Breast cancer is the most common cancer in American women other than skin cancer. Many factors influence breast cancer risk, but the main one is simply advancing in age. Being familiar with how your breasts look and feel can help you notice symptoms such as lumps, pain or changes in size that may be of concern. You should report any changes you notice to your doctor or health care provider. Mammograms are the best way to find breast cancer early, when it is easier to treat and before it is big enough to feel or cause symptoms.
The Breast Cancer Research Foundation of Alabama has raised more than $7.7 million to support cancer research at the University of Alabama at Birmingham Comprehensive Cancer Center. The BCRFA helps ensure physicians and scientists can seize every opportunity for groundbreaking discovery and bring them directly to their patients.
In honor of October’s being Breast Cancer Awareness Month, the BCRFA and other local organizations are hosting many events in and around Birmingham.
Sept. 10: Full Moon Bar-B-Que’s Half-Moon Cookies for a Cause
Beginning Sept. 10, the iconic half-moon cookie tins have gone pink, and $1 from every pink tin of cookies will be donated to BCRFA. All money raised through the fundraiser will then be matched by Coca-Cola Bottling Co. Order cookies at fullmoonbbq.com/bcrfa-cookie-tin-drive.
Sept. 24-29: Wrapsody Hoover Breast Cancer Event
Donate $5 to Wrapsody’s Wrapped in Hope Raffle for a chance to win a $250 gift card. Also, 10 percent of sales and 100 percent of raffle proceeds will be donated to the Angel Squad at UAB’s Kirklin Clinic.
Sept. 30: Revvin’ 4 Research Charity Motorcycle Ride
Join Heart of Dixie Harley-Davidson for the 10th annual “Revvin’ 4 Research” Charity Ride, benefiting BCRFA. Registration begins at 11 a.m. at Heart of Dixie Harley-Davidson in Pelham, with kickstands up at 12:30 p.m. The escorted ride will offer lunch, provided by Courtyard Oyster Bar, before departure and an after-party with live music at the Yellow Rose. Register online at revvin4research.com or call 205-996-5463.
October: Cahaba Brewing Goes Pink for BCRFA
During the entire month, stop by Cahaba Brewing Company anytime and support them as they go pink to support BCRFA. Cahaba Brewing will have a tart cherry and hibiscus Berliner Weisse specially brewed for the month, as well as navy and pink Cahaba Brewing Co. T-shirts, with a percentage of proceeds from both benefiting BCRFA.
October: The Cowfish’s TataTinis
Be sure to dine at The Cowfish Sushi Burger Bar and order a TataTini throughout October. The Cowfish is donating $2 from every specialty pink martini to BCRFA.
October: Pink Ribbon Project
Fire stations across the state will Go Pink! to support breast cancer research in Alabama throughout the month of October. More than a dozen stations across Alabama will be selling specially designed Pink Ribbon Project T-shirts for $15 and $20. Proceeds from shirt sales will help the BCRFA provide seed dollars required to secure national grants for breast cancer research at the UAB Comprehensive Cancer Center.
October: Tameron Automotive Breast Cancer Awareness Campaign
Tameron Automotive Group will donate $100 in support of breast cancer research for every new car sold during the month of October at Tameron Honda (1675 Montgomery Highway, Birmingham) and Tameron Hyundai (1595 Montgomery Highway, Birmingham).
October: Renasant Bank Fundraising Campaign
Renasant branches statewide will hold fundraisers for the BCRFA, and accept donations from their account holders throughout the month of October. Renasant Mortgage will donate $25 for every mortgage closed in October with Renasant. Click here to find your local Renasant Bank Branch.
Oct. 2: BCRFA’s Go Pink! T-shirt Sale
Short- and long-sleeved T-shirts will be available for sale Tuesday, Oct. 2, from 10 a.m.-5 p.m. and Friday, Oct. 5, from 9 a.m.-2 p.m. in the second floor Atrium of the North Pavilion Building at UAB. Short-sleeved shirts are $15, and long-sleeved are $20. Proceeds go to fund research and save lives. Click here to see T-shirt designs.
Oct. 5: Jim ‘N Nick’s Angel Squad Breast Cancer Awareness Day
UAB’s Angel Squad members will be present in Jim ‘N Nick’s restaurants throughout the Birmingham area from 11 a.m.-2 p.m. to promote breast cancer awareness and the importance of early detection with mammograms by distributing informational brochures, pink ribbons, bracelets and stickers throughout the day. They will also be selling Jim ‘N Nick’s gifts cards for $10; half of the proceeds will go to the Angel Squad to support breast cancer patients, including assisting navigators in the Breast Health Center and Diagnostic Mammography at The Kirklin Clinic of UAB Hospital.
