Understanding Ovarian Cancer Early Detection and the Progress Being Made

In this episode of What to Know Down Below™, Beverly Wolfer, Executive Director of Tina’s Wish, is joined by Tina’s Wish Scientific Advisory Board member and funded researcher, Lan Coffman, MD, PhD of UPMC, and Andrew Brozman, co-founder of Tina’s Wish and husband of the late Tina Brozman.

Their conversation honors Tina’s legacy, highlights the urgent need for early detection, and showcases the innovative, collaborative research making real progress in the fight against ovarian cancer.

tinaswish.org/whattoknow

Transcript

Introduction 0:05

Welcome to what to Know Down Below. By Tina's Wish, we're here to empower you with the knowledge and tools you need to advocate for your own gynecologic health. Knowledge is power, and we encourage everyone to join us in learning more about what you need to know down below.

Beverly Wolfer 0:24

Hello, my name is Beverly Wolfer and I'm honored to be a part of the Tina's Wish team. Tina's Wish is a national not-for-profit that was founded in memory and in honor of the Honorable Tina Brosman, who, sadly, was diagnosed with ovarian cancer in 2007. Our goal and our mission is to fund scientific research for the early detection and prevention of ovarian cancer and, in addition, we provide education and awareness around gynecologic health. I'm so grateful to be here today representing this important work. Today, I'm really honored to be in conversation with Andy Brosman and Dr Lon Kaufman. We're going to talk a little bit about the inspiration behind the founding of the foundation, as well as the impact that our funding has had in the scientific community.

Beverly Wolfer 1:14

We're going to start by hearing from Andy Brosman, who is Tina's husband, former partner at Clifford Chance Law Firm and an important part of the Tina's Wish Board. We're also going to be in conversation with Dr Lon Kaufman, a leading medical oncologist at the University of Pittsburgh Medical Center. She's also a Tina's Wish-funded researcher and an invaluable member of the Scientific Advisory Board at Tina's Wish. Andy, over the past 13 years that I have been at Tina's Wish, there's not a year that goes by that I do not receive an email or a handwritten note that shares with me about the incredible person that Tina was. While I wasn't privileged to work or get to know her in person, I've really gotten to know her through those notes and through the stories that you've shared with me over the years. Can I ask you to share with us about who Tina was and the inspiration behind founding Tina's Wish?

Andrew Brozman 2:16

Sure, beverly, thank you very much for having me on today. I think it's very important that we give some background as to who we are and why we are. We give some background as to who we are and why we are. Tina was a remarkable woman who achieved the heights of her profession. She was a preeminent financial restructuring lawyer. She became the youngest person ever appointed to the federal bench in the United States Bankruptcy Court for the Southern District of New York, ultimately becoming the chief judge. But more than that, tina was someone who inspired people to do the right thing. In her line of work, which also was my line of work, there was always a tremendous amount of contention, which is the nature of the legal system to begin with. But Tina was able, in a very strong and firm but always cordial way, to induce consensus among disputing parties, and it was that type of characteristic that helped us launch Tina's Witch.

Andrew Brozman 3:27

Tina was diagnosed with ovarian cancer at the age of 52. She was feeling a little bit of discomfort abdominally, she gained a little girth in her waist and she had written it off to middle age changes. She went to her gastroenterologist. She went to her gynecologist, neither of whom diagnosed ovarian cancer, neither of whom really even raised the possibility of ovarian cancer. It was only our old-time general practitioner who spotted it and Tina found herself in debulking surgery the very next day. This was obviously a shock to all of us. Tina was a very healthy woman in the prime of her life, extraordinarily fit and not given to illness in any respect, so it was quite uncommon that she would find herself feeling ill. She was somebody who was resilient in just about every situation. She was a person who was more attuned to taking care of other people than being concerned with her own well-being. But obviously this was something that we had to address. Tina was I guess the best way of putting it somebody who inspired people to love and respect her, and we sort of had a leg up on what we ultimately came to do with this foundation, because Tina was so universally admired and loved by the community in which she worked, which is the financial community. So we had an outpouring of support that was built in as a result of who Tina was.

