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I n his speech, the former President announced that the budget he was presenting to Congress the following Monday would include a Precision Medicine Initiative that he believed would bring America closer to curing diseases like diabetes and cancer. A year later, the Precision Medicine Institute was launched with the help of a $215 million investment from the federal government. Given this amount of federal resources being poured into precision medicine initiatives, it's important that we gain a better understanding of what promises to be the future of American medicine. Dr. Steven Brower is the Director of The Lefcourt Family Cancer Treatment Center, as well as Chief of Surgical Oncology at Englewood Hospital and Medical Center. We recently spoke with Dr. Brower about what precision medicine means for the future of cancer treatment, and how Englewood Hospital is helping shepherd this new era of medicine. "Everything used to be about treatment. You would make the diagnosis and then hopefully deliver the most appropriate surgery, radiation or chemotherapy. But it was a therapy based on a tumor type, not so much an individual patient's tumor," Dr. Brower said. Dr. Brower explained that what has changed is the foundational questions doctors ask themselves when faced with making decisions for their cancer patients. "The questions were once: what is best for all breast cancer patients? What is best for all lung cancer patients? Well today, precision medicine is just about that patient, that particular tumor, at that moment in time," Dr. Brower said. Instead of using what Dr. Brower refers to as, "a shotgun approach" to all tumors, doctors are now studying cellular and molecular characteristics and genes in order to provide customized treatment to their patients. Removing the generalizations means that doctors will only embark upon treatment that is appropriate for their patients, potentially eliminating needless surgeries, invasive tests and wasted efforts. Advancements in diagnostic technology play a major role in pushing forward the mission of precision medicine. The invention of the MRI fusion ultrasound biopsy has revolutionized the process of detecting prostate cancer and strategizing treatment. Determining whether a prostate cancer patient is high or low risk is crucially important because the treatments for prostate cancer can range anywhere from surveillance of the cancer, to surgery or radiation treatment. "In the past it was pretty much a blind biopsy. Now, this new MRI fusion ultrasound biopsy more accurately determines whether a patient has high- risk prostate cancer or low- risk. And by making this determination, physicians can better inform patients about their treatment options," Dr. Brower said. Dr. Brower and his colleagues at Englewood Hospital are at the forefront of precision medicine. "Our lab is one of the top in the country in terms of diagnosis of pathology and how we apply these new understandings of genetics and pathways," Dr. Brower said. Each week at Englewood Hospital an elite group of medical professionals gather in a kind of round-table setting. At the table sits experts in medical, surgical and radiation oncology, as well as experts in genetics, survivorship and pain management. Specialists in all of the various forms of cancer are present to discuss thoroughly the best and most precise options for new patients. "It's like the patient is getting an opinion, not from one doctor, but from 20 different people. We consider the VUE ON WELLNESS V U E N J . C O M 118

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