An Inquisitive Mind: Endocrinologist Frederick Singer brings an impressive skill set to the Institute where he has worked since 1991

July 10, 2015

One of the nuggets of advice Frederick R. Singer, MD, likes to shares with young physicians and researchers was something he learned from his own mentor, John Thomas Potts, Jr., MD, when he was a young endocrinology trainee at Massachusetts General Hospital in the 1970s. Dr. Potts encouraged his students to identify medical research projects that fascinated them and learn everything they could from the top experts in the field.

“Young investigators need to determine what they might be interested in, in terms of medical research, and find a mentor—someone to start with who teaches them,” says Dr. Singer, now the director of the endocrine/bone disease program at the John Wayne Cancer Institute. “I was very fortunate to have that experience. Even after decades of work, keeping active is important to me. I’m still inspired by work.”

And active he is, collaborating with numerous colleagues inside and outside the Institute on diverse research projects that center on endocrinology, cancer and bone health.

Dr. Singer is the only endocrinologist on staff and is a national expert on the impact of cancer and cancer treatments on bone health. He has served on numerous medical society, industry and government committees and in 1991 was president of the American Society for Bone and Mineral Research.

“Even after decades of work, keeping active is important to me. I’m still inspired by work.” – Dr. Frederick Singer

He has become an advocate for improved oversight of bone health for cancer patients. Some types of cancer therapies can weaken bone and lead to the bone-thinning disease osteoporosis.

“In the last 20 years, I’ve seen many more breast cancer survivors, which is good. But one of the side effects of treatment is the development of osteoporosis,” he explains. “They can’t take estrogen (which helps prevent bone loss). They also get chemotherapy, which can weaken bones, or they receive hormone therapy, and that treatment lowers estrogen to nothing. So bone loss is a significant concern.”

Bone damage during cancer treatment is “completely preventable,” Dr. Singer notes. But oncologists or the patients’ primary care doctors must recognize the risk and prescribe protective medications. Dr. Singer hopes to work with oncologists to develop such protocols throughout the Providence Health & Services network of hospitals and clinics.

Some men treated for prostate cancer are also at risk for bone loss, he adds. “Some prostate cancer patients, before or after surgery or radiation, are given a drug that wipes out testosterone,” says Dr. Singer. He estimates that more than half of elderly men with prostate cancer are not treated for ongoing bone loss.

VITAMIN D DEFICIENCY

Another area where endocrinology may intersect with cancer is in vitamin D deficiency. Dr. Singer is studying the link between melanoma skin cancer and low levels of vitamin D, a nutrient that’s produced by exposure to sunlight.

In work that began years ago with Institute co-founder Donald L. Morton, MD, Dr. Singer has found evidence that vitamin D deficiency is associated with lower survival rates in melanoma patients. That’s an ironic finding, given that a single bad sun-burn increases the risk of developing melanoma.

Blood samples from 300 patients that were stored in the Institute’s specimen repository were used to measure vitamin D levels and were found to predict survival of melanoma patients. Simon Lavotshkin, MD, a surgical oncology fellow, presented the study results in March at the annual meeting of the Society of Surgical Oncology.

PAGET’S DISEASE RESEARCH

Dr. Singer is also an authority on Paget’s disease, a disorder that causes bones to become abnormal and even deformed. The disorder usually develops in people over age 50. He has treated almost 1,000 patients with the disease and co-chaired a panel that released guidelines for treatment. The paper appeared in December in the Journal of Clinical Endocrinology and Metabolism.

The cause of Paget’s disease is controversial, but Dr. Singer’s research has long pointed to viruses as possible causes. “It’s still controversial, but the evidence is very strong that the measles virus is involved,” he says. “There is also evidence that genetic factors can produce susceptibility to develop the disease.”

He believes a recent decline in Paget’s disease diagnosis may be explained by use of the measles vaccine beginning in 1963.

LOOKING AHEAD

With so many projects underway, Dr. Singer doesn’t entertain thoughts of retirement. He plays tennis in his free time and loves the theater and concerts. One of the best parts of his job, he says, is the ability to travel to faraway destinations to attend medical conferences.

“I’ve met wonderful people and have friends in different places in the world,” he says. “You end up feeling like the work you do results in better care—and that’s a nice feeling.”

For more information about supporting hyperparathyroid research programs, please call Michael Avila at 310-829-8351 or michael.avila@stjohns.org.

Research on Parathyroid Tumors

shutterstock_186874151_720x575_72_RGBDr. Singer’s latest research project will require the support of donors, and it’s a project well worth pursuing, he says. Over the years he developed expertise in parathyroid conditions. The parathyroid consists of four tiny glands adjacent to the thyroid gland in the neck. They produce parathyroid hormone, which controls calcium, phosphorus and vitamin D levels in the bone and blood.

Some people, women in particular, can develop a parathyroid tumor in one or more of the glands. But doctors often struggle to identify which of the four glands is affected. Imaging tests, such as ultrasound, may not show the tumor.

Dr. Singer, in collaboration with Melanie Goldfarb, MD, assistant professor of surgery at the Institute and director of the new Thyroid Nodule Clinic, is studying ways to improve the detection of abnormal parathyroid glands to better guide surgeons. Dr. Singer is also collaborating with Dave S.B. Hoon, PhD, professor and director of molecular oncology, chief of scientific intelligence and director of the genomics sequencing center at the Institute. Dr. Hoon’s lab possesses gene sequencing technology that may help identify proteins indicating whether a tumor is in a single gland or all four of the glands.

“There may be a more certain way to determine how many parathyroid glands are abnormal, something that will help the surgeon know what to expect,” Dr. Singer says. “It’s definitely worth trying to make the surgery more successful and easier on the patient.”

Tips
If you’re being treated for cancer, ask your physician about ways to protect your bone health. Here are some tips from Dr. Singer:

  • After radiation treatment, make sure your doctor orders a bone density scan to assess your bone health.
  • If a scan shows evidence of weakening structure, medications to strengthen bones should begin at the same time as chemotherapy.
  • Women with breast cancer and men with prostate cancer may be given medications that can weaken bones. Ask your doctor if you’re susceptible.