Tag Archives: National Cancer Institute

The Biggest Challenges Facing Metastatic Breast Cancer Research

Kudos to Julia Belluz, Brad Plumer, and Brian Resnick for their wonderful July 2016 Vox article, “The 7 Biggest Problems Facing Scientists According to 270 Scientists.” As one of my nephews would say, “Nailed it!”

The authors surveyed  270 scientists all over the world, including graduate students, senior professors, laboratory heads, and Fields Medalists. In a nutshell, they learned  that scientists’ success often isn’t measured by the quality of their questions or the rigor of their methods. It’s instead measured by how much grant money they win, the number of studies they publish, and how they spin their findings to appeal to the public.

Here are some of the seven points that really resonated with me, a woman living with Stage IV breast cancer who is relying on research to help me–or failing that–my family, friends and well, everyone. Please note that these points as I am relaying them are in reverse order of importance.

WHERE ARE THE CELEBRITY MOLECULAR BIOLOGISTS? Point No. 6  hit home for me: Science is Poorly Communicated to the Public. “If I could change one thing about science, I would change the way it is communicated to the public by scientists, by journalists, and by celebrities,” writes Clare Malone, a postdoctoral researcher in a cancer genetics lab at Brigham and Women’s Hospital.

Amen! The general public has no idea that breast cancer represents something that went wrong at the cellular level. It is not a punishment for eating too much sugar or too little kale. It is not God’s way of sending you a wake-up call. It means that something has gone wrong with some of your 30 trillion cells and they are growing out of control. The onset and progression of cancer is due to multiple dysregulated proteins and cellular pathways.

But according to musician and amateur molecular biologist Melissa Etheridge, “Cancer is just a symptom of our bodies being out of balance and the cure is to understand health. It’s to understand our bodies and our spirits—our souls—better. That’s the cure.”

 Melissa Etheridge was diagnosed with Stage 2 breast cancer in 2004. She had a lumpectomy, 15 lymph nodes removed and then  five rounds of chemotherapy and radiation. Apparently this is the basis of her expertise.

In her spare time, Etheridge dabbles in genetics, too.  In a 2015 she told AARP: “I have the BRCA2 gene but don’t encourage women to get tested. Genes can be turned on and off. I turned my gene on with my very poor diet.”

The article drew the ire of many, including a non-profit that advocates for those with hereditary breast and ovarian cancers. “Everyone is born with two copies of both the BRCA1 and BRCA2 genes, which play essential roles in preventing cancer,” wrote Sue Friedman, executive director and founder of FORCE. ” Individuals born with a change or mutation in one of these genes bear a higher lifetime risk of breast, ovarian, and other cancers than those without a mutation not because the gene is ‘turned on’ but because they lack a working copy of one of the genes involved in preventing cancer development.

Attention journalists–some celebrities are knowledgeable about their conditions–but please give some thought as to how these influential figures’ words and actions will be received. Angela Jolie, for example, seems well-informed about why her personal family history made a prophylactic mastectomy and oophorectomy a logical choice–for HER. However, please take the time to point out that MOST cancer is NOT hereditary–90 percent of ALL cancers  are considered sporadic, meaning they just happen. So in other words, the vast majority of us–in looks or genes–are not like Angela Jolie at all.

Another plea: Please remember those who won’t “kick cancer’s ass.” It’s not like we did something wrong or we didn’t try hard enough or we blew off doctors’ appointments. We are living with a chronic, progressive and ultimately fatal disease. Don’t treat us like losers or pretend we don’t exist. Think outside your pink ribbon expectations.  Breast cancer is second only to heart disease and lung cancer as the leading cause of death in women. Where are your lung cancer special sections? Pancreatic cancer is a devastating diagnosis–there is no early detection for this disease. Like ovarian cancer, it is a silent killer–where are those stories?

As someone living with the fatal form of breast cancer, I am so tired of self-appointed experts–celebrity and other wise–expounding upon a disease that they know little about. I am a member of United Airline’s MileagePlus program. I have been a passenger on many flights.  Amazingly, I have no insights on the science behind keeping a plane aloft, how to fly a plane or the latest pilot union grievances. Journalists: When interviewing a celebrity, please ask yourself, “What makes this person an expert? What is their understanding of basic human biology let alone the disease in question?”

