This special advertising supplement did not involve the reporting or editing staff of the Los Angeles Business Journal. By JENNIFER LANG, MD P EOPLE get cancer for lots of different rea- sons. Our current understanding is that cancer cells develop due to a complex interplay of genetics and environment. In some cases, we’ve identified specific gene mutations that lead to an enormous increase in a person’s risk of developing a certain type of cancer. Mutations in the BRCA 1 and 2 genes (otherwise known as the breast and ovarian cancer syn- drome) are the most famous examples of this. However, most cancers are not caused by a sin- gle gene mutation. They are the result of a life- time of exposure to different environmental conditions that determine how a series of genes will function or malfunction. That being said, what we put into our bodies on a daily basis has an enormous impact on modifying our risk of cancer. Scientists currently believe that between 30-40 percent of all cancers can be linked to obesity. That means that besides staying away from cigarette smoke and avoiding multiple blistering sunburns, prevent- ing obesity is the single most important thing you can do to reduce your risk of cancer. The reasons for this are many, and in a very abridged way I will describe some of them here. Now I want everyone to put down this article for a moment and google: “Body Mass Index cal- culator.” Enter your height and weight into the little boxes and you will come up with a number that puts you in one of the following categories: underweight, normal weight, overweight, and obese. This is a very rough estimation of where you fall now, and forms a good baseline for understanding where you should aim to be. Next visit, talk to your doctor about your “BMI,” and come up with some specific goals. Now pick up this article again and learn about why. Excess body fat increases our risk for cancer in at least the following ways: #1 Excess fat promotes chronic inflamma- tion. Visceral fat (the fat that surrounds your internal organs) produces high levels of IL-6, C- reactive Protein (CRP), and TNF-alpha, three pro-inflammatory substances that have been associated with increased cancer risk and shorter survival in many different cancer types. #2 Excess fat is hormonally active. Fat cells (adipocytes) secrete estrogens, high levels of which have been associated with breast and endometrial cancer in women. #3 Excess fat suppresses the immune sys- tem. Levels of Natural Killer cells (NK-cells) are lower and they exhibit decreased function at scavenging tumor cells in obese individuals. Furthermore, adipocytes produce the enzyme that turns inactive cortisone into active cortisol. Cortisol is an immune suppressant. #4 Excess fat tissue stores toxins. Persistent organic pollutants and heavy metals bioaccu- mulate in fat tissue. This is why the higher up the food chain you eat, the more bioaccumu- lated toxins you ingest in your food supply. These substances have been associated with cancer risk. #5 Excess fat decreases insulin sensitivity. Lower insulin sensitivity leads to higher levels of free circulating insulin and insulin-like growth fac- tor-1 (IGF-1). Higher circulating insulin and IGF-1 levels are associated with elevated cancer rates. October 28, 2013 • An Advertising Supplement to the Los Angeles Business Journal Breast Cancer Awareness Preventing Cancer Through Nutrition Continued on page 37
Transcript
This special advertising supplement did not involve the reporting or editing staff of the Los Angeles Business Journal.
By JENNIFER LANG, MD
PEOPLE get cancer for lots of different rea-sons. Our current understanding is thatcancer cells develop due to a complex
interplay of genetics and environment. In somecases, we’ve identified specific gene mutationsthat lead to an enormous increase in a person’srisk of developing a certain type of cancer.Mutations in the BRCA 1 and 2 genes (otherwiseknown as the breast and ovarian cancer syn-drome) are the most famous examples of this.However, most cancers are not caused by a sin-gle gene mutation. They are the result of a life-time of exposure to different environmentalconditions that determine how a series of geneswill function or malfunction.
That being said, what we put into our bodieson a daily basis has an enormous impact onmodifying our risk of cancer. Scientists currentlybelieve that between 30-40 percent of all cancerscan be linked to obesity. That means thatbesides staying away from cigarette smoke andavoiding multiple blistering sunburns, prevent-ing obesity is the single most important thingyou can do to reduce your risk of cancer. Thereasons for this are many, and in a very abridgedway I will describe some of them here.
Now I want everyone to put down this articlefor a moment and google: “Body Mass Index cal-culator.” Enter your height and weight into thelittle boxes and you will come up with a numberthat puts you in one of the following categories:underweight, normal weight, overweight, andobese. This is a very rough estimation of whereyou fall now, and forms a good baseline forunderstanding where you should aim to be.Next visit, talk to your doctor about your “BMI,”and come up with some specific goals. Now pickup this article again and learn about why.
Excess body fat increases our risk for cancer inat least the following ways:
#1 Excess fat promotes chronic inflamma-tion. Visceral fat (the fat that surrounds yourinternal organs) produces high levels of IL-6, C-reactive Protein (CRP), and TNF-alpha, three
pro-inflammatory substances that have beenassociated with increased cancer risk and shortersurvival in many different cancer types.
#2 Excess fat is hormonally active. Fat cells(adipocytes) secrete estrogens, high levels ofwhich have been associated with breast andendometrial cancer in women.
#3 Excess fat suppresses the immune sys-tem. Levels of Natural Killer cells (NK-cells) arelower and they exhibit decreased function atscavenging tumor cells in obese individuals.Furthermore, adipocytes produce the enzymethat turns inactive cortisone into active cortisol.Cortisol is an immune suppressant.
#4 Excess fat tissue stores toxins. Persistentorganic pollutants and heavy metals bioaccu-mulate in fat tissue. This is why the higher upthe food chain you eat, the more bioaccumu-lated toxins you ingest in your food supply.These substances have been associated withcancer risk.
