study was Paul D.P. Pharoah (University of Cambridge).

Funding for the study comes from the European Commission’s Seventh Framework Programme grant, the Ovarian Cancer Association Consortium, the U.S. National Cancer Institute GAME-&shy;â€ON Post-&shy;â€GWAS initiative, and numerous grants from funders including the American Cancer Society, the Canadian Institutes of Health Research and other cancer societies and organizations throughout the world.

Kelemen, L.E., Lawrenson, K., ... Pharoah, P.D.P., Gayther, S.A., Berchuck, A. (2015) Genome-&shy;â€wide significant risk associations for mucinous ovarian carcinoma 

. Published online June 15, 2015; doi: 10.1038/ng.3336

Hollings Cancer Center at the Medical University of South Carolina is a National Cancer Institute-designated cancer center and the largest academic-based cancer program in South Carolina. In addition to the full range of clinical services, the cancer center has more than $42 million in cancer research funding and more than 200 clinical trials open to patients.

Hollings offers state-of-the-art diagnostic capabilities, therapies and surgical techniques with multidisciplinary clinics that include surgeons, medical oncologists, radiation therapists, radiologists, pathologists, psychologists and other specialists equipped to the full range of cancer care. For more information, please visit www.hcc.musc.edu.

ABOUT THE OVARIAN CANCER ASSOCIATION CONSORTIUM (OCAC)

The Ovarian Cancer Association Consortium (OCAC) was founded in 2005 and its activities are supported by the Ovarian Cancer Research Fund (OCRF) in New York City. OCAC comprises over 75 groups of investigators from around the world who are conducting genetic epidemiology studies of ovarian cancer. The group meets biannually and is working together to discover common genetic polymorphisms that affect a woman's risk of developing ovarian cancer.

International genome-Â­wide association study (GWAS) also identifies key gene responsible for expressing subtype of ovarian cancer.

International Team Including Hollings Cancer Center Scientist Finds Genetic Variants Key in Understanding Origins of Ovarian Cancer

Researchers, including a professor from the Medical University of South Carolina Hollings Cancer Center, say a new genomic test is a breakthrough for lung cancer testing in some current and former smokers. It’s more accurate and less invasive than older options.

Gerard Silvestri, M.D., is Hillenbrand professor of thoracic oncology at MUSC and co-leader of the study. “Clinicians want to avoid missing a cancer when one is present and avoid unnecessary invasive and perhaps harmful testing in patients ultimately found to have benign disease,” Silvestri said.

Traditionally, when a scan shows something troubling on a patient’s lungs, clinicians use bronchoscopy to try to capture some of the tumor’s cells to check for malignancy. Because lung cancer tends to develop deep in the lungs, the bronchoscope doesn’t always reach it. Consequently, the results can be inconclusive, leading to a more invasive needle biopsy or opening the chest to examine the tumor.

Researchers set out to see if they could improve the performance of the bronchoscopy. The new genomic test they studied used small brushes on the bronchoscope to collect some of the thin epithelial cells that line the patient’s airway, not just the cells suspected of being cancerous. 

The study showed, as the researchers suspected, that the epithelial cells are a good indicator of whether the tumor is malignant.

The research involved 639 patients at 28 sites in the United States, Canada and Ireland. The genomic test, when evaluated with the bronchoscopy, had a combined sensitivity of 97 percent for detecting lung cancer, compared to 75 percent for bronchoscopy alone. 

"This study has some important findings.  The first is that there is a high non-diagnostic rate of bronchoscopy when evaluating patients with new lung masses and a suspicion of cancer,” Silvestri said.

Second, he said, “Using this bronchial genomic classifier in patients with an intermediate risk of cancer and a non-diagnostic bronchoscopy helps patients avoid unnecessary testing because a negative classifier in this patient population strongly suggests that the lesion in the lung is benign and further invasive testing could potentially be avoided."

The test was developed in the lab of Boston University School of Medicine researcher Avi Spira, M.D. Other research centers and companies involved in the study include the University of Pennsylvania School of Medicine; Veracyte, San Francisco; Elashoff Consulting; and the University of Wisconsin School of Medicine and Public Health.

About a quarter of a million patients have a bronchoscopy for suspected lung cancer each year, with approximately 40 percent of those procedures inconclusive.

New England Journal of Medicine Publishes Study Co-Led by Hollings Cancer Center Researcher Showing Potential of New Genomic Test In Lung Screening.

