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E2: Another Shot on Goal

Dr. Denise Wolf tells the story of her serendipitous path from electrical engineering to precision oncology research, and why studying something interesting was not enough.

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Additional Information

Denise is now a bioinformatics scientist at the University of California, San Francisco working on predictive biomarkers for breast cancer patients and the I-SPY clinical trials.

Music on this episode is by Loyalty Freak Music and Komiku.

Episode Transcript

DENISE WOLF: Hey Peggy!

PEGGY WANG: Hi Denise!

PEGGY: Meet Denise Wolf, a bioinformatics scientist at the University of California, San Francisco, where her research is to…

DENISE: Try to make precision oncology a reality for breast cancer and even other cancers.

PEGGY: Denise works on the analyses for a clinical trial.

DENISE: You actually look at the molecular features of the tumor and try to use all that information to figure out like, which treatment would be most likely to save their life. And then you can see whether the person is responding to the treatment you thought would work. And if they're not, then you get another, you get another shot on goal.

PEGGY: And this work, is in many ways, perfect for Denise.

DENISE: It's a great trial and it's great people. Love it.

PEGGY: To understand why, we need to go back to where Denise was before. I actually met Denise about 15 years ago. When I was an undergrad who wandered into her lab, and she was an experienced researcher, modeling bacteria with math.

DENISE: Well I remember you. No, I remember you. My PhD was in electrical engineering, and I don't know if you remember that.

PEGGY: Before bacteria, Denise had studied electrical engineering.

[SONG: “Traveling in Your Mind”]

DENISE: I was kind of looking for a way to combine biology with like the math that I liked and at the time, the field, you know, of you know, computational biology, it didn't exist in the same way that it does now, and so I kept kind of falling back into engineering. And even as an undergraduate I thought I was gonna go to medical school, and then I realized I don't like to be around sick people and I'm afraid of dogs, I can't be a vet.

PEGGY: Denise started off in grad school working for a professor who was…

DENISE: He was doing these experiments where he was interested in audition but he was cutting the heads off of turtles and sticking wires in their necks and I just didn't—I like the turtles, I didn't want to kill them, so that didn't really work. And so I kept kind of like running into walls around being in bio in one way or another.

PEGGY: So after a few tries of getting into biology, Denise ended up working on more traditional engineering topics…

DENISE: Doing systems theory and nonlinear circuits.

PEGGY: But when she was about to graduate, she went to a lecture given by a computer science professor.

DENISE: He had this beautiful lecture that kind of showed all these relationships between computer science and mathematics and like basic problems in biology and I was entranced. I went to his lecture and basically followed him back to his office.

PEGGY: Denise had learned about a fellowship, and thought if she could get it, it would be an opportunity to work on computational biology with this professor.

DENISE: The deadline was that next Monday and after the talk I just kind of went up to him like, hey, what if I applied for this and went to work with you? And he's like, okay. So over the weekend I wrote this little grant, and sent it in, and I got it.

PEGGY: And that was how Denise got into computational biology. Except, not yet.

DENISE: The whole extent of his actual like work in biology was that lecture. It went no further. It's like I think he wanted to get into the field and he never did. And then I found the Human Genome Center at LBL.

[SONG: “Traveling in Your Mind”]

PEGGY: Lawrence Berkeley National Lab, the campus is up the hill from UC Berkeley where Denise did her PhD. There she tried a couple more groups that also didn't work out.

DENISE: And knowing I wanted to do, you know, some sort of computational biology, but needing a community. And then I met Adam Arkin. You know he's sort of my intellectual soul brother, I would say. And so we, you know, hit it off completely and started working on projects together and I moved into his group. And that's where we met, was I was doing the systems microbiology you know with Adam and I did micro, you know, one way or another for about 12 years, you know working on B. subtilis and you know E. coli and a little bit on HIV. Yea, it took me a couple years of kind of wandering around.

PEGGY: Meanwhile, she had met her husband, Joel.

DENISE: We got married in ‘96 and bought a house in Berkeley and we had our first daughter in ‘97 and our second daughter in 2000. And actually both girls, their first word was the name of our dog at the time, Piggy.

PEGGY: And for her younger daughter…

DENISE: She wanted me to tie her shoe and I was doing something, and I said, go ask piggy. And she walked up to piggy and she said, piggy shoe tie! That was her first sentence. Two daughters and many pets.