#5 Excess fat decreases insulin sensitivity.Lower insulin sensitivity leads to higher levels offree circulating insulin and insulin-like growth fac-tor-1 (IGF-1). Higher circulating insulin and IGF-1levels are associated with elevated cancer rates.
October 28, 2013 • An Advertising Supplement to the Los Angeles Business Journal
30 AN ADVERTISING SUPPLEMENT TO THE LOS ANGELES BUSINESS JOURNAL OCTOBER 28, 2013
By DENNIS R. HOLMES, M.D., F.A.C.S.
NOT too long ago, the media wasabuzz with news of AngelinaJolie’s decision to undergo pre-
ventive double mastectomy. As writtenin her New York Times Op-Ed Column,Jolie’s decision to undergo this proce-dure results from her having been diag-nosed as a carrier of a breast cancergene mutation, called BRCA 1.
Jolie’s disclosure shed light on thedifficult decision that a significantnumber of women must face every day.BRCA mutations occur in about 1 outof every 500 women in the generalpopulation and about 1 out of every 20women diagnosed with breast cancer.Among the 290,000 women expectedto be diagnosed with breast cancer inthe U.S. in 2013, one can expect that14,500 will also learn that they, likeJolie, are BRCA mutation carriers.
The implications of a BRCA 1 orBRCA 2 diagnosis are quite profound.BRCA 1 mutation carriers have an 80%lifetime risk of breast cancer and a 40%lifetime risk of ovarian cancer. BRCA 2mutation-carriers have a slightly lowerlifetime risk of breast (60%) and ovari-an (25%), but an increased lifetime riskof melanoma, pancreatic cancer, malebreast cancer and prostate cancer. Bycomparison, the average lifetime risk ofcancer for non-BRCA carriers is “only”13% (about 1 in 8) for breast cancerand 1% for ovarian cancer. In addition,BRCA mutation carriers are more likelyto be diagnosed with breast cancer
before the age of 50 instead of after age50 for most non-mutation carriers.
Since Jolie’s announcement, manywomen have voiced a growing interestin preventive mastectomy. As breastsurgeon, I would like to offer a fewwords of caution. Ms. Jolie’s decision toundergo bilateral preventive mastec-tomies may not be the right decisionfor every woman. Jolie’s particulargenetic circumstances made a double
mastectomy a reasonable personal deci-sion due to her high future risk ofdeveloping breast cancer.
The good new is that 7 out of 8women in the general population willnever be diagnosed with breast cancer.In addition, the vast majority ofwomen diagnosed with breast cancercan be treated effectively with lessextensive surgery that preserves thenatural breast with minimal risk ofcancer recurrence in either breast.
What one can learn most fromJolie’s decision is that her diagnosis of aBRCA 1 mutation came before she wasever diagnosed with breast cancer.
Herein lies the greatest value of BRCAtesting. It empowers BRCA-mutationscarriers to take control of their ownhealth destiny by allowing them optfor preventive surgery or increased sur-veillance before ever facing a breastcancer diagnosis.
Another critically important mes-sage that comes from Jolie’s announce-ment is the importance of payingattention to one’s family cancer history
since it influences personal cancer risk.Jolie’s mother’s diagnosis of ovariancancer was a clear sign that BRCA genetesting needed to be considered.Similarly, if you have a family or per-sonal history of breast cancer diag-nosed before age 50, ovarian cancer, orbreast cancer in a male relative, youshould speak with your doctor aboutyour family history and seek BRCAtesting if you meet criteria.
All that is required is a simple bloodor mouthwash test. Most insurancecompanies will cover the cost of genet-ic testing in individuals who haveeither a personal history or family his-
tory of cancer and who meet certainguidelines. Both maternal and paternalfamily history is important since BRCAmutations can be inherited from eitheryour mother or your father.
For BRCA mutations carriers whoelect preventive double mastectomy,breast surgeons can offer a range ofbreast reconstruction options thatremove the insides of the breast whilepreserving the nipple and skin. Thispreserves and sometimes evenimproves the outward appearance ofthe breast thought the resulting breastusually lacks normal sensation.
Preventive double mastectomy pro-cedure can be performed through asmall 2-3 inch incision on the front ofthe breast or through a small incisionthat can be hidden behind the breast.These options are also available toselected non-BRCA mutation carrierswho desire double mastectomy fortreatment of cancer.
Publicly confronting a diagnosis of aBRCA mutation takes personal courageand the kind of steely determinationthat epitomizes Jolie’s many starringmovies roles. In her current real lifestarring role, Jolie is not only inspiring,she also provides a tremendous gift towomen and men who until now mayhave been unaware of this condition.
Dennis R. Holmes, M.D., F.A.C.S. is abreast surgeon who serves as MedicalDirector for the Los Angeles Center forWomen’s Health at California HospitalMedical Center.
The Angelina Jolie EffectBREAST CANCER AWARENESS
DEPENDING on where you live andwork, you’re likely to beexposed to many plastic prod-
ucts every day. Food and beverage con-tainers, some disposable plates, and toi-letry bottles are all plastic and all aremade from chemicals. Research sug-gests that all plastics may leach chemi-cals if they’re scratched or heated.Research also strongly suggests that atcertain exposure levels, some of thechemicals in these products, such asbisphenol A (BPA), may cause cancer inpeople.
BPA is a weak synthetic estrogenfound in many rigid plastic products,food and formula can linings, dentalsealants, and on the shiny side ofpaper cashier receipts (to stabilize theink). Its estrogen-like activity makesit a hormone disruptor, like manyother chemicals in plastics. Hormonedisruptors can affect how estrogenand other hormones act in the body,by blocking them or mimickingthem, which throws off the body’shormonal balance. Because estrogencan make hormone-receptor-positivebreast cancer develop and grow,many women choose to limit theirexposure to these chemicals that canact like estrogen.