MUST BE THE MONEY–the authors noted that US academic researchers need outside grants to pay for their salaries, assistants, and lab costs.  University funding is paltry–many faculty are expected to cover at least 75 percent of their salaries with grant money. Grants typically expire after three years–far too short a time to supply the kind of research needed for meaningful results in studying metastatic breast cancer. Research can take decades.

Our federal government is the largest source of cancer research funding and as Vox reports, “that pool of money has been plateauing for years, while young scientists enter the workforce at a faster rate than older scientists retire.” You can bash all the breast cancer non-profits all you want for funding more “awareness” than research. But where are the protests, the outrage over the federal government slashing research funding? The Moonshot is all well and good, but it can’t eradicate YEARS of federal penny-pinching and indifference when it comes to research. As Belluz, Plumer and Resnick observe:

Take the National Institutes of Health, a major funding source. Its budget rose at a fast clip through the 1990s, stalled in the 2000s, and then dipped with sequestration budget cuts in 2013. All the while, rising costs for conducting science meant that each NIH dollar purchased less and less. Last year, Congress approved the biggest NIH spending hike in a decade. But it won’t erase the shortfall.

The consequences are striking: In 2000, more than 30 percent of NIH grant applications got approved. Today, it’s closer to 17 percent. “It’s because of what’s happened in the last 12 years that young scientists in particular are feeling such a squeeze,” NIH Director Francis Collins said at the Milken Global Conference in May.

 James Watson was 25 years old when he co-discovered the double helix structure of DNA in 1953. Watson benefited greatly from the work and mentorship of older colleagues. Where are the James Watsons, Frances Cricks and Rosalind Franklins of 2016? Sadly, they are probably going into more lucrative fields–and they probably aren’t staying the US, either.

There is actually a non-partisan group dedicated to  “seeking the immediate restoration of funding for NIH followed by steady, predictable budget support in the future to enhance lifesaving research for patients around the world.” Medical research in the United States is in crisis according to ACT for NIH. “Adjusted for inflation, NIH receives nearly 19 percent less funding than it did in 2003. Because of this decrease in funding, NIH must reject research proposals that could lead to future discoveries of cures and treatments for cancer, Alzheimer’s, heart disease, stroke, diabetes, and other diseases. Our brightest young scientists are turning to other careers, and  other countries now threaten our global leadership in biomedical research.”

Again, where is the groundswell of outrage?

Global SpendingPUBLISH OR PERISH–Researchers are under enormous pressure to publish–unfortunately, the need to amass credentials can sometimes lead to the publication for the sake of publication–we end up with white-bread-and-mayonaisse studies that will ultimately help no one–except the authors’ careers. Metastatic breast cancer research creeps along at a tortoise-like pace–meanwhile these MBC researchers are being lapped by hares, eager to advance their careers. Sometimes researchers–perhaps even unconsciously–may create studies that are heavy on hype but slim on actual meaningful results. Says Vox:

The consequences are staggering. An estimated $200 billion — or the equivalent of 85 percent of global spending on research — is routinely wasted on poorly designed and redundant studies, according to meta-researchers who have analyzed inefficiencies in research. We know that as much as 30 percent of the most influential original medical research papers later turn out to be wrong or exaggerated.

The Vox article does not specifically address metastatic breast cancer research funding. But the Metastatic Breast Cancer Alliance (MBCA) has identified the following roadblocks to MBC research:

 Funding

  • MBC researc is  underfunded. MBC-focused research made up only 7% of the $15-billion invested in breast cancer research from 2000 to 2013 by the major governmental and nonprofit funders from North America and the United Kingdom. Specific scientific areas are understudied. The field of MBC research is relatively small. 
  • Overall cancer research is also underfunded (0.1% of the Federal budget.) Other areas receive more funding including the military, farm subsidies and education.

Matched Tissue Samples

  • To advance MBC research, better access to tissue is needed, including the primary tumor and interval blood samples collected and banked between the primary and development of the recurrent metastatic tumor.
  • MBC tissue from different populations needs to be studied (e.g., MBC in younger, premenopausal women vs. MBC in older women).

Model Systems

  • The previously available laboratory models for MBC research were discouraging but in 2013 and 2014, several laboratories have demonstrated interesting MBC models.
  • MBC models need to be validated and standardized across laboratories.

