This week is National Women’s Health Week. In honor of this important health awareness week, the Women’s Health Research Institute recently hosted the third annual Celebrating National Women’s Health Week event at Prentice Women’s Hospital in Chicago, IL. Activities included keynote speaker, Holly Herrington, MS, RD, LDN, from the Center for Lifestyle Medicine, a poster session featuring current research in women’s health, and exhibitors from in and around Chicago promoting women’s health through advocacy, research, and/or education. Approximately 400 people attended this event, making this year the most successful turnout yet!

Anxious to take part in this fantastic event bringing awareness to gender specific health issues and organizations, we signed up to participate alongside two dozen other groups promoting women’s health. Exhibiting next to us was a local organization called SHINE, which provides infertility group support in Chicago for men and women experiencing fertility struggles. Together, we proved to be a popular stop for health care professionals, specifically nurses, eager to bring fertility preservation information back to their patients. Recognizing fertility as a critical component of patient care, they expressed their gratitude for the Consortium’s efforts to educate clinicians about the value of discussing reproductive health outcomes with newly diagnosed pediatric, adolescent, and young adult cancer patients, and their parents when appropriate.

While perusing the exhibit tables, attendees were also exposed to a poster session displaying the latest in women’s health research. Woodruff Lab members presented their research to captivated audiences eager to learn more about the future of women’s reproductive health. Another Woodruff Enterprise making its mark at the poster session was the Women’s Health Science Program (WHSP), providing science education programs to females from underserved communities. WHSP targets young women who are considering careers in science and medicine and prepares them with valuable knowledge and skills to successfully become the next generation of women science leaders.

At noon, keynote speaker, Holly Herrington, RD, LDN, a Registered Dietitian in the Center for Lifestyle Medicine at Northwestern Medical Faculty Foundation, took the stage to discuss how women should be eating to maintain optimal health at every age. Holly’s presentation centered on helping attendees understand how nutritional needs for women evolve across their lifespan, and how they change based on different health and disease states. She provided information on nutrients, vitamins, and the evidence behind dietary recommendations, which can protect against or contribute to the development of chronic health issues, such as obesity, osteoporosis, and other diseases. The takeaway message from her presentation was to eat a healthy diet mainly comprised of superfoods in an effort to lower cholesterol, reduce the risk of heart disease and cancer, improve mood and keep your weight in check. Sounds like good medicine to us!

To read more about Celebrating Women’s Health Week, please visit the Women’s Health Research Institute website.

May is National Skin Cancer Awareness Month and this time of year brings skin, our body’s largest organ, into focus as the  weather warms up and people spend more time outside in the sun. Skin cancer is sometimes referred to as a “lifestyle disease” because its occurrence can be dramatically reduced through behavior modification, education, and early detection. Learning more about the disease and how it can be easily prevented and/or treated if found early, will hopefully inspire our readers to make some positive lifestyle changes and reduce their risk of skin cancer.

What is skin cancer exactly? Skin cancer is defined as the uncontrolled growth of abnormal skin cells. It occurs when unrepaired DNA damage to skin cells, most often caused by ultraviolet radiation from sunshine or tanning beds, triggers mutations, or genetic defects, that lead the skin cells to multiply rapidly and form malignant tumors. Cancer of the skin is often divided into two categories: non-melanoma and melanoma. The American Cancer Society estimates there are well over 1 million unreported cases of non-melanoma (basal cell or squamous cell) cancers annually in the United States. Melanoma, the more-serious form of skin cancer, is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for young people 15-29 years old. Furthermore, women aged 39 and under have a higher probability of developing melanoma than any other cancer except breast cancer, and up until age 40, significantly more women than men develop melanoma.

Current statistics show that skin cancer is the most common type of cancer in the United States, as well as some other countries, and unfortunately the incident rate continues to rise.  Although the frequency of melanoma and non-melanoma skin cancer diagnoses indicate that this disease remains a significant health concern, it’s important to note that, research and public awareness campaigns are promoting prevention and early detection of skin cancer. Staying informed with the latest news on prevention and screening are important steps in reducing your risk of developing skin cancer. Here are a few tips from the Skin Cancer Foundation for reducing your skin cancer risk:

• Seek the shade, especially between 10 AM and 4 PM.
• Do not burn.
• Avoid tanning and UV tanning booths.
• Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
• Use a broad spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher every day. For extended outdoor activity, use a water-resistant, broad spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher.
• Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside.
• Reapply every two hours or immediately after swimming or excessive sweating.
• Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months.
• Examine your skin head-to-toe every month.
• See your physician every year for a professional skin exam.