Andrew Brozman 5:34

Tina was a remarkable woman, married for almost 25 years and we had three wonderful children. I like to tell people that they're wonderful because Tina was instrumental in raising them. She was so compassionate. She made our family a real unit. She was inviting of our children's affection. She was inviting of my affection. I wonder all the time on what more she could have achieved. And who wonder all the time on what more she could have achieved and who she could have become as she aged with me. And the thing that I regret most about this is not having that opportunity to grow old with her and continue to be guided by her sense of wonder and exploration and adventure. That really was the hallmark of how she lived. So I think this foundation arose because of who Tina was and has been successful, because of who Tina was and has been successful.

Andrew Brozman 7:05

Because of who Tina was. She came up with the idea of having a foundation to pursue the early detection of ovarian cancer as she was sick and getting sicker, because she understood that women stood a very small chance of surviving ovarian cancer unless there was a way to detect the disease in its earliest and most survivable stages. She was diagnosed in stage four and she understood that the prognosis was very poor for her. So it became an extraordinarily important thing for her to devote her energy, her remaining energy, to creating a means for women who would follow in her footsteps not to suffer the same fate of late diagnosis, and I think that she's inspired all of us to take up that mission and, in her spirit, persist in the face of every kind of adversity and induce people to understand how important this is, not only to women but to their families as a whole.

Beverly Wolfer 8:23

Well, thank you for sharing really about who, not just who she was, but really her spirit.

Beverly Wolfer 8:28

You know, when I look to hire people, at Tina's Wish, I always tell them I'm hoping that you're going to help me put all of us out of a job. So and I don't say that in jest, but since the time I've come to me, tina's wish is really an aspiration and something that we can actually accomplish, and I don't know how many people in their lifetime can actually say that. And I know that she continues to inspire all of us. You know every day all the people that work with us.

Andrew Brozman 8:58

Yeah, I think that her personality and her ability to draw people to her was an essential foundation for her foundation to be a success, and we have had a remarkable ride thus far, from our very small and kind of unguided founding to the part where we are today, and I'm most pleased that her name has become associated with one of the most important resources for funding ovarian cancer research in the country.

Beverly Wolfer 9:36

And we're going to talk a little bit about that, really how we've become somewhat of a think tank for the research community in the early detection space. Think tank for the research community in the early detection space. Just one more piece, just really, about Tina. Something that's always been important to the foundation was the creation of the Tina Brosman Mentoring Award that we present annually. Can you maybe just share like one mentoring story that you remember or something that maybe she shared about a mentee, because so often people that I meet will share about how they were either in her courtroom or they would go to her for advice and what an impact that made on them.

Andrew Brozman 10:13

Well, there's two areas where I think she was very impactful. One, recognizing how difficult it was for young women to both devote untold hours to becoming a successful lawyer and, at the same time, trying to raise a family. She spent a lot of time mentoring young women as to how they could succeed in doing both. But the story I'd like to relate was one day a young woman came into her courtroom and made an argument before her by reading from a written script. After the court recess for the day, tina suggested that the woman stay after and speak to her directly.

Andrew Brozman 11:04

Tina said throw away your script. Now make your argument again to me, and I think what this did was let a young lawyer know that they had these abilities within themselves, and it only took an unlocking of that to become a more proficient lawyer, and I don't think there's another judge that I'm aware of who would have done something like that. But this is how Tina was. The mentoring aspect was so important to her and it's really just a translation of how she raised her own children.

Beverly Wolfer 11:46

Wow. I think that's inspiration to anyone listening today that you can. You never know how you're going to impact somebody else and by really providing constructive and honest advice, you know what that can mean for someone else, both personally and professionally. So, lon, so excited to be talking with you as well. One of the things that I've heard about Tina over the years was that she would oftentimes say I'm not angry for having ovarian cancer, I'm angry I didn't have a fighting chance. And since I heard that and I've met so many women who are along this ovarian cancer journey it's a similar sentiment that they share. Why is that?

