COVID-19 and Breast Cancer Care: What Patients Need to Know

 

woman's hands getting chemo in chair

During these uncertain times, everyone’s wondering what they should do to stay healthy and how to protect themselves from novel coronavirus COVID-19. Those diagnosed with breast and other cancers have ongoing concerns about immunity and continuing treatment, adding an extra layer of fear.

We recently spoke with BCRF’s Scientific Director Dr. Judy Garber of Dana-Farber Cancer Institute on a special edition of our podcast for her insights on living with breast cancer during this pandemic.

While the best advice for dealing with a breast cancer diagnosis and concerns around COVID-19 is to talk to your doctor, here is Dr. Garber’s guidance on some common questions. 

What should I do to protect myself from COVID-19?


Everything medical experts have recommended is what everyone—including cancer patients—should be doing. Wash your hands and avoid touching your face. Stay inside as much as possible. Try to be as hygienic as possible, wiping down surfaces and cleaning your house regularly.

RELATED: The CDC’s guide to protecting yourself

Am I more at risk of contracting COVID-19 because of my treatments? 


For breast cancer patients, chemotherapy tends not to be as toxic to the immune system (compared to chemotherapy for other kinds of cancers, like leukemia, which is generally more intense and wipes out the entire immune system). But chemotherapy can affect a patient’s ability to fight bacteria, and for that reason, they’re given injections to boost white blood cell counts.

Cancer patients whose treatment protocols involve immunotherapy have a special set of concerns. In general, immunotherapy isn’t a widespread treatment for breast cancer, but it is sometimes used for breast cancers like triple-negative. Immunotherapy can affect the lungs, potentially making patients more vulnerable to COVID-19.

Patients getting hormonal therapy may not feel completely normal during their treatments, but their immune systems are much less compromised.

The bottom line: All patients undergoing treatment should follow the CDC’s advice to limit the spread of the virus. Those undergoing chemotherapy and immunotherapy should be extra cautious and consult with their doctors about additional precautions.

What about if I successfully completed treatment? Am I immunocompromised?
 

Breast cancer survivors are not generally immunocompromised by past treatments, but they should talk to their doctors about any concerns or underlying conditions.

Should I continue to go to my treatments?


It’s fair to be concerned about leaving the house right now for treatment. Hospitals and treatment centers are aware of this and are taking extra precautions to protect patients.

Your treatment is important. Most of the time, doctors will try to keep treatments on schedule. But again, consult with your doctor about whether he or she advises any modifications.

What about mammograms and other routine screenings?


While cancer treatments need to continue for many, mammograms and other routine screenings are a different story. Some providers and hospitals are not offering certain preventative services to save their resources for COVID-19.

It may be best to put off that exam or screening until things settle down, if your doctor agrees. If you have immediate concerns about symptoms or medications, many doctors have introduced virtual visits to answer questions while practicing social distancing.

What symptoms should breast cancer patients be on the lookout for?


The most important COVID-19 symptoms to pay attention to are fever and shortness of breath. Breast cancer patients in treatment should always be on the lookout for those symptoms anyway. Call your doctor at the first sign.

What’s tricky is that we’re currently in allergy season. So, if you feel like you felt last year and you're not undergoing chemotherapy or immunotherapy, you might be inclined to wait before calling your doctor.

What guidance do you have for managing stress?


We’re all living with more stress than usual. There are several helpful online tools for everything from yoga to therapy.

Everyone has different ways of managing stress. Some might find things like listening to music comforting. Many symphonies and musical groups are giving free concerts that you can tune into if music helps you relax. People are meditating, calling friends, having Zoom dinners, and participating in all kinds of virtual activities. Finding a way to feed your inner self is critical for patients and their caretakers, too.

This is a scary, new reality for everyone, but know that your healthcare team is committed to getting you through this cancer experience. Don’t hesitate to lean on them for support, and, most importantly, know you’re not alone.

Breast Cancer Care and COVID-19: From the Frontlines with Dr. Judy Garber

 

bcrf podcast logo with the words special edition in a bubble


Breast cancer—and any cancer—can be incredibly stressful under the best of circumstances for patients, survivors, and their families. In this time of the novel coronavirus (COVID-19), concerns can feel like they’re rising exponentially. So, what do we all need to know? With tons of new information bombarding us at once, what should cancer patients and families consider? Are there practical tactics or is there tangible guidance to stay safe?

In this special episode of Investigating Breast Cancer, we talk to Dr. Judy Garber for the answers. Dr. Garber is BCRF’s scientific director and chief of the Division of Cancer Genetics and Prevention at the Dana-Farber Cancer Institute in Boston.

Subscribe to Investigating Breast Cancer here:


Read the transcript below:

Chris Riback: Let's talk first about breast cancer patients and their families. There's so much news and so many rumors as well, and obviously we're talking about folks who are under a fair amount of stress, to put it mildly, even in the best of circumstances. What are you hearing from the breast cancer community, and what are you hearing from your own patients?

Dr. Judy Garber: Well, from the community, I think people are making the same efforts as all of us to get reliable information. When people are part of large organizations, often they are sending what can seem like an overwhelming amount of information every day with updates and statistics and recommendations and requirements for the way we're to manage in this crisis.

I think for our patients, for my patients, some of them use me as the source of information and Dana-Farber, where I am, and I'm sure everywhere else people have tried to make that information accessible to patients. The CDC remains an important website. The World Health Organization [WHO]. Everyone has tried to put access to reliable information. And I really emphasize that there's so much fear that it's hard to know where to go for the real thing. So WHO has been a good place and the CDC especially.

I think people's doctors can help them to place themselves in this context, in this craziness. But because everyone feels that they know the reasons they might be especially vulnerable. And fortunately some people are just the same as the rest of the population. People who are long-term survivors of breast cancer, we hope are not compromised by their treatment long ago. People who are currently in treatment, well they do need to take special precautions when that treatment includes things like chemotherapy or immunotherapy, maybe less so when it's hormonal therapy. So doctors and nurse practitioners and PAs who are part of their care can help them.

Chris Riback: I want to ask you about the various therapies and some practical concerns, questions, and guidance that you might have. But broadly on viruses in general and maybe this one in particular, to the extent that you have insight or thoughts on this? What do you know about the virus? And more specifically maybe, what guidance would you normally give patients about how to protect from a virus? We are surrounded by viruses potentially all the time. Is this situation different in the way you think about it for patients?

Dr. Judy Garber: Well, it certainly is different. But let's say under usual circumstances most of the chemotherapy for breast cancer, for example, is not as toxic to the immune system as let's say things like treatment for leukemia, which is so intense and meant to wipe out the immune system. Most chemotherapy for our patients affects their ability to fight bacteria and for that reason, we give things, injections to try to keep their white blood cells up. They're less affecting their immune function against viruses. So we always tell people you'll be miserable if you get a cold, but that's all.

And yet you see that some viruses like herpes virus, for example, people who are ill and under stress are more likely to get an attack of shingles, which is just reactivation of their chicken pox virus.

Chris Riback: Yes.

Dr. Judy Garber: So viruses are not all the same. This Coronavirus is different because very few of us are immune to it. Even though it's part of a family of viruses we might've seen long ago, there's so little crossover that our immune systems don't seem to remember. And that seems to be part of why we're having so much trouble fighting it off. And if, on top of that, you have to have treatment that may make you overall a little less strong than you normally would be, a little more debilitated, then there is more fear that your response to that kind of stress would be more difficult.

Chris Riback: Let's follow up on what you were saying about various treatments, people who might have cancer right now, and survivors. Are cancer survivors at a greater risk than the general population? Are there special concerns for people currently being treated for cancer? You touched on this a little bit. And as well, are there certain types of cancers that are at greater risk than others?

Dr. Judy Garber: So it's a little hard to know how to group all this but let's say that for people who have cancers requiring, at the moment, immunotherapies, that those people have special challenges. Some of the side effects of those treatments can affect the lungs to begin with and we know that the lungs are the most vulnerable place for the Coronavirus and their immune systems overall are being altered. We're suppressing part and hoping that the cancer fighting part will be more potent. But I don't think we know exactly how that's going to do in relation to the virus. And people are very concerned that patients getting immunotherapies and who gets immunotherapy.

Well, they're standard of care now for things like advanced melanoma or lung cancer, bladder cancer, kidney cancer. Not so much in breast cancer, although there is some use in treating triple-negative disease. So, patients who require immunotherapy already are being specially managed and this will be part of that special management now.

I think patients getting chemotherapy also are always a little more vulnerable to other outside influences and are trying to balance treating the cancer and managing to have normal systems survive the treatment. And that is in varying degrees of intensity. And I think that's a place where it's particularly important to have your doctor advise you. But look, we're asking people who have no health conditions to try to protect themselves by staying inside and cleaning everything inside. And I think we, at the very least, would recommend that to our patients undergoing chemotherapy.

And then there are patients who have other kinds of treatment. Breast cancer patients getting hormonal therapy or prostate cancer patients getting hormonal therapy. And although those people often don't feel completely normal in their treatments, their immune systems are much less compromised. So, I think they are less vulnerable.

Now, if they have some underlying lung conditions or other medical issues that can raise their risk. And those can be things just like cardiovascular disease, which are pretty common or diabetes. This is the time to try to make sure you're not stressing that part of the body or the parts of the body that deal with them as well. And so it's not to say that everyone who has these underlying conditions, including their cancers, will therefore be the ones who get the virus or do worst with it. But certainly, we want to try to protect everyone and our cancer patients as much as everyone. We want them all to be survivors. And if they're already in the fray, this may be much harder.

Chris Riback: And I would assume that for patients who are undergoing any kind of treatment, whether that's chemotherapy, other immunotherapies, etc., that anyone who's got a question on, "Well, I'm under this regimen. Should I cancel it?" I assume that first thing you would guide is I would assume not. And beyond that I would assume please talk to your doctor.

Dr. Judy Garber: Oh, absolutely, Chris. I think that everyone is concerned about even having to come to the hospital to be treated, that there are people here who might be more likely to be positive or just more people than all of us are trying to be in contact with. And we're well aware in the hospitals and the treatment centers that these risks are there and taking extra, extra precautions to try and protect the patients. I do think that it is as safe as it can be and for some people really important to come for treatment and for others maybe not so important. And maybe they and their physicians and providers and I leave nurse practitioners and PAs and this, everybody's trying to figure this out together.

Chris Riback: Yes, yep.

Dr. Judy Garber: But I think that they and the team can try to decide is this the right time to come? Do you have symptoms? Maybe you should stay home. What if we delay a little bit? What if we don't? And those are pretty individualized discussions and they're taking place all around us.

Chris Riback: And just to put a point on that, because I could imagine this would be the type of question that listeners would have, so on that guidance that might go to upcoming doctor's appointments. That might go to scheduled screenings for cancer survivors.

Dr. Judy Garber: Yes.

Chris Riback: That might go to whether or not to keep a scheduled annual mammogram. Am I understanding you correctly?

Dr. Judy Garber: Well, let's talk about that separately.

Chris Riback: Okay.

Dr. Judy Garber: So treatment is one thing and I think treatment most of the time, we're going to try to keep that on schedule and intact. Maybe spread out a little more, but I do think people want to maintain treatments they thought were important enough to have in the first place. Screening is different, and I think here many people are trying to go to virtual visits where instead of coming for that breast exam you thought was so critical, you might be able to ask questions, talk about any side effects from oral medications, but put off the exam and the screening imaging until things settle down a little more.

Many places are not offering screening mammograms or colonoscopies at this time. Saving their resources to try to deal more with the virus and its effects. And that is, most of the time really, I think in the balance of things, a safe thing to do. We are not worried, even among our highest risk patients, our BRACA carriers and our Lynch syndrome patients and our cancer survivors. Sometimes logistics put your appointments off a month or two and we're hoping here we're not talking more than about three months.

Chris Riback: Yes.

Dr. Judy Garber: But the risk of coming and being exposed against the benefit of a test that's 99% likely to be negative is really no calculus at all.

Chris Riback: Let's talk about precautions. You mentioned it briefly earlier, but as specifically as you can, what precautions should cancer patients take? At this point, we all know the general recommendations to wash our hands, refrain from touching our face. But should cancer patients be doing anything else? What about face masks, for example? Although, those are plenty hard to acquire. And our hospitals need them. So what precautions should cancer patients take?

Dr. Judy Garber: Well, I think in their normal lives at home, that really the things we've been recommended to do are what we should be doing, but really doing them. Suddenly you realize how many times a day you actually touch your face. Really have to try to be as clean as possible. Things brought into the house should be wiped down. The house should be wiped down. The doorknobs, places you don't think about. We really have to make every effort to be as clean as possible, and we all seem a little obsessive compulsive, but that's okay at this time. And then when there's time to go out and be among others, especially in a medical setting, I think extra precautions are needed and often patients will be offered some of that. You'll see the staff wiping down the room as you walk in the door and when you leave and it's not a reflection on what they think about you. It's just being as careful as we possibly can.

Chris Riback: And this also, I'm sure very, very tough to answer, but when should a cancer patient be concerned? I mean we all are looking around the second one of our kids coughs or we have a cough. You think, "Oh, are you okay? You feeling okay?" And you're like, "Well, it's allergy season, so I'm coughing because..." For what symptoms should they start to be seeking medical attention, thinking about it? Is a cough something that someone should be paying attention to? And here, I mean, cancer patients. A runny nose? How do you decipher between something that's just normal and something that’s more, "Hmm, I better pay attention to this"?

Dr. Judy Garber: What a good question and what a tough question as allergy season starts among us. Which is nice, at least things are blooming. But here we've got allergy season on top of all the effects and maybe a little less influenza, so that's a good thing. I think the most important symptoms to pay attention to, of course, are fever and any shortness of breath and those anyway, as a cancer patient, you always should call your providers for those. I think cough and runny nose, if it's at a tiny bit, you might be inclined to wait. I heard this morning a discussion for allergies. If you felt like you felt last year and you're not on active treatment with chemotherapy drugs or immunotherapy drugs, you might tolerate a little bit longer before you call. But if you have any concerns you should just call. Why worry by yourself when someone can help you decide? I do think for people who are receiving medications that it's a different thing. Some medications will mask a fever and you have to know if you're taking one of those. Anything that could cause a shortness of breath, obviously that's urgent. You really have to call.

Chris Riback: Taking one's temperature—

Dr. Judy Garber: You do know you have to call before you go and get tested because you can't just show up anywhere. I don't think. Certainly not in Massachusetts where I am. You can't drive to a drive through. You can't go to an emergency room without calling ahead so that they know you're coming and can deal with you when you come with this question.

Chris Riback: Yes.

Dr. Judy Garber: So you’ve got to call. Hopefully we'll have home tests soon, but not yet.

Chris Riback: Yes, yes. Soon. Soon, we all hope. To start to out the conversation, you just mentioned a moment ago something that was on my mind as well. You said if you've got that concern, call. Why should you worry alone? What is your guidance on stress? I mean from what any of us lay people know and hear about stress generally that it seems to always be something to be concerned about. Stress can cause all sorts of challenges for any of us at any time. This is obviously a particularly stressful time for the whole world and I would assume it's a particularly even more stressful time for the folks that we're talking about. What guidance do you have regarding stress? How to manage it, how to think about it.

Dr. Judy Garber: Well, I wish I had the secret, but I think everything we're all seeing now, now that we're all living with more stress than usual, suggests that we should pay attention to it and not pretend that we don't have it. There are a number of websites I've seen where you can have yoga classes online, where you can have someone to talk to. A lot of therapists are doing their work online. If you have a therapist, you might find out whether virtual visits are available through the institution where people are getting care. Many of the providers, social workers, psychologists, psychiatrists, et cetera, are making themselves available online. But people also have other ways that they manage stress in their lives.

They try to put some other activity into their day. Music, online many of the symphonies and musical groups are giving free concerts that you can tune into if music helps you relax. People are meditating, calling friends, people are having Zoom dinners and all kinds of—

Chris Riback: Yes, yes.

Dr. Judy Garber: ...virtual activities. I think finding a way to feed your inner self to help get through this time is critical for care for our patients and for their caretakers too. Families will find out how well we get along under this kind of stress and everyone wants to support people who are under particular stress and that certainly includes our cancer patients.

Chris Riback: Is there one thing, Dr. Garber, that you would want all patients to know? And no one wants false hope of any kind, but is there a message of hope that you would add that is not giving false promise by any stretch but just things that you think people should keep in mind?

Dr. Judy Garber: Well, I think I would say two things. One is your healthcare team, your healthcare providers, those people who've committed to getting you through this cancer experience are still very much committed and there for you. They don't think it's any less important helping you deal with cancer during this time than it is any time. They are still there and they're still available, maybe more so. So, I would say don't hesitate to involve them and don't feel alone. That community is still present, and all of your support networks hopefully are still present.

For the virus? Oh boy. I think, this is going to test our mettle, but everyone says that this is something we will ultimately get through. I'm sure we'll be different afterwards. But look at China, they are not having new cases. There is a limit. This is not the new reality that will last forever. We will get through this crisis and we'll pick up the pieces and go on. And I think our cancer patients, I hope, will be very much part of that survival.

Chris Riback: What's it like to be a doctor at this moment?

Dr. Judy Garber: Well I think that, Chris, it's a different thing. So I'm an oncologist and what I know to do for cancer patients is probably not what people need on the front lines. But my daughter is a cardiology fellow and my son is a pulmonary fellow who works in intensive care units. And I would say that they're very much on the front lines and absolutely as passionate and committed as you would want doctors to be and as worried. So we all hope the protective equipment will catch up with this crisis as well. I think it's still a privilege to take care of patients, especially in a time of crisis and to take care of each other. And I think we all are caretakers. That's what we do. We just try to adapt what we do to new demands.

Chris Riback: Dr. Garber, thank you. Thank you, of course, for what you do every day under normal circumstances. And thank you for taking the time to help explain and give folks some really practical things to think about at a time when everyone's looking for the information you described.

Dr. Judy Garber: Well, thank you, Chris. We will get through this together.

Global Collaboration on Immunotherapy and Drug Resistance Research

 

pink liquid in vials at laboratory

Several BCRF investigators recently joined fellow researchers and clinicians from around the world to present some of the latest progress in breast cancer immunotherapy and drug resistance research.

The Breast Cancer Think Tank Symposium was established by Drs. Marc Lippman of Georgetown University and the late William McGuire 30 years ago to bring breast cancer researchers and clinicians together with the pharmaceutical and biotech industries to discuss recent developments in the field. Since Dr. Mcguire’s untimely death in 1992, the meeting has been organized by Drs. Lippman and C. Kent Osborne of Baylor College of Medicine.

The symposium’s format encourages communication to identify new strategies for breast cancer diagnosis, treatment, and prevention. “This meeting is unique in that participants work together for a full week, which greatly amplifies the opportunities for new collaboration and study,” Dr. Lippman said.

BCRF was proud to sponsor the symposium as it celebrated its 30th anniversary in January. This year’s think tank highlighted key topics, including drug resistance in anti-estrogen therapy (endocrine therapy), immunotherapy, and intra-tumor heterogeneity.

Drug resistance in endocrine therapy

Endocrine therapy targets the interaction of estrogen with the estrogen-receptor (ER) and has significantly decreased mortality in women with ER-positive breast cancer. Unfortunately, about 25 to 30 percent of patients who undergo endocrine therapy experience breast cancer recurrence or metastasis (breast cancer that has spread to other tissues) because they develop endocrine resistance.

BCRF Invesigator Dr. Benita Katzenellenbogen of the University of Illinois at Urbana-Champaign discussed ongoing work in her laboratory based on her previous finding that FOXM1 gene and family of proteins are key factors in resistance to endocrine therapy. Dr. Katzenellenbogen and her team have identified potential new targets related to FOXM1 function that restore sensitivity to chemotherapy and endocrine therapy and are continuing work in this area.

Although CDK4/6 inhibitor therapy has been utilized in metastatic patients to overcome endocrine therapy resistance, some patients also develop a resistance to it, as well. BCRF Investigator Dr. Vered Stearns of Johns Hopkins School of Medicine highlighted a novel mechanism of resistance to CDK4/6 inhibitor therapy. Her group used data from a clinical study in metastatic patients to identify potentially targetable genetic alterations in the HER2 gene in patients with ER-positive/HER2 negative breast cancer. These alterations can be important drivers of CDK4/6 inhibitor therapy resistance.

Dr. Geoff Greene of the University of Chicago presented his lab’s research on the development of novel anti-estrogen compounds to reduce resistance to endocrine-based therapy. Using existing drugs that target the estrogen receptor, Dr. Greene’s group hopes to design the next generation of inhibitors capable of treating or preventing drug resistance.

Finding the right targets for immunotherapy

Immunotherapy uses the power of the immune system to attack cancer cells. Recent studies suggest immunotherapy has the potential to improve outcomes for breast cancer patients in combination with chemotherapy.

Since chemotherapy has been shown to increase immune checkpoint inhibitor proteins, Dr. Bert O’Malley of Baylor College of Medicine discussed the importance of timing immunotherapy and chemotherapy in order to kill breast cancer cells in a way that avoids the immunosuppressive effects of checkpoint inhibitor proteins.

To advance immunotherapy in breast cancers, researchers are working to identify potential targets other than checkpoint inhibitors. Dr. Douglas Yee of the University of Minnesota presented his work on insulin receptor-A, especially since insulin receptor-A expression does not appear to be affected by endocrine treatment resistance. He hopes this may be especially applicable in patients with ER-positive breast cancer who are less likely to respond to drugs targeting checkpoint inhibitor proteins.

Diversity within a single tumor: intra-tumor heterogeneity research

Breast cancer is a complex disease, made even more so by intra-tumor heterogeneity—meaning that a single tumor is comprised of many genetically diverse cells. Tumor heterogeneity is believed to be a driving force in drug resistance, recurrence, and metastasis.

BCRF Investigator Dr. Matthew Ellis of Baylor College of Medicine discussed his work using proteogenomics, a discipline based on a combination of protein and genomic analysis, to identify new breast cancer cell subtypes that may be involved in metastasis.

BCRF Investigator Dr. Adrian Lee of the University of Pittsburgh discussed the power of single cell sequencing to characterize individual cells within a tumor that may be specific drivers of metastasis.

Dr. Mohamed Bentires-Alj of the University of Basel presented his research on the factors that contribute to breast cancer cell dormancy and possible triggers that cause dormant cells to metasticize.

The Breast Cancer Think Tank Symposium promotes unique collaborations across institutions, industries, and disciplines. Providing researchers with the opportunity to share ideas and developments is key to progress.

How Math is Helping Researchers Understand and Treat Cancer

 

Lab work station with calculator

Math has long played an important role in breast cancer research. Take one of the field’s most significant impacts on cancer treatment: the Norton-Simon hypothesis. Developed in 2006 by Drs. Richard Simon and Larry Norton, the Norton-Simon hypothesis is derived from mathematical modeling of how cancer cells grow and how chemotherapy kills those cells.

It has since fundamentally changed how chemotherapy is delivered. Today, dose-dense chemotherapy, a strategy of delivering more doses in less time, has been shown to improve survival rates and is an example of the real world verifying mathematical predictions.

Math is helping researchers understand how cancers grow and how cancer cells function. This knowledge equips scientists with tools to predict treatment response and, in turn, improve those treatments overall.

How math is being used in cancer research

Math allows us to dive deeper into cancer cells. We are generating more information about genes, proteins, functions, and connections every day, but this vast amount of data is too great for individuals to analyze.

Investigators are applying complex math and geometric network algorithms to look for patterns in data and figure out which specific genes or gene networks might be involved in a drug response. Researchers hope this could lead to new biomarker tests or more effective combinations of treatments.

Much of cancer research is done in biological systems—cultured cell lines and other models of cancer. This line of research, though, has its limitations—not the least of which are time and money.

Mathematical modeling allows scientists to explore complex virtual biological systems, challenge those virtual systems, and test predictions. What takes years in biological systems, can take only weeks or months with mathematical modeling. Current investigative methodologies produce large amounts of data, even on a single breast cancer. More advanced mathematical methods are needed both for handling these large amounts of data and for developing predictive and diagnostic tools.

How BCRF is supporting mathematical oncology

In 2016, BCRF launched the Mathematical Oncology Initiative with the goal of applying mathematical concepts to accelerate discoveries in understanding how tumors develop and respond to treatment.

With initial support from the Henry and Marilyn Taub Foundation, BCRF investigators Drs. Joseph Deasy and Allen Tannenbaum launched a coordinated group of projects applying new mathematical tools to better understand the evolution of cancer—the changes that occur during its progressionas well as what makes one cancer different from another.

With generous support from the Simons Foundation, BCRF is able to continue to support the work of Drs. Deasy and Tannenbaum and have added a new investigator to its Mathematical Oncology Initiative: Dr. Nir Peled (Soroka Medical Institute, Israel).

This expanded collaboration converges several critical but largely underdeveloped threads of cancer research. In doing so, researchers hope to design better diagnostic and prognostic tools and treatment strategies to optimize cancer management—and ideally cure and/or prevent cancers.

Livestreamers Raise More Than $10,000 for Breast Cancer Research

 

KittyPlays of Twitch Streaming Group Team Kitty

Inspired by the gaming community’s passion for social good, BCRF recently launched a new partnership with the all-female Twitch broadcasting group, Team Kitty.

Team Kitty streamers shared BCRF’s mission with new audiences around the world—and raised more than $10,000 for BCRF through the stream, which took place from January 23 through World Cancer Day on February 4. Over the course of this marathon fundraising event, the group livestreamed content—from playing video games to hosting conversations (known as IRL streams)—each day.

Women make up 46 percent of the more than 2.5 billion people worldwide who play video games. Websites like Twitch, a livestreaming platform devoted to gaming, are amassing huge audiences and bringing nonprofits into the fold through charity streams.

Team Kitty is headed up by Kristen “KittyPlays” Valnicek and focuses on empowering women in the gaming community. “We’re a group of incredible, loving, positive, professional women,” Valnicek said.

For Valnicek and several members of Team Kitty, the choice to stream for BCRF was very personal. When Valnicek was 14, her mother was diagnosed with breast cancer and successfully completed treatment. Valnicek’s mother remains cancer-free today.

“She was lucky—it was caught early and she was able to get in for surgery right away and then start chemo,” Valnicek told her followers as she kicked off Team Kitty’s charity stream. “Going through that toughened me up as a woman and really made me love and respect my mom so much, watching how hard it was on her body.”

Throughout the two-week event, other streamers, like Kirsty “Psyche” Mawhinney shared their stories of moms, grandmothers, aunts, and others who had been diagnosed. “My mom had breast cancer 10 years ago now,” she told her followers. “She has done a lot to raise money for breast cancer research so it’s very important to me.”

To engage viewers and encourage donations, streamers got creative: They celebrated fundraising milestones with headstands and moonwalks, Warhead-eating, and tears, shared important breast cancer statistics, and even made ribbons in the games they were playing. Viewers donated in honor of family members and entered giveaways for gifts from BCRF partners, including Conair, Razer, and Manic Panic.

BCRF and Team Kitty also came together to design exclusive products, including a line of shirts and hoodies and a collection of Popsockets, that all benefit research with every sale.

“What we’re doing today does make a huge difference,” Team Kitty streamer Robin “HiveQueen_” Lee said during her stream. “We know that cancer affects so many of us and we know that we need to step up and make a difference.”

All told, Team Kitty’s charity stream for BCRF reached 14,555 viewers who watched 7,222 hours’ worth of content.

Reflecting on the success of Team Kitty’s stream, Valnicek said she was proud of what the Team Kitty community accomplished.

“Team Kitty started with the goal of bringing women in the gaming space together to create something bigger than themselves,” she said. “It is wonderful to see them and their supportive communities band together to manifest such a large sum for charity and spread positivity.”

Thank you to all of Team Kitty’s streamers who participated and helped be the end of breast cancer: KittyPlays, ItsEmmaElise, Psyche, KaraLynne, Ashaife, Samayyy, HiveQueen_, kellydanielle, Askesienne, Jayyytuck, Sarahmony, Jayyytuck, Lovinurstyle, and TheGreatHayley.

Women in Science and Research: How Far We’ve Come and What Still Needs to be Done

 

Headshot of Dorray El-Ashrey, BCRF's chief scientific officer

International Women's Day is a celebration of women’s achievements—artistic, political, social, economic, scientific, and more—around the globe. It's also a day when women everywhere rally in person and online to raise awareness about gender bias and the need for full equality. 

In keeping with that spirit, BCRF sat down with our Chief Scientific Officer Dr. Dorraya El-Ashry, a breast cancer scientist who came from an established career as a researcher to join our organization.

Here, she talks about her own impressive career, the rise in women in STEAM (science, technology, engineering, arts, and math) fields, and what gives her hope that society is on a path to gender parity in science and research. 

What first got you interested in a career in science and breast cancer research specifically?

I knew in grade school that I loved science. My dad is a scientist, and science and math were always emphasized in our house of two girls! When I was in the 4th grade, the President declared the “War on Cancer,” and I thought, Well then that’s what I’ll do. I’ll find a cure for cancer. Going through school and continuing to focus on science, I liked biology in particular. I chose to get my PhD in pathology since it’s the study of disease—the how, why, and what of diseases, including cancer—so it gave me a great foundation to pursue a career in cancer research. In college at Vanderbilt University, my two best friends’ mothers died from breast cancer. It was then that I decided I would have a career in breast cancer research.

