For those of you who don’t know, the 2012 Oncofertility Conference: Dialogues in Oncofertility, is taking place as we speak in Chicago, IL. We understand that not everyone can come to us, so we want to bring the Oncofertility Conference to you. Please visit our conference home page, and watch a live stream of this dynamic event. Even better, we are offering Continuing Medical Education (CME) credit so if you’re interested in adding some to your repertoire, please click on the link for those. We hope you can join us!
Killing two birds with one stone? Understanding common genetic features of breast cancers and ovarian tumors
The more we understand about our genes, the more we understand genetic diseases and eventually, how to best treat them. The recent efforts of a nationwide consortium of researchers suggests that the origins of the type of breast cancer a patient is diagnosed with may inform the most effective course of treatment.
The study, published in Nature on September 23rd, is one of the most comprehensive studies of breast cancer to date. The study revealed that the gene expression profile for one of the most aggressive forms of breast cancer, basal-like carcinoma, is more similar with ovarian tumors than with other breast cancer subtypes.
The four main breast cancer subtypes: Luminal A, Luminal B, HER2, and basal-like, were confirmed and characterized by leading researchers at several institutions as part of The Cancer Genome Atlas Network. The study is part of an NIH funded initiative with the Cancer Genome Atlas Network to build maps of genetic changes in common cancers. While most historical studies of breast cancer have utilized one or two methods to analyze and characterize the gene profiles of breast cancers, six parallel technologies were used for this study to examine mutations and defects in DNA, RNA, and proteins. Consortium scientists analyzed tumors from 507 women, with nearly 350 tumors being analyzed using all six technologies.
Basal-like breast tumors are also known as “triple negative” tumors. Triple-negative tumors lack receptors for the hormones estrogen, progesterone, and human epidermal growth factor 2 (HER2), which are the gene targets of a number of approved chemotherapies such as Tamoxifen and Herceptin. However, no receptor hormones means no drug targets. Basal-like tumors are a considered high-grade, indicative of an abnormal appearance of the cells under a microscope and a tendency to grow and multiply more rapidly. These tumors have a poor prognosis for treatment and are more prevalent in younger women, women with BRCA1 and BRCA2 mutations, and women of African-American descent.
Currently, basal-like breast tumors are treated like most other breast cancers, using similar chemotherapy strategies. However, basal-like breast tumors are aggressive and not been shown to respond well to therapies targeting hormone receptors or to standard chemotherapy regimens. Consortium researchers found that each subtype could be identified by unique genetic markers, and that mutations in only three genes, TP53 (tumor suppressor gene 53), PIK3CA and GATA3, occurred in common with all four subtypes. These findings suggest that not all breast tumors are alike and therefore, may not respond similarly to the same chemotherapy regimens.
Consortium scientists found that basal-like and HER2 tumor subtypes were characterized by the highest mutation rates. Basal-like tumors shared common features with ovarian tumors and lung cancers, including high rates of TP53 mutations, BRCA1 inactivation, and a loss of RB1 and cyclin E genes, which are known to promote genome instability. The study shows that 80% of basal-like tumors had TP53 mutations and approximately 20% also have mutations in the BRCA1 or BRCA2 genes. Mutations in the TP53 gene have been strongly linked to poor treatment outcomes, while BRCA1/2 mutations are known to increase breast and ovarian cancer.
A growing body of research suggests that tumors should be characterized and treated based on the presence of abnormal genes and abnormal gene expression profiles rather than on their location in the body. Consistent with these findings, consortium researchers found that basal-like tumors are genetically more similar to ovarian tumors based on their genetic profiles. Ovarian tumors are also characterized by a high frequency of TP53 mutations, widespread genomic instability and share other gene mutations in common with similar frequency. These results give biologic reasoning to consider the potential benefits to patients with basal-like tumors to be treated with platinum-based chemotherapies currently approved for the treatment of ovarian cancer or PARP inhibitors which target tumors with BRCA1 and 2 defects.
Clinical trials are a lengthy but necessary step to determine if platinum-based compounds, currently used to treat cancers elsewhere in the body, and/or PARP inhibitors hold promise for patients diagnosed with basal-like breast carcinoma. For now, this study offers much needed insight into the origins of the most aggressive form of breast tumor and promising possibilities for future personalized treatments.
After nearly ten years of research, a team of 20 doctors and specialists at the University of Gothenburg in Sweden, have performed the first mother-to-daughter uterine transplants in two Swedish women.
The two women, both in their 30s, received new wombs donated by their mothers on September 15th and 16th without complications. One of the women was born without a uterus, while the other, a cervical cancer survivor, had to have her uterus removed many years prior.
The uterine transplant procedure was developed as a reproductive technology to allow women of childbearing age, who lack a uterus, to bear children. Both women began hormonal treatments for in-vitro fertilization before the surgery. Frozen embryos will be thawed and transferred to their new wombs once doctors have determined that they are healthy enough to support a pregnancy.
