ONCOGENOMICS 101: TUMOR VARIANTS & RECURRENCE OPTIONS

ONCOGENOMICS: PRECISION ONCOLOGY 

Precision medicine, also known as personalized or individualized medicine, utilizes information gained from a person’s genetic makeup, along with their environment and lifestyle, to guide disease prevention, diagnosis, and/or treatment strategies. [1]  Oncogenomics is a form of precision medicine that enables more personalized approaches to cancer diagnosis, treatment, and prognosis. [2]  Cancer is often considered a genetic disease, whereby genetic mutations in the DNA of cells lead them to grow uncontrollably and become cancerous. With the increased emphasis on studying DNA and its role in cancer, the next step was to study the genetic characteristics of cancers to develop better treatments.

 

GENETIC CHARACTERISTICS OF A TUMOR 

Oncogenomics was launched in 1998 with the FDA approval of Trastuzumab (Herceptin) for HER2+ breast cancer. It was the first chemotherapy agent developed using genetic analysis of tumors to create a more effective and less toxic treatment that is still used today. [3]. Classified as a “targeted” therapy, it is an antibody that blocks specific receptors called HER2+ that are present in about 20% of breast cancers, and more recently have been found in other types of cancers as well. [4] Since then, more than 150 new therapies targeting specific components of tumors have been approved by the FDA, and just over half of these are considered “precision oncology” drugs targeting specific DNA mutations in tumors. But despite this tremendous progress, most tumors still do not have identifiable mutations that can guide or predict treatment response. [5]

One of the reasons for this is that, while there are some core genetic mutations common across many cancers, each tumor type can also have many variations that vary from individual to individual. This makes the process of identifying and confirming each mutation, as well as matching it to a specific treatment, quite time-consuming and costly. 

MATCHING TUMOR GENETICS WITH TREATMENT

When sequencing the DNA of a tumor, we are looking for mutations in specific types of genes known to contribute to cancer development and growth. However, our current knowledge still has gaps, so the DNA has to be evaluated very closely and analyzed for potentially new mutations as well. With this information, the next step is to try to match them to a specific therapy that would be effective. This is a very fine-tuned way to try to match the treatment with that tumor. 

Another obstacle is the emerging role of epigenetics in cancer development and growth. Separate from genetic mutations, epigenetics regulates the expression of genes by turning them on and off. Research is revealing epigenetic alterations as yet another layer that contributes to all cancer types. Precision oncogenomics now includes some drugs for cancers that target these epigenetic changes - especially hematologic cancers, as solid tumors appear to be more challenging. [6]. 

As technological advances enable us to do this faster and easier, we will continue to accelerate progress toward a vision of truly personalized approaches to treating cancer. The pharmaceutical companies are investing heavily in the efforts to come up with personalized drugs. It’s big business to do this, in addition to improving patient care.  OncoType DX is a great example of the impact of this approach. Assessing the estrogen receptor and HER2 characteristics of breast tumors has resulted in more precise treatment, as well as better prediction of recurrence risk.

GENETICS OF THE PERSON INFLUENCE TREATMENT

Even in the era of precision oncology, conventional chemotherapies still play a major role in treatment, either by themselves or in conjunction with these newer precision drugs. These drugs are often toxic to the person as well as to the tumor, causing side effects. 

One of the contributors to recurrence can be linked to how well people tolerate chemotherapy – as well as how they respond. Vastly underutilized is the role of pharmacogenomics, which looks at how a person’s genes influence how they process medications. This includes effectiveness as well as risk of adverse effects. Despite research showing that 99% of people carry at least one genetic alteration that affects their response to medications [7], and the FDA has approved genetic associations for more than 250 medications [8], it is still rarely utilized when selecting chemotherapy drugs and doses. 

 

L-Image source: Rendell T, Barnett J, Wright D. How community pharmacy pharmacogenomics testing services around the world can inform their design and delivery in the UK. 2021 The Pharmaceutical Journal.

PREVENTING CANCER RECURRENCE: THE HOLY GRAIL

Allopathic medicine doesn't typically focus on prevention. Rather, it is primarily concerned with diagnosing and treating diseases – including cancer.  Clearly, we want to do everything we can to try and really get precise about what each person’s cancer is about so we can treat it most effectively. 

But the next question beyond this is how to reduce the risk or even prevent recurrence. Recurrence typically happens for three reasons: 

1. Treatment did not remove or kill all of the cancer cells. 

2. Reactivation of dormant cells.

3. Not addressing all of the underlying factors that contributed to the cancer developing in the first place.

You’ve likely heard that ‘we all have cancer cells somewhere in our bodies’. It is a normal part of our biology to have damage or errors like mutations happen to our DNA. We also have built-in ways to detect and fix these or destroy those cells so they never become cancerous. This then leads to the question of why some people develop cancer, and other people don't – and this includes recurrence. Answering this question is the directive of where I believe we should be when it comes to research and genetic testing of cancer patients. For this, we need to dig deeper into our genetics, epigenetics, and our biology.

Cancers are designed to evade the immune system, and this is one way they can grow beyond single cells or resist treatment. As an example, research has demonstrated the ability of breast cancer cells to “hide” these receptors, only to have them reappear later. It's a dynamic process because tumors are living things that respond to their environment in ways that help them survive. [9] This is one reason it is challenging to not only fully treat cancers, but to also prevent their recurrence.

Strategically speaking, the focus on the complexity of the genetic and epigenetic makeup of cancers is part of the challenge as to why we keep missing this ‘Holy Grail’ of curing cancer.  I feel that having reviewed enough testing paradigms, the community is neglecting the DNA and epigenetics of the person who developed the tumor in the first place.

