Fieldwork Time Log

Students Name: Becca Bornstein

Fieldwork Project: Genetics

Mentors Name: Dr. Colleen Yavarow

Date

Correspondence: Provide a record of each time you correspond with

your mentor (phone & email) and the topic of your conversation.

9/11/15

This was my first call with Dr. Colleen Yavarow. We discussed two major
project focuses that I can choose from. The first focus is about the 25 different
cancer genes and how they are tested for. For example, at the office they do
Risk Assessment Genetic tests, which involve studying blood. The other
project idea was to focus on the environmental hazards that Attleboro Texas
Instruments had in the 60s, 70s, and 80s, which caused cancer. Now there are
many cases of people that go into the office that were exposed to cancerous
materials, and therefore they receive money through lawsuits. I figured out that
I want to focus on the 25 different cancer genes and what happens with bad
genes, why there are changes in DNA, and a general overview of genes. In
addition, we discussed some hands on opportunities at the office including,
sitting in on initial and result consultations with patient permission, reviewing
the results of patients, their history, and a plan of action, and looking at blood
under microscopes to see cancerous vs. noncancerous blood.

1/27/16

Dr. Colleen Yavarow and I corresponded through e-mail to confirm that we

were meeting on Saturday the 30th. She also informed me that she had a great
agenda planned for us when we meet.

1/30/16

Dr. Colleen Yavarow and I corresponded through e-mail to confirm the time we
were meeting at (2 pm) and then she told me where she was sitting in Panera
so I could find her (way in the back at a large table with a computer).

1/30/16

I e-mailed Dr. Colleen Yavarow a copy of my family cancer tree history because
she is presenting my familys case to a group of geneticists. It is very cool that
she will be using my tree to do that.

2/11/16

Dr. Yavarow e-mailed me back thanking me for sending my familys pedigree to

her. In addition, she sent me the contact information for the first person I am
going to interview. The next step is to prepare for the interview.

2/28/16

I emailed Dr. Yavarow my prepared questions for my first interview. I wanted

her to look them over and asked her for any suggestions before I call the
patient.

3/9/16

Dr. Yavarow and I emailed back and forth about starting the research process
for the paper and about when we can meet next. We are planning to meet on
April 30th. From now until then she gave me tasks to work on. For example, in

order to start the introduction I need to write about why the patient went into
the doctors office in the first place for genetic testing as well as the concerns
for the patients children. In addition, I need to contact the patient in order to
get more information about cancer, tumors, GI syndromes, and colonoscopy
results in the patients family.

Date

Fieldwork with your Mentor: Provide a description of all work

completed under the direct guidance of your mentor.

9/15/15

Today I had my first face to face meeting with Dr. Colleen

Yavarow. We went into her office and discussed my general
plan about what I want to learn, which is about a 25 cancer
gene panel genetic test. What I learned:
Myriad is the company that her office uses for the genetic test,
used to be the only company that could test for the BRCA
genes, but the Supreme Court ruled other companies could too.
Their lab is in Utah, where all of the blood tests taken at the
office are sent to through FedEx. The results take about one
month to be returned.
We looked at actual patient results, comparing the three types
of results (Positive, Negative, and Variant). As of now variants
are considered to be harmless. They can be reclassified if
more data comes in that determines that the variant is actually
harmful. Variants are determined by collections of information
in a database.
We talked about what would happen if you got positive results
for a faulty gene. The preventative measures depend on each
individual patient, but some examples are chemotherapy,
radiation, 6-month mammogram and MRIs, or a major surgery
like removing the ovaries or a mastectomy. A mastectomy
reduces your chance of breast cancer from 90% to 3%.
We discussed specific patients that might be willing for me to
sit in on their appointments. One is a 59 year old woman who
had breast cancer in the past and she tested positive for BRCA.
Therefore, her two sons received the genetic test as well
because they have a 50% chance to also have the faulty gene.