It was a little over 25 years ago that my 37-year-old aunt, my Dad’s youngest sister, was diagnosed with metastatic breast cancer. She had two young daughters, and while she was treated and had some response, she died two years later. In the intervening years, several friends (and friends’ mothers) and other relatives have been treated for breast cancer. Some are surviving and others we have lost. This is what I and my colleagues dedicated our careers to—ending deaths from breast cancer.

Before coming to BCRF you worked as a breast cancer researcher. What was your research focused on?

For much of my career, my lab studied mechanisms underlying estrogen receptor (ER) negative breast cancer, a more aggressive form of the disease with worse clinical outcomes and fewer therapy choices. We were seeking to identify reversible mechanism for the lack of ER expression in ER- breast cancers with the idea that if those could be identified, then new therapeutic targets that when blocked would allow for the restoration of ER expression. We did in fact demonstrate that there were dynamic factors that regulated ER expression and that when blocked, ER expression (and in some cases, anti-estrogen responses) were restored to ER- breast cancer models. We further identified a microRNA pattern reflective of these dynamic factors that associated both with poor overall clinical outcome and with poor response to anti-estrogen therapy.

Then, as often happens, pursuit of more in-depth research into this microRNA pattern revealed a significant role for the tumor microenvironment (TME), and in particular one predominating cell type within the breast cancer TME, the cancer associated fibroblast (CAF). Our research, along with others, found that different subtypes of breast cancer had associated different subtypes of CAFs that helped drive and support some of the characteristics of that breast cancer subtype. More recently, and more importantly, we discovered that these CAFs leave the breast along with the cancer cells, getting into the circulation and traveling along with circulating tumor cells and helping the CTCs get out of the circulation and into other organs to set up home and grow as metastases. This work has several potential impacts, from liquid biopsies to new targets for therapeutic prevention of metastasis, that are currently being pursued both by the lab and in collaborations with other investigators. 

A lot has been written about how STEAM and research are still very male-dominated and that there’s more work to be done to achieve gender equality in these fields. Did you encounter any challenges working as woman in research? How have things changed since you entered the workforce?

There are certainly challenges for women in science and research today.

We have more women than ever interested in careers in science and research. We have mentors at the graduate school, PhD, and post-doctoral levels who, male or female, are completely supportive of women in science. Women are coming out of these programs, especially of younger generations, thinking, I had a great experience, and I’ve been supported and encouraged. Where women still face a challenge is once they become a faculty member and move from assistant professor to full professor. There is a lack of opportunity and inclusion. Not being asked to sit in on development meetings, not being included in meetings about big program project grants, not necessarily getting leadership roles. This is generally about unconscious bias.

There are studies indicating that if you don't put names on grants that women's grants are chosen as often as men’s grants. But once names are included, right out of the gate, the same grant is viewed differently depending on the name. Female speakers are more often introduced by their first name while male speakers are introduced as “Doctor.” This has certainly happened to me.

Are you encouraged and hopeful that research is moving in the right direction in terms of gender parity?

I’m encouraged because there has already been a lot of progress. At BCRF, we fund the best and brightest—and we are proud that about half of our awardees are women scientists.

My husband teaches elementary school science. He has noticed over his career that when he asks kids to draw a picture of a scientist on the first day, more and more of them are drawing women. I think we’re moving forward, changing the perception of science in the general public.

I also feel hopeful when talking with one of my groups of friends. We’re all scientists of the same age—many of us had similar mentors. We work to advance and increase women in science and in leadership positions, as well as helping develop women as mentors.

Investigating Breast Cancer: Developing Personalized Risk Prediction

 

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Most breast cancers are not the result of inherited mutation in cancer causing genes. For families with a high incidence of breast cancer, however, a genetic component may underlie an inherited risk. We know the BRCA genes are the most common of these inherited mutations, but scientists have uncovered many more genes implicated in a risk of breast cancer.

How can researchers provide more precise risk estimates so that individuals with inherited risks can make informed decisions about their health, so that the right women are getting the right tests at the right age?

Dr. Robson is conducting studies that employ advanced technologies that incorporate information from genetic tests to enhance the precision of genetic risk assessment in women with mutations in the BRCA gene.

Dr. Robson has been a BCRF investigator since 2006 and is an associate attending physician of Clinical Genetics and Breast Medicine Service in the Department of Medicine at Memorial Sloan Kettering Cancer Center.

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Read the transcript below:

Intro: Most breast cancers are not the result of inherited mutation in cancer causing genes. For families with a high incidence of breast cancer, however, a genetic component may underlie an inherited risk. We know the BRCA genes are the most common of these inherited mutations, but scientists have uncovered many more genes implicated in a risk of breast cancer.

So how do genes influence breast cancer risk? And can we develop strategies to precisely predict risk on an individual level? In other words, how can researchers provide more precise risk estimates so that individuals with inherited risks can make informed decisions about their health, determining the level of risk for enhanced screening so that the right women are getting the risk tests at the right age?

Dr. Mark Robson is one to ask. With Dr. Kenneth Offit, Dr. Robson – among other activities – is conducting studies that employ advanced technologies that incorporate information from genetic tests to enhance the precision of genetic risk assessment in women with mutations in the BRCA gene.

Why does he do it? What motivates him? You’ll want to hear Dr. Robson’s thoughtful response about the breast cancer community that included references to James Madison, Virgil, and the that that, as Dr. Robson says: “Life is full of nuances,” and that “everyone experiences” the disease “in a different way.”

Some background: Dr. Robson is an Associate Attending Physician of the Clinical Genetics and Breast Medicine Service in the Department of Medicine at Memorial Sloan Kettering Cancer Center. He is currently the Clinic Director of the Clinical Genetics Service and the chair of the Cancer Genetics Subcommittee of the American Society of Clinical Oncology. He has been a BCRF Investigator since 2006.

Chris Riback: Dr. Robson, thanks for joining me. I appreciate your time.

Dr. Mark Robson: Thank you for having me. Glad to be here.

Chris Riback: I'd like to start with your helping differentiate between two paths to breast cancer, those that result from inherited mutation and cancer causing genes and those that don't. Do the types of breast cancers that result from these paths differ and which path is more common?

Dr. Mark Robson: Yes. So, the vast majority of breast cancer is not due to mutations or the term now is pathogenic variants, which is a little bit more fancy but precise. The vast majority of breast cancer is not caused by those genetic changes. They arise because of alterations that occur in the DNA and it's just acquired through life. But there are a fraction of women who develop breast cancer because of a specific inherited mutation.

And they're in general have the same outcomes as women who don't have mutations. And with one exception, the breast cancer is generally seem to resemble those of women who don't have mutations. The one exception is for women who have mutations in BRCA 1, which is linked to an increased risk of a triple negative breast cancer, which is a particular subtype.

The reasons for looking for these mutations are that ... There's a couple of different ones. One is that women who have mutations, for instance in BRCA 1 or BRCA 2 may be an increased risk for other types of cancer, either second breast cancers in the other breast or ovarian cancer. And that risk means that we should do different things to follow them up.

Also, their family members may be at increased risk if they share the mutation and benefit from specific surveillance approaches and potentially even preventive surgeries. And lastly, women who have metastatic breast cancer with mutations in some genes, although not all genes may benefit from treatment with a specific class of drugs called PARP inhibitors.

Chris Riback: And that's what I just wanted to ask you about. When we talk about inherited risk or pathogenic variants perhaps and genes and breast cancer, most often we hear about what you just raised, BRCA 1 and 2. But those aren't the only genes implicated in a risk of breast cancer, are they?

Dr. Mark Robson: No. Indeed not. When a new type of technology called next generation sequencing became available a number of years ago, it became possible to test individuals for many different genes at the same time. And once that became possible, so-called panel testing came into the clinic.

And we discovered that a significant number of women have pathogenic variants or mutations in genes other than BRCA 1 and BRCA 2. And while BRCA 1 and BRCA 2 are still the most common identified inherited risk factors, there are a range of others that in aggregate are equally calm.

Chris Riback: There was a quote I saw recently from Larry Norton of Memorial Sloan Kettering, but also obviously BCRF, where he said, "We know from our data at Memorial Sloan Kettering that if you only test people with strong family histories, you miss half the cases." And I know this is a key question. If we know inherited risk is a thing but we don't necessarily know which genes drive the risk, how can individuals with inherited risks make informed decisions about their health?

Dr. Mark Robson: Well, I think that that's a topic that we're having a lot of discussions about right now. So, I think what Larry was referring to was that even among women who have BRCA 1 and BRCA 2 mutations... Sorry about the phone. Even among women who have BRCA 1 and BRCA 2 mutations, half of the women with mutations aren't found until they themselves develop a cancer and would not have been tested based upon what their family history is until they themselves develop a cancer.

That's one component of the unidentified risk. The other component is that the genes other than BRCA 1 and BRCA 2 are actually much less strongly predisposing than BRCA 1 and BRCA 2. So, they may move through families without actually causing cancer. And so, can be hidden, if you will, until perhaps someone is unlucky enough to develop the disease and get tested.

Chris Riback: Let's talk about your work and some of your goals. Because among your goals, as I understand it, is to determine not only how we can make more precise risk estimates but how we can precisely predict risk on an individual level. Take me through that process. How are you trying to do that? And perhaps relatedly, what are single-nucleotide polymorphisms?

Dr. Mark Robson: Right. Should we call SNPs because there's so much easier to say?

Chris Riback: Thank you. We will call them SNPs.

Dr. Mark Robson: Yes. SNPs. So, what we've been talking about so far are so-called rare variants. In other words, everybody has the BRCA 1 or BRCA 2 gene but very... Because they perform normal functions in our bodies. But very, very few people actually have mutations or pathogenic variants in those genes. In the general population, it's probably only around one in 400, maybe one in 500 people have a mutation. Although in certain populations that we'll talk about later, it may be more common.

These rare variants are predisposed to cancer but not everybody who has a mutation in one of these genes gets cancer. So, for instance, for BRCA 1, it's probably about 65 to 75% of women get breast cancer and 40 to 60% get ovarian cancer depending on the study. For BRCA 2, the numbers are perhaps a little bit lower. It's maybe two thirds get cancer and 15% or so get ovarian cancer.

And for genes like those other so-called moderate penetrance genes, those other genes that we talked about a little bit earlier, one such gene is called CHEK2. And for those women, the lifetime risk of breast cancer is maybe about 25%. So, the question becomes what's different about the women who do get breast cancer and don't get breast cancer when they have a mutation in one of those genes? And there's a number of things that play into that.

But one thing is genetic background. And we have millions and millions of places throughout our DNA where we're subtly different from other people. These are so called common variants or SNPs. And it turns out that some of those SNPs are associated with greater or lesser risks of disease. And this isn't just breast cancer, this is all kinds of diseases, diabetes, cardiovascular disease, et cetera, et cetera.

And they're not mutations in the sense that they don't cause problems with genes but they're just part of us, part of our background. And we can now through genetic testing in research settings, identify the pattern of common variation that a person has. And what we found is that certain patterns of common variation, so-called polygenic risk scores are associated with greater or lesser risks of disease both in the general population and in people who have mutations in genes like BRCA 1, BRCA 2 or CHEK2.

So, one of the things that we're trying to do is measure this background variation in individuals, predict how that might affect the risk that's associated with say a mutation in BRCA 1 or BRCA 2 and see whether if we give that information to women, the differences are sufficient to influence their decision making about things like preventative surgery.

Chris Riback: Almost focusing the light on the amount of risk based much more on an individual reading it seems than on the readings that we have had to date.

Dr. Mark Robson: Correct. Because right now when a woman goes in for a genetic counseling, for a BRCA mutation, she is often given a fairly wide range of potential risks. Say, "Your risk may be anywhere from 65 to 95%." And what we're exploring is whether it is helpful to those individuals to become a little bit more precise. There's still going to be some range but the question is can we narrow that range in a way that it's helpful?

And it may be that for the very strongly predisposing genes, the precision may be helpful. We may narrow the range but the range may still be so high that it doesn't change decision making. But for this other group of genes that we have been talking about, the moderate penetrance genes, it may matter.

Because if your average risk is 25 to 30% but there's some group of women that are in the 15% range and some group of women that are in the 40% range, that may well have an influence on what they decide to do. So, we're also as a next step looking at polygenic modification of moderate penetrance.

Chris Riback: And is this the Prospective Registry Of Multiplex Testing, PROMPT? So, we had SNP earlier and now we have PROMPT. First, is this the group that you are doing this work with? And then two, how would you characterize where you are on the work? How far along would you say you are?

Dr. Mark Robson: So, PROMPT is actually a little different. PROMPT is when multigene panel testing became available, it is the thing about which we have very little evidence to understand how people are receiving the information, how the information is being communicated to them and what they are choosing to do with the information.

This was something that multigene panel testing was rolled out commercially, not as a research test, with very broad adoption very quickly but with still a lot of questions about how best to use the information. So, we created PROMPT as a voluntary internet based registry for people who had been found to have mutations on multigene panel testing to share their experiences, to tell us what they had because that in and of itself was something that was interesting. What were the diseases that they had, et cetera.

But also, what were they doing subsequently in terms of screening or surgery? And what was their understanding of these alterations? What had they been told? What had they received? And now, we're following these... Largely women, not exclusively but largely women serially over time to try to understand longitudinally what they're doing.

So, that's an observational project that I think is very important because it's giving us a view of what's happening in the real world with multigene panel testing. With regard to the risk modifier work, we were facing some challenges getting a clear based... Which is a laboratory approved assay done that we could share with people that we had enough confidence would be accurate.

We've now circumvented that hurdle through a relationship with a vendor, have achieved the appropriate regulatory approvals and are now moving it into the clinic to start offering the testing to women who have had newly identified BRCA mutations so that we can give them this information and essentially measure what it is that they choose to do with it.

Chris Riback: And the point that you were just making, I'm sure it's a question that any person would have first of all around genetic testing and understanding one's own risk and modifying one's own risk as much as possible. But in particular, individuals at risk of carrying BRCA 1 or 2 mutation, this becomes even more powerful for them.

You wrote in a recent editorial in the journal of the American Medical Association with a colleague, you wrote a little bit about this. And one of your lines was, "Identification of individuals at risk of carrying a BRCA 1 or 2 mutation can be lifesaving and should be a part of routine medical care."

Now, that may have been geared towards a particular population but I thought that might be something to get some guidance on or some insight on from you because it's an area obviously that so many people would be curious about.

Dr. Mark Robson: Right. So, we have reasonably strong observational evidence. That if you identify a woman who's having a BRCA mutation and then prevent her from getting ovarian cancer by doing a preventive surgery to remove her fallopian tubes and ovaries, that that will improve the survival of the population because screening for ovarian cancer is inadequate and it's a tough disease that frequently presents an advanced stage.

There is also some potential benefit from women who choose to undergo preventive mastectomy, although whether that has much of a survival advantage is not clear. But prophylactic oophorectomy is something that we believe does save lives. So, finding women who have BRCA mutations, that's not something that you want to do lightly, certainly not in younger women because premature menopause is quite a significant impairment to quality of life and potentially to longterm health.

Dr. Mark Robson: So, finding the women who've got mutations is important. The way that we have done that to this point has been by using things like family history to try to predict who is more likely to have a mutation. Remember as I said earlier, it's only about one in 400 to one in 500 in the general population. So, creating a system of testing, everybody becomes challenging.

The thought is perhaps to start this process by concentrating on groups who have higher risks of carrying a mutation. So, for instance, the population of the Ashkenazi Jewish individuals. So, individuals of Eastern or Central European Jewish descent have about a one in 40 chance of carrying one of three specific BRCA 1 or BRCA 2 mutations.

So, nearly 10 times higher. And there has been thought now that perhaps everyone who is of Ashkenazi Jewish descent... And defining that becomes a little bit of an issue. But everybody who's of Ashkenazi Jewish descent should at least be offered or have a discussion about the possibility of undergoing BRCA testing, at least for those three common mutations.

Chris Riback: So, it's a bit of a shifting of the thinking around who might want to do it. And I'm sure that there's still much discussion and increasing the number of the amount of testing carries... “controversy” is the wrong word, but one wants to manage – and you were saying this – and handle testing appropriately.

As I'm talking to you, so much of it seems what you think about, what you have worked on in your career, what you've dedicated yourself to is around the genetic component and about the considering and the managing of risk. I found myself thinking about you almost as a medical actuary doing, thinking... So, why? What interests you about that? And have you ever thought of yourself as a bit of a medical actuary?

Dr. Mark Robson: No. I never thought of myself as a medical actuary. Because why am I interested in it? That's a fascinating question that I've really never deeply thought about. My perception is that life is full of nuance. And what I enjoy about this area is trying to communicate with people about uncertainty and help them navigate that in a way that is concordant with their values and how they want to approach managing potential threats to their health.

I mean, not everybody who has a BRCA mutation gets cancer. And certainly, not everybody with a moderate penetrance mutation gets cancer. And yet when they have a test result, many people seem to internalize that as a diagnosis, essentially pre-cancer. And the question is how can we help them navigate that and just recognize that this is something that is a risk that you know about. Perhaps there are others that you don't. And that's what I enjoy about it.

Chris Riback: And does that lead in some way to your clinical work? I mean, it wasn't lost on me that my understanding of the clinical side for you, you'll correct me if I have this wrong, is that your practices weighted toward the management of young women with breast cancer, especially hereditary breast cancer. I recently had a discussion with Doctor Ann Partridge, who runs the young and strong program for young women with breast cancer. The disease is different for young women, isn't it?

Dr. Mark Robson: I think that the disease is different for everybody, right?

Chris Riback: Yes.

Dr. Mark Robson: I mean, everybody experiences it in a different way and it has a different impact. I do work a lot with younger women just because I work a lot with inherited risk and that overlaps. But also take care of people who are older as well. And it's the same concept. I mean, if you think about after a diagnosis and treatment of breast cancer, once again, people are living with a pretty fair degree of uncertainty.

About at least for a while, "Is this going to come back? How am I going to integrate this into my life? " And again, it becomes a conversation about moving forward in the face of uncertainty. And uncertainty with a possibility of something not good happening, right? And I think that from the humanist perspective of Madison that being a little bit of a Virgil in that setting, is a privilege. And I enjoy doing that.

Chris Riback: Was it always medicine for you? Was science always the direction that you were going to go? You mentioned Virgil. Were there other areas of interest for you growing up?

Dr. Mark Robson: I've always been interested in the arts and humanities. But mainly as a way of, again, informing perspectives on life. Gosh, I'm getting all philosophical here on a Thursday afternoon. But no. I mean, I've been joking with my daughter who's now in 10th grade and I remember actually starting thinking about doing medicine when I was in 10th grade biology class.

So, yes. I mean, it pretty much has always been medicine for me but for different reasons. When I was younger, it was because it was tough and it was hard and I felt like it was intellectually challenging, which has a certain arrogance to it. And then, as I got older, it became much more because it was a life of connection. And connection not only to your patients but connection to your colleagues and connection to the broader world. And I think that's a very nourishing thing.

Chris Riback: Yes. It's not a bad way to go through. And to close out, I'd be remiss if I didn't ask you, doing the amounts of research that you do and that other researchers, scientists, doctors do can be challenging at times, what role has BCRF played in your research?

Dr. Mark Robson: Well, BCRF has been an incredible financial supporter. The model is very unique. And the idea that you have funding to explore ideas that would be difficult to get funded through other mechanisms because of the novelty, because of the newness of what you're trying to do. So, there's that component to it.

The other component goes back to what we were just talking about is that it's a phenomenal community of both researchers but also... And perhaps more importantly, patients, family members, supporters, who are energizing through their dedication to the course and their energy for the course.

And so, I think we all talk about the research support that's critically important. But the community writ large is in my mind equally important and perhaps even more so.

Chris Riback: Well, thank you. I'm certain that they're grateful to have you part of that community. And yes, it's a remarkable community to say the least. Dr Robson, thank you for taking the time. And of course, thank you for the work that you do.

Dr. Mark Robson: Thanks very much. Appreciate it.

Women-Led Brands Helping Fund Breast Cancer Research

 

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At BCRF, our corporate partners help accelerate research breakthroughs that improve cancer prevention, diagnosis, treatment outcomes, and survivorship. This Women's History Month, we thank all our brand partners who are championing women’s health and helping fund lifesaving breast cancer research.

We’re proud to partner with women-founded and women-led companies that support our mission including: Adina’s Jewels, AERIN, Alex Woo, Anine Bing, Bandier, Beautyblender, CUUP, Dee Ocleppo, Erin Condren, Ippolita, Kendra Scott, Koi, Lilly Pulitzer, Manic Panic, Mantraband, NakedCashmere, Ouidad, Pretty Rugged, Pronovias, Sabika, S’well, TIEM, Tory Burch, Tracy Anderson Method, and Veronica Beard.

Here, we highlight a few you can support today to fund breast cancer research.

Adina's Jewels Logo

Adina’s Jewels
Adina's Jewels, a new-to-BCRF-partner in 2020, will be supporting breast cancer research year-round. Adina's Jewels customers will have the opportunity to round up their purchase at check out in support of BCRF and the brand will match 100% of all customer donations. Inspired by her grandmother who was impacted by the disease, the brand's founder, Adina Kamkhatchi, is passionate about supporting lifesaving breast cancer research through her company’s partnership with BCRF.

Alex Woo
Alex Woo is an award-winning designer who has been creating personal and timeless jewelry for more than 20 years. As someone dedicated to advancing breast cancer research, Woo designed the Activist PINK pendant as a sleek sculpture that can sit up on its own—a subtle reminder to stand together. Twenty percent of the purchase price of every necklace sold is donated to BCRF.

Dee Ocleppo Shoes

Dee Ocleppo
The brand supports BCRF year-round by donating 10 percent of annual revenues—meaning every product supports BCRF and the lifesaving research we fund. As a longtime personal supporter of BCRF, Dee, who launched her namesake label in 2018, recognized an opportunity for her pink-soled shoes and pink-lined handbags to do good. In 2019, Dee joined BCRF’s Board of Directors, furthering her commitment to breast cancer research.
Ippolita Jewelry

IPPOLITA
"I love the idea of women buying jewelry for themselves,” says Ippolita Rostagno, founder of IPPOLITA. “It’s wonderful to have witnessed a confidence revolution: The modern woman waits for no one and buys jewelry for herself.” With women’s empowerment and causes being important to Rostagno, IPPOLITA has pledged to make a 20 percent donation to BCRF from every purchase of her special-edition Rose or Magenta Carnevale Ring this year.

Kendra Scott Butterfly Charm

Kendra Scott
As a creative mind with a love of natural gemstones, Kendra Scott designed her first collection of jewelry in 2002. Since she began her company, Kendra has lived by three core values: family, fashion, and philanthropy. She created a brand and culture that authentically values giving back and making a positive difference in the community. In 2018, Kendra also joined BCRF’s Board of Directors. "Breast cancer is a disease that has affected so many of my loved ones,” Scott says. “Their strength through the struggle inspires me.” Fifty percent of the sales of the Breast Cancer Butterfly Charm will support Scott’s BCRF research grant, The Kendra Scott Award in Honor of Holley Rothell Kitchen.

Koi Scrub Top

koi
In 2006, in a small cramped L.A. apartment, Kathy Peterson started koi with a simple mission: Make scrubs people love to wear. Today, koi is proud to be one of the only independently owned, woman-run companies in the industry. koi has been a part of the BCRF Partner Family since 2013 with the koi Cares Courage Collection of designer items for nurses and other medical professionals. $2 from each scrub top benefits breast cancer research.

Naked Cashmere Sweater

Naked Cashmere
“The LOVE Collection is straight from my heart,” says Leslie Gifford, creative director and president of Naked Cashmere. Gifford created the LOVE collection to make an impact and support research with every purchase. For every item sold from the collection, up to $50 will be donated to BCRF. Gifford also sits on BCRF’s Advisory Board.
Ouidad Curls for a Cure Logo

Ouidad
As a hairstylist, Ouidad has witnessed women lose their hair during breast cancer treatment. Her own experience with the disease gave her a new perspective on this loss, and she decided to make it a priority for her company to address the unique needs of this community. Ouidad has supported BCRF’s mission for 15 years—first through her namesake company, Ouidad, and most recently through the Curls for a Cure year-round donation program. “I think research is changing the world,” she says. “It changed mine. I’m a result of research.”

Pretty rugged blanket

Pretty Rugged
Pretty Rugged has launched their partnership with BCRF in honor of Sheila Mendleson, Pretty Rugged’s Director of Business Development and Collaborations, who is celebrating seven years being cancer-free. This year, Pretty Rugged has committed to donating $10,000 through the sales of the Luxe Faux Fur Pink Mink Blanket in both large and baby sizes, the Luxe Fax Fur White Wine Tote, and the Luxe Faux Fur White Mink Blanket in large, medium, and small sizes. Fifty percent of the purchase price from this collection will be donated to BCRF. “Pretty Rugged is an example of what I think of when I think of the words, ‘the American Dream,’” says founder Tracy Slocum.

Tiem Slipstream

TIEM
In 2016, TIEM’s founder, Tracey McLeod, set out to fill a void in the sportswear market for functional and stylish cycling footwear and launched her brand with its signature Slipstream indoor cycling shoe. In 2018, TIEM and BCRF joined forces to ride well and do good. Ten percent of the purchase price from each Vivid Pink Slipstream sold benefits breast cancer research year-round.

Research Update: Emerging Therapies in Triple Negative Breast Cancer

 

Lab worker with samples

Triple negative breast cancer (TNBC) is very aggressive and fast-growing, with a worse prognosis than other types of breast cancer. TNBC represents 10 to 20 percent of diagnosed breast cancers and is more likely to affect younger people and those with a BRCA1 gene mutation.

The “triple negative” in TNBC refers to the cancer cells lacking three key markers found in more common breast cancers: receptors for estrogen (ER), progesterone (PR), or HER2. Unfortunately, this means that TNBC will not respond to drugs that target ER, PR, or HER2, leaving women with this type of breast cancer with fewer treatment options.

But that landscape is changing. Recent discoveries from BCRF investigators and others have provided new insights into the molecular complexity of and potential targets for TNBC therapy. Using complex methods of molecular analysis, researchers have identified four distinct molecular subtypes of TNBC, each with a unique biology. These findings open the door for more effective treatment options. A few promising developments are highlighted here.

Rethinking hormone therapy in TNBC

Unlike ER-positive breast cancers, which have a very good prognosis because of targeted therapies that block ER-driven growth, TNBC does not depend on estrogen or progesterone, so it is not a candidate for these therapies. However, there is currently a renewed interest in a different hormone driver of TNBC—the androgen receptors (AR). While AR is typically associated with prostate cancer, it is often present in breast cancer cells. Evidence from ongoing clinical trials suggests that patients with AR-positive luminal-type (LAR) TNBC may benefit from anti-androgen drugs that are used to treat prostate cancer. BCRF is investing $10 million as part of its Drug Research Collaborative to advance our understanding of LAR TNBC and accelerate targeted therapies to the clinic.

Progress and challenges in immunotherapy

Most TNBC tumors fall into a category called basal-like. These are typically thought to be the most aggressive types of TNBC and are treated with chemotherapy. We now know that not all basal-like TBNC are the same. Based on the most recent classification, there are at least two types of basal-like TNBC—BL1 and BL2—and that the type of basal-like matters when it comes to treatment.

BL1 is most likely to respond to chemotherapy. In fact, patients with BL1-TNBC who respond well to chemotherapy often have a very good prognosis. BL2 TNBC are characterized by an immune signature that includes a high amount of immune cells in and around the tumor and a gene signature associated with immune functions. BL2 are predicted to be the most responsive TNBC to immunotherapies. This classification may help to explain why most patients with TNBC have not benefited from immunotherapy—and help identify those who will.

In 2019, the FDA approved the first immunotherapy drug for TNBC, atezolizumab, based on results from the Impassion130 study led by BCRF investigator, Leisha Emens, which showed a substantial survival benefit of atezolizumab combined with chemotherapy in patients with advanced TNBC. In partnership with the Parker Institute for Cancer Immunotherapy and Cancer Research Institute, BCRF is funding a study that will provide important information about how patients respond to immunotherapy to advance our understanding of who is likely to benefit, as well as strategies to improve response so more patients can benefit. This represents one of 55 projects BCRF is funding in immunology, 14 of which are focused on triple negative breast cancer.

Understanding BRCA-mutated TNBC

About 70 percent of BRCA-mutated breast cancers are basal-like TNBC. Breast cancer cells that have a BRCA mutation can be targeted with a class of drugs called PARP inhibitors that work by blocking a DNA repair pathway on which BRCA-mutated cells depend on to survive. To date, two PARP inhibitors, olaparib and talazoparib, have been FDA-approved for people with advanced breast cancer and a BRCA mutation.

Even with this targeted approach, tumors develop resistance, making novel combination approaches an attractive option. Two phase II clinical trials combining PARP inhibitors and immunotherapy agents are underway: One is studying olaparib with atezolizumab and the other is studying talazoparib in combination with the immunotherapy drug avelumab.