Oct. 6: The Patsy Pull in Downtown Collinsville, Alabama
Gather a team of eight to see if you have what it takes to pull a fully loaded fire truck 40 feet. The fastest time will take home bragging rights, all in support of BCRFA. Enjoy live music, good food, inflatables, door prizes and halftime competitions. Find more information on Facebook at The Patsy Pull.
Oct. 12: Pink Luncheon Benefiting BCRFA
This year’s 10th annual luncheon theme is all about getting your groove on and “Stayin’ Alive.” Make a minimum donation of $25 to BCRFA, and head over from 11 a.m.-2 p.m. to enjoy a buffet and prizes at the MSE Building Co. (5500 Derby Drive, Birmingham). RSVP at 205-833-9010.
Oct. 11: Charity Shopping Event at Kendra Scott at The Summit
Kendra Scott at The Summit will have a charity shopping event from 5-7 p.m., with a percentage of sales benefiting BCRFA.
Oct. 12-21: Calera Goes Pink!
Join the City of Calera as they “Go Pink” to support breast cancer research in Alabama. This citywide event kicks off with the Calera High School football game on Friday, Oct. 12, and a golf tournament at Timberline on Sunday, Oct. 21. For details on how you can get involved, call BCRFA at 205-996-5463.
Oct. 13: Susan G. Komen North Central Alabama Race for the Cure
The Susan G. Komen Race for the Cure is the largest series of 5K run/fitness walks in the world. The local race will begin at Regions Field in downtown Birmingham. Race-day registration and packet pickup will begin at 7 a.m. The parade will be at 8 a.m., the 5K starts at 9:15 a.m., and the 1-mile fun run/walk is at 9:45 a.m. Detailed information and registration is available online.
Oct. 19: Rock Creek Pharmacy “Shot for Cure”
Rock Creek Pharmacy in Bessemer, Alabama, (6817 Warrior River Road, Suite 101) will donate $5 to BCRFA for every flu shot given that day.
For many cancer patients, high-intensity treatments such as intubation and ICU admission are administered during their end-of-life care, but little is known about whether that care is in line with a patient’s wishes and treatment goals. In an analysis recently published in the Journal of Clinical Oncology, data was collected from patients who died within one year of receiving a stem cell transplant to better understand what end-of-life for these patients entails and how it can be improved upon to ensure that a patient is dying in the way they would like.
Emily Johnston, M.D., assistant professor in the University of Alabama at Birmingham Division of Pediatric Hematology-Oncology and member of UAB’s Institute of Cancer Outcomes and Survivorship, was the lead author.
“From our data, we understand there is a correlation with high-intensity end-of-life care in patients who die within one year after receiving a stem cell transplant, but we are still unsure if that was the care they wanted,” Johnston said. “As oncologists, we need to better understand a patient’s wants — what are their end-of-life goals? Do they want to undergo further treatment or return comfortably home? Improving end-of-life care is the goal, and we need to make sure that care is what the patients want.”
According to the study of more than 2,100 pediatric and adult patients, the most common end-of-life care high-intensity treatment included 83 percent dying in the hospital, 49 percent being admitted to the intensive care unit and 45 percent undergoing intubation. High-risk groups identified in the study included patients ages 15-21 and 30-59, patients with acute lymphoblastic leukemia, and patients with comorbidities at the time of their stem cell transplant.
However, the data does not indicate the patient’s preference in their high-intensity end-of-life care. As Johnston explains, better understanding patient goals, how caregiver outcomes are affected by the intensity of end-of-life care, and the added expense associated with high-intensity medical care at this phase of a patient’s life is what needs to determine how patients want to spend their remaining time.
Further, quality markers for pediatric end-of-life care need to be developed to understand how to best care for children who are dying.
“The findings suggest that, as oncologists, we need to start having end-of-life care conversations earlier with patients to determine if a high-intensity treatment plan is consistent with their goals, or if a lower-intensity treatment plan is best; it’s not a one-size-fits-all approach in end-of-life care,” Johnston said. “My hope is that, through continued studies, we can better give patients the opportunity to die in the location they want after receiving care that is consistent with their end-of-life goals.”