BPA also seems to affect brain devel-
opment in the womb. In 2011, a studyfound that pregnant women with highlevels of BPA in their urine were morelikely to have daughters who showedsigns of hyperactivity, anxiety, anddepression. The symptoms were seen ingirls as young as 3. It’s not clear whyboys aren’t affected in the same way.
Steps you can take
While it’s likely impossible to com-pletely avoid all plastic products, try touse as little plastic as possible, especial-ly if you’re pregnant, and never use itaround food.
To reduce your exposure to BPA:• Carry your own glass, steel, orceramic water bottle filled with fil-tered tap water.• Reduce how much canned foodyou eat and how much canned for-mula your baby uses.• Use baby bottles with labels thatsay “BPA free.”• Avoid handling carbonless copycash register receipts. If you get a car-bonless receipt, don’t recycle it.Recycling receipts with BPA in themcan spread the BPA to other productsmade with recycled paper, includingnapkins and toilet paper.• Look closely at plastics with anumber 7 recycling symbol on the
bottom. If the plastic doesn’t also say“PLA” or have a leaf symbol on it, itmay contain BPA.
To reduce your exposure to otherchemicals in plastics:• Don’t cook food in plastic contain-ers or use roasting/steaming bags; theplastic residues may leach into foodwhen heated in a regular or microwaveoven.• Use glass, porcelain, enamel-cov-ered metal, or stainless steel pots,pans, and containers for food andbeverages whenever possible, especial-ly if the food or drink is hot.
• Plastics with recycling symbol 2, 4,and 5 are generally considered OK touse. Plastics with recycling symbol 7are OK to use as long as they also say“PLA” or have a leaf symbol on them.The recycling symbol number is thecode that shows what type of plasticwas used to make the product.• Recycling symbol 1 is also OK touse, but shouldn’t be used more thanonce (no refilling those store-boughtwater bottles!). Keep all plastic contain-ers out of the heat and sun.
Information provided by BreastCancer.org
Avoiding Exposure to Chemicals in PlasticMay Help Prevent Breast Cancer
Another critically important message that comes
from Jolie’s announcement is the importance of
paying attention to one’s family cancer history since
it influences personal cancer risk. Jolie’s mother’s
OCTOBER 28, 2013 AN ADVERTISING SUPPLEMENT TO THE LOS ANGELES BUSINESS JOURNAL 31
At Pomona Valley Hospital Medical Center, Every Woman Gets One.
Did you know that traditional 2-dimensional mammography misses up to 20% of breast cancers?
What’s more, approximately 10% of women must endure the stress of being recalled for additional mammograms,
even when no cancer is actually present. Pretty frightening statistics. That’s why we are excited to be the first Southern
California hospital to exclusively offer 3D breast imaging, the most accurate technology available.
Why 3D breast imaging outperforms traditional mammography3D breast imaging (aka Tomosynthesis) creates exceptionally sharp, 3-dimensional images of the breast.
The images are easier to read and far more accurate than a traditional mammogram.
So there are fewer missed cancers and “false positives.” Women with dense breast tissue or breast
implants also benefit from this advanced imaging. All of this means a lot less anxiety for you.
Be one of the first to take advantage of 3D breast imaging at PVHMCWe are committed to bringing our community the best possible breast cancer screening available
anywhere, we offer appointments at 3 convenient locations. For more information,
visit www.PVHMC.org/3DMammogram or call (909) 784-1559.
Most insurances accepted.
Every woman deserves state-of-the-art 3D mammograms
29 38_sfvbj_breast_cancer_awareness.qxp 10/24/2013 11:14 AM Page 31
32 AN ADVERTISING SUPPLEMENT TO THE LOS ANGELES BUSINESS JOURNAL OCTOBER 28, 2013
By JOANNE SCHOTTINGER, MD
IT’S October again and time to thinkpink. Why? Because it’s probable thatnearly half your workforce is female.
And, one out of eight women will getbreast cancer during her lifetime.
Finding breast cancer early, not onlysaves lives, but also minimizes theunpleasant interruption and anxiety thedisease can cause in an employee’s per-sonal life, as well as in your workplace.
Early detection begins with a mam-mogram. While many women may fearthe procedure, or a positive result, inreality, the vast majority of womendiagnosed with breast cancer are aliveand well today. There are more than2.8 million breast cancer survivors inthe United States, according to theAmerican Cancer Society.
As a business owner, you have a lotinvested in your employees. It takes along time to train them; you wantthem healthy and you want them tokeep working, so encouraging preven-tion is essential. In addition, findingbreast cancer at an early stage makes itmuch easier to treat and takes a lessertoll on employees, which means theyreturn to work quicker.
No matter what kind of businessyou’re in, you want your employeeshealthy and productive. You want theirfamilies to be well also. Even if youremployee is a male truck driver, youdon’t want his wife to develop
advanced breast cancer because mostlikely he’ll need time off from work tocope with her illness. Whereas if shegets a mammogram, finds it early, hasa small surgery, or doesn’t needchemotherapy, that’s great and time offwill be minimal!
