University of Virginia physician Dr. Richard Santen has research, and then he has his passion project.
For much of his career, Santen has been a highly respected endocrinologist who in 2014 and 2015 served as president of the Endocrine Society. He made groundbreaking discoveries that helped people who had had breast cancer navigate therapies which prevent estrogen from acting on the cancer.
For the past several years, though, he has turned his attention to a challenge that is simpler, medically speaking, but also difficult to navigate: getting appropriate treatment to people with diabetes who live in underserved — often low-income and rural — areas.
There is a shortage of about 1,500 adult and 100 pediatric full-time endocrinologists nationwide, according to a recent workforce analysis report by the Endocrine Society; meanwhile, the number of children and adults diagnosed with diabetes and other hormone conditions is increasing.
So, Santen, in the midst of his regular work, calls colleagues and recruits them to join a telehealth initiative. Through the phone, and with assistance from a nurse, he can train a patient to check their own blood sugar and monitor results. In four years, he has helped about 100 patients through the six-month rotation, he said.
“We ought to reboot retired physicians and allow them to use telehealth to give back,” he said.
In March, Santen will be honored with the Fred Conrad Koch Lifetime Achievement Award by the Endocrine Society.
His research has uncovered the role of hormones in promoting breast cancer and pioneered the development of aromatase inhibitors, which are now the standard of care treatment. Due in part to his research, physicians have learned how to safely give doses of medication that blocks estrogen to post-menopausal women who have had or are at risk of developing breast cancer.
Estrogen stimulates breast growth in young women but, especially as women age, it can also encourage the growth of breast cancers.
Before menopause, estrogen is produced by a woman’s ovaries. After menopause, the adrenal gland converts androgen into estrogen.
Researchers tried to stop the growth of breast cancer with two hormonal therapies: one blocked estrogen’s ability to act. The other blocked the production of enzyme that converts androgen into estrogen, meaning that estrogen doesn’t travel to breast cells and encourage cancerous growth.
“If you block the aromatase enzyme you block the production,” he said.
Huge collaborative studies established aromatase inhibitors as highly effective treatments of breast cancer and for use in reproductive disorders.
In 2010, the field had made such strides that Santen was asked to write a statement about everything then known about progesterone and estrogen. Many doctors and women had been told confusing and contradictory things about hormone therapy and potential side effects.
“It was an attempt to try to cut through the noise.”
Methods pioneered by Santen to effectively use hormones to treat breast cancer and manage menopause symptoms are now seen as standards of care.
Physicians’ understanding of how hormones interact with cancerous cells has grown by leaps and bounds, Santen said. It has been neat, he said, to watch the research develop and to see the distance traveled.
“The first generation Model T got followed up by the Cadillac and the Porsche,” he said.
Santen and his colleagues discovered, though, that aromatase inhibitors are only effective from about 6 months to 10 years; eventually, the body develops a resistance.
Santen is now working on a therapy called tissue selective estrogen complex, which is a pill that contains both estrogen and a designer estrogen. It helps address menopausal symptoms but doesn’t affect breast development, and, according to preliminary trials, may prevent breast cancer.
“It’s really the first effective treatment for postmenopausal women,” he said.
Santen will receive his award at the society’s annual meeting in March.