Monthly Archives: April 2010

On the Path to Early Detection: Fox Chase & Sloan-Kettering Researchers Identify Early Ovarian Cancers

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Researchers at the Fox Chase Cancer Center and the Memorial Sloan-Kettering Cancer Center discover early tumors and precancerous lesions in cysts that fold into the ovary from its surface, called inclusion cysts. “This is the first study giving very strong evidence that a substantial number of ovarian cancers arise in inclusion cysts and that there is indeed a precursor lesion that you can see, put your hands on, and give a name to,” says Jeff Boyd, PhD, Chief Scientific Officer at Fox Chase and lead author on the study …

Ovarian cancer kills nearly 15,000 women in the United States each year, and fewer than half of the women diagnosed with the disease survive five years. A screening test that detects ovarian cancer early, when it is still treatable, would likely reduce the high mortality, yet scientists have not known where the tumors originate or what they look like. Now, researchers at Fox Chase Cancer Center think they have answered both questions. The study, published on April 26th in PLoS ONE, reports that they have uncovered early tumors and precancerous lesions in cysts that fold into the ovary from its surface, called inclusion cysts.

Jeff Boyd, Ph.D., Professor, Chief Scientific Officer & Senior Vice President, The Robert C. Young, MD, Chair in Cancer Research, Fox Chase Cancer Center

“This is the first study giving very strong evidence that a substantial number of ovarian cancers arise in inclusion cysts and that there is indeed a precursor lesion that you can see, put your hands on, and give a name to,” says Jeff Boyd, PhD, Chief Scientific Officer at Fox Chase and lead author on the study, which also involved colleagues at the Memorial Sloan-Kettering Cancer Center. “Ovarian cancer most of the time seems to arise in simple inclusion cysts of the ovary, as opposed to the surface epithelium.”

Clinicians and researchers have been looking for early ovarian tumors and the precancerous lesions from which they develop for years without success. In this study, Boyd and colleagues used a combination of traditional microscopy and molecular approaches to reveal the early cancers.

“Previous studies only looked at this at the morphologic level, looking at a piece of tissue under a microscope,” Boyd says. “We did that but we also dissected away cells from normal ovaries and early stage cancers, and did genetic analyses. We showed that you could follow progression from normal cells to the precursor lesion, which we call dysplasia, to the actual cancer, and see them adjacent to one another within an inclusion cyst.”

To learn where and how the tumors arise, the team examined ovaries removed from women with BRCA mutations, who have a 40% lifetime risk of developing ovarian cancer, and from women without known genetic risk factors. In both groups, they found that gene expression patterns were dramatically different in cells in the inclusion cysts compared to the normal surface epithelium cells, including increased expression of genes that control cell division and chromosome movement.

Moreover, when they used a technique called FISH (fluorescence in situ hybridization), which can be used to identify individual chromosomes in cells, they saw that cells from very early tumors and precursor lesions frequently carried extra chromosomes. In fact, the team found that 9% of the normal cells isolated from the cysts had extra chromosomes, even though the tissue appeared completely benign under the microscope. By contrast, virtually none of the cells isolated from the surface of the ovary, which was previously thought to be the site of early ovarian cancers, carried extra chromosomes.

With these new data on the origin of ovarian cancer in hand, Boyd and others can now start to develop screening tests, perhaps based on molecular imaging, that could be used to detect early ovarian cancers in asymptomatic women.

Co-authors on the study include Bhavana Pothuri, Mario M. Leitao, Douglas A. Levine, Agnès Viale, Adam B. Olshen, Crispinita Arroyo, Faina Bogomolniy, Narciso Olvera, Oscar Lin, Robert A. Soslow, Mark E. Robson, Kenneth Offit, and Richard R. Barakat of Memorial Sloan-Kettering Cancer Center.

About the Fox Chase Cancer Center

Fox Chase Cancer Center is one of the leading cancer research and treatments centers in the United States. Founded in 1904 in Philadelphia as one of the nation’s first cancer hospitals, Fox Chase was also among the first institutions to be designated a National Cancer Institute Comprehensive Cancer Center in 1974. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are also routinely recognized in national rankings, and the Center’s nursing program has received the Magnet status for excellence three consecutive times. Today, Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research, with special programs in cancer prevention, detection, survivorship, and community outreach. For more information, call 1-888-FOX-CHASE or 1-888-369-2427.