Academic-Initiated Clinical Trials

  • Academics have not focused enough on MBC (in basic research, clinical trials or cooperative groups), although focus is rapidly shifting to MBC as a priority
  • MBC research is complicated, costly and time-consuming (e.g., early breast cancer studies in animals can be two or three months; MBC animal studies can take up to 9 months to run a single set of animal experiments).
  • Lack of academic involvement has resulted in MBC trials being led by the pharmaceutical industry and business interests, including correlative science studies.

Epidemiology

  • We need to better understand the epidemiology of MBC. How many patients have a recurrence? How many of these represent a metastatic recurrence? What are their treatments and responses? How long do they survive? We don’t know because our national cancer registry (SEER) does not track metastatic breast cancer recurrence–we only have incidence, initial treatment and mortality data. Very few people present with MBC as I did (10% or less). Unfortunately, this isn’t the  first breast cancer rodeo for most people with a Stage IV diagnosis. But we don’t have recurrence statistics. You cannot manage what you do not measure.

 

I was diagnosed with MBC in 2009. Over that time, US cancer research funding

I was diagnosed with MBC in 2009. Over that time, US  cancer research funding dropped by about 20 percent. Come on! We’re counting on you, Congress! Give NIH the support it needs!

I am proud to be a board member for the Metastatic Breast Cancer Network (MBNC). We are a founding member of  the Metastatic Breast Cancer Alliance (MBCA). The Alliance is led by advocates and, since forming with 15 groups in October 2013, has grown to be the largest breast cancer alliance in the U.S. with more than 40 of the leading cancer charities, advocacy groups and individuals and pharmaceutical industry partners represented. The Alliance is working to address all of the above questions. This work is hardly glamorous–there are many meetings, conference calls, committee work and countless hours spent writing and reviewing documents and other tasks. Most members of the Alliance are busy with their regular job duties–as someone living with the disease, I am beyond grateful for their efforts. As you can tell from the Vox article, we have our work cut out for us.  It’s not easy, but we are making a difference and will continue to do so!

 

 

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Highlights from MBCN’s 2012 Chicago Conference on Metastatic Breast Cancer

Canadian friends Penny Overes, Catherine Spencer and
Danielle Smith were among the 200+ attendees. Alberta represent!

MBCN’s 6th Annual National Conference (“Moving Forward With Metastatic Breast Cancer,”) took place Oct. 13, 2012 at Northwestern’s Lurie Cancer Center in Chicago. In a few weeks, videos and presentation handouts will be posted at MBCN.org. In the interim, here are some highlights from selected breakout sessions, from attendee Pam Breakey. Pam is a long-time participant on the BC.Mets.org site and, as you will see, takes wonderful notes.
Part One: General Sessions

Part Two: Selected Breakout Sessions

We were honored to have Medical Lessons blogger and Atlantic correspondent  Elaine Schattner join us. Dr. Schattner is a trained oncol­ogist, hema­tol­ogist, medical edu­cator and jour­nalist who writes and speaks on med­icine. Her views on health care are informed by her expe­ri­ences as a patient with sco­l­iosis since childhood and other con­di­tions including breast cancer. Her work has appeared in Slate, the New York Times, Sci­en­tific American, Cure Mag­azine and the New York Observer. Read  her great article for the Atlantic here.

MBCN Honors Dr. Pat Steeg’s Dedication to Metastatic Research With the Ellen Moskowitz and Suzanne Hebert Leadership Grant Award

MBCN board member Shirley Mertz presented the award to Dr. Pat Steeg.

In other conference news, MBCN presented Dr. Patricia Steeg with the Ellen Moskowitz and Suzanne Hebert Leadership Grant Award. “For the last 20 years, in her laboratory at the National Cancer Institute, in Bethesda, Maryland, Dr. Patricia Steeg has been researching how cancer cells from the primary tumor in the breast travel to vital organs, in particular the brain,” said Shirley Mertz, MBCN board member and prominent patient advocate. “Dr. Steeg identified the first cancer suppressor gene and has done pioneering work on brain metastasis. Although metastatic research is difficult and involves long and complex experiments, Dr. Steeg remains undeterred. She exerts strong leadership in the research community nationally and internationally.”