Prevention or reducing the risk of breast
cancer
Leading a healthy lifestyle is essen-tial to reduce the risk of many cancers,including breast cancer. Smoking andobesity are the two greatest lifestyle
factors that contribute to cancer. • First and foremost, don’t smoke. Notsmoking is the most important thingone can do to prev ent any cancer. • Have an ideal body weight, whichmeans a body mass index (BMI) of 25or lower. • Exercise regularly. It can be as basic aswalking 30 minutes a day, five days aweek. • Get all screening tests when yourdoctor recommends them. • Eat a healthy diet, low in saturatedfat. Aim for five fruit or vegetable serv-
ings per day and limit your consump-tion of red meat.• Consume alcohol in moderation.• Know your family history. If you dohave a positive family history, considergetting counseling or getting tested forthe BRCA mutation (harmful mutationin the genes that produce hereditarybreast and ovarian cancer). • There are additional screening tests,such as an MRI, for women at high riskbecause of family history or geneticpredisposition. Women who are at veryhigh risk may also be treated with
Tamoxifen or Raloxifene. This information is applicable to
any business owner, because the oddsare we will all be touched by breastcancer – either individually, or possiblya wife, mother, sister, daughter, signifi-cant other, or your female employees.
Treatment after diagnosis of breast cancer
I’ve been practicing for almost 30years and treatment is much easiernow, but we’d still rather catch it inthe early stages. Women are livinglonger and doing better. It’s delightful
to see women that I diagnosed twodecades ago who are still doing great.
Lifestyle after breast cancer
Since the vast majority of womensurvive breast cancer, it’s importantthey continue to take good care ofthemselves, which means living ahealthy lifestyle and continuing withroutine screenings, including checkingfor high blood pressure, diabetes, andcolon cancer.
Wellness in the workplace
Encourage your employees to takecare of themselves. If they have benefits,such as sick leave, consider making iteasy for them to use half a day of sickleave to get all necessary preventivescreenings done. Equally important, asthe business owner, you’re vital to theoperation. Take time to care for yourself;get the preventive screenings you need.
Resources
Go to kp.org or cancer.org for breastcancer screening guidelines. Kp.org alsohas a variety of free health videos andpodcasts for website visitors.
Joanne Schottinger, MD, is AssistantMedical Director of Quality and ClinicalAnalysis at Kaiser Permanente SouthernCalifornia. She practices OncologicalMedicine at Kaiser Permanente PanoramaCity, and is board certified in Oncology andInternal Medicine.
Employee Wellness Begins with Health Screenings
An Exceptional HealthcareExperience You Deserve
I realized that I hadn’t had a mammogram in 10 years. It always seemed like there was never any time to get it done.
When I finally went and learned that I had breast cancer, I was dumbstruck. Luckily, I had a great team of doctors.
Dr. Brousseau was the breast imaging specialist who discovered I had cancer. He caught it very early. My surgeons Dr. Holmes and Dr. Keagle were so easy to speak with and made me feel very comfortable.
This outstanding team at California Hospital Medical Center is the reason I have a smile on my face in this picture.
When was your last mammogram?
Call the Los Angeles Center for Women’s Health atCalifornia Hospital Medical Center and schedule an appointment.
Make an appointment today.Call 213-742-6400
We accept most insurance plans.
David Brousseau, MD, Jennifer Keagle, MD
Dennis Holmes, MD and Eva, patient
BREAST CANCER AWARENESS
Finding breast cancer at an early stage makes it
much easier to treat and takes a lesser toll on
employees, which means they return to work quicker.
THERE is no disputing that we aremaking great strides in the fighttowards eliminating cancer, but
there is so much work still to be done.However, the undisputed fact remainsthat when it comes to a cancer diagno-sis, the earlier it is detected, the betterthe chances for remission. That’s whyit’s so vitally important to have all rec-ommended screenings. In keeping withBreast Cancer Awareness month, there isno better time to reiterate the fact thatscreening for various types of cancer isabsolutely imperative. From mammo-grams to yearly pap smears for women,to prostate screenings for men; earlydetection of cancerous cells is crucial.
Obviously, no one likes to thinkabout receiving a diagnosis of cancer.However, it is a possibility that we allneed to acknowledge. According to theAmerican Cancer Society, this yearalone about 580,350 Americans areexpected to die of cancer, whichamounts to nearly 1,600 people perday. About 1,660,290 new cancer casesare expected to be diagnosed in 2013.Of those nearly 235,000 will be diag-noses of breast cancer. Fortunately, thesurvival rates continue to improve dueto advances and breakthroughs in sci-ence, technology and medicine.
However, a cancer diagnosis willinvariably result in multiple doctor vis-its, treatments, and medications, eachwith corresponding costs. No matterthe type of insurance coverage youhave, the likelihood that your insur-ance will cover all of the costs associat-ed with your cancer treatment isextremely low. That’s precisely why
more and more employers are begin-ning to offer what are known as work-site voluntary benefits to employees.These low cost additional policies donot cost employers anything.Moreover, they often have incrediblylow monthly premiums, sometimes aslow as $30/month. These “cancer cov-erages” are designed to help offset thecosts directly and indirectly associatedwith cancer prevention screening, anda cancer diagnosis.
pap smears, colonoscopies, and bloodtesting for breast, ovarian, colon andprostate cancers. For example, you mayreceive a $150 benefit simply for hav-ing your yearly mammogram. A yearlyphysical may provide a benefit of $50.
They will also help offset the of theindirect costs of a cancer diagnosisincluding loss of wages from missedwork; travel expenses to and fromtreatment; lodging and meals if neces-sary; ambulance transport, childcareand deductibles from other policies, inthe event that you need to be confinedto a hospital for treatment. Benefitspaid directly to you may reimburse youfor hundreds of dollars per day, andthousands of dollars per treatment.