TNBC is a varied and complex type of breast cancer, which is why BCRF is investing more than $21 million in research related to TNBC in 2019-20. Understanding the molecular classifications of TNBC and how best to target each one will bring us one step closer to making sure each patient receives treatment tailored to their specific TNBC subtype.

For information on clinical trials in triple negative breast cancer, please go to breastcancertrials.org.

Related:

BCRF researchers Drs. Robert Vonderheide and Leisha Emens discuss how immunotherapy is informing TNBC treatment

BCRF researcher Dr. Charles Perou shares advances in triple negative breast cancer

BCRF Researchers Identify Protein Associated with Metastasis and Drug Resistance

 

New Novel Target

A BCRF-supported study has connected a protein involved in embryonic development with drug resistance, offering a novel new avenue for targeted treatment.

The study, published in the journal Proceedings of the National Academy of Sciences (PNAS), links high activity of Forkhead Box Protein A1 (FOXA1) with resistance to anti-estrogen therapies and breast cancer metastasis. Spurred by findings from Dr. Xiaoyong Fu, a scientist and assistant professor in the laboratory of Dr. Rachel Schiff and Dr. Kent Osborne at Baylor College of Medicine (Houston), BCRF researchers from Memorial Sloan Kettering Cancer Center (New York) and Dana Farber Cancer Institute at Harvard Medical School (Boston) joined forces to identify a potential target for advanced breast cancer. A possible drug is in clinical trials for advanced cancer that may benefit a subset of breast cancer patients as well.

“This work reveals a novel new target in a well-known pathway of drug resistance,” Dr. Schiff said. “It represents just one example of how BCRF has enabled discovery research to lead us in new directions.”

Understanding resistance to anti-estrogen therapies

Drug resistance is a prominent hallmark of advanced breast cancers with poor prognosis. Even when effective therapies exist, as for the most common type of breast cancer—called estrogen receptor (ER)-positive, drug resistance can develop, sometimes many years after initial therapy.

Dr. Schiff’s research has focused on understanding how drug resistance occurs. “If we understand how resistance happens, we can develop models to study how to circumvent it,” she said.

One of the most well-known drivers of resistance to anti-estrogen (endocrine) therapies involve the estrogen receptor gene (ESR1). Mutations in ESR1 occur in about 30 percent of advanced ER-positive breast cancers, but less is known about other resistance mechanisms.

FOXA1 belongs to a group of proteins that regulate genes involved in early embryonic development. By co-opting factors like FOX, tumor cells can activate aggressive growth programs that allow them to survive anti-cancer treatments and activate metastatic processes.

Narrowing the focus

When Dr. Schiff’s team determined that FOXA1 promoted resistance to anti-estrogen drugs in breast cancer cells, they set out to identify potential targets that could counter this effect. “Because of its many functions, targeting FOXA1 itself would be toxic to healthy cells as well as cancer cells,” she said. This led the researchers to look at genes regulated by FOXA1, before ultimately identifying the protein hypoxia-inducible factor-2α (HIF-2α) as a key player in the development of resistance to anti-estrogen therapies.

“HIF-2α represents a new paradigm in endocrine resistance,” Dr. Schiff said. “Our paper shows that it activates a complex pro-metastatic program in ER-positive breast cancer cells with high FOXA1 and that it works independently of mutations in the ESR1 gene.”

Next steps

Discovering HIF-2α as a unique potential target of endocrine resistance opens up potential new therapeutic options to prevent or treat endocrine-resistant and metastatic disease. In fact, a drug that specifically targets HIF-2α is currently in clinical trials for advanced kidney cancer and a type of brain cancer called glioblastoma.

Dr. Schiff’s team will now test their findings in laboratory models of endocrine resistance and metastases.

“Our goal is to identify the FOXA1 program that is driving this effect, so that we can develop an effective strategy,” she said. “It’s never about targeting just one protein. Tumor cells will find a way around one target. We have to be able to shut down the program.”

Dr. Schiff is optimistic the HIF-2α inhibitor that is currently in clinical trials for other cancers will be effective for some breast cancers, but it will be important to identify biomarkers to determine what patients will be most likely to benefit. Part to this work is being done through her collaborations with BCRF investigators and others at Dana Farber (Myles Brown, Rinath Jeselsohn, and Nikhil Wagle) and Memorial Sloan Kettering Cancer Center (Jorge Reis-Filho) who are helping validate her laboratory findings in clinical samples.

What does this mean for patients?

While ER-positive breast cancer is very treatable and has a very good five-year survival rate with early diagnosis, this type of breast cancer can return many years later. These late recurrences suggest that there are already micro metastases—tumor cells that have escaped the primary tumor—at the time of diagnosis, even very early diagnosis.

The researchers hope that targeting a FOXA1 program through HIF-2α and other factors may be a strategy to prevent micro-metastases from becoming life-threatening cancers or offer a new option to halt the growth of metastases.

Dr. Schiff credits her BCRF funding not only for this discovery but all the work in her lab.

“BCRF is an enabler,” she said. “There is almost not one paper or one grant that our group has produced in the last 15 years that did not come from BCRF-supported work.”

Confronting Cancer as a Team

 

Ouidad and Peter in a portrait

When Peter Wise and his wife, Ouidad, learned that she had breast cancer in 2004, the couple was devastated. Life had been good to them: They had nurtured a strong 20-year marriage, raised a son and daughter, and, as business partners, successfully launched a chain of internationally renowned salons and a line of hair care products for people with curly hair. It was Ouidad’s dream.

“I admit that some of my first thoughts were a little selfish,” Peter said. “‘What about the kids? What about me?’ I was scared. But I knew that Ouidad and I would tackle this together because we always do. And when we dive into something, we’re in it all the way.”

Ouidad’s diagnosis wasn’t the first time that breast cancer affected their lives. Her mother had died of metastatic breast cancer at 46 years old—the same age Ouidad was diagnosed. Sadly, Ouidad’s mother passed just three months before the couple married in 1984.

With his wife facing the same disease 20 years later, Peter threw himself into learning everything he could about it. The couple sought out several opinions for treatment, and Peter attended every appointment with Ouidad so they could discuss and decide on the path forward together.

After weighing treatment options, Ouidad opted to undergo a mastectomy and breast reconstruction and take tamoxifen, a hormonal therapy. The doctor they chose said it was the best course of treatment given Ouidad’s family history of breast cancer, but it wasn’t an easy decision to make.

“Ouidad is such a beautiful woman, and the idea of losing her breasts was hard for her,” Peter said. “But breasts aren’t what make her a woman."

In addition to providing emotional support, Peter wanted to be hands-on when it came to his wife’s recovery. He met with the doctors and nurses to learn how to provide post-operative care, such as changing her bandages and drainage bags and filling her implants with saline.

“Honestly, it was reassuring for me to be there to help with her care,” he said. “And our family and friends really rallied around us. It a sweet time in our lives in that way. Everyone got closer.”

Thankfully, Ouidad has been in remission since her surgery. But breast cancer still plays a major role in the couple’s lives—this time as a cause. Shortly after Ouidad’s recovery, she and Peter founded Curls for a Cure to support BCRF. To date, they’ve raised more than $575,000 for breast cancer research—and counting.

“Obviously this disease hits very close to home for us,” Peter said. “We wanted to fund research to make sure that our daughter—or anyone—wouldn’t experience what Ouidad and her mother went through.”

He also has words of advice for those whose spouse has been diagnosed with breast cancer: “Embrace it. Embrace the fact that this is a project you need to confront and tackle as a team. Together you can do it. As horrible as the disease is, it made Ouidad and I even closer.”

How Regular Exercise Can Help Reduce Your Risk of Breast Cancer

 

Two women do push ups

Obesity is a major contributor to the nation’s cancer toll and is quickly overtaking tobacco as the leading preventable cause of cancer, according to the American Society of Clinical Oncology, making a healthy diet and regular exercise that much more important.

Exercise has many benefits—but chief among them is maintaining a healthy weight. Regular exercise helps reduce the risk of obesity-related diseases, including cardiovascular disease, diabetes, and many types of cancer, including breast cancer.

The link between breast cancer, body weight and exercise

Breast cancer and obesity are both on the rise worldwide and, interestingly, the two diseases are connected. Obesity can significantly increase a woman’s risk of breast cancer after menopause, according to the National Cancer Institute. Furthermore, women who are obese at the time of diagnosis have a 30 percent higher chance of dying from breast cancer or other causes in the years following their diagnosis. The American Cancer Society’s 2019 statistics attribute rising incidence rates of hormone receptor (HR)-positive breast cancer—the most common type of breast cancer—to the increasing prevalence of excess body weight.

Remarkably, even dietary choices in childhood and adolescence can have an impact. Studies by BCRF researchers Drs. Graham Colditz, Walter Willett, and others have shown that being overweight early in life increases a woman’s risk of benign breast disease, which can increase her chance of future breast cancer.

The good news is that studies have consistently shown that making lifestyle changes including keeping a healthy diet, losing weight, and doing moderate intensity exercise—just 150 minutes a week or more of aerobic exercise and strength training—can play a role in preventing breast cancer and improving prognosis after a breast cancer diagnosis. It is estimated that a third of breast cancers could be prevented with lifestyle choices, particularly those that help to maintain a healthy weight, including eating a balanced diet and exercising.

Unraveling the obesity-breast cancer connection to improve outcomes

Although the evidence is clear, we do not yet fully understand the connection between exercise, body weight and breast cancer risk. BCRF investigators are working to unravel the biologic mechanisms underlying this relationship and develop effective intervention strategies.

Drs. Andy Dannenberg and Neil Iyengar have identified inflammatory markers that may predict risk of breast cancer, even in women of normal weight. A study, led by Dr. Stephen Hursting, is examining the effect of a combination of diet, exercise and anti-inflammatory medication in reversing breast cancer risk. Dr. Anne McTiernan has launched the first-ever clinical trial to test the immediate effects of exercise on breast cancer biomarkers related to inflammation and blood vessel formation. Drs. Melinda Irwin and Vered Stearns are looking at the importance of weight loss after a breast cancer diagnosis, and early findings have shown that exercise, good nutrition and guided weight loss are effective strategies to improve outcomes and decrease the risk of recurrence.

Ultimately, understanding the impact of exercise, diet, and weight loss on breast cancer risk could lead to the development of personalized and more effective prevention strategies, like specific diet and exercise plans.

Navigating Intimacy and Sex After a Breast Cancer Diagnosis

 

Couple holding hands in front of a sunset

Valentine’s Day is a celebration of love and intimacy, but a breast cancer diagnosis can make it feel like anything but.

Once she gets beyond the words “You have breast cancer,” a newly diagnosed patient faces a barrage of information. “One day at a time” turns into weeks and months of treatments, scans and follow-ups. Navigating life after breast cancer comes with its own complications.

Breast cancer therapies, though lifesaving, have both short- and long-term effects on our physical and mental wellbeing. For many women, maintaining some semblance of normalcy amidst all that has changed—a woman's hair, her figure, her energy level, her libido—can be as overwhelming as the diagnosis itself.

For young women facing a breast cancer diagnosis, issues around intimacy are particularly important. BCRF Investigator Dr. Ann Partridge, professor of medicine at Harvard Medical School and director of the Adult Survivorship Program at Dana-Farber/Brigham and Women’s Cancer Center, says women who have been diagnosed with breast cancer feel physically, and more often, emotionally uncomfortable with the look and feel of their chest/breast area after treatment.

“It is so important for them to be patient with themselves as they adjust in their survivorship,” Dr. Partridge said. “It may be helpful to speak to a mental health provider, particularly someone who specializes in sex and intimacy after cancer.”

Talk about your symptoms

Conversations about sex and intimacy might already be uncomfortable topics to discuss with a physician. More importantly, a woman may not even associate difficulties with sex and her breast cancer treatment.

But women face a variety of issues and symptoms that can interfere with their relationships and sex lives during and after breast cancer treatment, including body image concerns (such as scars, hair loss and loss of breasts) and changes to their sexual health and comfort (like vaginal dryness or loss of libido resulting from hormone treatments). Young women may face complications such as the loss of ovaries or chemotherapy-induced premature menopause.

There are remedies for some symptoms, including loss of libido, vaginal dryness, pain during sex, and depression, which could be underlying factor in a loss of interest in sex. But your doctor needs to know what you are experiencing.

Although doctors are encouraged to ask their patients about all potential side effects of treatment, including changes in sexual intimacy, it is important to speak up about anything you are experiencing. Even if your doctor doesn’t have the answers, he/she will be able to refer you to someone who can help.

Pay attention to your mental health

According to the AACR/ASCO Survivorship Care Guidelines, 22 percent of breast cancer survivors report experiencing depression and anxiety. These conditions can negatively impact intimacy and libido.

The risk of depression is even higher in younger patients. Since symptoms of depression are not often clear, the patient and her doctor may not immediately recognize them. A person may just feel that things are different and express a desire for life to return to “normal,” but may not be able to put these changes into words.

Depression can often be treated with therapy and, in some cases, medication. Be sure to tell your doctor if you’ve experienced a loss of interest or pleasure in doing things, feelings of hopeless, guilt or depression, a lack of energy, any changes in appetite or anything out of the ordinary.

New challenges in relationships, intimacy, and sex are common after a breast cancer diagnosis and treatment. But talking about your concerns with your doctors, partners, and loved ones can help.

For additional information about breast cancer and relationships:

Craft Store Owner Uses Her Creative Skills to Fund BCRF’s Researchers

 

April (left) at her decked-out store wearing pink

For the tenth year in a row, April Barnes made her O’Fallon, Illinois-based store, Three Sisters Crafts, as pink as possible for a fundraising party that raised more than $3,500 for BCRF.

“I love parties and I’m a pretty good hostess, so I love doing it,” Barnes said. “It’s a way of making a little bit of difference in my community.”

At the Three Sisters Annual Pink Party, held this past Saturday, guests sipped on pink punch and ate pink, cherry-flavored cookies, made pink- and pink ribbon-themed crafts and heard from speakers who have been diagnosed with breast cancer. Games like “breast cancer bingo” aimed to educate.

“Instead of calling out letters and numbers, we asked a question about breast cancer and people looked for the answer on their cards,” Barnes explained. “We gave them the answer in order to improve their knowledge of the disease.”

While her yearly party is a lot of fun (and Saturday’s event was no exception), Barnes was inspired to create the event following a somber life event: the death of her close friend Pat McKelvey—who she calls “my heart and soul”—from breast cancer 15 years ago.

“We hadn’t actually known each other for very long, but she was one of those people you click with right away,” Barnes said. “She was always trying to remind me to slow down because there was more important stuff than working all the time. I was really devastated to lose her.”

Rather than hold the event during Breast Cancer Awareness Month in October, Barnes chose February “when everything is pink” in her store for Valentine’s Day. Every year, friends and members of the community help her organize the party, make refreshments, and obtain raffle prizes ranging from hot pink Tupperware to box-seat tickets to a St. Louis Cardinals game.

The pink party is always well attended, and Barnes often surpasses her fundraising goal. Even people who can’t come to the event still make donations—and they’re often larger than the party’s $20 entry fee.

Her most cherished participants, she said, are breast cancer survivors—and her friend Pat’s widow.

“At first I’d hesitated to tell him that I’d created the pink party in Pat’s honor because I wasn’t sure how he’d take it,” she said. “But he was really touched, and he makes a big donation every year. He always comes to the event with his granddaughters, who have a great time and understand that everything that’s going on is for their grandma.”

Run with Team BCRF in the 2020 TCS New York City Marathon

 

Marathon runner on Team BCRF

For the ninth year in a row, BCRF has 15 spots in this year’s TCS New York City Marathon on November 1st. Each season, we are honored to have Team BCRF runners take on the challenge of participating in this monumental race to support breast cancer research.

For those interested in applying to be on Team BCRF in the 2020 TCS New York City Marathon, please fill out the application form and take note of the conditions below.

Each participant is required to raise a minimum of $3,000 for BCRF. In return, the race entry fee will be waived and each runner will be provided with a Team BCRF shirt, as well as pink ribbons and bracelets to advance their fundraising efforts.

All applications must be received by April 1, 2020 and will be reviewed on a first come first serve basis. The names of selected runners will be announced no later than April 15, 2020.

For any additional questions, please email Christine Ward at cward@bcrf.org.

Research Is the Reason I Can Help Others

 

Every year Ouidad—a renowned hair stylist who created a company that bears her name—gets a mammogram around the time of her birthday. It’s a routine rooted in loss. Her mother died of metastatic breast cancer when Ouidad was 25 years old.

“After my mom passed away, I felt it was vital to take care of myself,” she said.

In 2002, after her annual mammogram, Ouidad received a call to come back for a biopsy. The test later revealed she had breast cancer. At the time she was 46 years old, the same age her mother was when she died from the disease.

“It was a shock,” Ouidad said. “But I was determined to make sure my kids wouldn’t grow up without their mom.”

She underwent a bilateral mastectomy and was put on tamoxifen for five years. After her diagnosis and treatment, Ouidad remained committed to her health but also saw an opportunity to help others through her company.

“My diagnosis changed my life and it changed our business,” she said.

As a hair stylist, she had witnessed other women with breast cancer lose their hair during treatment. Her own experience with the disease gave her a new perspective on this loss, and she decided to make it a priority for her employees to address the unique needs of this community.

“It put me in different paradigm,” she said. “It empowered me and my team to help others going through a breast cancer diagnosis and treatment.”

For Ouidad, this extended to advancing breast cancer research as well. Her company has supported BCRF’s mission for 15 years, first through her company, Ouidad, and most recently through her Curls for a Cure donation program, which she promotes year-round.

“I think research is changing the world,” she said. “It changed mine. I’m a result of research.”

She hopes her company’s commitment to BCRF’s mission will give her a chance to leave a lasting legacy beyond the one she has maintained professionally.

"When I’m gone, I want people to say ‘She's the one who helped her clients emotionally through a tough time in their lives,’" she said.

“Research is the reason I can help others.”

 

 

Imagining a World Without Breast Cancer

 

Imagining a World Without Cancer

Breast cancer is a global issue. It is the most common cancer diagnosed in women worldwide and the leading cause of cancer deaths. In the U.S., the incidence of breast cancer has been stable for the last two decades and deaths have dramatically declined, but both incidence and deaths have increased in developing countries in Africa, Asia, and Latin America. Globally, an estimated 2 million new breast cancer diagnoses and 262,700 breast cancer deaths occurred in 2018.

Building capacity to improve breast cancer outcomes in Nigeria

When Dr. Olopade, a native of Nigeria, returned to the country to study breast cancer, she found there was no infrastructure, no electricity, no human capital. In addition, she was faced with a lack of awareness of and treatments for breast cancer.

“At that time, the health care priorities in Nigeria were treating and preventing infectious diseases. There was no word for cancer,” she said. “No one knew what to do with cancer and there were no treatments available.”

Since then, Dr. Olopade has been working to change all of that. With BCRF support, she established the Nigerian Breast Cancer Study, a trans-Atlantic collaboration focused on improving the quality of breast cancer care in underserved, low-resource communities through rigorous science, technology, and research infrastructure. These efforts have supported the establishment of a highly trained clinical care staff, a cancer risk clinic for genetic counseling and testing, and a platform for clinical trials.

This year the Nigerian Breast Cancer Study group is launching the first multicenter clinical study in Nigerian women with HER2-positive breast cancer. The study, which will enroll patients across four clinical sites in Nigeria, will be the first to examine neoadjuvant (pre-surgical) chemotherapy plus HER-directed therapy in a Nigerian cohort. The goal of the study is to determine whether some women may be spared additional chemotherapy after surgery.

“The clinical trial infrastructure established with support from BCRF will become increasingly important in Nigeria and across Sub-Saharan Africa, as there is currently no affordable standard of care for women in the region,” Dr. Olopade said. “With funding from BCRF, we will continue to develop a strong clinical research infrastructure, which can be used to further strengthen the country’s capacity to address and respond to emerging cancer care needs.”

Bringing clarity to the disparity in breast cancer risk and outcomes for women of African descent.

While Dr. Olopade’s success in Nigeria is fostered by collaborations within and between countries, scientific and technology breakthroughs in genetics, tumor pathology, and molecular profiling have been crucial to advancing our understanding of breast cancer risk in women of African descent across the diaspora.

It was with these tools that Dr. Olopade and her collaborators began to understand that the poor breast cancer outcomes in African-American women compared to white women have a biological underpinning (African-American women diagnosed with breast cancer in the U.S. are 40 percent more likely to die of their disease than white women.)

“We would see African-American women in our Chicago clinic with advanced breast cancers and attribute it to late diagnoses,” Dr. Olopade explained. “What we’ve learned is that many of those advanced cases were caused by aggressive disease, such as triple negative BRCA-driven and HER2-enriched breast cancers. This made me wonder if the same was true for breast cancers in Nigerian women.”

In collaboration with BCRF researcher Dr. Mary-Claire King, Dr. Olopade performed genetic analysis of Nigerian women with breast cancer. The results, published in the Journal of Clinical Oncology in 2018, did indeed reveal inherited mutations in BRCA and related genes in 12 percent of breast cancer cases, suggesting higher risk of aggressive breast cancer. The team followed that work with a collaboration with Novartis Institute for Biomedical Research, which found that 30 percent of these women had HER2 enriched breast cancers but lacked access to life-saving trastuzumab. The majority of women in the world diagnosed with HER2-positive breast cancer die from the disease because they have no money to pay for trastuzumab and have no health insurance to cover high-quality treatment.

Today, Dr. Olopade and her international colleagues are leveraging the infrastructure, training, and resources to improve the care of breast cancer patients across the diaspora. With BCRF support and a broad network of collaborators, she is seeking to understand the biology underlying the aggressiveness of breast cancers in women of African ancestry in comparison to women of European ancestry and identifying biomarkers that can be used to optimize more effective, less toxic therapies in low resource settings in the US and Nigeria. 

“We have to imagine a world without cancer, where skilled people are deploying disruptive and innovative tools to treat cancer patients where they live,” she said. “If the tools, medicines, and resources available to patients in the U.S. and other high-income countries were available in low resource communities like those in Nigeria, we could save millions of lives. We must be in solidarity to have a world without breast cancer.”

This year, Dr. Olopade is the recipient of BCRF’s The Estée Lauder Companies’ North America Manufacturing & Distribution and Global Research & Development Award and The Ulta Beauty Award.

SABCS Annual Symposium 2019: Preventing and treating hormone receptor-positive breast cancer

 

The San Antonio Breast Cancer Symposium (SABCS) is the largest breast cancer meeting in the world. BCRF staff attends SABCS every year to hear updates on the latest breast cancer research, connect with BCRF researchers, and represent BCRF at advocacy events.

Highlights of the 2019 meeting, held on December 10th to the 14th, included updates on the treatment of ER-positive breast cancer and the prevention of recurrence:

Patients with high-risk estrogen receptor (ER)-positive breast cancers may be able to forgo chemotherapy prior to surgery.

ER-positive breast cancer, also referred to as luminal breast cancer, is the most commonly diagnosed form of the disease. When detected early, it typically has a very good 5-year prognosis. But not all luminal breast cancers have the same favorable prognosis. Luminal B breast cancer is typically more aggressive than luminal A breast cancer, and for this reason it is often treated with chemotherapy before surgery (neoadjuvant therapy).

The SOLTI-1402/CORALLEEN study (NCT03248427) is a Phase II study that aims to test whether neoadjuvant therapy with an anti-hormone drug (letrozole) plus a CDK4/6 inhibitor is just as effective in reducing the risk of recurrence as multi-drug chemotherapy in women with high-risk luminal B breast cancer. The investigators used the Prosigna® test (also known as PAM50) to determine a risk of relapse (ROR) score at the time of surgery.

Reporting at SABCS, the study investigators said they were encouraged to see similar clinical benefit (low ROR score) between the two therapeutic strategies and fewer side effects with the non-chemotherapy treatment. While these preliminary results need to be confirmed in additional studies and patient follow-up, the study also demonstrated the utility of molecular diagnostics in guiding treatment and assessing treatment response. This study was supported in part by BCRF and was published in The Lancet Oncology.

Breast cancer prevention benefits of aromatase inhibitor therapy continue long after stopping treatment.

Anti-hormone therapy with tamoxifen or an aromatase inhibitor (AI) is an effective prevention strategy in women at high risk of breast cancer or a breast cancer recurrence. The International Breast Cancer Intervention Study (IBIS-II) was designed to determine whether 5 years of the AI anastrozole can safely and effectively prevent breast cancer in postmenopausal women with a high risk of the disease as determined by family or personal history or presence of breast density. In the study, 3,864 high-risk women were randomized to receive anastrozole or placebo for 5 years.

The results, presented at SABCS by BCRF investigator, Jack Cuzick, PhD, FRS, CBE, reported on the incidence of breast cancer after a median of 10.9 years of follow-up, starting after treatment ended. The latest results confirmed earlier reports at 7 years of follow-up that 5 years of anastrozole reduced the risk of estrogen receptor-positive breast cancer by 54 percent. These results further support the use of anastrozole for prevention of ER-positive breast cancer in high-risk postmenopausal women.

To read more of our coverage from SABCS 2019, click the links below:

BCRF Researchers Honored at the 2019 San Antonio Breast Cancer Symposium

Highlights from SABCS Annual Symposium 2019: HER2-Positive Breast Cancer Updates

Highlights from SABCS Annual Symposium 2019: Examining the future of immunotherapy for breast cancer

Highlights from SABCS Annual Symposium 2019: Determining the Risk of Recurrence in Early-Stage Breast Cancer

New Study Shows That Sustained Weight Loss in Women Over 50 May Lower Risk of Breast Cancer

 

In a study supported in part by BCRF, researchers found that women over the age of 50 were less likely to be diagnosed with breast cancer if they lost weight and kept it off.

“We found that sustained weight loss of 10 pounds or more was associated with a 25 to 30 percent lower risk of breast cancer compared to women with a stable weight,” explained Walter Willett, MD, DrPH, BCRF investigator and co-author of the study. The effect was greatest in women who were initially overweight or obese.

The study, published in the Journal of the National Cancer Institute, combined data from 10 large prospective cohort studies from the U.S., Australia, and Asia (totaling 180,885 women) to examine the effect of weight loss in healthy women after age 50 on risk of breast cancer. The women provided at least three body weight measurements between 1996 and 2004. Weight loss was categorized as stable weight (less than 4.5 kg* lost), moderate weight loss (between 4.5-9kg), and significant weight loss (more than 9kg).

Key findings of the study

  • Women who had a sustained weight loss of two or more kilograms (roughly 4.5 pounds) had a lower risk of breast cancer compared to those with a stable weight. The benefit in reduced breast cancer risk was greater with larger weight loss.
  • Sustained weight loss of five or more kilograms (11 pounds) was associated with 32 percent lower risk compared to women with stable weight. Even when women gained some of the weight back, those who lost at least 11 pounds still had the lowest risk of breast cancer.
  • There was no effect of weight loss in women using hormone replacement therapy (HRT).

Strongest data to date on the benefit of weight loss and breast cancer risk

Many studies have shown that excess body weight after age 50 increases the risk of breast cancer, which is not surprising because excess body fat is a major source of estrogens in postmenopausal women. This is the strongest data to date to demonstrate the benefit of weight loss in reducing breast cancer risk, and it further suggests that obesity-associated breast cancer risk can be reversed with sustained weight loss.

“These findings provide strong evidence that even after age 50, women who are overweight or obese can reduce their risk of breast cancer by modest, sustained weight loss,” Dr. Willett said.

Because the study combined multiple smaller cohorts, it had the power to identify associations of weight loss and breast cancer risk that may not be detected in smaller studies. Additionally, this is the first study to look at weight loss after age 50 and breast cancer risk, providing evidence that it’s never too late to lose weight and reduce risk.

Understanding obesity and breast cancer risk

Obesity is a growing epidemic not only in the U.S.—where more than 2 out of 3 adult women are overweight or obese (BMI over 25 or 30, respectively)—but globally as well. The World Health Organization estimates that 40 percent of adult women worldwide are overweight. The obesity epidemic is expected to spread as low-resource countries become more affluent and adopt Western diets and lifestyles. Thus, the rise in breast cancer and other obesity-related chronic disease is expected to increase. The findings from the study suggest that weight management can help prevent breast cancer from becoming an epidemic as well, in addition to many other well-documented benefits, such as reducing the risk of heart disease and type 2 diabetes.​

Caveats

The study does not show cause and effect, and the authors stress that further studies are needed. The results do not suggest that losing weight will prevent breast cancer in all women.

“These new findings—combined with the known connections between body weight, blood estrogen levels, and breast cancer risk—provide strong evidence that even moderate weight loss later in life can tip risk of breast cancer in a favorable direction,” Dr. Willett explained. “Doing this by increasing physical activity and choosing healthy foods and beverages will have many other benefits as well.”

BCRF researcher Kala Visvanathan, MBBS, FRACP, MHS, was also a co-author of this study.

 

* A kilogram is equal to 2.2 pounds.

Highlights from SABCS Annual Symposium 2019: Determining the risk of recurrence in early-stage breast cancer

 

The San Antonio Breast Cancer Symposium (SABCS) is the largest annual meeting dedicated to breast cancer research. Each year SABCS attracts thousands of experts from around in the world in clinical oncology and basic and translational research, as well as representatives from industry, government, and patient advocacy.