Tomorrow, April 25th, we are excited to be hosting Dana Gossett, MD, Chief of the Division of Obstetrics & Gynecology at Northwestern University’s Feinberg School of Medicine, for our Virtual Grand Rounds (VGR) at 2 PM CDT. Please take note that her presentation entitled, “Management of Abnormal Uterine Bleeding During Cancer Treatment,” will be taking place at 2 PM CDT as opposed to our regular morning VGR schedule. Dr. Gossett’s research projects focus on delivery of health care and patient outcomes and she has co-authored several publications analyzing the clinical outcomes of patients with gynecologic cancers.  Click HERE to watch Dr. Gossett present her Virtual Grand Rounds, tomorrow at 2 PM CDT.

Our LIVE Virtual Grand Rounds provide researchers, clinicians, and others the opportunity to hear emerging research findings in cancer and fertility from anywhere across the globe and participate through a live video chat. Virtual and in-person attendees to the rounds can receive free continuing medical education (CME) credits by following the instructions HERE.  Participants can also receive free CME’s by watching a recorded version of the Virtual Grand Rounds which can be found on our website HERE. To read more about receiving education credits from the Oncofertility Consortium, read about the Oncofertility Online program.

Since the 1990s, researchers have published conflicting results about the connection between cancer risk and fertility drugs. As a result, there has been a lingering concern among women that using fertility drugs may increase their risk for later developing hormone receptor positive cancers. Hormone receptor positive tumors consist of cells that express receptors for certain hormones such as estrogen or progesterone, but are most commonly known as estrogen receptor tumors. These types of tumors depend on the presence of estrogen in order to grow and spread throughout the body, making the risk for gynecologic cancers cause for concern in some women undergoing IVF treatment.

Fertility drugs have come under scrutiny because they stimulate hyper-ovulation, meaning they cause a woman’s body to produce more eggs. They have been linked to certain gynecologic cancers, such as breast and ovarian cancer. One reason research published in the 1990s may have suggested a link between fertility drugs and cancer risk, is due to the drugs that were being prescribed 20 years ago. Researchers have also blamed the mixed nature of the findings on the studies’ relatively short length, or on including women who have not given birth as they are known to have an increased risk of some cancers.

New research, however, suggests that using fertility drugs does not have an impact on your risk for developing ovarian cancer down the line. Lead author of the study and clinical fellow in the Division of Reproductive Endocrinology at the Mayo Clinic in Rochester, Minnesota, Dr. Albert Asante and his colleagues gathered medical information on 1900 women from an ongoing ovarian cancer study at the Mayo Clinic. The researchers compared 1,028 women with ovarian cancer to 872 women of similar age who did not have cancer. As reported in Fertility and Sterility, approximately 24 percent of the women who did not have ovarian cancer reported having used fertility drugs, while roughly 17 percent of women who had ovarian cancer had used fertility drugs.

The researchers took into account factors that can influence the risk for ovarian cancer, such as age and use of the birth control pill, and found no difference in cancer rates between the groups. Dr. Asante looked specifically at whether women in the study who reported being infertile- whether or not they had taken fertility drugs – had a greater chance of developing ovarian cancer, and found no added risk. He said one explanation for the result is that most of the women in his study had infertility issues, but eventually became pregnant. According to Dr. Albert Asante, “One important message [from this study] is women who need to use fertility drugs to get pregnant should not worry about using these fertility drugs.”

To read more about this new study, click HERE for the full text. To learn more about your reproductive options when faced with a cancer diagnosis, please visit www.SaveMyFertility.org.

Next week in the United States is designated as National Minority Cancer Awareness Week. While cancer affects men and women of every age, race, ethnic background, and economic class, the disease has a disproportionately severe impact on minorities and the economically disadvantaged. National Minority Cancer Awareness Week promotes increased awareness of prevention and treatment among those segments of the populations that are at greater risk of developing cancer. The week’s emphasis gives clinicians, healthcare professionals, and researchers an opportunity to focus on high-risk populations and to develop creative approaches to battling cancer problems unique to these communities.

The Centers for Disease Control and Prevention (CDC) report that cancer death rates for women are highest among African Americans, followed by Caucasians, Hispanics, and Asian/Pacific Islanders. Cancer is the leading cause of death for female Asian Americans since 1980. Colon cancer continues to kill more African Americans than Caucasians for reasons that are not completely understood. According to the Intercultural Cancer Council, this is due in large part to delayed diagnosis coupled with less than appropriate patient care. In addition, individuals of all ethnic backgrounds who are poor, lack health insurance, or otherwise have inadequate access to quality cancer treatment experience higher cancer incidence, higher mortality rates, and lower survival rates. As a result, members of these populations may put off the expense of seeing a doctor until they are very sick and are diagnosed at a later stage, and thus have a poorer chance of survival.

