Unspoken Issues Impacting Women: Poverty, Health, Sexual Exploitation and Self-Confidence at NAWRB Conference 2018

From its title alone, you can tell this panel was a little different from the others. Wide-ranging in scope, yet narrow in its focus on issues that derail women from advancing in life, the conversations held on stage focused on topics people are sometimes uncomfortable talking about including sexual exploitation and poverty.

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Beyond Abuse: Finding Our Voice on World Elder Abuse Awareness Day

It started with a phone call from Capital One Financial Corporation on January 14th, 2016. “Ms. Patno, are you the sole owner of Desiree Patno Enterprises, Inc.?”

That simple call was how I found out that my husband’s accountant had been dispersing my unsigned business checks illegally, with some going into her personal accounts and several others paying her bills directly.

I was (and still am) angry that not only my trust was betrayed, but after years of hard work and developing a reputation as a successful businesswoman in the housing and real estate sector, I was, to put it quite simply, duped.

How could this happen to me? And if this could happen to me, in my mid-fifties, plugged into and engaged fully in my businesses, what happens to women older than me, with fewer resources at their fingertips and perhaps cognitive issues?

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Driving Collaboration across the Health Care Continuum

We all have those moments when our careers and personal lives converge. As a business leader at the largest health care real estate investment trust (REIT), I focus on investment projects in collaboration with senior living communities, health systems and medical groups to create the real estate infrastructure needed to deliver care for a growing number of aging Americans. As a wife, mother, sister and daughter, I also think about what my parents, aging relatives and even my future 80-year-old self will need when it comes to living well as we age.

The growth of the aging population is the most significant demographic trend impacting the U.S. According to the Population Reference Bureau, the number of Americans age 65 and older is projected to more than double from 46 million today to over 98 million by 2060. In addition, the number of people age 85 and older is projected to more than triple from 6 million today to nearly 20 million by 2060.

This increase in life expectancy is accompanied by an increased prevalence of chronic conditions, including dementia. According to the CDC, in the United States alone, more than a quarter of older Americans are burdened with multiple chronic disease, more than 5 million Americans are living with Alzheimer’s disease and countless family members spend their days serving as unpaid caregivers. The most expensive and at risk population for the health care system to treat are the physically and cognitively impaired. We need to rethink how to best deliver care for this growing segment of the population.
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Even When an Obese Person Loses Weight, Health Problems Could Persist Due to Epigenetics

When an obese person loses weight, he or she immediately starts to feel better. Blood pressure improves, cholesterol levels diminish and energy levels rise. Because that person is no longer obese, the risk of developing type 2 diabetes, as well as liver, colon and breast cancers and other diseases linked to obesity, diminishes, right?

That might not be the case.

A new study by City of Hope researchers found that even after a low-fat diet is consumed, long-term disease risks could persist.

The reason could be epigenetics, which refers to changes to genes caused by external factors, such as pesticides or nutrients, that don’t change the DNA sequence. However, these changes can be passed to the next generation, according to Dustin Schones, Ph.D., an assistant professor in the Department of Diabetes Complications and Metabolism within the Diabetes & Metabolism Research Institute at City of Hope.
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Staying Healthy as a Busy Professional

Being busy connotes that you don’t have a lot of free time, which is directly related to staying healthy amid the hustle and bustle of your personal and professional life. Having to make quick dietary decisions can often lead to choosing what is easiest and unfortunately, unhealthy foods such as fast food or prepackaged snacks provide a tempting immediacy and convenience.

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Good Habits When Sleeping and Waking Up

A demanding job, the commute, after-work errands or maybe even dropping off and picking up kids from soccer practice can leave you drained after a long day. Often times however, exhaustion and the need for a nap creep in during the day, much earlier than anticipated and without warrant. The solution isn’t an energy drink it’s sleep.

Just as important as how long you’re sleeping is how you’re getting your sleep. Five hours of good sleep can make you feel more rested than seven hours of mediocre shut-eye.
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Engineering Viruses to Target Resistant Breast Cancer

It has long been said that imitation is the sincerest form of flattery. At City of Hope, researchers are implementing this concept of imitation—of making one thing similar to another—in a leading-edge approach to treating difficult cancers.

City of Hope’s new chief of surgery and an enthusiastic researcher, Yuman Fong, M.D., has been developing a therapy that essentially makes resistant breast cancer respond like thyroid cancer, which is cured in 90 percent of patients.