Lan Coffman 12:30

I think it comes down to we have no way of finding this at a stage where it's curable, or at least highly curable Ovarian cancer, unlike other cancers. When you think of things like breast cancer, which starts as a mass in the breast and kind of slowly gets bigger and bigger, and we have ways to do things like mammography and MRIs, we can find that tumor and we know those things save lives. We find that tumor, we can cut it out, we can save patients' lives and that has been a huge success. You know, in ovary cancer, by the time a woman is diagnosed, unfortunately, like Tina, it is cancer cells who spread everywhere. You know, when you talk about metastasis, that just means that the cancer cell has spread from where it started and learned to live in new places. And once that happens, cancer cells are really good at evading all our treatments. We can cut it out, throw lots of chemotherapy at it, we can throw new targeted treatments at it, but really it's just buying time.

Lan Coffman 13:36

The ability to cure that cancer that's already found its way to live in other spots is really low. And so I think that not having a fighting chance is because we don't find it early enough and it's really because we don't know enough about it. Fortunately, there have been folks that have been devoted to figuring out how ovarian cancer starts and this starts the very basic biology of it, and now we know that most ovary cancer actually starts in the fallopian tube. Unfortunately, a lot of people don't even know what a fallopian tube is and kind of how that relates to the ovary, but most ovary cancer starts in the fallopian tube as changes in the lining of the fallopian tube, changes in 10 to 20 cells that grow into maybe 200 cells, and then those can invade or break off and spread, and so being able to find those 200 cells in the fallopian tube is an incredibly difficult challenge. But that's really where we need to go to be able to find this at an early stage or even to be able to prevent this cancer from forming.

Lan Coffman 14:42

And then that's how we're going to give women a fighting chance. That's how we're going to save lives. It's how we're going to make ovarian cancer a curable thing, or, hopefully, something that's not even an issue anymore. If we could prevent it, that would be by far and away the best way to go.

Beverly Wolfer 14:56

That is definitely part of our mission statement. Before we start talking a little bit about the research that you're doing, I want to go a little bit back to kind of the disease itself. So I think myself, like many other women out there, we go for an annual exam and we get a pap smear, but that's really only for cervical cancer. Why don't we have a test yet? Or does such a test exist and I'm just not getting it.

Lan Coffman 15:21

The test does not exist and again, I think it's because of where these cancer cells start. The changes in the fallopian tube happen at the far end, that's closest to the ovary, and so it's kind of deep within your body. It's not something that you can sample on a pap smear or when you're doing a pelvic exam. You can't feel any changes there. There have been big studies to look at things like ultrasound. So can we look at changes in the ovary and the fallopian tube with ultrasound, but unfortunately, because it's so tiny when it starts, it just doesn't work. And so you know you're not missing a test. There just isn't a test. And pap smears are wonderful for detecting most cervix cancers. They just don't do anything for ovary cancer, unfortunately.

Beverly Wolfer 16:10

Okay, so we'll transition a little bit to kind of the work that we're funding. Can you share first, though, how you became involved with Tina's Wish?

Lan Coffman 16:22

Sure. So as a physician scientist, when I was training through medical school and doing my PhD, I really focused on ovary cancer and started doing research in that space because it was an area of unmet need Particularly, there aren't a lot of medical oncologists that are doing research in the area and I loved the patient population and so my research really started in metastatic disease right, because that's how most women present. There's tons of tissue, unfortunately, and it's just an easier thing to study. There's tons of tissue, unfortunately, and that it's just an easier thing to study. There's lots and lots of cells there. They've spread. It's an easy place to study.

Lan Coffman 17:03

But my mentor at the time was involved with Tina's Wish and there was a funding opportunity for a rising star investigator, basically to get young investigators interested in actually working in the early detection prevention space. So we kind of took that leap to say let's look at a really hard question, Not to say that studying metastatic ovary cancer is not a hard question. It's a lot harder when you're looking at a, you know, a lesion that's only 200 cells big and that's something you can't find on ultrasound or CT or anything. So it was really that funding through Tina's Wish that got me to ask the hard questions about what's happening in the fallopian tube when ovary cancer is starting, and that's really engendered kind of a big push in our lab and interestingly that research actually was just published. It was back when I was a fellow, so it takes a while, but it was really wonderful to see when we started to focus on what's happening in the tube found some pretty profound changes.

Lan Coffman 18:12

I study the tumor microenvironment, so not as much the tumor cell itself.