The University of Alabama at Birmingham and UAB’s School of Nursing will host Friday’s Biden Cancer Summit event in Birmingham to coincide with the national summit taking place in Washington, D.C., and in cities around the country.
Matt Might, Ph.D., director of UAB’s Hugh Kaul Precision Medicine Institute , will give the Birmingham keynote presentation on the groundbreaking work that UAB and the UAB Comprehensive Cancer Center are engaging in to identify and treat cancer — and the work that must still be done.
The event, which is free and open to the public, will be at 11 a.m. Friday at the UAB School of Nursing, located at 1701 University Blvd., Birmingham, in Room NB 1054.
Representatives from the American Cancer Society, Children’s Hospital, Ronald McDonald House and other organizations will also be on hand to showcase volunteer opportunities.
Former Vice President Joe Biden and Dr. Jill Biden will host the national Biden Cancer Summit to focus on the patient’s journey from prevention through a cancer diagnosis, treatment through survivorship, and determine what must be done to accelerate progress. The summits are meant to draw attention to the progress doctors and scientists have made in treating cancer, and to highlight the work that still needs to take place.
From 2016 to 2018, Might was a strategist in the Executive Office of the President in The White House. At The White House, Might worked primarily on President Barack Obama’s Precision Medicine Initiative with both the National Institutes of Health and the Department of Veterans Affairs. Prior to this role, he was a faculty member in the Department of Biomedical Informatics at the Harvard Medical School. At Harvard, Might’s research focused on rare disease discovery and diagnosis, and on the development of personalized therapeutics for rare disease.
At UAB, Might’s NIH and philanthropically funded research focuses on precision prevention, diagnosis and therapeutics across rare disease, cancer, and common/chronic conditions. A principal theme in his research is the use of computer and data science to enhance clinical and academic medicine.
Learn more about UAB’s Precision Medicine initiative — including more on Might’s incredible journey from computer scientist to identifying and treating his son’s potentially fatal disease — by visiting UAB’s Precision Medicine website.
Researchers with the University of Alabama at Birmingham have received a five-year $11.7 million grant from the NIH and National Cancer Institute to test effective and scalable diet and exercise interventions among underserved cancer survivors in Alabama, Mississippi, North Carolina and Tennessee.
“Cancer survivors age 60 and older are an at-risk population for obesity, functional decline and many other chronic diseases after their cancer diagnosis,” said principal investigator Wendy Demark-Wahnefried, Ph.D., R.D., professor and Webb Endowed Chair of Nutrition Sciences. “This grant allows us to target older individuals who may be at risk and help them to have better lives post-cancer.”
Researchers from the schools of Health Professions and Public Health, Divisions of Hematology and Oncology and Preventive Medicine, and the UAB Comprehensive Cancer Center will all be part of the intervention efforts.
Demark-Wahnefried says she and her team will be recruiting 652 participants across four states for three separate initiatives that test three distinct diet and exercise interventions — for the program titled “Adapting MultiPLe behavior Interventions that eFfectively Improve Cancer Survivor Health,” or AMPLIFI. The interventions will be web-based and assessments will take place in the field, so researchers can monitor participants from miles away.
This study will be a multidisciplinary effort including faculty members from across UAB’s campus. Other team members include Laura Rogers, M.D., Dori Pekmezi, Ph.D., Maria Pisu, Ph.D., Robert Oster, Ph.D., Kelly Kenzik, Ph.D., Natalya Ivankova, Ph.D., Yumei Schoenberger-Godwin, and Kevin Fontaine, Ph.D., all of UAB; and Michelle Martin from the University of Tennessee Health Science Center.
Recruiting will begin soon. For more information, please call 205-975-4022.
Women with ovarian or endometrial cancer who followed the ketogenic diet for 12 weeks lost more body fat and had lower insulin levels compared to those who followed the low-fat diet recommended by the American Cancer Society, according to a new study published by researchers at the University of Alabama at Birmingham.
The study, A Ketogenic Diet Reduces Central Obesity and Serum Insulin in Women with Ovarian or Endometrial Cancer, was published in the Journal of Nutrition.
Researchers studied 45 overweight or obese women with ovarian or endometrial cancer. The participants were not actively attempting to lose weight and were not on special diets at the time of enrollment. Each was randomly assigned to either the ketogenic diet or the American Cancer Society-recommended diet.