Image source: Vignoli, A., Risi, E., McCartney, A., et al (2021). Precision Oncology via NMR-Based Metabolomics: A Review on Breast Cancer. International Journal of Molecular Sciences, 22(9), 4687. https://doi.org/10.3390/ijms22094687

MULTIPLE INTERACTIONS: A WHOLE ECOSYSTEM

It is now possible to find out more information about this person that might help us fill in some missing pieces, including their own DNA and epigenetics. Genetic, genomic, and epigenetic testing can provide insights into their predispositions for altered functioning and predisposition to many diseases, including cancer. This helps give us a more precise map for that individual so that we can actually identify their vulnerabilities and create personalized strategies to address these. Addressing hidden factors that may have contributed to developing cancer in the first place may help to decrease the recurrence of the cancer.

Estrogen-sensitive breast cancer is one of the most studied in terms of genetics and risk of recurrence. With standard treatment of surgery and 5 years of endocrine therapy, one of the first and most successful precision medicine stories, the risk of 20-year recurrence is still as high as 50%. Research has thus far discovered genetic alterations in the tumor that can explain about 40% of relapses, indicating there is still much more to learn. New research is giving insights into the mechanisms by which dormant cancer cells adapt to endocrine therapies, including altering genetic expression through epigenetics. [9 

 

Image source: [Barozzi I, et al. Cancer Discov (2024) 14 (9): 1612–1630]. 

These epigenetic changes result from the interaction of the tumor cells and the environment of the tumor – called the microenvironment. The microenvironment is regulated by the person’s DNA and epigenetics, which are, in turn, interacting with that person’s total biology - influenced by their diet, lifestyle, exercise, stress and trauma, toxin exposures, medications, and more.

Alterations in a person’s DNA can alter gene expression and how their biology is functions, thus influencing potential development of cancer. BRCA1 and BRCA2 mutations are some of the most well-known mutations that can predispose to cancer. But there are also smaller genetic alterations called SNPs that can also affect a person’s cancer risk. Although these SNPs create more subtle influences than mutations, each of these can interact with each other and a person’s environment to increase or decrease a person’s cancer risk. [10] 

LINK TO THE LYNCH SYNDROME/NEW HOPE FOR GENETIC DISEASES ARTICLE. Epigenetics adds yet another layer to the complex biological processes that can lead to cancer development and growth, and modify genetic risk. [11]

FIGHTING RECURRENCE: THE MAGIC TRIO

With all of the advances in oncogenomics, as well as analyzing a person’s DNA and epigenetics, we have some powerful tools to fight recurrence. But we need to use them. 

The first is to choose the most effective treatment – for the person and the cancer. This involves the latest advances in precision oncology as well as other approaches to treatment.

The second is identifying contributing factors that may have contributed to their cancer. Here, the focus is on assessing the person’s genetics, epigenetics, diet, lifestyle, and environment - and then creating personalized strategies to support more optimal functioning of these biological systems – potentially reducing the risk of recurrence. 

 

Image: Rulten, S. L., Grose, R. P., Gatz, S. A., et al (2023). The Future of Precision Oncology. International Journal of Molecular Sciences, 24(16), 12613. https://doi.org/10.3390/ijms241612613

The third is active surveillance for early detection, enabling a higher chance of success if recurrence does happen. This is best done with a combination of lab testing and diagnostic imaging. Lab testing can provide reassurance that strategies are working as intended or guide adjustment, as well as give early clues to abnormalities that may indicate recurrence. Newer epigenetic tests can now look for cancer cells before they are visible by imaging. Regular imaging can evaluate for early signs of local recurrence or metastasis, providing peace of mind that all is well or ensuring that any recurrence is detected early. 

THERE IS HOPE

Research continues to build on this foundation, and we are expanding the ways that genetics, genomics, and epigenetics can help us better understand the causes and choose the best treatments for various cancers. But we don’t have to keep waiting for more to take action. We have the knowledge and tools now to give us crucial insights into the biology of cancer, how best to treat it, and ways to reduce the risk or even potentially to prevent recurrence. 

References:

1. https://www.genome.gov/genetics-glossary/Precision-Medicine

2. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/precision-medicine

3. Ferreira-Gonzalez, A., & Mardis, E. R. (2019). Precision oncogenomics. Cold Spring Harbor Molecular Case Studies, 5(2). https://doi.org/10.1101/mcs.a004150

4. Maadi, H., Soheilifar, M. H., Choi, S., et al (2021). Trastuzumab Mechanism of Action; 20 Years of Research to Unravel a Dilemma. Cancers, 13(14). https://doi.org/10.3390/cancers13143540

5. Suehnholz ,S. P., Nissan, M. H., Zhang, H. et al. Quantifying the Expanding Landscape of Clinical Actionability for Patients with Cancer. Cancer Discov (2024) 14 (1): 49–65. https://doi.org/10.1158/2159-8290.CD-23-0467

6. Yu, X., Zhao, H., Wang, R., et al. (2024). Cancer epigenetics: From laboratory studies and clinical trials to precision medicine. Cell Death Discovery, 10(1), 1-12. https://doi.org/10.1038/s41420-024-01803-z

7. Ji, Y,. Skierka, J. M., Blommel, J. H., et al. Preemptive Pharmacogenomic Testing for Precision Medicine: A Comprehensive Analysis of Five Actionable Pharmacogenomic Genes Using Next-Generation DNA Sequencing and a Customized CYP2D6 Genotyping Cascade. J Mol Diagn. 2016 May;18(3):438-445. doi: 10.1016/j.jmoldx.2016.01.003. 

8. Pritchard, D., Patel, J. N., Stephens, L. E., & McLeod, H. L. (2022). Comparison of FDA Table of Pharmacogenetic Associations and Clinical Pharmacogenetics Implementation Consortium guidelines. American Journal of Health-System Pharmacy: AJHP, 79(12), 993-1005. https://doi.org/10.1093/ajhp/zxac064

9. Barozzi, I., Slaven, N., Canale, E. et al. A Functional Survey of the Regulatory Landscape of Estrogen Receptor–Positive Breast Cancer Evolution. Cancer Discov (2024) 14 (9): 1612–1630. https://doi.org/10.1158/2159-8290.CD-23-1157

10. Fahed, A.C., Wang, M., Homburger, J.R. et al. Polygenic background modifies penetrance of monogenic variants for tier 1 genomic conditions. Nat Commun 11, 3635 (2020). https://doi.org/10.1038/s41467-020-17374-3

11. Baylin, S. B., & Jones, P. A. (2016). Epigenetic Determinants of Cancer. Cold Spring Harbor Perspectives in Biology, 8(9). https://doi.org/10.1101/cshperspect.a019505

SPOTLIGHT: OVATIONS FOR THE CURE OF OVARIAN CANCER

In our continued search for leadership in outreach, advocacy and support for research, the Women's Health Collaborative applauds the committed work of SUSAN PATTERSON of Boston, Mass.  Our editors found her organization, OVATIONS FOR THE CURE OF OVARIAN CANCER at nancyslist.org and proceeded to learn about the origins and the mission behind her crusade. 