Prior to accepting the award, Steeg gave a presentation on “Research on Treatment to Contain Metastatic Growth.” The researcher made a case for redesigning clinical trials to do what she termed “phase II randomized metastasis-prevention trials.” Currently, phase I and phase II clinical trials are done in patients with advanced, refractory metastatic cancer, patients who have had many therapies. In phase II trials,
researchers typically are trying to determine if a drug shrinks metastases.
“But a drug that prevents metastasis may not shrink a large, refractory tumor,” said Steeg. “It has a different mechanism of action that is not picked up by the clinical trial system.” Steeg referenced a
perspective piece, “The Right Trials,” she wrote for Nature this past May.

“The proposal I’ve put forth should apply to a number of different cancers, particularly those where the majority of patients are diagnosed before they have full-blown metastatic disease, or if they have limited, treatable metastatic disease,” Steeg told NCI Cancer Bulletin this past June. “One could imagine applying this to prostate, bladder, and colon cancers.”

Don’t Miss These Awesome Photos:

But wait! There’s more! Awesome conference photographs, courtesy of Ellen Averick Schor are Here.

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NCI’s Pat Steeg: Let’s Redesign Clinical Trials to Test Therapies That Prevent Metastasis

More than 200 people with metastatic breast cancer and their supporters came to Chicago for the 2012 National Metastatic Breast Cancer Conference held on Oct. 13th, National Metastatic Breast Cancer Awareness Day. Photo credit: Ellen Schor

As hundreds of metastatic breast cancer patients offered a standing ovation, the Metastatic Breast Cancer Network (MBCN) presented Dr. Patricia Steeg with the Ellen Moskowitz and Suzanne Hebert Leadership Grant Award. The award was given at MBCN’s 6th Annual National Conference which took place Oct. 13, 2012 at Northwestern’s Lurie Cancer Center in Chicago.

“For the last 20 years, in her laboratory at the National Cancer Institute, in Bethesda, Maryland, Dr. Patricia Steeg has been researching how cancer cells from the primary tumor in the breast travel to vital organs, in particular the brain,” said Shirley Mertz, MBCN board member and prominent patient advocate. “Dr. Steeg identified the first cancer suppressor gene and has done pioneering work on brain metastasis. Although metastatic research is difficult and involves long and complex experiments, Dr. Steeg remains undeterred. She exerts strong leadership in the research community nationally and internationally.”

 

Shirley Mertz with NCI’s Pat Steeg

The award—which includes a monetary grant to be used for metastatic research—is named after MBCN’s former President, Ellen Moskowitz, and former Vice-President, Suzanne Hebert.  “Ellen and Suzanne worked side by side for five years to establish MBCN as the voice of people living with metastatic breast cancer,” said Mertz. “Together, they pushed for change and inspired many to take action to promote awareness and provide education for metastatic breast cancer patients and professionals alike.”

The MBCN board wanted to honor these remarkable women by recognizing a scientist and researcher whose persistent leadership and work embodies what Ellen and Suzanne fought for—research about metastatic disease that could result in treatments to extend the lives of metastatic breast cancer patients.

Mertz presented the award to Steeg “with great appreciation and anticipation for the future…along with our deep thanks for your dedication and persistence in metastasis research.”

Prior to accepting the award, Steeg gave a presentation on “Research on Treatment to Contain Metastatic Growth.” The researcher made a case for redesigning clinical trials to do what she termed “phase II randomized metastasis-prevention trials.” Currently, phase I and phase II clinical trials are done in patients with advanced, refractory metastatic cancer, patients who have had many therapies. In phase II trials, researchers typically are trying to determine if a drug shrinks metastases.

“But a drug that prevents metastasis may not shrink a large, refractory tumor,” said Steeg. “It has a different mechanism of action that is not picked up by the clinical trial system.” (Steeg referenced a perspective piece, “The Right Trials,” she wrote for Nature this past May: http://www.nature.com/nature/journal/v485/n7400_supp/full/485S58a.html)

Conference chair and MBCN board member Deb Tincher noted that many attendees cited Steeg as their favorite speaker at the 2012 event. “One person described Dr. Steeg as ‘spectacular and passionate’ and we certainly agree,” Tincher said. “We also agreed with the rest of her comment: ‘Dr. Steeg is in the trenches helping us and it showed!’ We are proud to recognize and support Dr. Steeg’s work.”

“I’m glad Dr. Steeg is on our side!” said one metastatic breast cancer patient at the 6th Annual MBCN Conference.