Triple-negative breast cancer—named for its lack of three important receptors that can be targeted with common, effective therapies—remains a challenge for women, as well as for the oncologists who care for them. Fong is energized by this challenge and the promise of discovery. “If we can find something that can kill [these types of] cancer cells, it would be a big breakthrough for the field,” he says.
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Running Guide

Proper Running Technique

Try not to overstride. When you lengthen your legs out too far in front of you while running, you can injure yourself. Instead, run in a way that feels comfortable for you. Try to land in the middle of your foot as opposed to on your heel or toe. This helps to absorb the shock and is best for your calves and knees. Once you have landed in the middle of your foot, you should roll through to your toes. Make sure you are standing erect and looking straight forward. Make sure your shoulders are back—but that you’re still comfortable.

Proper Running Shoes

According to Running Warehouse, people should purchase running shoes that are a size bigger than their normal shoe size. The reason for this is because running shoes generally run small. It’s also important to have your feet measured once every year because they can increase in size with age, and with pregnancy. When trying on running shoes, it’s best to do so later in the day, because feet tend to swell toward the end of the day. Runners can use the website RunnersWorld.com to find the perfect shoe for their height, weight, foot shape, running level, and more.





Triple-Negative Breast Cancer

When Homa Sadat found a lump in her breast at age 27, her gynecologist told her she was too young to have breast cancer.

With the lump dismissed as a harmless cyst, Sadat didn’t think about it again until she felt a shooting pain. A biopsy of the lump confirmed breast cancer; a biopsy of a lymph node confirmed that the cancer had spread. Sadat was diagnosed with triple-negative breast cancer.

Pathologists who test breast cancer cells look for the presence of estrogen and progesterone hormone receptors and the overexpression of receptors for a type of protein called HER2. Breast cancer that is positive for one of the hormone receptors can be targeted with a tamoxifen or an aromatase inhibitor. Trastuzumab (Herceptin) and its newer versions are used to target HER2-positive breast cancers.

But breast cancers that are negative for all three receptors have no targets for these drugs, making them very difficult to treat. Fortunately, triple-negative breast cancer is rare — affecting approximately 15 percent of all women with breast cancer. It is diagnosed at a higher rate in patients with hereditary breast cancer associated with the BRCA1 gene, as well as in African-American women.

City of Hope researchers are fighting back by studying these cancers, in hopes of discovering more effective treatments.

“We offer several innovative clinical trials for newly diagnosed and Stage 4 triple-negative breast cancer patients that are part of a national effort to address these difficult-to-treat tumors,” says George Somlo, M.D., professor in the departments of Medical Oncology & Therapeutics Research and Hematology & Hematopoietic Cell Transplantation at City of Hope.

One such trial for newly diagnosed patients is evaluating the effect of destroying cancer cells with chemotherapy before patients have surgery. “Once the tumor is completely eliminated, or at least reduced in size, surgery follows. Patients with newly diagnosed triple-negative breast cancer who do not experience a recurrence within five years are likely cured,” says Somlo.

Sadat initially sought treatment at another center and came to City of Hope for a second opinion from Somlo. She enrolled in a City of Hope phase II clinical trial that offered chemotherapy prior to surgery and was treated with carboplatin and a novel nanoparticle drug called nab–paclitaxel (Abraxane).

After eight weeks on the chemotherapy regimen, the tumor had shrunk significantly. Sadat volunteered for a biopsy, and to her surprise, the tumor was gone.

Ongoing research, ongoing advances

Another eight weeks later, Sadat underwent surgery at City of Hope to remove the area of breast tissue that had contained the tumor, as well as several lymph nodes. No cancer cells were found in these tissues. Her cancer was in complete remission.
Somlo is close to completing this particular clinical trial, as well as a randomized, phase II, national study assessing the role of carboplatin and the PARP-inhibitor veliparib in patients with Stage 4 BRCA1- and BRCA2-associated breast cancer.

“We are learning that triple-negative breast cancer consists of at least a half-dozen subtypes, each of which may require personalized therapies,” says Somlo.

“We must intensify our current laboratory and translational research to improve next- generation clinical trials for much better control and eventual cure of triple-negative Stage 4 metastatic breast cancers. The next generation of trials will need to be more tumor-target specific, so we can help individual patients overcome their particular subtype of triple-negative breast cancer,” he adds.

Research reported in this study was supported in part by the National Cancer Institute of the National Institutes of Health under grant number NIH-NCI CA 33572. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Women’s Cancers: Basic research seeks new ways to attack cancer

Advances in immunotherapy
Peter P. Lee, M.D., chair of cancer immunotherapeutics and tumor immunology at City of Hope, is pursuing several projects that are part of a what he calls integrated immunotherapy. This concept advances the idea that effective cancer treatment must address each phase or action of the body’s complex immune system.