At the meeting, researchers presented findings from two studies aimed at predicting recurrence in patients with early-stage breast cancer:

Circulating tumor (ct)DNA may predict recurrence in patients with triple negative breast cancer

Triple negative breast cancer (TNBC) is an aggressive disease with a high rate of recurrence. In many cases, patients with TNBC will undergo treatment before surgery (called neoadjuvant therapy) to reduce the tumor size.

In a study of 196 women with early-stage TNBC, investigators from Indiana University collected blood samples from patients with residual disease after neoadjuvant therapy to examine mutations in ctDNA. After 2 years of follow-up, those patients with detectable ctDNA after neoadjuvant therapy had a worse prognosis. The study authors will use this information to stratify patients in a clinical trial planned for 2020 to further test whether ctDNA may be used to guide treatment decisions in patients with early-stage TNBC. Read more about the study here.

Residual cancer burden is an important indicator of outcome across breast cancer subtypes

In a study reported by BCRF investigator Fraser Symmans, MD, and supported in part by BCRF, residual cancer burden was prognostic of patient outcome after neoadjuvant (pre-surgical) therapy. Residual cancer burden (RCB) is estimated from routine pathologic sections of the primary breast tumor site and the regional lymph nodes after the completion of neoadjuvant therapy.

Dr. Symmans and his team devised a calculation of RCB to determine the RCB index: RCB I (minimum cancer burden); RBC II (moderate burden); and RCB III (extensive burden). He and colleagues from the I-SPY Clinical Trial Consortium compiled data from 12 cancer centers or clinical trials representing over 5,000 patients and found that the level of RCB index (I, II, III) correlated with patient outcomes after 10 years of follow-up, with those with the highest RCB index having the worst prognosis. The results were consistent, regardless of cancer subtype.

While the RCB index isn’t uniformly used across cancer centers, standardization of RCB could make it a useful tool in determining long-term prognosis. Read more about the study here.

To read more of our coverage from SABCS 2019, click the links below:

BCRF Researchers Honored at the 2019 San Antonio Breast Cancer Symposium

Highlights from SABCS Annual Symposium 2019: HER2-Positive Breast Cancer Updates

Highlights from SABCS Annual Symposium 2019: Examining the future of immunotherapy for breast cancer

 

BCRF Researcher Finds That Antioxidant Supplementation During Chemotherapy May Worsen Outcomes

 

Studies have shown that the use of nutritional supplements, as well as other types of alternative therapy, has increased as patients seek less toxic and more holistic approaches to health. However, a new study conducted by BCRF investigator Christine Ambrosone, PhD, Professor and Chair of the Department of Cancer Prevention and Control at Roswell Park Comprehensive Cancer Center in Buffalo, NY, has revealed new evidence supporting recommendations against the use of one type of alternative therapy—antioxidant supplements—during chemotherapy.

Chemotherapy is a standard component of most cancer treatments and is very effective at killing cancer cells. A number of chemotherapy agents work through the generation of inflammatory molecules called reactive oxygen species (ROS) that are toxic to cells. Antioxidants reduce ROS, which is a good thing—but not when the goal is to kill cells. There has been concern that supplemental antioxidants, which patients may take for their purported health benefits, can counter the effect of chemotherapy by reducing ROS.

The study, called Diet, Exercise, Lifestyle and Cancer Prognosis (DELCaP), was conducted within a clinical trial led by SWOG Cancer Research Network (S0221) to compare chemotherapy dosing regimens in newly diagnosed patients with high-risk breast cancer. Patients received the same drugs but at different dosing regimens to see if one dosing schedule was more effective than the other.

Patients participating in the DELCaP study were asked to complete a questionnaire about supplement use, diet, exercise, and other lifestyle factors at the beginning of the study and after completion of chemotherapy. 1,600 patients were enrolled; the study, published in the Journal of Clinical Oncology, included 1,134 patients who completed both surveys.

The key findings: Continuous antioxidants use, but not multivitamin use, was associated with worse outcomes.

  • Patients who took supplemental antioxidant (vitamins, A, C, E, carotenoids, coenzyme Q) before and during chemotherapy had a 40 percent increase in the risk of experiencing a recurrence or death than those with less frequent antioxidant use.
  • Antioxidant use had no effect on outcomes when taken either before or only during chemotherapy. The continuous use seemed to be a factor in causing worse outcomes.
  • Multivitamin use did not affect outcomes and in some cases may have attenuated the adverse effect of antioxidants.
  • Supplemental vitamin B-12 and iron were strongly associated with disease progression and death.

Other studies have looked at supplement use and cancer outcomes, but none have studied supplement use specifically during chemotherapy. This is the first study to assess supplement use before, during, and after chemotherapy with a median follow-up of over 8 years. Another strength of Dr. Ambrosone’s study is that it was conducted in the context of a clinical trial where all patients received the same drugs.

The researchers were somewhat surprised by some of the findings. They hoped that a clinical trial of more than 3,000 patients would be an excellent opportunity to assess the effects of supplement use on patient outcomes. What they found, however, was that the number of patients taking antioxidants was much lower than trends would predict. This hampered their ability to assess the effects of individual antioxidants or to draw firm conclusions.

While there was not enough data to assess individual antioxidants, Dr. Ambrosone’s team found that supplemental vitamin B-12 before or during chemotherapy was strongly associated with worse outcome. The same was true for supplemental iron during chemotherapy.

What’s next? This study was observational in nature and was not designed to determine causation (whether supplement use is the reason some patients had worse outcomes). But it does support a recommendation of caution with supplements, particularly antioxidants, during chemotherapy. Dr. Ambrosone is collaborating with colleagues at Kaiser Permanente Northern California on a prospective study of more than 4,000 women with breast cancer, which collects data on habits at multiple timepoints. This large study may shed some additional light on the effects of dietary supplements on treatment outcomes.

Highlights from SABCS Annual Symposium 2019: Examining the future of immunotherapy for breast cancer

 

The San Antonio Breast Cancer Symposium (SABCS), held on December 10th to the 14th, welcomed thousands of physicians, researchers, patient advocates, and healthcare professionals from around the world. In the field of cancer research, SABCS is among three major annual meetings that provide a forum for researchers across all disciplines to present new and emerging data to the scientific community for open discussion, feedback, and debate.

Here we present updates on the use of immunotherapy for breast cancer.

Atezolizumab, a PD-L1 (checkpoint) inhibitor, was approved in combination with chemotherapy for advanced triple negative breast cancer (TNBC) in March 2019. Efforts are ongoing to determine the efficacy of adding checkpoint inhibitor therapy earlier in treatment—for instance, during neoadjuvant (pre-surgical) therapy. In this setting, patients who achieve a pathological complete response (pCR, or no evidence of tumor at the time of surgery) typically have a better prognosis. For this reason, pCR is a primary outcome in neoadjuvant trials. Updates from two such clinical trials were presented at SABCS.

Preliminary report from NeoTRIPaPDL1 (NCT02620280).

NeoTRIPaPDL1 is a phase III open-label, multicenter trial to test the combination of atezolizumab plus chemotherapy in the neoadjuvant setting in patients with early high-risk and locally advanced or inflammatory TNBC. In preliminary results, the study investigators did not see a significant improvement in pCR with the combination therapy. However, as in the IMPASSION 130 study, which led to the approval of atezolizumab in advanced TNBC, the presence of the PD-L1 protein was the most significant predictor of response. Presenting the results for the study investigators, BCRF researcher Luca Gianni, MD, stressed that while the difference in pCR did not meet certain pre-defined criteria, the benefit of adding atezolizumab may be seen in further analysis.

Findings from KEYNOTE-522 (NCT03036488).

This is a randomized Phase III study evaluating the efficacy and safety of pembrolizumab—another PD-L1 targeted immunotherapy drug—plus chemotherapy compared to chemotherapy plus placebo in newly diagnosed patients with TNBC, also in the neoadjuvant setting. Chemotherapy is standard treatment for TNBC, and studies have shown that TNBC patients who respond well to neoadjuvant chemotherapy have a better prognosis with less likelihood of recurrence than patients with tumors who do not respond.

Results on pCR from KEYNOTE were presented at the European Society for Medical Oncology (ESMO) Congress in 2019. Researchers reported a more than 13 percent improvement with pembrolizumab plus chemotherapy versus chemotherapy alone after approximately 15 months of patient follow-up. Results presented at SABCS were consistent with the ESMO report, showing a significant improvement in pCR across stages of disease including patients with locally advanced disease. The study is ongoing.

Discussion of new immunotherapy studies, including two funded by BCRF.

As we strive to see the same results with immunotherapy in breast cancer that have been reported in other cancers, understanding how patients on immunotherapy are responding will be important. Elizabeth Mittendorf, MD, PhD, from Brigham and Women’s Hospital, discussed the future of immunotherapy in breast cancer and emphasized the BCRF-funded TRIBUTE study. The TRIBUTE study will establish a repository of clinical data, biospecimens, and imaging results that will allow researchers to better understand how immunotherapy is working in the context of routine clinical care and how best to optimize responses to improve immunotherapy in breast cancer.

In the same discussion, Dr. Mittendorf mentioned another BCRF-funded study called AVIATOR. This study is funded through the BCRF Drug Research Collaborative and led by Ian Krop, MD, PhD, at Harvard Medical School. AVIATOR is bringing immunotherapy to other subtypes of cancer, in particular HER2-positive breast cancer. This trial is the first to combine targeted HER2 therapy with immunotherapy and will provide important predictive biomarker data.

In 2019-2020, BCRF is supporting 55 projects, more than $14.5 million, aiming to advance immunotherapy in breast cancer.

Racial Disparities in Breast Cancer: Why They Persist and How to Narrow the Gap

 

In the United States, breast cancer continues to be the most common cancer diagnosed among women after non-melanoma skin cancer and is the second leading cause of cancer death. It is estimated that more than 268,600 new cases of invasive breast cancer and 62,930 new cases of non-invasive breast cancer were diagnosed in women in the United States last year. While there has been an overall 40 percent decline in breast cancer deaths over the last 30 years—thanks to progress in awareness, early diagnosis, and treatment—there is a persistent mortality gap between black women and white women.

New data from the American Cancer Society concerning racial disparities in breast cancer highlight the need to continue working toward closing this gap. Despite the fact that incidence rates have remained relatively stable since the early 2000s, the disparity in breast cancer incidence between black and white women has widened over that time (though it has remained stable in recent years). While black women have a slightly lower incidence of breast cancer, they have the highest breast cancer mortality rate of any race—a rate 40 percent higher than the rate seen in white women. Among women under 50, the disparity is even greater: The mortality rate among black women is double that of white women. It is clear that the advances in treatment that have dramatically reduced breast cancer mortality have not equally benefitted all groups.

What accounts for the disparity?

The gap in breast cancer incidence and outcome among black women is complex and multifactorial. Social, economic, and behavioral factors may partially account for the disparity. Black women are more likely to have diabetes, heart disease, and obesity, and are less likely to breastfeed after childbirth—all of which are risk factors for breast cancer. They are also more likely than white women to have inadequate health insurance or access to health care facilities, which may affect access to screening, follow-up care, and completion of therapy. Finally, black women are also more likely to live in stressful environments and feel the need to be strong, which may influence their decision to seek medical care. Through continued research, it is becoming increasingly clear that biology also plays a role. Black women are about twice as likely as white women to be diagnosed with more aggressive forms of tumors, such as triple negative breast cancer (TNBC), and they are often diagnosed at more advanced stages.

Working toward a solution

According to the National Cancer Institute, the gap in cancer care can be improved in two ways: by creating statewide cancer screening programs that are accessible to underserved populations and by addressing the biological differences in breast cancer across racial and ethnic groups. A recent study that analyzed characteristics of breast cancer patients on a city level showed that women with more resources (such as education and income) may be better equipped to take advantage of healthcare advances. Indeed, cities that have confronted this problem by increasing access to state-of-the art mammography facilities made significant progress in narrowing the breast cancer mortality gap between black and white women.

The biology of breast cancer is inherently complex, which is why we often hear the phrase, “Every woman’s breast cancer is unique.” While we have made significant progress in understanding the molecular drivers of breast cancer, most studies and clinical trials are in white women. We have only recently been able to decipher some of the underlying biology to explain the higher incidence of aggressive tumors in black women and to identify biomarkers that could ultimately inform personalized therapies and improve outcomes for black women diagnosed with breast cancer.

BCRF is committed to eliminating disparities

BCRF recognizes the continued need for disparities research by fostering the innovative and collaborative science needed to resolve this issue. BCRF investigators are working on understanding the differences in breast cancer biology across racial and ethnic groups. For example, Drs. Christine Ambrosone and Chi-Chen Hong are studying the types of immune cells found in and around breast tumors from both black and white women to determine if they affect tumor aggressiveness. Drs. Funmi Olopade and Dezheng Huo are identifying genetic factors responsible for TNBC in diverse groups of women. Work led by Dr. Charles Perou and BCRF collaborators has uncovered differences in biology in breast tumors of black women compared to those in white women that may be targetable to decrease the disparities in breast cancer outcomes. Dr. Fergus Couch has identified inherited mutations in breast cancer susceptibility genes that confer an increased risk of TNBC and may be important for screening in high-risk black women.

A deeper understanding of tumor biology and its variations among people holds the promise to improve prevention strategies, early detection, and treatment of breast cancer. BCRF continues to work towards this goal.

Investigating Breast Cancer: Unraveling Metastatic Breast Cancer

 

Metastasis, the spread of cancer cells from the breast to other sites in the body, is responsible for nearly all breast cancer deaths. Approximately 150,000 men and women are diagnosed with metastatic breast cancer each year. Today, BCRF is the largest private funder of this critical area of research.

Dr. Martine Piccart is passionate about metastasis research and the vital role that international collaboration plays in her work. A BCRF investigator since 2004, Dr. Piccart’s research aims to better understand the origins of metastatic breast cancer and how it evolves. Through the Breast International Group (BIG), she oversees the AURORA-EU study, the Belgium-based arm of the Evelyn H. Lauder Founder’s Fund for Metastatic Breast Cancer Research. Named for BCRF’s founder, the Founder’s Fund is a multi-year, international collaboration. In 2019, AURORA-EU presented findings on the molecular differences between metastatic cells and other tumor cells, revealing a new avenue of research including the potential for targeted treatments.

Dr. Piccart is Professor of Oncology at the Université Libre de Bruxelles, Belgium, and Director of Medicine at the Institut Jules Bordet. She is also the co-founder and chair of BIG, which unites 55 academic research groups from around the world, running over 30 trials, and developing numerous research programs.

Subscribe to Investigating Breast Cancer here:


Read the transcript below:

Intro: I’m Chris Riback. This is Investigating Breast Cancer, the podcast of the Breast Cancer Research Foundation and conversations with the world’s leading scientists studying breast cancer prevention, diagnosis, treatment, survivorship and metastasis.

We frequently discuss metastasis, which, of course and unfortunately, is directly related to the overwhelming and challenging role it plays in cancer broadly and breast cancer specifically.

Which is only part of what makes the goal that today’s guest has set for herself so audacious: To understand the origins of metastatic breast cancer and how it evolves.

Why would someone set such a standard? As Dr. Martine Piccart explained to me: She’s frustrated. She is grateful for the advances that have been made to date, for sure – the trials, drugs, therapies, approaches. She also wants more. Like everyone else, she wants the metastasis to end, and to get there, she wants a molecular understanding of the disease. In this outstanding conversation, she explains her passion and how she plans to get there.

More about Dr. Piccart: She is Professor of Oncology at the Université Libre de Bruxelles, Belgium, and Director of Medicine at the Institut Jules Bordet.

She also is co-founder and chair of the Breast International Group, which unites some 55 academic research groups from around the world, running over 30 trials, and developing numerous research programs. As you’ll hear, AURORA – a study to better understand metastatic breast cancer – is the most ambitious of these.

Dr. Piccart is President of the European Cancer Organisation, past-president of the European Organisation for Research and Treatment of Cancer, immediate past-president of the European Society for Medical Oncology and has served on the ASCO Board. She is author or co-author of more than 470 peer-reviewed publications, and among her awards includes the Jill Rose Award, William L. McGuire Award, Umberto Veronesi Award for the Future Fight against Cancer, the 2013 David A. Karnofsky Memorial Award, among others.

Chris Riback: Dr. Piccart, thanks for joining me.

Dr. Martine Piccart: Thank you for giving me the opportunity.

Chris Riback: Can we start with your career goal? I read that it is to understand the origins of metastatic breast cancer and how it evolves. Now what really interests me about that is for most of us, but perhaps too many of us, our goals usually center on the end of the journey, rather than trying to understand the beginnings. Your mind or at least your approach seems to work differently, why is that?

Dr. Martine Piccart: Okay. Let me try to explain to you what is behind. I have been treating women with breast cancer now for 30 years, and I am still very frustrated that we are unable to offer cure for women whose disease relapses in distant organs. Clearly I've seen progress in the disease with the development of some great medications. These drugs help patients to live longer and live better many times with the disease. But at the end of the day, we don't cure any of these women. My frustration comes from the fact that we basically understand nothing about metastatic breast cancer. We don't know why the disease in some patients, for example, comes back in bones and stays there for several years and suddenly one day, it will go to the liver, the lungs and obviously become life-threatening. Then in other patients, the disease will immediately attack different organs at the same time.

These patients will present with disease in the liver, in the lungs, sometimes in the brain and in the bones. Our molecular understanding of this disease is minimal and the clinical trials run today, the most efficient ones, are run by pharma. Pharma is of course, taking metastatic breast cancer as a kind of laboratory to test new drugs. This is good, this is essential because this is also why we've better drugs certainly today than the ones available when I started my career 30 years ago. But what I think is clearly missing is the molecular understanding of this disease. We do have fantastic technological tools to try to understand what's going on, but we have never applied them in a consistent fashion and on very large number of patients. Because what complicates the job is that breast cancer is not one disease but several very different diseases.

We need therefore, to do the study on relatively large subgroups of patients. When I had this idea that it was time to do something better for these women, I was extremely lucky that I could very easily convince the Breast Cancer Research Foundation that this was a very worthwhile research project. But you know when you get money to start something, it helps you to convince other organizations to help you.

Chris Riback: Of course.

Dr. Martine Piccart: The project is the following one. We want to study at least 1000 women presenting with metastatic breast cancer. What we are going to do for these women, and by the way, the program has already entered more than 800 women, so it's moving very nicely forward. We want to go back and recuperate the primary tumor, the original tumor in the breast. Then we want to collect tissue from a metastatic lesion, in the liver or in the lung.

Chris Riback: So the place to where the cancer has traveled?

Dr. Martine Piccart: Exactly. Then there is this other fantastic opportunity which is to just take blood, isolate plasma and there with these new technologies look for genetic material that the cancer cells are releasing in the circulation. Now we can of course detect this genetic material, distinguish the material from the genetic material that normal cells are also spreading in the blood. We can then study this genetic material in-depth so we can find aberrations in the genetic material like mutations. What the program has, which is really unique because there has been several attempts already to confront the analysis of the primary tumor with the analysis of the metastatic lesion using Next Generation Sequencing, that has been done by several teams. But what all BCRF funded program overall does, which is unique, is to follow these women to all their sequential therapies to collect the information on whether or not these therapies have been helping or have not been helping.

Essentially, we followed all these women until the end. At each disease progression, we sample blood once more. We do sequential sampling of plasma to look at the evolution of the genetic material that the cancer cells are spreading. Of course, our hope there is that by studying the longitudinal evolution of the molecular landscape of breast cancer, we might get a better understanding of which changes are driving this metastatic process. Possibly and that's my dream, we could even design strategies to even prevent the metastatic disease to take place. For sure, we are going to find more intelligent ways to treat women with metastatic breast cancer, I'm confident in this. But we might also go one step further and start thinking about some clever preventive strategies. You know that today to prevent the cancer from coming back, we gave to many women chemotherapy or endocrine treatment, or some targeted treatments.

But here, I'm thinking that we could become even more specific and that's what is so exciting about this program. I can tell you that when we ask women whether they are willing to participate, they are all enthusiastic. Even though very often they understand that they might not necessarily benefit from the knowledge that you are going to acquire to this program. But they fully understand that it could help possibly their daughters if they get the disease. It's a very exciting program that was very difficult to initiate because it's a European-based research program, where we have the analysis centralized and we have currently over 60 hospitals participating across 12 countries. At the beginning of course, it was difficult. The physicians got a little bit discouraged because sometimes when you do a biopsy of a metastatic lesion, well, you don't do it well and then the tissue you get is not usable.

Dr. Martine Piccart:  Anyway, there were a lot, a lot of barriers. But after two years, finally the program started to run smoothly. Today, we have every month, 20 fully evaluable patients entering the program. We are not even thinking that we might try to go a little bit beyond 1000 women. Again, because breast cancer is complex and is divided in different entities. Of course, we want to get solid knowledge about each of these entities. That's where we are today. The program is clearly not finished. We have already done an in-depth analysis of the first 381 patients entered in the program, and we are now working on studying the next 300 in-depth because you have to realize that we are not only looking at genetic aberrations. We want to go beyond that, we want to look at the stages of the immune system. So we want to study the microenvironment of the cancer cells in the metastatic lesions. We are also collecting frozen material to do RNA sequencing.

It's going beyond just DNA and trying to finally, perhaps, I hope understand better what is going on and what we can do these women and to offer them hope. Call the program AURORA, because it refers light in the darkness, a program that will offer hope for the future.

Chris Riback: That is an excellent, excellent overview. I understand why you have the end dream that you have and perhaps you will get there. I understand as well the steps in between that you hope and frankly it sounds like expect to reach. There's so much that I want to follow up with you on so many of the things that you just discussed. One of them is your use of the word evolution, because that was the image that was coming to my mind as you were discussing the progression and how you are looking at that initial tumor. Then you are looking as well at the lesion, the metastasis that has occurred someplace else in the body. Then you're continuing to look as the disease progresses hopefully does not progress of course, but as the patient continues to go forward. That sounds like an evolution, and I can imagine that folks may be wondering.

So you can describe in a sense how metastasis works or that it works. You can describe what happens, the cancer travels from one part of the body to another. I think that folks can understand that you don't have a cure for that yet, obviously, that's the work that you're doing. Why is it so challenging scientifically to understand the why? If so many, and you talked about that frustration, if so many people are looking at this and thought about it, and it is such a tremendous challenge, why is the why so hard? Even if we can't fix the why, scientifically, why is it so hard to get that handle on exactly why the metastasis occurs?

Dr. Martine Piccart: Well, I will give you my personal opinion on this. If you look at the research currently done in metastatic breast cancer at all the hospitals, you will very quickly realize that this research is driven by the pharmaceutical industry. Pharma develop drugs and then they think about what is the clinical situation where my new drug can really show an improvement beyond what is available today. That approach means already in itself that you are not looking at the evolution of the disease from the beginning to the end. You are just studying with your new drug a certain clinical situations. For example, is my drug better than what is available today after patients have failed a first-line treatment for the metastatic disease? All the research is done in this way and it is supported by pharma. So investigators, clinicians of course, are desperate about new drugs. They want to go to participate into these trials and clearly, it's important, but the result is also that all the other aspects are neglected.

Nobody has been thinking, why are we seeing an evolution that is, at the end, little? Why is this evolution taking two years in some women and 17 years in others? These kind of in-depth thinking has not happened. Then even if it happens, who is going to pay for that? This is exactly the situation where foundations like BCRF, we could simply not do the work even if you are enthusiastic about the work. I think it's part of what I call academic initiatives without commercial interest, there is no obvious commercial interest, at least in the first place. I imagine that if we find some new things in this program, there could potentially be some commercial exploitation of the findings. But at first glance, this is a very cerebral program and I am not sure that too many commercial enterprises would be interested in supporting it.

I think it's understandable that we have not seen these kind of effort happening before. I've seen that some of my colleagues in the UK are doing a similar program for lung cancer. It's likely to happen for other cancers, but it just beginning. At least in breast cancer, I have not found a similar program yet in the world

Chris Riback: Well, I'm sure if there were one, you would certainly know about it.  Another area that you discussed that as I have read about you makes total sense that it's something that you would incorporate into a project such as AURORA. That is the coordination with multiple doctors and hospitals, and countries. Tell me the importance of that. You have a keen interest, it seems to me it's in fact part of your core philosophy that to make the advances needed in cancer and breast cancer in particular, this is going to be a global... I guess if not global, certainly a Pan-European or a Pan-regional, but it's going to be a global effort. It's not going to occur necessarily just with one person. That seems to be core to who you are and how you approach what you do.

Dr. Martine Piccart: Exactly. Well, I have two personal reasons for that. One is that, when I was 27 years old, so I was starting my studies to become an oncologist, my mother got breast cancer and there I suddenly became aware that they were very important questions regarding the optimal treatment of women with breast cancer that had no answers. I became impatient. I thought, "How is it possible that these essential questions have no answers?" Then the second reason is that of course I am based in Brussels, so I'm Belgian and Belgium is a small country. It is a small country, but it's very open to Europe as you know, because we have the headquarters of the European Union in Brussels. I immediately got interested in international collaboration. I started to work for several years with EORTC, which is a European Organization on the Research and Treatment of Cancer.

I could really feel the power of international collaborations. Of course it's difficult, you lose time at the beginning because it's cumbersome, the administration is very heavy to get all the countries aligned. But the time you lose at the beginning, you recover so efficiently after, you can really do things so much faster. I think patients today, they have not a lot of time to wait for us to become efficient in research. I am really enthusiastic about international research and I have indeed been looking for international collaboration during my entire career. You are right.

Chris Riback: Yes. It is evident in your history. I'm curious, when you were 27 and you got the news on your mother, were you already in science, were already a researcher, a scientist, a doctor?

Dr. Martine Piccart: Yes. I was starting, so I was a physician but I was doing my training to become a medical oncologist, and I was working in a lab to do a thesis on resistance to endocrine treatment. Yes, I was already involved. But I can tell you, I got upset because there were very important questions such as; how many cycles of chemotherapy should my mother receive, and this is a very unpleasant and toxic treatment. At that time, it was not known and in fact, my mother got a one-year treatment with chemo, which we never, don't do anymore today. Because it has been shown in clinical trials that six courses is enough. Then came the question about the duration of endocrine treatment. All these questions that are so important for women because of the burden of the treatment on your daily life, they had no answers. Then I looked and I found clinical trials of a few hundred patients here, a few hundred patients there. All these trials were completely underpowered to answer the question.

Anyway, that gave me the idea that I had to create a very large breast cancer network, which is the Breast International Group.

Chris Riback: Yes. Yeah, it's an extraordinary network. The last thing that I want to follow up with you on from your opening statement and just terrific description of everything that is happening. You talked about the women's willingness to participate. I can tell you, I have heard that in so many of these conversations, there's an all truism almost around the women and the men, the people who participate in these programs, in trials. It is very much a sense, nobody is unaware of the challenges, but it's very much about doing this for others. What is it about that community, what generates that? Do you believe now that you've looked at it for so many years, what generates that sensibility in that sense within that community?

Dr. Martine Piccart: That's an interesting question. Of course, I am not sure I can give a broad answer because I am only treating women with breast cancer so I don't know much about other cancers, in particular, cancers happening in men. But for the women, a clear motivation is of course that, if you get breast cancer, well, the risk for your daughter is there. It might not be a huge one if the disease is not genetic, but the risk is there. That to me easily explains that women with this little disease, metastatic breast cancer, have this fairly strong desire to contribute to something that might make things a lot better for their daughters. It's the explanation that I have out of my experience, let's say.

Chris Riback: Yeah. Well, I do hear about it quite often. You see it and you see it in the women who participate, and it's remarkable. Dr. Piccart, to close this conversation, in listening to you, I'm struck by what feels to me to be a paradox within you but maybe there's a reason or maybe you'll explain it. On the one hand, you do not seem to be a very patient person. You discussed your frustration, you want action, everyone wants action, you want action and you are frustrated. In fact, I came across, I have to find it here but there was a quote I found of yours from 2015. You said the same thing I heard as a 2015 video of you. Where you said you were disappointed in much of the research output because very few biomarkers have been validated for their predictive value.

It struck me when I heard it there. It's striking me when I'm hearing it now. At the same time, you are running a project and working on a project, AURORA, that requires incredible patience. You are watching a disease within hundreds, maybe thousands of people over a period of years in order to work your way backwards to the origins of the disease. How do you reconcile those two sides of you that I'm hearing, the frustration? The fact that on some level, you perhaps and we're all grateful for this, are not very patient. On the other hand, you're running and working on a project that requires incredible patience.

Dr. Martine Piccart: Ah, that's another interesting question. Well, what I can tell you about AURORA and what gives me a lot of excitement and probably also helps me to be a little bit more patient is that of course, we are not going to wait until we have accumulated all the data on these 1000+ women. We are analyzing the material and the clinical data in badges. Already with the first analysis we did, I learned things that I didn't know, and that is what excites me. For example, we found that one in four metastatic breast cancer is displaying alterations in genes that are very important to repair DNA damage. That indicates that probably we are not using, at least for these women; one, four, we are not using the best possible cytotoxic agents that we have to treat them initially. If you look a little bit at guidelines for the treatment of metastatic breast cancer, you will see that the preferred regimen you should start with is a toxin.

