Dr. Michael Jones (Guest): Historically, excess tissue has been disposed of as a biomedical waste. In the past, any tissue that was left over after appropriate material was taken for diagnostic studies was just disposed of as medical waste.
Melanie: Then what happens now? What’s the difference with what happens now and why would patients even want this procedure?
Dr. Jones: Now, we live in an era of genomics and proteomics and a high level of technology that allows us to take leftover tissue and understand what’s going on in the cancer from a molecular standpoint, the genetic standpoint. In the past, we weren’t able to do that. Now that we have advanced technology that can, in a way, dissect out the genome and dissect out the proteins that are involved in a cancer, and because we also now have drugs to fight the cancer that are directed specifically at some of those genetic and protein events, we have found out that that tissue that we used to discard is actually very valuable for molecular research. So nowadays, in many academic institutions, including Maine Medical Center, we have a program in which patients can consent to donate, if you will, that leftover cancer tissue that used to be disposed of to research. That research can be quite varied, of course, but that research is critical in advancing the fight against cancer in the sense that it helps us understand much better what exactly is going on in those cancer cells.
Melanie: Dr. Jones, how do you go about asking a patient if they want to donate that extra if you’re going to be taking out a tumor from them? Are they worried about privacy and that now their cancerous tumor is sitting in some refrigerator somewhere with their name on it. How does that work?
Dr. Jones: We approach all of the patients pre-operatively. We approach them either at the preadmission unit when they’re getting their work done before they come in for their surgery date, or we know that the patient is coming in from farther away and we send them information on our tissue banking program. We follow up with a phone call and then when they come in the day of the surgery, we get consent from them. As far as the rules and regulations go, the Federal government and IRBs, in general, have gotten much more sophisticated and developed a lot more rules to deal with things such as privacy than there used to be in the old days. By old days, I mean in the ‘50s and ‘60s and ‘70s when a lot of these wasn’t going on. The information about the patient, their pathology report is de-identified, stripped of any data that might allow identification of the patient and given a research code, so that when that piece of tissue goes to the research, the researcher really has no way of knowing who that came from or where it came from, for that matter.
Melanie: After you’ve collected these tissue samples, what is the storing process and the associated data with it? Are there methodological, ethical, legal, and technical problems with storage? How do you store this tissue for use by any of the researchers involved?
Dr. Jones: That’s a good question. There are three main ways in which we store the tissue. The tissue may be used fresh. By that, I mean it’s not placed in any kind of preservative or fixative, we would say, in the pathology laboratory because sometimes we want to look at issues or molecular items in a particular cell that we don’t want to preserve it with any fixatives. There’s fresh tissue sometimes. Then there’s tissue that we flash freeze, so we freeze it very quickly. That allows preservation of many molecules that we might want to understand or then the researcher might want to understand later on. Finally, the third way, is that we place the tissue in a preservative and we create what is called a block of tissue which is a little wax block with tissue in it. Very commonly for cancers, we have the tissue preserved in multiple forms. Each different form might be for a different type of research or allow the investigation of different types of molecules, depending upon what the investigator is interested in. For instance, DNA is a very hardy molecule and will withstand all kinds of preservatives and still yield lots of important information. RNA, which is the expression of the DNA, is much more labile. So it just depends on what the particular researcher or investigator is interested in looking at.
Melanie: Does the patient benefit at all from the research done on their tissue?
Dr. Jones: The patient doesn’t benefit individually. Ninety-nine percent of scientific discovery, of course, is based on lots and lots of data and lots and lots of sample. It’s a general scientific truth that any one sample is not so unique that one can discover a new drug based, for instance, on one particular sample. It takes thousands of samples and repeated experiments, of course, to validate discovery in science. That’s an important thing for people to understand. Although the individual tumor contribution is important, it’s almost always the case that the discovery off of any one sample is not enough. It’s usually a huge pool of samples. For instance, we may have to look at 300 or 400 colon cancers to understand whether what we’re seeing is actually real. In general, what the patients get is, in essence, that they’re really contributing in an important way to the advancement of science and the fight against cancer. Because nowadays, the real Holy Grail, if you will, of cancer treatment is to develop therapies that are specifically directed at these genetic events that are going on in these cells. In the years past, we had no way to understand, but we do now. But there’s no individual benefit per se.
Melanie: Do you need to collect any general, broad health information from their health records such as ethnicity or whether they were a smoker for these tissue samples to be donated?
Dr. Jones: No. We don’t have to do that. If the patient was being approached for a particular study in which that information was needed, they would know that up front. Typically, all that is really known about the tumor to the researcher is actually the pathologic features of the tumor, nothing about the patient per se. In every tumor sample, when we look at it pathologically, we’re rating it, we’re doing a lot of things, but those don’t relate to the individual patient per se. If a particular researcher wanted to look at, for instance, outcome and how a patient did, then the patient would have to give permission, of course, for their course to be followed. That would be in a different type of study than just generic tissue banking.
Melanie: Is there any cost to tissue banking?
Dr. Jones: Yes, there is. There is the cost of the technologies and there are certain consumable supplies, of course, that are not really expensive. The big cost is really the labor involved. We have research technologists who are handling the tissue, who are freezing the samples, who are doing all the work, and that’s the major cost really. It’s just the labor. Then there’s a little bit of capital cost, freezers to freeze the tissue, etcetera. Typically, the cost is covered out of investigator’s research grants. Many researchers who are proposing a particular study that requires a certain, say, 200 colon cancer samples, when they write that grant, they’re writing into the grant the cost of acquiring that tissue from somebody like us, so that’s generally where the money comes from to defray the cost of the collection of tissue.
Melanie: But no cost to the patient donating the tissue?
Dr. Jones: No, not at all. No, there’s no cost. Again, in the past, the tissue would just be thrown out. I suppose if the patient wanted their tissue back, we would give it back to them, but that’s exceedingly rare that anybody wants that.
Melanie: Dr. Jones, in just the last minute, if you would, give patients listening your best advice about considering donating that extra tissue from a tumor and why they should do that at Maine Medical Center.
Dr. Jones: I think that nowadays the advancement of research, particularly as it relates to developing new drugs to fight cancer really, truly depends on the tissue being donated. If investigators didn’t have access to the real cancer samples, it would just bring cancer research or probably the single biggest area of cancer research to a halt. Since it’s no big deal for the patients, I think a lot of patients don’t even think about what happens to their tumor after it’s removed. Nowadays, scientific discovery really depends on access to those samples, and so I would strongly encourage anybody who is approached to allow us to preserve their cancer samples in a way that researchers both at Maine Medical Center and other academic institutions can use it for discovery.
Melanie: Thank you so much. That’s really great information. You’re listening to MMC Radio. For more information, you can go to mainemedicalcenter.org. That’s mainemedicalcenter.org, mmc.org. This is Melanie Cole. Thanks so much for listening and have a great day.