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PARP Inhibitor Olaparib Benefits Women With Inherited Ovarian Cancer Based Upon Platinum Drug Sensitivity

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Olaparib (AZD2281), a new type of cancer drug known as a “PARP inhibitor,” produced promising results in patients with platinum-refractory, platinum-resistant, and platinum-sensitive ovarian cancer linked to an inherited BRCA1 or BRCA2 gene mutation.

A new type of cancer drug — known as a “PARP inhibitor” — produced promising results in patients with ovarian cancer linked to an inherited BRCA1 or BRCA2 gene mutation. The trial results were published online in the Journal of Clinical Oncology on April 19th.

Scientists at The Institute of Cancer Research (ICR) and The Royal Marsden Hospital, working with pharmaceutical company KuDOS Pharmaceuticals, now a subsidiary of AstraZeneca, found the experimental drug olaparib shrank or stabilized tumors in approximately half of ovarian cancer patients possessing BRCA1 or BRCA2 mutations.

The five-year survival rate for ovarian cancer is just 40 per cent as the majority of patients are diagnosed with an advanced form of the disease. Most patients initially respond well to radical surgery and platinum and taxane-based chemotherapy, but relapse after an average of 18 months. Subsequent treatments generally become less effective as patients build up resistance.

Professor Stan Kaye, Head of Section of Medicine, Institute of Cancer Research; Head of Drug Development Unit, The Royal Marsden Hospital; and Cancer Research UK-funded scientist

“There is an urgent need to find new drugs for women diagnosed with ovarian cancer,” says Professor Stan Kaye, Head of the Section of Medicine at the ICR and Head of the Drug Development Unit at The Royal Marsden Hospital and a Cancer Research UK-funded scientist. “Olaparib is still in early-stage testing but the results so far are very encouraging. These findings raise the possibility that carefully selected patients in future may well be offered olaparib as an alternative to chemotherapy during the course of their treatment.”

Between 2005 and 2008, about 50 women with confirmed or suspected BRCA1 or BRCA2 mutations began treatment with olaparib in a dose escalation and single-stage expansion of a Phase I trial. Twenty patients responded with their tumors shrinking or with significant falls in their ovarian cancer marker CA125, or both. The disease also stabilized in three patients. The drug was effective for an average of seven months. Notably, several patients are still taking olaparib (for nearly two years). Drug side-effects were generally mild, especially when compared to current chemotherapy treatments.

Olaparib is a new type of drug known as a PARP inhibitor that works by turning a tumor’s specific genetic defect against itself. In susceptible cells, olaparib prevents the repair of naturally occurring breaks in DNA, which healthy cells are able to repair. Susceptible cancer cells – those with an existing defect in a DNA repair pathway caused by a mutation in the BRCA1 or BRCA2 genes – are unable to repair themselves, and therefore, die.

Platinum-based chemotherapy, particularly carboplatin, is one of the main treatments used for ovarian cancer. When this treatment ceases to be effective, theoretically, olaparib might be less effective too, so the ICR scientists examined whether olaparib would still benefit patients whose response to previous platinum-based drugs was limited. Finding new drugs to treat these “platinum-resistant” ovarian cancer patients (those who relapsed within six months of previous platinum therapy) is a particularly high priority as they have a lower chance of benefiting from re-treatment with chemotherapy and a poorer prognosis.

The research team found that the clinical benefit rate with olaparib was indeed higher — 70% — among patients with “platinum-sensitive disease” (disease recurrence more than six months after previous platinum therapy). Crucially, however, the clinical benefit rate was still 46% in platinum resistant patients.

ICR Study Findings:

  • 50 patients participated in the study (13 had platinum-sensitive disease, 24 had platinum-resistant disease, and 13 had platinum-refractory disease (according to platinum-free interval).
  • 20 patients (40%) achieved complete or partial responses under RECIST (Response Evaluation Criteria in Solid Tumors) criteria and/or tumor marker (CA125) responses.
  • Overall clinical benefit rate (complete response + partial response + stable disease) = 46%.
  • Median response duration was 28 weeks.
  • There was a significant association between the clinical benefit rate and platinum-free interval across the platinum-sensitive, resistant, and refractory patient subgroups (69%, 45%, and 23%, respectively).
  • Analyses indicated associations between platinum sensitivity and extent of olaparib response.
  • CONCLUSION: Olaparib has antitumor activity in BRCA1/2 mutation ovarian cancer, which is associated with platinum sensitivity.