New Genomic Test Will Benefit Patients Being Screened for Lung Cancer

Dr. Matthew J. Carpenter, an associate professor at the Medical University of South Carolina (MUSC) and researcher with the MUSC Hollings Cancer Center, is the recipient of the 2015 Governor’s Young Scientist Award for Excellence in Scientific Research. The award was presented by Lieutenant Governor Henry McMaster at a ceremony at the State House this week.

The Governor's Awards for Excellence in Science, administered by South Carolina Academy of Science (SCAS), were established in 1985 to honor an individual or team within the state whose achievements and contributions to science in South Carolina merit special recognition and to promote wider awareness of the quality and extent of scientific activity in South Carolina. The Young Scientist Award is directed to a gifted young researcher who has demonstrated the potential for major contributions to his discipline.

Dr. Carpenter is an associate professor with the Department of Psychiatry and Behavioral Sciences and conducts research through the Hollings Cancer Center’s Cancer Control Program. His research, mostly funded through the National Institutes of Health, focuses on tobacco use and smoking cessation techniques.

“Dr. Carpenter has been an important cornerstone in building the Hollings Cancer Center’s Cancer Control Research Program, and he is already rising to stardom in tobacco control research internationally. We are truly fortunate to a have a young scientist of such formidable talents right here in the state of South Carolina,” said Anthony J. Alberg, Blatt Ness Distinguished Endowed Chair in Oncology, Professor of Public Health Sciences, and Interim Director of the Hollings Cancer Center at MUSC. “We can all anticipate seeing firsthand how his contributions to curbing tobacco use will translate into a genuine population health impact in South Carolina and beyond.”

According to Dr. Alberg, Dr. Carpenter joined the faculty at MUSC in 2006 and since that time has been extraordinarily productive both in pursuing high-impact, innovative independent research and in collaborating with other researchers to strengthen their research teams.

Dr. Carpenter received his doctorate in clinical psychology from the University of Vermont in 2003. He was awarded the prestigious Developing Scholar Award at MUSC in 2009, and in 2011, he was awarded the New Investigator Award by the Society for Research on Nicotine and Tobacco. He has served regularly as a reviewer on NIH Study Sections; as a consultant on grants from the University of Vermont, University of Minnesota, and University of Rhode Island; and on two editorial boards and as ad hoc reviewer for many of the major journals in his field.

The Hollings Cancer Center at the Medical University of South Carolina is a National Cancer Institute-designated cancer center and the largest academic-based cancer program in South Carolina. In addition to the full range of clinical services, the cancer center has more than $42 million in cancer research funding and more than 200 clinical trials open to patients.

Dr. Matthew J. Carpenter, an associate professor at the Medical University of South Carolina and researcher with the MUSC Hollings Cancer Center, is the recipient of the 2015 Governor's Young Scientist Award for Excellence in Scientific Research.

Hollings Cancer Center Researcher Receives Prestigious Governor's Award for Science

 Overwhelming evidence presented in the 2014 Surgeon General’s Report resulted in the conclusion that smoking causes adverse outcomes in patients with cancer.

 Current smoking increases risk for overall mortality by a median of 51% and increases the risk of cancer-specific mortality by a median of 61%. Smoking further increases the risk of developing a second primary cancer and has strong associations with an increased risk of toxicity from cancer treatment. One or more adverse effects of smoking are noted across virtually all cancer disease sites and for all treatment modalities including surgery, radiotherapy, and systemic therapy.

Yet despite these data, most oncologists do not regularly provide evidence-based tobacco cessation support for patients with cancer who smoke.

 Some of the reasons that oncologists do not offer this support include not feeling confident in their ability to assist their patients in stopping smoking, a lack of time, and a lack of available resources.

However, addressing tobacco use by patients with cancer is not as difficult as some might think. Established evidence-based guidelines are available

 and online resources have been developed specifically for use by clinical oncologists.

 Recent reviews have discussed methods to improve cessation support for patients with cancer that basically rely upon asking patients about tobacco use, advising patients to quit smoking, and assisting patients in quitting smoking using principles of behavioral counseling and pharmacotherapy.

 Physicians and other clinical providers can directly assist patients with cessation support or can refer patients to resources such as dedicated institutional tobacco cessation programs, state help line services, or specialized counselors who can be integrated into a busy oncology clinic.

Recognizing the merits of such efforts, leading cancer organizations such as the American Society of Clinical Oncology, the American Association for Cancer Research, and the International Association for the Study of Lung Cancer have advocated for providing cessation support to all patients with cancer who use tobacco.