According to the Centers for Disease Control (CDC), more than 600,000 hysterectomies are performed annually in the US. Although the vast majority of hysterectomies are performed electively as a treatment for symptoms associated with gynecologic disorders, removal of the uterus is frequently recommended when cancer of the cervix, uterus, vagina, fallopian tubes and/or ovaries is invasive. Similarly, hysterectomy is recommended in cases of uterine fibroid tumors, endometriosis and uterine prolapse.
Uterine transplants are unique amongst organ transplants in that they are not required as a life-saving intervention. Because the procedure is not regarded as life-saving, researchers had to perfect the procedure to make it as safe as possible using non-human primates. The first successful transplant for the team was reported via a series of publications lead by Mats Brannstrom around 2003. The team of more than 10 surgeons who performed last weeks uterine transplants, trained together for several years first with mice, reporting successful pregnancy and offspring. The team has since been successful in other animal models including baboons.
Although it is too soon to know, the mark of success for these transplants, and one performed last year by Turkish doctors using a womb from a cadaver, is a successful pregnancy. If successful, the option of uterine transplant may affect thousands of women of reproductive age that have had to have their uterus removed due to uterine or cervical cancer, endometriosis, and those born without a uterus due to genetic disorders such as Turner’s Syndrome.
The often partners with Stupid Cancer, a non-profit organization that empowers young adults affected by cancer through innovative programs and services, to ensure that the needs of the adolescent and young adult (AYA) cancer community are prevalent in the scientific community. Young adults account for 72,000 new diagnoses each year, or roughly 10% of the cancer population. AYA cancer patients face a variety of hurdles along their medical journeys. While survival rates for young children and elderly cancer patients increased over the past few decades, rates for 15 to 40 year-olds are unchanged.
This year, Stupid Cancer founder, Matthew Zachary, will be a featured speaker at the 2012 Oncofertility Conference, highlighting the special needs of the AYA cancer community. Not only will he be speaking at the conference, but he will also be performing a piano concerto at our cocktail event, An Evening for Pediatric and Young Adult Cancer Survivors, Thursday, September 27th, at the Ann and Robert H. Lurie Children’s Hospital. We are so excited to have Stupid Cancer take an active role in the conference this year because of their incredible ability to connect young cancer patients with a support network that they may not have known about otherwise. One of the more popular networking events that Stupid Cancer hosts across the country are informal “Happy Hours,” to promote its mission and provide entertainment to young cancer patients. These kinds of events connect patients undergoing treatment, those in remission, and healthcare professionals in a continuing effort to ensure that young cancer patients get the best support possible.
Fortunately for Chicagoans, Stupid Cancer is partnering with Imerman Angels, an organization that matches and individually pairs a person touched by cancer (a cancer fighter or survivor) with someone who has fought and survived the same type of cancer, to host a Happy Hour on Thursday, September 27th from 7-9pm at Moe’s Cantina following the Oncofertility Conference. In the words of Stupid Cancer, “Come out for a different kind of social mixer with no pressure, no judgments, no stigma and—best of all—no sitting around a circle sharing your feelings. Chill out, make friends and hang with folks who don’t care if you have one boob, one ball, port scars or a serious lack of eyebrows.” For more details, visit Stupid Cancer Chicago Happy Hour or click here to register for the 2012 Oncofertility Conference. We hope to see you there!
The 2012 Oncofertility Conference: Dialogues in Oncofertility begins next Thursday, September 27th in Chicago, IL. This 6th annual conference will include talks from experts across the globe on topics that range from factors influencing primate folliculogenesis to the psychosocial needs of young cancer patients. The keynote presentation from Dr. Hamish Wallace, will address, “Fertility Preservation for Young People with Cancer: What Are the Remaining Challenges?” In addition, an evening cocktail hour will include a celebration for pediatric and young adult cancer survivors with national advocates, survivors, researchers, and clinicians…and a special piano performance from the founder of the young adult cancer advocacy organization, Stupid Cancer, Matthew Zachary.
For those who are not able to attend the conference in person, we are happy to announce that the educational presentations will be available through live web streaming. Virtual attendees can join in from across the globe by going to this website (http://bit.ly/virtualoncofert) during the conference hours on Thursday, September 27 – Friday, September 28. In addition, complementary CMEs, nursing, and physicians assistant credit hours will be available to online attendees. Learn more about this virtual broadcast and pre-register to receive CMEs through the virtual conference.
To attend the 2012 Oncofertility Conference in person, limited registration is still available. We look forward to seeing you there!
