JALBCA presented its 25th Annual Ellen P. Hermanson Memorial Symposium on March 15, 2022 on the topic “What’s All the Buzz about Alcohol and Breast Cancer?” The program was available both by Zoom and in person. As in past years, The Ellen Hermanson Foundation sponsored this legendary program. Both SHARE and the Women’s Bar Association of the State of New York served as supporting organizations. The New York City Bar Association hosted the event.
Dr. Norton’s Medical Update
The Symposium kicked off with an update on developments relating to breast cancer, presented by internationally renowned medical researcher and longtime friend of JALBCA, Dr. Larry Norton. Dr. Norton is presently Senior Vice President; Medical Director, Evelyn H. Lauder Breast Center and Norna S. Sarofim Chair of Clinical Oncology at Memorial Sloan Kettering Cancer Center (MSKCC). Dr. Norton referred to an enormous amount of medical development since the prior JALBCA symposium and, in the limited time available, he tried to focus just on high points.
For starters, he confirmed that there is no longer any debate that mammography saves lives. MSKCC recommends annual mammograms starting at age 40, although it does not detect cancer in everyone and so additional options of MRIs and contrast-enhanced mammography (where blood vessels show up better, and which are appropriate for women particularly with very dense breasts) are available. He next discussed tests to locate abnormal DNA, which is a controversial topic because of the accuracy of the test and, also, what to do once abnormal DNA molecules are found and one does not know their sources. He described this as an area in evolution.
Dr. Norton then described some major advances in the therapeutic area (which supplement adjuvant therapies and drugs to control cancer metastasis). Some of these include a massive expansion of the types of treatment drugs, with a focus on personalized medicine which allows individualization of care (e.g., he mentioned two tests that look at the amount of RNA — which is signaled by DNA — for specific genes in breast cancer that are estrogen-receptive positive when found in the breast and these help estimate a patient’s prognosis and indicate whether chemotherapy (which are cancer-killing drugs) would, or would not, improve prognosis). It turns out that many patients would not be helped with chemotherapy. Further, there are other drugs that can improve the effect of other therapies — for example, they can stop mechanisms by which cancer cells may become resistant to hormone therapy, or they attack a molecule that is another mechanism of resistance.
Moreover, researchers have learned new ways to deliver drugs that can kill cancer cells. Dr. Norton referred to these “antibody drug conjugates” (ADCs), which are basically antibodies which can be made outside the body but will attach to cells inside the body. ADCs can be made to attach onto the cancer cell and carry a “warhead”. The advantages of ADCs are they enable one to avoid a lot of toxicity to the body but also deliver a higher dose of the drug. There are ADCs for HER2 and for triple negative breast cancer (TNBC). TNBC cells also have targets on the cancer cell surface, just like other kinds of cancer cells. These are called Trop2 targets. Trop2 is overexpressed in 80% of TNBCs, with TNBCs being the most aggressive subtype of breast cancer. (See, Soyoung Son, Anti-Trop2 antibody-conjugated bioreducible nanoparticles for targeted triple negative breast cancer therapy, IJBIOMAC, Volume 110, 15 April 2018, Pages 406-415)
Dr. Norton added that researchers have found anti-HER2 drugs that get absorbed by the brain better than prior drugs. Also, there are now drugs that enable the immune system to attack the cancer cell directly. This has been a long time coming but, especially with TNBC, researchers have found that immune therapy can dramatically increase the ability of doctors to control the growth of the cancer.