Ovarian Cancer continues to be one of the most insidious and challenging cancers to battle. Known as the 'silent disease', organizations like "Ovations for the Cure" understand the importance of continued research in finding answers to someday gather enough clinical data and produce innovative solutions to eliminate ovarian cancer from attacking our global community.

INTERVIEW WITH SUSAN PATTERSON 

We started back in 2007, which at that time, there wasn't much for ovarian cancer.  It wasn't talked about- and you didn't tell anybody you had it. It was a secret. My friend had it... her mother had it before her, but she did not know that because they didn't talk about it. So when she was diagnosed, she had a vision of leaving something behind.  After years of treatment, she finally ran out of options. 

Patty was a talker and she would go into the hospital and she'd talk to everybody- reminding women that they were not alone. They don't have a sisterhood. They don't have a group. They're lone survivors out there and that's sad. So we have made our focus support for the women while they're in treatment- and what that involved was to help them and their whole family. We work with a local company similar to HelloFresh. We make sure they have the proper diet and nutrition. The whole family has meals, transportation, any type of thing that comes up along the way that they need help with. 

The other thing we did was we created what my founder called the sisterhood for every woman nationwide.  We would work with social workers at different hospitals and connect with women that are diagnosed to get a free gift from us.  Right now, it's a teal butterfly bracelet in the hopes that they will see another woman wearing this bracelet during their treatment and can open a conversation. What this also does is when they apply for the treatment, they join our email list and we connect them with other women in their area as well. 

We're in Boston- and our local annual awareness event (in November) is a Learning for Living symposium. We call it a day of hope and healing.  We do it at the Four Seasons Boston for women and their care partners. The morning they hear about  updated medical information from the local doctors at the area hospitals.  Dr. Ursula Matulonis, who is one of the top research doctors at Dana Farber and is on our board of directors.  She chooses the speakers and best topics.  This is followed by a lunch where all the women can connect and share what they heard about today. The other half of it is the non-medical world. In a separate room of the hotel they have some one-on-one time with Reiki and support groups and other nonprofits, which I started last year.  I was searching for other local nonprofits to let the women know there's other people here to help them. So it's all about these women for one day at no cost to anybody. This is all paid for by our sponsors, and the Four Seasons has been wonderful. 

We also work with women and families to create a lot of smaller and local events. We help them create an event to remember her- and we do that year round. We try to have small community events so that the family members can remember and spread the awareness about this disease.  We do videos and we also do a big team fundraising at the Jimmy Fund walk every year to go directly to Ursula Matulonis Ovarian Cancer Research Fund. To date, we've donated over 1.7 million and for a small one person organization, we are pretty darn proud of that. So the focus is always on awareness, education, and research.

This feature is published in: www.womenshealthdigest.org

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UNDERDIAGNOSED WOMEN & THE FALSE NEGATIVE

Over a decade after Gilda Radner’s passing in May of 1989, Dr. Nancy Cappello (a startlingly similar case of professional inefficiency and neglect) was diagnosed with stage 3C breast cancer in 2004 from a mis‐read mammogram, concealed behind dense breast tissue. A false negative mammography scan unidentified a large 2.5 cm suspicious lesion, which was later found via ultrasound readings was confirmed to be stage 3c breast cancer. This same cancer had metastasized to 13 lymph nodes. This sparked Dr. Cappello to create the "Are You Dense?" Foundation‐ an international awareness crusade to better support dense breast diagnostics and initiatives pass legislation to enact laws requiring mammography centers to inform patients about their breast density and the associated cancer risks.

Dr. Cappello passed away on Nov 15, 2018, from secondary myelodysplastic syndrome (MDS), a bone marrow cancer that was a complication of her prior aggressive breast cancer treatments. But she ignited a legacy of fighting for improved policies, advancing imaging technologies and continued research to better address this health crisis that puts the est. 40% of the female population (women with dense breasts) at risk of a false negative readings or other dense‐breast related cancers. The disorder or the cause may vary, but sad endings to stories like these remain common in our patient community.  We stand at a major point in history when medicine offers the highest advancements in technological innovations and treatment options- if not for HUMAN ERROR, or the mis-management of those entrusted to give professional care.    (See reprised feature from 10/2021 @: www.NYCRANEWS.com)

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The Latest: Advancement in Early Detection of Ovarian Cancer

According to the Society for Women's Health Research, Over 20,000 women will be diagnosed with ovarian cancer this year in the United States and women have a 92% chance of surviving for five years post-diagnosis. However, more than three-fourths of women are not diagnosed until later stages." [1] Abnormal ovaries are often benign simple cysts, however the complex cysts are classifiable with the new ultrasound scoring system as to how suspicious they may be. The same way we detect prostate tumors by routine yearly ultrasound screening in high risk patients, we could save many lives because sometimes the first sign of ovarian cancer is a gland in the neck that pops up, a mass under the arm or jaundice because the liver is filled with metastatic tumor.

EVOLUTION & INNOVATION IN DIAGNOSTICS

Written by: Dr. Robert L. Bard -excerpt from AngioResearch Journal(501c3)

Historically, the risk of ovarian cancer is linked to the current state of diagnostic technology. Though mortality rates have decreased over the years, cases of ovarian cancers may still reach critical stages when they are detected too late.  This happens because early ovarian cancer is commonly hard to feel on a routine pelvic exam. In addition, by the time it spreads, it fills the abdominal cavity with metastatic fluid, making it difficult to palpate. 

