Week 2: Angelina Jolie

     I attended my first research meeting for the physicians at the Weill Cornell Women's Health Center on 61st Street. Dr. Vahdat went over each study/clinical trial that was currently happening. There was the Galena Study which was immunotherapy based, the Immunomedics Trial which contains an antibody-drug conjugate for patients with epithelial cancer, and the Ovarian Reserve Study which studied the effects of therapy on ovarian reserve in premenopausal women with early state breast cancer just to name a few. Next, she proceeded to explain the steps of beginning of a study/clinical trial starting with a confidentiality agreement, some legal work, Clinical Study Evaluation Committee (CSEC), submission, Institutional Review Board (IRB), approval, more contracts, Site Initiation Visit (SIV), screening/enrollment, amendments, and finally a completed study. This was an excellent review of the clinical trial process and provided a substantial timeline from beginning to end. After the research meeting, I followed Dr. Tessa Cigler, who specialized in low risk breast cancer. I saw two patients with relatively small tumors who just needed radiation or chemotherapy. The recurrence of there tumors where incredibly low, 2-5%.

     I shadowed Dr. Vahdat and met with her patients who had complicated cases of breast cancer.
I met with a student in Dr. Vivek Mattel's lab and discussed a possible research project that I could work on. Lauren is researching microRNA to suppress metastasis, work that is very similar to my research. I will meet with her next week to go over project details. Later that day, I met with Ann Carlson, a genetics counselor in Dr. Vahdat's office. We watched a webinar titled, "Bridging the Gap: Genes for Reproductive Oncological Setting." The webinar was about identifying genes with autosomal recessive conditions and their reproductive risks. BRCA 1/2 are the most well known and verified mutations that put patients and their children at a higher risk of breast and cervical cancer. There are some other genes such as ATM, RAD50, RAD51C, FANCC, PALB2, BRIP1, XRCC2, and MRE11A. Less is known about these genes but research is being done to collect even more information as to their correlation with cancer. Ann met with three patients that day who wanted genetic testing. One patient was just diagnosed with breast cancer and the other two patients were just inquiring based on their family history. The patients could either provide saliva (cheek cells) or blood (white blood cells) to be compared to a panel of genes so as to identify certain mutations. BRCA testing is the easiest and most common to do. It costs relatively less than a large panel and most insurances approve it if you have a family history or just diagnosed. To determine family history, Ann would create a pedigree based on the information provided by the patient about the members in the family, going all the way back to great-grandparents and all the way forward to great-grandkids. For each family member, she would ask the age, alive or deceased, any diseases, and if they were alive and well. Based on this information, Ann could tell if they were at a high risk of being a mutation carrier and recommend what test each patient should get. Ashkenazi Jewish puts one at a higher risk for breast and ovarian cancer with a BRCA mutation. Also, many women in the family that are diagnosed or die of breast cancer can put one at a higher risk of getting breast cancer. Earlier screenings, exams, genetic testing, mastectomy, and hysterectomy are usually the options for those patients that have these genetic mutations. Angelina Jolie Pitt is a famous case of a patient undergoing a preventative, bilateral mastectomy and risk-reducing salpingo-oophorectomy once she found she had a BRCA1 mutation.