Okay, so a general statement, which of course cannot be true because it cannot be the drug that fits the shoes of all the patients, it's impossible. I'm starting to realize that if we get some better knowledge of what's really going on in the cancer cells, we might become a lot better at choosing the best drugs. The best drugs if you have alterations in DNA with their genes, could be, for example, all drugs that are not too much excited about anymore, like Cytoxan. Cytoxan is a very good drug if you have these kinds of alteration. Cisplatin is another good drug. Usually, they are no longer part of the first, even not the second line choice of physicians. The way we practice medicine is okay, but I still have the feeling that we could do a lot better. This program will help us become better doctors.

Chris Riback: Well, I'm sure that it will. I'm not sure that ... You are a great doctor to begin with and luckily for the rest of us, and impatient one. We appreciate your lack of patience and your drive in your work, thank you. Thank you for the work that you're doing, thank you for taking the time to talk with me today.

Dr. Martine Piccart: Thank you.

Highlights from SABCS Annual Symposium 2019: HER2-Positive Breast Cancer Updates

 

Approximately 15 to 20 percent of breast cancers require a protein called HER2 for growth. While HER2-positive breast cancer was once a very difficult disease to treat, there are now several targeted therapies available for this type of breast cancer.

However, many HER2-positive tumors will become resistant to these drugs, and if the cancer spreads to other tissues it is considered incurable. However, strides are being made to extend the lives of patients with advanced (metastatic) HER2-positive breast cancer. The HER2-targeted drugs under investigation—tucatinib and trastuzumab deruxtecan—bring new hope to patients:

HER2CLIMB (NCT02614794)

This is a phase II clinical trial testing tucatinib, an oral HER2-targeting drug, in combination with capecitabine (a chemotherapy drug) and trastuzumab (another HER2-targeting drug) versus the chemotherapy agents alone. The trial investigators reported that the addition of tucatinib resulted in improved overall survival with a 34 percent reduction in risk of death compared to chemotherapy. Importantly, 47 percent of participants in the trial had brain metastases—a group of patients often excluded from clinical trials. Even in this difficult-to-treat population, progression-free survival was increased by 2 months.

Based on these results, the FDA announced Breakthrough Therapy designation for tucatinib with trastuzumab and capecitabine. The results were published in the New England Journal of Medicine.

DESTINY-Breast01 (NCT03248492)

This is a phase II clinical trial testing a HER2-targeting drug, trastuzumab deruxtecan (T-DXd). Like ado-trastuzumab emtansine (T-DM1, trade name Kadcyla), T-DXd is an antibody drug conjugate. This class of drugs combines a HER2-targeting portion that directs the drug to the HER2 on breast cancer cells with a chemotherapy payload.

Presenting at SABCS for the study investigators, BCRF researcher Ian Krop, MD, PhD, reported an objective response rate of 61 percent with T-DXd and a durable benefit in patients with advanced HER2-positive disease who had progressed on multiple prior treatments. Commenting on the findings, Dr. Krop said: “The high rate of durable responses observed with trastuzumab deruxtecan in patients whose cancers had progressed on T-DM1 and other therapies suggests this agent could provide a new treatment option for this patient population.”

More than 50 percent of patients reported adverse events of grade 3 or higher, however, and there were four fatal cases of lung toxicity while on the study. These events will need to be closely evaluated and monitored as studies continue. The results were published in the New England Journal of Medicine.

Based on these results, the FDA subsequently approved T-Dxd (ENHERTU®) for patients with advanced HER2-positive breast cancer whose cancer advanced on other HER2-targeting drugs.

BCRF Supporters Go the Distance for Breast Cancer Research

 

For the seventh year in a row, Ellen Holbrook and Lisa Felder are organizing Pinkathon San Francisco, a fundraising race benefitting BCRF that offers courses ranging in length from 5K to 50K. Since its launch in 2014, the event has raised nearly $27,000 for BCRF, and is now poised to raise $25,000 this year alone.

“Raising more and more money for breast cancer research has been so rewarding,” Ellen says. “Pinkathon is a lot of work, but thinking about the impact the funds will have on ending breast cancer is very motivating.”

The race is deeply personal for her and Lisa Felder, a prominent ultra runner who became her co-organizer in 2015. Running is what initially brought them together: The two met in 2000 when Ellen joined the East Bay Run Team for the Leukemia and Lymphoma Society's Team-in-Training Program, of which Lisa was the assistant coach.

While they bonded over their love of the sport, they also shared another commonality: both are breast cancer survivors. 

Ellen was diagnosed first in 1999. An accomplished long-distance runner, she had completed seven marathons and several triathlons prior to learning she had breast cancer.

“Back then, there wasn’t much discussion about people like me being at risk for breast cancer,” Ellen says pointing to her age, fitness level and lack of family history. “The perception was that it happened to people who are older, overweight, and had relatives who’d had it. But the truth is that no one is immune to breast cancer.”

Ten years after she and Lisa met, Lisa learned she had breast cancer. Her reaction was very similar to Ellen’s.

“I was in the best shape of my life,” recalls Lisa, who has run over 100 ultra marathons and founded her own coaching business, Ultra Fitness Beyond Imagination. “I honestly thought that maybe my doctor had made a mistake. It took a long time for my diagnosis to sink in.”

But ultimately, their shared experiences—and their passion for running—have fueled a commitment to help ensure that the prevention and treatment of breast cancer continues to improve. And they each bring key skills to the table, says Lisa: Ellen is tech-savvy and more of a businessperson, while she has a lot of connections in the running community. Both have helped grow the Pinkathon. Today, about 150 people participate in the race, up from 30 in 2014.

“That’s about as many people as we can handle because the goal has always been to keep expenses low so all the money raised goes to BCRF,” Ellen says. “So we’ve had to come up with new ways to raise more money.”

That has included asking local businesses to donate services that can be raffled off at the race and getting volunteer help from local hospitals. And this year, Lisa was able to secure slots for 9 runners to raise money for BCRF in the Miwok 100K Trail Race, an ultra marathon that takes place in California every spring.

Now, directors of other races are starting to come to her to offer slots for runners who want to raise money for BCRF.

“I’m ecstatic,” Lisa says. “Working on Pinkathon has been such a fun way to contribute to a good cause, and the event just keeps growing.”

To donate to Pinkathon San Francisco and help Ellen and Lisa reach their fundraising goal, click here.

BCRF Researchers Honored at the 2019 San Antonio Breast Cancer Symposium

 

The San Antonio Breast Cancer Symposium (SABCS) is the largest international conference focused entirely on breast cancer. The annual event, which was held last year from December 10-14, attracts thousands of attendees from around the world who participate in a variety of sessions presenting new information on the etiology, prevention, diagnosis, and treatment of breast cancer and premalignant disease.

It is also an opportunity for the breast cancer research community to recognize the accomplishments of those who have had a significant impact on the understanding and treatment of breast cancer. BCRF is pleased to acknowledge the following BCRF investigators who were honored at SABCS this year:

Myles Brown, MD, received the AACR Distinguished Lectureship in Breast Cancer Research. He was recognized for his work in elucidating the action of steroid receptors—including the discovery of hormone receptor co-regulators and their role in gene regulation—which transformed our understanding of steroid receptors, both in normal physiology and cancer development.

Matthew Ellis, MB, BChir, PhD, received the Brinker Award for Scientific Distinction in Clinical Research. He was honored for his seminal contributions in understanding the genomics of breast cancer and drug resistance and for translating that knowledge to improve outcomes in patients and advance personalized breast cancer treatments.

Geoffrey Lindeman, BSC (Med), MBBS (Hons), FRACP, PhD, shared the Brinker Award for Scientific Distinction in Basic Science with his wife and colleague, Dr. Jane Visvader. Both were honored for their contributions in understanding how normal cells and cancer cells develop, including the identification of the clonal lineage of breast cell types in the evolution of breast cancer.

Joseph Sparano, MD, was the 2019 recipient of the William L. McGuire Memorial Lecture Award for his work in clinical and translational research, including his leadership role in the ECOG-ACRIN Cancer Research Group, where he served as study chair on the TAILORx trial. Results from TAILORx were practice-changing in demonstrating the ability of a gene-based tumor assay in selecting women diagnosed with early-stage breast cancer who can forgo chemotherapy. His work has moved the field forward towards more effective and personalized therapies for breast cancer patients.

BCRF also congratulates Celina Kleer, MD (University of Michigan), for being named the 2019 recipient of the AACR Outstanding Investigator Award for Breast Cancer Research, underwritten by BCRF. Dr. Kleer was honored for her pioneering studies that led to key insights into the development of aggressive forms of breast cancer, specifically the identification and characterization of clinical biomarkers and potential therapeutic targets for difficult-to-treat breast cancers.

5 Ways to Reduce Your Breast Cancer Risk in the New Year

 

A New Year’s resolution may be hard to keep – especially when it comes to maintaining a healthy lifestyle. Fortunately, when it comes to lowering your risk of developing breast cancer, there are a number of simple ways to protect yourself. While it’s true that some of the factors that contribute to your individual risk of the disease are out of your control—such as genetics, family history, race, and ethnicity—the lifestyle choices you make play a pivotal role in prevention as well.

We recently spoke with BCRF researcher Dr. Walter Willett of Harvard Medical School. As a global leader who focuses on the intersection of diet, lifestyle and health, his research is aimed at characterizing the impact of diet and lifestyle on health outcomes, especially in relation to breast cancer risk.

To start lowering your risk of breast cancer today, below are his research-backed tips to take into consideration in the new year:

Maintain a healthy weight. Putting on a lot of extra pounds in the early stages of adulthood nearly doubles your chance of developing breast cancer after menopause. But if you’re able to avoid gaining weight, your risk is cut in half.

Eat less red meat. High consumption of red meat is related to a greater risk of developing breast cancer. Aim to consume more plant-based sources of protein, such as beans, nuts, and quinoa.

Serve more fruit and vegetables. Lower intake of fruits and vegetables is associated with breast cancer, particularly estrogen receptor (ER)-negative breast cancer. The USDA dietary guidelines recommend consuming 2 cups of fruit and 2½ cups of vegetables each day.

Limit alcohol. Even moderate alcohol consumption—defined as up to one drink per day for women and up to two drinks a day for men—is associated with breast cancer.

Quit smoking. Make 2020 the year you finally kick cigarettes for good: Several studies have demonstrated a link between smoking and an increased risk of developing breast cancer.

Research Is the Reason My Cancer Was Caught Early

 

Tracy McNeal remembers the morning clearly. The mother of three woke up and felt a pea-sized lump on her breast. She decided to have it checked out immediately.

“While my doctor assured me it was benign—and my initial mammogram was normal—I pushed for additional scans, which revealed the mass was breast cancer,” she said. “I later learned my disease was triple-negative, a subtype you didn’t want to have.”

With no targeted therapies for triple-negative breast cancer, the subtype is often defined by its aggressive nature and limited treatment options. Tracy underwent two surgeries and chemotherapy. She credits research and the early stage of her disease with her positive prognosis. She’s been in remission for nearly three years.

“Every school play and soccer game is a milestone I would have missed if it weren’t for research,” she said. “But more work needs to be done.”

Throughout her treatment course, she continued to live life as normally as possible for her kids. This included working out, which has always been part of her daily routine.

“I felt I was losing so much of myself,” she said describing the challenging times during her treatment. “I was determined to keep this part.”

She regularly posted her home workouts on social media. Her fitness friends--both in person and online--rallied around her, which gave her the boost she needed during her most difficult days.

“It kept me motivated. Exercise proved to be as much emotional support as it was physical,” she said.

Today, Tracy is relishing life in remission with her husband and three daughters. She decided to share her story to advocate for more research into the rare and aggressive form of the disease to prevent more women from following in her footsteps.

“I know I’m one of the lucky ones,” she said. “I feel strong and healthy – and I want more women facing triple-negative breast cancer to get this chance too. Research can make this possible.”

Investigating Breast Cancer: Dr. Ann Partridge

 

For young women, a breast cancer diagnosis presents a unique set of challenges not only due to age but the biology of the disease as well. While a diagnosis under the age of 40 is rare, the disease tends to behave more aggressively. Compared to older breast cancer patients, young women treated for the disease tend to have an increased risk of experiencing emotional distress, treatment-induced sexual dysfunction, and concerns about future pregnancies.

This is where Dr. Ann Partridge steps in. Her BCRF-supported research seeks to understand the complex issues young women with breast cancer face. Dr. Partridge studies the biology behind their breast cancers as well as focusing on how young women make their way through their experiences – whether it’s physical or emotional.  

A BCRF researcher since 2016, Dr. Partridge is co-founder and director of the Young and Strong Program for Young Women with Breast Cancer and serves as the Director of the Adult Survivorship Program at Dana-Farber Cancer Institute and Brigham and Women’s Hospital. Dr. Partridge is Professor of Medicine, Harvard Medical School.

Subscribe to Investigating Breast Cancer here:


Read the transcript below:

Chris: I’m Chris Riback. This is Investigating Breast Cancer, the podcast of the Breast Cancer Research Foundation and conversations with the world’s leading scientists studying breast cancer prevention, diagnosis, treatment, survivorship and metastasis… which just happens to be the topic of today’s conversation.

A breast cancer diagnosis for anyone, of course, can be life-altering. For young women, it can be even more difficult: Not only because of the time in life – finishing school, building careers, raising families – but also the biology: The cancer can be aggressive, and the chances for recurrence significant.

Which is only part of what makes Dr. Ann Partridge’s work so important and remarkable. On the biology, among the areas she studies is the “why”: Why is the cancer so aggressive? But she also focuses on the how: How these young women will make their way through the challenges.

Dr. Partridge is co-founder and director of the Young and Strong Program for Young Women with Breast Cancer, an extraordinary, unique offering that has guided more than 4,500 young women on their journeys through and beyond cancer, offering comprehensive care, support, and education tailored specifically for them.

More on Dr. Partridge: She is a Professor of Medicine at Harvard Medical School and serves as the Director of the Adult Survivorship Program at Dana-Farber Cancer Institute and Brigham and Women’s Hospital. She has been a BCRF Investigator since 2016.

Chris Riback: Dr. Partridge, thanks for joining me. I appreciate your time.

Dr. Ann Partridge: My pleasure, Chris.

Chris Riback:  Breast cancer, of course, presents an incredible challenge and fear for any patient. Let's focus on what you focus on – What is different, maybe harder but definitely different, about breast cancer in younger women? And for purposes of the conversation, and I guess for purposes of your work, how should we define young?

Dr. Ann Partridge: That's a fantastic question to start off. And I completely agree with the first premise, which is a cancer diagnosis and breast cancer specifically is a scary diagnosis. It's scary for women or men of all ages, but it is probably the most scary for our youngest patients. And that's with good reason. And when we think about young, we've seen in numerous data sets over the years, many studies, many populations both in the United States and across the world, that when a young woman develops breast cancer, on average she's more likely to die of it. I mean, that's just the stark reality, even in 2019, and that's not okay. That's not acceptable, right? We need to improve cancer care and breast cancer care specifically, which of course is the mission of the BCRF, for women of all ages and particularly for our most vulnerable, those who are at higher risk of hearing from it again and potentially succumbing to it.

So that's the reality for young women, and that's why they'd be more scared. And young here can be defined at 40 or younger, which is where the data are most robust, the strongest data to support that there's a higher risk of hearing from breast cancer again, and having to fight it again, and potentially dying from it. So that's the stark reality of the age disparity.

And the things that are different for young women, beyond a higher risk of recurrence on average ... It's not true that every young woman's high risk, but on average are that, one, young women are more likely to get the more aggressive breast cancers. So when we think about the buckets of breast cancer, young women are more likely to get the higher grade, HER2-positive or triple negative breast cancers. The incidents, the likelihood of those occurring as women get older go down, and so they're more common in younger women. That's one. Two is young women typically aren't screened. In this country, we don't begin mammogram screening, which is our gold standard screening, and it's the best we've got for populations. It's not perfect, but we don't even begin doing that until women are in their thirties or forties. And so in young women, you're typically getting an unscreened cancer diagnosis, which means the tumors are bigger, and they're more likely to be node-positive. And part of that also has to do with the biology of the tumors they get, those higher risk tumors.

So you've got this double whammy of being more likely to get more aggressive disease, and more likely to have it be more advanced when it's detected for the youngest patients. That's kind of the biology stuff. That's the disease stuff. And then you add on to that, and this is where young women are really different because older women can get risky tumors, and they can obviously be diagnosed with more advanced disease. But young women are diagnosed at a time in their lives when no one expects breast cancer. But women going in for mammography are getting screened for a cancer, right? So they know that they're at risk for it. Young women are just busy, living their lives, trying to start young families, trying to start careers, trying to get through school. And then, wham, they can be hit with a breast cancer. And it's completely unexpected and completely non-normative. It's not something that their friends are facing. And then of course all the treatments and all the side effects. Even if you don't need that much treatment, a young woman having hot flashes at the age of 30 compared to her peers who are out, again, having young families, partying, whatever they're doing, making romance. This is not something that you have peers to support you for or that you remotely expected.

And so this is another area where there is a disparate problem for young women. They're more likely to suffer, even if they're going to survive. And the vast majority will survive their breast cancer, thank goodness. Even though it's worse for young women, they still are most likely to survive and do well in the long run from a disease standpoint. They're more likely to suffer emotionally and socially because of the diagnosis of breast cancer. Those hits occur with beauty, sexual health, fertility, emotional health, anxiety, fears, depression. These are all the things that young women are more likely to have to contend with. So, all of those things come together and just make it just harder for young women to be diagnosed, treated, and then kind of thrive beyond the breast cancer.

Chris Riback: It's quite an overwhelming set of factors. And a couple of things jump out to me. One is, and this seems exactly consistent with what I take from your approach to this challenge. It's an incredible combination of the biology plus the emotional. As we both stated at the top, that's surely the case for everyone who suffers from this disease or any disease. When any of us gets something unexpected and something so potentially dire, that's very shocking to say the least, and there's that combination of biology plus emotion. But you're describing the unique components of it for this segment of the population, and so I want to talk to you about that.

A couple of questions to make sure I'm understanding on the biology portion so that we can level set there. What's the why behind it being, on average, a more aggressive form of breast cancer? So I'm getting the fact that young women won't have mammographies necessarily in practice. And so I get the fact that because of that, when they're noticing breast cancer, when that's coming up, it might then be at a later stage, in a more advanced age, et cetera, et cetera. But why a more aggressive form? Why does that go more towards this audience than not?

Dr. Ann Partridge: That’s the million-dollar question. And to be honest, we're not 100% sure. That's what a lot of our researchers are working on, including myself. That being said, some things we do know that point in the direction of why. One is that young women are more likely to have a hereditary predisposition to their breast cancer. They're more likely to have a BRCA1 or two mutation, or some of the newer genes that we now know predict breast cancer risk and the development of a cancer. And those genes are associated with developing more aggressive breast cancers. So, for example, BRCA1 mutation carriers, it's more prevalent. The hallmark of having a mutation is early onset breast cancer or young age. They're more likely to have triple-negative breast cancer, which is one of our more aggressive subtypes. Young women or people with p53 mutations, which is fortunately rare, are more likely to have HER2-positive breast cancer, which is more aggressive. The good news is we have really good and effective treatment for it these days, but they're more likely. Those tumors tend to be larger, node-positive, and require kind of a kitchen sink approach, on average, for the treatment.

So, some of it's the genetics. And then you know the rest, we're trying to work that out. And there's some really interesting kind of early data suggesting that there may be some kind of deeper genomic changes in the tumors that arise in young women, and that there may actually be some evidence that women who are immediately postpartum, meaning having recently had a baby, that the biology of the cells as the breast changes back to a not postpartum state may increase the likelihood in that short term of a more aggressive biology of cancer. There's some data suggesting that, certainly not ready for prime time to think about with patients yet, but we're to figure that out.

Chris Riback: Two questions then: One, one the genetic factor and that component. Is it proper of me to believe that women who have a genetic predisposition, whose mothers, older sibling, older sisters, aunts, et cetera, grandmothers, that that they would be more likely to potentially get mammograms at an earlier age. And so therefore when you talk about, which I would assume to be the case, that many women don't get them at an early age. We don't give them until 30. Are you talking about a subset who don't have a genetic predisposition, or is it even the case that with a genetic predisposition too many women may be in a situation where they're not getting mammographies at an early enough point? That was one question. I'll ask the other one-

Dr. Ann Partridge: Yes. There are too many women who have family histories who aren't having this discussed, who aren't getting tested, and who aren't getting any screenings, even when they have a hereditary predisposition. And you could be tested and be found positive. In the general  population, just to clarify, the current guidelines for screening range, depending on which group you're looking at, whether it's the US Preventative Services Task Force or the American Cancer Society, range from starting at 45 to starting at 50. So your average person in the population, a proportion of whom will have an unknown hereditary predisposition to breast cancer, they're not even being recommended to get screening until they're beyond the young age of breast cancer. That's one.

Two is, even when we know someone has a hereditary predisposition, and we do start screening, the recommendation is 10 years before the earliest onset of breast cancer. So if a woman with a BRCA1 mutation had a mother who had breast cancer or a father's sister who had breast cancer in her thirties. Let's say we start screening at 25, and we do mammograms alternating with MRIs, which is what we recommend, generally, if she tests positive. Even in that setting, A, our imaging isn't perfect. Mammograms are not great in younger women because its breast tissue is more dense. MRIs are more sensitive, but they're still not perfect. And then the other thing to remember is that screening is not prevention. And so screening might pick it up earlier, yes, but it's still going to be a cancer.

Chris Riback:  You're seeing it there. That is such a, such an important point.

Dr. Ann Partridge: And so that's where we offer women prevention, which is a heavy load too, if they're very high risk. But that's a really hard thing also to offer a young woman when she's, again, in this kind of developmental life stage where the idea of taking breasts off or taking out ovaries when you haven't had your babies yet, especially, for many of these young women. Especially in our society, many women are waiting for lots of good reasons. That's a pretty challenging situation as well.

Chris Riback: Yes. That is not part of the narrative, or the expected narrative, or the desired narrative for anybody, no doubt, particularly at that age.

Dr. Ann Partridge: And the good news is we have lots of supports for these patients. For these women who we call "previvers," who are at risk, we've got lots of work going on to try and support them to make the best decisions for themselves, whether it be prevention or monitoring, and aim for early detection, if they're ultimately going to get a cancer. And then, of course, once women develop the disease, if they're destined to, to get them through and beyond. So I don't want to be all gloom and doom here. It's just it's a tougher fight, and you need more to support our younger patients.

Chris Riback: And I want to ask you about some of those efforts, of course, particularly your programs. “The Young and Strong Program for Young Women with Breast Cancer,” which by the way, that's just great branding, young and strong.

Dr. Ann Partridge: Thank you. Came up with by one of my patients, by the way. One of my patients came up with that.

Chris Riback: I hear that. So you do get so many scientists, researchers, doctors, caregivers do get great feedback and insights from their patients. I have heard that. So, that's terrific. And I'm sure you share all of the royalties off of merchandise and all the selling of stuff.

Dr. Ann Partridge: Yes, if only.

Chris Riback: Yes, I know.

Dr. Ann Partridge: That part, we need some help with.

Chris Riback:  I understand. And I'm teasing, of course.

Dr. Ann Partridge: Thank you BCRF, given our lack of ability to get our own royalties in this world… at least in the clinical side.

Chris Riback: That's not what we're looking to you for. We're looking to you for the science and the research. So I wanted to ask you about that. I wanted to ask you about the Adult Survivorship Program. I had just one other question about the biology that you were talking about, and that was the postpartum situation and the way the tissue, the cells change as the breast returns. You said it differently, afterwards and the changes that go on. Is that aligned with genetics, with family history? Or is what you're describing there, that's kind of irrespective to family history, and therefore that's a period to be aware of, separate from the family history question?

Dr. Ann Partridge: That's a fantastic question. And the answer is probably. Right? If you're higher risk, then any perturbation, any change that promotes a cancer is probably going to be more likely to promote it in a person who's higher risk because of genetic instability or inability to repair genes, which is the problem with genes like BRCA1 and BRCA2 mutations, but that has not been specifically looked at yet that I'm aware of. So these two kinds of ... Different kinds of research have been looked at independently, and therefore the evolving data that mammary changes after a pregnancy, which is called involution, technically, that there's a lot going on in the breast, and that there's an influx of immune cells and what we call immune signature clustering that might predispose the breast cells in there to be more likely to turn into a cancer. And that probably is happening, if it's happening, both in a person who's not high risk, but it's most likely ... If it's happening in people who are not high risk, it would happen probably even more in women who are high risk. Does that make sense? And there's some epidemiologic data that this may be true. But in women who are very high risk, it may not matter whether they've had a pregnancy or not. Whereas it might be more likely to push someone towards a cancer, should they have had a more recent pregnancy, if they're not high risk. If you're following me.

Chris Riback: I am following you. Now, I know you're looking ... You've got nothing to do. You have no studies going on, no research, no programs that you're running. So, there you go. There's another thing potentially to look at.

Let's turn, and tell me about Young and Strong. Tell me about the Young and Strong Program for Young Women with Breast Cancer. What is it? How did you create it? with others, I'm assuming. And what does it provide?

Dr. Ann Partridge: So, yes, it's a team effort. And any of the research I'm talking about, whether I've been a part of it, or it's been from the larger cancer research community, it's all a team effort. There's no ... There are competitors, but the fact is that we all have to work together to figure this out. And from a clinical standpoint, while I love the research, there's a lot that we already know that I realized early on patients were coming to me for a second opinion, or they were seeing a colleague who was maybe new or wasn't focusing on young women, and they weren't hearing about things like fertility. Or they'd come from a second opinion, and they wouldn't have had genetic testing yet, and they were 35 years old, and it might've impacted on their treatment decisions. And they certainly weren't getting, across the board, more comprehensive kind of survivorship and supportive care once they were kind of through the immediate treatment trenches.

And so in 2005 at the Dana-Farber, with support of patients and philanthropic funds and colleagues, we established this program for young women with breast cancer, which we rebranded to be Young and Strong. And again, coming from the patients saying, "Look ... " And patients have also said, "You don't have to be strong." And I say back to them, "That's right, but we're going to be here and be strong to help and support you in case you're not strong. We've got your backs." And so we created this community basically, and we've served over 5,000 new young patients directly in our clinic and scores of women. beyond that, I'm sure.

And we've been working for now over a decade to try to not only push the field forward in terms of research, but to help disseminate best practices, and best supportive care, and best, you know, "Make sure you talk to the young woman about fertility before she starts her treatment. So if she wanted to do anything to preserve fertility, make sure you plug her in with the psychosocial supports, with a social worker, or with resources in her community all along the way because each step of the way has different stressors. Make sure that you think about the aftermath for this young woman, not just when you're talking about the risks of chemo before you have them sign the consent, but later when she's still feeling tired, six months after she's finished all her treatment, or when she's feeling down, or when she's having hot flashes, or when, she doesn't know it, but her bones may be thinning, and you've got to think about bone health in the long haul because she needs to have those bones for another five or six decades." And so this is the kind of comprehensive approach we try to follow.

And as you alluded to earlier, this is something that affects not just the patient, but the patient's whole system. So we've got to think about her loved ones, her partner, for young women, if she has a partner, or her ability to partner, or her children. And so trying to kind of have a comprehensive approach to kind of total patient care and getting women to, not only live through a cancer, which of course is super important, but kind of thrive through and beyond a cancer diagnosis and treatment. And that's where the challenges, but we're up for it. And this program, I think has really helped more young women to cope, to find community and support and resources and better care, and we've tried really hard to disseminate our best practices beyond the hallowed halls of Dana-Farber and to get to not just our affiliates and satellites, but to share resources with colleagues across the country. And it's super cool because we've actually developed this really nice collaboration with folks across the world.

And now every two years we meet in ... Right now we meet in Lugano, Switzerland, and we develop guidelines for young women. And this is in conjunction with the European School of Oncology, which is based in Europe, obviously. And we develop guidelines for best practices, you know, "How do you distill the latest research to apply to our youngest patients?" Because sometimes people don't know whether it should apply to the young patients. And so we sit there, a group of experts and patients and advocates sit and think about it in the context of our youngest patients. And then we publish it, so it's available for other providers and researchers and patients to learn from and potentially impact on their care. That's exciting.

Chris Riback: It is exciting, and it's a really important point, I think, for any listeners or anyone really to know about. In my own learning about your efforts to prepare for this conversation, I saw it. I mean, that you've put together, and by you, I mean the royal you, you and colleagues, et cetera, have put together videos, slideshows, speeches, presentations, data, guidelines and more. I just think that that's, I'm sure for you as well, that's imperative for folks to know about. And it said to me as well that, among the many ways I'm interpreting you seeing your role ... You are a researcher. You're a scientist. You're a doctor. You're worried and focused on the biology. You're worried and focused on the emotional, mental, psychological components, but you're also a communicator. And that the communications on this is ... it feels like is part of how you see your role.