Lan Coffman 18:18

So you can kind of think of cancer as having like cancer cell seeds, which are the cancer cells, but they have to sit in fertile soil to be able to grow, and so my research is focused on that soil. And when we first started studying the earliest steps in ovarian cancer initiation we asked the question is there actually changes in the soil in the fallopian tube that allows these cancer cell seeds to start to turn into cancer and to grow? And then the work we just published actually shows that there are big changes that happen in the fallopian tube before there's any cancer and as the fallopian tube soil starts to become more fertile for cancer initiation, that's when we can actually see cancer cells start and then start to invade and spread. And so it was lovely to see some of that work come into fruition.

Lan Coffman 19:12

Obviously there's so much more to do, but it gives us another area to target. We're not just looking at those 200, you know cancer cell seeds, but looking at this huge fertile soil that happens before, and can we find biomarkers for that soil? Is there a way to block it so it doesn't promote cancer initiation, to block it so it doesn't promote cancer initiation? So it's really it's sparked a whole other investigative field in our lab and hopefully something that will really move forward and help us come up with an early detection or prevention strategy.

Beverly Wolfer 19:48

Wow, that analogy is so powerful. It allows me, being a super lay person, to kind of get a little better glimpse into the work that you're doing. I think one of the things that has been really exciting as we've watched your work grow, is the collaborative work you're doing across institutions. Can you tell us a little bit about the work that you're now doing with MIT?

Collaborative Research Approaches

Lan Coffman 20:07

Sure, and the collaborations actually started way back from the beginning, and it was one of the things I love about Tina's Wish and I will say it's the only foundation that is, it's the only funding mechanism that funds just early detection research, which is huge right. If we don't actually focus on this really difficult problem, we're never going to be able to reach our goal there. But I think what was more powerful in the funding itself was the community that I entered into. I remember coming to our first meeting and presenting our work and meeting these amazing scientists that were all focused on this really hard question and it wasn't competitive at that point and it's still not. It's collaborative. Welcome you in. Here are these tools, here are these models, here are these patient samples how can we help? And so, from that that initial meeting, I collaborated with folks from Hopkins and Penn and they are still very close collaborators.

Lan Coffman 21:05

And then we had a teen is wish summit, which actually brought investigators that were not really in the cancer biology field but across different disciplines, which was amazing.

Lan Coffman 21:18

And so I met Dr Kripa Varnashe and Dr Angie Belcher from MIT, who are engineers, and they bring just such a different approach to the same problem. And so we started a collaboration where we're looking actually at the physical properties of this soil. So all of my work has been to look at the soil in a cell biology standpoint. How is it signaling to the overlying cells? How are they moving together? But it turns out that they actually have physical changes, things like pH, things like stiffness, things that our engineering colleagues can measure, and so we're collaborating on being able to measure those changes as cancer initiates and actually being able to use tiny little scopes like a fallopiscope, which will go up into the fallopian tube and detect these changes so we can actually find those early lesions before they've turned into full-blown cancer. So it's been amazing both lovely people and wonderful scientists. But to bring people that think a little bit differently and approach a problem from a different way to come together, I just think it is really powerful, and so that's been a really fun and fruitful new collaboration.

Beverly Wolfer 22:36

I'm always so blown away at our summit or symposiums where people are doing what you just said collaborating because I think about so many other professions and it's so siloed and so I almost just wonder, like, could we also be inspiration for other communities to work together? Andy, we were talking a little bit earlier offline about really the growth of the foundation, where, in 2008, the first grant funding went to one institution for $200,000. And now this year we're funding $2.5 million across 15 different institutions. When you began the foundation, did you ever imagine that not only would you be funding such a robust and diverse set of grantees, but also the really just growth of the foundation, as we said earlier about becoming like a think tank and being to bring together all of these researchers and all of the new initiatives that we've been able to take on?

Andrew Brozman 23:34

Well, we started off as a group of uninformed lawyers and judges who knew nothing about fundraising or running a not-for-profit organization, so the chances of our succeeding were pretty low.

Andrew Brozman 23:49

However, again because of who Tina was, the degree of success she achieved is something that we couldn't help but model ourselves after.