PEGGY: So this was the snippet of Denise that I knew, she mentored me for a while, and eventually I graduated and left. I wouldn't talk to Denise again for more than 10 years. Then, I came across her name while reading some papers: “The Immune Landscape of Cancer,” “Molecular Classification of 10,000 Tumors”. Denise had transitioned fields again, this time to cancer genomics. And I knew there was a story behind this.

[SONG: “Friend to Friend”]

PEGGY: I'm Peggy Wang and this is Personal Genomics, a podcast from the Center for Cancer Genomics at the National Cancer Institute. Today, one researcher's journey to cancer genomics. Denise had been enjoying her work in microbiology for about 12 years, when one day, everything changed.

PEGGY: Can we talk about, about when you, you found your tumor?

DENISE: It was the week of Valentine's Day in 2008, so it's mid-February, and I remember like I was 43 years old, and I remember the like, maybe a week before I thought I felt something but then I didn't. And then I kind of checked again. I was in the shower and it was unmistakable. I had a huge lump. And so the tumor must have been hiding behind something, some other like not, you know, scary feeling bump and it must have shifted. Because I actually knew it was cancer the minute I felt it. Oh, I'm in for it. And so the next day, I you know got myself in to be seen and then you know started the mammogram and then the biopsy and it was February 28th that I got the news that it was indeed cancer.

I was diagnosed with triple negative breast cancer, which means that the estrogen and progesterone receptors were not present. So they were negative.

PEGGY: Stage 2A.

DENISE: When I look back on it, the funny thing is, I so didn't understand, when I first, when I first found that out, I didn't know that it was actually really bad. I thought, oh that means I won't have to take tamoxifen for 10 years.

PEGGY: Tamoxifen is a drug used to treat HR Positive breast cancer. While for triple negative breast cancer…

DENISE: Prognosis for triple negative breast cancer is much worse than the other subtypes and there, at the time there was no targeted treatment. I just remember you know in my naivete at the time, feeling relieved.

PEGGY: Denise, who studied bacteria, knew nothing about cancer.

DENISE: I never expected to have cancer. No one in my family had cancer, I wasn't like looking for, it wasn't the way I expected things to go. I mean, I don't know that anyone ever expects it, but I think if you have a family history, you're more alert to the possibility but I was not at the time.

PEGGY: Her two daughters were 7 and 10.

DENISE: Yea, the thought of leaving them was just awful, and you know as a parent you know the idea of leaving your children motherless is just horror. And you know, worse in some ways than the thought of losing one's own life is like leaving them.

PEGGY: After being diagnosed with cancer, what do you do? Go into shock or denial, maybe. But then what? For Denise, who calls herself a realist…

DENISE: You look up the survival and you see the Kaplan-Meier curves and you know they're hard to look at but that's just what it is. Sitting in a support group, I remember my early stage breast cancer support group, sitting in a room and looking around and I already looked up all the odds, and okay there are 23 of us in this room and you know, you could just know, like okay well at least five of us are gonna die of breast cancer and probably two of us in the next year and a half.

[SONG: “Beach”]

DENISE: If you're the sort of person who whose imagination goes to dark places…

PEGGY: You think about dying. A lot.

DENISE: How long is it going to take? What's the road going to be like?

PEGGY: But somehow, Denise snapped info action.

DENISE: I kind of cranked all the wheels like a crank, I joined support groups.

PEGGY: She got into meditation and yoga to help cope with the fear.

DENISE: Mindfulness, tonglen meditation is very very helpful because it allows you to become more comfortable with your own mortality.

PEGGY: She started doing what she could on all fronts.

DENISE: Picking doctors and working with the consultant and you know, I saw this kind of herbalist guy on Pine Street.

PEGGY: And as a trained researcher, she started researching her own disease, learning everything she could, from other patients, scientific literature. She consulted with multiple oncologists, eventually coming to a key decision.

DENISE: I did something that now is standard of care, but at the time was only was pretty much only done in clinical trials. But I you know, as a scientist I didn't want to go through, I didn't want to be treated with chemotherapy without having a readout.

PEGGY: By readout, Denise means having some way to track her tumor's size during treatment.

DENISE: If you have surgery first and you remove the tumor then you have no way of knowing whether, what you know, your, whether your treatment was actually effective because you have, you know, there's no, there's nothing to shrink.

