Sisterhood of Breast Cancer Warriors by Monica Calabrese


Sisterhood of Breast Cancer Warriors by Monica Calabrese

I am happy to be part of this privileged community, the sisterhood of Breast Cancer Warriors!

Ever since my diagnosis in October 2017, and getting over the terrifying shock and realization that I too was facing this disease, I have encountered nothing but wonderful people in my path.

From the medical team at NYU Langone, to the women that openly and graciously shared their experiences in undergoing breast cancer with me, to my New York family and friends, to the staff at the infusión center at NYU Pearlmutter Cancer Center, as well as with the strangers I interacted with almost every day, I found nothing but love, support, and compassion at every turn.

The hardest thing I had to go through with my breast cancer was to make my plan and arrive at a decision about how to proceed and where to do it. It was hard because I had little information and speaking to other women that had gone through this experience helped enormously, but I did make a plan and then I was set. Once all of my decisions were made, I knew in my heart that everything was going to be okay.

I am a runner and very active. Aside from the post surgical obligatory recovery time of four weeks, I kept active. The year that I had chemo I did the NYC Marathon, my eighth marathon, and not only completed it but ran strong! It was quite a celebration. And a sense of accomplishment to cross the finish line like never before!

I have had enough complications after the full reconstructive surgery, more than I care to remember but at the end of the day, I was determined to see it through and open my heart in ways I never imagined! This in itself was healing!

Now I have a group of women that are starting their journey and I stay in touch with them for whatever they need! Compassion and support! Cancer forever changed me. And so I am energized to participate in this year’s Cheryl Diamond NYC 5k Schlep run/walk for breast, ovarian and prostate cancer on June 2, 2019 in Battery Park, New York. Mobilize. Please join us—the Sisterhood of Breast Cancer Warriors. 

To register for the NYC 5K Schlep, please visit


Cancer Pushes New York’s ‘First Girlfriend,’ Sandra Lee, Onto Political Stage

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VAN NUYS, Calif. — She strolled slowly through the neighborhood, a down-to-earth sprawl of sun-blasted ranch houses, and Sandra Lee was in her element.

In contrast to her high-gloss public persona, Ms. Lee wore a simple, loose-fitting dress, no makeup, the only thing adorning her face a pair of oversized sunglasses. Still, she could not contain her inner rah-rah: Whenever a jogger passed, she stopped to cheer them on.

And then she resumed the conversation, back to the art of the undersell.

“I have magazines and cookbooks, come on,” she said, pooh-poohing the idea of her as any kind of political figure, ceremonial or otherwise. “It’s not who I am,” she said. “I don’t do that.”

There might have been a time when that was indisputably true, certainly in the 1990s, when Sandra Lee started her first successful business enterprise from this Los Angeles suburb, in a rear bedroom of her relatives’ house.

But that was before she became a television cooking celebrity, before her relationship with Gov. Andrew M. Cuomo, and well before her extended and well-documented bouts with breast cancer.

And it was absolutely before her cellphone rang that day.

It was Gov. Jay Inslee of Washington, a Democrat like Mr. Cuomo. And just like that, Ms. Lee — the reluctant and unofficial first lady of New York — started to pitch Mr. Inslee on replicating a New York law concerning cancer coverage, urging him to provide money in his state’s budget for screenings and asking if she can send him bill language to examine.

All the while, Ms. Lee, who had just laughed off the idea of herself as a political player, is nodding and smiling at Mr. Inslee’s seemingly encouraging response. She thanked the governor for his time, and then signed off.

“Please tell the first lady,” Ms. Lee said, “that the first girlfriend said hello.”

It would be difficult to describe a woman who has spent much of her adult life in front of television cameras as reclusive; Ms. Lee is arguably more famous as a Food Network star than Mr. Cuomo is as a governor. But during the governor’s nearly eight years in office, Ms. Lee has largely avoided the political spotlight, appearing only sporadically at events like Easter egg hunts and gay pride parades.

She does not campaign with Mr. Cuomo, and while she stood beaming on the dais in Midtown Manhattan on election night, as he was easily elected to a third term, she was not in photos of the campaign and governmental team taken at a private celebration later.

In recent months, however, Ms. Lee has begun to flex her ample charm and determination in what she calls “my campaign,” a nationwide effort to fight breast cancer. Ms. Lee, 52, is a survivor of that disease, having been diagnosed in March 2015; she underwent a double mastectomy two months later.