Dr. Ann Partridge: Yes. And for any researcher, if a tree falls in the forest and no one hears it ... And so we do need to be able to, not just share our results, but there's a whole school of, "How do you disseminate the findings and help to implement changes in care?" And even with a hot new drug where you have a whole, usually a pharmaceutical industry pushing the drug and sales forces doing that, it can take three years for a drug to get disseminated to the majority of people. Now try and think about like supportive care approaches. It's just so much harder. And so we, people who are working on this, need to remove the barriers and make it accessible because we don't have sales forces. And so we need to make it kind of a priority in that ... And most providers want to treat their patients better. And so, getting out there, shouting it from the hilltops, developing resources that are good for the providers and good for the patients and accessible, that's what we've tried to focus on.

And personally, I've been very grateful because groups like the BCRF recognize that. And they support my work, that's not drug development in this context; it's improving survivorship care for young breast cancer patients and developing an intervention right now that is web-based, so phone, web, laptop, tablet, log on from home.

Chris Riback: Yes, all the ways we connect.

Dr. Ann Partridge: Yep, and can log on and get support in the middle of the night. That's what we're trying to do. And their providers can refer them to that, which helps the provider because then they're not calling the patient ... Excuse me, then the patient's not calling them in the middle of the night or suffering, more importantly, for six months until their next follow up visit in survivorship, which is more likely to happen because a patient's not going to page their doctor in the middle of the night for a hot flash. But if there's a remedy for that that they could access from a trusted source, wouldn't that be wonderful? And so that's what we're kind of working on.

Chris Riback: And to do be clear, and you'll correct me if I'm wrong, but then I need to ask you about the research and two of the studies that you're working on right now. The Young and Strong program as well as the Adult Survivorship Program, my takeaway was that those are unique programs, but there seem to be deep connection and maybe even some overlap, but that they are separate programs. Did I interpret that right, or are they kind of more closely aligned than that?

Dr. Ann Partridge: Yes. So at Dana-Farber, we have these two unique and separate programs, the program for young women, or Young and Strong, and the Adult Survivorship Program. And they are separate, but at Dana-Farber are unified because I am the director of both of them.

Chris Riback: Got it.

Dr. Ann Partridge: But the goal of the Adult Survivorship Program is to help to support survivors across the cancer spectrum. Right?

Chris Riback: Okay.

Dr. Ann Partridge: But there's a lot of overlap because survivorship begins at diagnosis, and things like oncofertility and fertility preservation for young adult and adolescent cancer survivors is an issue, for example, that's not unique to breast cancer survivors. It's something that's appropriate for all young cancer survivors from the date of diagnosis. So, there is a fair bit of overlap. And so I started to run Adult Survivorship after some of the successes of our young women's program. And the ability to kind of scale up has  been a bit of a challenge. "How do I help the young testicular survivors?" things like that. So, we work on that. And it's a much different scope and a larger team and very multidisciplinary, even beyond the breast cancer trenches because you have to think about all of the other diseases for that. But there's a lot of overlap. And I think the Young and Strong Program has helped to provide some experience for how to better deliver care and how to better disseminate  findings and things that we already know within a large cancer center and then beyond to people who are not coming into a comprehensive cancer center like ours, so they're synergies.

Chris Riback: Got it. Understood. And yes, I understand how the Adult Survivorship, it sounds like covers a range of cancers. And that's a whole separate conversation. I have gotten so much from talking to scientists and researchers about how much gets learned in one area of cancer research or care, and then goes into an experiment or a study to try to apply it in other areas. So, makes total sense.

Dr. Ann Partridge: Right. And it helps that ... I'm all against, as I'm sure you guys are, we're against silos, right?

Chris Riback: Yep.

Dr. Ann Partridge: And it's easy to have a silo when you're busy and you're focused. And so one of the things that we work on really hard is not silo-izing the research from the clinical care, right? These things have to be kind of iterative and go back and forth from bench to bedside to population. And then on top of that, I don't want to siloize breast cancer in either direction. So, yes, we've separated cancer now in order to make breakthroughs, but what we learn in breast cancer, we can now sometimes move to lung and colon and testicular and other cancers and vice versa. Right?

Chris Riback: Yes.

Dr. Ann Partridge: And so that's true from a biomedical standpoint, and it's also true from the supportive care standpoint.

Chris Riback: So it's important that I get to ask you about and get to learn about your research. You are launching two parallel studies that will build on prior research to improve the understanding of the complex medical and emotional problems that we've been talking about, the ones that face young women with breast cancer, with a new focus, as I understand it, on intervention and outreach. One of them is the “Young Women's Breast Cancer Study Two.” And the other one I believe is titled the “Young Women's Breast Cancer Study Two: Internet.” Tell me about each of them please.

Dr. Ann Partridge: Sure. And that has evolved. So I will say, just to clarify, we've kind of put them together.

Chris Riback: Ah, okay.

Dr. Ann Partridge: We've just completed a pilot where we have developed a web-based portal, as I alluded to earlier, that is designed to help women both report symptoms and problems and informational needs. And in the moment that they trigger and report a problem or an informational need, they are actually sent to their portal, information or support or how to manage that need or that concern or that symptom. So, it's kind of real-time iterative supportive care. Again, you can sit on your couch at midnight and answer the survey that asks, "Do you have hot flashes?" or, "Are you worried about your sexual health?" or, "Are you're worried about your pain or fatigue?" And if you say more than no, if you say a little or a lot, in different degrees, you will get information about how to manage that particular symptom that comes to you.

And if you don't say anything, if you say, "I'm totally fine," you'll just get some supportive care things generally about what to think about and how to optimize your health behaviors and things like that. So you get something no matter what. And plus, we're pulling people to come together to form a community within the portal. So it's a way for other young women to connect with other young women as well as our team. And they can also do journaling because we know from other data that that can help young women to process and emotionally deal with a breast cancer diagnosis and survivorship.

So we just finished a pilot of the portal that the women can also track their symptoms over time and see if they're improving. They can also, again, as I said, communicate with one another. And so we just finished this pilot, and it was very, very successful. Women were very engaged. We accrued women who had newly diagnosed breast cancer, age 45 and younger for this one because it's supportive care, and women who are survivors, meaning out of initial disease treatment and kind of moving beyond. And then another group of women living with advanced breast cancer, living with metastatic disease. And we got feedback from these women. So not only did they respond to the surveys, but they also told us what they thought. We're interviewing. We're almost done with the interviews. And we're interviewing them now. And we're learning about the pros and the cons and the, "Was it wasn't too much, or was it too little?" And, "What would help you engage more?" And this is the kind of research that you have to be very patient with because you want to hear all the criticisms, right?

Chris Riback: Mm-hmm (affirmative).

Dr. Ann Partridge: You want them to tell you what they liked, and what they didn't, and have them be honest because you ultimately want a product that they're going to engage with.

Chris Riback: Of course.

Dr. Ann Partridge: And so we are in the process of revising the portal right now based on that feedback. And then our next step is to launch three different initiatives, one for each of those groups that will use this web-based platform, that will now be tweaked for each of those groups. For example, in these survivors, the top symptoms weren't nausea or vomiting. They were anxiety, hot flashes, sexual health, right?

Chris Riback: Mm-hmm (affirmative).

Dr. Ann Partridge: And so we're not going to ask them about nausea and vomiting very often, right? Because they don't need that information. They're too far out. And in the metastatic patients, that actually was true too. So we're going to ... We're tweaking things, but we didn't know that until we surveyed them and found out that, "Nobody's really interested in this. And people are more interested in that." And we also found out, interestingly, in the feedback, a high proportion of people were ... When we talk about survivorship, we think a lot about the kind of system issues and the patient direct issues. And one of the things that we hadn't thought about, which I'm embarrassed to say because now it's like common sense, is they wanted more information and support about the financial toxicity. Right?

Chris Riback: Yes.

Dr. Ann Partridge: Of course it makes sense. And yet I hadn't thought of it. It wasn't in there as a ... They didn't trigger that because we didn't ask them. We didn't ask them. We ask them, "Tell us what else you'd like to see," in an open forum, which this is one of the things they told us both then and in the interviews. So it's pretty cool, right? This is why we pilot this, because you've got to learn from your patients what do you need to deliver better and what more. So, now we're working on adding that as well and plugging in resources, which is just hard, but they're out there. And some of this is about connecting patients with resources.

Chris Riback: Incredible how any of us, but in this particular case people like you and colleagues who do this, have done this every day for years, talk to patients every day for years, and yet still can learn new insights and gather new data and then refine your activities or opportunities for patients to more customize it, make it more relevant and make everything just more directly useful, and the continual learning that can occur really in just about any area in life is always fascinating. And I'm sure that's one of your takeaways as well.

I've got to understand. And in listening to you, how did you get into this? And I mean going back, way back. Where did you grow up? For you, was it always science? Was it always research? Or were you just on the verge of becoming a world class Olympic athlete, and at the last minute you just said, "Nah. I'm not going to do that. I'm going to do science instead"?

Dr. Ann Partridge: So I was always going to be a doctor. In fact, I tried to talk myself out of it because my wonderful father is a physician. He's now retired. So that was kind of in my blood for lots of reasons. And yet I kind of fell into breast cancer, to be very honest, not because I necessarily needed to do breast cancer, but because I found a mentor that was a breast cancer rock star, Eric Winer, when I was a fellow. I knew I wanted to attach my wagon to his star in terms of just ... I wanted to be like him. And that's the idea of a mentor. So, and I was happy to do breast cancer because I was interested in women's health, and I liked the long term relationships. And I also liked the evolving science that I was seeing in the early fellowship oncology trenches. So that's how I initially started with breast cancer.

I grew up on Long Island, by the way. I'm a New Yorker by birth, but then I came up to Boston for a man. But that being said ... And for my Dana-Farber fellowship.

Chris Riback: Of course.

Dr. Ann Partridge: It was a good one. But really it was about my now husband. So, fast forward though. I'm in the oncology trenches. I'm trying to figure out what I want to do when I grow up in oncology. I start working with Eric Winer. And two things happened. One is that, in the clinic, because I'm a clinical doc. I'm not a test tube researcher. I started seeing in the clinics what I described to you earlier in this, the suffering of the youngest women. I started seeing ... They were just pulling on everybody's heart strings. And I felt like we could do more for them so, and we could learn more for them. And when they'd ask questions about, "How likely am I to go through menopause with this chemotherapy?" We didn't have enough answers.

And so that's where I found my niche clinically and thought, "Hey, this is an unanswered area. I could dive right in here because it's both fascinating to me, and I could do good, and there's room." And so for me, that was kind of what hooked me. And then I will tell you, when I was about 29, and my best friend was 30, I got a call from her, my best friend from high school. She had a lump. She was in New York, actually. And fast forward. It ends up being breast cancer. And fortunately, her survival was actually not the thing we were worried about.

But I heard from her from the inside, from ... She shared with me things you don't share with your doctor typically, but what you share with your best friend, which is, "How do I deal with one breast, and the shirt I want to wear on Friday night?" I have this new partner. And how do I deal with that from an intimacy standpoint? Can I have a baby? Or is that not going to be safe?" And then we weren't sure whether it was safe. Now we're pretty sure that it is probably safe to have a baby after breast cancer based on available evidence. But at that time, we didn't have enough data to even answer those questions, or enough resources to answer kind of the beauty and self-image stuff. And I heard from her kind of firsthand, how hard it was, even when it wasn't about surviving the cancer. It was really about kind of moving on.

And so for me personally, that made me even that much more interested in the supportive care stuff, the softer stuff that the doctors and even the nurses, quite frankly, don't pay that much attention to, and yet are so important for the day to day for our patients that we kind of should help them with this. And so we've tried to build ways to help them better, in partnership with other groups, with advocacy groups, and with duty groups, and with all kinds of good partnerships where we all want the same thing. We want people to look and feel good, right?

Chris Riback: Yep.

Dr. Ann Partridge: And so that's kind of been an area ... That's where it came out of. That's where ... For me, it was, "Okay. This is a good fit for me, and my personality, and my mission." And that's how I'm here.

Chris Riback: That's an incredible series of inputs in both the personal and the professional ... Yes, I mean those conversations with your girlfriend. As well, I can say I had the great privilege of doing one of these conversations with Dr. Winer. And so, I get it. You were fortunate-

Dr. Ann Partridge: You met the rock star.

Chris Riback: I got to talk to the rock star, yes. So, yes, I get it. If you had the opportunity ... If one had the opportunity to work with him, I can see how that could be life changing and could really help direct a career, which I am willing to bet you have either passed forward and passed on, or will. But my guess is you likely already have too many folks. So, thank you. Thank you for that. And thank you for taking the time with me today.

Dr. Ann Partridge: Oh, it was a treat. Thank you.

BCRF’s New TRIBUTE Study Uses Data-Driven Approach to Immunotherapy

 

Metastatic triple negative breast cancer is one of the most aggressive and fatal forms of breast cancer. Currently, there is no cure.

But recently, there was a breakthrough for this deadly subset of breast cancer in immunotherapy. In October 2018, results from the large scale IMpassion 130 clinical trial were published. This multicenter study demonstrated a clear benefit of adding immunotherapy in treatment plans for select patients with metastatic triple negative breast cancer (mTNBC). These findings led to FDA approval of a new immunotherapy agent, known as atezolizumab, for treating metastatic triple negative breast cancer in March 2019.

“The IMpassion 130 trial brings new optimism that immunooncology drugs will soon become routinely used in treating breast cancer patients,” said Dr. Dorraya El-Ashry, BCRF Chief Scientific Officer. “It is a game-changing outcome and opens the door for new avenues of research into understanding how to make immunotherapy effective in breast cancer.”

Immunooncology harnesses the power of the body’s own immune system to fight cancer. BCRF has been committed to this field for more than a decade. To that end, in August 2018 the Foundation hosted a think tank comprised of leading researchers in the field from: the Parker Institute for Cancer Immunotherapy (PICI), the Cancer Research Institute (CRI) and BCRF. Led by Dr. Elizabeth Mittendorf of Brigham and Women’s Hospital and Dana-Farber Cancer Institute, the investigators conceptualized a new study, the TRIBUTE study, designed to capitalize on the recent success of the IMpassion 130 clinical trial.

This collaborative effort will follow patients treated with immunooncology agents and collect samples for future analysis and research. These clinical data and tissue, blood, and stool samples will form a repository, a first-of-its kind resource, available to the broader scientific community, and is expected to catalyze further advancements in immunotherapy treatments.

“We have a tremendous opportunity to predict which patients are going to respond to immunotherapy,” said Dr. Elizabeth Mittendorf. “These three tremendous organizations have allowed us to pool six leading academic sites, to do the highest level of science, to learn from these patients.”

Researchers hope their efforts could improve outcomes for more patients receiving immunotherapy treatments for example, by adjusting the timing and combinations of the immunotherapy treatment or adding an additional therapy that might create a stronger immune response. The information gathered from patients, like side effects and microbiome analyses, can inform how these immunooncology agents will work for metastatic triple negative breast cancer patients and potentially in a larger variety of solid tumors.

“The results will have far-reaching implications on the resolution and treatment of not just breast, but all cancers,” said El-Ashry.

TRIBUTE is a collaboration between BCRF, the Parker Institute for Cancer Immunotherapy, and the Cancer Research Institute.  BCRF’s commitment is fulfilled thanks to the generosity of BCRF Board Member and longtime supporter, Karen Hale and her husband, Rob, who are investing  $1 million to support this project, and other immunooncology initiatives.

“We are proud to support the visionary work of Dr. Elizabeth Mittendorf and BCRF’s contributions to the TRIBUTE study,” said Karen Hale. “Fostering collaboration is one of our greatest passions, and BCRF is a leader in bringing scientists together.  We have great hope in studies like TRIBUTE to yield tangible results for women and men around the world.”

Research Is the Reason I Can Be Their Role Model

 

When Valorie Kondos Field learned she had breast cancer, one of her first thoughts was her students. As the former head coach of the UCLA Gymnastics Team, she wanted to use her experience to educate others.

“Immediately I thought, 'What an amazing teaching moment for my student athletes,'” she said.

What she did next was unorthodox, but she believed was necessary. She let her students feel her malignant tumor.

“I realized this was an opportunity to educate. While I was nervous the head of HR was going to come in screaming with sirens telling me I'm fired – for me, it didn't matter. That moment was so important for them,” she said.

Throughout her treatments, Valorie continued to coach. She didn’t want to let her diagnosis interfere with her passion for remaining  a role model for her student athletes. 

“By coming into work every day, I showed my students that cancer was a small part of my life and a small part of my day. It wasn't my whole life and day – and it certainly didn't define me,” she said.

Today, Valorie is in remission. Her cancer was HER2-positive and she credits targeted therapy for her successful treatment. It’s an outcome she values deeply as she watched her mother die from colon cancer.

“When I was diagnosed, I went into a panic,” she said. “My oncologist explained had I been diagnosed a decade earlier there would have been limited treatment options for my type of cancer.”

This changed her outlook about her diagnosis.

“I was invigorated that I was living through a time where targeted therapy was available for people in my position,” she said. “It was my ‘aha’ moment where I saw that every dollar given to research saves lives,” she said.

Valorie maintains a strong belief in the power of research for giving her the opportunity to thrive.

“Research is the reason I’m alive.”

PRESS RELEASE: The AURORA-US Project Reports First Key Findings of Changes Between Primary Tumors and Metastases

 

San Antonio, TX, Dec 12—Today, investigators of BCRF’s AURORA-US project announced the discovery of key molecular changes between primary tumors and metastases, particularly between Luminal-type tumors and Basal-like tumors. The results, presented at the San Antonio Breast Cancer Symposium by lead investigators Drs. Tari King and Charles Perou, highlight promising new avenues for research.

The AURORA-US and AURORA-EU projects are the centerpiece of the Breast Cancer Research Foundation’s Evelyn H. Lauder Founder’s Fund and were established in conjunction with the Translational Breast Cancer Consortium (TBCRC). The AURORA-US project was established to conduct precise molecular analyses of primary and metastatic breast cancer samples to better understand the evolution of metastasis and the mechanisms of drug resistance that allow tumors to grow and spread. Investigators collected primary breast cancer-metastasis pairs for multi-platform genomic profiling in order to identify the molecular drivers of metastatic disease.

In this first report of the retrospective phase of the study, archived tissue samples from the primary tumor and at least one distant metastasis were collected from 10 TBCRC institutions. In total, samples from 55 patients, including 105 distinct metastatic lesions, were subject to multiple DNA and gene expression genomic analyses — the most comprehensive analysis to date of metastatic lesions.

When comparing features of the primary tumors and patient matched metastatic lesions, changes in both gene expression and gene regulation appeared to differ between luminal-type tumors, the breast cancer molecular subtype that is typically estrogen dependent, and basal-like tumors. Specifically, luminal-type primary tumors and their metastatic pairs frequently differed in the expression of genes that define the classic breast cancer molecular subtypes, resulting in a change in subtype classification in approximately 30% of cases. On the other hand, basal-like primary tumors tended to retain their basal-like characteristics in the matched metastatic lesions.

Other notable differences in gene expression between primary tumors and metastatic lesions suggest a prominent role for the tumor microenvironment in metastasis. Immune-related gene expression was higher in basal-like primary tumors and was down-regulated in the metastatic lesions; at the same time, immune-related gene expression was lower at baseline in luminal-type tumors and did not change with progression to metastatic disease. In contrast, expression levels of genes related to the stromal content of tumors such as normal fibroblasts were higher in luminal-type primary tumors and significantly decreased in the paired metastases.

“These observations suggest that, depending on the breast cancer subtype, there are varying changes happening in tumor progression, and/or in response to treatment,” Dr. King said, “and this highlights the need to biopsy and study metastatic lesions as opposed to relying on information from the primary tumor.”

While findings from this retrospective phase are the first step towards unravelling the mystery of metastasis, it underscores the critical importance of obtaining biopsies from metastatic lesions in order to advance our understanding of breast cancer progression and improve the ability to treat - and one day prevent - metastatic disease.

The recently launched second phase of the AURORA-US project is a prospective study to identify molecular targets. It is expected to enroll 200+ patients with recurrent metastatic breast cancer across 19 TBCRC institutions. Visit www.auroraus.org for more information.

About the Breast Cancer Research Foundation Evelyn H. Lauder Founder’s Fund

The Evelyn H. Lauder Founder’s Fund, established in 2013, is dedicated exclusively to addressing the persistent challenges of breast cancer metastasis and has dedicated $31 million to date. Inspired by The Cancer Genome Atlas (TCGA)—which compiled the landmark genomic database of primary tumors—AURORA is building the world’s largest multi-disciplinary repository of matched primary and metastatic tumor data. The AURORA-US and AURORA-EU projects are the centerpiece of the Founder’s Fund. Deep analysis of metastatic tumor DNA, RNA, and proteins are providing new insights into the processes and mechanisms of metastatic cancer. This invaluable resource can be mined to fuel future research and help provide answers to questions we haven’t yet formulated.

About Metastatic Breast Cancer

Metastatic breast cancer (MBC) occurs when breast cancer cells spread to other parts of the body, such as the lungs, brain, liver or bones. Metastatic breast cancer, also referred to as stage IV or advanced breast cancer, is incurable and responsible for virtually all breast cancer related deaths, leading to more than 42,000 deaths in women and men in the U.S. each year.

About the Translational Breast Cancer Research Consortium (TBCRC) 

The Translational Breast Cancer Research Consortium (TBCRC) is a collaborative group founded in 2005 to conduct innovative and high-impact clinical trials for breast cancer. The goal of the TBCRC is to conduct innovative, high impact, biologically driven translational and clinical research. 

 

 

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PRESS RELEASE: The Breast Cancer Research Foundation Announces the Continued Expansion of the Drug Research Collaborative to Speed the Delivery of New Treatment Options

 

BCRF_Research_374

NEW YORK, NY – December 11, 2019 – The Breast Cancer Research Foundation (BCRF) announced $5 million in funding provided by Eli Lilly and Company to conduct investigator-initiated studies of the CDK4 & 6 inhibitor, Verzenio® (abemaciclib). Lilly will also provide the drug, at no cost, to investigators to conduct the studies they design. Recent results from the MONARCH 2 study showed that Verzenio in combination with fulvestrant significantly extended life in women with HR+, HER2- advanced breast cancer previously treated with endocrine therapy. This project is an extension of BCRF’s already vibrant Drug Research Collaborative. It will allow academic physicians and scientists to further explore the ability to help patients with breast cancer, to define mechanisms of resistance and find ways of overcoming them, to develop novel combinations and schedules, among many other opportunities.

Lilly is the latest industry leader to join BCRF’s Drug Research Collaborative. This unique program is aimed at bringing together the best academic investigators, the most promising oncology drugs and the top medical centers to accelerate the development of critical new treatment options. The program has created the opportunity to creatively explore approaches to treating cancer that would not otherwise be possible. Since the launch of the Collaborative in 2016, BCRF has dedicated $25 million to this program, supporting 15 internationally renowned investigators.

“What makes the Drug Research Collaborative so productive is that the best attributes of both academia and industry are melded together. This program allows the academic community to design and conduct innovative, cutting-edge trials based on original laboratory research and using the best drugs. It both facilitates and speeds progress.” said Larry Norton, MD, BCRF Founding Scientific Director and Medical Director of the Evelyn H. Lauder Breast Center at Memorial Sloan Kettering Cancer Center.

“We are excited to work with BCRF to support the Drug Research Collaborative and further study the role of Verzenio for the treatment of breast cancer,” said Maura Dickler, M.D., vice president, late stage development, Lilly Oncology. “This is a unique opportunity to collaborate with scientists and clinical investigators. It underscores our ongoing dedication to advancing the science and developing new treatment strategies that may help doctors and their patients more effectively treat this disease.”

In spite of the great progress against breast cancer that research has accomplished since the time of the founding of BCRF, much remains to be accomplished. The use of medicines early in the course of disease is still needed to prevent metastasis from happening in more patients and the 155,000 women and men now living with metastatic breast cancer need to know that the BCRF is dedicated to developing treatments that are maximally effective while minimizing harmful side effects. The Drug Research Collaborative is an important part of being the end of breast cancer.

About BCRF
The Breast Cancer Research Foundation (BCRF) is dedicated to being the end of breast cancer by advancing the world's most promising research. Founded by Evelyn H. Lauder in 1993, BCRF-funded investigators have been deeply involved in every major breakthrough in breast cancer prevention, diagnosis, treatment, survivorship and metastasis. This year, BCRF has awarded $66 million in grants to support the work of nearly 275 scientists at leading medical and academic institutions across 14 countries, making BCRF the largest private funder of breast cancer research worldwide. BCRF is also the highest-rated breast cancer organization in the U.S. Visit www.bcrf.org to learn more.

About Lilly Oncology
For more than 50 years, Lilly has been dedicated to delivering life-changing medicines and support to people living with cancer and those who care for them. Lilly is determined to build on this heritage and continue making life better for all those affected by cancer around the world. To learn more about Lilly's commitment to people with cancer, please visit www.LillyOncology.com.

About Eli Lilly and Company
Lilly is a global health care leader that unites caring with discovery to create medicines that make life better for people around the world. We were founded more than a century ago by a man committed to creating high-quality medicines that meet real needs, and today we remain true to that mission in all our work. Across the globe, Lilly employees work to discover and bring life-changing medicines to those who need them, improve the understanding and management of disease, and give back to communities through philanthropy and volunteerism. To learn more about Lilly, please visit us at lilly.com and lilly.com/newsroom.

© Lilly USA, LLC 2019. ALL RIGHTS RESERVED.

Verzenio® is a trademark owned by or licensed to Eli Lilly and Company, its subsidiaries, or affiliates.

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Media contacts:
Sadia Zapp, BCRF Managing Director of Communications, (646) 497-2639 or szapp@bcrf.org

BCRF-Supported Breast Screening Trial Aims to Improve Early Detection for Women with Dense Breasts

 

About 40 percent of women over the age of 40 have dense breasts. The condition, characterized by relatively high amounts of glandular tissue and fibrous connective tissue and low amounts of fatty breast tissue, can make reading and detecting breast cancer on a mammogram difficult. It’s a challenge that BCRF researchers want to meet head-on. Current guidelines call for supplemental screening with whole breast ultrasound (WBUS), however, this can result in false positives, as does screening with MRI.

“Women with dense breasts need better and more accurate screening options than what is currently available,” said Dorraya El-Ashry, PhD, BCRF Chief Scientific Officer. “Early detection remains key to improving breast cancer outcomes and our collective goal is to optimize critical tools for diagnosis.”

In an effort to improve early breast cancer detection and reduce false positive exams in women with dense breasts, BCRF is launching a groundbreaking study. Seeded by The Lampert Foundation, BCRF along with the American College of Radiology (ACR) and GE Healthcare are partnering to support the Contrast Enhanced Mammography Imaging Screening Trial (CMIST).

The planned clinical trial, managed by the ACR Center for Research and Innovation, seeks to validate early positive findings that contrast enhanced spectral mammography (CESM) screening provides more accurate cancer detection compared to combination of digital breast tomosynthesis (DBT) and whole breast ultrasound (WBUS) in women with dense breasts.

“CMIST will investigate the challenges of current screening options for women with dense breasts,” said Dr. El-Ashry. “The goal is to reduce false positive rates while improving breast cancer detection.”

CESM combines mammography and vascular-based screening methods that may offer a more efficient screening approach. The technology highlights areas of unusual blood flow patterns in a simple and quick procedure. Early studies of CESM in screening women with dense breasts have shown that CESM has the potential to increase the breast cancer detection rate by 70-80% compared to conventional mammography.

Trial sites have yet to be confirmed for the multicenter clinical trial that is expected to launch in spring 2020. Participants will have mammographically dense breasts – defined as a BI-RADS density categories C and D – be between the ages 40-75, at average-to-intermediate risk for breast cancer. The performance of CESM will be evaluated in screening women with dense breasts compared to the combination of tomosynthesis and ultrasound.

“The trial can help determine if CESM can provide a more accurate and efficient screening approach for women with dense breasts,” said CMIST Principal Investigator Christopher Comstock, MD, FACR, FSBI, director of breast imaging clinical trials, Memorial Sloan Kettering Cancer Center.

While current supplemental screening modestly improves breast cancer detection, it takes more time, has a high false positive rate, and can increase breast biopsies and costs. Results from the CMIST trial may provide a new avenue for women with dense breasts.

“We know that one size does not fit all when it comes to breast care, and that it’s critical to offer a personalized approach to breast cancer screening,” says Agnes Berzsenyi, President and CEO of Women’s Health at GE Healthcare. “We’re excited to support this important study to further evaluate the clinical benefits of CESM so that clinicians can be even more confident in their diagnosis and quickly get answers for their patients.”

5 Holiday Fundraising Ideas to Support Breast Cancer Research

 

The most festive time of the year has finally arrived, and we hope you’re getting into the holiday spirit. Hanukkah, Christmas, and New Year’s are rife with opportunities to support BCRF’s dedicated researchers in a variety of fun and meaningful ways.

This holiday season, we’re grateful to the countless individuals and groups from around the world who are transforming their passions into creative ways to fund the groundbreaking research that is improving lives of people impacted by breast cancer.

Whether you’d like to plan a holiday fundraiser on your own, with friends and family, or with your community at large, there are ample ways to organize a successful event. But if you’re feeling stumped, here are some ideas to inspire you:

Holiday celebrations. Invite your friends and family members to contribute to the cause when you throw a Hanukkah, Christmas, or New Year’s Eve party.

