Despite the many advances in human health, research focused on women’s health has a more complex history. The Morgridge Institute and the general public gathered on March 17 for a hybrid webinar in the Fearless Science Speaker Series — a fitting event for Women’s History Month — to hear from experts on this topic, specifically focused on discovery, prevention, and access to care.
The panel included Melissa Skala, Morgridge investigator in biomedical imaging; Megan Spurgeon, Morgridge investigator in virology; and Noelle LoConte, oncologist and UW–Madison associate professor of medicine. Morgridge Board of Trustees Chair Jacquelyn Frederick provided introductory and closing remarks.
The following is an abridged transcript highlighting questions and key takeaways from the discussion, with light editing to reformat and rearrange similar topics for readability. A recording of the webinar can be viewed in full above.
Opening remarks
Jackie Frederick: I would like to welcome all of you present here in the room and attending online to our talk on shaping the future of women’s health insights and innovations. Our topics tonight are wide ranging and promise to be engaging and informative. Now it is my pleasure to introduce our scientists, Noelle LoConte, Megan Spurgeon and Melissa Skala.
How does your work help shape the future of women’s health?
Melissa Skala Melissa Skala: I’m both a scientist and an engineer. We get to straddle many different disciplines. My lab develops microscopy techniques, things with optics that help us image living systems that can be used across many different disciplines, including biology and medicine. Specifically, we’ve done a little bit of work on preterm birth, where we measured changes in fetal membranes. We’re trying to understand the mechanical properties of what leads to preterm births.
Noelle LoConte: I am a medical oncologist, which is to say I am a chemotherapy doctor. I started my career as a clinical trialist and then made an intentional pivot toward public health research. I’m now the leader of community outreach for the Carbone Cancer Center.
Megan Spurgeon: My lab studies oncogenic viruses, which is a fancy term for viruses that cause cancer. Specifically, I study two types of oncogenic viruses. One is called Merkel cell polyomavirus. That’s the newest human tumor virus that was discovered, and it causes a rare type of skin cancer. I also study papillomaviruses, which many of you are probably familiar with as the etiological agent of cervical cancer.
What are the latest advances in HPV and cervical cancer research?
Spurgeon: Almost all cervical cancer cases are caused by human papillomaviruses. However, there are other types of cancers, such as vulvar cancer, vaginal cancer, anal cancer, oral cancer, as well as cancers of the head and neck that are caused by these viruses.
The good news is that there is a highly effective prophylactic vaccine that can prevent infection with these viruses. The bad news is that access to this vaccine, especially in developing parts of the world is critically low, and therefore a lot of people are not having the ability to prevent cancers caused by this virus. The other bad news is that there is no cure or treatment for these cancers and for this virus infection.
My lab uses and develops preclinical models to study not only the virus, but also the host factors and environmental factors that synergize to cause cancer. My lab has developed several groundbreaking models to study not only papillomavirus sexual transmission in mice, but we can now also study persistent infections, as well as the transmission dynamics associated with sexual transmission in both males and females. We’re also using these models to study the interplay between papillomaviruses and the microbiome.
It’s important for us to identify things that we can do to intervene. But to do that, we have to know who’s at risk first. Melissa Skala
Are there any advances in screening methods for gynecological cancers?
LoConte: There are pockets not only that are not getting the vaccine, but pockets of populations that are not getting screened. The classic screening test for cervical cancer is the Pap smear, where we take some of the cells from the cervix and look at them under a microscope. It requires a pelvic exam, which for some people is difficult or impossible.
So, a big advance has been the emergence of self-collection for high-risk HPV. It’s a swab that women can perform in their own home or private area and then send in and we look for some of these high risk HPV types. It is in front of the FDA, and I believe now it has been approved in other countries. We’re hopeful that it will have approval soon and that that may be a real radical game changer for also very rural women that might have difficulty accessing care providers.
What are the major barriers to breast cancer prevention?
LoConte: One is that we’ve known for quite some time that there is a drug, which the phase one trial was done at the University of Wisconsin, called tamoxifen. It cuts your risk of many types of breast cancer in half for your whole life, if you take it for five years. We even know you can take a half dose that’s called “baby tam” and you get the same efficacy reduction in risk — yet almost no women take it. You qualify based on something called your Gail Score, which incorporates your family history, your age, where you got your first period, when you had your first baby, etc. If we could just ramp up baby tam use, we could cut breast cancer down considerably.
The other is alcohol. Alcohol causes seven types of cancer. One is breast cancer. It increases your blood rate of estrogen, and so it’s really associated with estrogen receptor-positive breast cancer. Women should drink one serving a day or less. Most people are not even aware of that — even if you stayed within those guidelines, that does slightly increase your risk. We’ve been trying to increase awareness of alcohol as a carcinogen.
What about health disparities — how can white women have a higher incident rate of breast cancer, but black women have a higher mortality rate?
LoConte: Yes, a lot of cancer health disparities is about access to care — because of bad policies and historic racism, disenfranchisement, people do not have the same access to quality care. A lot of this is breaking down those barriers, which I anticipate is going to get very hard in the next four years.