PEGGY: Working with her doctor, Denise did something called neoadjuvant therapy, where she would first get chemotherapy, and then have surgery to remove her tumor. This way, they could track and see if the tumor was getting smaller with chemo.

DENISE: We started off with one protocol, which was the standard of care at the time, and that was doing Adriamycin and Cytoxan followed by a taxane. And those are really awful drugs.

PEGGY: Denise started chemotherapy. She kept a blog while she was a patient and gave me permission to read a few excerpts.

[SONG: “Resolution”]

PEGGY: March 18. Hey, I'm back. It's over and I survived (so far)! The day itself was far easier than I had guessed. We mostly sat in this little room and chatted with lots of people as the chemicals dripped into my veins. We arrived at 10:30 am and didn't get home until 5:30. It was kind of like a really, long coffee clatch, minus the coffee and plus the hazmat suit on the nurse. One of the drugs, Adriamycin, is bright red, and injected into the line in a 'push'. The other, Cytoxan, dripped in slowly over hours along with a lot of IV fluids. I have a bit of a headache and am feeling generally “weird”. As in, a little shaky, a little unsteady on my feet. But mostly, what I am is incredibly grateful that the first day, up to now (knock on wood) was basically a walk in the part.

April 18. Funny how the emotional component is so much harder for me than the physical.

Physically, I certainly don't feel great, but it is bearable. Emotionally, I keep falling into a well, struggling to claw myself out. Superficially, today was ok in that I made it to yoga went grocery shopping and just came back from dinner out with Joel, the girls, and my in-laws. But on a deeper level I've been doing some serious suffering, falling into despair. A lot of really ugly whispering in my head. I'm also very lonely with these feelings. It's like being stranded on an island without shade or any sense of when or if rescue might come. I'm hoping that tomorrow will be better, that I will feel more hopeful and less doomed.

PEGGY: Denise felt exhausted, had trouble sleeping, lost her hair, and felt really depressed.  After two cycles of this…

DENISE: It was clear that my tumor was not shrinking and if anything, it felt harder and maybe bigger so and I was really, really scared.

PEGGY: Meanwhile, in the midst of dealing with cancer, Denise had still been going to work.

DENISE: It was about the second week in after starting chemo and I was feeling so tired and I could see that that I was going to have to, I couldn't work and be like ‘on’ as a parent and do like self-care stuff. Work was what was going to have to go because I, you know obviously wasn't going to be less present as a mother, I wanted to be more present as a mother, if anything. And I needed those other things because I was having trouble coping. I think everybody's individual in kind of what they need to do to make it through, emotionally.

[SONG: “Resolution”]

PEGGY: April 5. In the wee hours I wake from a dream of loss, my work desk having been given away, boxes of my stuff nowhere to be found, late at night near a dark apartment without a

car or any clear way of getting home. The pattern emerges: chemo Tuesday and Wednesday are ok, and then I descend, body and spirit Thursday and Friday, only beginning to emerge Saturday. I hear whispers: “it's not shrinking,” “the chemo isn't working.” Tears spring to my eyes right now, after hours of battering dark fantasies of recurrence and my body invaded beyond reach. Maybe I can cry out the doubts and fears and hours of lost sleep.

DENISE: I remember like telling people and being like in the office and having people around me and, but it was like a hard thing to share. I was very sad, I was crying, I mean it was like I felt like I was like leaving my life, you know, in a certain way. It wasn't very long before I knew it was the right thing to do. I was less tired, you know. I could focus more on just getting through the experience and on you know being with the kids and Joel.

PEGGY: Denise had more room now to be present with her family and take care of herself, and also to grapple with what to do next, since her tumor did not seem to be responding to her chemo. Was it too soon to tell? Should she switch drugs? Go straight to surgery? It was scary, and frustrating.

DENISE: I didn't understand why there was no way of using the fact that the treatment didn't work and maybe some molecular feature of my cancer to then figure out what I should have instead.

PEGGY: She even wrote to one of her doctors

DENISE: You know I have an engineering background, maybe I could help make this actually happen.

PEGGY: But there was nothing like that available. So, she consulted with multiple doctors who gave her multiple opinions. In the end…

DENISE: We switched to a different kind of treatment which now has been shown to have a much higher response rate in my subtype which is adding a platinum drug carboplatin.