A recent story on the Today Show sparked my interest and practically begged for me to write about it. It involved cancer, fertility, and surrogacy so it seemed right up our alley, but there’s a caveat I should disclose before you read any further – the mother of the mother-to-be was carrying her daughter’s child. Are you following me so far? Keep reading…
Chicagoan Emily Jordan was diagnosed with cervical cancer when she was 30 years old, leaving both her and her husband Mike, certain that children would not be in their future. Even more devastating news would follow – when she went into surgery to have her uterus removed, doctors informed her that she was actually pregnant. Although doctors could not save the fetus, they assured Emily that they would try and save her ovaries so she could still produce eggs.
After Emily’s surgery, she and Mike underwent invitro fertilization (IVF), but because she no longer had a uterus, they needed a surrogate to carry their embryo. At the time, her 52 year old mother Cindy, was anxious for a grandchild and heartbroken for her daughter because she couldn’t carry her own child. Cindy offered to be her daughter’s surrogate. Emily and Mike initially dismissed her proposal thinking it was not a realistic option. After broaching the subject with Emily’s OB/GYN, she found out that her mother was exceptionally healthy, and actually a good surrogate candidate, so Emily and Mike made the joint decision to have Cindy carry their child.
According to Emily, “This is just a continuation of everything she has done for me her entire life, which is to make sure that I have the best life possible. This just reaffirms everything I know about her and love about her.” Just days after Emily turned 32, baby Elle Cynthia Jordan was born via C-section. Even though the procedure required hormone shots for several months, Cindy said she would do it again: “When I watch both of them hold that baby and look into her face, it’s like everything I could have imagined wanting for them, better than I could have imagined. This is what it was all about for me.”
As you may have heard us mention a time or two before, the 3rd book in the oncofertility series, Oncofertility Medical Practice: Clinical Issues and Implementation, was just released on Amazon.com and is available for purchase. Besides just letting our readers know that important piece of information, we’d also like to give you an inside look into the wealth of knowledge this informative new book contains. To begin, let’s take a look into chapter 13, “Patient Navigation and Coordination of Care for the Oncofertility Patient: A Practical Guide,” by Kristin Smith, Brenda Efymow, and Clarisa Gracia to see the true role of patient navigators in oncofertility management.
Adolescents and young adults facing a new cancer diagnosis need immediate access to oncofertility care in order to maximize their fertility preservation options. In order to do this, patient navigators act as the go-between among a variety of health care providers including oncologists, and reproductive specialists, during a highly stressful and complex time following a cancer diagnosis. According to the authors, “Within the health care setting, the patient navigator bridges institutional and disciplinary boundaries so that cancer patients are able to receive timely information regarding fertility preservation options.” Once cancer patients receive this pertinent information, they are better able to make informed decisions about their course of treatment.
Cancer patients making the decision to preserve their fertility have a limited timeframe to process and make this decision that individuals not facing a cancer diagnosis often do not have to navigate. They do not have the time to flesh out their decision and/or save up for the expensive procedure. According to the authors, “The average out-of-pocket cost for invitro fertilization (IVF) in the United states is $12,500.” A fertility preservation patient navigator can assist patients by directing them to programs established to defray the cost of fertility preservation, or draft appeal letters to insurance companies, which can result in a savings of thousands of dollars.
Finally, patient navigators act as the “experts” in fertility so that oncologists don’t have to be. They serve not only the patient, but also the provider, making a complex topic more accessible to healthcare professionals who may be uncomfortable with their level of knowledge in oncofertility, increasing the likelihood that they will not refer patients for consultation. At Northwestern, Fertility Preservation Patient Navigator Kristin Smith works closely with healthcare professionals, shepherding patients between specialists in oncology, urology, and reproductive endocrinology. Kristin is also the face of the new Fertility Preservation Patient Navigator website, designed to provide virtual assistance to young patients wishing to learn about their reproductive options in the midst of a cancer diagnosis. To learn more about this website, read our blog, “Introducing the Virtual Patient Navigator for Fertility Preservation,” by Kate Waimey Timmerman, or click here to go directly to the website.
To learn more about the Patient Navigators’ role in fertility perseveration, read, “Patient Navigation and Coordination of Care for the Oncofertility Patient: A Practical Guide,” in Oncofertility Medical Practice: Clinical Issues and Implementation.
Here at the Dialogues in Oncofertility. At the conference, experts will discuss which cancer treatments are likely to damage later reproductive ability for men, women, and children and new fertility preservation methods. At this year’s sixth annual conference on September 27 – 28, 2012 in Chicago, IL, clinicians and scientists will discuss recent advances in oncofertility scientific and medical treatment., we are busy putting the final touches on the upcoming 2012 Oncofertility Conference:
The program for this two-day conference on fertility after cancer features translational and clinical research on fertility preservation, lessons learned from individual fertility preservation programs, a speech and special performance by the founder of the adolescent and young adult cancer advocacy group, Stupid Cancer, and a Keynote Symposium by Hamish Wallace, MD (Royal Hospital for Sick Children, Edinburgh). During the two days of the conference, more than 20 invited speakers from across the globe will present cutting-edge information to attendees.