“Compared to the diet recommended by the American Cancer Society, which is moderate- to high-carbohydrate, high-fiber and low-fat, 12 weeks on a ketogenic diet, which is low-carbohydrate, high-fat, produced significantly lower levels of fat mass,” said Kevin Fontaine, Ph.D., co-author of the study and chair of the Department of Health Behavior in the UAB School of Public Health. “The ketogenic diet group also had significantly lower levels of fasting insulin.”
Researchers decided to focus on women with ovarian and endometrial cancers based on the cancers’ health outcomes and risk factors.
“Ovarian and endometrial cancers are some of the deadliest cancers among women in the United States,” Fontaine said. “These cancers are also strongly linked to obesity and higher levels of insulin.”
The ketogenic diet was used because it limits the number of carbohydrate foods that are consumed, foods that increase glucose and insulin.
“Because cancer cells prefer to use glucose, diets that limit glucose may be beneficial,” said Barbara Gower, Ph.D., senior author and professor in the School of Health Professions at UAB. “These diets are called ‘ketogenic’ because they allow the body to burn fat as a fuel. Some of the fat is converted to ketones, which are used by the brain and many other tissues as another type of fuel. Because they limit glucose and several growth factors, ketogenic diets will limit the ability of cancer to grow, which gives the patient’s immune system time to respond.”
In previous animal and small-scale human studies, the ketogenic diet has been shown to affect the development and health outcomes of cancer. This study showed that the diet had a number of favorable effects in women with ovarian or endometrial cancer.
“First, it lowered insulin, which is a growth factor,” Gower explained. “High-glucose diets result in high insulin, which stimulates cancer cell growth. Second, this ketogenic diet resulted in selected loss of visceral fat. Visceral fat is the ‘bad fat’ in the abdomen that is associated with elevated risk for cancer and diabetes. Third, we noted that patients with higher ketones had lower levels of IGF-1. IGF-1 is also a growth factor that stimulates cancer cells.”
While the study’s findings show the benefits of the ketogenic diet in cancer patients, the study authors hope to continue to expand their research to see if it impacts cancer treatment too. Both Fontaine and Gower are senior scientists in the UAB Comprehensive Cancer Center.
“We hope to acquire additional grant funding so we can conduct a larger study that begins the diet right at the time of diagnosis so we can better estimate its effects on treatment, prognosis and survival,” Fontaine said.
Breast cancer is the most common cancer in women in the United States, according to the Centers for Disease Control and Prevention. That is why having an annual mammogram beginning at age 40 is the best way to prevent deaths from breast cancer.
Breast imagers at the University of Alabama at Birmingham School of Medicine explain when and why women should have mammograms, what having a mammogram feels like, and the risk factors women should be aware of when it comes to breast cancer.
When should women get mammograms?
“All women with no special risk factors should start having annual mammograms at age 40,” said Caroline Reich, M.D., Ph.D., breast imaging medical director in the Department of Radiology at UAB. “About 20 percent of the cancers found in asymptomatic women are in individuals between the ages of 40 and 49. To me, this is one of the biggest reasons to start having mammograms at 40.”
Reich adds that the cancers found in premenopausal women tend to be more aggressive than those found in postmenopausal women.
“Studies have shown an increase in breast cancer incidence in women at and beyond the age of 40 with statistically significant reduction in mortality among those women screened starting at age 40,” said Lawrence Manalo, M.D., Ph.D., a breast imager at UAB.
Why should women have annual mammograms? Why not every other year?
“The benefits of a yearly screening mammogram far outweigh the risks,” Manalo said. “Detecting cancer while it is small and hasn’t had a chance to spread and getting treated appropriately significantly improve a woman’s mortality.”
Manalo adds that most breast cancers are sporadic and are detected in women of average risk, including women with no family history of breast cancer.
The largest and longest-running breast cancer screening trials in history have reconfirmed that regular mammography screening cuts breast cancer deaths by roughly one-third of all women age 40 and over, according to the American College of Radiology and the Society of Breast Imaging.
“Annual mammography screening saves lives,” Reich said. “Studies have shown that being screened annually results in more lives saved from breast cancer than screening every other year.”
Why are some women reluctant to have mammograms?
One reason some women may avoid having mammograms is the fear that it will hurt from the compression.