Race is a social construct. There’s no biologic reason why there should be a difference. Tamoxifen reduces both incidence and mortality. I don’t want to oversell baby tam, but I think if people are wondering, “what can I do?” that there are very few medical interventions where you do five years of treatment, and you see a lifelong benefit. So, I do think it is something that we could consider. And then getting screened every year starting at 40, there’s a movement to start people at 35, making sure you get the highest quality mammogram you can.
What about high levels of estrogen as a risk factor for cancer development? Are individuals that are taking hormonal birth control at risk for that?
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Megan Spurgeon Spurgeon: There is some epidemiological evidence in women that several factors that contribute to higher estrogen levels are associated with persistent HPV infections as well as cervical cancer development. There is some controversy in the field because depending on how you design your study and your cohort and your data, you can get different results.
Certainly in our preclinical models, we consistently see this association between increased estrogen levels and cervical cancer development. And in our mouse models, you can treat animals with drugs similar to tamoxifen and not only prevent cancer but also treat those cancers. So that might be a promising potential therapeutic approach in the future.
How many of these research models are being designed to incorporate trans people and how much is that currently involved in clinical space?
Spurgeon: I can start with basic research, and I would it’s woefully underrepresented. You hit the nail on the head. I’ve often thought about incorporating particularly trans women that are on estrogen therapy into some of my research to see if higher estrogen levels do correlate with HPV related cancers. And I think it’s a great question and I think we need to do better.
LoConte: We rely on things like the LGBTQ network, for example, to give us guidance. But it’s very much like flying by the seat of your pants. We’re trying to make sure that people that are trans are correctly identified in the medical records so that we can do those large studies. But we’re very much in the baby stages right now.
What tools are being used to study preterm birth?
Skala: Usually people are using ultrasound, but the problem is the resolution of ultrasound is poor. The actual membranes that break when your water breaks are very thin. We didn’t really understand the structural properties of those membranes. And that’s what our study was aiming to do. The next question is, can we build something that can be used in the clinic to screen people at high risk?
We’re still in the discovery phase, where we’re trying to understand multiple components of a very complex system. And the hope is, once we understand those components, we could start to build models to predict who might be at risk. Even if you’ve delivered preterm before, or if you haven’t delivered preterm before, that’s still a poor predictor of how your next pregnancy will go. And the mortality and morbidity can be high. So, it’s important for us to identify things that we can do to intervene. But to do that, we have to know who’s at risk first.
Why is multidisciplinary research important?
Spurgeon: I think multidisciplinary research is absolutely vital to progress in biomedical research and advances in human health. It’s really impossible for each one of us to be an expert in all of the facets of our research program. Being able to find that expertise, whether it’s here at Morgridge or UW or even across the country or the world, is really important. And I think we are particularly lucky here that there is such a concentration of expertise across several different scientific disciplines. It just helps speed up the pipeline from the bench to the bedside. It’s certainly enhanced and benefited my research. I think this idea that I think since even I’ve been in science, this idea of all of us being in our own silos has really gone by the wayside.
LoConte: Science is iterative. And having a big diverse team just helps you be better at iteration.
I think multidisciplinary research is absolutely vital to progress in biomedical research and advances in human health. It just helps speed up the pipeline from the bench to the bedside. Megan Spurgeon
What are the key steps to connecting basic research, translational research, and clinical care?
Skala: Basic research is where you go out and find a flatworm and start asking how does that flatworm regenerate itself when it gets cut? You have no idea if that’s going to lead to anything relative to human health — it usually does though. But you’re just trying to understand basic parts of nature.
Translational research is where you’re more directed at trying to understand human health. You think of mouse models, or human cells or tumor samples in a lab, and you’re trying to ask what specific molecules might be changing with cancer development or with response to a viral infection. You try to model it in a mouse and then understand how that might relate to a human.
Clinical care is where you might start thinking about clinical trials where things are proven to work, or maybe proven to work semi-well, and you test them out in patients and then they become FDA approved. That’s when physicians routinely will prescribe these things.
If I’m thinking about how I can translate a discovery to the clinic, I have to talk to someone like Noelle because she understands that process starts with us communicating. It comes down to collaborations, but it also comes down to persistence, because this is where I think a lot of this research fails. This pipeline where we talk about a leaky pipeline where some basic research may not make it to translational research, and some translational research might not make it to clinical care. That’s because those jumps are very hard even if you have all the right partners.
How do you work towards translating technical knowledge into things the average woman can understand and use?
Noelle LoConte LoConte: I think it’s two things. I’ve been a patient a lot longer than I’ve been a physician and so it’s important to remember what it was like as a patient. I think it just comes down to how would you explain it to your family members or your neighbor? Having an open and collaborative relationship where people can ask questions — there are no silly questions. And helping teach scientists how to get out into the community and train them up on how to do that.
How can women approach health concerns with a provider who might not take them seriously or dismiss their concerns?