Up to 15 per cent of breast and ovarian cancers have known BRCA1 or BRCA2 mutations on blood testing and, importantly, laboratory data strongly suggests that olaparib may also be effective in cancers linked to DNA repair defects not caused by BRCA1 and BRCA2 mutations. This could apply in about half the cases of the most common histological type of ovarian cancer.

“We have good reason for thinking that the benefit seen with olaparib in BRCA mutation-linked ovarian cancer may well extend to a broader population of patients with this disease,” says Professor Kaye.

Randomised trials of olaparib – in which some patients receive the drug and others a placebo – are underway and results will be available later this year.

KuDOS Pharmaceuticals (a wholly owned subsidiary of AstraZeneca) was the major funder of the trial, along with Cancer Research UK and the National Institute for Health Research. Olaparib was identified and developed at KuDOS Pharmaceuticals and subsequently at AstraZeneca.

PARP Inhibitor Clinical Trials:

To view a list of open ovarian cancer clinical trials that are testing olaparib (AZD2281), click here.

To view a list of open solid tumor clinical trials that are testing olaparib (AZD2281), click here.

To view a list of open ovarian cancer clinical trials that are testing various PARP inhibitors, click here.

To view a list of open solid tumor clinical trials that are testing various PARP inhibitors, click here.

About The Institute of Cancer Research (ICR)

* The ICR is Europe’s leading cancer research centre.

* The ICR has been ranked the UK’s top academic research centre, based on the results of the Higher Education Funding Council’s Research Assessment Exercise.

* The ICR works closely with partner The Royal Marsden NHS Foundation Trust to ensure patients immediately benefit from new research. Together the two organisations form the largest comprehensive cancer centre in Europe.

* The ICR has charitable status and relies on voluntary income, spending 95 pence in every pound of total income directly on research.

* As a college of the University of London, the ICR also provides postgraduate higher education of international distinction.

* Over its 100-year history, the ICR’s achievements include identifying the potential link between smoking and lung cancer which was subsequently confirmed, discovering that DNA damage is the basic cause of cancer and isolating more cancer-related genes than any other organization in the world.

* The ICR is home to the world’s leading academic drug development team. Several important anti-cancer drugs used worldwide were synthesised at the ICR and it has discovered an average of two preclinical candidates each year over the past five years.

For more information visit www.icr.ac.uk.

About The Royal Marsden Hospital

The Royal Marsden opened its doors in 1851 as the world’s first hospital dedicated to cancer treatment, research and education. Today, together with its academic partner, The Institute of Cancer Research, it is the largest and most comprehensive cancer centre in Europe treating over 40,000 patients every year. It is a centre of excellence, and the only NHS Trust to achieve the highest possible ranking in the Healthcare Commission’s Annual Health Check for the third year in a row. Since 2004, the hospital’s charity, The Royal Marsden Cancer Campaign, has helped raise over £43 million to build theatres, diagnostic centres, and drug development units. Prince William became President of The Royal Marsden in 2007, following a long royal connection with the hospital.

For more information, visit www.royalmarsden.nhs.uk

About Cancer Research UK

* Cancer Research UK is the world’s leading charity dedicated to beating cancer through research.

* The charity’s groundbreaking work into the prevention, diagnosis and treatment of cancer has helped save millions of lives. This work is funded entirely by the public.

* Cancer Research UK has been at the heart of the progress that has already seen survival rates double in the last thirty years.

* Cancer Research UK supports research into all aspects of cancer through the work of more than 4,800 scientists, doctors and nurses.

* Together with its partners and supporters, Cancer Research UK’s vision is to beat cancer.