Fitness challenges. If you resolved to improve your health in the new year, consider signing up for a 5K in your area, joining an exercise class, or cycling or swimming to help fund breast cancer research.

Community events. Bond with your co-workers or fellow students by holding a holiday bake sale, board game tournament, or used book sale.

Personal milestones. Ask for donations for your birthday, wedding, or anniversary.

Get inspired. There’s a way to turn just about any activity into an opportunity to raise funds.

Excited to get started? Set up an online fundraising page on our website to launch your event by clicking here. Be the first to donate to show your commitment to supporting breast cancer research, and then share your link with friends, family, neighbors, and colleagues.

If you have any questions or need help organizing your fundraiser, please email fundraising@bcrf.org.

Investigating Breast Cancer: BCRF Symposium & Awards Luncheon

 

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Every October, BCRF-funded researchers are honored at the annual Symposium & Awards Luncheon in New York City. This is when BCRF makes its formal announcement of research grants for the upcoming year and recognizes its investigators for their devotion to ending breast cancer with their trailblazing scientific inquiry. The event provides a unique opportunity for BCRF researchers to convene, share ideas and collaborate with fellow colleagues from around the world. This year’s program began with a symposium featuring an expert panel of BCRF investigators. They discussed current breaking topics in breast cancer research, ranging from prevention and diagnosis to treatment and survivorship. We’re proud to share that discussion here in this special bonus podcast. 

Subscribe to Investigating Breast Cancer here:


Read the transcript below:

Intro:   I’m Chris Riback. This is a special bonus episode of Investigating Breast Cancer, the podcast of the Breast Cancer Research Foundation and conversations with the world’s leading scientists studying breast cancer prevention, diagnosis, treatment, survivorship and metastasis.

Each October, BCRF-funded investigators are honored at the annual Symposium & Awards Luncheon in New York City. The event announces the Foundation’s grant investment for the coming year and recognizes BCRF investigators— many of whom we feature in these Investigating Breast Cancer conversations — for their devotion to ending breast cancer and their trailblazing scientific inquiry. The audience is comprised of researchers and BCRF supporters, and the gathering provides the rare and unique opportunity each year for BCRF researchers to be in one place to share ideas and collaborate with fellow colleagues from around the world.

This year, the program began with an extraordinary symposium. An expert panel of BCRF investigators discussed current breaking topics in breast cancer research, ranging from prevention and diagnosis to treatment and survivorship.

We’re proud to bring you that discussion here, in this special bonus podcast. The symposium panelists included:

  • Dr. Eric Winer, of Dana-Farber Cancer Institute. Dr. Winer is also the recipient of BCRF’s 2019 Jill Rose Award for Scientific Excellence.
  • Dr. Dawn Hershman of Columbia University Medical Center.
  • Dr. Neil Iyengar of Memorial Sloan Kettering Cancer Center.
  • Dr. Judy Garber, of Dana-Farber Cancer Institute. Dr. Garber also serves as BCRF Scientific Director.

The panel was moderated by BCRF’s Founding Scientific Director Dr. Larry Norton of Memorial Sloan Kettering Cancer Center.

We’ll have our regular episode of Investigating Breast Cancer in the next weeks. Now, here is Dr. Larry Norton and BCRF’s 2019 Symposium.

Dr. Larry Norton: Welcome everybody. I don't know how many years we've been doing this, but every year it gets better and better. And thank you all for being here. Other people will be coming in as the usual thing over this next hour or hour and 15 minutes that we're doing this.

We changed the format just a little tiny bit and we've asked this extraordinary group of grantees, clinician scientists to be educational in their focus as well as talking about their own research, but also to educate on very important topics.

And I'm going to pass the podium on to the group so as not to waste time as a nascent to introduce themselves as Dawn Hershman, Eric Winer, Neil Iyengar and of course, Judy Garber, who's the scientific director of the BCRF to introduce themselves and we will talk about their topics a little bit more depth than we've done in the past.

Before we get started, I've introduced my colleagues here. I just want to introduce one other person because it's an exceptional few weeks is Bill Kaelin, one of our grantees from 2006 just won the Nobel Prize. Bill.

Okay. Thank you. Very gratified by your work, extraordinary and huge impact. And I expect all the other grantees who are sitting on both sides and may have comments as we go forward. Every year I want one of you to win a Nobel Prize. All right. It's extremely important that we do that because we got to keep the momentum going in this regard.

Okay. Let's just start off with the main program. And I'd like to introduce Dawn, introduce yourself and tell us about your topic.

Dr. Dawn Hershman: I'm Dawn Hershman, I'm a professor of Medicine and Epidemiology at Columbia University and a breast cancer oncologist. Early in my career, I think one of the things that really stood out to me was the number of people that would really... We'd have all these great treatments for breast cancer even though we have a long way to go, we have some really spectacular treatments.

And it always stood out like that, a large number of people wouldn't get those treatments. They wouldn't start those treatments, they wouldn't finish those treatments, and we spent all of this time, energy and effort trying to discover and put forward new, better ways of treating breast cancer, but not everybody got them.

I remember early on, we started using anti-hormone therapy, anti-estrogen therapy, and patients would come in after we put on aromatase inhibitors in particular, just in tears because the side effects would make them miserable. They would say things like, "I can't get up from my chair. I can't go down the stairs in the morning. I know these medicines work, but I can't take them, I don't know what I'm going to do."

And it really made us start to think like, well, how many people are like this out there? How many people can't take their medication and what are the reasons why? And we started to investigate that and we found that over 50% of patients couldn't complete the five years of treatment on time the way they were prescribed.

A lot of people stopped, they took it intermittently. So it made us start to think, well, what can we do to try to help fix that problem? And when we first started to go back to the clinical trials, they were why, why is there a discrepancy in terms of what people are saying versus what we see in the clinical trials, in the clinical trials maybe only 8%, 7%, so they had a problem with side effects.

We started to realize that we weren't really measuring side effects in clinical trials because we weren't asking patients how they felt. And it really opened our eyes to the importance of asking patients while they're on treatment, what the side effects are that they're experiencing so that we can better measure it, we can have appropriate outcomes to know, but also so that we can control those side effects so that we can keep people on their treatments.

So it started a whole way of us thinking about patient-reported outcomes and incorporating that into trials and putting in the patient's voice so that we know exactly what we're talking about when we get these results. In thinking about side effects and why people stop taking their medications, we've looked at a lot of different things.

We looked at financial factors and how even small differences in the amount of money you have to pay out of pocket can make a big difference in terms of your likelihood of staying on a medicine or the type of insurance you have. But the number one reason why people stop taking their medication is side effects.

So we started to investigate all different types of things in terms of controlling side effects from the aromatase inhibitors and we looked at medications like antidepressants and certain types of medicines like we call Duloxetine or Cymbalta, they can work, but people don't want to take them because often we hear, "I don't want to take another medicine that causes side effects to control side effects from a medicine I have to take."

It's totally reasonable, so let's think about other ways we can try to control these side effects. And so we worked with Melinda Irwin who's a grantee on looking at exercise and can exercise control these side effects? And her study showed that yes, actually exercise can control some of the side effects and hopefully keep patients on their medications.

We looked at other types of compounds like Omega-3 fatty acids to control side effects and that can be effective too in some types of patients, but probably the most impactful thing we did was we studied acupuncture, and we did a very large rigorous multicenter trial looking at whether or not acupuncture could control those side effects.

And people say, "Well, of course acupuncture is going to work because patients would just get it." But it's really important to test these things because people pay a lot of money out of pocket and you can have an influence if you find out that it's actually effective.

What we found was that, we analyzed the data all different types of ways no matter how we analyzed it, acupuncture was better. And what was it better than? Well, we had an arm that was sham acupuncture, so we tried to trick people into a placebo of acupuncture and we had people wait until they got their acupuncture.

The true acupuncture actually was significantly better; it reduced those side effects by more than 50% in terms of improvement. And so if people say, "Well, why do you need to do that?" Well, the reason we need to do it is so that we can convince insurance companies to pay. And the results of those trials enabled us to pressure a fair number of the commercial insurance companies to cover those costs.

And it's important because we need to think globally and work with every patient in a personalized way to help make sure that whatever the problem is that's stopping them from getting the treatments that work, that we come up with a solution that's right for them.

Dr. Larry Norton: Excellent. Thank you so very much. Acupuncture also helps you chair these kinds of meetings by the way. I have a needle in me right now, and if it were not for that.

Eric Winer, who's the Jill Rose award recipient this year and I have a lot of nice things and some not nice things to say about him a little bit later this morning that you'll hear. Eric, what's your topic? Who are you.

Dr. Eric Winer: Who am I? I'm up in Boston and I am a medical oncologist. Oh, sorry, not close enough. Excuse me. I'm at Dana-Farber in Boston where I direct the breast cancer program. I'm a medical oncologist, I do research, I take care of patients. I try to keep everybody happy there, meaning all the people we work with.

You'll just forgive me if I just tell you a brief story, which is that the fact that I know a lot about breast cancer and very little about everything else was brought home to me many years ago by my oldest son, who at the time was about 11. This is many years ago. And he had a rash on his face, which I kept telling him was because he got chocolate all over his face whenever he ate anything that had chocolate in it.

And he went to the dermatologist, the dermatologist said, "Your father's wrong. You have perioral dermatitis." Jeffrey comes home and he says, "Dad," And he said, "you're wrong." I said, "No, Jeffrey, I still think it's like getting all that chocolate on your face." He said, "Dad, if I had breast cancer on my face, I'd listened to you, otherwise I'm going to the dermatologist."

So when your own family feels that way, what can you say? So I asked Judy and Larry what I should talk about and the answer I got was that I should talk about breast cancer treatment and what has happened with breast cancer treatment over the past five, 10, 15, 20 years. And I'll do this pretty briefly.

Twenty years ago we thought of breast cancer as one monolithic disease. We treated it all about the same. Somebody would come in and say, "What kind of breast cancer do I have?" And I'd say, you have stage one, you have stage two, you have stage three breast cancer." But in other ways, we didn't know how to tell one woman's breast cancer from another.

And the stage tells you how much cancer there is, but it doesn't tell you anything about the personality of the cancer. And where we have excelled over the last two decades is understanding more about the personality of different cancers or the biologic behavior of those cancers.

And the result is we no longer have one size fits all treatment; we have one size fits all. We have treatments for women who have HER2-positive breast cancer, and women who have estrogen-receptor-positive cancer, and women who have Triple-negative breast cancer. Now in all of these areas, we're finding out that there are sub diseases within those individual entities, so not all HER2-positive breast cancer is the same.

Certainly, not all triple-negative breast cancer is the same, and for sure the 75% of women who have estrogen-receptor-positive and HER2-negative breast cancer, that's a very mixed group of tumors and patients who have them. And so we're doing a lot better.

We're doing a lot better in terms of having better treatments for many women, and for many others, we're also learning that we can do as well by them and avoid a lot of these toxicities and side effects that Dawn was talking about by and at sometimes backing off, but backing off in a very thoughtful way so that we're not putting anyone at risk, but we're simply trying to give the most effective treatments to the patients who need them.

And for those who may not need such aggressive treatment, we're learning that in some situations we can carefully do less and there are many people around the country who have taken that approach in terms of trying to figure out which are the patients where we need to develop new drugs and new treatment approaches, and who are the patients where perhaps a little bit less is equally good?

And this isn't just in medical oncology with drugs. I looked over and saw Laura Esserman sitting someplace here, right there who is as many of you know a surgeon at the University of California at San Francisco and has run a large research program looking at both ways that we can give more and give less medical therapy, but also thinking about the surgical issues and the radiation issues.

Because the whole treatment approach we take sometimes is pretty overwhelming for people. And to the extent that we can be more specific and more tailored to our approaches, we're going to do better. And I actually think that we're really getting there. Happy to answer questions about this as time goes on.

Dr. Larry Norton: Thank you. Thank you so much. There's clear linkage here between the notion. I just want to say editorially is that I've seen the whole transformation of the treatment of breast cancer really in my career. I've been involved in medical oncology from seven years after the very beginning except for the first seven years, I've seen the whole evolution of the field.

And in breast cancer, which has really taken the lead in many respects in terms of moving forward in many ideas. We've really reached a point where we can start talking about making the therapies more effective and less toxic simultaneously by choices, appropriate therapy for the right patient by handling side effects of therapy and make sure people take their medications.

And this is really a remarkable thing because you go back 20 years ago, 25 years ago, it was just more and more and more suffer. You got to suffer to get the maximum effect, you got to push people forward in that regard, and that was a very important point in the evolution of the field, extremely important point in the evolution of the field.

Now we're at another point, which is really extremely gratifying, and we'll probably have more to talk about as we move forward. And to talk about like feeling really good, I brought Neil Iyengar. All right.

Dr. Neil Iyengar: That's a great introduction, thank you. Thank you, Larry. I hope I can make everyone feel really good this morning. I'd like to start by saying good morning and it's my great privilege and honor to be sitting on this esteemed panel and we're grateful for the support of the BCRF for really accelerating our research program.

My name is Neil Iyengar. I'm a medical oncologist and a clinical investigator at Memorial Sloan Kettering Cancer Center and we focus on how we can optimize our metabolic health for cancer and for improving response to cancer therapies. In other words, preventing resistance to cancer treatment.

So what do I mean when I say metabolic health? Well, I'm talking about factors that we might think about when we go to see a cardiologist or an endocrinologist. Things like diabetes, blood sugar levels, insulin levels, cholesterol, obesity. We know from the work of several BCRF investigators, epidemiologists here today that obesity is a leading modifiable risk factor for the development of several cancers.

At least 13 cancers are related to obesity, and that number will probably grow as we learn more. And if we think about obesity as a classic state of metabolic dysfunction, there's a lot going on. So we partnered several years ago with the insights of Cliff Hudis who many of you know, with Andy Dannenberg, a BCRF investigator who's here today as well to collaborate on really understanding the biology of why obesity can promote the growth of breast and other cancers.

If you think about the breast, it is largely composed of fat. Fat is our most metabolically active tissue. And many of you have heard about the concept of the tumor microenvironment. Well, if you look at the tumor microenvironment of breast cancer, one of the most prominent components of that microenvironment are fat cells.

And what we've learned is that in the setting of obesity, the fat tissue in the breast and elsewhere can become dysfunctional. Specifically, it can become inflamed and produce inflammatory molecules, which can directly stimulate the growth of cancer cells. In addition to that, those inflammatory molecules can stimulate the production of the enzyme aromatase, which many of you know is the key enzyme for the production of the hormone estrogen.

And so what we've found is that this fat tissue dysfunction in the breast can create a tumor microenvironment that is inflamed and pro-estrogenic and ripe for the growth of breast cancer. And this classically happens in the setting of obesity, but beyond obesity, we've also found that in up to one third of women who are not classically defined as obese, who have a normal weight, who appear to be healthy and may even be told by their physician that they're healthy, up to one third of these women also have this fat tissue dysfunction, inflammation, higher levels of aromatase in the breast fat.

And so we've learned from the research of several other BCRF investigators here today who've pioneered lifestyle interventions for the treatment of side effects, which we heard about from Dawn, that these lifestyle interventions can also improve the metabolic state of the body.

And so now we're very interested in how we can develop precision lifestyle interventions to help in the prevention and treatment of breast cancer. And what I mean by prevention or precision lifestyle interventions is building on what we heard about from Eric that this concept of one size fits all doesn't apply not only to our breast cancer treatments, but also to lifestyle interventions.

And so we're developing personalized exercise prescriptions using BCRF support to leverage technologies like tele-exercise where we're shipping treadmills out to patient's homes equipped with tablets such that they can interface through video conferencing with our exercise physiologists here in Manhattan to participate in supervised precision personalized exercise.

We're developing nutritional interventions, for example, partnering plant-based diet approach with precision exercise for women who are taking aromatase inhibitors to try to improve that health of the breast fat. And finally, if you think about the biology of tumors and how we develop new molecular therapies that are specific to the biology of tumors, we can start to think about that same paradigm for lifestyle interventions like nutrition.

Some tumors are dependent on growth factors or growth pathways that involve insulin. So we're testing diets that lower insulin, like low carbohydrate or on the other end of the spectrum high protein diets like even the ketogenic diet for supporting the treatment effect of some of our new breast cancer therapies.

And so what I hope I've conveyed to you is that one diet or one lifestyle intervention may be right for one person, but may not be the right approach for another person, similar to how we think about our breast cancer therapies. And with that approach, we hope to really develop personalized guidelines, interventions and recommendations for lifestyle interventions that could have an anti-cancer effect.

Dr. Larry Norton: Neil, thank you very much. The general theme is, which we didn't intend, but is obviously rising is personalization, doing the right thing for the individual. The right way to intervene so that people can actually take medicine they're supposed to take, the right treatment and the right exercise.

I saw a lot of heads shaking while that was going on. Fill out your questions, all right, please and hand them forward because I think we have a lot to talk about with all of these three topics. But of course the thing that's most, most specific to you are your genes, and that's something you can't escape, the genes you're born with. Judy, do you have any thoughts about genes and cancer?

Dr. Judy Garber: Is that what you wanted me to talk about? Oh, I'm Judy Garber. I'm a breast oncologist too and I do clinical cancer genetics at the Dana-Farber Cancer Institute in Boston. And I was hoping Neil would have an exercise intervention for the investigators that would help us do it.

Dr. Larry Norton: Oh, no, no, I'm-

Dr. Judy Garber: We're in a do or not do, we're in the do side, so personalized would be great. I've worked in cancer genetics for a long time. BCRF has been involved in supporting cancer genetics really almost since Mary-Claire King first mapped the first BRCA 1 gene.

And many of us collaborate, which is something else that's characterized BCRF investigators and breast cancer as a field because we needed to work together to get enough numbers to work. So we've known now for many years that breast cancer in particular, but also ovarian cancer could travel in families and be related often to a genetic factor.

And thanks to work by Mary-Claire and many others in this room, we now know about many genes. So we know about BRCA 1 and 2 that are the most common genes, which we've been testing now in many women with breast cancer and many with family histories for more than 25 years I think and finding mutations, but we've also learned that there are more genes.

And we've learned part of that through the work of people like David Livingston, Alan D'Andrea, Alan Ashworth who figured out what BRCA 1 and 2 did, that they're important in DNA repair, and then mapped down the pathways, looking at all the other genes that were involved to ask, were they also important in breast cancer?

And some of them are, and some to a lesser extent, and some of them contribute to risk of other cancers as well. So for our patients that we tested in the early days and didn't find anything, who still wonder, could there be something genetic? The answer might be that it's time to look again now at other genes.

And we've learned that our early thinking as is often the case in research, was guided by being strict, as strict as possible to try to have the closest definition so we can at least find these genes and figure out how to use them. So that was what I mean by that is people with the strongest family histories.

But we've learned that many people may not have a very strong family history. Through no fault of their own. They may have mostly male relatives in which you don't see the breast or ovarian cancer, so you've had to think about expanding who gets tested and how to make testing more accessible to the broader population of people who may not realize testing is for them.

Now we've had to make testing safer, so to work to make the penalties by your insurance companies or otherwise against discrimination against testing. And we've had time to do some of that, but now we can concentrate on making testing more available for appropriate populations.

We're not ready to tell everybody necessarily to be tested, although I don't think we're too far from that, at least every cancer patient. So there are studies that are here like the before study, which is for the Ashkenazi Jewish population looking at people who really may not realize at all that they have risks, but just by having even a Jewish grandparent, you may be Jewish enough to have a 10 fold higher chance of carrying a BRCA mutation.

And you may not find it until you're like the internist I saw on Tuesday who's had absolutely no family history, but had ovarian cancer. And that's when she learned that she has a mutation that she inherited from her father and so hadn't been seen. One in 40 if you've heard about them, that's their story.

We want to prevent this and prevent the deaths from cancer that are avoidable, not only for our breast families, but also now we've learned ovary, pancreas, advanced prostate cancer. So the guidelines for testing have expanded so that people with those diagnoses are found.

And part of that is to help prevent cancer in their families, and part of that is because there are treatments now for people whose tumors arise in the setting of a mutation that makes them vulnerable to certain kinds of exploitation by treatment.

So Eric can talk about personalized treatment, this is really personalized treatment. It's about the way the tumor came to be as much as it's biology determined by that. So these are the PARP inhibitors. And now there are drugs for people whose tumors become resistant to the PARP inhibitors and can get other drugs to try to restore sensitivity.

Many people in this room are responsible for trials showing that these drugs are effective in advanced disease, now there are studies moving them back to an earlier phase of treatment. And not only treatment, but actually, probably the reason many of us went into this field was to look for prevention strategies, and not necessarily only the prevention strategies that we all find, at least in theory, much more acceptable like diet and exercise, which you know are hard to get people to do.

So we'll leave that to Neil, but also to other strategies, immune strategies, which are very interesting. Try to get the immune revolution to also benefit prevention, but also drugs that target particular targets. Geoff Lindeman is here and his work has identified a molecule that looks to be important in BRCA 1, breast cancer development.

And now there's an international study asking, "Can we actually reduce the risk of breast cancer or at least delay it so we can put off those prophylactic mastectomies?" And in that mode, even beyond that, BCRF is investing in prevention, in prevention studies, Novel trials, and Novel approaches this year that we hope will move prevention forward so we can catch up to treatment.

Dr. Larry Norton: Superb. My goodness. The evolution of our field toward knowing much more about the individual so that we can do things that are specific to the individual rather than groups of individuals has really been extraordinary. And I think it's revolutionary to actually hear it with my colleagues actually presented the notion that it's not just a matter of what exercise... Go to the gym and exercise is not necessarily good advice, is bad exercise.

You can actually exercise too much, for example, so knowing something about that, knowing about your genes specifically for prevention strategies and moving forward. And I think we're going to have a lot of discussion of that as we move forward. What is the right therapy so you don't get stuff that's going to hurt you and not necessarily help you.

And also, frankly in my mind, leave room for advances that could then be added in. If you clog up treatment to make it too complicated, it's very hard to back down and very hard to add onto it things that may be useful going off in the future. And ways of handling the complications of therapy in such a way that people can actually adhere to regimens that can help them all depends upon analysis of the individual.

And so it's the revolution of the individual that we're hearing about, which is really remarkable. I think it's partially in my mind just to share with you, it's advances in science in terms of understanding this, but also I think it's part of the digital revolution, the idea of enormous amounts of information that can be available and that can help individuals.

We all have enormous access to information that we never had before. I have a smartphone in my pocket, I can get more information out of this than I could have any other time in history and all of us can basically do that. But the idea that information about you as an individual is power for you in terms of your health and the health of your family, I think is all part of this dramatic change really in society, a dramatic change in our way of thinking about ourselves.

Now, you'll notice I'm not wearing glasses this year because I had my cataracts done, but that also has a downside, which I got to do this all right, which I couldn't do before. This is a really, I think an overarching question I think for all this, and I'm just going to read the question because I think it's well worded.

Why do some people still get breast cancer even when they do everything right, healthy weight, diet, exercise, no drinking, family history, et cetera? There's a philosophical, sociological component of this. Who wants to start that off? Do you have to do something wrong to get breast cancer? Is breast cancer a punishment for something you've done wrong? What do you think? Judy, what do you think?

Dr. Judy Garber: No. Unfortunately, we're not able to explain most breast cancers. We can point to genes sometimes, we can think about lifestyle factors, we can talk about diet and all kinds of unhealthful behaviors, but most of that, but the Metalogic studies show that we can't attribute a cause for breast cancer.

And I think to some extent it's chance that our genes are reproducing all the time. Every time your cells turn over, you have to completely reproduce with almost exact fealty, the DNA content of your cells, all your chromosomes. And cells make mistakes and they have DNA repair systems, but as we get older, we make more mistakes, and those mistakes, if they're in the breast, can go on to be breast cancer.

If the genes are the ones that are responsible for keeping the cells on track, then it's even easier for cancers to develop. But this is true of all cancers, not just breast cancer, of childhood cancers, we can't explain those either. So I don't think that it's really possible to be organisms without some risk of cancer.

Unfortunately, too often in women, these are cancers, and I would say that I neglected in that to talk about environment because despite decades of very careful study, we've done not very well at being able to figure out, which environmental factors we could remove to reduce breast cancer risk. And I do think that there's something to that.

Dr. Larry Norton: Neil.

Dr. Neil Iyengar: I think I would like to add to that especially in the realm of lifestyle interventions like diet and exercise that we really have to be careful to distance and move away from the notion that it's something that a person did. Their diet or their exercise for example, that may have given rise to their breast cancer, that's far from the truth.

And I think that part of that might be how the message is put out there, for example, many of you may have seen the updated guidelines for exercise, for prevention and during cancer treatment published yesterday by The American College of Sports Medicine. The article in the New York Times of course suggests that we may be able to avoid cancer by exercising.

I think that that diminishes the science and the understanding of the complexity of the individual, their genetics, their environment, everything we heard about just now from Judy. And really understanding that individual biology and parent lifestyle interventions that may compliment other prevention strategies or cancer treatment strategies is something that we have to think about with much greater nuance and depth.

Dr. Larry Norton: We could talk about this one topic really forever. There's always that question, which is a recurring question always reminds me of the opening scene of... There was a book about the beginning of the space program called The Right Stuff and they made a really good movie about it. I think the book is better than the movie actually, even though the movie was really great.

And the opening scene is a bunch of test pilots sitting around because one of their colleagues testing the airplane has just crashed and died. And they all go around saying all the things that that pilot did wrong, "Oh, we know he never checked his fuel, he never checked his gauges, he never got enough sleep." They were all going round in a circle.

The fact that matters is he's a test pilot, sometimes planes are going to crash and you could do everything right and they're going to crash, but there is one other thing you can do in addition to everything we've talked about, in addition to understanding that that things can happen to you that are bad even though you've done nothing, which is support research. You're all here to support research.

All the advances we're talking about just didn't happen by just random chance, they all happened because of the sport of research, basic research, applied research, clinical trials, survivorship, the whole spectrum, which is represented by my extraordinary colleagues on both sides of this room.

So your supportive research helps you and helps your family, and I just want to point that out as an extremely important component of what you can actually do in addition to all the personal things that you can do that we've already mentioned.

I have a question here that I know was going to come up because it was just on the news yesterday and apparently made a whole big fuss, so I'm just going to answer. Is about a breast cancer vaccine that was tested in Moffitt apparently and it was presented in a very short press release as a major, really advanced.

She got a vaccine and her cancer disappeared. It wasn't breast cancer, it was ductal carcinoma in situ, which is not a cancer. It's a sign... It's a bad term because it has the word cancer carcinoma in it, but it's basically it's an indicator of the possibility the breast would turn to cancer.

She had a positive biopsy, she got a vaccine, then had re-excision and they didn't see evidence of DCIS. Sometimes do nothing if you have a positive biopsy and do a re-excision, you've got no evidence of DCIS. It needs an enormous amount more study to see whether it's something that's a value or not.

And it's received a lot of... When I got home last night after we had BCRF events last night, I had about 40 emails about, "Why can't I get this new vaccine?" So really it's very early on, it's got to be tested appropriately. It wasn't a cancer vaccine, it was a vaccine for cancer predisposition. So I just wanted to mention that because we have a bunch of people that have asked about that.

One thing I'd like to ask Eric about is there are a number of questions here about the side effects of chemotherapy. We heard about the side effects of aromatase inhibitors therapy, what's going on in decreasing the side effects of chemotherapy?

Dr. Eric Winer: It's a complicated question because there are a number of different things going on. First of course, is trying to give less chemotherapy and doing it... avoiding chemotherapy when we don't need to give it. And the second I would say is, how we give the therapy. We know that when we combine many drugs together that there are more side effects than giving drugs one at a time.

We know that sometimes it's better to combine them, but sometimes it isn't. But in terms of actually reducing the side effects that exist, there's also a great deal of research that's going on looking at that and there are many BCRF investigators who have focused their efforts in that area.

We know that treatment of nausea for example, is something that is still a problem, but it's very different than it was 20 years ago. I think one of the most challenging side effects that we see is actually neuropathy, which can both be an acute problem and a chronic problem, and so needs a great deal of study.

But that's another one where I think that much of what we need to do is pay close attention to the patient and be careful to back off on the therapy when the side effects are beginning to get to be perhaps worse than any other problem. I think it's something that when a patient is seeing a doctor, there's often a focus on treating the cancer and not so much paying attention to the side effects.

And sometimes patients don't want to waste time and the appointment to talk about side effects as much as they want to talk about where they're going with their cancer treatment. And I just remind everyone that it's really something that has to be part of medical conversations all the time because the one thing we don't want to do is treat someone effectively and then leave them seriously debilitated with side effects, and that does happen occasionally less than it ever did before.

Dr. Dawn Hershman: Just to add to that. I think one of the areas, Eric spoke about nausea, it used to be debilitating, used to be the number one reason why people couldn't get their treatment. And with a lot of research now there are so many drugs, it's just not an issue anymore. So few people really suffer.

Now, it's not totally gone, but it's so much better than it used to be.

Dr. Eric Winer: You always have to be careful when an oncologist says that something's well tolerated.

Dr. Dawn Hershman: Exactly. One of the reasons why-

Dr. Judy Garber: Except Dawn.