[SONG: “Resolution”]

PEGGY: May 5th. Tomorrow I go in for the next chemo infusion. I'm hoping that this time will be a smoother ride, or if not smoother, at least more knowing and more compassionate. Physically, I'll know to expect the swollen tongue and throat, the mouth sores, the tingly fingertips, the dry skin, the digestive destruction, and nausea. I’ll also try to keep in mind that it passes, that my body has amazing regenerative powers, and that I have help and love of so many people to bring me through yet again.

June 25. Baldy Gets Some Good News. We had the MRI today, and the results by this evening. The chemo seems to be doing something good! The main tumor is one third the volume it was before we started poisoning me, and the satellite mini-tumors it had spawn are completely gone. Also, the blood dynamics have gone from 3% to 0% super-aggressive. All in all, good news! Of course, the best news, with the best prognosis, would be complete wipe-out of the tumor by chemo, which we obviously haven’t seen yet. Let's keep our fingers crossed that the last two rounds of chemo will do the job. Man, am I tired. This was a Hard day.

PEGGY: Her tumor had shrunk enough that the doctors could perform a lumpectomy: removing a lump of tissue around the tumor, or what was left of it, along with some lymph nodes. Then the doctors test the lump and nodes and hope for…

DENISE: Pathologic complete response. And what it means is that over the course of your treatment, the treatment has you know eliminated all live, you know invasive cells from the breast and the nodes.

PEGGY: For patients whose tumor has completely shrunk and disappeared, and their nodes are negative for cancer, they have…

DENISE: A 97% chance of being recurrence free the rest of their lives so basically of being cured.

It's a big deal. I had a lumpectomy and that shouldn't have been like a big traumatic thing, but I had some kind of anaphylactic reaction to the dye they used.

PEGGY: The dye helps the surgeon visualize where the lymph nodes are.

DENISE: I ended up in the ICU with super super low blood pressure. It was pretty scary.

PEGGY: Denise was given epinephrin and steroids and lots of fluids, which made her body swell up a lot. The blue dye that was supposed to stay in her breast somehow spread throughout her body, turning Denise into…

DENISE: A blue bear, a big puffy, blue bear [laughing]. I scared my children. I was blue, I was puffy, I was bald. But my surgeon kept powering through and did the surgery, for which I was grateful.

PEGGY: The good news was, after a scary start, Denise's surgeon removed the tissue and the nodes as planned. She had a rough night in the ICU and was able to go home the next day. And her nodes tested negative for cancer. But the bad news was there was some tumor left. She did not have pathologic complete response.

DENISE: I was left with residual disease, and so my odds of having a metastatic recurrence were about 50 percent. Because I had done all this research I knew that and I was you know, I was really scared.

PEGGY: Denise had gone through eight grueling rounds of chemotherapy, a really scary surgery, and also 35 rounds of radiation that we're not even getting into on this podcast. But, after all this, she still had residual disease. Meaning her odds were still 50/50, and this was the end of her fight—there were no other available treatments at the time.

DENISE: My prognosis was not that good and so you know I had to live with that knowing that and it was scary. The hardest part of cancer for me, and for many others, is it's not going through chemotherapy, feeling sick, you know losing my breasts, losing my hair. You know it wasn't that stuff. It was knowing that I didn't know whether I would live. The thing about the uncertainty is we all have uncertainty. Like even when you're healthy you have uncertainty. Every day no one knows how their life is actually going to turn out or how long it’s going to be. You don't have to be in touch in a daily kind of way with the uncertainty around one's own existence and cancer forces you to do that.

PEGGY: So, what do you do when you have cancer, go through treatment, have residual disease, and don't have any more treatment options? The answer came to Denise through a dream.

DENISE: I was watching myself on some kind of a like an operating table. And I could see my heart beating and the blood in my heart. There was this like really red, bright, like rich light coming from my heart and it would stream down my arms and it stopped at my wrists, it didn't make it into my hands.

PEGGY: Later, as part of an exercise in therapy, Denise was asked to imagine lining up to see a guru.

DENISE: Every person could come up and whisper what they what their heart most desires and it would come true. What I had assumed, because of course I wanted to like raise my children and not leave them motherless, was that the thing I would most want was you know, to survive to raise them, but that's actually not what came into my mind. What came into my mind was ‘may I be useful’.

When I look back at that dream you know with the heart and the blood pumping out of it that didn't make it to the hands, I interpreted that to mean almost like a little prayer, like ‘may my hands do my heart's work.’ So I knew that I wanted my hands to do my hearts work and my hearts work was not microbial signal transduction it was doing something for cancer patients.