Lastly, Dr. Norton introduced a class of drugs called PARP inhibitors. PARP inhibitors are a type of targeted therapy that inhibits the enzyme poly ADP ribose polymerase (PARP), which enzyme helps cells repair themselves if they become damaged. PARP inhibitors stop the PARP from repairing cancer cells and these drugs make those cells less able to survive. PARP inhibitors have multiple indications, including the treatment of heritable cancers. Dr. Norton discussed them in the context of cancer patients with BRCA mutations. Supplementing this explosion of therapies in recent years, Dr. Norton noted trials other than the traditional, gold-standard for clinical research, i.e., the randomized clinical trial. Specifically, he mentioned (1) human trials, (2) de-escalation trials and (3) real world evidence — evidence obtained from real world data which are observational data obtained outside the context of randomized controlled trials. In the area which is the topic for the 2022 Symposium — the link between alcohol consumption and breast cancer — real world evidence seems particularly relevant given that there are not, and will not be, randomized clinical trials to generate data. Telemedicine is also in use in connection with trials, although Dr. Norton noted some legal obstacles associated with states which do not permit this.
Symposium’s Legal Portion
Following Dr. Norton’s presentation, medical and legal experts testified at a mock public hearing in the city of “Gotham” concerning a proposed new rule that would require alcohol purveyors (liquor, grocery and drug stores) to post signage at the point of purchase where alcohol is sold warning of the reported connection between alcohol consumption and breast cancer. (Currently, existing alcohol bottle labels contain requisite disclosures of two risks: don’t drink while driving or pregnant.)
The program participants were experts in their respective areas. The testifying medical witnesses at the mock hearing were Shoshana Rosenberg, ScD, MPH, Assistant Professor of Population Health Sciences, Division of Epidemiology, Weill Cornell Medical College; and Priscilla Martinez, MPhil, PhD, Principal Investigator, “Drink Less for Your Breasts” and Scientist, Alcohol Research Group/Public Health Institute. The “testifying legal witnesses” were: Jacqueline Flug, Esq., JALBCA Co-President and General Counsel, Drizly; Henry M. Greenberg, Esq., Partner, Greenberg Traurig LLP; Burton N. Lipshie, Esq., Special Counsel, Stroock & Stroock & Lavan LLP; and Paul F. Millus, Esq., Member, Meyer, Suozzi, English & Klein, PC. The “Board of Health members” were: Hon. Linda M. Capitti, JALBCA Vice President, NYC Family Court, Kings County; Hon. Marguerite A. Grays, JALBCA Co-President, NYS Supreme Court, Administrative Judge, Civil Term, Eleventh Judicial District, Presiding Justice, Commercial Division, Queens County; Hon. Judy H. Kim, JALBCA Secretary, NYS Supreme Court, New York County; Hon. Robert R. Reed, NYS Supreme Court, Commercial Division, New York County; and the Board “Clerk”, Rian A. Silverman, Esq., Court Attorney to the Hon. Karen B. Wolff, Richmond County Family Court.
The context for JALBCA’s choice of Symposium topic, investigating the link between alcohol and breast cancer, was a World Health Organization (WHO) statement in March 2021 in which it elaborated on cancer and efforts to prevent and control it. The WHO wrote that “alcohol use” is a risk factor for cancer, regarding which it commented that: “Between 30 and 50% of cancers can currently be prevented by avoiding risk factors and implementing existing evidence-based prevention strategies.” It then stated that cancer risk can be reduced by taking some of these actions:
- not using tobacco;
- maintaining a healthy body weight;
- eating a healthy diet, including fruit and vegetables;
- doing physical activity on a regular basis; and
- avoiding harmful use of alcohol. (Emphasis added.)
The WHO does not define “harmful” or quantify what level of alcohol consumption should be considered harmful.
During the “Board of Health Hearing”, the legal presenters discussed whether:
- the Board exceeded its authority as an executive branch entity;
- the Alcohol Signage Rule is “arbitrary and capricious”;
- the Alcohol Signage Rule infringes on the affected stores’ First Amendment rights;
- the Alcohol Signage Rule is preempted by state and federal statutes; and
- the rights of opponents to challenge the Alcohol Signage Rule if passed and the process by which to do so.