In 1980, I gave a talk for the American College of Obstetricians at Memorial Sloan Kettering Cancer Center where we presented the use of real-time imaging for the instantaneous documentation of the fetal heart beat by intrauterine cardiac sonogram to detect fetal demise instead of waiting 2 weeks to see if the fetus was growing. We asserted a similar use of ultrasound technology to monitor abnormal ovarian cysts as small as two centimeters (2-3 cm is about the size of a normal ovary). Early cancers could not be felt, but are imaged with ultrasound as the technology advanced. With today's high resolution and 3D imaging, (including endo probes with elastography for the uterus and ovaries) recent upgrades offer even better capabilities to conduct regular screening in real time called a  noninvasive “virtual biopsy”.

In the 1990's, advancements in imaging allowed us to accurately detect prostate cancer, uterine cancer, and particularly see abnormal ovarian tumors. In addition, there is now an entire classification of ovarian cysts promoted by all the ultrasound and gynecologic societies to discern the fact that not all cysts are suspicious while some will be cancerous. Most of the ovarian cancers have cystic components. In my history as a practitioner, the first possible indicator of ovarian cancer was the swollen belly. Oftentimes, patients would come in after a CT for abdominal distension might show a fluid-filled abdomen, malignant ascitic fluid- and then when they drained the fluid, you might find an ovarian cancer tumor that metastasized to the lymph nodes, the mesentery membrane (the wall around the stomach area) or the liver. 

Today's 3D imaging not only finds tumors that could be cancerous as small as 3cm, but we are also able to detect and look at suspicious lesions. While 3cm is considered sizable in the ultrasound field, it's not big in the gynecologic field because that's about the size of an average tumor. Ultrasound technology is now able to see three millimeter cancers in the glands, which we have been doing for the past 10 years

Instead of conducting biopsies on abnormal glands, we now employ the sonogram in areas like the axillary lymph nodes. If there is an abnormal gland with a tumor under ultrasound guidance we insert a tiny biopsy needle and aspirate cells for cytology, which are contemporaneously analyzed microscopically providing timely diagnosis and reduced patient anxiety from waiting and often avoids the risks of a full dissection of the axillary or groin lymph node.

Thanks to modern endo probes that can scan deeper organs, we study micrometastatic nodules throughout the body in superficial areas and in deeper areas like the ovary. The endo probes resolution is 5x greater than the MRI or the CT scanner.  It is able to see not only the size and the irregularity in the cancerous wall of a cyst, but it measures the blood flow, which gives you a number of the abnormal tumor vessels in a cancer. Measuring the number of cancerous arteries indicates the severity of an ovarian tumor would be. Similarly, the fewer feeding blood vessels, the less malignant it is likely to be. 

With our current 3D screening solutions, we now have a way to find cancers before they metastasized throughout the body. And we have the technology that can be used to study a cyst instead of doing a exploratory laparotomy to take out a suspicious ovary. 

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2024 CLINICAL PROFILE OF THE DENSE BREAST PARADIGM - for the Obstetrics & Gynecology Society    Written by: Roberta Kline, MD / Published by ICRS Medical Press Ltd.

Breast cancer affects the lives of hundreds of thousands of women every year and is a leading cause of death.  While we have made great progress in advancing earlier diagnosis and more individualized treatments, we still need to improve our approach to achieve our ultimate goal - prevention. This requires a deeper understanding of the molecular mechanisms and the multitude of factors that contribute to the development of breast cancer.  

Dr. Roberta Kline, recognized speaker and publishing crusader for women's health brings you a comprehensive review and a deep-dive analysis of the current research  findings about breast density and its major risk factors for breast cancer.  Her reports uncover current imaging practices and clinical protocols updated in great support of breast density detection and the means of addressing this growing condition that affects over 45% of the female population. "Knowing a woman has greater breast density is a critical first step, but it doesn’t end there... we need to go further by understanding the causes of breast density, and how they relate to breast cancer-- we now have another avenue to proactively intervene to reduce risk or even prevent breast cancer in the first place."  This textbook is a champion in targeting the Dense Breast Paradigm as a blueprint and a clear course study for all clinical professionals who are dedicated to women's early detection and prevention programs. (More information)

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CONTRIBUTORS:

ROBERT L. BARD, MD, DABR, FAIUM, FASLMS - is a diagnostic imaging specialist in advanced 3-D sonography for the detection of a wide list of cancers. His medical career began in 1972 in the USAF as a diagnostic radiologist and evolved into the practice of non-invasive 3D imaging with ultrasound, MRI and laser technologies. He has served as the head Radiologist at several leading hospitals, and published a multitude of textbooks and scientific papers. Dr. Bard maintains a busy consulting practice in New York City, committed to improving non-invasive cancer testing and developing minimally invasive image guided technologies. Dr. Bard leads various diagnostic and research programs including breast cancer screening, pediatric imaging and occupational exposures in the fire service.. https://drrobertbard.com/

ROBERTA KLINE, MD (Educational Dir. /Women's Diagnostic Group) is a board-certified ObGyn physician, Integrative Personalized Medicine expert, consultant, author, and educator whose mission is to change how we approach health and deliver healthcare. She helped to create the Integrative & Functional Medicine program for a family practice residency, has consulted with Sodexo to implement the first personalized nutrition menu for healthcare facilities, and serves as Education Director for several organizations including the Women’s Diagnostic Health Network, Mommies on a Mission. Learn more at https://robertaklinemd.com/

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NY Cancer Resource Meetings get a Global Network Boost

Meet the new INTEGRATIVE CANCER RESOURCE SOCIETY!  With recently elected  Executive Director, Dr. Leslie Valle-Montoya (Sta Barbara, CA), the group is a much expanded platform  that started from the NY Cancer Resource Alliance.  ICRS is an all-volunteer self-funded (Linkedin Based) independent volunteer group of non-profit foundations/charities, clinical professionals, researchers and community leaders joined under the spirit of collaboration and partnership.  Meetings and collaborative connections are conducted to explore new ideas in support to cancer patients, survivors and all those seeking current information about cancer care.  