[SONG: “Together We Are Stronger”]

PEGGY: One part about getting cancer that had made an unexpected impact on Denise was connecting with the cancer community.

DENISE: I felt like after going through this whole experience, in addition to it being like scary and difficult, it was also, there was also something really beautiful about it. Which was that I felt like there were people everywhere who were helping us you know: people in the community who were bringing food and giving the kids rides and going with me to you know procedures and tests and even like at the Medical Center. You know the doctors, the nurses, the technicians. It was like all these people who were so generous with their time and their expertise. And If I only have a few years to work I wanted to use my skills to try to help this population.

PEGGY: Remember when Denise's tumor wasn't responding to her first chemo drug?

DENISE: I didn't understand why there was no way of using the fact that the treatment didn't work and maybe some molecular feature of my cancer to then figure out what I should have instead.

PEGGY: Denise knew that this was what she wanted to spend the rest of her time, the rest of her life essentially, working on…

DENISE: So that when future patients kind of are in the same situation, there are more tools available to help them maneuver you know, in a rational way.

PEGGY: So Denise had a very clear research goal. And this time, the electrical engineer turned microbiologist, would have to transition to cancer.

DENISE: What would make more sense is for me to find someone at LBL who is doing cancer research that like so that I could switch fields and you know, learn how to be a cancer researcher.

PEGGY: She started looking at LBL, where she was before. But one day, Denise went to a talk at UCSF given by someone named Dr. Laura Van't Veer about…

DENISE: A trial called I-SPY 1 and the molecular data they were capturing and some of the objectives. And in that room I felt like I had found my people, like oh this is it, this is where I should be, this is my real community. But, you know I didn't know quite how to make that happen.

PEGGY: Soon after the talk, by coincidence or luck, Denise happened to see Laura walking down the street. And pulling the same move she did 13 years earlier, she followed her.

[SONG: “Traveling in Your Mind”]

DENISE: I stopped and said hello and I told her I remembered her and asked where she was going.

PEGGY: She was on her way to meet another scientist.

DENISE: She was going to be you know, trying to start a project with him. And I asked whether I could come to the meeting and I and I kind of tagged along.

PEGGY: Denise followed her to the meeting, and they hit it off. Laura, at the time, was being recruited to UCSF.

DENISE: She decided to come and she offered me a job. I was actually her first hire.

PEGGY: This time, things worked out with the first person she followed.

DENISE: I really feel like life is a lot of, is largely a series of you know, sort of accidental paths. You know like where you might respond more to one thing to another and maybe pursue something harder than something else but that overall there's a lot of serendipity.

It's been a very productive collaboration. It's been a great opportunity to do important and good work. So the trial that I support with biomarker work is all about like trying out different treatments and seeing which ones work for which people and how you define the subsets that respond to each type of therapy.

PEGGY: She started doing her heart's work. Meanwhile, she was still expecting to get recurrence and get sick again at any time.

DENISE: How long is it going to take? What's the road going to be like?

PEGGY: And not long after she had gone back to work, a blood test showed…

DENISE: My tumor marker started to climb up. So it went from the normal range to the abnormal range. I was completely freaking out and then my oncologist is like, okay let's do let's do a scan. And lo and behold, we saw nodules in my lungs. And they were too small to biopsy. And so they're like okay well in five months from now we're going to rescan and see if they've grown. And if they've grown you know then, we know that you have metastatic disease.

PEGGY: Denise was told to simply wait. Wait 5 months where…

DENISE: I thought you know, I thought I was going to die of my disease in not too long and leave my kids orphaned and just not have the full meal of life that we all want.

PEGGY: She worked. She went on vacation.

DENISE: Maybe it's my last vacation.

PEGGY: And she waited.

DENISE: Like I had to really grapple with it and I was really afraid.

PEGGY: And she waited

DENISE: And so when I went back for that second scan to see whether the lung nodules had grown, they saw just damage due to like an immune reaction to the radiation.

PEGGY: After months of thinking this was the beginning of the end, she had been fine.

DENISE: I was of course extremely relieved and you know just so grateful. I also never again wanted to go through a nine-month period of wondering whether or not I had advanced disease and have it turn out to be a false alarm because the cost, the emotional cost of that was enormous. It was enormous.