For further information about Cancer Research UK’s work or to find out how to support the charity, please call 020 7121 6699 or visit www.cancerresearchuk.org

About Experimental Cancer Medicine Centre (ECMC)

Experimental Cancer Medicine Centre (ECMC) status has been awarded to 19 centres in the UK that are specialist centres conducting research into new cancer treatments. The aim is to bring together cancer doctors, research nurses and lab scientists to make clinical trials of new treatments quicker and easier. The ECMC initiative is funded by Cancer Research UK and the Departments of Health of England, Scotland, Wales and Northern Ireland. Together they are giving a total of £35 million pounds over five years to the 19 centres. The centres will use this money to run trials of new and experimental treatments. They will also analyse thousands of blood and tissue samples (biopsies) to help find out more about how treatments work and what happens to cancer cells.

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Increased Ovarian Cancer Metastases Identified In Women With BRCA Gene Mutations; May Shed Light on New Treatment Approach

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U.K. researchers have found that patients with hereditary ovarian cancer – whose tumors are caused by faulty BRCA1 or BRCA2 genes – are more likely to experience metastases of the liver, lung, spleen, and viscera. … [T]he researchers suggest that ovarian cancer patients whose tumors spread to the solid organs … should be tested for the faulty genes – BRCA1 and BRCA2 – to ensure they are given the most appropriate treatment.

Dr. Charlie Gourley, Acting Head, Medical Oncology, University of Edinburgh Cancer Research Centre

U.K. researchers have found that patients with hereditary ovarian cancer – whose tumors are caused by faulty BRCA1 or BRCA2 genes – are more likely to experience metastases of the liver, lungs, spleen, and viscera. This is despite the fact that their overall prognosis is better than other ovarian cancer patients.  The research is published in the April 20th online edition of the Journal of Clinical Oncology.

In the study, researchers discovered that the percentage of women with BRCA1 or BRCA2 gene mutations who experienced visceral, liver, lung, and splenic metastases were 58%, 42%, 16%, and 32% , respectively, as compared with 5%, 0%, 0%, and 3%, respectively, in non-BRCA gene deficient women.  The researchers note that sporadic (i.e., non-hereditary) ovarian tumors tend to remain within the lining of the abdomen and pelvis.

Based upon the study findings, the researchers suggest that ovarian cancer patients whose tumors spread to the solid organs such as the liver, lungs, and spleen should be tested for the faulty genes – BRCA1 and BRCA2 – to ensure they are given the most appropriate treatment.  For example, patients with hereditary tumors, which account for 10 per cent of ovarian cancers, may be suitable for trials of a new drug called olaparib [AZD2281], which has fewer side-effects than normal cancer treatments. Olaparib belongs to a class of drugs known as “PARP” (Poly (ADP-ribose) polymerase) inhibitors.

Researchers say the study findings will improve the detection of faulty BRCA genes, as current criteria for genetic testing may miss as many as two-thirds of ovarian cancer patients carrying the mutated genes.  Improving the identification of BRCA mutations will help relatives of ovarian cancer patients, who may themselves be at increased risk of developing hereditary ovarian cancer.

Dr. Charlie Gourley, who led the research at the University of Edinburgh, said:

“We are beginning to understand the importance of tailoring cancer treatments according to the specifics of each patient’s tumor. These findings demonstrate that tumors which arise because of defects in the BRCA1 or BRCA2 genes behave differently to other ovarian cancers. This information should also help us to identify the patients carrying these genetic mutations, give them the most effective treatment for their cancer and offer their relatives genetic counselling.”

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Researchers Identify A New Breast & Ovarian Cancer Susceptibility Gene

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German researchers identify a new breast and ovarian cancer susceptibility gene known as “RAD51C.”  The risk for breast cancer in women with the RAD51C mutation is 60 to 80 percent, while the risk for ovarian cancer is 20 to 40 percent.

The discovery 15 years ago that the genes BRCA1 and BRCA2 confer high risks for breast and ovarian cancer was a breakthrough for cancer prediction and therapy, especially for familial cases.  Now the research group of Prof. Alfons Meindl (Klinikum rechts der Isar of the Technische Universitaet Muenchen), in collaboration with other groups from Germany, the U.K., and the U.S., can identify another gene that increases susceptibility to breast and ovarian cancer. Their results have been published online in Nature Genetics. The identification of such high risk-conferring genes is a prerequisite for offering women tailored early recognition programs and more individualized therapies.