Dr. Dawn Hershman:  ... a lot of women didn't want to get chemotherapy is because they didn't want to lose their hair. And in the past couple of years we've made enormous progress with some treatments to preserve women's hair, and that's a really big quality of life issue for people now that we've reduced the length of some of the duration of treatments, but women would still lose their hair and that was really devastating.

And to be able to offer somebody and say, "Look, it's awful that you have to go through this, and I'm sorry you have to go through this, but there is one thing we can do to help you get through it, and maybe we can keep... maybe if you..." And what the treatment is called, scalp cooling, and Hope Rugo was one of the lead authors on that.

I know she's a BCRF researcher and others. Some of the cooling technologies to preserve hair has been a huge improvement for people.

Dr. Larry Norton: Mary-Claire, I'm got to ask you this question because this is a question of historic importance. I'll just read the question specifically. Are breast and ovarian cancer related? And if so, how?

Dr. Mary-Claire King: Thank you, Larry. I'm honored that you ask an option a medical question. They certainly are related. This reminds me to tell you one of my favorite mantras, which is that we, at least, we females are the most successful mammals there have ever been. We are fertile during a longer period of our lives than any mammal has ever been previously.

We are cognitively active post fertility longer than any mammal has ever been previously, and at the heart of both of these tremendous evolutionary success stories is estrogen. And estrogen is also at the heart of the relationship between breast cancer and ovarian cancer.

So while from the point of view of a geneticist and of course a lover of BRCA 1, it's critical to think about the ways in which mutations in BRCA 1 and its sister genes predisposed to both breast and ovarian cancer and how we can prevent both breast and ovarian cancer by being aware of those mutations.

It is, I think from the point of view of a woman, enormously important that we think about the role of estrogens in all of this. And from that perspective, the activity of BCRF in supporting the work of my colleagues here who work on the basic biology of estrogens and how by understanding that basic biology, we can hope to modulate the effects in order to preserve for us are tremendous evolutionary advantages and our cognitive activity, and our looks well, well, well past, past youth.

At the same time to be able to modulate those effects so as to reduce the risks of breast and ovarian cancer both for women with mutations in BRCA 1 and the sister genes and for women who are mutation free. Thank you, Larry.

Dr. Larry Norton: Okay. Thank you. Judy, somebody here had their BRCA test 10 years ago and it was reported to them as negative for a deleterious mutation. Should they get retested?

Dr. Judy Garber: I think for many people the answer will be yes if they had enough risk of having a positive test to have thought about it before, and the test was negative. Now the technology would let you look more completely at the BRCA 1 and 2 genes and to look at other related genes.

But this is still a question you could ask your health care provider who should know, and if not, then in New York there's no way to avoid genetics programs. They're everywhere and you can ask a genetic counselor or a genetic health professional whether you should rethink testing.

It's easy to do and still a blood test or a saliva test. It's much less expensive than it used to be and it is more complete.

Dr. Larry Norton: I would mention the whole idea of genetic counseling really started with Joan Marks working closely with Mary-Claire. Very early days when we didn't really know anywhere as much as we know now. She was a recipient of an award from BCRF many years ago really for that work, and I just want to call her out as somebody who really started a whole field that I think has been extraordinarily productive.

Can BRCA genes skip a generation? This is somebody whose mother actually had deleterious mutation and she got tested and was negative, but she's still worried about her kids getting the abnormal gene. Go ahead Judy. Quick answer.

Dr. Judy Garber: So unless my colleagues have discovered something else recently, I don't think so. Genes cannot skip a generation. They have to go from parent to child, but you do have to remember that we're not the only parent. The other parent could have inherited a gene that may not have been tested for, that also could be transmitted to the child.

But in general, if you have tested negative, you cannot pass this onto your children. They don't need to be retested to confirm that.

Dr. Larry Norton: Okay.

Dr. Eric Winer: I think what's confusing is that diseases can skip a generation because just because someone doesn't have breast cancer doesn't mean that they, for example, didn't inherit an abnormal BRCA gene or, this applies to other illnesses as well. But genes are pretty certain

Dr. Judy Garber: Certain. That's not qualified unless somebody else is willing to stand up and say otherwise, they don't skip a generation.

Dr. Larry Norton: I hate to say this, but it's very important to say it. A surprisingly high percentage of people have a father that's different than they think they do.

Dr. Eric Winer: I knew that was coming.

Dr. Larry Norton: All right.

Dr. Judy Garber: I did try to point out there was another parent.

Dr. Larry Norton: And the scary thing about that is when I ever make that statement, all the women in the audience laugh and the men stay stony silent with a heart. So I just want to emphasize that. And the whole question, I think this is going to evolve over the next two or three years even very, very quickly, the whole notion of family history being the best predictor of who should be tested and whatever.

And Mary's written extensively about this and there's a lot of discussion and we're seeing a big movement toward more testing rather than less. But I think we're going to leave that for subsequent discussions because it's really such a big topic and we should have really formal presentations on this.

Dr. Larry Norton:  Dr. Chandarlapaty recently joined the scientific advisory board BCRF as has Eric indeed, and the question really is, people are hearing a lot about blood testing for diagnosis of cancer and for screening for cancer.

Dr. Larry Norton: I've seen ads on late night TV myself in this regard for following patients who've had cancer. It all relates basically to test for DNA in the blood. What do you think of that?

Dr. Sarat Chandarlapaty: This is an amazing research opportunity for us to be able to noninvasively look for biomarkers that can tell us about cancer that may still be there or that may be getting worse on therapy. It is still very much in the research realm. However, we don't really have a current test that we can widely give to either detect cancer as a screening modality or else to modify treatment.

Not yet, but I think that that's something that we're all working on in the research setting that I think is extremely promising, showing very robust results.

Dr. Larry Norton: Okay. Thank you. Laura Esserman, UCSF has something to add to that right here.

Dr. Laura Esserman:  It's just as important that we think about personalizing screening and prevention in the same way. And we're running a large national study called The Wisdom Study to test annual screening against personalized screening. And I think these kinds of tests we have to be very thoughtful about.

We don't want to do a lot of things to people who have extremely low risk because you're likely to do more harm than good. So I think a personalized screening approach may be the perfect way to find the very populations at the highest risk where a different kind of testing are earlier detection may make a big difference and where you're going to do less harm and a lot of good.

Dr. Larry Norton: Good. Laura, thank you. Lisa Carey, are you around? Why is everybody who I'm asking is sitting way in the back here. Come up to the forward because the people have heard that you can actually design studies that are targeting DNA abnormalities and mutation status rather than the diseases, and they're calling them basket trials.

You gave a really superb talk about this yesterday to the scientists in our symposium. What's your current feeling about the notion of treating the molecular abnormality rather than treating the disease specified by the organ, which it arose?

Dr. Lisa Carey: Well, I think the world of cancer therapy is absolutely moving towards using the molecular aberrations as the guide to what targeted therapy is going to work the best because that also allows you to emphasize the effectiveness and minimize the toxicity, so there is no question that we need to do that.

It does get complicated and I think in some of the ways that Larry is mentioning, we can't underestimate the complexity of this. And there have been studies where people had super effective drugs for melanoma with particular molecular problems in their DNA and they just assumed the drug would work the same if you found that same molecular abnormality in a colon cancer and it doesn't.

And the truth is that cancer, the biology is very, very sophisticated and complicated, and so it's not easy. So you need our scientists who actually help inform what we're studying and how we're studying it. And we have to look at things in a system-wide way and not just assume that looking at one thing at a time is going to work.

Dr. Larry Norton: Excellent. Thank you. Obesity is bad for you, we all know that. But is it the obesity or is it the things you are eating to make you obese that is the bad thing? In other words, if you happen to be overweight or even on the obese side, but for some reason there's some genetic predisposition to fat accumulation in your body and you're actually, you're eating a fairly healthy diet.

This one zeroes in specifically on dairy, but I think is a general question. Is it the fat in your body or is the things you eat to make you fat that's important?

Dr. Neil Iyengar: I think that's an excellent question and it gets back to this notion of understanding individual biology. I mentioned earlier that we find this fat tissue dysfunction in up to a third of people who are normal weight, who are not defined as obese. And in fact there is a small percentage, up to 10% of individuals who do meet the definition of obesity, who actually have functioning fat tissue and healthy fat tissue.

And so I think that there are components one can develop the bad biology of obesity independent of what body weight is through their lifestyle, but that's not the whole story. There are certainly genetic predispositions, environmental factors that contribute to whether or not a person's metabolic state is actually healthy or unhealthy and is going to contribute to the growth of cancer.

So the short answer to that question is it really depends on the individual, whether or not it's their underlying metabolic state or it's their lifestyle or a combination of both.

Dr. Larry Norton: Superb answer. This is a recurring question, which I'm just going to talk about here. Do you want to answer that briefly, Joyce? Mic over there, but then I want to make a general comment.

Dr. Joyce Slingerland: A lot of people ask the question, is there good fat and is there bad fat? Am I a fat person who has okay fat? And I think we don't know a lot about how the microbiome and the specific components of our diets-

Dr. Larry Norton: Define microbiome.

Dr. Joyce Slingerland: Microbiome are all of the bacteria that are part of our normal body in our skin, in our gut, in all of the openings to our body, our nostrils, our vagina, and all of those other places. There are ways in which our body interacts with the environment that influence putting on weight, et cetera.

So there are a lot of things we don't know about fat, but one of the things that I think is really an important take home message is that interventions that reduce weight have been shown to affect survival from breast and colon cancer, so bariatric surgery in individuals who are obese has been shown to influence survival from breast and colon cancer.

And interventions, there's very active ongoing investigation to see whether lifestyle interventions with diet and exercise impact survival from breast cancer and the answers are not yet all in. But I think there's very clear evidence from biomarkers that blood tests and markers of inflammation do go down with exercise, and estrogens do go down with diet and exercise.

And so if we can influence by weight loss, the biomarkers are bad outcome of breast cancer, it's probable that we will influence things. And I think the take home message is wait, wait, wait and wait. There's probably not good fat... There may be details of good fat and bad fat, but for the majority of people, getting rid of it is what really matters most.

Dr. Larry Norton: There's a recurrent... Thank you. Just two comments, one quick editorial is that when we first started doing the symposium, we talked a lot about the cancer cell and you'd hear we're talking a lot about other kinds of tissues in the body that are very related to the cancer, white blood cells, fat cells, even bacteria that exists in the GI tract.

The whole picture of what is cancer is rapidly evolving. The leaders in the field are all around the room or dispersed among you in terms of answering these questions, and I think that's an extraordinary, exciting time biologically. The other point that I wanted to make is that... It's a recurring question is, you folks are saying a lot of smart things.

How does my doctor know these things? How do I get this information? Am I getting too much therapy? I'm getting too little therapy. What about side effects? How can this be handled? I think one of the important things that BCRF is going to be... is already involved in it, Judy already mentioned something called The B4 study, which is a study of genetic predisposition.

But a very important component of that can often sitting in the front row, instrumental and others in the room in this regard is how to disseminate information, how to educate people about themselves so that they can then ask the right questions and get the right answers that are really specific for them.

We're not very good at this yet, frankly, and I think that it's not something we've emphasized in a whole lot in the evolution of healthcare, but now's the time to do it and it's something BCRF really needs to focus in on. Eric is dying to say something, and then Dawn who's going to say something to you after that?

Dr. Eric Winer: Want to go first?

Dr. Dawn Hershman: I was just going to say, we now have many technological tools. Healthcare technology has advanced a lot to help us disseminate information better. Things like Twitter, you see like important results getting disseminated very quickly.

You see that there are social networks that help doctors that are from areas where they may not have experts to ask questions to experts to get answers quickly that we can make the world a lot smaller by using technology, and that can help us disseminate information all over the world.

Dr. Eric Winer: Great. Two quick comments. One, we are in the midst of conducting a very important national study that there may even be people in this room who are participating in, which is asking the question that if you're a woman with breast cancer and you are presently overweight, does intervening with an intervention that seeks to reduce weight, whether that changes your chance of having a recurrence of the cancer.

They're going to be 3,000 women enrolled in that study. There are already about 2,000 enrolled. It's being conducted by one of our colleagues, Jennifer Ligibel and many others working with her nationally and it's really important.

The other comment that I just wanted to make is, comes back to the importance of research. And it's not just about drugs of course. Drugs, you can only take when the FDA finally approves them, and so when something's being studied, it's not necessarily easy to just take a drug.

That's not always the case with other sorts of interventions, or circulating DNA, or a variety of different tests or interventions that don't necessarily need to be FDA approved. But I think it's very important that we're rigorous about how we evaluate these things. And I'm sure Sarat would agree with me that in terms of circulating DNA that companies are advertising.

At the moment, we have to be very careful about how we apply those kinds of things in practice until we have more information. And so just because something's available doesn't mean you should rush to get it.

Dr. Larry Norton: My favorite quote is, Mark Twain, "It's not what you don't know that gets you in trouble, it's what you know for sure that turns out to be wrong." And in healthcare, this is extremely important.

I'm just underlining what Eric has just basically said is that the big change in this regard is, I guess, also part of the digital revolution is that on the basis of almost no information, or false information, or manipulated information, or very preliminary information, you can have big changes because of the dissemination of the recommendation via social media tools and basically change the landscape in ways that we can't ask the questions really anymore and get to the definitive answers.

So it's extremely important to have definitive answers before you proceed. And there's lots of people, by the way, and New York city has become really one of the hotbeds for all sorts of alternative ways of treating cancer. People getting all sorts of infusions of things that are supposed to prevent cancer, and prevent heart disease, and other things.

You can go into any health food store and shelves, and shelves, and shelves of various products, each one of them is promising wonderful things. Be really careful. I've said this from this podium before, but I'm saying it again, is there is evidence and then there is superstition. Opinion is not valid, you really want evidence.

Science is really important, supporting science, following science, evaluating things scientifically is important for you as an individual as well as for all of us as a society. There's another question that comes up, that'd be a third card is about immunotherapy for breast cancer.

And so Jedd Wolchok is sitting right here, one of the great... We have many leaders of the field basically in this room as well, but I'd like to ask Jedd to talk about current status from your point of view, is immunotherapy for breast cancer primetime?

Grab a mic over here.

Dr. Jedd Wolchok: It only works if I stand up? Okay.

Dr. Larry Norton: Yes.

Dr. Jedd Wolchok: I'll try not to read into the fact that you introduced the immunology question with is the superstition or not. So I think-

Dr. Larry Norton: Those were two unrelated thoughts.

Dr. Jedd Wolchok: Okay. All right.

Dr. Larry Norton: That's your own paranoia there, so go ahead.

Dr. Jedd Wolchok: I guess I've been working with you for too long. So I think that we're very aware that immunotherapy has emerged as another standard way to treat some cancers, and melanoma and lung cancer, bladder cancer are some of the more well-known ones where they've made a very significant impact for some patients with those diseases.

More recently, I think it's quite clear that a subset of patients with breast cancer do benefit in a modest way, and these are of course patients with triple-negative breast cancer where we think that the biology and the genomic landscape, the pattern of mutations that make the cancer perhaps look different than the normal breast tissue is more prominent in triple-negative cancer.

And that when combined with chemotherapy, an immunotherapy that blocks a pathway called the PD1 pathway, which is essentially a molecular break on the immune system can lead to more patients having regressions. I think it's an important first step. It's clearly not the end of our investigations in how to best use immunotherapy in breast cancer.

I think we need to understand more about why other breast cancers may not be as responsive and what we might do to try to remedy that. So I think now in 2019, immunotherapy is a standard approach to treat breast cancer, specifically triple-negative breast cancer, but we have much more research to do, the importance of which was emphasized by Larry. Thank you.

Dr. Larry Norton: Thank you. I passed out a couple of cards because there were a couple of questions I think are specific to presenters. Eric, brain metastases.

Dr. Eric Winer: Is there a specific question or…?

Dr. Larry Norton: Where do we stand in the treatment of brain metastases?

Dr. Eric Winer: In certain types of breast cancer, so for example, HER2-positive and triple-negative breast cancer, brain metastases or the cancer spreading to the brain is actually relatively common during the course of someone who has advanced breast cancer. Very uncommon to be the first place that that cancer shows up again after a woman has been treated for breast cancer.

But again, in somebody who is living with advanced breast cancer, it's relatively common, and it can happen for that matter in women who have estrogen-receptor-positive breast cancer as well. Our treatments have gotten better. There's still a long way to go and we have challenges, and I talked a little about this yesterday at our retreat, but some of those challenges are that the brain probably doesn't allow drugs to get in as readily, although it does allow some drugs to get in.

There may be differences in the tumor microenvironment in the brain or in the microenvironment such that brain tissue is different for fairly obvious reasons than many other parts of your body. And there may be some specific genetic changes that occur in these tumors or tumors with specific abnormalities may tend to spread to the brain, and we need to understand all of that better.

There are many people working on new drugs for treatment of brain metastases and the FDA has recognized the importance of this. And finally, I think that we can't underestimate the importance that has been played by surgery and some new and much, much more specialized radiation techniques and treatment.

So by no means is this a happy story in breast cancer. We don't want to see patients whose cancer spreads to their brain, but people can live with that complication and live with it well at times for much longer than was ever the case in the past. And I think we will continue to make progress, but we need support.

Dr. Larry Norton: Thank you, Dawn.

Dr. Dawn Hershman: I guess two things. One, I just wanted to comment on the issue of supplements because we've done studies that have shown that certain supplements, people were taking to prevent the neuropathy that Dr. Winer was talking about, actually can make it worse. And the critical importance of doing the rigorous studies is not just tell people what to do, it's also to tell people what not to do.

So it's not just about us having a perception that these things can be harmful, there's evidence that these things can be harmful, so it's important to do the research. The question on the card was, "Should I be taking hormonal therapy for 10 years? What's the optimal duration of hormonal therapy to take?"

I think it's very confusing for people because it's hard enough to get through the first five years, let alone to get through 10 years or even longer. And that's again where the whole concept of personalized treatment comes up. A lot of the benefit for longer duration hormonal therapy is actually to prevent a new breast cancer.

So are you at risk for developing breast cancer? Do you still have your breasts? Those are important questions. I think we're moving into, do you tolerate the hormone therapy? What is your risk to begin with in terms of the cancer coming back? And I think what's really exciting is that there are a lot of molecular tests being developed that may help guide these decisions to help figure out who's actually at risk for a late recurrence so that we can guide those answers better in terms of who should be on treatment longer versus not.

Dr. Larry Norton: And that work is connecting to cell-free DNA and monitoring, and I think it's a really rapidly evolving, very exciting field. Neil, I can't resist this one because this one is about yoga. Neil Iyengar... No, it's true, he's from that family.

Dr. Neil Iyengar: So we have a few poses?

Dr. Larry Norton: He's the only person I know you can have a conversation with him while he's standing there and putting his foot behind his neck. Health benefits of yoga and potential dangers of hot yoga. What are your thoughts?

Dr. Neil Iyengar: Okay. Well, I'll start a little more generally. There has been work, important work looking at yoga and we know that from the standpoint of mental health interventions that emphasize mindfulness, as well as more structured interventions like cognitive behavioral therapy and so forth, can be effective tools for managing a lot of the side effects including anxiety or mood changes that accompany breast cancer treatment.

And certainly yoga is within that toolbelt of potential interventions that can be incredibly helpful for managing those types of side effects or not even side effects, but just general experiences of individuals who are either at high risk or have developed breast cancer.

We are learning about the specific effects of certain types of exercises or physical activity behaviors, and there has been some preliminary work looking at yoga and other types of lower intensity exercise on metabolic factors, and I think that that's an exciting area of research as well.

So for now, all I can say is that we know from the mental health standpoint that yoga is incredibly helpful for some people. And to answer the hot yoga question, I'm afraid I don't have a good answer to that right now other than it is important that we think about safety for any type of intervention, be it a drug or be it physical activity.

And that's why one of the things that we are doing is taking a drug development approach to the development of exercise in, for example, phase one trials to find the right dose of exercise, the right type and dose of exercise, phase two trials to determine if that dose is effective in helping to shrink tumors, and ultimately phase three trials to look at survival.

And this is the kind of research that we need to do to develop lifestyle interventions.

Dr. Eric Winer: I'm trying to decide if I want the treadmill shipped to my house or the personalized yoga instruction.

Dr. Judy Garber: Both.

Dr. Neil Iyengar: I would say both attractive opportunities.

Dr. Larry Norton: Eric, I think we going to have to randomize that one. I think that's clearly a randomized question.

Dr. Neil Iyengar: That will be my next [crosstalk]-

Dr. Larry Norton: We have only a couple of minutes left, so I'm going to get myself into real serious trouble here because one of the questions is, on several of the cards, why is there so little research on metastatic breast cancer? But the fact is that BCRF has had a huge imprint, and I'm going to ask Dorraya, actually, I'm shocking you.

I know you're going to beat me up for this afterward. Come on right here, I'm going to give you the mic. She's really our new Chief Scientific Officer. Recent recruit has done a spectacular job. I just want to emphasize, everybody thinks that the BCRF is like us, there it is.

BCRF in terms of the science has an extraordinary small, but extraordinary effective scientific leadership group that Dorraya is now running, Maneesh who's not... He just doesn't hand out mics, but he's also been incredibly involved. And Margaret Flowers is here somewhere, Sarah Boll.

Why are we doing so little research on metastatic breast cancer?

Dr. Dorraya El-Ashry: Hi. We don't do so little research on metastatic breast cancer at BCRF. Since 2011 alone, we have invested over $160 million in metastatic breast cancer research. And at BCRF, metastatic breast cancer research goes along two pathways. We have the Evelyn H. Lauder Founder's Fund, which is focused solely on metastatic breast cancer and incorporates both basic research, but also clinical trials, and that has a $31 million to date investments in it.

And then in our annual work program of which many of the investigators are in this room, this year alone, we have $27 million, which is more than 40 percent of the BCRF investment total for this year in metastatic breast cancer research. So if we go back over the years, at least a third of all the investment in BCRF, in research is in metastatic breast cancer research.

It is the area that was my own research area. It is near and dear to my heart and I will steward BCRF to continue to keep this as a high priority of investment in metastatic breast cancer research.

Dr. Larry Norton: Thank you. All right. We've run out of time, we've got a ton of important questions here, some of them are rather specific. I'm trying to figure out some way that I can get the answers, people to answer that question and maybe BCRF's blog or some other means that we can... Some of these have more general topics so we're going to get to it.

I thank all of you for being here, for answering these questions. My extraordinary panelists, all the scientists who are around you, thank you for being here. Let's have a great lunch.

Outro: That was BCRF’s 2019 Symposium and a special Investigating Breast Cancer podcast. Thanks for listening. To learn more about breast cancer research or to subscribe to our podcast, go to BCRF.org/podcasts.

BCRF Supports Young Scientists with Conquer Cancer®, the ASCO Foundation

 

BCRF has long recognized the importance of supporting promising young investigators. Without funding, early-career scientists cannot gain the independence they need to make significant contributions to breast cancer research and impact patients’ lives.

Since 2001, BCRF has supported the career development of tomorrow’s leading physician-scientists in breast cancer through its partnership with Conquer Cancer, the ASCO Foundation. BCRF has provided $14 million in critical funding to 83 early career clinical research projects through this partnership, including early research by Dr. Vered Stearns and Dr. Lajos Pusztai, current members of BCRF’s Scientific Advisory Board.

This year, BCRF is supporting five Conquer Cancer Young Investigator Awards, two Career Development Awards, one Advanced Clinical Research Award, and a special award honoring the late Dr. Arti Hurria that provides travel support to a young investigator in geriatric oncology to the ASCO Annual Meeting.

For 2020, BCRF is adding to this list a five-year professorship in breast cancer disparities.

Conquering Cancer by Empowering the Next Generation of Researchers

Recently, Conquer Cancer hosted its fifth annual Scientific and Career Development Retreat for its early career award recipients. The retreat featured talks from ASCO and Conquer Cancer leadership as well as opportunities for networking and selected research presentations from awardees.

“The Conquer Cancer annual retreat affords our grant recipients — including those whose work is generously supported by BCRF — opportunities to share their research, network, and form connections with peer physician-scientists and discuss important topics in career growth.” said Susan P. Sandler, Associate Director, Foundation Giving for Conquer Cancer.

A highlight from this year’s featured research presentations included Dr. Prasanna Alluri, recipient of BCRF and Conquer Cancer’s Young Investigator Award (YIA) in 2017.

“My 2017 Young Investigator Award not only jump-started my career but allowed me to pursue studies that will improve the care of patients with metastatic breast cancer,” he said referring to his BCRF-supported research that focused on developing innovative strategies to overcome endocrine treatment resistance.

Dr. Corey Speers, a YIA recipient in 2014, was an oral presenter at the retreat. Since receiving his award, he’s made significant progress towards personalizing radiation treatment for individual patients. Mentored by BCRF investigator, Dr. Lori Pierce, Dr. Speers has gone on to receive additional funding and is currently supported by BCRF through a partnership with the American Society for Radiation Oncology.

Dr. Heather McArthur attended the meeting and also spoke about career development. In addition to her BCRF funding, Dr. McArthur is the recipient of Conquer Cancer’s Advanced Clinical Research Award (ACRA) in Breast Cancer, also supported by BCRF. This three-year award is allowing her to build on earlier BCRF-supported work with a large, multi-center, randomized study of immune therapy in women with triple negative breast cancer.

“BCRF took a chance on funding our immune therapy study for early stage breast cancer in 2009. To my knowledge we were the first group to explore immune therapy administered with curative intent for breast cancer,” she said.

“The ACRA has allowed us to build on their early experience by supporting a large, multi-center, randomized study of immune therapy in women with treated triple negative breast cancer that are at high risk of recurrence. Innovation in this area would not have been possible without the support of BCRF and ASCO.”

Run with Team BCRF in the 2020 United Airlines New York City Half Marathon

 

Group Photo

For the second year, BCRF has spots in the 2020 United Airlines New York City Half Marathon on March 15th. A long time charity partner of the TCS New York City Marathon, we are honored to continue expanding Team BCRF opportunities and have runners take on the challenge of participating in this monumental race to support breast cancer research.

For those interested in applying to be on Team BCRF in the 2020 United Airlines New York City Half Marathon, please fill out the application form and take note of the conditions below.

Each participant is required to raise a minimum of $1,500 for BCRF. In return, the race entry fee will be waived and each runner will be provided with a Team BCRF shirt, as well as pink ribbons and bracelets to advance their fundraising efforts.

All applications must be received by December 18, 2019 and will be reviewed on a first come first serve basis. The names of selected runners will be announced no later than December 31, 2019.

For any additional questions, please email Christine Ward at cward@bcrf.org

Mother-Daughter Team Up to Raise Funds and Awareness for Metastatic Breast Cancer Research

 

For Carol, running has been a way of life. She started at the age of 13, and nothing has stopped her from hitting the pavement – including when she was diagnosed with metastatic breast cancer.

“Since my initial diagnosis, my oncologist encouraged me to run and race,” she says. “I’m undergoing treatment for the rest of my life, so having goals keeps me motivated.”

Now, Carol is gearing up for another race: the New York City Marathon. Not only will this be her twentieth marathon, but she will be running the course with her daughter, Lina.

“My mother’s tenacity and ability to run despite her diagnosis has always been an immense source of positivity and inspiration for me,” Lina says.

Unlike Carol, Lina began running a couple years ago as way to connect with her mother. Since then, the mother-daughter duo trained together and ran the Boston Marathon in 2018. It was Lina’s first marathon and the conditions that year were particularly challenging. But the Chaouis persevered.

“It was the worst weather,” Carol said. “We had rain ponchos on until the final stretch where we finished side by side.”

This year’s New York City Marathon also signifies another form of determination for Carol. She had initially signed up for last year’s race but had to defer after she met a medical setback: 40 lesions developed on her brain.

“Last year was my worst year of cancer treatment,” Carol said, recalling the harsh side effects of the medications she was on. Her running routine ceased altogether, until March when she ran a half marathon.

Then, she qualified for a targeted therapy. For the first time, her scans reported regression in her brain lesions and tumor markers.

“This was the first good news I received in over a year,” she says. “This is a direct result of research.”

Initially diagnosed in 2009, Carol experienced a recurrence in 2015 and has been living with metastatic disease since. While blood draws, scans and treatments have become her new norm, running has remained her passion. Her focus has now shifted from beating the clock to educating others about metastatic breast cancer.

On race day, she’s hard to miss with her signature cape emblazoned with the words: “Stage IV Needs More.” On Instagram she’s dubbed herself “MBC Wonderwoman.”

“It definitely sparks conversation,” Carol says.

While many people are aware of early-stage breast cancer, Carol has made it her personal mission to humanize advanced breast cancer. Each race is a new opportunity to share her story and to show how research advancements have given her the ability to pursue her passion while undergoing treatment. 

“Research is going to help patients like myself have access to better treatments with hopefully less toxic side effects,” she says. “There are more options in the pipeline thanks to research.”

For Carol’s daughter, Lina, supporting research is crucial to improving her mother’s prognosis. So far, she has raised more than $12,000 for BCRF ahead of the New York City Marathon.

“Research is so important to me because it will allow us to go beyond the currently available treatments so that those with MBC can live longer and more fulfilling lives," she says.



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