Key Statistics about Cancer in Minorities from the American Cancer Society:

• African-Americans have the highest death rate and shortest survival following diagnosis of any racial and ethnic group in the U.S. for most cancers.
• It is estimated that about 169,000 new cancer cases will be diagnosed among African-Americans by year’s end. Approximately 66,000 African-Americans will die from cancer.
• The most commonly diagnosed cancers among African-American men are prostate, lung and colorectal.
• Among African-American women, the most common cancers are breast, lung and colorectal. 
• Nearly 99,000 new cancer cases in Hispanic men and women were diagnosed in 2009. Among Hispanics, there were 29,000 cancer deaths.
• Prostate cancer is the most commonly diagnosed cancer in Hispanic men, while lung cancer accounts for the largest percentage of deaths in that group.
• Breast cancer is both the most commonly diagnosed cancer and the leading cause of cancer death among Hispanic women.
• Among Asian Indian and Pakistani women, breast cancer is the most diagnosed cancer and the leading cause of cancer death. (National Cancer Institute)

For more information about how cancer affects minority populations, please visit the Intercultural Cancer Council or click HERE.

Tomorrow, April 11th, we are excited to be hosting Clarisa Gracia, MD, MSCE, Associate Professor of Obstetrics and Gynecology at the University of Pennsylvania, for our Virtual Grand Rounds at 10 AM CDT. Her presentation entitled, Case Studies in Oncofertility, will analze indviduals who have undergone fertility preservation following a cancer diagnosis, and the developmental factors related to their decision. Dr. Gracia is also a contributing author in the Oncofertility book series, lending her clinical expertise and experience to the subfield, and she is an integral member of the Oncofertility Consortium. Click here to watch Dr. Gracia present her Virtual Grand Rounds, tomorrow at 10 AM CDT.

For those who are not aware of these special rounds, they are live videoconferences with experts in the fields of reproduction, cancer, and oncofertility. The rounds provide researchers, clinicians, and others the opportunity to hear emerging research findings from anywhere across the globe and participate through a live video chat. Virtual and in-person attendees to the rounds can also receive free continuing medical education (CME) credits by following the instructions here. Within one week of the rounds, a video recording will be posted on the Oncofertility Consortium website and CME credits will be available to online viewers. To read more about receiving education credits from the Oncofertility Consortium, read about the Oncofertility Online program.

By Danielle Alyce Fanslow, Francesca Duncan, and Kate Timmerman

There are several methods of fertility preservation open to female cancer patients who wish to start a family after treatment including cryopreservation of oocytes, embryos and ovarian tissue. Cryopreservation is a method of preserving biological material by storing it at extremely low temperatures. Choosing a  fertility preservation method is highly patient-specific and depends on factors such as patient age, the availability of a partner, and/or the sensitivity of the tumor to hormones.  A good option for pre-pubertal patients and patients who must undergo treatment as soon as possible after diagnosis may be cryopreservation of ovarian tissue.  However, current techniques for tissue cryopreservation may be improved as only 22 successful pregnancies have resulted from this method [1].

A group of Oncofertility researchers at the Oregon National Primate Research Center (Ting, Yeoman, Campos, Lawson, and Zelinksi) together with cryopreservation experts (Mullen and Fahy) have been developing new methods for cryopreserving ovarian tissue with the focus on preserving follicle health and quality.  Findings from their most recent work was published in the journal Human Reproduction in an article entitled “Morphological and functional preservation of pre-antral follicles after vitrification of macaque ovarian tissue in a closed system.”  This work provides insight that may lead to improved clinical protocols for ovarian tissue cryopreservation.

The goal of cryopreservation is to minimize injury to cells from the freezing process while limiting the toxicity of cryoprotective agents [2]. The current protocol for ovarian tissue cryopreservation involves slowly freezing the tissue with low concentrations of cryoprotective agents to avoid ice crystal formation inside the cell but to allow ice formation outside the cell [1]. However, ovarian tissue has an abundance of cell types and important extracellular material making it more complex to freeze compared to isolated cells. Vitrification is a method of cryopreservation that can avoid ice crystal formation inside and outside of the cell by quickly freezing the tissue with a high concentration of cryoprotective agent [3].   This method holds tremendous promise in the setting of fertility preservation and has already been applied successfully and routinely to egg and embryo freezing. However, researchers must optimize ovarian tissue vitrificaiton before it can be used in a clinical setting.