The gene newly identified as causing breast and ovarian cancer in familial cases is designated RAD51C. It is, like BRCA1 and BRCA2, essential for DNA repair within cells. Mutations in the gene can therefore cause either breast or ovarian cancer. In index cases from 1,100 German families with gynecological malignancies, six mutations within the RAD51C gene were found exclusively in 480 pedigrees [i.e., family trees] with occurrence of breast and ovarian cancer. The six RAD51C mutations were not found in 620 pedigrees with breast cancer only, or in 2,912 healthy German controls.  The risk for breast cancer in women with mutation of RAD51C is 60 to 80 percent, while the risk for ovarian cancer is 20 to 40 percent. As the cancers in such families were diagnosed significantly earlier than in women who developed sporadic breast or ovarian cancer, experts might also call the newly identified gene BRCA3.

“These results reinforce our assumption that various rare gene mutations contribute to hereditary breast and ovarian cancer. The now known genes that predispose women to breast and/or ovarian cancer only explain 60 percent of the high-risk families,” says TUM Professor Alfons Meindl, Klinikum rechts der Isar, but novel technologies allow the rapid identification of other such rarely mutated disease-causing genes.

“We are also optimistic that in the future the individual breast cancer risks for the majority of women can be determined. These risk predictions will allow the offering of tailored prevention and small meshed early recognition programs. Risk-aligned prevention will become a new clinical area,” explains Prof. Dr. Rita Schmutzler of the University Hospital of Cologne, one of the other main authors of the article.

About Technische Universitaet Muenchen

Technische Universitaet Muenchen (TUM) is one of Germany’s leading universities. It has roughly 420 professors, 7,500 academic and non-academic staff (including those at the university hospital “Rechts der Isar”), and 24,000 students. It focuses on the engineering sciences, natural sciences, life sciences, medicine, and economic sciences. After winning numerous awards, it was selected as an “Elite University” in 2006 by the Science Council (Wissenschaftsrat) and the German Research Foundation (DFG). The university’s global network includes an outpost in Singapore. TUM is dedicated to the ideal of a top-level research based entrepreneurial university. http://www.tum.de

About Klinikum rechts der Isar, Munich, Germany

The Klinikum rechts der Isar (on the right hand side of the river Isar) serves its patients with a highly skilled team of dedicated doctors, nurses, research scientists, and technical assistants. The Klinikum rechts der Isar is a university hospital of the Technische Universitaet Muenchen.  With a workforce of over 4,000 personnel, the university hospital is a renowned center for the care of the sick, for medical research, and for the teaching of medicine. The Klinikum rechts der Isar is composed of more than 30 separate clinics and departments treating some 45,000 in-house patients and 170,000 out-patients yearly. With more than 1,000 beds, the hospital covers the entire spectrum of modern medicine with state-of-the-art efficiency. Through the close cooperation between health care and research, the latest advances in medical techniques can be quickly integrated into patient treatment procedures.

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Expression of Proteins Linked to Poor Outcome in Women with Ovarian Cancer

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Scientists have established the presence of certain proteins in ovarian cancer tissues and have linked these proteins to poor survival rates in women with advanced stages of the disease.

Christina M. Annunziata, M.D., Ph.D., Assistant Clinical Investigator, Medical Oncology Branch & Affiliates, Molecular Signaling Section, National Cancer Institute

NF-kB Signaling Pathway

Scientists have established the presence of certain proteins in ovarian cancer tissues and have linked these proteins to poor survival rates in women with advanced stages of the disease. The study, led by scientists at the National Cancer Institute (NCI), part of the National Institutes of Health, appears in Cancer online, April 19, 2010.

The proteins in question belong to the nuclear factor kappa Beta (NF-kB) family. NF-kB controls many processes within the cell including cell survival and proliferation, inflammation, immune responses, and cellular responses to stress.

“This study sheds light on the distinctive genetic features of the NF-kB pathway and may provide targets for the development of novel therapies for ovarian cancer,” said lead investigator, Christina M. Annunziata, M.D., Ph.D., associate clinical investigator, Medical Oncology Branch.

