Dan and Cecilia Carmichael

Florida couple helps Mayo Clinic find answers based on your genome

By Mayo Clinic Staff

Soon after Dan and Cecilia Carmichael moved to Florida five years ago, Dan scheduled an appointment for a physical at Mayo Clinic. He suggested Cecilia come in for one, too. But she said she felt fine and already had an OB/GYN exam scheduled for later that year. She was vigilant about annual mammograms. As her husband of 47 years, Dan asked her to humor him.

The exam revealed a lump in her breast. It was malignant.

"When you get a diagnosis of cancer, it hits you really hard," Cecilia says. "It's a scary thing because that's when death hits you in the face."

The staff helped Cecilia and Dan through her treatment, every step of the way. Dan says that's when they began to see "Mayo operate at its best."

"The doctors are always the ones that get a lot of credit, but it's the staff that also makes a difference," Cecilia says. "All of them — they hold your hand all the way through it. When you smile at someone and go that extra little step when someone's sick, it really, really makes a difference, and that's what I got throughout my breast cancer treatment."

Thinking of children and grandchildren

"I think when someone is diagnosed with cancer, you go through various stages of denial, anger, frustration," Cecilia says. "And for me, I started doing a lot of research — everyone I could talk to, every physician I knew, every physician friends knew, every Internet website."

Cecilia found that each cancer is different. One woman can live with stage IV cancer for many years, yet another with stage I doesn't survive.

"That's what started our feeling that there's got to be something to determine what makes a difference," she says. Soon the Carmichaels discovered Mayo Clinic was already finding these answers through the breast cancer genomic work of Edith A. Perez, M.D., the deputy director at large of Mayo Clinic Cancer Center and director of both the Breast Cancer Translational Genomics Program and the Breast Program at Mayo Clinic in Florida. Dr. Perez also is the Serene M. and Frances C. Durling Professor of Medicine. Dr. Perez was evaluating how specific genetic markers indicated a cancer's development and aggressiveness — why a cancer kills one person and not another.

She had just gained international recognition overseeing multisite trials of the anti-tumor drug trastuzumab (Herceptin), which established the benefit of an antibody that targeted cancer cells. It led to a breakthrough in care for thousands of women.

In about one-fifth of breast cancers, a gene mutation causes overproduction of the HER2 protein, which encourages the cancer to grow. For these women, the new Herceptin therapy reduced recurrence by 50 percent and increased the cure rate by more than one-third.

The Carmichaels knew that even better genetic information could help millions more women, possibly even those they loved.

"When you have breast cancer, you start thinking about your children and grandchildren," Cecilia says.

The same year Cecilia began her cancer fight, the Carmichaels accelerated Dr. Perez's work by establishing the Mayo Clinic Carmichael Family Endowed Fund for Individualized Breast Cancer Medicine.

A deeper commitment

As the Carmichaels became more engaged with Mayo Clinic, eventually joining the Florida Leadership Council and becoming co-chairs this year, they learned more about Mayo Clinic's genetic work. They were inspired by the formation of the Center for Individualized Medicine, which harnesses Mayo's collective expertise to find answers based on a person's genetic makeup.

"The exciting thing now is they can take the cancer cells and test them with different chemotherapies," Cecilia says. "So if our daughter or granddaughters were to get cancer, hopefully it could be cured immediately and there would not be this thing hanging over them that it could come back. Because with breast cancer, at any time it can come back."

Individualized medicine also uses genomic testing and other technologies to provide insight for patients with serious medical conditions who have not been able to be diagnosed elsewhere or who have undergone treatment that has not been effective for their illness.

"We are leveraging innovative genomic technologies so our physicians can understand a patient's disease at its most fundamental level and use that information to find answers specific to that patient's needs," says Alexander S. Parker, Ph.D., associate director of the Center for Individualized Medicine at Mayo Clinic in Florida.

To accelerate such work, the Carmichaels made a leadership gift to establish the Cecilia and Dan Carmichael Family Associate Director for the Center of Individualized Medicine in Florida and to establish the Cecilia and Dan Carmichael Family Fund for Individualized Breast Cancer Medicine Honoring Edith Perez, M.D.

"We are just very lucky," Cecilia adds. "Whether you give $10 or $10,000, it's really important to further the research. Without people wanting to pay back, there will be no research."

As a former insurance executive, Dan sees both the human and financial impact of individualized medicine.

"Talking about revolutionizing medical treatment and lowering the cost, the way to lower the cost is to cure the illnesses," Dan says. "We're on the verge of that, not just with breast cancer and cancer overall, but with a number of diseases. It's really an exciting time, and we can't take it with us, so we'd much rather have the staff that we've gotten to know and love at Mayo Clinic take it and do something with it that will be helpful to our next generations, as well as other people who need it."