Voluntary cancer coverages also payfor various surgical procedures, somereconstructive surgeries, anesthesia, sec-ond opinions and more. Direct treat-ment benefits also include radiation,imaging, bone marrow, blood, plasma,transplants, medications, chemothera-py and more.
Worksite voluntary benefits aredesigned as a supplement to your exist-ing insurance. Offered through youremployer (who does not have to payfor them, but merely have a deter-mined number of employees who wantto enroll), these policies are designed asan incentive to keep you proactive
about maintaining good physicalhealth. They will also pay, regardless ofthe type of other insurance you have.As an added bonus, you can generallytake the policies with you if you hap-pen to change jobs, and they are typi-cally guaranteed to renew as long asthe premiums are paid on time.
This month, it’s worth looking intopreventative measures you can take tokeep yourself healthy, which mayinclude this optional, valuable coveragesupplement. Employers interested inoffering worksite voluntary benefits,including cancer coverages should con-tact a trusted insurance agent for infor-mation on signing up for these pro-grams. Employees considering purchas-ing a voluntary benefit should also talkwith an expert in these coverages todetermine which policy is best for you.
Steven Driss is President of LifelineEmployee Benefits in Tarzana, Ca. LifelineEmployee Benefits was established in1985 to help individuals and small busi-nesses identify and purchase affordablehealth insurance, life, disability and othergroup insurance. Steven also serves as aninsurance expert/guest lecturer at UCLAand CSUN. For additional informationvisit www.health-quotes.net, contactSteven directly at (818) 774-1003 or viaemail at [email protected]
Cancer Coverage: The ABC's of Worksite VoluntaryBenefits for Employers and Employees
OCTOBER 28, 2013 AN ADVERTISING SUPPLEMENT TO THE LOS ANGELES BUSINESS JOURNAL 33
“My name is Sherrie Padelford
and I am a Breast Cancer Survivor.”
Before my diagnosis in 2011 my daily life was jam-packed. Then, I noticed a lump that a mammogram and biopsy revealed was breast cancer.
At the Thomas and Dorothy Leavey Cancer Center, I was supported by a team of experts guiding and caring for me each step of the way as I underwent a lumpectomy, chemotherapy and radiation. Thoughcancer changed my life in many ways, my days are once again filled with activities I happily call ‘normal.’
The Leavey Cancer Center at Northridge Hospital offers the latest in Progressive Treatment Options, including:
Leavey Cancer Center
��State-of-the-Art Imaging: - Digital Mammography - PET/CT - 64-Slice CT - Triphasic CT scanning - Angiography��Prostate Seed Implant ��Clinical Research ��Computerized Tumor Localization ��Survivorship Program
IN 1913, cancer was a mystery andtalking about it was taboo. Silence,fear and business as usual allowed
cancer to thrive. A bold step was need-ed, and in that year a small group ofpeople made a promise to speak out,take action, save lives and change thecourse of cancer forever.
This year marks the 100th birthdayof the American Cancer Society and acentury of momentous progress thattoday sees 68 percent of people diag-nosed with cancer surviving at leastfive years. Because of this progressmore than 12 million cancer survivorsnationwide - 1.3 million of those herein California - will be able to sing“Happy Birthday” and celebrate anoth-er year with us.
The Society can list crucial achieve-ments in the fight against cancer dur-ing the last 100 years: providingunprecedented leadership in cancerresearch; offering free patient and care-giver services; advocating with local,state and federal government; and pro-viding education through evidence-based, unbiased cancer information tothe public.
Success through the Society’s missionpermeates the history books and has
paved the way for a future in which weare committed to saving more than1,000 lives a day from the disease.
One shining example lies in theSociety’s commitment to fund promis-ing cancer researchers young in their
careers. Dennis Slamon, MD, PhD, ofUCLA’s Jonsson Comprehensive CancerCenter was first funded by the Society
The Road to More Birthdays:One Hundred Years in the Making
Excellence in all we do
Since 1958, Valley Presbyterian Hospital has
served the community with leading-edge
medical technology, precise medical expertise
and heartfelt compassion.
Today, we are among the only locally based
hospitals and our 350-bed facility is one of the
largest full-service acute care centers in the
San Fernando Valley.
Our commitment to the dignity and well being
of our patients is our mission and the reason
Valley Presbyterian Hospital stands apart. We
take the extra step with each person we treat.
And it shows.
Excellence in all we do.
The Difference is Excellence.15107 Vanowen Street
Van Nuys, CA 91405
valleypres.org
818.782.6600
34 AN ADVERTISING SUPPLEMENT TO THE LOS ANGELES BUSINESS JOURNAL OCTOBER 28, 2013
in 1988 as he worked to identifyunique molecular changes in tumors.Slamon was looking to identify geneticalterations that could be targets fornew drugs. His research led to thedevelopment and 1998 FDA approvalof Herceptin. The drug targets breastcancer that has spread to other parts ofthe body, turning one of the deadliestforms of the disease into one of themost treatable.
The Society has also committedsubstantial resources to making sureindividuals receive help when theyneed it, at the time of diagnosis andcontinuing throughout their cancerjourney and beyond. Free servicesrange from providing rides to andfrom treatment, finding lodging forthose needing to travel significant dis-tances for care, offering support pro-grams and trained patient navigatorsat partner medical facilities who helppatients through every step of thehealth system.