New ICRS Brand Pursues Borderless Collaboration for Research & Advocacy

According to Dr. Robert Bard, one of the founding clinical advisors of the NY Cancer Resource Alliance, "forging a global alliance of clinical professionals allows for a much wider scope of collaborative exchange from the international community of clinicians and researchers. I have always enjoyed different scientific approaches from abroad alongside my extended training from other countries. Decades later, I have amassed a significant network of collaborative minded health specialists from  Australia, Europe and Asia (remotely), arming me with new technologies and methodologies.  Decades in (and thanks to the world wide web), the trend of globalized connectivity is (just) now becoming more commonplace in our healthcare system- but we have ways to go for ideas from other continents to align with ours. The future is clear; formalizing a BORDERLESS coalition brings more resources and concepts for consideration when it comes to resources and patient care modalities- especially when it comes to cancers and any other health disorders.  And having our California partners (like Dr. Montoya) build our bi-coastal presence was a great start."

Meeting #1 about Women's Cancers

MEETING ABOUT WOMEN'S CANCERS

9/21/2023 - A new collaboration concept introduces THE COALITION OF WOMEN'S CANCER ORGS, uniting a round table discussion with public advocates, educators and clinical experts in support of new cancer research programs and resource initiatives.  

The ICRS Women's Powermeet* Series was originally was spearheaded by Dr. Noelle Cutter & Dr. Roberta Kline in 2021 as a digital mixer that brought together advocates and dedicated experts from various sciences during the rise of the Covid-19 pandemic.  The Powermeets tradition invites only 9 speakers per meeting to fill what was formerly known as the "9 Squares of Care"- to account for a well-balanced and manageable number of introductions and collaborative exchange. 

"We had many attempts at formatting... both time management and getting the right number of invitees was important.  The success ofo network building is about learning about everyone and making the time to explore synergy", stated Joe Cappello of "Are You Dense?" Foundation.

This season's mixer was managed and co-moderated by Lennard Gettz (founder of NYCRA). The first half of the event presented 2 cancer clinicians-   Dr. Robert L. Bard & Dr. Noelle Cutter speaking about UPDATES IN CANCER CARE.  Dr. Cutter is an assoc. professor at Molloy University, a clinical researcher at Cold Spring Harbor Labs and is part of research programs about Dense Breasts and its link to Breast Cancer. Dr. Bard is a seasoned NYC-based cancer researcher & imaging specialist focused on Breast, Ovarian, Skin and Prostate.  

“It is incredibly important for Cancer Support Community Greater NY & CT at Gilda’s Club (formerly Gilda’s Club Westchester) to collaborate with community partners to empower cancer patients and their families”, says Debbie Vincent, Director of Outreach and Clinical Partnerships. "Opportunities to join with other cancer-focused individuals and organizations, such as those provided by the ICRS Powermeet virtual conferences, enable us to learn from one another, consider new ways to advocate for those impacted by cancer, and join forces to launch important initiatives.”

The second half of the virtual event was moderated by Dr. Roberta Kline, co-founder of the Women's Diagnostic Network, Mommies on a Mission (dot org) and Editor of the Women's Health Digest. Dr. Kline is an OB/GYN and a Genomics specialist with vast experience in women's disorders. She invited some of the most recognized advocacy groups including "GILDA'S CLUB WESTCHESTER" (with Debbie Vincent & Andrea Markowitz), "ARE YOU DENSE? FOUNDATION" (with Joe Cappello), THE NY STEM CELL INSTITUTE/Ovarian Cancer Research (with Laura Andres‐Martin) and Dr. Leslie Valle-Montoya, recently elected as the Executive Director of the Integrative Cancer Resource Society.

*The Underdiagnosed Woman"- published by the NY Cancer Resource Alliance: 10/27/2021- Written by Graciella Davi & Lennard Gettz.

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WHO IS NANCY NOVACK?

NANCY'S LIST: The Power of Compassion and Loving Help

INTRODUCTION

10/12/2023- For so many in the cancer community, it is rare to spot a bouquet of white roses and not think about the kindness and the giving spirit of Dr. Nancy Novack, founder and CEO of Nancy's List (NancysList.org).  This year, Nancy (as she prefers to be addressed) was inducted unanimously by the collective board of the Integrative Cancer Resource Society (ICRS) as "the Top 2023 Cancer Crusader" during the Fall Women's Roundtable Powermeet Conference.  

This meeting, hosted by the Coalition for Women's Cancers aligned a special grouping of community leaders, clinicians and advocates working together to share information about the current state of cancer care. "It was such an honor to finally be connected with Nancy", starts Dr. Leslie Valle-Montoya- recently elected executive director of ICRS. "You couldn't be in the cancer awareness community and not hear about Nancy's List. To hear firsthand HER story (with that soft and genuinely loving voice) including how it all started truly hits you deep into your soul- and makes you want to be part of her mission!"

Nancy's List is a free website that started in 2008, researching, organizing and publishing resources for cancer patients and survivors. According to the website, it's core beliefs "inspire community-wide support system for children, teens, and adults who are living with, through, and beyond cancer.  Nancy's List is a compassionate grassroots effort committed to significantly improving the quality of life for these individuals, their families, and their caregivers.  

INSPIRING OUR COMMUNITY "TO BE THE VERY BEST IT CAN BE" - From an interview by: Nancy Novack

I am a survivor of 20 years of stage four ovarian cancer. I knew nothing about cancer at that time, and just was complaining of what I thought was an appendicitis attack. (Of course) that didn't turn out that way. I was swept away to Stanford where I was treated pretty traditionally by a wonderful man whom I have a tremendous amount of respect and trust in- and I haven't had a recurrence in 20 years. I love being Stanford's poster poster child, but I think in the process I learned a great deal about the psychology (which I'm a psychologist) of cancer. I don't have the medical knowledge, but I certainly understand the psychology within my work with so many cancer patients. (see complete spotlight on Nancy Novack of Nancy's List)

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2024 CLINICAL PROFILE OF THE DENSE BREAST PARADIGM - for the Obstetrics & Gynecology Society 

Written by: Roberta Kline, MD

Published by ICRS Medical Press Ltd.