As for the underlying science, Dr. Shoshanna Rosenberg explained the medical relationship between alcohol and breast cancer. She noted that both the amount and type of alcohol may affect breast cancer and she referenced the fact that a typical alcoholic beverage serving, in medical literature, for females, is as follows: light or moderate (3-7 drinks/week) and heavy (greater than seven drinks/week). Further, she estimated that approximately 16% of breast cancer diagnosed in women is related to alcohol intake and described that alcohol consumption is a probable cause of pre-menopausal breast cancer and a convincing cause of post-menopausal breast cancer (4% increased risk for light drinking; 23% increased risk associated with moderate drinking; 61% increased risk associated with heavy drinking). The American Cancer Society guidelines as of 2020 recommend no more than one drink per day for women and two drinks per day for men.
Dr. Priscilla Martinez, participating virtually, spoke about the “Drink Less For Your Breast Campaign”, a social media campaign that has become a national project. She emphasized that most women in the U.S. do not know about the link between alcohol intake and breast cancer — only about 25% of women in a 15-44 age sample could identify alcohol as a risk factor. The link is not intuitive, she said. Mechanisms for the link include: (1) there is a higher level of estrogen than in women who do not drink alcohol, and increased estrogen levels can cause breast cells to grow and multiply, which raises the risk of developing breast cancer; (2) alcohol makes it harder for your body to absorb folate, which is vital to how DNA is made and maintained, so drinking damages a cell’s DNA (which controls a cell’s normal growth and function), making it more likely that a cell will become cancerous; and (3) alcohol is metabolized into acetaldehyde, a known carcinogen that damages DNA and keeps the body from repairing the damage.
Dr. Martinez indicated that the link is not better known for several reasons: the theory (now debunked) that moderate drinking is good for you and people enjoy doing what they think is good for them; people do not like to hear bad news about things that make them feel good; pink campaigns muddle the message; and failure of public health to do a better job of educating the public. In response to questions about any relevance of racial or ethnic differences in alcohol consumption, Dr. Martinez advised that we know less about this but, generally, young white women drink more than Latino women who, in turn, tend to drink more than black women (though we know that black women are more likely to be diagnosed with certain kinds of breast cancer). There are currently no standard guidelines as to what oncologists are to advise their patients about drinking alcohol when they are undergoing treatment for breast cancer. This is because, she explained, pre-clinical and clinical information is lacking (e.g., does it affect treatment outcomes?). She added that alcohol is not just related to breast cancer (in women) — it is related to five other cancers as well (i.e., esophageal, colorectal, voice box (larynx), liver and mouth and throat). This information can also be found at a CDC link: https://www.cdc.gov/cancer/alcohol/index.htm.
A video of the Symposium is available for viewing at:
Special thanks to the Symposium Planning Committee for developing and executing the program:
Hon. Linda Capitti, Judge, NYC Family Court, Kings County; JALBCA Vice President
Amy D. Carlin, Esq., Partner, Larocca Hornik Rosen & Greenberg LLP
Hon. Judy H. Kim, Justice, Supreme Court, New York County, Civil Term; JALBCA Secretary
Desiree LaSalle, Esq., Assistant General Counsel, Ferrero USA, Inc.; Member of JALBCA Board of Directors
Jason LaSalle, Systems and Training Specialist at Alston & Bird LLP
Sandra Lespinasse, Esq., Principal Law Clerk, Appellate Division, First Department; JALBCA Vice President
Rian Silverman, Esq., Court Attorney, Richmond County Family Court; Member, JALBCA Board of Directors
Virginia K. Trunkes, Esq., Partner, Gordon & Rees Scully Mansukhani, LLP; JALBCA Vice President
JALBCA enjoyed an in-person annual celebration at The Ziegfield Ballroom on May 9, 2022, after two years of having scheduled virtual annual events, and attendees were grateful and pleased to be able to mingle.