Number of
Hours
45 Minutes

Another woman, who is 31 and had breast cancer at 29, might

let me interview her.
Dr. Colleen Yavarow gave me materials about the 25 genes to
read and write down questions for our next meeting on
September 28th. We also discussed looking at blood smears
the next time we meet.
9/28/15

10/20/1
5

Today I had my second meeting with Dr. Colleen Yavarow. We

went into her office and discussed the answers to my questions
that I got from my reading and notes. I learned the following:
If you have one type of hereditary cancer, are you at more risk
for other types (in comparison to the general population)?
No. The genes are like eye color. If you have a gene for blue
eyes, then you are not more susceptible to brown eyes.
Therefore, each gene is not connected to the other.
When do you use oral vs. blood genetic tests?
You would use oral tests if someone is very scared of needles.
However, they are less reliable because you need a lot of spit,
hence it is more difficult to get enough cells. Oral tests used to
be used a lot, but blood tests are now the primary method.
Has the median age for being diagnosed with cancer older
because of advancements in technology? What is the trend in
annual cases?
Sort of. In the 70s and 80s people were not as likely to go get
screenings, but now for the most part it has become a norm in
society, especially for breast cancer. Therefore, it may seem as
if there is an increase in cancer cases, however it is really
because people are more aware and are getting tested more
often.
Dr. Colleen Yavarow also gave me two packets of printed
papers. One talks about BRCA1 and BRCA2 and the other
packet is an overview of mutations and health. In addition she
gave me a handbook of different types of cancers and their
staging. We picked a date for our next meeting on October 20th.
She also told me great news that one woman has agreed to let
me interview at some point this year.

45 Minutes

Today I had my third meeting with my mentor, Dr. Colleen

Yavarow. This meeting began with a discussion of my research
paper and what I have learned so far. I talked to her about
genetic discrimination that is present in the military and in the
workplace. We then discussed how I could branch off of that by
looking at certain legislations such as GINA that are in place
and if they are effective. We continued to do some research
together and printed out interesting articles about GINA and
fetus gene altering. In addition we created a plan of action in

1 Hour 30
Minutes

order for me to complete some of my goals. For example, we

created a list of potential patients that I would be able to
interview (we would prepare for the interviews together), we
picked out blood smears to look at next time, we talked about
creating my family tree, and potentially we discussed sitting in
on a result consultation. Lastly, she showed me the needle
device that is used for bone marrow biopsies. Our next meeting
is scheduled for November 24, 2015. She also informed me that
she is leaving Sturdy Memorial Hospital to a hospital in Maine,
however she will still continue to be my mentor because she
frequently has to come back to Attleboro for meetings and her
own doctor appointments. Also, she will still be living in
Massachusetts, however commuting to Maine.
11/24/1
5

Dr. Colleen Yavarow and I first caught up with a little small talk
in her office. We then looked at a specific case. There was a
man who went to her for testing because his family had a lot of
history of cancer. (Father died of prostate cancer at 59, paternal
uncle died of pancreatic cancer at 64, paternal aunt has breast
cancer and the BRCA gene, and another paternal aunt has
breast cancer. The mothers side does not have a lot of cancer
in the family history, but has heart problems.) He has two kids,
an 11 year old boy and a 9 year old girl. He was concerned that
he might have the BRCA gene and that he could pass it to his
kids. He also has a 41 year old brother with one son who is 5.
He is not Jewish. (BRCA is very common in Jewish people). My
mentor gave me a copy of his family history. Dr. Colleen
Yavarow tried calling him so I could sit in on the result
consultation, but unfortunately he did not answer. His results
were negative for the BRCA gene mutation, which is very good
news. This means that his kids also cannot have the mutation.
If the result was positive the next step would be to send him to
an urologist to screen for prostate cancer, send him to a
dermatologist because the BRCA gene is also linked to
melanoma, and he would also get mammograms done. There
are not a lot of preventative measures that are taken with
pancreatic cancer. The only time people are screened is if they
begin to show symptoms such as pain and nausea. We
continued to talk about new technology that one woman has
tried, in which you try to remove the BRCA gene mutation from
the embryo through the in vitro process. My mentor then
mentioned a class that she is taking through the City of Hope,
which is based in California. She told me about something
called imprinting, which she is learning about. It is a strange
inheritance pattern when the cancer seems to skip a generation

1 Hour 30
Minutes

because when it is inherited from a woman it is silent, but when

it is inherited from a man, the gene creates a harmful mutation.
In addition, she mentioned that she is going to use a patients
test results in a case study for this course in which I will be
able to be involved. She will be reporting a family history to
about 100 people. She invited me to this class, which I am really
hoping I will be able to go to. Lastly, we were able to look at
blood samples under a microscope. I saw normal blood cells,
anemic blood cells (iron deficient), hairy cell leukemia, chronic
lymphocytic leukemia (CLL), and myeloid leukemia. Hairy cell
leukemia appears in old men and is not fatal. CLL is also not
fatal. My mentor showed me how to identify the different cells.
For example, anemic cells are oval and more teardrop like.
Leukemias have purple cells in the smear. The darker the
purple the more mature the cell is. We made an appointment for
our next meeting on January 30th.