Breast cancer affects the lives of hundreds of thousands of women every year and is a leading cause of death.  While we have made great progress in advancing earlier diagnosis and more individualized treatments, we still need to improve our approach to achieve our ultimate goal - prevention. This requires a deeper understanding of the molecular mechanisms and the multitude of factors that contribute to the development of breast cancer.  

Dr. Roberta Kline, recognized speaker and publishing crusader for women's health brings you a comprehensive review and a deep-dive analysis of the current research  findings about breast density and its major risk factors for breast cancer.  Her reports uncover current imaging practices and clinical protocols updated in great support of breast density detection and the means of addressing this growing condition that affects over 45% of the female population. "Knowing a woman has greater breast density is a critical first step, but it doesn’t end there... we need to go further by understanding the causes of breast density, and how they relate to breast cancer-- we now have another avenue to proactively intervene to reduce risk or even prevent breast cancer in the first place."  This textbook is a champion in targeting the Dense Breast Paradigm as a blueprint and a clear course study for all clinical professionals who are dedicated to women's early detection and prevention programs. (More information)

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Disclaimer & Copyright Notice: The materials provided on this article are copyrighted 2023 and the intellectual property of the publishers/producers (The NY Cancer Resource Alliance/IntermediaWorx inc. and Bard Diagnostic Research & Educational Programs). It is provided publicly strictly for informational purposes within non-commercial use and not for purposes of resale, distribution, public display or performance. Unless otherwise indicated on this web based page, sharing, re-posting, re-publishing of this work is strictly prohibited without due permission from the publishers.  Also, certain content may be licensed from third-parties. The licenses for some of this Content may contain additional terms. When such Content licenses contain additional terms, we will make these terms available to you on those pages (which his incorporated herein by reference).The publishers/producers of this site and its contents such as videos, graphics, text, and other materials published are not intended to be a substitute for professional medical advice, diagnosis, or treatment. For any questions you may have regarding a medical condition, please always seek the advice of your physician or a qualified health provider. Do not postpone or disregard any professional medical advice over something you may have seen or read on this website. If you think you may have a medical emergency, call your doctor or 9-1-1 immediately.  This website does not support, endorse or recommend any specific products, tests, physicians, procedures, treatment opinions or other information that may be mentioned on this site. Referencing any content or information seen or published in this website or shared by other visitors of this website is solely at your own risk. The publishers/producers of this Internet web site reserves the right, at its sole discretion, to modify, disable access to, or discontinue, temporarily or permanently, all or any part of this Internet web site or any information contained thereon without liability or notice to you.

The Major Occupational Hazard of Post Traumatic Recall (PTSD) - part 1

Updated 1/2/2023 (original feature published 8/15/2019)

INTRODUCTION:

High risk professions like law enforcement, military service, healthcare and emergency response are known to have exposure to some of the most extreme levels of trauma - both physically and psychologically.  They range in effects from manageable symptoms to crippling disorders.  Over time, most people overcome disturbing or traumatic experiences and continue to work and live their lives. But others who get affected by traumatic experiences may trigger a reaction that can last for months or even years. This is called Post-traumatic Stress Disorder, or PTSD. Proportionately, studies have shown a lower percentage of retirees from such challenging careers acquire PTSD (from 15-20%) while an estimated 30-40% who suffer from PTSD associated symptoms go undetected or do not register as full cases. A larger percentage ‘on the job’ might be able to maintain the expected work standards throughout their career and even make it to retirement without visible signs. But “POST traumatic recall” leading to fully blown PTSD occurs when repeated exposure to trauma compounds on the tolerance capacity that eventually, one’s coping ability collapses.  The individual may feel stages of grief, depression, anxiety, guilt or anger from uncontrollable issues like recurring flashbacks and nightmares. [1]


REVIEW OF POST TRAUMATIC RECALL (A field report by: Jessica Glynn, CSW)
PTSD can occur in all different extremes with at-risk professionals (like cops, responders and veterans). The trauma that they experience are above the ordinary that they could cause extreme flashbacks, anxiety and depression—heavily affecting their quality of life. The average civilian is also prone to this disorder starting with MICRO-TRAUMAS that can happen to everybody throughout any point in their lifetime.  Usually stemmed from childhood issues, micro-traumas actually shape the way an individual reacts to other people. As an example, child bullying may lead to developing a protective or defensive personality disorder.  Anytime they feel disrespected or embarrassed by others, feelings of extreme uncontrollable anger may arise without knowing the source of the hurt or why they're acting in that way.  This dilemma often causes problems in relationships.

Similarly, a first responder who experiences extreme traumas like horrendous disasters may stick with them in a much harsher way that could lead to flashbacks that are hallucinatory.  If gone unchecked or untreated, these symptoms (including auditory hallucinations) can get increasingly more intense and expand to other symptoms that can affect their daily functions.  A common way that anxiety can debilitate a sufferer is from recurrent lack of sleep disrupted by bad dreams triggered by the traumatic event.

Enduring trauma is different and unique for everyone. Some cases are event-specific (having intense auditory impact or visual intensity of a terrifying event) while other cases are contingent upon the tolerance of an individual. There are people who are more emotionally expressive than others- and that might help with if they talk about the trauma that they've been through. A latent emotional disorder like PTSD symptoms can come out over time just like anything that is suppressed or repressed. It could take some time for somebody who came back from combat or a first responder who has been in a traumatic event to show signs of disturbance. They could be holding it in and repeatedly thinking about it privately (or ruminating over it) allowing the disturbing memories to get more intense by the day.  This can often be a coping mechanism- protecting themselves from dark or negative feelings for a while, but eventually it builds up and can become symptomatic like flashbacks and anxiety, then leading to an eventual explosion.  Meanwhile, some people just have flashbacks right after the experience because of the way that everybody's brain processes differently. Others obsess over thoughts that keep popping up over and over again. It really just depends on the person.