Abnormalities in NF-kB signaling have been found in several types of cancer, including ovarian cancer, but the mechanism and importance of such alterations in ovarian cancer was not defined. To address these knowledge gaps, the research team investigated the expression of NF-kB-related proteins in the cells of tumor tissue obtained at surgery from 33 previously untreated women who were newly diagnosed with advanced epithelial ovarian cancer. The patients had similar stage (all late stage), grade, and type of disease. All patients were treated with a three-drug regimen of standard chemotherapy agents in an NCI clinical trial that was conducted at the NIH Clinical Research Center.

To assess NF-kB family members and associated proteins in ovarian tumor cells, the scientists used immunohistochemistry, a method that uses antibodies — a type of protein that the body’s immune system produces when it detects harmful substances — to identify specific molecules in tissue specimens. Subsequently, they looked for associations between the percentage of tumor cells in individual proteins and patient outcomes.

“This study sheds light on the distinctive genetic features of the NF-kB pathway and may provide targets for the development of novel therapies for ovarian cancer,” said lead investigator, Christina M. Annunziata, M.D., Ph.D.

The data revealed that the presence of one NF-kB family member—p50—in more than one-quarter of the cells was associated with poor survival. Low-frequency or nonexpression of a target gene, matrix metallopeptidase 9 (MMP9), was also associated with poor prognosis. Further, the team identified two NF-kB family members—p65 and RelB—and a protein called IKKa that plays a role in promoting inflammation, that were frequently expressed in the same cells, providing more evidence that NF-kB is active in some ovarian cancers. It is possible that the NF-kB activity in these cancers could increase their growth and/or resistance to treatment.

“This work continues to define and characterize the biological relevance of NF-kB activity in ovarian cancer by translating research findings with ovarian cancer cells in the laboratory to ovarian cancer in women at the time of initial diagnosis,” said Annunziata.

About the National Cancer Institute

NCI leads the National Cancer Program and the NIH effort to dramatically reduce the burden of cancer and improve the lives of cancer patients and their families, through research into prevention and cancer biology, the development of new interventions, and the training and mentoring of new researchers. For more information about cancer, please visit the NCI Web site at http://www.cancer.gov or call NCI’s Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

About the National Institutes of Health

The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Comment

If NF-kB activity is ultimately determined by Dr. Annunciata et. al. to be biologically significant to ovarian cancer cell growth and/or treatment resistance, there are NF-kB inhibitor drugs (e.g., bortezomib (Velcade) or denosumab (Prolia)) in existence that theoretically could be tested in ovarian cancer clinical trials. In addition genistein, a soy isoflavone, and BAY11-7082, a preclinical compound, could be tested through preclinical/clinical testing as potential NF-kB inhibitors.  See Miller SC et. al. study below for a complete list of known NF-kB pathway inhibiting drugs and compounds.

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Libby’s H*O*P*E*™ National Ovarian Cancer Coalition 6th Annual Women’s Health Expo Presentation

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On March 20, 2010, Libby’s H*O*P*E*™ made a presentation at the National Ovarian Cancer Coalition’s 6th Annual Women’s Health Expo.  The presentation was entitled, A Patient Advocate’s Perspective on the Importance of Ovarian Cancer Awareness and Helpful Online Resources.

On March 20, 2010, Libby’s H*O*P*E*™ made a presentation at the National Ovarian Cancer Coalition’s 6th Annual Women’s Health Expo.  The presentation was entitled, A Patient Advocate’s Perspective on the Importance of Ovarian Cancer Awareness and Helpful Online Resources.  The topics covered in the presentation include:

  • Genesis of Libby’s H*O*P*E*™,
  • Ovarian Cancer Overview,
  • Helpful Online Resources,
  • Stories of Hope, and
  • Making a Difference

The full presentation is provided below in Adobe Reader PDF document format. To view the full presentation, simply click on the image below.  If you require free Adobe Reader software, click here.

I want to extend special thanks to Nancy Long and Paula Kozik, co-presidents of the National Ovarian Cancer Coalition’s Central Maryland Chapter, for the invitation to speak at this worthwhile event.  Nancy and Paula are two very special ovarian cancer survivors, who put together an informative conference that was well attended and enjoyed by all.  It was both an honor and a privilege to meet Nancy, Paula, and many other ovarian cancer survivors during the conference.  Many women shared with me their personal stories of struggle, inspiration and hope.  These women are my “everyday heroes.”  If you have any questions regarding the presentation, please feel free to contact me by clicking on the homepage “Contact” tab.