Andrew Brozman 24:03

We would have been a tremendous disappointment to her if we didn't achieve a similar level of success. She didn't expect anything less of herself than she would have expected of us, and I think she drove us to become what we have become today, and that is a very successful organization that's focused on a single scientific issue, single scientific issue. I think that if we were to look back on who we were and how we started, one of the things I recall thinking was we will be successful when Tina's name is both associated with the cause and, at the same time, the least important part of what Tina's wish is Because if we can institutionalize ourselves, as I think we had to a great degree, then we are long down the path of having achieved Tina's mission. True, we have a very daunting scientific issue to resolve, but I'm quite confident that, not only because of the quality of the researchers we fund, like Lan, but because of Tina's indomitable spirit, that this is something that we will succeed in achieving.

Beverly Wolfer 25:32

What advice do you think she would give us today?

Andrew Brozman 25:44

You know, in a sense Tina was very resolute, she was very goal oriented and, as I mentioned, she was very successful in achieving those goals. I think she would have told us that in our deepest moments of doubt which arise unfortunately regularly because of the difficulty of scientific problem our researchers are attacking that we should remain undaunted and that we should continue to push and, push and push until we achieve the breakthrough that she, I think, would have been very confident we would have achieved, and I think that her resolution and sense of purpose would continue to push us to become the one resource that, at the end of the day, is going to solve this incredibly difficult problem.

Beverly Wolfer 26:40

So, Alon, was there a moment in your lab that you felt like you're getting closer to achieving the goal and the mission of Tina's Wish?

Lan Coffman 26:51

Yeah, I think, you know, the first time that we saw these changes, these soil changes and actually primary patient samples. So, you know, as part of the research process, we model a lot of things in the lab, but you always need to bring that back to actually what's happening in person. And so we were fortunate enough, through collaborations, through Tina's Wish, to have a whole series of flipping tubes from women that either had completely normal tubes, from women at higher risk because they have BRCA mutations, or from women that have these early lesions, which are called stick lesions, by the way and so we did this kind of fancy imaging that allows us to look at lots of different markers. But we were able to actually see that these stromal changes were starting to cluster around these precursor stick lesions and then would expand millimeters, almost a centimeter away from that lesion, and then we actually found them in tubes of just healthy women. And so to be able to see that, wow, what we're finding, you know, in our tissue culture, is actually happening in patients, this is real and impactful and it's there in a fairly large abundance.

The Impact of Seed Funding

Lan Coffman 28:12

So I think that was the point, like, wow, this is important and this is something that we can leverage to come up with a biomarker for early detection. So that's been our biggest moment thus far. But I do say you know every step we take forward, whether it's negative or positive, is a step in the right direction. Medical advances don't happen without basic science. So that basic bacterial yeast work is important and I think sometimes we lose that understanding. But to be able to see that basic research start translating forward is really exciting. So I hope we'll get there soon.

Andrew Brozman 28:56

I think that Lan struck a very important note and she has explained how important the collaborative process is, and I really believe that this is the beating heart of this organization and it somewhat differentiates our process from those of other not-for-profits in this field.

Andrew Brozman 29:22

There's a very big difference that allows collaborative work to become innovative and extraordinarily exciting that a non-collaborative process does not encompass and you mentioned earlier the summit. I think the summit is one of the most remarkable sessions I have ever witnessed, bringing people from disciplines outside the ovarian cancer field whether it's engineers or those who specialize in other cancers and to watch, as a layperson, this kind of incredible fusion that takes place in a room and the excitement that that generates and the projects that we've been able to fund as a result of that excitement is just extraordinary, and I think that really is at the heart of what we do.

Beverly Wolfer 30:23

I couldn't agree with you, warwick. It's one of the most favorite times of the year for me and I always leave so inspired. I may only understand like three percent of what they're actually saying and I'm googling half the terms that they're talking about, but when you start to see the sparks and we've actually seen Lon's project being one and we have another one that actually came about because people were in the same room talking to each other and realizing that if they work together, they might actually be able to come up with a completely new solution to this incredible challenge.

Andrew Brozman 30:54

We had honored President Clinton and his work with the Global Women's Health Award, and one of the things he said in accepting the award really, really stuck with me, and he said that your foundation is going to succeed because you're doing it the right way, and what he was referring to is the collaborative way, and I think that it was great to hear that from President.

Beverly Wolfer 31:23

Clinton.

