Breaking New Ground
Just before his fourth-year clinical rotations one day, medical student Geoffrey Yang took a quick minute to check his email. Sitting in his inbox was a note from one of his professors. In this digital age, Yang regularly receives messages from faculty members. This one, however, stood out. It was a forward from his research mentor, Jeremy Bordeaux, MD, sharing the news that their paper on risk assessment of cutaneous melanoma after a previous cancer was accepted for publication in the December 2011 issue of Archives of Dermatology.
And with that, Yang—the research lead and first author of the paper—joined the ranks of a growing number of colleagues who have successfully conducted and published important research while still medical students.
Yang’s cutaneous melanoma research had rolled out of the curriculum requirement at the School of Medicine, which gives every student the opportunity to complete a four-month research block and write a thesis. The research focus is even more pronounced in the Medical Scientist Training Program, where students spend even more time on research.
“This gives them authentic experience in how to come up with their own research question, how to come up with a method to investigate it, and how to communicate that in a standard way to get published,” says Todd Fennimore, director of the school’s Office of Medical Student Research.
Like Yang, many students end up getting their research published—about 40 percent, estimates Fennimore. The students frequently get to serve as second or third authors on a research study. Yang’s experience was especially unique, however, because he served as the project lead and first author. “It’s one thing to take on a project that’s being worked on by a post-doc or resident,” he says, “but it’s a whole other experience if it’s your own project and you have a lot invested in it.”
Onward and Upward
Yang caught the research bug when he began looking for avenues to help beef up his research competency. “During my time as an undergraduate, I didn’t have much research experience, so going into medical school I felt a bit lost at times when it came time to discuss different research methodologies and papers,” he says. “So by the second year of medical school, I knew that I wanted to take a year off to do some full-time research.”
Yang approached his society dean, Elizabeth McKinley, MD, about the idea, and she recommended intensive research programs like the Howard Hughes Medical Institute Research Scholars Program through the NIH, where students work with a researcher on the NIH campus in Bethesda, Md.
“The school was very supportive of my choice to take a year off,” says Yang. “And I think it’s becoming much more common now for medical students to do that.”
Yang applied and was accepted to the NIH program, and ended up working on a study that looked at different prognostic markers of esophageal squamous cell carcinoma and colon cancer using microRNAs. The team he was working with discovered that a group of five microRNAs could help predict survival in patients with esophageal squamous cell carcinoma, independent of TNM staging, and also that microRNA-145 acts as a tumor suppressor.
Once Yang returned to the School of Medicine, he was due to complete his four months of research as part of the curriculum. After having spent a year focused on basic-science research, Yang was interested in broadening his spectrum with some epidemiological research. He decided to focus on cutaneous melanoma.
“It’s pretty well known that melanoma survivors have an increased risk of developing certain cancers,” he explains. “What was not known at the time we were thinking about a study design was what are the risks of melanoma development following a previous cancer.”
Yang delved into the Surveillance, Epidemiology and End Results (SEER) database of cancer patients maintained by the National Cancer Institute. He and his team looked at the data and collaborated with a biostatistician at Case Western Reserve.
The study compared 70,819 patients with cutaneous melanoma as a first cancer and 6,353 patients with cutaneous melanoma who had a previous cancer, and then compared the survival characteristics of the two groups and calculated the relative risk of cutaneous melanoma in people who had already had a cancer.
The results? Yang and his collaborators found that patients who were under 45 when they were first diagnosed with cancer had a higher risk of cutaneous melanoma after previous cutaneous melanoma or other non-epithelial skin cancers, Kaposi sarcoma, female breast cancer or lymphoma. For patients over 45 when they developed a first cancer, the risk of cutaneous melanoma was elevated after a previous diagnosis of cutaneous melanoma or other non-epithelial skin cancer, ocular melanoma, female breast cancer, prostate cancer, thyroid cancer, lymphoma or leukemia. This risk for cutaneous melanoma was highest in patients who had already developed a breast cancer; this was particularly apparent in patients under the age of 45.
Yang credits the faculty and research opportunities at the university for his successful research and publishing experience. “I think Case Western Reserve was excellent in providing me with the time and the mentorship to pursue this research project,” he says. “The fact that the School of Medicine gave us a few months of time to just do research was amazing, because at many other institutions you may not have the opportunity.”