1/30/16

Today I met with my mentor at the Panera in Walpole since she 2 Hours 30
is no longer working in Attleboro. We were able to still
Minutes
accomplish a lot of interesting and informative things.
She showed me videos of very well known geneticists
presenting different patient cases.
She showed me a non-profit organization called Bright Pink,
which focuses on early detection of breast and ovarian cancer.
The organization was founded in 2007 by a woman who was the
youngest person at the age of 23 to ever get a double
mastectomy. They do different fundraisers and informative
meetings. The organization is linked to genetic testing and
preventative medicine.
We looked at a patients family tree that I have been working on
and she explained to me what she thinks it all means. We were
able to deduce what cancer genes the children have, which is
one allele for a colon cancer gene. However, as of now that
gene is known to be more risky if you have two alleles, which is
extremely rare. Since the parent has two alleles, that is what
makes this family cancer history so unique. Therefore, my
mentor is taking the tree and presenting the case to geneticists
in California. She is going to ask them a lot of questions and do
research on what that one copy for the children mean and the
two copies for the parent. Also, she is going to try to figure out
if that gene could be linked to other familial problems such as
pancreatitis and Crohns Disease.
We talked about my findings in my research paper and what I
found the most shocking. This was a very interesting
discussion because she was able to confirm what I researched

Date

actually does happen. She said that she never thinks that
genetic discrimination will be eliminated from the military, but
life insurances have made some progress.
We discussed future plans as well:
We talked about people I could interview. I will definitely be able
to interview one woman and possibly a second patient. She is
still trying to find someone I can interview who is BRCA
positive.
We also discussed possibly putting together and information
presentation that I could maybe present to an AP class or to the
health club. We talked about multiple things that I could present
including, genes, cancer, or the field of genetics and career
opportunities as a lot of students are figuring out their majors. I
want to have some final way to pull my whole project together.
We planned another meeting for March 12th.

Independent Fieldwork: Provide a description of

all fieldwork you complete independently.

9/20/15

Today I began to take notes of the information booklets Dr.

Colleen Yavarow provided me. The first guidebook is A
Patients Guide to Hereditary Cancer. Within this booklet I
learned about:
The differences between hereditary, familial, and sporadic
cancer
The percentages of the risk factor of having a type of hereditary
cancer
Multiple genes can be associated with a single cancer and
multiple cancers can be associated with a single gene
This specific genetic test tests 25 genes across 8 important
cancer types (Breast, Ovarian, Colon, Uterine, Melanoma,
Pancreatic, Gastric, and Prostate)
The different genetic test results (Positive, Negative, or
Uncertain Variant)
Managing Hereditary Cancer Risk (increased surveillance,

Number of
Hours
1 Hour

chemoprevention, and surgery)

50% chance that your relatives will have the gene mutation if
you do (important to look at mother and fathers family history)
In addition to everything I learned I wrote down some questions
to ask Dr. Colleen Yavarow next time we meet.
Are there theories why familial cancer occurs even if there is
not a pattern of inheritance?
Are there other genes that make people more susceptible to
cancer?
What can cause sporadic cancer? Is it mostly environmental?
If there cant be surgery done for some cancers how are they
prevented?
Can she explain the 99% risk factor for people with hereditary
colon cancer.

9/27/15

11/27/1

Today I continued to take notes from the guidebooks Dr.

Colleen Yavarow gave me. The guidebook I read today is called,
myRisk Clinical Handbook. The first section I read and took
notes about focused on an overview of hereditary cancer. It
talked about the benefits of testing (actionable direction for
patient management), genes and associated cancers,
accuracy of this test compared to others, and about the
process of the genetic tests and the results. The second
section discussed an overview of various cancer sites in
general populations. Some questions I came up with that I am
going to ask my mentor about are:
Are there some faulty genes that show up more than others?
What is Familial Adenomatous Polyposis?
If you have one type of hereditary cancer, are you at more risk
for other types (in comparison to the general population)?
When do you use oral vs. blood genetic tests?
Has the median age for being diagnosed with cancer older
because of advancements in technology?
I learned the following while taking notes:
Myriad (company that Dr. Colleen Yavarow uses for genetic
tests) focuses on testing for 8 primary cancers by analyzing 25
genes
The results take 14-21 days to come back
Action plans combine genetic test results and family history
Myriad has a 99.92% analytical sensitivity for finding mutations
compared to a 99% analytical sensitivity at other labs
Myriad has a 99% certainty for understanding mutations, while
other labs have up to a 50% certainty

1 Hour

Today, I began to research how to complete my family tree. My

mentor told me about the company, Progeny, that has a free
online generator. I made a family tree using that software, but

1 Hour 30
Minutes

unfortunately it was not as detailed as I wanted and it was

making incorrect connections. I found another online software
called Invitae that was much better. I started a new tree on that
website. I was able to add my sister, mom, dad, maternal
grandparents, and paternal grandparents on it so far.