PEGGY: So Denise did something else that was not standard of care, to say the least. Something that some friends and family, and her doctor, didn't agree with.

DENISE: I just didn't go back anymore.

PEGGY: She decided: no more blood tests, no more scans. She would just let the symptoms of metastatic disease tell her she was sick again, and meanwhile, try to live her life.

DENISE: So if you find out six months or a year earlier, that's an additional time where you're feeling sick, you're on chemo, you, you know, lost your hair, you probably stopped working. You know versus having that time to live fully. I just thought well if cancer wants me, it's going to have to come get me. I'm not going to go looking for it.

[SONG: “Beach”]

PEGGY: So when you got out to 6 years, were you surprised?

DENISE: Yea. Yea, I was surprised. Just very happy and grateful and surprised, because it started off as kind of a coin toss.

PEGGY: Denise made it.

DENISE: I knew the probability of metastatic disease on a t—like, like as a function of time and so if you make it to three years, you know you're much less likely. And then if you make it to five years, your curves actually cross with the ER positive cancers. And then if you make it to six years, you’re really unlikely to ever have metastatic recurrence. So I would say that my fear attenuated pretty much exactly with my own odds increasing [laughing]. You know like, I was maybe like too worried, but my worry was definitely proportional to risk. I'm almost 11 years out now.

PEGGY: Today, Denise continues her work with the same group.

DENISE: We're right now putting together the thing I wished had existed when my cancer wasn't responding to treatment. It's the thing I asked for that didn't, that wasn't, didn't exist so it feels like I've come I'm coming full circle right now.

PEGGY: She does computational work for the I-SPY 2 trial, where…

DENISE: You actually look at the molecular features of the tumor: gene expression, protein and phosphoprotein levels, sequencing to look at mutations and mutational spectra and clonality, immunohistochemistry. And try to use all that information to figure out like which treatment would be most likely to save their life. You can see whether the person is responding to the treatment you thought would work, and if they're not, then you get another, you get another shot on goal.

[SONG: “Together We Are Stronger”]

PEGGY: Another shot on goal—that Denise had desperately wanted to take when she was left with residual disease.

DENISE: So we're developing a real understanding of who responds to what and why and we're using this understanding in the next phase of the design of the trial where not only are we going to test new agents, we're also going to test some of these biomarkers we've developed.

PEGGY: And this is all possible, this has all come together, because of everything she’s been through.

DENISE: My own experience having cancer, my experience being helped by others, and my desire to help, plus my background which makes doing the kind of help that I'm doing—computational work—possible. You know when you find something that looks good, it feels good because you, you think that maybe, you know maybe something you're working on could help somebody find the right treatment in the future.

PEGGY: I was curious, especially as a researcher dedicated to figuring out who responds to what and why, did Denise wonder how she survived? Like, did she do it by…

DENISE: Keeping the tumor in and by switching treatments when I wasn't responding? But of course I can't know. It could have been my own immune system, it could have been that I was never gonna die of breast cancer even if I'd only had surgery and had no chemo.

PEGGY: And does that bother you, not knowing what it was that saved you?

DENISE: No. I'm curious though, and actually I have some data and I have tissue and I've had this sort of like pet project in mind but I never have time to do it, of actually doing the full analysis on my own tissue to try to see if I can understand why I'm still alive. It’s FFPE in the drawer, like right here.

PEGGY: Her tissue remains in the drawer, and Denise wisely uses her time to focus on her precision oncology work, being grateful for surviving, and being a mother to her two daughters.

DENISE: It's very hard on kids. You know they don't want their parents to be vulnerable and of course, they need us so much. The thought of losing us is horrible and unbearable, and they can't let themselves think about it or they wouldn't be able to function and grow and learn and be happy children like they should be.

And they're in college now [laughing] like my youngest child is in college and that's always what I want I wanted. That ten years and I got it. So it’s all gravy from here on out.

[SONG: “Victory”]

PEGGY: I want to extend a deep, heartfelt thank you to Denise for letting me, letting all of us dig into this awful experience of her past, and invade some deep, dark corners of her mind. It was a really difficult time that is still difficult to share. So thank you, thank you, so much, Denise.

If you or a loved one have cancer, and have questions, you can visit NCI's Cancer Information Service at cancer.gov/contact. This story is not a substitute for a doctor's advice. For more information about this and other episodes of Personal Genomics, visit our website at cancer.gov/personalgenomics.

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