Clinicians and researchers at the Hollings Cancer Center (HCC) at the Medical University of South Carolina (MUSC) have seized upon these recommendations to develop a dedicated cessation program to provide assistance to all patients with cancer who use tobacco. Prior work demonstrated that an automated referral process for patients to a dedicated cessation program was very well received by patients,

 with more than 90% expressing an interest in participating in tobacco cessation.

Through this platform, patients are screened for tobacco use using a structured tobacco assessment; all patients identified as using tobacco within 30 days of assessment are referred for cessation support, and all patients are followed to ensure that they are using recommended evidence-based cessation treatments and making progress toward quitting. Patients can opt out of the tobacco cessation program, but the service is offered to all patients as a standard of care.

Patients are contacted by a trained cessation counselor who discusses the adverse effects of smoking on their cancer treatment and the need to quit smoking as an important part of their cancer care. Patients are then further assessed for how ready they are to quit using tobacco, what problems they have in quitting, what behaviors they can change, and what medications are needed to help them quit. An individualized tobacco cessation treatment plan is developed, and patients are followed to help ensure that they are able to maintain a successful quit attempt.

The program at HCC is coupled with an inpatient program available to all hospitalized patients at MUSC. All inpatients who report smoking at admission are automatically referred to a dedicated inpatient tobacco cessation counselor, who then rounds on patients to discuss the importance of quitting smoking. Evidence-based recommendations are placed into the electronic medical record for clinicians to reference for patient treatment. Upon discharge, patients are then followed with an automated interactive voice recorder system that tracks tobacco use and provides real-time referrals to South Carolina’s Tobacco Quitline for patients who request additional help.

Using this design, HCC and MUSC are able to effectively screen patients for tobacco use, deliver evidence-based cessation support as a standard of care, document interventions, and obtain follow-up data. Using an automated approach reduces selection bias for physician referrals and allows more patients who need cessation support to receive evidence-based care. In patients with a mandatory referral for cessation support at HCC and MUSC, more than 90% of cancer patients and more than 80% of inpatients are receptive to cessation support.

Moreover, this approach allows clinicians to focus on other aspects of medical care. Locating cessation services in the hallway across from clinic allows for clinics to continue operating at a high volume without being slowed for behavioral counseling sessions and medications. Clinicians can also facilitate cessation without a strong experience base by advising all patients to quit smoking and allowing evidence-based cessation to be provided by trained counselors.

With the conclusive evidence that smoking causes adverse outcomes in cancer patients,

the need to provide evidence-based tobacco cessation support is clear. Clinicians should evaluate effective methods to help their patients quit smoking as a standard part of cancer care and should realize that many patients are receptive to help. Clinicians who are reticent about providing cessation support themselves should engage institutions, insurers, and the community to develop dedicated tobacco cessation resources to help patients quit smoking. Collectively, tobacco cessation may be one of the most effective adjunctive agents to improve cancer treatment outcomes.

			US Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014.Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General; 2014.

			Warren GW, Marshall JR, Cummings KM, et al. Practice patterns and perceptions of thoracic oncology providers on tobacco use and cessation in cancer patients. 

			Warren GW, Marshall JR, Cummings KM, et al. Addressing tobacco use in cancer patients: A survey of American Society of Clinical Oncology members [published online July 29, 2013]. 

			Fiore MC, Jaén CR, Baker TB, et al. Treating Tobacco Use And Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: US Department of Health and Human Services. Public Health Service; May 2008.

			American Society of Clinical Oncology. Tobacco cessation and control resources. http://www.asco.org/practice-research/tobacco-cessation-and-control-resources. Accessed February 26, 2015. (last referenced 2-26-15)

			Warren GW, Sobus S, Gritz ER. The biological and clinical effects of smoking by cancer patients and strategies to implement evidence-based tobacco cessation support [published online October 26, 2014]. 

			Karam-Hage M, Cinciripini PM, Gritz ER. Tobacco use and cessation for cancer survivors: an overview for clinicians [published online May 9, 2014]. 

			Toll BA, Brandon T, Gritz ET, et al. Assessing and stopping cancer patients’ tobacco use: an American Association for Cancer Research policy statement [published online April 9, 2013]. 

			Hanna N, Mulshine J, Wollins DS, et al. Tobacco cessation and control a decade later: American Society Of Clinical Oncology policy statement update [published online July 29, 2013]. 

			Cummings KM, Dresler CM, Field JK, et al. E-cigarettes and cancer patients. 

			Warren GW, Marshall JR, Cummings KM, et al. Automated tobacco assessment and cessation support for cancer patients [published online October 25, 2013]. 