Andrew Brozman 31:25

And it also really was emblematic of who we are and how we go about our research.

Lan Coffman 31:32

I would emphasize collaborative and not competitive, and the nature of research funding is competitive and that's a good thing. But Tina's wish is really unique in that you bring the investigators together and say work together, and it truly is. Because it's such a small community, you build strong collaborative relationships that help one another and and and you know come together and get funding from. You know our more traditional government-based fundings and things, but it's a unique environment. I've honestly met some of my best collaborators, so my best friends and the research community here you were just talking about that funding comes from multiple places.

Beverly Wolfer 32:16

Can you talk a little bit and share with us why is the seed funding that Tina's Wish provides so important?

Lan Coffman 32:23

You know, I think A because it's a really hard question and because it's such a hard question, it's hard to break into the area. You need to be able to build models, you need to be able to have samples to do this testing on. And so the seed funding is critical to get that preliminary data, to get that kind of initial chunk of experimental data to say, wow, there's something here and I can build upon it, and then that'll allow you to then apply for bigger funding grants and things like that. And so you know, the initial Rising Star grants allowed us to get other NIH and DOD funding to continue that forward and actually in collaboration with other Tina's Wish investigators. And so without that seed funding to be able to do that really initial work, there's no way you can get other funding. You need to show when your idea is more than idea, there is actually some data behind it.

Andrew Brozman 33:27

No, I think it's also important, as Lan pointed out, because of the difficulty of getting funding in this area and these days generally, we, I think, make a point of trying to fund innovative research. In that sense we are willing to take recent risks that I think other foundations in this field do not take, and sure, some of them may not end up the way we'd want them to. And, as Lan pointed out, that too is educational and moves the process forward. But the idea that we could be a resource to incubate innovation is very exciting and it really is, I think, one of the most important aspects of how we comport ourselves in this business.

Beverly Wolfer 34:22

Right Now. I couldn't agree more. Lon, is there an example that you could share with us where the Tina's Wish funding helped you secure additional funding, and can you quantify that for us?

Lan Coffman 34:34

Sure, so so, yes, so the the Tina's Wish funding, starting from the Rising Star grant I've been very fortunate to have other team science grants through Tina's Wish really fund allowed us to get the data to say, you know, we should be looking at these stromal soil cells in the fallopian tube and how they are impacting the overlying epithelium and that process of malignant transformation. And so somewhere in between the Rising01 funding and the DoD CDMRP funding, and so that was, I think, in total maybe about $7 million in grant funding, again across a collaborative group of us, to be able to expand that research, which really culminated in our recent paper describing these soil changes and how they're influencing the epithelium. So that's kind of the ideal way things happen, right, you start off with something small that allows you to get that data, you apply bigger grants and you're able to fund, you know, these these large studies that that hopefully are impactful and allow us to translate things forward. Because you know, I think one thing that folks don't always recognize is how expensive research is, particularly some of the more cutting-edge things we do. So you know, one of the main challenges in ovary cancer research is the fallopian tube's tiny, as I mentioned. These little stick.

Lan Coffman 36:22

Lesions are tiny, and so you only get one or two shots at getting as much information from that lesion as possible. So we have to use pretty advanced techniques, largely things that are multispectral immunofluorescence, that you can look at seven to eight different markers at once, and then you can choose little areas and do digital spatial profiling, so kind of looking at the signals that the cells are sending, but all multiplexed, so all across one sample, and so each sample that we do is a couple thousand dollars, and then you have to add that on right, and so we had about 50 samples and so huge cost just for one modality. But that's really how we're going to make advances, and so being able to get that research funding that allows us to do that is important and also obviously allows us to have to hire folks in the lab. No one does this by themselves or we talk about collaboration, but we all build our own labs and hopefully we're training the next generation of researchers, and so folks in my lab get trained in things that are hopefully going to help build their careers, and they'll have interest in ovarian cancer early detection.