12/20/1
5
1/4/16

1/26/16

1/30/16

2/28/16

1.
2.
3.
4.
a.
5.
6.

Today I began calling some of my relatives to get information

about my family history of cancer in order to complete my
family tree. I called both of my grandmothers and my great
aunts. I was able to learn about their parents and their siblings.

2 Hours

Today I continued to work on my family tree using the online

tool and the information I gathered from my calls with my
relatives. I was able to add up to my great grandparents and
down to my first cousins. In between I still have add my
grandparents siblings onto the tree in order for this section to
be complete from my generation to my great grandparents.

1 Hour

Today I sat down with my grandma from my dads side of the

family to work on my family tree cancer history. She was able to
help me add a lot of information to her side of the family and
also confirm the information I already had put into my family
tree.

30 Minutes

Today after I met with Dr. Yavarow I worked on creating a

family tree that my mentor could have to present to the
geneticists in California at the conference. She said that it
would be extremely helpful if I could expand as far out as the
patients second cousins. I sent her the first draft of it and I
have made a lot of progress on it.

1 Hour

Today I prepared questions for my first interview with one of Dr. 30 Minutes
Yavarows patients. The patient I am interviewing had breast
cancer at a very young age. Also, her father had cancer. She
did get genetic testing done and has a variant. Lastly, she did
take preventative measures as part of her treatment. I am going
to interview her sometime soon and ask the following
questions:
How old were you when you were diagnosed?
What type of cancer did you have?
Did you get genetic testing before or after you were diagnosed
with cancer?
What was your treatment plan?
Would you recommend a mastectomy to other people?
Did you ever think that you would have cancer?
Do you have a family history of cancer?

a. Did your father get genetic testing done? What type of cancer

did he have?
7. Do you have any children? If so, do you want them to get

tested?
8. What are your thoughts about genetic testing? Would you
recommend it to others?
9. How did you feel when you were diagnosed?
10. How did your diagnosis affect your family?
I hope to gain a patients perspective of genetic testing and
preventative medicine since I am a strong advocate for both. In
addition, before I interview her I am going to talk over the
questions with my mentor.
3/11/16

I called the woman I am going to interview in order schedule a

time we can both talk. I am interviewing her on Sunday the
13th.

3/11/16

I began the research process for the medical paper. I asked the 1 Hour 30
patient why she wanted to get testing done and took notes on
Minutes
what she said. Basically she wanted to get testing done
because she knew that she had a strong history of breast
cancer in her family. Therefore, she wanted to know if there was
anything she could do in terms of preventative medicine as well
as gain knowledge for her children. Also, I wrote about the
concerns regarding her children in terms of GI problems. In
addition, I began to use Google scholar and the schools
databases to begin to gain knowledge of the mutation. I found
out that the mutation is common in Ashkenazi Jews,
specifically the variant was found in about 6.1% of Ashkenazi
Jews. This mutation is linked to colon cancer.

3/13/16

I called the woman I was supposed to interview, but she did not
pick up. We rescheduled through my mentor for Tuesday the
15th at 3pm.

3/15/16

I interviewed the patient today. She called me around 3pm and

then I told her a little about myself and senior project including
that I am going to Tulane to study public health, why I wanted
to do something genetic related (love math and science), and
that Dr. Yavarow has guided me through the project (blood
slides for example). I asked her 12 questions and typed her
answers while I was talking to her. The major ideas that I got
from the interview are:
She is a very big advocate for genetic testing because if it is
possible to prevent cancer then people should. Therefore, if
more genes became available to test without a doubt she
would. She wants all of her children to get tested as well.

5 Minutes

5 Minutes

15 Minutes

 Cancer affects the whole family.

It took her a couple of weeks to tell her children because she
needed to comprehend it first.
It was one of the most devastating news she had ever heard.
She had drastic lifestyle changes including diet (tries to limit
sugar intake), exercise, and a double mastectomy.
Her family was affected positively (never gets attitude from
children even the teenagers because they still think about what
if she wasnt able to beat cancer).
Most people never actually think they will get cancer.