“I think patients worry about discomfort and are scared of the compression, especially those women who have never experienced a mammogram before,” Reich said. “However, with every generation of new technology, adjustments are being made to make patients more comfortable and make the procedure less intimidating. New technology has enhanced the design of mammography machines to minimize discomfort and make the screening faster.”
“It is important to educate women that having their breasts compressed appropriately aids in cancer detection due to less overlap or superimposed normal breast tissue that can hide cancers,” Manalo said.
Reich says exposure to radiation is another concern she hears from her patients.
“There is a perception that you will be exposed to a high amount of radiation, but that is not the case,” Reich explained. “The amount of radiation a woman receives during a screening mammogram is the equivalent to what they receive from background radiation walking around for a seven-week period. The benefits of early detection far outweigh the risks of such a small amount of radiation.”
Anxiety about finding a cancer is also a factor that may deter women from annual screenings.
“Anxiety, especially in women with a history of breast cancer or a family history, can be overwhelming for patients,” said Stefanie Woodard, M.D., a breast imager at UAB. “Our technologists are excellent at comforting patients during their exams. We want patients to feel confident and supported when they come for their screenings.”
What happens during a mammogram?
During a mammogram, a technologist will walk you through the process, then assist you throughout the screening by positioning your breast for each image.
“We take anywhere from four to six images of the breast,” said Tricia Reed, a mammography technologist at UAB. “There will be some compression, but it is not as bad as what patients typically expect.”
As for the compression, Reed says the purpose is to take the best image of the breast tissue. Each compression lasts for about10 seconds per image.
“The tighter the compression, the better images we can get from you so the doctor can see more tissue,” Reed explained. “The breast is made up of fibroglandular and fatty tissue, and if we don’t spread it out, you can’t see clearly through the tissue.”
The technologists will take images of the breasts from top to bottom, the sides and the lymph nodes.
“A lot of people don’t realize that your breast tissue goes under your arm,” said Kernesha Weatherly, manager of Breast Imaging at UAB. “This image gives us the best picture of the lymph nodes and muscle tissue where cancers may be found.”
Patients who are active portal members will receive the results within 24 hours of their images’ being read.
What does it mean if I receive a breast density notification?
Alabama has a breast density notification law, meaning health care providers are required by law to tell patients if 50 percent or more of their breast tissue is dense.
“A lot of people become nervous when they hear they have dense tissue,” Weatherly explained. “The notification does not mean there is a problem. It is only because it is a state requirement.”
However, dense breast tissue may make it harder to find cancer on a mammogram, which is why women with dense breasts may benefit from digital breast tomosynthesis or semi-3D mammography in addition to clinical breast examinations.
Who is more at risk for breast cancer?
Simply being a woman is the main risk factor for breast cancer, according to the American Cancer Society. Men can get breast cancer too, but the disease is about 100 times more common in women than in men.
While a family history of breast cancer plays a role in the risk, it does not mean you are in the clear if you do not have a history of the disease.
“The majority of women who get breast cancer do not have a family history,” Reich said. “However, people with a family history have a greater chance of developing breast cancer, particularly if someone has a mother or a sister who developed pre-menopausal breast cancer.”
If you do have an immediate family history of the disease, meaning a mother or a sister has had breast cancer, particularly at an early age, Reich suggests that you discuss this with your doctor to see if you should begin screening before age 40.
How can I schedule a mammogram at UAB?
To schedule a mammogram, contact the UAB HealthFinder line at 800-822-8816. You may also request an appoint online.
However, many women are unaware of their potential risk for developing a gynecologic cancer and the symptoms that indicate they may have cancer.
What is gynecologic cancer?
According to the Centers for Disease Control and Prevention, gynecologic cancer is any cancer that starts in a woman’s reproductive organs. The five primary gynecological cancers include ovarian, cervical, vulvar, uterine/endometrial, and vaginal, all posing unique symptoms and risk factors.
“Most people who get a gynecologic cancer don’t have obvious risk factors,” said Warner K. Huh, M.D., division director of the University of Alabama at Birmingham Division of Gynecologic Oncology. “With these types of cancers, what women can control is being screened regularly and seeking medical advice if something doesn’t seem right with their bodies.”
Any woman can be at risk for any gynecologic cancer. Risk tends to increase with age, and there is always a heightened possibility of cancer due to family history or race. Lifestyle choices such as chronic smoking and obesity can impact one’s risk for developing a gynecologic cancer; for instance, there is a correlation between higher rates of uterine/endometrial cancers in obese women.