Lan Coffman 37:49

I actually have a trainee who has applied for a Rising Star grant, so we're coming full circle a trainee who's applied for a Rising Star grant, so we're coming full circle and she's actually really interested in endometriosis-associated ovary cancer and I don't think we talk about that much. So I've been talking about the fallopian tube, which generally is where most ovary cancer starts. So 70% of ovary cancer which is high-grade serous the other 30% actually is likely linked to endometriosis and they're called endometriosis-associated overgancers. But it's kind of a different disease and we have no way to detect that either, and so it's lovely to see her interest in that area because it's also critically important and so also looking, focusing on the soil, but the soil and endometriosis instead of the fallopian tube, and how that leads to malignant transformation. So all of that research funding helps us mentor the next generation in our labs, which will hopefully you know this will be exponential and we'll have more and more folks that are using their resources to attack this question.

Parting Messages and Call to Action

Beverly Wolfer 38:59

I think you've just shared so many powerful nuggets right there. I mean, one is just how expensive this is, and two, though, once you are able to get some demonstrable results, as you were, from the Tina's Risk Grants you were able to apply so any of those business people listening to us out there that return on investment was incredible. I don't know how many other people can make just a few hundred thousand dollar investment and get a seven and a half million dollar return. So congratulations. I know that's no small feat. But I think you also raised the important point about how important it is to be training the next generation of researchers, who are also bringing along with them the new technologies, the new approaches, and so we also, through our Rising Star Grant, feel grateful to be helping to support those individuals, and I think it's probably no surprise that it sounds like you're kind of carrying on that, tina Brosman, spirit of mentorship through your own lab, and so we're really grateful to you for that as well.

Lan Coffman 39:58

It is absolutely a privilege and, honestly, it would only be to my trainees' benefit to be able to be within the Tina's. Wish community because it really has been such a great kind of incubator for future success.

Beverly Wolfer 40:13

So, before we wrap up today, what is the one message you would like all of our listeners to take from today's conversation? Lana, I'll start with you.

Lan Coffman 40:23

I think investing in hard questions and challenging topics is important. If you don't try, you're never going to reach it, and all it takes is that initial step and then you start to build momentum and then you can actually make real progress. So I certainly run across folks in my career who are like, oh, that's never going to happen. Well, if you don't try, you're never going to get there. And I think you look at the amazing results that we've seen from you know other folks in Tina's wish and beyond and you get inspired and say yes, this is something we can actually do.

Lan Coffman 41:02

So you know, investing in difficult questions is important, because that's actually how we're going to answer them.

Beverly Wolfer 41:09

That's so important. Thank you.

Andrew Brozman 41:12

Andy, one of the things that was very important to Tina in coming up with the idea of this foundation was to ensure that other women wouldn't suffer the same fate that she did. And I think our listeners have to appreciate how important this project is. Although ovarian cancer is one of the cancers that are not broadly felt, in terms of the percentage of women who are stricken with it, it is the most deadly ovarian deadly of all of the gynecological cancers and I think that once one accepts the fact that, how important it is to save women and all of the people in contact with any given woman her family, her friends, her mentees.

Andrew Brozman 42:23

I think they'll come and understand why what we're doing is so urgent, and I think that the best way of proceeding to solving that problem is through that understanding and the generosity it inspires.

Beverly Wolfer 42:40

I just want to thank you both for being so open and honest and sharing your expertise with us in a way that those of us who don't have MD or PhD after our names could understand, and Andy also really just sharing with us about who this foundation was named for and really her inspiration, and I know that I'm inspired by her every single day. So I hope it gives you some degree of comfort, which I know it's still really challenging to both talk about her and remember her. But I also like to think that when someone continues to impact the world, even after they're gone, they're not really gone, they're still really with us, and so I'm really privileged and honored to be able to work with Tina's Wish and in support of the mission and really and truly hope to accomplish the mission one day. So thank you.

Andrew Brozman 43:25

Thank you, Beverly.

Lan Coffman 43:26

I would also say thank you for doing things like this. Education is hugely helpful, just raising awareness. Education is hugely helpful, just raising awareness. Ovarian cancer is something out there that we have no early detection for. That is a huge problem that creates so much suffering and death. It's important just to raise awareness, just to say the word. This is something that we need to be focused on. So thank you very much for doing this.

Introduction 43:59

For more information about gynecologic health, visit tinaswishorg slash. What to know, that's tinaswishorg slash. W h a t to k n o w and like, follow or subscribe wherever you listen to your favorite podcasts.