That procedure is a central part of an HBO documentary, “Rx: Early Detection, A Cancer Journey with Sandra Lee,” that her company, Sandra Lee Incorporated, produced and debuted in October.

As part of the campaign to promote the film and her cause, Ms. Lee offered The New York Times a rare glimpse of her life and partnership with Mr. Cuomo, as she highlighted her efforts to get other states to replicate a so-called “No Excuses” bill that Mr. Cuomo signed in 2016, expanding breast cancer screening and eliminating insurance co-pays for screening mammograms.

Ms. Lee has been carefully assembling a to-do list — color-coded, naturally — and calling top officials in several Democrat-led states. And while her method of lobbying is often as casual as her “semi-homemade” cuisine, which famously combines prepackaged ingredients with a smattering of fresh ones, her intentions are far more deliberate.

“I think that the older that you get and the more thoughtful that you get and the more educated that you get about the well-being of the next generation to come, you have to be focused,” Ms. Lee said. “If you’re not spending your days making the planet a better place, what are you doing?”

In conversation, she is unfiltered, self-effacing and frequently extemporaneous. At one point during an interview, she handed a reporter a handwritten copy of her favorite smoothie recipe. “You should have that every morning,” she said.

In speaking about politics, she immediately mentioned her distaste for it, particularly the bare-knuckled variety practiced in New York, where Mr. Cuomo and Mayor Bill de Blasio have often skirmished.

“I don’t like the nonsense of the fighting,” Ms. Lee said. “I think it’s unnecessary. I think everybody deserves a seat at the table, and everybody gets a say.”

“I hate conflict,” she added, at another moment. “Conflict and I am not …” Then she stops, and suddenly pivots. “I like Bill de Blasio. I like him. We have a rapport,” she said.

“I’ll stand there and I like him. I do,” she concluded. “I don’t like conflict. With anybody.”

That bonhomie could be catching: Mr. de Blasio’s Office of Media and Entertainment honored Ms. Lee at the Gotham Awards on Monday for her 40-minute film, which is arresting in its portrait of her medical battle, with graphic depictions of the surgery and her recovery, including nudity and necrotizing skin.

And that was the point, she said.

“I want this to be a tool for people that have to do it to understand what it means to do it,” Ms. Lee said. “And I want people who have done it to understand what they went through.”

The film also makes clear how serious Ms. Lee’s health problems were. The cancer was initially found in three spots in her right breast, and surgeons found even more cancerous tissue. She herself has said she did not realize how bloody and invasive the surgery was until she saw the raw footage.

“I went into the editing bay and it was the surgery and I just started crying,” she recalled. “I walked in and immediately lost it.”

The battle with the disease was just the latest chapter in a personal biography with enough turns and tribulation for a telenovela.

The eldest of five children, Ms. Lee grew up in chaotic fashion in California, Washington and Wisconsin (three states, not surprisingly, where she plans to lobby elected officials about copying Mr. Cuomo’s cancer bill). When Ms. Lee was 2, her mother, then 18, dropped her and her younger sister at their grandmother’s house in Santa Monica.

“She left that day promising to return shortly,” Ms. Lee wrote in her 2007 memoir, “Made from Scratch.” “We didn’t see her again for several years.”

When her mother returned, the family moved to Washington and became Jehovah’s Witnesses. Her mother was abusive, depressive and suicidal, and her stepfather beat her with a belt and molested her. She started working at 13 and left home at 15, headed for Wisconsin to live with her birth father.

But after her father was sent to jail for two years on a charge of second-degree sexual assault during a domestic violence incident involving an argument with his girlfriend — Ms. Lee had to testify against him — Ms. Lee’s aunt and uncle offered her a place to live in California.

She accepted, and soon after she started her first business — a line of window dressing accouterment — out of their house. (She still stays there when she visits, usually about once a month, to care for her aunt and uncle, now in their 80s and in faltering health.)

That business, Kurtain Kraft, blended ordinary objects and a do-it-yourself craftiness that landed Ms. Lee and her products on QVC. It was also a gateway to her Food Network career.

Ms. Lee met Mr. Cuomo at a party in 2005, the same year that her four-year marriage to Bruce Karatz, the former chief executive of KB Home, ended in divorce.