Signs and symptoms
A primary challenge in the detection of gynecologic cancers is that many of the signs and symptoms are ones that women experience regularly, be they with menstruation or as side effects from another condition. Furthermore, symptoms range from woman to woman, so it can be hard to definitively say that each woman will experience the same thing.
“What women need to be looking for is the chronicity and abnormal frequency of symptoms, even if the symptoms are ones that don’t seem out of the ordinary,” said Huh, who is also the senior medical officer for the cancer service line at the UAB Comprehensive Cancer Center. “If they are experiencing symptoms like persistent bloating, ongoing bleeding or persistent pelvic pain, they need to be aware of the persistence and length of these symptoms as they may indicate that a formal medical evaluation is needed.”
While each woman’s reaction may be different, the signs and symptoms below are general indicators for each cancer. As Huh notes, it is important for women to use these symptoms as guides, ultimately knowing that they are the only ones who know for certain that there is something atypical, uncomfortable or intolerable about the symptoms they are experiencing.
- Cervical: vaginal bleeding unrelated to one’s period; postmenopausal bleeding; pain or bleeding during intercourse; significant or foul-smelling discharge
- Ovarian: loss of appetite or feeling full quickly; gas; bloating; nausea; frequent urination; pelvic pain or pressure
- Uterine/Endometrial: postmenopausal bleeding; irregular bleeding between menstrual cycles; heavier and/or longer menstrual bleeding; pelvic pain
- Vaginal: postmenopausal bleeding; pain or bleeding during intercourse; pelvic pain and constipation; vaginal mass
- Vulvar: constant itching and/or burning sensation in the vulva (outer part of female genitals); change in skin color of the vulva, including rashes, sores or warts
Prevention and detection
Women undergo different screenings at their annual OBGYN appointment — screenings that can ultimately save their lives if they are positive for cancer. Both the Pap test and HPV test are routinely administered at an OBGYN visit and are conducted during pelvic exams by means of cell collection with a swab.
The Pap test — often referred to as a Pap smear — tests for cervical cancer through the collection of cells from the cervix. The test not only can detect active cancerous cells but can detect changes that may identify a risk for cancer in the future. The Pap test does not screen for cancers beyond cervical. Women as young as 21 will undergo routine Pap tests in their annual OBGYN visit, and their doctor may suggest a schedule for Pap tests moving forward, such as getting one every three years.
The HPV test is similar to the Pap test in the way cells are collected, but it tests more broadly for other types of cancers and human papillomavirus. The current recommendation is that women 30 years and older receive an HPV test in addition to the Pap test at their annual visit.
“We know that, with most malignancies, screening is critical and early detection can help save the life of the woman,” Huh said. “The biggest takeaway for women is to stay mindful of their bodies, report any symptoms that appear even remotely irregular and make sure they have their screenings conducted on a yearly basis. These actions can ultimately save their life.”
What about the HPV vaccine?
Huh strongly advises that all women — and men — receive the vaccine to protect against cancers caused by human papillomavirus. The recommendation is for girls and boys starting as young as age 9 up until age 26 to receive the required dosages. In women, the HPV infection can cause cervical, vaginal and vulvar cancers, so the vaccine provides added protection for this population.
If you or a woman you know is experiencing abnormal symptoms, talk to your doctor about what you are feeling. Pay attention to your body and know what is or is not normal for you.
When Hayden Hatfield Ryals got married in Hartford, Alabama, June 9, 2018, there was one attendee whose presence tied the whole day together — Skye Savren-McCormick, flower girl and the 3-year-old recipient of Ryals’ bone marrow. The two struck up an unbreakable bond after Ryals donated her liquid bone marrow to Skye, a life-changing and -saving transplant.
Becoming a donor
In April 2015, Ryals was a student at Auburn University and noticed a table for Be The Match, the largest and most diverse marrow registry in the world. A passionate believer in donating blood platelets and plasma — she has donated more than 28 times — Ryals figured that participating in the simple cheek swab was just another way she could give back. Like many, Ryals never thought that anything would come of that casual interaction and DNA donation.
However, just one year later, Ryals received a phone call informing her that she was a perfect match for a 1-year-old girl with juvenile myelomonocytic leukemia, a rare and aggressive form of blood cancer.
“After processing what I had found out, without hesitation I knew that this is what I was meant to do — God chose me to help this girl, and He knew that it was my calling,” Ryals said. “I had been in a low place in life, and felt this was my opportunity to have purpose.”