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SIGNS AND SYMPTOMS From The National Institute of Mental Health [3] Not every traumatized person develops ongoing (chronic) or even short-term (acute) PTSD. Not everyone with PTSD has been through a dangerous event. Some experiences, like the sudden, unexpected death of a loved one, can also cause PTSD. Symptoms usually begin early, within 3 months of the traumatic incident, but sometimes they begin years afterward. Symptoms must last more than a month and be severe enough to interfere with relationships or work to be considered PTSD. The course of the illness varies. Some people recover within 6 months, while others have symptoms that last much longer. In some people, the condition becomes chronic. A doctor who has experience helping people with mental illnesses, such as a psychiatrist or psychologist, can diagnose PTSD. To be diagnosed with PTSD, an adult must have all of the following for at least 1 month: • At least one re-experiencing symptom • At least one avoidance symptom • At least two arousal and reactivity symptoms • At least two cognition and mood symptoms Re-experiencing symptoms include: • Flashbacks/Bad dreams - reliving the trauma over and over, including physical symptoms like a racing heart or sweating • Frightening thoughts Re-experiencing symptoms may cause problems in a person’s everyday routine. The symptoms can start from the person’s own thoughts and feelings. Words, objects, or situations that are reminders of the event can also trigger re-experiencing symptoms. Avoidance symptoms include: • Staying away from places, events, or objects that are reminders of the traumatic experience • Avoiding thoughts or feelings related to the traumatic event • Things that remind a person of the traumatic event can trigger avoidance symptoms. These symptoms may cause a person to change his or her personal routine. For example, after a bad car accident, a person who usually drives may avoid driving or riding in a car. Arousal and reactivity symptoms include: • Being easily startled • Feeling tense or “on edge” • Having difficulty sleeping • Having angry outbursts Arousal symptoms are usually constant, instead of being triggered by things that remind one of the traumatic events. These symptoms can make the person feel stressed and angry. They may make it hard to do daily tasks, such as sleeping, eating, or concentrating.

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HOW STRESS CAN MAKE YOU SICK

By: Dr. Jesse A. Stoff

For our well-being, stress is so powerful that it can affect just about every function in our bodies right down to our cells. Stress can cause major weight gain, headaches, hair loss, dental problems, major fatigue, respiratory issues, digestive problems, psychological & focal disorders.  It is also known to affect the performance of our immune system - allowing for skin issues, colds, allergies and a host of chronic diseases. Stress management is important for more than psychological health; stress can greatly affect immune functioning, inflammation and even hormonal balance. Studies have shown that stress can reduce natural killer cell function. These are normally the cells that attack foreign invaders including viruses, bacteria and fungi. They are also the cells that patrol the body as the first line of defense against the development of cancer. 

Stress links to Cancer

When stressed, the body responds to physical, mental, or emotional pressure by releasing stress hormones (such as CORTISOL, EPINEPHRINE AND NOREPINEPHRINE) that increase blood pressure, speed heart rate, and raise blood sugar levels. When chronically elevated, these stress hormones can corrupt the performance (and even paralyze) our immune system which can lead to osteoporosis, weight gain (especially the dangerous visceral fat), high blood pressure, cardiovascular disease and cancer. These stress hormones are known to bind with cancer cells and stimulate angiogenesis, cell migration and invasion, leading to increased tumor growth and progression. Long term stress also increases blood supply that adds to the growth of cancerous tumors.

See complete article at IMMUNOLOGY TODAY
Also see video on "THE PITTS- 5 Elements that Affect the Immune System"

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TRANSCRANIAL NEURO-IMAGING FOR STRESS RELATED DISORDERS
By Dr. Robert L. Bard

Emotional traumas and stress influencers are scientifically aligned with anxiety, depression, behavioral disorders, drug/alcohol abuse and a wide list of physiological health issues.  These symptoms are typically diagnosed by mental health professionals through observational science and behavioral analysis.  But within the past 15 years, global advancements in transcranial imaging pioneered the ability to detect trauma-related issues in the brain through neurological imaging. Now, neurological stress can be identified clinically by monitoring chronic imbalance and changes in the neurochemical structure (or circuitry).  The shift in memory performance - specifically the hippocampus and the medial prefrontal cortex is one indicator of this imbalance whereby a stressful event can show images with signs of neuronal dysfunction.

Neuro-imaging measures brain thought activity which has known chemical tissue changes by observing the alterations in capillary blood vessels in the retina located in close proximity to the main emotional center of the anterior brain. Functional MRI (fMRI) is currently used to show brain chemical changes with cognitive commands such as “death vs freedom.” Most recognizable patterns with suicide occur in the anterior cingulate cortex of the brain which lies directly behind the globe and is vascularized by orbital branches of the anterior cerebral artery. Functional near infrared imaging (fNIR) devices show changes in brain oxygenation linked to suicide.

Another imaging innovation is the TRANSCRANIAL DOPPLER (TCD) - a type of sonogram that is a non‐invasive, non‐ionizing, inexpensive, portable and safe technique that uses a pulsed Doppler transducer for assessment of the blood flow in the anterior cerebral arterial circulation. This technology has been used to evaluate intracranial steno‐occlusive disease, subarachnoid hemorrhage, and extracranial diseases (including carotid artery disease and subclavian steal syndrome), detection of microembolic signals and acute strokes. [5] The Transcranial Doppler has been used to examine the mean speed of blood circulation of patients to validate and monitor treatment efficacy by tracking cranial blood vessels and vertebrobasilar flow vasospasm.  (See complete report from Military Medicine)

Another device used by imaging specialists to detect mental distress is through an EYE SONOGRAM or  Real Time Sonofluoroscopy of the orbital soft tissues of the eyes.  This process is performed in multiple scan planes with varying transducer configurations and frequencies.  Power and color Doppler use angle 0 degrees and PRF at 0.9 at the optic nerve head. 3D imaging of optic nerve and carotid, central retinal arteries and superficial posterior ciliary arteries performed in erect position before & after verbal communication and  orbital muscle tissue contractions may be observed as a precursor to visual changes in facial expression. Retinal arterial directional flow is also measured with peak systolic and diastolic values. Bulging of the optic nerve head is checked as increased intracranial pressure may be demonstrable in this condition. Other innovations such as the TRANSORBITAL DOPPLER, 3D/4D VESSEL DENSITY HISTOGRAM and the RETINAL OCT (optical coherence tomography) are also being explored in the pursuit of studying brain performance through the eyes.  An expanded review on these solutions will be available in part 2 of this report.