During the past year, JALBCA lost two treasured members, Roy Reardon, Esq. and Hon. Eileen Bransten (retired), both of whom had served as longtime-Board members and, in addition, as Co-Presidents. They were fondly memorialized during the event by Hon. Shirley Werner Kornreich (retired, NYS Supreme Court) and Hon. Saliann Scarpulla (Appellate Division, First Department), respectively. A very special tribute and thank you was also made by Hon. Michael Katz for outgoing JALBCA Executive Director, Claire Gutekunst. In that capacity, Ms. Gutekunst led JALBCA and managed day-to-day operations for the last five years. Special recognition was also made for outgoing Co-President Jacqueline Flug, whose role will be assumed by incoming Co-President Virginia Trunkes.
The balance of the evening was devoted to our award recipients and, thereafter, time for the Lawyers’ Division of JALBCA to accept donations to support the cost of the mammography vans sponsored by JALBCA (note: JALBCA subsidizes the cost of the vans but all health-related services are provided by independent licensed professionals) and JALBCA’s grants to entities which have programs to provide legal services for women and families who face breast cancer. This year’s award recipients included the following: the Leadership Achievement Award to the U.S. District Court judges for the Southern District of New York (the award was accepted by Chief Judge, Hon. Laura Taylor Swain and presented by New York State Chief Judge Janet DiFiore); the Maite Aquino Memorial Grant Award to Tony West, Chief Legal Officer of Uber and the Uber Legal and Compliance Team (the award was accepted by Mr. West and presented by Lucy Fato, Executive Vice President and General Counsel of AIG); and JALBCA’s founders and current and past Co-Presidents were honored for their many years of service to JALBCA (honors were accepted by Hon. Helen Freedman (retired) and presented by Chief Judge Janet DiFiore). Attendees were delighted to be joined by Destini Hines, who received services from one of JALBCA’s grant recipients, The Family Center in New York City, and shared her experience.
JALBCA thanks all of its sponsors and contributors. The evening was a great success and a good time was had by all.
Webinar – July 27 – “Tissue Is the Issue”
On July 27, 2022, four co-sponsoring organizations will present the webinar, “TISSUE IS THE ISSUE: Using the Immune System to Fight Triple Negative Breast Cancer and How You Can Help by Donating Tumor Tissue and Blood.” JALBCA will join three other co-sponsors — SHARE, TOUCH Black Breast Cancer Alliance and Young Survival Coalition — for this novel program.
Presenters will include Drs. Silvia Formenti and Karen Cichowski and Chris Farley. Dr. Formenti and Dr. Cichowski are members of the TRANSFORMATIVE BREAST CANCER CONSORTIUM funded by the Department of Defense Breast Cancer Research Program. The Consortium will investigate the use of immunotherapy in treating breast cancer. Dr. Formenti is enrolling people with triple negative breast cancer in the DIGNITY Study which will be using 3D organoids to monitor changes that take place if a tumor progresses. Patients will only be asked to donate tumor tissue when they need a biopsy for their treatment. They are required to undergo their biopsy or surgery at Weill Cornell Hospital or its affiliates. Dr. Formenti will also be monitoring a patient’s blood to see changes that take place in immune cells.
Dr. Cichowksi will be using the organoids to test different drugs focusing on a new class of epigenetic drugs called EZH2 inhibitors that may enhance the immune response to triple negative breast cancer. For more information on the DIGNITY Study contact: firstname.lastname@example.org.
Chris Farley will join the doctors to speak about the importance of African American participation in research studies and clinical trials.
Registration for this program begins June 21, 2022 at the SHARE website or at websites of the other sponsoring groups.
The Ellen Hermanson Foundation will sponsor the 27th Annual Ellen’s Run on Sunday, August 21, 2022, rain or shine. It is scheduled to take place from 9 am to 12 pm at the Southampton Intermediate School, 70 Leland Lane, Southampton, NY, 11968. Whether you run, walk, or cheer on participants virtually, your registration supports critically needed access to breast health care. To register or for further information, visit https://www.ellenhermanson.org/events. JALBCA is proud to remember Ellen Hermanson as its first Executive Director and the Ellen Hermanson Foundation remains the longstanding sponsor for JALBCA’s annual symposium.