Once committed to the donation, Ryals was referred to the University of Alabama at Birmingham Blood and Marrow Transplantation and Cell Therapy Program for her bone marrow harvest, the collecting the lifesaving stem cells used in transplantation. While the process of donating marrow can be done by means of harvesting stem cells from a donor’s blood, the most common procedure is done under general anesthesia, giving doctors the ability to withdraw liquid marrow from blood-forming cells that made from a person’s pelvic bone. The surgery takes roughly two hours, and most patients can leave the hospital within 24 hours.
“The process of collecting stem cells is safe, is simple and most importantly can save a person’s life,” said Ayman Saad, M.D., interim director of the BMT&CT Program and Ryals’ doctor. “Many of the patients in need of a bone marrow transplant are out of options, and the simple donation from a match — which may be the only match in the world for them, ever — can be the very thing that saves their life.”
Most candidates for a bone marrow transplant are undergoing treatment for bone or marrow cancers and/or leukemia and lymphoma. There is a common misconception that it ’is painful to donate bone marrow, something that often deters people from donation; but for Ryals, that was not something that steered her from her decision.
“When I thought about the fact that this simple donation was saving someone’s life, I never thought twice,” Ryals said. “After completing the process of harvesting and donation, I can say confidently that there is a lot more pain and strife that I would be willing to go through if I knew it could give another person a second chance for a healthy life.”
An unbreakable bond
During the first year after transplant, Be The Match allows for elective, anonymous communication to take place between a donor and recipient and for updates about the recipient’s condition to be shared. Often at the end of the first year after transplantation, direct contact is allowed. Ryals knew that she wanted to initiate consent of contact the first chance she could, and luckily, her recipient’s family agreed as well.
For Ryals, she just wanted to know the recipient’s name and know about her condition. At first, anonymous letters were exchanged, which quickly turned into emails, phone calls, texts and Facebook requests. A bond between Ryals and Skye’s mother, Talia, grew deep, ultimately leading to Ryals’ asking the now 3-year-old Skye to be the flower girl in her wedding.
“To me, having Skye be a part of my wedding was indescribable, but it really brought the whole experience about bone marrow transplantation full circle,” Ryals said. “I could never have imagined that, when I simply stopped to learn more about Be The Match and the importance of bone marrow transplantation when walking to class, I would end up on this journey with Skye.”
Saad and the UAB team perform bone marrow harvests and transplantations daily, but knowing that a personal bond has come of Ryals’ donation is something that reminds Saad that their work is meaningful.
“It’s a very selfless act to register to be a donor, so I hope stories like Hayden’s encourage people to take that first step and get swabbed,” said Saad, a senior scientist in the Experimental Therapeutics Program at the UAB Comprehensive Cancer Center. “The Be The Match registry stretches worldwide, so you never know how a simple cheek swab could save another person’s life.”
Ryals knows she is not alone in her experience, but hopes that people looking to find meaning and give back do not forget about bone marrow donation.
“All the time, people want to do good things and sometimes don’t know where to start; but Skye is living proof that the journey I embarked on was worthwhile. People comment about how amazing it is that I saved her life, but the donation I gave actually saved mine,” Ryals said.
Join the Be The Match Registry now by visiting its website. Learn more about UAB’s Blood and Bone Marrow Transplantation and Cellular Therapy Program by visiting its website. Complete information about UAB’s Comprehensive Cancer Center is also available online.
Researchers at the University of Alabama at Birmingham have found that a plant-based diet is more effective in preventing breast cancer later in life for the child if the mother consumed broccoli while pregnant. The 2018 study out of the UAB College of Arts and Sciences and Comprehensive Cancer Center used epigenetics — the study of biological mechanisms that will switch genes on and off — as a mechanism to identify ways we can change human gene expressions in fatal diseases, including breast cancer.
“An important risk factor for breast cancer is individual genetic background, which is initially generated early in human life — for example, during the processes of embryogenesis and as a baby develops in a mother’s womb,” said Yuanyuan Li, corresponding author and assistant professor in the School of Medicine’s Department of Pharmacology and Toxicology at UAB. “Bioactive dietary components that are found in cruciferous vegetables like broccoli sprouts, cabbage and kale have been shown to reduce the risk of developing many common cancers through regulation of epigenetic mechanisms.”