Margaret Cuomo, the governor’s sister, called Ms. Lee “my de facto sister,” and said that her influence on Mr. Cuomo is invaluable. “It’s a high-stress job and not everyone will have his best interest in mind,” she said. “She does. And that’s a precious gift.”

Ms. Lee is protective of her relationship with Mr. Cuomo, and of his three daughters from a previous marriage to Kerry Kennedy — Cara, Michaela and Mariah — to whom she has been a surrogate mother for more than a decade.

On a tour of the house they share in New Castle, N.Y., much of it is deemed off-the-record, if not off-limits. What she did share showed a family home festooned with all manner of personal memento and political keepsakes: a dining room lined with reproductions of letters from the Founding Fathers and an antique ballot box; a den with a wall-size, wooden replica of the Constitution; hallways and stairwells densely populated with casual photos of family and friends, including former President Barack Obama.

The kitchen contains a space-capsule-size cage for Ms. Lee’s two cockatoos — Phoenix and Halo — adjacent to an almost all-white sitting room, with views of the patio fireplace on one side and on the other, a duck pond, surrounded by small signs noting the New York State Police patrols to warn off trespassers.

Ms. Lee’s two Emmy Awards sit on a piano that belonged to her grandmother. Bathroom hand towels are adorned with gold Cs and Ls, in cursive. They are disposable.

Ms. Lee mostly sidestepped questions about Mr. Cuomo, but allowed that she was affected by what she said were unfair portrayals of his character.

“I am the one who watches him work every single hour of every single day and not sleep,” Ms. Lee said, sitting outside their home surrounded by pumpkins and other autumnal decorations.

Emotion stopped her for a moment, and then she continued.

“It’s hard to watch this be hard on someone you love. And know that they do everything right, every day, for everyone,” she said, adding, “It’s not O.K.”

She continued: “I think if people saw the day to day, they would only say, ‘Thank you.’ That’s the truth.”

Ms. Lee even briefly became an issue on the campaign trail, when Mr. Cuomo’s Republican opponent, Marcus J. Molinaro, suggested that her financial information should be made public. (Because they are not married, Mr. Cuomo does not have to disclose any information about Ms. Lee’s business dealings.) Ms. Lee did not feel that was warranted, and said she appreciated Mr. Molinaro’s wife telling him to not attack her.

In another aside, during the pre-election stroll in Van Nuys, she also dismissed talk that Mr. Cuomo would run for president. “He’s told me he doesn’t have any interest right now,” she said.

Again and again, Ms. Lee said she understands how politics works — “I know how to maneuver it. I have friends that are in it, obviously my partner is part of it,” she said — but she wants to stay out of the fray.

“If you’re going to get mad, get mad because someone has cancer,” she said. Or because children are hungry, or “elderly people are being abused.”

And then, she said, turn that anger into action.

In the meantime, other projects await: a how-to show with her sister, Kimber; a series of children’s books featuring a character called Aunt Sandy Claus; another series based on her 2013 novel “The Recipe Box.”

She also said she wants to do a documentary about dying, tentatively called “Silent Lucidity,” a title borrowed from the heavy metal band Queensrÿche, one of several hard-rock groups she likes. (Def Leppard, Rush and Led Zeppelin also make the cut.)

Ms. Lee is healthy; she announced in 2016 that she is cancer free. Still, there’s something in her that suggests that she now sees the world in the same winner-take-all prism that Mr. Cuomo often does.

“Were you part of the solution or were you part of the problem?” she said, calling her life and body “just a vessel” for good works. “And I think you have to choose every single day which part of that you’re going to be on.”




The Future Of Heart Surgery, In The Palm Of His Hand


Aortic stenosis, wherein the valves of the heart don’t fully open, has long been a bane of the cardiology community, which has historically resorted to risky open-heart valve-replacement surgery or simply deemed aortic stenosis patients inoperable.

But in recent years, transcatheter aortic valve replacement – which, in a nutshell, inserts a stent into a narrowed or collapsed valve – has gained momentum as a minimally invasive next-generation solution.

Unlike surgical aortic valve replacement, which involves opening the patient’s chest to replace the aortic valve, a TAVR can performed through very small incisions, using a catheter to insert the new valve.

