THE DASHING MALCOLM PIKE

Malcolm Pike runs with a pack of researchers who are leading the way in reducing the risk of breast cancer in women. 

By Alfred Kildow

To catch up with Malcolm Pike, you have to run. That's because Pike is a man in a hurry, a man to whom the term "dashes" can be appropriately applied-if you can catch him.

Pike, who holds the Flora L. Thornton Chair in Preventive Medicine at the USC School of Medicine, is on a career-long mission to stop breast cancer. And it's no wonder. Breast cancer kills nearly 50,000 American women a year.

According to the National Cancer Institute, breast cancer diagnoses had been increasing at a rate of about two percent per year during the 1970s and '80s; recently, however, the rate reached a plateau. The survival rate for breast cancer is improving: 75 percent of women diagnosed this year will be alive five years from now; for those with localized breast cancer, the five-year survival rate has reached 93 percent.

These numbers hold the promises that keep Pike on the run. "Survival rates are getting better," he said. "But we have to do much better-and we can."

Pike literally darts from office to lab to conference room in his new quarters in the Topping Tower at the USC/Norris Comprehensive Cancer Center.

He also heads the Department of Preventive Medicine. As such, he is the point man for a complex team of scientists and physician-scientists who are attacking the breast cancer problem from a number of perspectives. Recently, Pike was honored with the USC Associates Award for Creativity in Research and Scholarship. At the 15th annual Academic Honors Convocation, at which he received the award, Pike was also the keynote speaker. He observed that he was especially touched by his award:

"Whatever other honors and recognition one may receive, it is particularly gratifying to be recognized by one's own institution," because the award comes "from one's closest colleagues. . . ."

Noting that he began his university education at the University of Witwatersrand in Johannesburg, South Africa, "at the height of the insanity of apartheid," Pike said that his university "was intolerant of racism on its campus. This taught me that standing up for one's beliefs was the only honorable way to behave, and that this was central to the highest standards of academia."

Pike told the convocation: "I am extremely fortunate to have had a university education. To get into a first-class university you need application to your studies, a fairly high IQ, and it helps a great deal to have a supportive family. Only the first, application to your studies, is of one's own making. . . . (The others) can only be regarded as the kindness of fate. A number of my undergraduate teachers made me aware of my good fortune in this regard. It was one of the most valuable lessons I ever learned. Keeping oneself aware of one's good fortune will generally make one much more generous to others, and ameliorate the worst excesses of self-indulgence. . . .

"Academia should be all of this-teaching, research, scholarship, integrity, tolerance of dissent, generosity of spirit and reverence for the glory of the Open Society. This is what we celebrate here today."

Pike noted that he was honored specifically for his work on the prevention of breast cancer, and described the pursuit that he and his colleagues have undertaken to find solutions to the disturbingly high rates of breast cancer in the United States and other developed countries.

"We have made a number of notable contributions to this endeavor, and now have a fundamental understanding of the reason for the high rates and how these rates may be significantly reduced," Pike explained.

Pike joined three pioneering scientists at the National Cancer Institute's Special Virus Cancer Program at USC in 1973: Murray Gardner, Robert MacAllister and Brian Henderson. He describes them as scientists "enthralled by what they were doing, and Henderson had the boldness to decide that USC could, starting essentially from scratch, rapidly rise to the first rank of epidemiological research programs by basing the research on a firm biological foundation-quite novel at the time."

Trained in mathematics in South Africa, and at Cambridge and Aberdeen Universities, Pike brought high-order mathematical modeling and statistical skills to the medical epidemiology and biology skills of Henderson, Ronald K. Ross and Thomas H. Mack. They meshed with the endocrinological expertise of Rogerio A. Lobo and Frank Z. Stanczyk in the Department of Obstetrics and Gynecology, and, more recently, with Darcy Spicer and John R. Daniels in the Department of Medicine.

What they confronted were some intellectually stimulating puzzles:

Asian women in Asia had low rates of breast cancer in their homelands, yet had rates approaching that of other Americans if they were born and lived here.

Animal studies had show that ovarian hormones-especially estrogens-could induce breast cancer. Did ovarian hormones differ between Asian and American women?

Gradually, over the 1970s and early 1980s, the USC researchers and others determined that increased levels of natural and synthetic ovarian hormones as well as synthetic ones from birth control pills led to higher breast cancer rates. The pivotal paper, published by Henderson, Ross, John T. Casagrande and Pike in 1982, conclusively demonstrated for the first time that the suspect hormones increased normal cell division in breast tissues and it was the increased cell division that led to cancer, merely because of the increased possibility of error as the cells repeatedly divided.

Realizing that there were many clues in the lifestyles of Asian women, Pike and his colleagues, joined by Anna H. Wu and Mimi Yu, looked at the effects of diet on ovarian function; Leslie Bernstein, Ross and Henderson found that modest amounts of exercise markedly reduced ovarian hormone function in teenage women, and then directly demonstrated that exercise reduced breast cancer risk.

The Asian women living in Asia differed from Asian-Americans on two scores: diet and exercise. Asians in Asia ate leaner foods and worked harder at physical tasks than their American counterparts. Both practices led to reduced ovarian activity and thus lowered the risk of cancer.

Meantime, Pike and Spicer focused on an improved hormonal contraceptive. They were driven by findings-some of them their own-that The Pill profoundly reduced risk of both endometrial and ovarian cancer-as much as by half after six years of use, a reduction in risk that persisted after use of The Pill stopped. The Pill did not reduce breast cancer, but that possibility intrigued the two. Spicer designed studies and found expert nursing assistance no further away than Pike's wife, Anne. They scuffled for funding and found a large measure of it from a USC Innovative Research Award and local Los Angeles charities.

The pursuit of a hormonal contraceptive cum breast cancer preventative was joined by Daniels and the chair of the Department of Obstetrics and Gynecology, Daniel R. Mishell, Jr.

"This is a team effort," Pike says repeatedly. "The team deserves any credit that is due. We have every reason to be confident that this work-and the work on diet and exercise-will be able in the foreseeable future to provide women with solid practical advice on how breast cancer risk can be significantly reduced.

"This is not a fantasy. USC faculty will have played a central role in bringing it about."