 

ABOUT MBCN’s ANNUAL CONFERENCE

MBCN held its first conference at Memorial Sloan-Kettering Cancer Center in 2006. Subsequent conferences have been held at M.D. Anderson, Dana-Farber, Indiana University’s Simon Cancer Center and at Johns Hopkins.

 

ABOUT THE METASTATIC BREAST CANCER NETWORK

MBCN is a national, independent, nonprofit, patient advocacy group dedicated to the unique concerns of the women and men living with metastatic breast cancer. MBCN was founded in 2004 by Jane Soyer and Nina Schulman. When diagnosed with advanced breast cancer, they experienced feelings of isolation from the very groups established to provide support. They felt the stigma of being a “failure” in the breast cancer community. Their belief that cancer cannot be viewed as a disease from which one is either a “survivor” or to which one has succumbed, fueled their desire to advocate for change.  See www.mbcn.org.

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Spread the Word: Metastatic Breast Cancer Conference is Coming to Chicago on Oct. 13

Many of you know that I volunteer with the Metastatic Breast Cancer Network, (MBCN),  an all-volunteer, non-profit group that serves the 150,000 U.S.  people currently living with metastatic breast cancer. In 2006, the group held its first conference at Memorial Sloan-Kettering Cancer Center. The conference was a huge success with more than 300 attendees from 19 states and Canada. Subsequent conferences have been held at  M.D. Anderson, Dana-Farber, Indiana University’s Simon Cancer Center and at Johns Hopkins.  This year’s conference will be held in Chicago on Oct. 13 at at Northwestern University’s Lurie Center. Please help us spread the news!

If you have metastatic breast cancer, I hope to see you at this event. Caretakers and friends are welcome, too.  Some scholarships are available to help defray travel and hotel costs. (Here’s the registration link.) Please join us! You will be glad you did.

The goal of MBCN’s annual conference is to:

  • Help to ease the isolation of living with metastatic disease
  • Expose misconceptions about the disease –misconceptions held not only by some patients, family and friends but also by some doctors …doctors who give up on metastatic patients too soon
  • Fight for drugs to extend life as we search for the cure

Along with medical presentations, attendees will hear testimonials from people living with MBC.  We will share our struggles, triumphs and coping mechanisms. A Friday night pizza party at Chicago’s famous Gino’s East is a great chance to catch up with old friends and make new ones. Before I attended the 2009 conference in Indiana, I hadn’t met any MBC patients in person. It made a tremendous difference to actually see  I was not alone.

If there is anything I can help you with, leave me a comment! Please helps us publicize this very worthy event!

—KOB

We have expert speakers from Northwestern,  University of Chicago, Rush University the National Cancer Institute and more. Agenda highlights include:

“Understanding MBC”

Virginia Kaklamani, MD  is an Associate Professor in Hematology/Oncology at Northwestern University. she completed her medical training with honors athe University of Athens and her residency in internal medicane at Newton-Wellesley Hospital in Boston. She received a Master of Science degree in clinical investigation from Northwestern in 2003 and joined the Northwestern faculty in that same year, following completion of her fellowship.Her clinical interests are breast cancer and cancer genetics.

“Emerging Research”

Steven Rosen, MD is the Genevieve Teuton Professor of Medicine and the Director of the Robert H. Lurie Comprehensive Care Ceter at Northwestern. He graduated from Northwestern Medical School in 1976 and completed his residency at Northwstern and fellowship in Medical Oncology at the National Canccer Institute. Dr. Rosen has received numerous awards and contracts and has published more than 200 scientific papers. He serves on several editorial boards and is editor of Cancer Treatment & Research. He is a member of all major national associations that focus on oncology and has held leadership positions in the Eastern Cooperative Oncology Group, the American Association of Cancer Institutes and the National Comprehensive Cancer Network.

“Research on Containing Metastatic Growth”

 Patricia Steeg, PhD received her PhD from the Univesity of Maryland in 1982 and was tenured in 1992 at the National Cancer Institute. She became chief of the Women’s Cancers Section in 1993. In 2004 she was appointed Director of the Moleccular Therapeutics Program, Center for Cancer Research at the NCI. Her research centers on identifying and containing metastatic growth.

BREAKOUT SESSIONS:

“Acupuncture and Chinese Herbology”

Virginia  Burns, LAC is a licensed acupuncturist at Northwestern University.