While TAVR procedures are already changing some treatment protocols, they’re hardly flawless. Post-operative complications such as calcification, valve migration, abnormal heart rhythms and paravalvular leaks have been known to increase stroke risks – and are limiting both the deployment of TAVR devices and their anticipated expansion to younger patients.

To that end, the National Institutes of Health’s National Institute of Biomedical Imaging and Bioengineering has awarded a $3.8 million grant to Danny Bluestein, a biomedical engineering professor at SBU’s College of Engineering and Applied Sciences, who is working with colleagues around the world to develop new materials and devices designed to optimize TAVR procedures and reduce those post-op complications.

The five-year grant – bestowed upon Bluestein and collaborators at the University of Arizona’s Sarver Heart Center, Tel Aviv University and Israel’s Rabin Medical Center – is based on Bluestein’s proposal to the NIBIB, titled, “Biomechanical Approaches and Technologies for Enhancing TAVR Outcomes.”

His primary target: calcific aortic valve disease, a major health issue that, left untreated, commonly leads to severe aortic stenosis and, ultimately, heart failure.

Calling it a “translational project,” Bluestein referenced international research that will combine imaging, computational and experimental techniques in an effort to “guide pre-planning and tailor TAVR procedures for achieving significantly better patient outcomes and reduce their ensuing complications.”

Team Bluestein – which also includes his SBU-based Biofluids Research Group – is also looking to break entirely new ground with a “disruptive technology,” according to the biomedical engineer, who said an ancillary objective of the years-long study will be the creation of “next-generation polymeric valves specifically optimized for TAVR.”


A BRCA Story

I tested positive for the cancer-causing BRCA mutation. Now what?
By Laura Osman, Published by JTA

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Curiosity about my ancestry spurred me to order an at-home genetic testing kit by mail earlier this year. Maybe my blonde hair was a result of some hidden Swedish genes?

When the kit arrived, I quickly spit in the tube and sent it off, not giving any thought to the genetic and ancestry testing boxes I checked off. Although I just went through a rigorous prenatal genetic testing process while pregnant with my third child less than two years earlier, I figured the small price difference to do more genetic testing could be worthwhile.

Several weeks later, an ordinary morning sipping coffee would become extraordinary. Quickly scrolling my phone, I clicked on my available testing report from the testing kit. First came my ancestry: 99.9 percent Ashkenazi Jewish. As I kept scrolling, my heart stopped as I saw BRCA1 POSITIVE. CONSULT WITH DOCTOR.

This is a mistake, I thought. No one in my family, men or women, have had breast or ovarian cancer. Shaken, yet hopeful of a lab error, I called my ob/gyn and explained the situation. That afternoon I was sitting in her office awaiting a medical grade test, the gold standard in BRCA testing.

Seven days later I received the call confirming my nightmare: I indeed was BRCA1 positive.

My initial shock and anger were replaced with a paralyzing fear that I already had developed cancer. Women carrying the BRCA mutation begin advanced screenings starting at age 25, and here I was at 37 never having had a mammogram or ovarian cancer screening. With the BRCA1 mutation, I faced an up to 88 percent lifetime risk of developing breast cancer and a 45 percent lifetime risk of ovarian cancer. My body, which I pushed to the limit as a track and cross country All-American in college, was a ticking time bomb.

Immediately I knew that feeling sorry for myself was not a productive option. When my breast and ovarian cancer screening (CA125 and a pelvic ultrasound) came back clear, I breathed a momentary sigh of relief, realizing how lucky I was to catch this. Then I moved quickly to a plan of action.

Five weeks after receiving the initial email from my at-home genetic testing company, I underwent my first surgery: a laparoscopic tube and ovary removal with my incredibly knowledgeable doctor at a major Los Angeles hospital. Eleven days later, my doctor laughed when I showed up to my post-op checkup anxiously awaiting to be cleared for exercise in my running shorts. Although I was hobbling and out of breath on that first run back, I was also smiling knowing I had significantly reduced my risk of ovarian cancer.

Next I had to tackle the surgery that scared me the most. A double mastectomy is not only physically difficult but emotionally loaded. Instead of ignoring my fears, I began open conversations about my emotions, the pain and recovery, and how it could potentially change my relationship with running. I reached out to Sharsheret, the national Jewish not-for-profit organization that supports women and families facing or at high risk for breast and ovarian cancer. Sharsheret’s Peer Support Network is a confidential program that connects women one on one with others who share similar diagnoses, treatments, family constellations and experiences.