Health care providers will be provided with CME or nursing contact hours at no additional cost. For more information or to register for the conference, visit the website at http://bit.ly/oncofert12 or email email@example.com. The 2012 Oncofertility Conference is funded by the NIH (Grant 5R13HD063248-03), and an unrestricted educational grant from Ferring Pharmaceuticals, Inc.
To learn more about fertility and cancer, visit SaveMyFertility.org and download the free iPhone app.
The Northwestern Community (university, hospital, faculty foundation, etc.) is extremely comprehensive, and offers so much in the realm of cancer care. We like to think that we’re a one stop shop for anyone dealing with a cancer diagnosis – taking care of patients’ physical, mental, and emotional needs not only while in treatment, but also in survivorship. One of the great services that Northwestern provides is a forum for patients, caregivers, and survivors of breast cancer to meet and discuss treatment options, symptom management, exercise & nutrition and survivorship, in a supportive environment.
The Lynn Sage Breast Cancer Town Hall Meeting is a free event that takes place once a year for individuals who are looking for information on moving forward after breast cancer. If you have questions about treatment options, nutrition and physical activity, family history and supportive oncology services, this is a great place for you to come and learn, interact, and take in all the information that you need. This interactive discussion about breakthroughs in breast cancer is a unique opportunity to have any of your cancer-related questions answered by experts at Northwestern’s Lurie Cancer Center. Participants also can visit the extensive range of exhibitors to discover community breast cancer resources, and learn more about local and national organizations providing support. Some panel topics are:
- Nora Hansen, MD – Understanding Breast Cancer Surgery Options
- Virginia Kaklamani, MD, DSc – Cancer Risk & Genetics
- Virginia Nothnagel, MS, RD, LDN – Eating Well & Staying Active
- Timothy Pearman, PhD – Facing Forward: Life after Cancer
The Lynn Sage Breast Cancer Town Hall Meeting takes place Sunday, September 30th from 1-4pm CDT, and is a free event open to the public. Learn more and register for the Lynn Sage Breast Cancer Town Hall Meeting here.
One of my favorite things about working at Northwestern University is access to the Women’s Health Research Monthly Forums, introduced by the Institute for Women’s Health Research in 2008. The monthly forums were developed to address a significant barrier to advancing women’s health research: lack of awareness among health professionals, researchers and consumers that sex and gender matter in health and disease. Through the monthly forums, the Institute provides a platform for leading professionals to present their evidence-based research that focuses on basic science, clinical applications, or social implications of gender differences. Each month, faculty and staff from and Northwestern Memorial Hospital attend the forum to gain a better understanding of women’s health. The three key objectives of the monthly forums are:
- To present current links between basic science research, clinical research and social/behavioral research to advance women’s health.
- To provide support and role models for emerging women’s health scholars via those who are already conducting sex- and gender-specific research.
- To encourage more sex- and gender-based research studies
Next week, on Tuesday, September 11th at 12:00pm CDT, the Women’s Health Research Institute is presenting: What Can Women and their Healthcare Providers Expect from the Affordable Care Act, led by Debra Stulberg, MD, MA, Assistant Professor in the Department of Obstetrics & Gynecology at the University of Chicago. The Affordable Care Act, otherwise known as ObamaCare, is a health care law that aims to improve our current health care system by increasing access to health coverage for Americans and introducing new protections for people who have health insurance. Under the Affordable Care Act, 47 million women will now have access to life-saving preventive care, such as mammograms and contraception, without paying any more out of their own pockets. Women and children face unique health risks and benefit from different preventive services and for too long, many have gone without these services due to out-of-pocket costs or lack of coverage.
Some Parts of the Law Right Now:
- Young adults can now stay on their parent’s health plan up to age 26.
- Insurance companies can’t deny health coverage to kids with pre-existing conditions, such as cancer.
- Adults who have been uninsured for at least 6 months and have been denied coverage because of a pre-existing condition, may now get coverage.
- Insurance companies can’t place dollar limits on the health care they cover in your lifetime, assuring people with diseases such as cancer, that they can continue to get the health care coverage they need.
President Obama recalled his mother telling him, “You can tell how far a society is going to go by how it treats its women and girls. And if they’re doing well, then the society is going to do well; and if they’re not, then they won’t be.” With that principle in mind, these new guidelines for women’s preventive health are a crucial step forward for the health of women, and for our society as a whole.
Please join us, Tuesday, September 11th at 12pm CDT in Prentice Women’s Hospital for What Can Women and their Healthcare Providers Expect from the Affordable Care Act? Click here to register for this event (space is limited). Forum registration closes September 10, 2012; or when room reaches capacity.