The study, conducted in mice and recently featured in the National Cancer Institute’s Nutrition Frontiers, suggests that women who eat broccoli sprouts while pregnant could more effectively prevent their child from breast cancer development later in life as compared with consumption of early-life and adult broccoli sprout diets. Postnatal early-life broccoli sprout diets starting prior to puberty showed protective effects in prevention of breast cancer but were not as effective as the prenatal/maternal treatment. However, an adulthood-administered broccoli sprout diet did not reduce breast cancer.
“Our results suggest that the prenatal/maternal broccoli sprout diet may impact early embryonic development by regulating global gene expression through affecting epigenetic profiles resulting in differential susceptibility to breast cancer later in life,” said Trygve Tollefsbol, Ph.D., professor in the UAB Department of Biology and senior author on the study. “These results suggest that a temporary exposure to epigenetic-regulating dietary components such as cruciferous vegetables could be a key factor in reducing the risk of breast cancer.”
This study may lead to translational breast cancer chemopreventive potential by appropriate administration of key dietary components, leading to early breast cancer prevention in humans.
Doxorubicin is a chemotherapy drug widely used in ovarian, bladder, lung, thyroid and stomach cancers, but it carries a harmful side effect. The drug causes a dose-dependent heart toxicity that can lead to congestive heart failure.
University of Alabama at Birmingham researchers now describe an important contributor to that heart pathology — disruption of the metabolism that controls immune responses in the spleen and heart. These immune responses are vital for heart maintenance, repair and control of inflammation. This dysregulated immunometabolism impairs resolution of inflammation, and chronic, non-resolving inflammation leads to advanced heart failure.
Immunometabolism is the study of how metabolism regulates immune cell function, and it is a recent and growing aspect of immunology. Two key players in immunometabolism are immune-responsive enzymes called lipoxygenases and cyclooxygenases. These immune-sensitive enzymes create a variety of bioactive lipid mediators that regulate immune cell responses.
The UAB researchers, led by Ganesh Halade, Ph.D., an assistant professor in the UAB Department of Medicine’s Division of Cardiovascular Disease, used a mouse model to study the effect of doxorubicin on immunometabolism. In the mice, doxorubicin induced fibrosis in the heart, increased the programmed cell death called apoptosis and impaired the pumping of the heart. The drug also caused a wasting syndrome in the heart and the spleen.
Mounting research has shown that the spleen — which acts as a reservoir of immune cells that speed to the site of heart injury to begin clearance of damaged tissue — plays a leading role in the initiation of immune response after a heart attack. Now, Halade and colleagues have found that the doxorubicin is also involved in the deleterious response to the spleen.
First, the UAB researchers found that doxorubicin induced irreversible dysregulation that lowered levels of lipoxygenases and cyclooxygenases in the left ventricle of the heart. This reduced the levels of bioactive lipids mediators produced by these enzymes, mediators that usually would help resolve inflammation.
Third, doxorubicin caused an imbalance of the cell-signaling molecules called chemokines and cytokines, and this imbalance suggests suppressed defense capacity of spleen-leukocyte immune cells. Specifically, the researchers found decreased levels of tumor necrosis factor-alpha in the spleen, and they found decreased levels of the immune-cells reparative marker MRC-1, also known as CD206, in the heart.Second, in the spleen, doxorubicin also poisoned a special group of marginal zone immune cells called CD169+ macrophages, causing the spleen to diminish in size. This loss of specialized macrophages means an impaired host defense system because these unique macrophages usually coordinate the first-responders monocyte deployment plan to sites of injury or infection in order to synthesize bioactive lipids to activate the resolution of inflammation.
Thus, Halade says, doxorubicin appears to have a splenocardiac impact in this non-cancer model. Knowledge of this mechanism may help explore strategies that will preserve spleen and heart health during doxorubicin treatment in cancer models.
Co-authors with Halade of the paper, “Doxorubicin triggers splenic contraction and irreversible dysregulation of COX and LOX that alters inflammation-resolution program in the myocardium,” published in the journal in American Journal of Physiology-Heart and Circulatory Physiology, are Jeevan Kumar Jadapalli, Griffin W. Wright and Vasundhara Kain, Division of Cardiovascular Disease, UAB Department of Medicine; and Mohammad Asif Sherwani and Nabiha Yusuf, UAB Department of Dermatology.
Support for research was provided by National Institutes of Health grant HL132989 and a UAB Pittman Scholar Award.