Beyond the peers, Sharsheret has a team of skilled and sensitive social workers and a genetic counselor who speak to thousands of women like me, helping us to cope, and stay strong and resilient while making very tough decisions about our bodies, our health and our future.

Without regret, I chose to preventatively remove both healthy breasts. On July 26, I underwent a nipple-sparing bilateral mastectomy with immediate direct-to-implant reconstruction. Although the initial recovery was filled with some dark moments, each week I gained strength and was surrounded by an army of support, which undoubtedly helped me heal both physically and mentally. Now, 12 weeks past my surgery date, I am back to my eight-mile runs and chasing around three small kids. As I set out running, I am so grateful to be strong, healthy and pain-free. Each step is a reminder of how lucky I am to have caught my BRCA mutation before it was too late.

When I look at my body today, it is not a terrible reminder of my genetic mutation, but rather a beautiful result of finding a team of supportive surgeons who believe you do not have to sacrifice aesthetics to prevent cancer.

The final piece to my puzzle was finding the origins of my BRCA1 mutation. As it turns out, my father carries the BRCA gene. Although male carriers are at increased risk for prostate cancer, the mutation often goes undetected in men, as it did in my father, who had prostate cancer. A common misconception is that women cannot inherit BRCA from their fathers. Because no women in my family had breast or ovarian cancer, the possibility that I carried BRCA flew under the radar.

All Ashkenazi Jewish women and men carry a one-in-40 risk of carrying a BRCA mutation as compared to one-in-500 chance in the general population. October may be Breast Cancer Awareness Month, but all year round, Jewish women and men everywhere need to ask more questions about their family genetic history on both their paternal and maternal sides. It is time for us to begin conversations with our doctors even when they may not initiate them with us. We need to be educated, and to raise awareness about how BRCA and other genetic mutations such as CHEK2 and PALB2 can be passed down from both parents. Stopping cancer before it stops us is now often in our hands. While prophylactic surgery might not be the right choice for every woman, knowing our risk and understanding our options will empower us to take control of our bodies and our lives, and will enable us to make informed and potentially life-saving decisions.

In the U.S., the average woman has a 12 percent chance of developing breast cancer and a 1 to 2 percent chance of developing ovarian cancer. But certain genetic mutations such as BRCA1 and BRCA2 can increase those lifetime risks to up to 88 percent and 45 percent respectively, according to studies published in the Journal of the American Medical Association. These mutations are found in Ashkenazi Jews 10 times more frequently than in the general population. At least 50 percent of hereditary breast cancer is related to genes we don’t know how to look for yet.

At-home genetic testing companies may offer tests for three such mutations most commonly found in those of Ashkenazi descent, making it much easier for them to get tested. It’s important to note that anyone who takes an at-home genetic test should first and foremost get tested by a medical provider and also consult a genetic counselor to discuss their results and help them navigate next steps.

Now that my cancer journey is behind me, I want to pay it forward and help. That’s why I am sharing my story so publicly — so that other men and women understand how learning their own cancer genetic profile can save their lives, and to give a “face” to those who inherit the BRCA mutation from their fathers.


Rabin Medical Center Updates


2018 has been a busy year at Rabin Medical Center in Israel.

Dr. Bror Dicker, head of the Obesity Clinic at Hasharon Hospital at Rabin Medical Center is studying the relationship between gut hormones and weight loss.

Professor Eran Sharon at Rabin Medical Center is developing a stress-reducing drug that limits metastasis of cancer cells.

A research team headed by Aaron Popovtzer at the Institute of Oncology at the Davidoff Cancer Center, has discovered that gold may be helped to fight mouth, nose and throat cancers.

Roy Mano, MD, recently conducted a survey that connected the BRCA mutation in men 40 years and older to high risk of PCa and other forms of cancers.

Dr. Dania Hirsch is studying differentiated thyroid cancer with distant metastases.

Dr. Zohar Levi is currently researching the link between adult colorectal cancer and weight as a teen.

Professor Yichayaou Beloosesky and Professor Abraham Weiss of Rabin’s Geriatric Department are running clinical trials on polypharmacy in nursing homes.

Dr. Aviram Mizrachi discovered this year that nanoparticles help drugs target head and neck cancers.