“Targeted Treatment for Isolated Mets”

Steven Chmura, MD is Assistant Professor of Radiation and Cellular Oncology at the University of Chicago. An expert in radiotherapy ad stereotactic radiosurgery(SRS), Dr. Chmura uses minimally invasive techniques to minimize tissue damage when diagnosing and treating cancers. He is an active researcher and principal investigator for the Radiation Trials Oncology Group. He received all of his training from medical school through internship and residency at the University of Chicago.

“Improving Daily Functioning”

Gail Gamble, MD specializes in Physical Medicine and Rehabilitation at Northwestern, where she is an Associate Professor. She graduated from the Mayo Medical School in 1979 and completed residency at the Mayo Clinic in Rochester.

“Treating Bone Metastases”

William Gradishar, MD is professor of medicine in division of hematology/oncology at Northwestern University. After recieiving his medical degree from the University of Illinois/Chicago, he completed residency at Michael Reese Hospital and Medical Center in Chicago and fellowship at the University of Chicago. Dr. Gradishar is hte Director of the Maggie Daley Center for Women’s Cancer Care at Northwestern Memorial Hospital. He has published extensively in the area of breast cancer therapy, with a focus on endocrine therapy, chemotherapy and novel targeted therapies. He is active in ASCO leadership, the Breast Cancer Treatment Guidline committee of the National Comprehensive Cancer Network and serves as a consultant to the Oncolgoy Drug Advisory Committee of the FDA.

“Living with MBC”  (Panel 1 for Those Under 40; Panel 2 for Those 40 and Older)

Roz Kleban is the administrator supervisor for psychosocial programs at the Evelyn H. Lauder Breast Center at Memorial Sloan Kettering Cancer Center where she oversees all social-work activities. With almost 25 years of experience working with oncology patients and their families, she leads weekly support groups for women dealing with early- as well as advanced-stage breast cancer and is a member of the professional advisory board of breastcancer.org.

“Brain Metastasis”

Lorenzo Munoz, MD is a neurosurgeon at Rush University Medical Center. He received his medical degree from the Ponce School of Medicine in Puerto Rico and completed internship and residency at University of Illinois. Dr. Munoz also completed fellowships in neurosurgical critcal care and pediatric neurosurgery.

“Triple Negative MBC”

Funmi Olopade, MD  is a Professor of Medicine and Human Genetics and Director of the Cancer Risk Clinic at the University of Chicago. She graduated from medical school at the University of Ibadan, Nigeria and completed internship and residency at Cook County Hospital and fellowship at the University of Chicago. Her current research interests include identifying the source of ER-negative breast cancer–an aggressive form of the disease, which is resistant to hormone therapy. Dr. Olopade has a special interest in women of African descent, who are at higher risk for the more aggressive breast cancer and more likely to be diagnosed at a younger age. She aims to develop new biomarkers and improve screening standards and early detection for moderate- and high-risk populations.

“Treating Pain and Neuropathy”Judy Paice, PhD, RN is Director of the Cancer Pain Program at Northwestern University and a Research Professor in the Hematology/Oncology Division. She received her RN from Rush Medical College in 1982 and her PhD from Unicversity of Illinois in 1992. Her interest are Pain Management, Palliative Care and Hospice.

“Hormone Positive MBC”

Dr. Ruta Rao is an Assistant Professor at Rush University Medical Center, where she completed her fellowship training. Prior to that, she attended University of Wisconsin Medical School and completed internship at University of Southern California and residency at University of Illinois.

“Role of the Caregiver”

 Sara K. Rosenbloom, PhD  earned her PhD from Northwestern in 2002.

 

When
Saturday October 13, 2012 from 8:00 AM to 5:30 PM EDT
Where
Robert H. Lurie Medical Research Center
303 E. Superior Street
Chicago, IL 60611
Contact
Metastatic Breast Cancer Network
888-500-0370 (voice mail)
mbcn@mbcn.org
“I have been to so many conferences where the focus was primary breast cancers and the topic of being metastatic was almost non-existent,” said an attendee at the inaugural conference in 2006.  “What about us?  What do we do?  What new therapies can we look forward to that will help keep us, that might prolong our lives for a very long time?  How do I deal with this?  If we don’t get the attention that is deserved, how can we expect non- metastatic women and men to not fear us? Thank you for doing this.”
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