In one project, Lee is studying the role of stromal cells, which make up connective tissue. He has found that stromal cells support cancer by attracting and modulating immune cells. His team is currently developing three-dimensional microculture systems to study the interactions among stroma, cancer and immune cells in tumors, with a goal of learning how to disrupt cancer’s support system and restore immune function.

Lee is also advancing the use of spectral imaging. Using powerful new technology, Lee is able to see two- and three-dimensional images of the location of cells, making it possible to understand how immune cells and cancer cells interact within the tumor and sentinel nodes (lymph nodes found under the arm, and often the first site of metastasis for breast cancer). One of the leaders in this sophisticated imaging technique, Lee recently led a worldwide webinar to teach other researchers about spectral imaging.

A novel way to target cancer
Yuan Yuan, M.D., Ph.D., assistant professor of medical oncology, is studying how tumor cells use nutrients to grow and proliferate, and how this process differs from normal cell metabolism, so that she can selectively target cancer cells. Yuan is collaborating with David Ann, Ph.D., professor of molecular pharmacology, who found that some types of breast cancer cells lack a specific enzyme and, as a result, need the amino acid arginine to grow.

Together, their research demonstrates how to deprive these cells of arginine and suppress tumor growth. Yuan seeks to translate this novel research to the clinic, where it will be the focus of a first-of-its-kind study for women with breast cancer.

How genes help cancer spread
Emily Wang, Ph.D., associate professor of cancer biology, focuses her research on understanding how microRNAs (miRNAs) regulate gene expression to promote or prevent cancer. She has found that breast cancer cells secrete specific miRNAs that dictate gene expression in healthy cells at potential metastatic sites for breast cancer.

Wang’s studies also showed that treatment with a miRNA inhibitor significantly delayed metastasis — suggesting a novel therapeutic strategy to prevent or treat metastatic breast cancer. Wang is collaborating with Yuan to translate these findings to the clinic.

Photo: City of Hope’s fight against breast cancer, shown here, includes immunotherapy and an exploration of gene silencing.

Molecular imaging and disease
Tijana Jovanovic-Talisman, Ph.D., assistant professor of molecular medicine, recently joined City of Hope to advance her research using super resolution microscopy. Jovanovic-Talisman is using this sophisticated imaging method to see and quantify proteins on the cell membrane and inside cells. On a biological level, this method allows Jovanovic-Talisman to better understand protein signaling, both in normal cells and in cells affected by disease. She is also collaborating with other researchers at City of Hope to design new compounds to target cancer cells.

In one effort, Jovanovic-Talisman is studying the tumor marker called nucleoporins 88, which is overexpressed in solid tumors, including breast and ovarian cancers. She is currently designing mimics, down to the nanometer scale, of the biological processes that are occurring in cancer and healthy cells. These models will be used to further understand how nucleoporins 88 causes cancer and to test drugs that target the molecule.

The quest for a novel therapeutic
Linda Malkas, Ph.D., associate chair and professor of molecular and cellular biology and the deputy director of basic research, is focused on identifying compounds that selectively target cancer. Previously, Malkas found a target in cancer cells, called cancer-associated proliferating cell nuclear antigen, that plays a role in DNA repair and helps cancer survive and proliferate.

Now, she is collaborating with City of Hope’s molecular chemists to modify small molecules that selectively block the antigen. Together, they have created a highly active synthetic compound called AOH1160. Recent animal studies have shown that AOH1160 is effective at inhibiting tumor growth. This exciting new compound could lead to a novel therapeutic for women fighting breast cancer.

Silencing genes to target cancer
Carlotta Glackin, Ph.D., associate professor of neurosciences, studies a protein called Twist1, which is overexpressed in many aggressive cancers, including breast and ovarian cancers. She is working to develop targeted therapeutics that inhibit Twist1 and stop cancer.

In collaboration with John Rossi, Ph.D., Lidow Family Research Chair and chair and professor of molecular and cellular biology, Glackin is exploring the use of small-interfering RNA (siRNA) bound to nanoparticles to deliver gene-silencing materials to tumors and block the expression of Twist1. Glackin studied this approach in cell lines and found that it was effective. Now, she is studying this therapeutic in animal models, and hopes to open a clinical trial at City of Hope. Glackin’s research provides another promising approach to therapy that could bring healing to so many women battling cancer.

Next: Part 2: Studies of risk and prevention