As the amount of human ovarian tissue available for research is limited, the Zelinski group used a non-human primate model to study several variables in the vitrification process including the type and concentration of cryoprotective agent used, the cooling rate, and the warming rate.  As a means to assess the quality of the tissue in each experimental condition, the researchers isolated ovarian follicles from the tissue and used them for encapsulated in vitro follicle growth (eIVFG) – a technique that this group had previously applied successfully to the non-human primate.  The researchers then monitored follicle health, diameter, and hormone production.   Using these techniques and assays,  the Zelinski group was able to determine a set of variables that resulted in the healthiest ovarian tissue. Through the findings by the Zelinski group, the field is one step closer to developing a standard protocol for ovarian tissue vitrification that can potentially result in a high rate of successful pregnancies.

References:

1. Ting AY, Yeoman RR, Campos JR, Lawson MS, Mullen SF, Fahy GM, Zelinski MB. Morphological and functional preservation of pre-antral follicles after vitrification of macaque ovarian tissue in a closed system. Hum Repro. 2013. Feb 20^th Ahead of Print.
2. Pegg DE. The history and principles of cryopreservation. Semin Reprod Med. 2002 Feb;20(1):5-13.
3. Pegg DE. The role of vitrification techniques of cryopreservation in reproductive medicine. Hum Fertil (Camb). 2005. Dec;8(4):231-9.

Alice Crisci, founder of Fertile Action, and contributing author to the fourth upcoming Oncofertility book, Oncofertility Communication: Sharing Information and Building Relationships across Disciplines, has been in the news recently for her vocal opposition to a California bill that prohibits women from getting paid for donating their eggs for medical research. Now at 11 weeks pregnant, we asked her to tell to share her cancer story with us, including her advocacy and policy work.

—————————————————————–

Q: Tell us a little bit about how you got involved in cancer and fertility advocacy?

I was diagnosed with breast cancer in 2008, and launched my non profit, Fertile Action, that same year. In 2009, I took my board to the National Breast Cancer Coalition (NBCC) annual conference. We were all shocked at the exclusionary policies of the NBCC towards young women, but had the good fortune of meeting with congress woman, Debbie Wasserman Shultz, about the Early Act (the Public Health Service Act to increase awareness of the risks of breast cancer in young women and provide support for young women diagnosed with breast cancer). We spent a day running around the Capitol lobbying for her bill, and I saw firsthand how I could be an influencer in setting or opposing policies. Since then I have worked at the California state level, and federal level on meaningful initiatives that support young adult cancer survivors.

Q: Based on your cancer diagnosis and treatment plan, how long were you advised to wait to start a family after you completed cancer treatment?

My treatment was very long – almost 3.5 years before I was taken off all medications. 2.5 years of that was spent in medical menopause so I was not producing hormones that could support a pregnancy. I started trying naturally about a year later and had three chemical pregnancies/early miscarriages. I finally decided to use the “totsicles” I created with a sperm donor when I was diagnosed. My first transfer was a success, and on my five year cancerversary I heard my baby’s heartbeat for the 2nd time and balled my eyes out! My doctor approved me going off tamoxifen early because of the additional treatment of medical menopause. It’s such a toxic medication that he recommended I wait six months before trying to get pregnant. That six month wait turned into almost a year before having my first pregnancy loss.

Q: How has your cancer survivorship care influenced your fertility story? 

Had anyone told me when I was first diagnosed that I would be in some form of treatment for over 3 years, I wouldn’t have started! I thought it was surgery, chemo and done. Six months of my life, and that was that. I was very sick from all the treatment for so many years, then dealing with so many side effects after ending treatment, My fertility plans continued to get delayed. I was also financially devastated from going through cancer, and it took a long time to start rebuilding to the level where I thought I could afford a family.

Q: You have been a vocal critic of the CA bill prohibiting compensation to women for donating their eggs to medical research. How do you think a reversal of this bill would impact cancer care?

To date, we have focused more on quantity, but there are ample women like me who have eggs left that don’t produce a live birth. If we can study chemo’s impact on quality then we can also discover new interventions for preventing that impact. Fertility preservation is still prohibitive for many patients so we need to keep innovating in other areas. California’s current bill prevents any of the amazing researchers in this great state from conducting this type of study. Institutional Review Boards (IRB), especially at the university setting, do a great job of overseeing ethics, and preventing exploitation of vulnerable populations. In many cases IRB’s are much more restrictive than legislation!