In Los Angeles County theSociety’s Patient Navigator Programbecame the first of its kind in thestate when it was inaugurated at theHarbor-UCLA Medical Center in2009. A collaboration between theSociety, the medical center and sig-nificant funders AstraZeneca
Pharmaceuticals and the AnthemBlue Cross Foundation, the free, con-fidential program places an emphasison assisting the medically under-served and allows patients to focuson getting well. It showcases how thepower of partnership can truly
change the course of cancer for anindividual. Patient navigators createone-on-one relationships withpatients and caregivers, serving as apersonal guide as they face the psy-chosocial, emotional and financialchallenges that cancer can bring. Thesuccess of the program is now beingrepeated at LAC+USC Medical Centerand has served approximatly 600patients since it began in Fall 2012.The patient navigator, SylvanoGonzales, exemplifies the Society’smission in action. A survivor of
childhood cancer, Sylvano received acollege scholarship from the Societyand is now proud to work for theorganization and serve as a voice inhelping others with their fight.
As we celebrate our successes wealso recognize there is a long road
ahead and that the American CancerSociety needs everyone’s help to con-tinue the momentum built during thelast 100 years.
How can you help us finish thefight? Take Susan Nelson of CanogaPark as a model. Susan recentlyenrolled in the Society’s CancerPrevention Study III (CPS-3), a long-term study that will help determinethe genetic, environmental andlifestyle factors that either do or don’tcause cancer. She not only enrolledherself, but worked with her employ-
er, Panavision, to host a public enroll-ment site at which nearly 50 peoplejoined. Susan also became a legacy asher mother was a participant in theSociety’s first Cancer PreventionStudy (CPS-1) that determined thelink between smoking and risk oflung cancer.
Just like Dr. Slamon, SylvanoGonzales and Susan Nelson, each of ushas a unique way to speak out againstcancer. They weren’t silent. They tookaction and so can you. There are manydifferent ways to help. Enroll in ourCPS-3 research study; form a team towalk in our community Relay For Lifeor Making Strides Against BreastCancer events; help people with cancerby driving them to treatment appoint-ments; speak up and tell your lawmak-ers that the cancer fight must be a toppriority at home and around the world;or make a monetary donation to helpsave lives.
If we’ve learned one thing in the lastcentury it’s that silence won’t finishthe fight. Action will. Please join usand help create a world with less can-cer and more birthdays for everyone.
David F. Veneziano is Executive VicePresident of the American Cancer Society –California Division.
OCTOBER 28, 2013 AN ADVERTISING SUPPLEMENT TO THE LOS ANGELES BUSINESS JOURNAL 35
BREAST CANCER AWARENESS
If we’ve learned one thing in the last century it’s
THE American Society of ClinicalOncology (ASCO) and theCollege of American Pathologists
(CAP) this month issued a joint, updat-ed guideline aimed at improving theaccuracy and reporting of human epi-dermal growth factor receptor 2 (HER2)testing in patients with invasive breastcancer. The guideline update is basedon a systematic review of medicalresearch literature, providing oncolo-gists and pathologists with detailed rec-ommendations for how to test forHER2 overexpression, interpret theresults, and recommend HER2-targetedtherapies. The guideline, originallyissued in 2007, is being published inASCO’s Journal of Clinical Oncology(JCO) and the CAP’s Archives ofPathology & Laboratory Medicine. Thejoint guideline was prepared by anASCO/CAP Update Committee consist-ing of experts in breast cancer and can-cer biomarkers.
Approximately 15 percent of allnewly diagnosed breast cancers areHER2-positive, meaning that thetumors have extra copies of the HER2gene and/or high levels of the HER2protein, which controls breast cancercell growth and spread. HER2-positivetumors usually grow faster compared toHER2-negative tumors. The purpose ofHER2 testing is to identify patients whocould benefit from effective HER2-tar-geted therapies, such as trastuzumab(Herceptin), lapatinib (Tykerb), per-tuzumab (Perjeta), and T-DM1
(Kadcyla). These treatments can sub-stantially improve survival in patientswith HER2-positive invasive breast can-cer. It is therefore important to accu-rately determine the HER2 status to
ensure that patients most likely to ben-efit are offered a HER2-targeted treat-ment. At the same time, those that areunlikely to benefit can avoid side effectsand costs associated with those drugs.
“Our ability to identify cancer sub-types that will lead to more individual-ized therapeutic decisions and that areshown to improve clinical outcomes israpidly improving. Consequently, andmore than ever before, society mustdemand access to high-quality cancerbiomarker tests that can help cancerspecialists match the right treatmentswith the right patients. This guidelineupdate strengthens and clarifies recom-
mendations for HER2 testing based onnew evidence,” says Antonio C. Wolff,MD, FACP, FASCO, co-chair of theASCO/CAP HER2 Testing in BreastCancer Panel and professor of oncolo-
gy at the Johns Hopkins KimmelComprehensive Cancer Center.
The two FDA-approved methodscurrently used in the United States totest for HER2 are immunohistochem-istry (IHC) and in-situ hybridization(ISH). IHC testing assesses how muchHER2 protein is present on the surfaceof tumor cells, whereas ISH testingmeasures how many copies of theHER2 gene are present inside each can-cer cell. The original guideline focusedon IHC and fluorescence in-situhybridization (FISH), whereas theupdated guideline adds recommenda-tions for a newer diagnostic technique
known as bright-field ISH. This tech-nique also evaluates for amplificationof the HER2 gene, and uses a regularlight microscope rather than a fluores-cent microscope. Some sources of vari-ability may be reduced with this tech-nique as the invasive component canbe more easily identified using bright-field microscopy.
The guideline recommends the fol-lowing:
• Always test HER2 status on allnewly diagnosed invasive breast cancers(primary site and/or metastatic site).Ensure that at least one tumor sample istested for either HER2 protein expres-sion (immunohistochemistry [IHC]assay) or (in situ hybridization [ISHassay]) for HER2 gene amplification.