Most oncologists do not regularly provide evidence-based tobacco cessation support for patients with cancer who smoke. However, addressing tobacco use is not as difficult as some might think. 

Helping Cancer Patients Quit Smoking Should Be a Standard of Care

	Increasing the minimum age of legal access (MLA) to tobacco products will prevent or delay initiation of tobacco use by adolescents and young adults, particularly those ages 15 to 17, and improve the health of Americans across the lifespan, says a new 

 from the Institute of Medicine.  The committee that conducted the study estimated the likely reduction in tobacco-use initiation that would be achieved by raising the MLA for tobacco products to either 19 years old, 21 years old, or 25 years, and used two tobacco-use simulation models to quantify the accompanying public health outcomes. 

	“We have made great strides in tobacco control, but cigarette smoking remains the leading cause of preventable disease and premature death in our society, and yet approximately one in five Americans still smoke cigarettes,” commented Anthony J. Alberg, a member of the 13-person committee and Blatt Ness Distinguished Endowed Chair in Oncology, Professor of Public Health Sciences, and Interim Director of the Hollings Cancer Center at the Medical University of South Carolina.  “This report assesses an important policy option, coming to the conclusion that raising the minimum age for purchase of tobacco products will help to prevent youths from starting to smoke cigarettes.” 

	Raising the MLA to tobacco products to 21 likely will have a substantially greater impact on reducing the initiation of tobacco use — defined as having smoked 100 cigarettes – than raising it to 19.  However, the added effect of raising the minimum age beyond age 21 to age 25 would probably be considerably smaller, the report says.

	Underage users rely primarily on social sources — friends and relatives – to get tobacco, and there is little evidence that these individuals are obtaining tobacco from the illegal commercial market.  Between ages 15 and 17, mobility increases with driving privileges, and social networks and potential sources of tobacco start to increase as some adolescents take on part-time jobs with co-workers who may be over the MLA.  Therefore, increasing the MLA to 19 may not change social sources substantially for this age group, but raising the MLA to 21 is likely to have a considerable impact on initiation. 

	Over the past 50 years, tobacco control efforts in the U.S. have led to an estimated 8 million fewer premature deaths. However, tobacco use continues to significantly affect public health, and more than 40 million Americans still smoke.  Although the Family Smoking Prevention and Tobacco Control Act of 2009 granted the U.S. Food and Drug Administration broad authorities over tobacco products, it prohibited FDA from establishing a nationwide MLA for tobacco products above 18 years of age.  In response to congressional direction, FDA asked the IOM to assess the potential public health implications of raising the MLA without making a recommendation about whether the MLA should be raised. The committee conducted its analysis within the context of existing youth access laws and enforcement policies across the U.S., which vary considerably.  Although most states currently set the MLA at 18, four states (Alabama, Alaska, New Jersey, and Utah) set it at 19, and New York City and several other localities around the country have raised it to 21.

	“While the development of some cognitive abilities is achieved by age 16, the parts of the brain most responsible for decision making, impulse control, and peer susceptibility and conformity continue to develop until about age 25,” said committee chair Richard J. Bonnie, Harrison Foundation Professor of Medicine and Law and director of the Institute of Law, Psychiatry, and Public Policy at the University of Virginia in Charlottesville.  “A balance needs to be struck between the personal interests of young adults in being allowed to make their own choices and society’s legitimate concerns about protecting the public health and discouraging young people from making decisions they may later regret, due to their vulnerability to nicotine addiction and immaturity of judgment.  These concerns support an underage access restriction, but they do not resolve the policy question about the specific age at which the line should be drawn.”

	The committee emphasized that policy decisions about the MLA should consider other factors in addition to projected health outcomes. One of those factors is the relative maturity of adolescents and young adults.  

	Of the people who have ever smoked daily, 90 percent first tried a cigarette before 19 years of age, and nearly all others tried their first cigarette before the age of 26.  This strongly suggests that if someone is not a regular tobacco user by age 25, it is highly unlikely he or she will become one. 

	If the MLA were raised now, the report says that in 2100, there would be approximately a 3 percent decrease in smoking prevalence for an MLA of 19, a 12 percent decrease for an MLA of 21, and a 16 percent decrease for an MLA of 25.

	Cigarette smoking is causally associated with a broad spectrum of adverse health effects, such as diabetes, impaired lung function, coronary heart disease, and numerous cancers, which cause suffering, diminished quality of life, and premature death.  Given the likelihood that raising the MLA would decrease the rates of initiation of tobacco use, tobacco-related disease and death consequently also would decrease.  For example, the report says that if the MLA were raised now to age 21 nationwide, for the cohort of people born between 2000 and 2019, there would be approximately 249,000 fewer premature deaths, 45,000 fewer deaths from lung cancer, and 4.2 million fewer years of life lost.