Dr. Amit Akirov in the Institute of Endocrin-ology conducted research showing that hypoglycemia doubles mortality rates.


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Dr. Amnon Raviv, a medical clown, uses humor for patients with serious illnesses and states, “is a survival order – a weapon to fight disease.” For the past 15 years, Raviv has worked as a medical clown at The Rabin Medical Center-Beilinson Campus.

Known for earning the first doctorate in the world for medical clowning, Raviv was in South Africa during August sharing his expertise and assisting the newly established NGO Dr. Heartbeat with medical-clown training.

“Many studies indicate that medical clowning reduces anxiety and pain in patients – children and adults – and thus allows for better coping with the disease and its consequences. We know that laughter causes the secretion of hormones called endorphins that strengthen the immune system. The special empathetic connection that the medical clown creates with the patients reinforces and strengthens them,” Raviv explained.

Adi Shachar, founder of Dr. Heartbeat, intends to pioneer the professional skill of medical clowning in South Africa. “The professional skill will be targeted at unemployed youth and aligned with the credentials of the Youth Empowerment Service [YES] Campaign,” recently launched by South African President Cyril Ramaphosa.

South Africa “faces a lot of challenges, with an enormous amount of trauma, stress and anxiety in many places…The medical clown has the ability to put smiles on the faces of very sick people and help their families make sense of the trauma they are experiencing,” and this should be encouraged.

On his visit to South Africa, Raviv told the Post that medical clowning should be present in every department and in every hospital around the world.

“I feel privileged to present medical clowning to the academic and medical establishment in South Africa and lay the foundation for cooperation. [I feel privileged] to train new medical clowns to work throughout the country and bring joy and humor to thousands of patients, children and adults across the country – and perhaps bring the message of medical clowning to the entire African continent,” he said.


Hormone-fueled breast cancer cells halted with new approach

Researchers have found a way to deplete breast cancer cells of energy and thus halt their growth. The findings may one day help to alleviate treatment-resistant breast cancer.

According to the American Cancer Society (ACS), 2 in 3 cancers are hormone-driven, meaning breast cancer cells possess proteins that act as hormone receptors and feed off of estrogen and progesterone.

These hormones help the breast cancer to spread, so hormone therapy aims to prevent cancer from spreading or recurring by blocking the hormone receptors.

New research — carried out by scientists from the Karolinska Institutet and Science for Life Laboratory in Solna, Sweden — offers new hope, as the team discovered a way to starve hormone-fueled breast cancer cells of energy. This may lead to better drugs in the future.

The researchers found a protein that helps breast cancer cells to get the energy they need to proliferate. They also found a compound that inhibits this protein. They discovered that NUDT5 is used by breast cancer cells to create energy in their nucleus. The nuclear energy thus created is used to drive cancer-causing gene expression.

This compound is called TH5427, and laboratory experiments revealed that it successfully acts as an NUDT5 inhibitor, stopping the spread of breast cancer cells.

The authors summarize their findings, saying, “Utilizing these state-of-the-art techniques led us to discover TH5427, a potent and cell-active NUDT5 inhibitor that can be used to further understand the role of NUDT5 in biological systems.”

Ultimately, Prof. Helleday and his colleagues hope to be moving toward human clinical trials.

The researchers hope that their findings will help to treat not only breast cancer, but hopefully other forms of cancer, as well.

The 2018 Cheryl Diamond NYC 5K Schlep: Breast and Ovarian Cancer Run / Walk will take place on Sunday, June 3, 2018 in Battery Park, NYC, starting at 9:00 am.

Each year, American Friends of Rabin Medical Center holds theCheryl Diamond NYC 5K Schlep: Breast and Ovarian Cancer Run / Walk, a certified 5K that brings together hundreds of participants from the New York tri-state area, and across the USA and overseas, ranging in age from 6 – 90 years old, bound together in solidarity to raise the hopes of those battling breast and ovarian cancer as well as awareness and funds to help further research and treatment.

The NYC 5K Schlep Run / Walk benefits a BRCA Multidisciplinary Clinic to serve women at high risk of breast and ovarian cancer and funds research to find cures for breast and ovarian cancers. The NYC 5K SCHLEP Run / Walk also supports studies in connection to BRCA mutation carriers.




Source: Article from Medical News Today.