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CONTRIBUTORS /  EDITORIAL TEAM


ROBERT L. BARD, MD, PC, DABR, FASLMS - Advanced Imaging & Diagnostic Specialist
Having paved the way for the study of various cancers both clinically and academically, Dr. Robert Bard co-founded the 9/11 CancerScan program to bring additional diagnostic support to all first responders from Ground Zero. His main practice in midtown, NYC (Bard Diagnostic Imaging- www.CancerScan.com) uses the latest in digital Imaging technology has been also used to help guide biopsies and in many cases, even replicate much of the same reports of a clinical invasive biopsy. Imaging solutions such as high-powered Sonograms, Spectral Doppler, sonofluoroscopy, 3D/4D Image Reconstruction and the Spectral Doppler are safe, noninvasive, and does not use ionizing radiation. It is used as a complement to find anomalies and help diagnose the causes of pain, swelling and infection in the body’s internal organs while allowing the diagnostician the ability to zoom and ‘travel’ deep into the body for maximum exploration.

JESSE STOFF, MD, HMD, FAAFP - Cancer Immunologist / Publisher of Wellness Programs
Dr. Stoff is a highly-credentialed medical expert studying all medical remedies in pursuit of resolving the most challenging health issues of our time. In many circles, he is recognized for his 35+ years of dedicated work in immunology and advanced clinical research in modern CANCER treatments. He has spoken worldwide in some of the most sought-after medical conferences about his experiences and analyses on the study of human disease. His integrative practice (INTEGRATIVE MEDICINE OF NY, Westbury, NY) has been continually providing all patients with the many comprehensive clinical options and modalities available- including "ONCO-IMMUNOLOGY", the science of battling cancer cells and reversing pre-cancerous conditions through a complete prevention program that has earned him great success in this field.  For more information, visit: www.Dr.JesseStoff.com

JESSICA A. GLYNN, LMSW, CPC, CEC - Responders' Mental Health Program

As a therapist and coach, a lot of my work with clients is helping to manage symptoms of anxiety and panic- that which manifests in physical, often frightening and alarming ways. We can experience things like racing heartbeat, shortness of breath, numbness in arms and legs which can all make us feel like we are out control of our bodies and our surrounding world. When we have experienced a traumatic event in our lives, these feelings can be even more severe and heightened. The trauma and residually related fear is one that is very close to my heart and a reason I can provide empathy and understanding to clients that have been affected by the horrific day. When we work to process physical emotions that arise from trauma, the hope is that one day we can be less affected by it and live more presently to enjoy life’s fulfilling moments. I work with clients to slowly pull apart the physical emotions we experience from the thoughts that we are having and process them in a more self-aware and grounded way., visit her website- www.jagtheracoach.com

** SIGNS AND SYMPTOMS segment is sourced from The National Institute of Mental Health website: www.nimh.nih.gov

References

1) https://www.rcpsych.ac.uk/mental-health/problems-disorders/post-traumatic-stress-disorder
2) https://www.psychologytoday.com/us/blog/cop-doc/201811/cops-and-ptsd
3) https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
4) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729089/
5) Transcranial Doppler: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2659960/
6) Transcranial Doppler 2: https://www.ncbi.nlm.nih.gov/pubmed/11725323
7) Design and Validation of an FPGA-Based Configurable Transcranial Doppler Neurofeedback System for Chronic Pain Patients https://europepmc.org/articles/pmc6069097
8) https://academic.oup.com/milmed/article/166/11/955/4819466
9) PTSD Diagnosis Aided By New Imaging Techniques  https://www.psychiatryadvisor.com/home/topics/anxiety/ptsd-trauma-and-stressor-related/ptsd-diagnosis-aided-by-new-imaging-techniques/
10) https://psychcentral.com/news/2014/12/02/imaging-studies-differentiate-ptsd-mild-brain-injury/78060.html
11) https://www.psychologytoday.com/us/blog/the-many-faces-anxiety-and-trauma/201904/how-do-we-diagnose-ptsd





Disclaimer & Copyright Notice: The materials provided on this website are copyrighted and the intellectual property of the publishers/producers (The NY Cancer Resource Alliance/IntermediaWorx inc. and Bard Diagnostic Research & Educational Programs). It is provided publicly strictly for informational purposes within non-commercial use and not for purposes of resale, distribution, public display or performance. Unless otherwise indicated on this web based page, sharing, re-posting, re-publishing of this work is strictly prohibited without due permission from the publishers.  Also, certain content may be licensed from third-parties. The licenses for some of this Content may contain additional terms. When such Content licenses contain additional terms, we will make these terms available to you on those pages (which his incorporated herein by reference).The publishers/producers of this site and its contents such as videos, graphics, text, and other materials published are not intended to be a substitute for professional medical advice, diagnosis, or treatment. For any questions you may have regarding a medical condition, please always seek the advice of your physician or a qualified health provider. Do not postpone or disregard any professional medical advice over something you may have seen or read on this website. If you think you may have a medical emergency, call your doctor or 9-1-1 immediately.  This website does not support, endorse or recommend any specific products, tests, physicians, procedures, treatment opinions or other information that may be mentioned on this site. Referencing any content or information seen or published in this website or shared by other visitors of this website is solely at your own risk. The publishers/producers of this Internet web site reserves the right, at its sole discretion, to modify, disable access to, or discontinue, temporarily or permanently, all or any part of this Internet web site or any information contained thereon without liability or notice to you.