	Although reductions in smoking-related deaths following an increased MLA will not be observed for at least 30 years, some direct health benefits, including those from reduced exposures to secondhand smoke, will be immediate.  An increase in the MLA for tobacco products likely will improve maternal, fetal, and infant outcomes by reducing the likelihood of maternal and paternal smoking.  Specifically, if the MLA were raised now to age 21 nationwide, the models project that by 2100 there would be approximately 286,000 fewer pre-term births, 438,000 fewer cases of low birth weight, and roughly 4,000 fewer sudden infant death cases among mothers age 15 to 49.

	The committee noted that the recent increase in use of hookahs and electronic nicotine delivery systems, such as e-cigarettes, by adolescents and young adults could have a substantial effect on the use of cigarettes and other tobacco products, but it is too early to make informed predictions about these effects. 

	“By assessing the public health implications of raising the minimum age for accessing tobacco products, this report aims to provide the scientific guidance that states and localities need when evaluating new policies to achieve the ultimate goal — the reduction and eventual elimination of tobacco use by children and youth,” said Victor Dzau, president of the Institute of Medicine.

	The study was sponsored by the U.S. Food and Drug Administration.  Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public.  The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.  A committee roster follows. 

	Alberg commented, “It was an honor to participate in the important work of this committee, particularly knowing the severe toll that cigarette smoking takes on the health of South Carolinians.  Hopefully this report will stimulate discussions and action to raise the minimum legal age for purchase of tobacco products nationally and here in South Carolina.  The health of our younger generation makes the stakes too high to ignore this valuable policy option.”

Increasing the minimum age of legal access (MLA) to tobacco products will prevent or delay initiation of tobacco use by adolescents and young adults, particularly those ages 15 to 17, and improve the health of Americans across the lifespan.

Hollings Cancer Center Interim Director Anthony J. Alberg, Ph.D., Part of Institute of Medicine Committee Convened to Study Minimum Age for Tobacco Purchases

today welcomes the Medical University of South Carolina’s Hollings Cancer Center as a partner in promoting the latest advances in cancer research, treatment and care through OncLive’s Strategic Alliance Partnership program.

In the new partnership, OncLive’s editorial and marketing teams will publicize important cancer-related news from Hollings Cancer Center, the largest academic cancer center in South Carolina. With over 200 experts in treatment, research, education, prevention and outreach, Hollings Cancer Center is leading the way in improving cancer care.

Hollings Cancer Center is the only cancer center in South Carolina that has earned National Cancer Institute designation, recognition of the center’s exemplary science and capacity to combine a variety of research approaches to attack the cancer problem.

Mike J. Hennessy Jr., senior vice president, oncology & specialty pharmacy, which includes OncLive,said, “We are pleased to partner with Hollings Cancer Center to spread the word about new developments in cancer research and care, from the Center’s approach to patient care to its research approaches that look at cancer from every angle. OncLive believes that sharing these stories will inspire the work of others.”

Anthony J. Alberg, Ph.D., interim director of Hollings Cancer Center, said, “We are devoted to decreasing South Carolina’s cancer burden by providing the most advanced cancer care to our current patients while investigating promising routes to better treatments in the future, with research that stretches from the laboratory to the clinic and to the community. We are pleased to partner with OncLive to share information that could make a difference for patients and healthcare providers well beyond our state’s borders.”

Hollings Cancer Center joins more than 30 other leading cancer centers, nursing schools and physician groups around the country in partnering with OncLive.

Hennessy added, “The Strategic Alliance Partnership program serves everyone committed to fighting cancer. When we work together and share our knowledge broadly, we are better armed to improve our efforts to overcome this devastating disease.”

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Hollings Cancer Center at the Medical University of South Carolina is a National Cancer Institute-designated cancer center and the largest academic-based cancer program in South Carolina. In addition to the full range of clinical services, the cancer center has more than $43 million in cancer research funding and more than 200 clinical trials open to patients. Hollings offers state-of-the-art diagnostic capabilities, therapies and surgical techniques with multidisciplinary clinics that include surgeons, medical oncologists, radiation therapists, radiologists, pathologists, psychologists and other specialists equipped to the full range of cancer care. For more information, please visit 

OncLive today welcomes the Medical University of South Carolina's Hollings Cancer Center as a partner in promoting the latest advances in cancer research, treatment and care through OncLive's Strategic Alliance Partnership program.