• Discuss the role of HER2-targetedtherapy if the HER2 test result is positiveand if there is no apparent histopatho-logic discordance with HER2 testing.
• Delay the decision to recommendHER2-targeted therapy if the HER2 testresult is equivocal. Mandatory retestingshould be done on the same specimenusing the alternative test if the initialHER2 test result is equivocal or on analternative specimen.
• Do not administer HER2-targetedtherapy if the HER2 test result is nega-tive. If there is apparent histopatholog-ic discordance with the HER2 testresult, additional HER2 testing shouldbe considered.
• Report a HER2 test result as indeter-minate if technical issues prevent one or
Updated Guidelines on HER2 Testing in Breast Cancer Released
36 AN ADVERTISING SUPPLEMENT TO THE LOS ANGELES BUSINESS JOURNAL OCTOBER 28, 2013
We can help !
BREAST CANCER AWARENESS
‘Our ability to identify cancer subtypes that will lead to
more individualized therapeutic decisions and that are
shown to improve clinical outcomes is rapidly
improving. Consequently, and more than ever before,
society must demand access to high-quality cancer
biomarker tests that can help cancer specialists
match the right treatments with the right patients.’
both tests (IHC and ISH) from beingdone in a tumor specimen, or preventthe test (or tests) from being reported aspositive, negative, or equivocal.
• Confirm that the testing laborato-ry conforms to standards set for accred-itation by CAP or an equivalent accred-itation authority.
In rare cases, it may be difficult toknow for sure if the result is positive ornegative. If additional testing on othertissue specimens is not possible,pathologists and oncologists shouldconsider all available clinical data onthe patient prior to recommendingHER2-targeted therapy.
According to M. Elizabeth H.Hammond, MD, FCAP, co-chair of theASCO/CAP HER2 Testing in BreastCancer Panel and professor of patholo-gy at the University of Utah School ofMedicine, “The number of patientswith equivocal HER2 test results usedto be rather large. But evidence sug-gests that the quality of HER2 testing isimproving and the frequency of equiv-ocal and inaccurate results is decreas-ing. We believe that this is at least inpart due to our earlier recommenda-tions in 2007. We hope the currentguideline will resolve remaining chal-lenges in the field, and ultimatelyresult in better outcomes for allpatients with breast cancer.”
The guideline panel also comment-ed on the large increase in the numberof pathology laboratories participating
in programs designed to evaluate thequality of testing of established breastcancer biomarkers, like estrogen recep-tor and HER2. The updated guidelinecontains more detailed recommenda-tions on key points doctors should dis-cuss with patients regarding HER2 sta-tus, such as the reasons for HER2 test-ing, types of tests used, interpretationof test results, and the potential needfor retesting in case of disease recur-rence. It also emphasizes the criticalneed for a close collaboration by allphysicians and health systems involvedin the care of breast cancer patientsand in the performance of tests thatcan be used to influence decisionsabout treatment.
In conjunction with publication ofthe guideline, ASCO and CAP havedeveloped clinical tools and resourcesfor oncologists and pathologists thatsummarize the findings and recom-mendations. The resources include sup-plemental information on clinicalquestions, as well as IHC and ISH testresult interpretation criteria and report-ing elements. ASCO and CAP have alsodeveloped a companion patient guide,available on ASCO’s cancer informa-tion website, www.cancer.net, and oncap.org, respectively.
More information on the newguideline and clinical tools andresources can be found at:www.asco.org/guidelines/her2 or atcap.org.
OCTOBER 28, 2013 AN ADVERTISING SUPPLEMENT TO THE LOS ANGELES BUSINESS JOURNAL 37
Enroll in Cancer Prevention Study-3.You can change the course of cancer by enrolling in theAmerican Cancer Society Cancer Prevention Study-3 (CPS-3).Your participation could help transform the disease fromtreatable to preventable.
The American Cancer Society has played a part in nearly every cancerresearch breakthrough in recent history, and you can be a partof the next big breakthrough by enrolling in this landmark study.
To make an appointment and enroll in this historic studyvisit cps3la.org or call 888.604.5888 for November datesand locations.
Together,
BREAST CANCER AWARENESS
#6 Excess fat makes it less likelyyou will be engaging in regular stren-uous exercise. Obesity-related arthritis,heart disease, fatigue and over-heatingcan all contribute to obese people notgetting the recommended amount ofstrenuous daily exercise. Women whoexercise regularly have a 30-40 percentlower risk of developing breast cancerthan sedentary women.
Now that we’ve covered some ofthe ways that excess body fat canencourage the growth of cancer in thebody, let’s briefly end with my pre-scription for how to start eating yourdaily cancer prevention diet. It’s verysimple: eat Real Foods. Before you putsomething in your mouth, ask your-self- is this a Real Food or is this achemistry experiment by the foodindustry? Clues may be found on thelabel. The best is no label at all, or asimple little sticker that says “USDAOrganic.” The longer the list of ingre-dients and the more ingredients youhave difficulty pronouncing the worseoff you are.
If you are eating a Real Food diet,you are almost by definition eatingan organic, minimally or completelyunprocessed, low glycemic-index,alkaline and immune-boosting diet.The one caveat is with meat anddairy consumption. I urge you to
consider containing this to a mini-mum in your diet. There are so manyhealthy plant proteins and fats thathave proven cancer-preventing prop-erties. Generally data on meat con-sumption shows that the higher it is,the higher the risk of cancers of theGI tract. If you choose to consumemeat and dairy, make sure you arenot also consuming all of the toxins,antibiotics and hormones that weregiven to that animal by choosingUSDA Organic products.