To learn more about your fertility options following a cancer diagnosis, please visit www.SaveMyFertility.org.

Don’t miss out on tomorrow’s Oncofertility Virtual Grand Rounds at 10 AM CST! For those who are not aware of these special rounds, they are live videoconferences with experts in the fields of reproduction, cancer, and oncofertility. The rounds provide researchers, clinicians, and others the opportunity to hear emerging research findings from anywhere across the globe and participate through a live video chat. Virtual and in-person attendees to the rounds can also receive free continuing medical education (CME) credits by following the instructions here. Within one week of the rounds, a video recording will be posted on the Oncofertility Consortium website and CME credits will be available to online viewers. To read more about receiving education credits from the Oncofertility Consortium, read about the Oncofertility Online program.

Tomorrow, March 7th, we are excited to be hosting Cassing Hammond, MD, Associate Professor of Obstetrics and Gynecology at Northwestern’s Feinberg School of Medicine, and Jessica Kiley, MD, Assistant Professor of Obstetrics and Gynecology at Northwestern’s Feinberg School of Medicine, for our Virtual Grand Rounds at 10 AM CST. Their presentation entitled, Contraceptive Options During and Following Cancer Treatment, will review current birth control methods available to cancer patients, which vary depending on the type of cancer a patient is diagnosed with. Click here to watch Dr. Hammond and Dr. Kiley present their Virtual Grand Rounds, tomorrow at 10 AM CST.

By Cathryn Smeyers

This is the final installment in a two-part blog story featuring Oncofertility Consortium member, Gregory Dolin, MD, JD, focusing on his recent Oncofertility Virtual Grand Rounds presentation. To read the 1^st blog, click here.

In his presentation, Dr. Dolin highlighted some of the problems that exist within the legislative process that make it even harder for scientific issues to be successfully conveyed to lawmakers.  According to Dr. Dolin, the hearing process, which many assume involves full congressional engagement, the presentation of relevant information and lively debate, is often more like “kabuki theater.”  Only invited participants are allowed to testify, hearings are rarely and sparsely attended, and the chairman has a nearly complete control of the agenda and the text of any proposal discussed.  Furthermore, after the hearing, much work is done by the staff in secret, the House Rules Committee can amend or rewrite the bill in any way it sees fit, floor debates may be very limited, and Conference Committees once again have the opportunity to amend or rewrite the bill outside of public view.

So what’s the solution?  How can we ensure that the people in control of federal dollars are scientifically literate and well informed?  Dr. Dolin proposes the creation of an objective body of scientific advisors charged with evaluating all proposed bills and advising Congress of the likely effect of legislation.  This body would also have to solicit scientific input from members of the public, which would allow scientists to register their opinions.  Models of this currently exist in the form of the Congressional Budget Office and the late Office of Technology Assessment. The creation of such an office, however, is just a proposal, and we are unlikely to see it realized in the near future.  In the interim, Dr. Dolin advises that scientists involve themselves in the legislative process and do what they can to ensure that Congress hears and understands complex scientific research.

The Oncofertility Consortium whole-heartedly agrees with Dr. Dolin, and we feel that Dickey-Wicker underscores the necessity for scientists to not only have a voice in the political sphere but to be adept communicators who can appropriately relay complex scientific information to a lay audience.  We hope our blog, for example, allows us to relay scientific research in a way that is both comprehensible and meaningful to our readers. Repropedia (www.repropedia.org) is another tool that we use to clearly communicate scientific information.

Repropedia is a website that is edited by scientists across the globe and serves as an authoritative source of definitions for reproductive health terms. This site directly interacts with other website by providing pop-up definition boxes, so a reader gets the information in context.  Our blog serves as the perfect example!  Of course, we couldn’t let Dr. Dolin go without contributing to this valuable resource. He kindly agreed to contribute a video definition of the term “parthenote,” and we sincerely hope that the general public (Congress included!) will benefit from his explanation.  In the end, it is exactly this kind of clear communication by the scientific community that will educate the public and inform public policy.

Click here to see Dr. Dolin’s Repropedia definition.  Click here to read the chapter he co-authored in the second Oncofertility book, Oncofertility: Ethical, Legal, Social, and Medical Perspectives, entitled, “Medical Hope, Legal Pitfalls: Potential Legal Issues in the Emerging Field of Oncofertility,” and look for his contribution to the fourth Oncofertility book due out later this year entitled, Oncofertility Communication: Sharing Information and Building Relationships across Disciplines.