LoConte: Yeah, can I get an amen? Bring an advocate or a friend or family. I support and encourage patients to record the visit. Not every physician is going to feel comfortable with that, but it doesn’t hurt to ask. I think there can be very strong patient advocates and nurses, so I would lean on those members of the team. If you’re feeling extremely bold, I think it’s great if you can call out your physician for being a jerk, but many people don’t want to do that. But that’s how we learn and get better.
For providers who are treating patients based on old research, what’s the plan to ensure that providers are up to speed on the latest information?
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LoConte: Continuous peer review and peer reporting to licensing boards when it gets particularly egregious. In medical oncology, everything is team-based, and I actually think that’s a strength because if one of us starts to get a little behind or a little crazy, there’s a team of immediate peers who will say “no, that’s not where we’re at now.”
There’s not much I can do if there’s a physician that I think is behind the times other than try to encourage collaborative conversations about that and try to encourage patients to get second opinions. Most physicians want to do a good job, so I think they’re probably open to helping each other.
This is the consequence of not having diverse teams in science — the more we have older folks, people of different genders, people of different backgrounds, the more people bring interesting questions to the table. Noelle LoConte
How can people better understand the effects of biological changes in women’s bodies as they age?
Skala: We do a little bit of aging research with some brain studies we’re doing in neuroscience, and I can tell you we’re not thinking about age or gender. We’re thinking very basically: What are the features that occur that affect memory? What affects neural regeneration? And how can we promote that with age? In this particular study, we’re not thinking yet about differences between men and women, but it could be the next phase because we do know that there’s differences.
LoConte: This is the consequence of not having diverse teams in science — the more we have older folks, people of different genders, people of different backgrounds, the more people bring interesting questions to the table. I think that’s an absolutely critical need in science and in medicine right now that we’re not really talking about, but it would fix a lot if we could have our workforce match our patients in every sense. Women’s health is generally far behind where our understanding of men’s health is across the board.
Spurgeon: I would say in basic research, the NIH has done a good job demanding in grant applications that we include sex as a variable. For instance, if you are getting primary cells to do a study, you need to have an equivalent number of those cells from men and women. But they have not incorporated age as such a variable. And I think we could improve on that as well.
How will changes in the federal research climate affect your work and what is your hope for the future?
Skala: What I’ve been thinking about a lot lately is the next generation of scientists and how it’s really vitally important to have long term plans to mentor people into these careers in science because it takes time, it takes a lot of hands-on experience and it takes involved mentors. It’s such a critical piece of what I think makes our research infrastructure the envy of the world — it’s the people.
If people are being turned away from getting that training, that is extremely concerning because, we all put ourselves in those shoes, right? Someone took a chance on us at some point and here we are living this amazing life where we get to do science for a living. Just shutting down opportunities to people has such long-term consequences.
But what do I hope for in the future? I do think people can do amazing things under extraordinary circumstances. And I think people eventually persevere and make the impact that they’re meant to make somehow. I always put my faith in people because I think people can do amazing things.
LoConte: It’s hard to be anything but scared. I can’t really sugarcoat it. But what makes me hopeful is that we stop relying on NIH funding as the holy grail and the only way to do science. And that we see the value in philanthropy, other agencies, non-federal funding, and that we really as scientists seek to have diverse portfolios because it really matters in moments like this.
I also think that when you get bit by the science bug, there’s not a damn thing you can do to make that go away. And people are going to find their way to science, hopefully in very creative and interesting and important ways. I’m excited to see how that bears fruit.
Spurgeon: I think a lot of people are preemptively being cautious. And that’s just kind of having a chilling effect across the board. For my own research, it could obviously influence funding in the future. I work on several potentially inflammatory topics such as infectious disease research, women’s research, research that’s tangential to a controversial vaccine, animal models, etc. So, I just think there’s a lot of concern and uncertainty, not only with the next generation, but also those of us that are currently scientists and mentors.
What am I hopeful about? I think it was last week or the week before a lot of people from the community went up to the capitol and stood up for science. Knowing that there are people in the community that are supportive enough to go out on a cold, rainy, snowy day to show support really gives me hope. I will agree that I’m hopeful that people will see the light and continue to understand how beneficial scientific research can be to human health.
Skala: Some of these things make me wonder what we can do to better address the importance of science in society. What we do and how. I think there’s a lot of misunderstanding about what academic research is and what basic research is and what translational research is. And that what we’re doing now is high risk. And the timeline is decades. I don’t know if it’s very clear to the public. I think we have a responsibility for communicating what we do and why it’s important and fighting the misinformation as well. I think we have to speak. If you remain silent, it’s not going to help.
Closing remarks
Frederick: If you would join me in thanking our panelists and I want to thank all of you for joining us this evening, both you who are here physically and those of you online. We at the Morgridge Institute sincerely appreciate your interest and support. Our passion is around fearless, curiosity-driven research, but we have another passion for our social responsibility as scientists to communicate and engage all of our communities. And I was thinking of all the questions and how full this room is. I think this is exactly what it means about engaging and listening to you so we can do better work.