Finally, a plea for the earth. Ourhealth is not separate from the healthof our planet. By choosing to consumefoods that do not poison the earth intheir production, packaging or distribu-tion we are choosing the health of ourpopulation for generations to come.
We may not be able to control ourgenetics, but we do have quite a bit ofcontrol over the environmental expo-sures that influence the expression ofthose genetics. Eating a plant-based,Real Food diet is a wonderful way totake your health into hand, and somefabulous fresh food into mouth.
Jennifer Lang, MD is with theGynecological Surgery department ofBeverly Hills Health Center in BeverlyHills. She specializes in minimally inva-sive gynecologic and oncologic surgery.
WHEN you’re fighting cancer,every day counts. Whetheryou’ve just been diagnosed or
are looking for a second opinion, thechoice of who helps you in your fightcan be the most important of all. AtDignity Health Northridge HospitalMedical Center, our cancer experts arehere to help treat, support and guideyou through this journey.
The Thomas & Dorothy LeaveyCancer Center has had the privilege oftreating many cancer survivors by pos-sessing a “Together WE CAN Fight &Survive Cancer” attitude. With decades
of cancer experi-ence, we’ve lis-tened to ourpatients andknow what theyneed and expect
from one of the San Fernando Valley’sleading Cancer Centers— advancedcancer technology, “Best in America”ranked Oncology Specialists and com-prehensive care all in one location.
Team Approach
A comprehensive care team ofMedical and Radiation Oncologists,Surgeons, Pathologists, Radiologists,Dietitians, Social Services and otherexperts formulate the most appropri-ate, individualized treatment careplan for each patient and innovativeprograms help alleviate symptomsrelated to treatment. Specially-trained
Oncology Nurses provide the balancebetween expert treatment and per-sonalized care. We partner eachpatient with their own NurseNavigator to answer questions and tohelp guide them through their treat-ment process.
We treat all cancers, complex andadvanced including:• Brain & Spine Cancer• Breast Cancer• Colorectal Cancer• Gynecological Cancer• Liver & Pancreatic Cancer• Lung Cancer• Lymphoma & Leukemia• Prostate Cancer• Skin Cancer
The Most Progressive Treatment Options
Every patient is unique, every fami-ly’s history is diverse and every canceris different. Our specialized cancerteam addresses this with a multi-prongapproach using the most advancedtreatment options:• Da Vinci Si Robotic Surgical System • Trilogy Linear Accelerator Stereotactic
System• BrainLAB Image-guided Navigation
System • Gamma Knife Radiosurgery • Molecular Diagnostics/Personalized
The Harold & Carole PumpDepartment of Radiation Oncologyprovides paperless electronic patienthealth records and an impressive selec-tion of advanced treatment options.• MammoSite• IMRT (Intensity-Modulated Radiation
Therapy)• Trilogy IGRT (Image Guided
Radiation Therapy)• High Dose Rate Brachytherapy• Prostate Seed Implant• Trilogy Stereotactic Body Radiation
Therapy• 3D Computer Treatment Planning• Computerized Tumor Localization
Breast Cancer Awareness Month
If found early, breast cancer is treatableto a five-year “all clear” status 99 percent
of the time. By being aware of your breasthealth, you become your own bestweapon. And, if needed, the LeaveyCancer Center is here to treat, supportand guide you with a WE CAN attitude.
Learn more about breast health atwww.NorthridgeHospital.org, including:• Your cancer risk revealed• How to do a breast self-exam• Top 9 excuses for not getting a mam-
mogram• Super foods already in your kitchen• Breast cancer myths and misconcep-
tions• Why choose digital mammography?
Information for this article was providedby the Leavey Cancer Center inNorthridge. For more information, visitwww.NorthridgeHospital.org.
38 AN ADVERTISING SUPPLEMENT TO THE LOS ANGELES BUSINESS JOURNAL OCTOBER 28, 2013
For advertising information,please call 323.549.5225
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adjacent to your industry list in the2014 Book of Lists to be published on
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LAW FIRMS Ranked by number of attorneys in L.A. County offices
150 THE LISTS 2013 • LOS ANGELES BUSINESS JOURNAL
LOS ANGELES
BUSINESS JOURNAL THE LIST
For the first time in 20
years, L.A. has a new
largest law firm: Gibson
Dunn & Crutcher LLP.
Gibson Dunn had held
the top spot back in the
late 1980s, the heyday
of the “L.A. Law” TV
phenomenon. Then
O’Melveny & Myers LLP
surpassed Gibson Dunn
in 1991 and maintained
the top ranking for the
next 20 years. But this
year, O’Melveny reported
a drop of 36 attorneys
to 259 at its two L.A.
offices as the firm has
been transitioning to a
more national focus. That
allowed Gibson Dunn,
which only dropped
six attorneys, to slip
back into the No. 1 slot,
with 262 attorneys at
its downtown L.A. and
Century City offices.
1
PROFITS: At O’Melveny,
profits per partner
increased by $195,000
to $1.72 million for the
fiscal year ended Jan.
31. The firm saw total
revenue fall slightly from
$782 million in 2010 to
$779 million last year.
2
Atlanta | Brussels | Charlotte | Dallas | Los Angeles | New York | Research Triangle | Silicon Valley | Ventura County | Washington, D.C. www.alston.com
Human Rights Campaign
“Who Represents America’s
Biggest Companies”
Corporate Counsel#2 |
The Best Lawyers in America147 |
Chambers USA:
America’s Leading Lawyers for Business 89 | Top 25 IP Firm
